Aims – The aims of the study are to evaluate the prevalence rates for headache among an Italian sample of early-adolescents and the role of possible related factors (school stress and social support). Methods – The survey reported here is part of the larger Health Behaviour in School Aged Children (HBSC) trans-national study, which is co-ordinated by the European Office of the World Health Organization. The data were gathered through self-administered questionnaires filled out by a representative sample of 4, 386 (48.4% males) Italian students (11-, 13- and 15-year old). The main areas covered in the questionnaire were health and health behaviour. Results – The overall prevalence of frequent headache (at least once a week) was 40.5%. Boys are less at risk than girls and the prevalence increases with age. Moreover, school demands (positively) and teacher's support (negatively) showed a significant association with the outcome. Conclusions – Compared to other countries, results revealed how this symptom is very common among Italian's early adolescents. Further, results shows the relevance of the school setting, in terms of teacher's demands and support, for the prevention of this symptom among early adolescents.

Declaration of Interest: The HBSC study is partly funded by the University of Padova through a scholarship attributed to Dr. Alessio Vieno (Year 2001 - prot. CPDR013233).

Structural and functional magnetic resonance imaging (MRI) of patients with psychosis has advanced to the point where there are clear abnormalities at a group level between patients and groups of healthy controls, and suggestions of different patterns of abnormalities between groups of patients. A major area of research endeavour is being able to translate these group differences into clinically relevant predictions at an individual patient level. Here, we briefly summarize our main findings in cohorts at high risk of psychosis because they come from families in which several members have schizophrenia or bipolar disorder, or have educational impairments. We highlight consistent predictors of psychosis in those at high risk of schizophrenia for genetic or cognitive reasons, as compared with quite distinct profiles between those at genetic high risk of schizophrenia v. bipolar disorder on functional MRI during an executive language task. We also consider future research directions and ethical issues in the early diagnostic testing of people at high risk of psychosis.

Objective - To compare psychiatric bed usage for major psychiatric illness in a fully community-centred psychiatric service (South Verona, Italy) with usage in a more conventional hospital-centred service (Canberra, Australia). Design - Registers of hospital admissions for schizophrenia and major affective illness in the three years 1986, 1987, 1988 were examined at each site. The characteristics, socio-demography and rates of admission, the duration of index admission and the rate of readmission in the subsequent twelve months were compared. Results - The community-centred service (South Verona) admitted fewer patients with schizophrenic and major affective illness but they appeared more severely ill, stayed longer and were more likely to be readmitted. The hospital-centred system (Canberra) used hospitals for a wider range of severity of major illness including good prognosis illness. Hospitalisation in Canberra was briefer and readmission less frequent. It appears that the hospital centred service was more willing to use beds for the initiation or stabilisation of treatment. The community based service did not lead to shorter hospital stay or less frequent readmission. Differences in the treated psychiatric morbidity in the populations overshadowed the effect of design of the service on usage. This difference in morbidity, concentrated in the younger age group, remains unexplained.

This paper concerns one of the four research projects developed during a training course in clinical epidemiology managed by the Lombardy training centers IREF. Objectives — To compare the recommandations for treatment concerning 9 vignettes derived from the Australian Quality Assurance Project. Setting — Six Mental Health Services of Regione Lombardia. Design and Participants — For each vignette, all psychiatrists working in the 6 Mental Health Services were asked to fill in a questionnaire about treatment location, psychopharmacology, psychotheraphy, priority between psychotherapy and psychopharmacology and degree of difficulty in answering. Results — 44 out of 52 target psychiatrists took part to the study. Remarkable variability for treatment location and psychotherapies; moderate variation for psychodrugs prescriptions and a good agreement for diagnoses were observed. In drugs prescription an eccess of association was observed. The most prevalent model of psychotherapy was the psychodynamic, followed by the cognitivebehavioural and the family-systemic. There was a tendency toward a flexible approach, as suggested by recommendations of different psychotherapeutic models according to the nature of the disorder. No case were judged very difficult; only in 3 cases a judgement of «somewhat difficult» was expressed by more than 20% (but less than 30%) of the psychiatrists. Conclusions — Studies of this type are very easy to carry out and give useful information for continuous training programs and Continuous Quality Improvement projects.

Objective – To verify the association between schizophrenic symptoms and multidimensional variables of social functioning and to look for a possible classification based on an empirical classification outcome oriented. Design – Forthy chronic schizophrenic patients, with a diagnosis ascertained through clinical interview and diagnostic criteria were enrolled in the study. Setting – All patients were followed in a State Mental Health center and were assessed in a stabilized phase of illness. Principal outcome measures – Psychopathological assessment was made with PANSS and CGI. Psychosocial assessment was made with Life Skills Profile and Global Functioning Scale. Results – A pervasive correlation among symptoms and psychosocial variables emerged suggesting a unitary concept of behavior related to diagnosis. Factor analysis revealed 2 main components able to explain the 79% of variance. Cluster analysis separated the patients in 3 different groups showing that clinical symptoms are aggregated with specific variables of social functioning. Conclusion – Schizophrenic symptoms and social functioning are organized in a tripartite structure. It suggests the existence of three different syndromes that are outcome oriented, and compatible with an unitary concept of schizophrenia.

Objective - Following the introduction of guidelines of rational drug use, the pharmacoepidemiology of psychotropic drugs was investigated in a sample of long-stay patients living in a Italian psychiatric hospital. Design - Aprospective, longitudinal two-year follow-up study was carried out. Information about sociodemographic and clinical characteristics of the inpatientpopulation, and about medications prescribed, was collected at baseline and after one and two years of follow-up. Setting - Three wards of the psychiatric hospital of Milan. Main outcome measures - Number of patients taking psychotropic drugs, number of patients taking more than one neuroleptic or benzodiazepine, mean neuroleptic dose, psychopatological status according to the Brief Psychiatric Rating Scale (BPRS). Results 70 patients were recruited and followed for two years. At follow-up a reduction in the number of patients taking neuroleptic drugs was recorded, together with a 50% decrease in the number of patients taking more than one neuoleptic. A reduction in the use of depot formulations was in addition shown. Patients taking benzodiazepines decreased of 50%. According to the BPRS, no psychopatological changes were observed during the study. Conclusions - These data suggest that education in psychopharmacology may guide towards a more rational use of drugs; longitudinal clinical audits should be implemented to monitor everyday practice.

Objective – This article attempts to provide an overview of different methods of analysis of information on service utilization from different approaches. Methods – A systematic review of the studies of pattern of care is done. The analysis of pattern of care has been divided into three different approaches: cross-sectional, longitudinal and dynamic. Results – In cross-sectional studies, information on utilization is based on the total number of contacts with mental health services during a given period. In the second approach, called longitudinal, survival analysis is applied considering the interval of time between each contact. The third type of analysis, called here the «dynamic» approach, involves the application of mathematical models based on the Markov chain to analyse the probability of change from one type of contact to another. Conclusions – We emphasise the need for further studies designed to analyse data from psychiatric case registers with standardised models for mental health services utilization analysis.