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Aims: To describe patterns of experienced and anticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO)., Methods: Cross-sectional survey on a sample of 50 people with clinical diagnosis of schizophrenia recruited in the Italian INDIGO sites of Verona and Brescia. The 41-item interview-based Discrimination and Stigma Scale (DISC-10), which assesses how experienced and anticipated discrimination affects the life of people with schizophrenia, was used., Results: The most frequently occurring areas of experienced discrimination were discrimination by family members (44%), making and keeping friends (33%), keeping (36%) and finding a job (34%), getting or keeping a driving licence (32%). Anticipated discrimination was common in applying for work, training or education (58%), looking for close relationships (50%) and doing something important (48%); 68% felt the need to conceal their diagnosis. Positive experiences were rare, and getting welfare benefits/disability pensions was the only area where participants reported being treated with advantage (34%) more commonly than with disadvantage (8%). Overall, experienced discrimination reported by Italian patients was in the intermediate position of the score range of all INDIGO sites, whereas anticipated discrimination was lower than that reported in the other countries., Conclusions: Interventions to reduce discrimination against people with schizophrenia may need to address both actual and anticipated discrimination. Targeted therapeutic strategies aiming to improve self-esteem of people with schizophrenia may be useful to facilitate their social participation and full inclusion in the community.

Aims: To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT'S Project (DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: (a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, (b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and (c) evaluating their actual application in Italian MHSs., Methods: The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management., Results: The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementing specific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process., Conclusions: The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocation processes that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.

Aims: Evidence from the literature show that patients affected by psychosis rarely are informed about their diagnosis and/or involved in the decision making process regarding the therapeutic program. The aim of the present study is to investigate psychiatrists' clinical experiences, beliefs and attitudes towards communicating the diagnosis to patients affected by psychosis., Method: Three focus groups were conducted with 28 psychiatrists of different levels of expertise (10 senior psychiatrists and 18 psychiatrists in training), all working at the South-Verona Community-based Mental Health Service. The group discussions were audiotaped and transcribed. The authors derived different thematic categories which were used by two raters to classify all contributions of the psychiatrists., Results: The main themes of interest which emerged were: experience with the communication of the diagnosis of psychosis and main communication strategies used; obstacles and personal difficulties in giving such information., Conclusions: In the psychiatric setting the disclosure of the diagnosis of psychosis implies different clinical and ethical issues and is felt as highly problematic. These findings suggest a need of psychiatrists to involve the psychotic patient in the information giving process in order to learn his/her informative needs which are the starting point for individually tailored information. The authors have no potential conflict of interest related to the subject of the paper.

Aim: To present the Italian version of the OPTION (observing patient involvement) rating scale, developed in UK by Elwyn et al. (2005), and its psychometric characteristics, together with some findings when applied on the consultations transcripts of a group of Italian General Practitioners., Methods: The OPTION scale assesses the extent to which clinicians involve patients in decisions and consists of 12 items to be rated on a 5 point scale (from 0--behaviour not observed to 4--high standard). The scale was applied to 235 transcripts of audiotaped consultations conducted by 6 male GPs. Interrater and test-retest reliability and internal validity indices were calculated on a subsample of 30 transcripts., Results: The Italian language version of OPTION showed good psychometric properties, similar to those reported for the original version. The ratings obtained for 235 consultations showed for each OPTION item a skewed distribution: the majority of scores (> 70%) were between 0 (behaviour absent) and 2 (minimum skill level)., Conclusions: The Italian language version of OPTION seems a reliable instrument to assess patient involvement in primary care settings also in Italy. The clustering of low scores confirms previous findings that clinicians without a specific training obtain very low levels of patient involvement in the decision making process.

