Objective – The ‘PROGRES’ (PROGetto RESidenze' Residential Project) project has 3 aims: 1. To survey all Italian psychiatric Non-Hospital Residential Facilities (NHRF) (Phase 1); 2. To assess in detail 20% of the NHRFs and the patients living there (Phase 2); and 3. To carry on training programmes for the mental health workers of these facilities (Phase 3). We report here the results of Phase 1. Methods: – All NHRFs were surveyed using a structured interview administered to the manager of the facility. In some cases, this information was supplemented with data gathered from other mental health workers at the NHRFs. Results – On May 31, 2000, there were in Italy 1,370 NHRFs with 17,138 beds, giving an average number of beds per facility of 12.5 and a rate of 2.98 beds per 10,000 inhabitants. This rate varies greatly between regions, with a ratio of 1:10 between the two regions with the lowest and the highest bed rates. Seventy-three percent of the NHRFs have a 24-hour staff coverage; more than 50% are directly managed by the NHS Departments of Mental Health and more than three-quarters of the NHRFs are directly funded by the NHS. In the course of 1999 38% of the NHRFs discharged no patients, and another 32% discharged fewer than 3 patients. In about half of the NHRFs the most common patient age group was 40-59 years. In the Italian NHRFs there are 11,240 full-time mental health workers, plus several thousand half-time staff. The average number of full-time mental health workers in each NHRF is 8.2. In 58% of the NHRFs the operational chief is a psychiatrist; some 40% of the overall number of mental health workers in the NHRFs have no specific psychiatric training. The total number of patients resident in the NHRFs is 15,943; among them, 58% have never been admitted to a mental hospital, 40% have been admitted and a small percentage (1.6%) has been previously admitted to a forensic mental hospital. The availability of NHRF beds is negatively associated with the availability of non-hospital facilities (e.g., community mental health centres, day-centres) and positively associated with the number of beds in private psychiatric facilities in each region. Discussion – The current rate of NHRF beds is higher than the officially recommended national standard (2/10,000 inhabitants). However, there is a great variability between regions, which is related to the overall provision of different types of psychiatric facilities. Most NHRFs provide intensive care, and the continuum of residential facilities with different types of care, support, degree of autonomy, etc. recommended by several authors for the long-term treatment of severe patients with different disabilities, seem to be lacking. NHRFs have a very low patient turnover rate, and this may create problems in the future. Conclusions – The PROGRES project is the first national study ever carried out in Italy to evaluate a specific type of psychiatric facilities in the context of the new system of psychiatric care. When all the data will be available, it will be possible to assess in detail for the first time a national representative sample of severe, long-stay patients and the care they are receiving; on this basis, it will also be possible to recommend evidence-based policies aimed at improving the care of the severely mentally ill.

Objectives - To present a comprehensive review of the studies assessing the frequency of PTSD in the general population, in clinical populations and among subjects at risk. Design - An extensive search was made using the Excerpta Medica Psychiatry CD-ROM 1980-1993 (October). Using post-traumatic stress disorder as a key word, a total of 1,057 papers published in this timespan were retrieved. A further search was made using the same key word with MEDLINE CD-ROM 1988-1993. A manual search was also performed for all issues of the Journal of Traumatic Stress. Results - A total of 135 studies meeting inclusion criteria were selected for this review. Almost two thirds (n = 86, 64%) of these studies were carried out in the United States; only 8 (6%) studies have been carried out in developed countries. The sample size ranges from a low of 11 subjects up to a high of 22,463 subjects. The mean sample size is 500 and the median is 108. In terms of assessment methods, in one third (n = 45, 33%) of the studies the investigators used a PTSD symptom checklist (either self- administered or administered by a clinician), based on DSM criteria, to generate a PTSD diagnosis. In more than in one third of the studies (n = 44, 33%) of the studies, a structured interview was administered (e.g., the DIS, the SCID, the SADS), while in the remaining surveys the diagnostic evaluation was based either on an un- structured clinical assessment or on the administration of other specific assessment instruments (e.g., M-PTSD, IES, SCL-90-R or others). In 77 studies (57%) the investigators based their assessment on DSM-III diagnostic criteria for PTSD, whereas in 55 studies (41 %) DSM-III-R criteria were employed. Prevalence rates are discussed separately for the different population groups. Conclusions - There has been a remarkable increase in the number and quality of epidemiological studies on PTSD over the past decade. A substantial amount of information is now available about the frequency of PTSD among different population groups and among at risk subjects, and about risk factors, common symptom patterns, and natural history of this disorder. However, a number of important limitations of these studies are to be noted and should be addressed by future research efforts.

Several discernible trends have changed the outlook of psychiatric resources available to the general public during the last 50 years in Western countries and particularly in Italy. Among these trends, two conflicting issues are here outlined. On the one side, evidence based medicine is the core of a methodological revolution, which asks for a deeper criticism of subjective judgements in clinical matters; on the other side, the study of emotions and attitudes has stressed the outstanding importance of conscious and unconscious expectations both in patients and in caregivers. Moreover, popular psychology has altered the way mental disorder is commonly perceived and treated. A comprehensive way of taking into account these three diverse trends seems to be still lacking.

