Cognitive deficits are prevalent in bipolar disorder even during the euthymic phase, having a negative impact on global functioning and quality of life. As such, more and more mental health professionals agree that neuropsychological assessment should be considered an essential component of the clinical management of bipolar patients. However, no gold standard tool has been established so far. According to bipolar disorder experts targeting cognition, appropriate cognitive tools should be brief, easy to administer, cost-effective and validated in the target population. In this commentary, we critically appraised the strengths and limitations of the tools most commonly used to assess cognitive functioning in bipolar patients, both for screening and diagnostic purposes.

Objective – To present an overview on current progress and future directions in psychiatric genetics. Methods — The review of studies that have demonstrated a genetic contribution to a wide range of psychopathology using family, twin, adoption studies and exploration of the methods and limitations of molecular genetic studies. Results – Single gene disorders has been the area that is most straightforward with striking advances in disorders such as Huntington Disease and early onset familial Alzheimer disease. Complex phenotypes such as schizophrenia and affective disorder have presented greater difficulties but late onset Alzheimer disease and dyslexia are examples where replicated molecular genetic findings suggest that gene identification is feasible even for multifactorial disorders. Conclusion – The combination of increasingly complete information on the genome together with accessibility to this on the internet provide the essential tools for the search for susceptibility genes. Another essential requirement in trying to identify genes of small effect is well characterized large scale collections of cases and this demands the interaction of epidemiological and clinical researchers. Advances in genomics will also allow tailoring of Pharmaceuticals pointing at treatment response and side effects. Hopefully all this perspectives together, will improve our understanding of the neurobiological pathogenesis of diseases such as Schizophrenia, Depression and Bipolar disorder ‘legitimizing’ them in the public view.

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.

Objective – Starting from research on environmental factors that influence schizophrenia, the author speculates on innovations that could reduce the occurrence of the illness, improve its course and enhance the quality of life of sufferers and their relatives. Results – Ranging from education about obstetric risks to a stigma-reducing campaign, the suggestions could be of interest, not only to clinicians, but also to advocates, policy-makers and communications specialists. Conclusions – Several of the suggestions, which would be innovative in the United States, are already established features of Italian mental health care. These features include social enterprises, family support payments and a disability pension system without severe disincentives to work.

Objective – The QUALYOP study has three objectives: 1) To describe both structural resources and organizational procedures of the 12 Psychiatric Hospitals and to assess the rate of decline in the number of in-patients; 2) to assess the quality of structures, organizational procedures and activities delivered by the hospitals; 3) to describe the socio-demographic, clinical and disability characteristics of the in-patient population. Data regarding this third objective will be presented in a future paper. Design – A transectional design has been adopted. The 12 Psychiatric Hospitals have been visited between July and November 1994. Administrative informations have been collected using an ‘Hospital Form’, filled up by the director of each Hospital; an ‘Hospital Ward Form’, filled up by a group of trained researchers, was adopted to evaluate the quality of each Hospital Ward. A reportage of the structural aspects of the hospitals has also been performed by a professional photographer. Setting – The 12 former Psychiatric Hospitals of Regione Lombardia (Bergamo, Brescia, Castiglione delle Stiviere, Codogno, Como, Cremona, Limbiate, Mantova, Milano, Sondrio, Varese, Voghera). Main outcome measures ‖ We utilized a set of indicators to evaluate the following three dimensions: human and logistic resources, organizational procedures, psychosocial rehabilitation activities. The quality of care has been judged in comparison with explicit reference criteria. Results ‖ 2752 patients are sheltered in the 12 Psychiatric Hospitals of Regione Lombardia. The quality assessment phase of the study has revealed that structures are inadequate in the majority of the wards (70%). In addition, in more than 70% of the wards procedures and rehabilitation activities aiming at decreasing the disability of patients have not been activated. Conclusions ‖ A low degree of consistency between avaliable structures and quality standards has been evidentiated. In addition, soft indicators have documented the inadequacy of organization procedures and activities. These results demonstrated that the dehospitalization policies are often inadequate and that educational policies are warranted to train and motivate mental health professionals. It has been also demonstrated the feasibility of Quality Assurance studies which use a system of reference criteria derived from reliable clinical studies, ethical values, experience, definition of ‘not admissible events’ and common sense.

Introduction — Many studies have been carried out recently to investigate the relationship between health conditions and family and self characteristics. Objectives — To identify family characteristics (such as type of family, socio-economic status, parent immigration, affection for parents, parents' psychological and physical health) and self characteristics (age, drug use, satisfaction for several life circumstances, psychosomatic symptomatology) that are differently distributed by sex and levels of psychological and physical distress among teen-agers. Methods — We carried out a cross-sectional study on a sample of teen-agers attending high schools in Pavia (Italy), using a self-administered questionnaire. The students were divided in four groups having different levels of psychological and physical distress, based on GHQ-30 (psychological distress indicator), on the number of hospital admissions and consultations to a physician in the last year (the last two are physical distress indicator). Data were analysed applying the multivariate analisy of Canonical Variate. Results — 1346 students were sampled, but only 1189 questionnaire were analysed: 36.8% regarding males and 63.2% females. The Canonical Variate analysis indicated that psycosomatic symptomatology, satisfaction for several life circumstances and affection for parents are important for describing the four distress groups. Conclusions — Only affection for parents has an important role on psychological and physical distress of adolescents, while family characteristics traditionally considered associated with psychological and physical distress in teen-agers (such as living with one or without parents, low socio-economic status) are not associated.

Psychiatry has been, among medical disciplines, the one showing the highest conflict between a «positivist» model and the «hermeneutic» tradition. In particular, in recent years several authors have suggested that both the scientific method and a scientific mentality should be introduced in psychiatric practice and research. They claim that criteria like a strong correlation among clearly defined signs and symptoms, a high predictive value towards the outcome and therapeutical response, and a clearly defined relationship between the symptoms and etiology are necessary to accept a diagnositc entity. Since in the case of e.g. schizofrenia such requirements are not met, some authors even suggest that the concept of schizofrenia should be abandoned. The present paper aims to show that such problems are not unique to mental disease, but are common to several branches of medicine. For example, the definition and classification of cancer follow a «polythetic» criterion which is similar to the concept of «family resemblances». Also, diagnostic reproducibility is often low in other medical disciplines. The paper examines how such methodological problems could be dealt with using the tools of epidemiology.

The metamorphosis from an extensive mental hospital system of care, rooted in a culture and tradition of self-sufficiency and isolation, to the concept and practise of delivery of psychiatric care in general hospitals is described. The obstacles, psychological and practical, to be overcome in this change process are outlined. The place of the general hospital psychiatric unit in psychiatric and general medical care is outlined. Relevant matters of design and management are briefly explored.

Lately on these pages, a discussion is going on over the opportunity of the use of the definition ‘outsider’. Especially in the USA, it is judged as demeaning, discriminating and inappropriate, whilst in Europe, it is used in a much more unconcerned way. Mr Gioni curator of numerous international exhibitions including Manifesta 5 (2004), the 4th Berlin Biennale (2006), the 8th Gwangju Biennale (2010) and the 55th Venice Biennale (2013) shares his perspective on contemporary culture and self-taught art.