Aims: A systematic review of the studies on use of alternative and complementary medicine by mental health services' users to investigate the prevalence and motivations of CAM used to treat mental disorders., Methods: This paper shows a part of the results of a literature review, limited to studies between 1966 and 2005, was carried out using Ovid Medline, PsycINFO and EBM Reviews databases. This was supplemented by hand searching of reference lists., Results: Ninety-one studies on CAM's use by psychiatric patients were analyzed. In this paper the twenty-five articles about the CAM's prevalence and use's motivations are described. The use of complementary and alternative medicine (CAM) varies across countries: data suggest that from 50% to 80% of people suffering of mental disorders use CAM. Heterogeneous methods, samples and results characterizing the studies make generalizations results difficult. Patients motivations of CAM's use were poorly investigated by research, however it seems that persons affected by mental disorders use MAC prevalently because they are dissatisfied with conventional medicine and/or because these alternatives approaches are congruent with their own values, beliefs and philosophical orientation toward health care., Conclusions: The review emphasize the importance of a best physicians' education and information about CAM to improve the management of non-conventional and orthodox medicine relationship. The motivations of CAM's use underline the relevance of patient's holistic conception and the therapeutic role of a patient-physician relationship based on emphaty. Besides it seems important to investigate furtherly patients' psychological and social aspects that influence their choise to use CAM.

Aims: This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health ("Progetto Obiettivo 1994-1996") ten years after its launch., Methods: The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents., Results: CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites., Conclusions: A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.

SUMMARY. Aims - Psychiatric patients often are not informed about their diagnosis and their involvement in the decision making process is rare. Aim of the study was to explore the informative needs of patients with schizophrenia and the knowledge about their illness. Method - Three focus groups were conducted with 25 long-stay patients with the diagnosis of schizophrenia, attending the Mental Health Centre of the South-Verona Community-based Mental Health Service. The group discussions were audiotaped and transcribed. Results - The authors identified 18 different thematic categories which were used by two raters to classify all patient contributions. The interrater reliability was satisfactory. The qualitative analysis evidenced that patients have little knowledge about their illness. Patients had confuse and vague ideas on schizophrenia but their knowledge on drug names, dosages and side effects appeared precise and detailed. Several patients have looked for information in encyclopedias and medical dictionaries. Conclusion - The findings suggest a need of patients affected by schizophrenia for an information exchange with their psychiatrists that takes into account their informative needs, corrects wrong beliefs and actively involves them in therapeutic decisions.

Aims: To start a process of Continuous Quality Improvement (CQI) in an Italian Community Mental Health Service by using a quality assurance questionnaire in a self audit exercise., Methods: The questionnaire was administered to 14 key workers and clinical managers with different roles and seniority. One senior manager's evaluation was used as a benchmark for all the others. Changes were introduced in the service practice according to what emerged from the evaluation. Meetings were scheduled to monitor those changes and renew the CQI process., Results: There was a wide difference in the key workers' answers. Overall, the senior manager's evaluation was on the 60th percentile of the distribution of the other evaluations. Those areas that required prompt intervention were risk management, personnel development, and CQI. The CQI process was followed up for one year: some interventions were carried out to change the practice of the service., Conclusions: A self audit exercise in Community Mental Health Services was both feasible and useful. The CQI process was easier to start than to carry on over the long term.

Aims: A narrative review of studies on the psychiatrists' opinion about the information process and the factors that may influence the extent to which patients are informed and involved in the information process., Methods: A literature review, without restrictions of time, was carried out using Medline and PsychInfo databases., Results: Twenty three studies of interest were identified. The diagnosis of depression, anxiety and substances abuse are comunicated in a high percentage of cases; while the diagnosis of schizophrenia and other psychotic disordes are often concealed to patients. As far as pharmacological treatment is concerned, psychiatrists are more inclined to communicate those side effects which from their point of view are considered as less stressfull for the patient. No studies refer to the comunication of prognosis. The reasons adduced by psychiatrists for informing or not informing regard the etiology and the validity of some psychiatric diagnoses, the cognitive difficulties of patients, worries about stigmatizing or damaging patients., Conclusions: The choice to involve patients in treatment should be made from the prospective of promoting patient's well being rather than to depend on psychiatrists' communication difficulties, prejudices or on a habit of a paternalistic relationship style.

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 PsychInfo 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.

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.

