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Aims: This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT'S. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: (a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; (b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services., Methods: In each of the 19 mental health departments or psychiatric services participating in the Project there were organized "multidisciplinary" focus groups and "specialistic" focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category., Results: Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable., Conclusions: In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators.

Aim: To assess the association between socio-demographic characteristics and community attitudes towards mentally ill people., Method: We assessed a sample of 280 subjects, stratified for sex and age, which has identified using the electoral registers of Brescia. A letter was sent to everyone in order to introduce the future potential study participant to the topics of the public attitudes towards mental illness and it included an invitation to take part in the study. After, 280 subjects were contacted by telephone. Finally, 174 persons, who expressed their willingness to collaborate, were visited by a team of four trained interviewers. The instruments used were: a semi-structured interview; the Community Attitudes to the Mentally Ill (CAMI) inventory, which is composed by 40 statements, concerning the degree of acceptance of mental health services and mentally ill patients in the community; and the Fear and Behavioural Intentions (FABI) inventory, which is composed by 10 items, concerning fears and behavioural intentions towards mentally ill people. 106 subjects refused to participate., Results: Factor analysis of the CAMI revealed three components Physical distance and fear, Social isolation and Social responsibility and tolerance. Factor 1 is associated with: people >61 years old; people being divorced/widowed/living separated; people who haven't participated in social or volunteer activities. Factor 2 is associated with: people > 41 years old; people being schooled at a level that's higher than elementary level; unemployed people. Factor 3 doesn't present any associations., Conclusions: The results of this study outline the need to: a) promote interventions focused to improve the general attitude towards people with mental illness; b) to favour specific actions in order to prevent or eliminate prejudices in subgroups of the population.

Aims: The present study aims to investigate whether exists a meaningful relation between quality of life and subjective well being with regard to the pharmacological treatment (antipsychotic typical versus atypical) in a sample of people with psychotic disorders integrated in a Community Residential Rehabilitation Centre; to examine whether the different antipsychotic treatment is correlated to a different answer to the psychosocial rehabilitation intervention in terms of significant improvement in the positive and negative symptomatology, subjective well-being and quality of life., Method: All patients, who suffer from schizophrenia and schizoaffective disorder according to DSM-IV criteria, treated with antipsychotic and stabilized from at least one month, were enrolled in the study., Results: 32 patients have participated in the study: 22 patients treated with atypical drugs and 10 with typical. The analysis of the collected data didn't show any significant statistical difference at baseline with regard to symptomatology, subjective well-being and quality of life. From the statistical analysis of the data to the endpoint, after a month of psychosocial rehabilitation, we found a statistically meaningful improvement in all the areas inquired in the group of the patients dealt with antipsychotic atypical drugs., Conclusion: The results confirm that the atypical antipsychotics are more effective, than the typical, to improve symptomatology, subjective well-being and quality of life of psychiatric patients.

Many knowledges on the mental disease that the community possesses are turning out of information disclosed from the media. It's common in the press to connect actions of violence and murders to the mental diseases. For this reason, the reader is induced to infer that murders and other violent actions are more frequent in people who have suffered from mentally ill, than in the general population. The mystifying impression provided by media accrues from the fact that these reports are rarely compensated from positive reports. Objective of the present study is to characterize the type of information concerning mental illness diffused from the local daily paper "Giornale di Brescia" in the year 2001. The results show that many articles connote negatively the mental disease. The journalistic sensationalism, denounced facing the speech of the prejudgment in the comparisons of the mentally ill people, seems to still remain, in the considered year of publication, one unchanging tendency.

Aims: To identify knowledge about medication in a sample of patients admitted in a residential psychiatric rehabilitation unit., Methods: All consecutive patients admitted in a psychiatric rehabilitation unit during January 2000-April 2001 were interviewed about the medications prescribed; in particular they were asked about names, daily dose, therapeutic and side effects of the psychotropic drugs they took., Results: 74 patients were surveyed about their knowledge of the psychopharmacological treatment they took. Most patients demonstrated a good knowledge about drugs' name (77%) and daily dose (74.3%); one-quarter (25.7%) had some understanding about the reason why the medications were prescribed and theirs intended effects while only 5.4% was able to indicate the side effects of medications prescribed. Overall, 21.6% of patients could correctly indicate drugs' name, daily dose and therapeutic effects of all medications they took., Conclusions: The results of our study indicate the importance in clinical practice to devote particular attention to the patients' understanding of provided information about treatment and the crucial role of strategies, aimed at improving compliance and maximize the effects of therapeutic interventions.

Aims: Assessment of the efficacy of the rehabilitation approach that is recommended by the manual VADO (AAOS in English: Abilities Assessment and Objectives Setting) in schizophrenic syndromes., Methods: Controlled trial, partly with individual randomisation. Centres were invited to recruit 10 patients who in most centres were randomly allocated either to the VADO approach or to usual rehabilitation practice. At least two professionals for each centre attended a brief intensive training course. Patients were assessed at baseline and six months later with a) the FPS scale, which is an improvement on the DSM-IV SOFAS; b) the BPRS 4.0; c) AR, a clinical tool that is contained in VADO., Results: 55 patients received the experimental interventions and 40 the control one. Six months later greater significant improvements were observed in the experimental group, both in social functioning and in psychopathology., Conclusions: The dissemination of structured rehabilitation approaches that are based on personalized definition of objective, intensive progress monitoring, patient's therapeutic education and validated strategies and do not imply additional costs, may be warranted. A longer follow-up is under way.

Aim: To obtain information regarding general practitioners' perception of their practice in mental health care, opinions, difficulties and educational needs., Methods: All general practitioners attending the last annual session of continuing medical education (October-December 2000) were asked to complete the questionnaire regarding: 1) perception of current practice in mental health care and difficulties in managing mental health problems; 2) opinions regarding their practice; 3) educational needs and perception of benefit from strategies to improve mental health care., Results: 254 general practitioners completed the questionnaire (response rate 70%). 81.4% recognize their role in mental health care and 89.9% report they should develop the necessary skills to deal with mental health problems, perceived as difficult to treat in general practice (77.3%). Educational priorities concern mainly anxiety, depression and somatization; further competences and skills are mainly necessary in doctor-patient communication and psychopharmacological treatment. Main difficulties concern the involvement degree with the specialists (44%) and the time patients need during the consultations (40.4%). Information about local mental health services, supervision and discussion with specialists and continuing medical education are considered useful to improve mental health care., Conclusions: As regard their role in mental health care, general practitioners perceive a lack of knowledge and skills. Relationship with specialists and mental health services, daily practice characteristics and time necessary to deal with patients represent barriers detracting from optimal mental health care in general practice.