The role of editor of a journal attracts the vision of a scholar isolated in an ivory tower selecting “la crème” of the submitted papers, with no other preoccupations that the scientific rigour. This, is of course, only one of the many roles – or, as this editorial calls them, lives – of an editor. The essential skills are many and more complex, and an editor will encounter many problems that are related to such diverse issues as anticipating scientific trends, investigating misbehaviours, settling ethical disputes, and interfacing with the lay press. It is exciting and rewarding, and never predictable.

Aims — Most of the available evidence on the relationship between socioeconomic indicators of social deprivation and patterns of use of mental health services has been produced in the United Kingdom, where the Ministry of Health has developed a resource allocation formula based upon the results of those studies. The main aim of the paper is to evaluate the replicability in the Italian context of such research, and of the resulting allocation strategies. Methods — Detailed description of the resource allocation method currently adopted in the United Kingdom, whose main purpose consists in reaching the best balance between available funding and patterns of need. Detailed description of resource allocation processes in Italy; discussion of the main methodological and statistical limitations restraining the replicability of the British formula in the Italian context. Conclusions — There is a growing interest in Italy towards the introduction of evidence-based methods in health decision making, in order to correct the overwhelming influence of political issues. What is needed is a better understanding of the relationship between higher levels of equity in health services access, and their effects in terms of better outcomes.

Declaration of Interest: the current paper has been developed within a Research Programme funded by the Agenzia Regionale per i Servizi Sanitari, Regione Piemonte (Deliberazione n. 54 del 31.07.02). None of the authors received any additional source of funding for the development of this paper as well as for the related research activities.

In una recente intervista (Pincus & Ferris, 1993), Nancy C. Andreasen, nuovo editor dell' American Journal of Psychiatry (AJP), ha ricordato come la proposta di adottare il metodo della blind review, cioè della revisione degli articoli inviati per la pubblicazione da parte di referee ai quali non viene reso noto il nome degli autori, venga riproposta ad ogni riunione del Comitato Direttivo dell'AJP. Finora, dice Andreasen, il Comitato si è sempre espresso in senso contrario, sostanzialmente per due motivi: il primo è che alcune Unità di Ricerca ed alcuni gruppi sono noti per essere più rigorosi di altri e questa «autorevolezza» è utile al referee per prendere una decisione; il secondo dipende dalla difficoltà di fare una review veramente blind, in quanto lo stile, la bibliografia e altri elementi spesso rendono possibile o addirittura facile l'identificazione degli autori del lavoro. Ciò non è giusto per quelli che invece non vengono identificati.

Il problema di assicurare una valutazione equilibrata e non distorta degli articoli inviati potrebbe più semplicemente essere risolto: a) facendo in modo che la revisione «in aperto» da parte dei referee sia fatta da persone non solo competenti, ma anche disinteressate, attendibili e note per la loro correttezza; b) garantendo ampia possibilità di accesso alla pubblicazione anche ai gruppi «minori» o agli autori che lavorano fuori dalle istituzioni più note, purché ovviamente i loro articoli soddisfino gli standard di qualità della rivista in questione. Il punto cruciale, dunque, è la scelta dei referee, scelta che spetta quasi sempre al direttore della rivista.

Aims – To compare different accreditation categories in Italy and to suggest some criteria to assess them. Methods – The A. compare specific characteristics of different model of normative and professional accreditation and suggest some criteria to distinguish different type of accreditation programme and to assess quality and usefulness of an accreditation programme. Results and Conclusions – Different types of accreditation are attributed to some basic criteria: voluntary/by law, high/low stan- dard, assessment object. Criteria to assess the usefulness are: check list accuracy, support to quality improvement, documental bur- den, services impact.

Objective – This article critically reviews the European Agency for the Evaluation of Medicinal Products (EMEA) recommendations on the conduct of clinical trials in psychiatry. The EMEA is a regulatory body which provides the institutions of the European Community with the best possible scientific advice on the quality, safety, and efficacy of medicinal products. Method – Systematic review of recommendations, guide-lines and official documents available in the EMEA web site. Results – Out of nearly 400 documents, we identified 4 documents on the conduct of clinical trials in specific psychiatric disorders and 5 on the use of placebo or active comparator in evaluating a new drug's efficacy and on methodological issues in establishing difference and equivalence of effect. The EMEA recommends clinical trials to detect a difference between the compound under investigation and placebo, and to assess at least non-inferiority against an active comparator. A placebo arm is intended to validate the study. The EMEA supports the use of placebo only when there is no serious risk for the patient. In schizophrenia, depression and bipolar disorder the Agency suggests that a three-arm study is the design of choice, to demonstrate superiority against placebo and a similar balance against an active comparator. Conclusions – Despite the many effective therapeutic options available for the pharmacological management of psychiatric disorders, the EMEA regulatory process still relies on the demonstration of efficacy in absolute terms, against a placebo. We discuss this position and put at issue the possibility of developing a new generation of trials to demonstrate superiority of effect of new compounds over reference ones.