Aims: To investigate in persons with mental disorders 1) the patterns of clinical course and their frequencies, 2) the impact of clinical course on two social dimensions of outcome, such as disability and quality of life., Methods: Study conducted with a longitudinal design in the "real world" of community mental health services. Clinical course was retrospectively assessed by using an instrument developed by our group, taking into account previous literature in this area; disability and quality of life were measured, respectively, with the WHO-Disability Assessment Schedule and the Lancashire Quality of Life Profile., Results: In patients with non affective psychosis, continuous and episodic course showed the same tendency to occur, whereas in subjects with affective disorders (either psychotic or neurotic) episodic course was more frequent. Continuous course was associated with higher levels of disability and lower quality of life in psychotic patients, while a poorer quality of life in some areas was associated with episodic course in patients with non psychotic disorders., Conclusions: The impact of clinical course on social disability and quality of life is different depending upon the specific diagnostic category. This suggests that specific and individualised interventions should be provided in order to prevent the negative impact of clinical course on life conditions of persons with mental disorders.

Aims: Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains very common in clinical practice. This systematic review was carried out to investigate the efficacy of clinical interventions that community psychiatric services can implement to reduce non-adherence in patients with psychosis., Method: Systematic review of randomised clinical trials, controlled clinical trials and observational studies assessing the efficacy of adherence enhancing interventions., Results: Forty-seven studies met the inclusion criteria and were included in this systematic review. Data suitable for re-analysis were reported in 24 studies; from the remaining 23 studies, with no data suitable for re-analysis, outcome data were extracted according to what study authors reported. In the group of studies included in the meta-analysis educational and psychotherapeutic interventions were more effective than usual care in reducing patient non-adherence. The remaining 23 studies reported contrasting findings regarding the efficacy of educational strategies. Case management models improved the adherence in half of studies, while other interventions were effective in the majority of studies reported., Conclusions: Community psychiatric services can arrange effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.

Aims: Reconstructing the models used for approaching the inequalities issues in health, identifying the most relevant theoretical and conceptual contributions., Method: Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch using the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002; integrated with manual search. The material was classified according to the conceptual and theoretical interpretative models or to the analyses of the association 'inequalities-health' where health was expressed as mortality, morbidity or services utilisation., Results: Four different interpretative models about the genesis of inequalities were identified. Further theoretical developments overcome the distinction among conceptuals contrapositions selection versus causation, statistic artefactual versus real differences, individual behaviours versus material context. Since the 80's the concept of material deprivation has been enlarged to include social deprivation to explain health inequalities. The social exclusion is related to material deprivation and to social fragility enlarging the traditional aspects of poverty. The theories that better adapt to the psychiatric field are the social selection and social causation., Conclusions: The social exclusion and the new methodologies for measuring the inequalities seems to be an effective way for understanding of the inexplored aspects of the mental health inequalities.

Aim: The aim of this paper is to present the results of a citation analysis concerned with the impact on the international literature of Italian researchers in psychiatry and psychology and of sub-fields, within these two disciplines, in 1995-1999 compared to 1985-1989., Method: We used a database prepared by the Institute for Scientific Information (ISI) that included all papers, with at least one Italian author, working in Italy, which appeared in two periods (1995-1999 and 1985-1989) in psychiatric or psychological journals listed in Current Contents. A citation analysis concerning the following years, up to 1999, was performed., Results: In 1995-1999 the most cited researchers were those involved in clinical psychology, psychiatry and psychopharmacology research. Neuropsychology, which dominated the period 1985-1989, underwent a clear-cut decline., Conclusions: Citation analysis, concerning relatively short periods of time (five years), appears to be a very helpful tool for monitoring the development of scientific research in specific disciplines and the trend of the scientific production of researchers.

