Objective - To try and specify questions of special relevance for suicidological research. Methods - Discussing the merits of questions pertaining to epidemiology and various theories on suicidal behaviour. Results - Four types of questions are defined: How many persons show suicidal behaviour? Who are they? Why do they do it? and What can we do about it? Answers to the first three questions are required when approaching question four: What can we do about it? Conclusion - The complex patterns and backgrounds of suicidal behaviour call for interdisciplinarity and for an increase in both multifactorial and process-related approaches as well as practicable, evidence-based and feasible intervention efforts.

Objective - To discuss the ethical and legal basis of ECT use in Italy, one year after the regulation set up by the Minister of Health. Methods - Literature review and presentation of authors' personal opinions. Results - Despite being the oldest somatic therapy still practised in psychiatry, ECT effectiveness has been systematically evaluated only during the last 20 years, and its clinical indications have become progressively restricted. Yet there are wide variations between countries and within each individual country about the extension, the modalities and the indications for its use. ECT seems to be practised mainly in large scale public psychiatric hospitals and in private clinics, but its use in systems following a community approach is very limited. Wide variations exist also with reference to the severity of regulations imposed by governments or suggested by professional associations. The extent of education and auditing by university centres varies considerably, but is generally considered unsatisfactory. There are still some reports about possible political and repressive use of ECT in some countries, especially developing ones. Conclusion - The authors consider that every national system of care should have a clear policy and clear regulations about ECT. The provisions set up by the Italian Minister of Health seem to be consistent with Italian health policies and psychiatric community care.

Objective - The aim of the present paper is to assess the supply and demand of psychotherapy in mental health services and to identify the factors predicting the start of psychotherapy, using routine data, including 18 clinic and extraclinic variables, collected at 10 Mental Health Centers. Setting - Ten Mental Health Services of Regione Emilia-Romagna. Design - A prospective longitudinal study regarding all «new» users in 1995 followed for one year after the first visit. Results - The percentage of the new users starting a psychotherapy was 11.5%, corresponding to an overall one-year incidence of 5.6/10000 inhabitans ≥18 years old (range 0.9-14.8 across the 10 centres). The demand of psychotherapy in 1995 was 16.1%, including both the request of the patients and the primary care physicians (range 0.6-33%). The predictive factors for the beginning of the psychotherapy were: the presence of a psychologist at the first encounter, the request of the patient for a psychotherapy, age < 48 years, high educational level, being student, living with the family, the Mental Health Center; the broad diagnostic group of «neurotic» diagnoses resulted to have a twofold probability with respect to controls to start a psychotherapy. The logistic regression analysis of 18 variables coudn't find a predictive model with more than 33% sensitivity. Conclusions - The psychotherapeutic treatment is not predictable in the 10 Centers we studied, because of extreme differences in psychotherapy supply among Centers and probably because of uncertainty of therapeutic recommendations for psychotherapies.

Objective – Description of the opinions on schizophrenia and its psychosocial consequences in a sample of relatives of patients with schizophrenia, recruited in 30 Italian Mental Health Centres (MHC), stratified by geographic areas and population density. Design – Cross-sectional study on key-relatives of clinically stable patients with a DSM-FV diagnosis of schizophrenia. Evaluation of relatives' opinions on schizophrenia and its psychosocial consequences, in relation to: a) patient's clinical and family's socio-demographic variables; b) geographic areas and population density. Setting – 30 Italian MHC randomised and stratified by geographic areas (Northern, Central, Southern Italy) and population density (> 100000 inhabitants; between 100000 and 25000 inhabitants; < 25000 inhabitants). Main outcome measures – Patient's clinical status and social functioning: Brief Psychiatric Rating Scale (BPRS) and Disability Assessment interview (AD). Interventions provided to patient and his/her family: Scheda di Rilevazione degli Interventi – Pattern of Care Schedule (SRI). Relatives' opinions on schizophrenia and its psychosocial consequences: Questionnaire on the Opinions of the Family (QOF). Results – Data on 709 patients and their key-relatives were collected. Relatives' pessimistic opinions on social competence of patients with schizophrenia were found to be associated with: high levels of patient's disability, hostility and negative symptoms, relatives' knowledge of patient's diagnosis of schizophrenia, residence in a medium or low population density area, low levels of relative's education. Relatives' pessimistic opinions on social restrictions imposed by schizophrenia were found to be associated with high levels of disability and high number of hospital admissions in the patient and older age in the relative. Conclusions – The results of this study emphasise the need to: a) provide families with educational interventions covering not only clinical aspects of schizophrenia, but also those concerning disability and psychosocial consequences of the disorder; b) plan educational campaigns on mental illnesses which take into account the socio-cultural characteristics of the target populations.

Scope – This overview analyses findings coming from researches that considered the interaction between depression and Alzheimer's disease (AD). Method – Information was collected from the Medline database and from a reasoned manual analysis of the published studies. Results – The prevalence of depressive symptoms in patients with AD is elevated (40-50%). The role of depression in the pathogenesis of AD (independent, prodromal symptom, factor of risk) still must be defined. Data on family history of depression suggest that AD could act as stimulus triggering depression from a basis of a genetic vulnerability. From a biological point of view the onset of depression could derive from an unbalance between cholinergic and noradrenergic systems. Psychological understanding sees depression as a reaction of mourning for the cognitive deficit. Current diagnostic instruments validated on patients with AD constitute a good aid for the clinician and the researcher. The identification of depression coexisting with AD is difficult, in absence of clear affective symptoms, since the cognitive, psychomotor and vegetative symptoms belong both to depression and to AD. The affective disorders most frequently reported are major depression and dysthymia. The use of antidepressant drugs with the lowest anticholinergic profile is strongly recommended. Good results have been obtained also using various psychoterapeutic interventions adapted for dementia sufferers. Conclusions – The current scientific debate is based on information still limited and sparse. Future analyses should consider a better definition of the hypotheses related to psychopathology in AD, a standardised definition of cases and selection procedures and a prospective longitudinal design.