Aim – To describe the rationale for introducing molecular genetic analyses to psychiatric epidemiology. This offers new possibilities for aetiological research on common mental disorders. Method – In addition to the traditional variables used in field surveys, it is now possible to include molecular genetic information. This is currently done by looking for allelic associations rather than by linkage analysis, and can be directed either at traits conferring susceptibility or at states. The purpose is to identify quantitative trait loci (QTLs) by examining candidate genes. An alternative strategy is genome scanning, which can identify genes by their chromosomal position with increasing resolution. Results – Some associations have already been reported in the literature, linking personality traits with particular alleles: extraversion or novelty-seeking with a polymorphism of the dopamine DRD4 receptor gene; and neuroticism with a polymorphism of the serotonin transporter gene. Conclusions – These findings are of major interest, but cannot yet be looked upon as confirmed. What is significant for epidemiology is the opportunity to link behavioural and psychiatric variables with genes influencing biochemical and physiological processes in the brain, and to do so at the population level. For further allelic association studies, there are four principal requirements: valid measures of phenotypes; replication of findings across diverse populations; more candidate genes; and exploration of the interaction between genotype and environmental exposures from conception to late life. Through such research, psychiatric epidemiology can now investigate biopsychosocial phenomena.

Objective — Advocacy in the mental health services field is gaining importance since the traditional role of mental health hospitals is changing, particularly in North America and in Western Europe. This review will define advocacy, its goals and fundamental principles. It will then delineate the skills and strategies needed for any intervention on behalf of a patient or a group of patients. It will also deal with the issues and approaches most frequently raised and used, and finally, with the limits of advocacy. Method — The method used for this review was mainly a recension of the literature concerning advocacy throughout North America and Europe, having in view to see emerging the principal stakes and concerns related to this process. Results — Advocacy has a significant impact patients' awareness of their rights and their capacity to exercise them. It also prevents potential abuse of patients. On the other hand, some patients have an increased opportunity to cease treatment, and this could lead to serious medical consequences. There is also the possibility of retaliation from staff, as a result of being involved with an advocate. The combination of high quality care and effective advocacy is the best guarantee that a mental health patient will get the care he wants and needs with human dignity.

Objective — This research concerns those patients who most attend the community Mental Health Centre (CSM), hereby called «everyday patients». According to a previous research (Pileggi et al., 1992) a sample of patients mostly attending the Centre had been pointed out. Basing on the number of attendances, it emerged that some of those patients (57) had been on the average attending the Centre more than twice a week and, despite being only 10% of the total number of users, they had taken on a large share of the services offered by the Centre (30%). Therefore, those patients were the ones the Centre had been working for more intensely and continuously. Three years later, the object of this research is to check the assistance and clinical destiny of such patients and compare their patterns of attendances to those ones regarding the remainder of the CSM users. The hypothesis is that «everyday patients» are assisted by different and continuous treatments and that such a procedure prevents patients from dropping out and determines a strong reduction in relapses and less frequent attendances. Design — Longitudinal study on a 42 patient sample (19 males, 23 females) on therapy at CSM. Setting — Mental Health Centre, «Saragozza» District, Sanitary Unit of Bologna. Main outcome measures — The following elements have been examined: 1) social and demographic features; 2) duration of psychiatric history; 3) clinical diagnosis according to DSM-HI-R, set by patients personal psychiatrist; 4) global functioning level as examined by two psychiatrists or psychologists from the Centre, using DSM-III-R Global Functioning Scale (GFS); 5) actions carried out and patterns of using the CSM services over the past 12 months. Concordance measures among independent examiners (Cohen K) and non-parametric variability measures for comparison between groups (Chi-square and Kruskal-Wallis tests) have been used. Results and conclusion — Results partially confirm the original hypotheses. In particular, complicated services (psychological and pharmacological therapies and rehabilitation) are carried out for the most of «everyday patients» and much more intensely to them than to the remainder of the users. No drop-out has been found out, the global functioning level of the patients is good in most of cases and the number of necessary admissions to psychiatric wards has been reduced. However, the «attendance share» relevant to the sample of «everyday patients» is still high compared to the total number of the CSM users. Besides, discharge rate is nought.