Aims: In the last years, in Italy as well as in many other developed countries, there has been a growing interest for health economics by researchers. As for as the psychiatric care is concerned, more recently, many research's groups have pointed their attention on new possible funding systems for mental health services and on their effects on services' functioning. The aim of this study is to define a new list of services' costs based on services actually delivered by a Community Mental Health Service (CMHS)., Methods: All psychiatric contacts recorded by the South-Verona Psychiatric Case Register during a 7-year period (1992-1998) have been included in the study (125,623 contacts made by 2,819 patients). Contacts were grouped into 19 type of services. The cost function methodology was used to describe, also reporting elasticity values, costs' behaviour in the South-Verona CMHS. The cost of each service includes expenses for professionals involved (directly or indirectly) in the contacts with the patients and capital costs., Results: For each service were reported a) the cost of the service as it is actually supplied in our CMHS, b) the cost per minute, c) an estimate of the cost of service delivered with standard modalities (duration equal to the mode value registered; staff composition take into account either the actual functioning of the CMHS either indication about a good clinical practice) and, finally, d) cost of the eight services included into the reimbursement system currently in use in Italy., Conclusions: Our results showed that services' definition used in this study allow to describe different types of psychiatric care supplied from the South-Verona CMHS. The national list currently adopted for the reimbursement in Italy should allowed to describe only 28% of the registered psychiatric contacts (35,230 vs. 125,632). The urgent need for a new list of psychiatric services, accepted at a national level, was confirmed. Cost values obtained clearly show that the funding system currently used underestimates the true costs of care delivered by the CMHS. The cost function makes available a tool to test a prospective per-capita funding system as provided in the Act No. 229 of the Italian Government.

Objective: The present paper represents the second part of a larger review on the studies assessing needs for care in mental health field. In the first part, studies assessing needs for services in the general population were reviewed. In this second part studies assessing needs on individual level were reviewed and the role played by the assessment of individual needs in planning mental health care was discussed., Methods: Studies published in international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs in the general population and in psychiatric patients were reviewed separately. The latter were reviewed on the basis of the diagnostic category (psychotic and non psychotic patients) and setting of care (outpatients and inpatients). Studies on particular categories, such as homeless, children and adolescents, elderly and patients with aggressive behaviour, have been also reviewed., Results: Psychotic patients show a wide range of both clinical and social needs. Patients followed by community-based mental health services show similar number of clinical and social needs, while inpatients (with the exception of acute patients) show more social needs. For both community-based mental health patients and inpatients, social needs are most frequently unmet and psychopharmacological treatments are used more frequently than psychotherapeutic or rehabilitative interventions. Non psychotic patients show lower number of needs than psychotic patients; these needs are both clinical and social, with a higher total number of clinical needs, but a higher number of unmet social needs., Conclusions: Studies on needs for care provide an interesting perspective on people suffering from mental illness. In the routine clinical practice needs assessment could be a valuable tool for providing specific, individualised and effective mental health care.

Objective: To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure., Design: "Case control". Cases had a GHQ-12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness., Setting: Six single handed primary care practices., Measures: Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index., Results: The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems., Conclusions: The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.

Objective: In Italy, mental health care is in phase of reorganisation. In this frame the measurement of users' needs may be a useful tool in planning individualised mental health service interventions and in their evaluation. Aims of the present study are (I) to highlight the basic concepts of 'needs for care' and give a brief description of the main needs assessment tools specifically developed for psychiatric patients; (II) to review studies assessing needs for mental health services in the general population; (III) to discuss the role played by the assessment of needs in planning mental health care., Methods: Studies published in the international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs for services and studies assessing needs on individual level were separately reviewed. Both groups of studies, in turn, were divided in studies assessing needs for mental health care in the general population and in psychiatric patients., Results: Although most studies on needs for services used indirect methodologies and employed quite heterogeneous experimental design, they provide at large overlapping results. In the general population, about 60%-70% of patients with anxiety, depression and other neurotic disorders and 30%-40% of psychotic patients do not receive any specialist mental health care, suggesting that the majority of subjects suffering from a psychiatric disorder do not receive the mental health care they need., Conclusions: Unmet needs for services show a higher frequency in patients with neurotic and depressive disorders, indicating a shortage in services delivery that should be taken into account both by psychiatrists and mental health planners. Moreover, the finding that a large number of patients suffering from psychotic disorders do not receive any kind of mental health care is of particular relevance for planning mental health services, since these subjects are usually the most problematic and difficult to treat.

