This work is directed to further investigate the significant relevance of psychotherapy to better management of acute psychiatric disorders. Over the last years, there was impressive increase of the amount of psychiatric patients referred to emergency and in-patient treatment and such increase allmost resulted from subjects with acute emotional discontrol associated with affective, personality and stress related disorders. According to such change of the clinical scene of contemporary psychiatry, more attention and funding are needed in the field of acute treatment services and combined treatment innovation and research is become a major challenge for community psychiatry. A real progress in the field is not, however a simple matter of psychoterapy technology transference. While several recent studies suggest that well designed combined treatment is cost-effective in these patients, new nosographic, management and dynamic models are required for succesful development of new crisis intervention programs within general psychiatry services.

Aims — The present review is aimed to evaluate the recent contribution of brain imaging techniques to the definition of neuroanatomofunctional models of panic disorder (PD). Methods — Structural and functional brain imaging studies of PD, conducted from January 1993 to October 2003 and selected through a comprehensive Medline search (key-words: panic disorder, emotions, brain imaging, EEG, Event-Related Potentials, MRI, fMRI, PET, SPECT, TC) were included in the review. The Medline search has been complemented by bibliographic cross-referencing. Results — The majority of the reviewed studies suggests that a dysfunction of a neural circuit encompassing prefrontal and temporo-Iimbic cortices is present in PD. A right hemisphere preferential involvement in PD has been shown by several studies. Conclusions — Reviewed neuroimaging studies suggest a dysfunction of frontal and temporo-Iimbic circuitries in PD. However, those studies cannot be considered conclusive because of several methodological limitations. Longitudinal and multi-modal studies involving larger patient samples, possibly integrated with population-based and genetic studies, would provide more insight into pathophysiological mechanisms of PD.

Declaration of Interest: Authors declare that none of them had any known real, potential, or apparent conflict of interest and that there was no business or personal interest that might be relevant to the topic of this article.

Aims – The purpose of this research is to make a contribution to analysing the complex issue of the relationship between Internet use and psychological disorders, and proposes a survey of the typical features and effects of such use among a sample of secondary school students. Pattern – The research was carried out on a sample of 1075 students aged 14-21 from two secondary schools, where students are prevalently male in one and female in the other; computer science is part of the teaching programme in both institutes. Instruments used – General Health Questionnaire (GHQ), Goldberg's 28-item version, together with a form to collect individual and social data and information about the actual use of Internet, such as number of years, number of hours a day/a week, subjective experience, quantitative-qualitative perception of the connection. Results – There is a clear and significant correlation between weekly hours of use and GHQ scores. Conclusions – Analysis of our sample confirms certain statements found in the relevant literature concerning a possible relationship between the use of Internet and psychological disorders.

Declaration of Interest: none.

Aims – To describe in a sample of 646 relatives of patients with physical long-term illnesses: a) the relatives' burden of care; b) the relatives' attitudes towards the patients; c) the social and professional support received by the families. Methods – The study has been carried out in 30 Italian geographic areas randomly selected taking into account geographic location and population density. The sample has been consecutively recruited in 139 specialised units for the treatment of chronic heart, brain, diabetes, kidney, and lung diseases. Family burden was evaluated in relation to: a) family's socio-demographic variables and patients' clinical variables; b) relatives' attitudes toward the patient; c) social and professional support; d) geographic area and population density. Outcome measures – Family Problems Questionnaire, physical illness version (QPF-O) and Social Network Questionnaire (QRS). Results – The consequences of caregiving most frequently reported were constraints in social and recreational activities, and feelings of loss. Burden was more marked in relatives of patients with higher physical disabilities, with neurological illnesses, and in relatives with lower support by their social network. Conclusions – These data highlight the need to provide psychological and practical support to caregivers of patients with long-term physical diseases on the basis of the evaluation of their needs for care.

Declaration of Interest: none of the five authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work, in the last 2 years.

Objective – The aims of this study are: (1) to estimate patients' costs in Italian non hospital Residential Facilities (RF); (2) to analyse the relationship between the costs of care received by residents and patients' or facilities characteristics. Method – The PROGRES study included all Italian private and public RF (1370) with more than 4 beds. Of those, 265 were selected through stratified random sampling to be included in phase 2. Data were obtained through a schedule filled in by the facility manager. Additional information about costs related to the use of Community Psychiatric Service (CPS) by residents has also been collected. The cost components of residential accommodation include the costs of the RF, of the CPS, of general medical care, of the informal assistance provided by family or friends, and other non-medical costs. Results – The mean annual cost of stay in RFs was approximately 34,000 Euro, and it was related to the RF size and to staffing levels. Both RF and CPS are more expensive in the north of Italy, as compared to the center and the south. Costs were lower for older patients. CPS costs are lower when RF staffing levels are higher. Conclusions – In general, patients in RFs cost between 20,000 and 40,000 Euro per year; to this sum, additional 2,000-6,000 Euros per year should be added to include the costs of care provided outside the facility. Both RFs and CPS have different costs depending on the geographical area where the facilities are located, and staffing levels. Changes in CPS costs seem to be related to patients' characteristics.

Declaration of Interest: none

Aims – A narrative review of studies on the information needs of psychiatric patients, the knowledge of their diagnosis and treatment expectations. Methods – A literature review, limited to studies between 1980 to 2003, was carried out using Medline and Psychlnfo databases. Results – Sixty five studies of interest were identified. Less than half of the psychiatric patients know their diagnosis and patients affected by schizophrenia are the least informed. Notions about aetiology and treatment are patchy, and the concept of ‘multifactorial cause’ seems unknown. Little knowledge emerged about drugs and side effects, expecially in the long term. Patients want to be informed, involved in decisions and their treatment programme. They feel that their psychiatrists are more interested in pharmacological aspects than in their personal problems. Conclusions – A better quality of communication, the involvement of patients in decision processes and meeting patients' information needs is necessary to improve therapeutic relationships, to encourage greater compliance with treatment programs and to reduce the stigma of psychiatric illness.

Declaration of Interest: none of the three authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work.