Objective – Satisfaction's measurement with Mental Health Services in patients and their relatives. Design – Satisfaction scale administration to the patients who were treated in community-based psychiatric service from 1.1.1996 to 31.3.1996 and the relatives who were primarily involved in caring for the patient. Setting – The ASL Rome «C» community-based psychiatric service. Main outcome measures – Verona Service Satisfaction Scale-54, a multidimensional instrument which measure satisfaction with community-based psychiatric service. Results – Main results (301 scales for patients, 163 scales for relatives), pointed out for patients a higher satisfaction for the technical and interpersonal skills of psychiatrists and psychologists (score of specific items >4). Lowest scores of satisfaction were towards the appearance, comfort level and physical layout of the facility (score 2.95) and towards the response of the service to emergencies during the night, weekend and Bank Holidays (score 2.87). Relatives were not particulary keen for the item regarding help to find open employement (score 2.76). Furthermore patients and their relatives gave a negative evaluation of the publicity and information offered by Mental Health Services. Dimensions's analysis reachs the same conclusions deduced items's average score. The result of this study emphasizes the patients higher degree of satisfaction than the relatives. Conclusions – The above results point out three aspects to be improved by the Menthal Health Service in order to satisfy the demands of the patients and relatives: 1. appearance, comfort level and physical layout of the facility, 2. publicity and information, 3. social actives and social skills.

Objective The purpose of this study is the systematic analysis of operators' points of view about psychotherapies concretely performed in the Public Psychiatric Public Services and inside the global operating mode of the assistance. Setting – The study has involved 26 CPS selected randomly in Lombardia. The sample has been built with 73 psychiatrists and 42 psychologists. Main outcome measures – All the therapeutists involved in this research have been submitted to a question-form querying socio-anagraphic data, professional training, orientations, operating modes in their CPS, rules and objectives of their psycotherapies, observations and evaluations about psychoterapic treatments and their effects. Results and conclusions: Psychiatrists and psycologists working in CPS, mostly the younger ones (less than 45 years old), followed a personal training in over the 70% of the cases. The prevalent orientation is the psycoanalityc one in both the categories. The most part of therapeutists deems that there has been an evolution in their way of conceiving psychiatry inside the public service. The lines at these evolutions have been mentioned explicitly in the article. Psychiatrists and psycologists, even with some concrete differences, seems to have mostly homogeneous points of view: psychiatrists have a more flexible vision of which practices can be considered as a psychotherapy, whereas psycologists are more rigorously linked to theoric reference models and to rules learnt during their training. They are both slightly favourable to the use of psychotherapies in their services, even if, as a matter of fact, they are used by just a few patients. No contrast between psycotherapy and psycopharmacology has been detected from operators' answers. These practices seem to be both considered useful and integrable.

Objective — Eighteen years after the 1978 reform law no. 180, psychiatric services have to find new roles and goals in the social arena, in order to continue to effectively pursue the improvement of mental health in the commi nity. The aim of the present paper is to show some theoretical and practical elements that could stimulate in the psychii trie services a deep consideration about the relationship between psychiatric services and «private social» bodies, part cularly social co-operatives and voluntary organisations. Method — The elements shown in this study come from an ani lysis: a) of the literature about the crisis factors of the Italian welfare state, particularly in the Public Health Service and i the social assistance; b) of the literature about the development of the «private social» and about the relationship with tl public services; c) of national and regional laws, particularly of Veneto region; d) of the present experiences in Sout Verona Psychiatric Service. Results — The crisis of the traditional welfare state, the emergence in large sectors of gener; population of needs related to social fragmentation and relational impoverishment, the aspiration of a great number (individuals excluded from society to benefit of the right to full citizenship, all this urgently questions the traditional roh and responsibilities, the organisation, operational modalities, and the community orientation of existing health and hi man services. Within this framework, the relationship between psychiatric services (or, broadly speaking, public serviet in general) and «private social» bodies, particularly social co-operatives and voluntary organisations, has become part of a foreseeing, strategic new awareness of mental health workers. Conclusion — A shift from a relationship of mutual exploitation between organisations, to one of co-operation between them, each considering the other as an equal partne may be a critical step forward a new model of welfare. This, in turn, would hopefully meet the needs for health of th population in terms of efficiency, quality, relevance and consideration of the users' resources and social competencies.