Objective: To assess the reliability and to describe the categories and the procedure to apply the VR-MICS/P (Verona-Medical Interview Classification System/Patient)., Setting: The interviews used for the reliability study were audiotaped. Five general practitioners (GPs) working in two general practices in South-Verona recorded their consultations., Sample: 50 interviews selected randomly from 120, 10 for each GP. The selection criterion for the participating patients was a GHQ-12 score of 3 and the consultation for a new illness episode., Main Outcome Measures: The VR-MICS/P classifies patients' verbal behaviours into 21 categories, 15 of them are defined by form (cue or statement) and content., Procedure: Two trained raters classified 50 interviews. Before applying the classification system each interview is divided into units which are numbered to define doctor's and patient's sequence of speech., Results: The reliability of VR-MICS/P was satisfactory (Kappa 0.85). Similarity Index (Dice, 1945) for categories varied between 0.71 and 0.94. Reliability for form and content classification was satisfactory too (Similarity Index between 0.81 and 0.89 and between 0.84 and 0.94, respectively)., Conclusions: The VR-MICS/P is a reliable measure for describing patients' verbal behaviours during medical interviews. It can be used together with the VR-MICS/D (Verona-Medical Interview Classification System/Doctor; Saltini et al., 1998) to describe the medical interview, the quality of doctor-patient interview and can be used as a measure of patient centredness.

Objective: To assess the reliability of the VR-MICS/D (Verona-Medical Interview Classification System/Doctor) and to identify the verbal behaviour by general practitioners in interviews conducted with primary care attenders with medical complaints and emotional distress., Setting: Two general practices in South-Verona., Sample: 100 primary care patients attending for a new illness episode with a GHQ-12 score > or = 3. The five participating GPs contributed each with 20 audiotaped interviews of 10 patients judged by GP as emotionally distressed and of 10 judged without emotional distress., Main Outcome Measures: The VR-MICS/D classifies GPs' verbal behaviour during the medical interview into 16 categories in terms of form (question or statement) and content and allows to assess their interview skills., Procedure: Two raters classified 30 interviews (15 with patients judged by their GP as emotionally distressed and 15 with patients judged without emotional distress). Having established satisfactory reliability, the overall verbal performance, based on 100 interviews, was assessed and GPs' verbal behaviours with patients judged as emotionally distressed was compared with that adopted with patients judged without emotional distress., Results: The reliability was satisfactory (Kappa 0.93). Percentage agreements for categories varied between 78.2% and 96.4%. The most frequent verbal behaviours were closed ended questions and information giving (58% of a total of 5522 classified verbal units). Interviews with patients judged as emotional distressed contained a greater number of psychological and psychosocial contents, facilitating comments and clarifications. These differences, however, were small, despite their statistical significance., Conclusions: The VR-MICS/D is a reliable measure for describing GPs' verbal behaviour during the interview with emotional distressed patients. The interview style of the GPs in this study was similar to that reported in the literature for GPs without formal training in communication skills and was characterised by a prevalently doctor-centred approach. This approach, particularly with emotional distressed patients, has severe limitations and underlines the necessity of the introduction of communication skills training.

Objective: The medical interview has important diagnostic and therapeutic functions and requires the integration of doctor-centred and patient-centred interviewing techniques to collect accurate and complete biopsychosocial data from the patient. Analysis of the interaction between patient and doctors which occur during the medical interview allow to evaluate physicians' interview techniques and to eventually improve them., Objective: 1. To review different Interaction Analysis Systems (IAS) used to describe doctor-patient communication in terms of clinical relevance, observational strategy, reliability and behavioural and verbal contents. 2. To critically evaluate these IASs on the basis of their relevant research outcomes., Method: Previous reviews on interaction and keywords for Medline research (HealthGate) listed above were utilised to collect the relevant literature., Results: Seventeen classification systems were identified and ten were discussed in a chronological order. Starting from a general sociological or psycholinguistic approach, the IASs over the years have became more specific and detailed, focusing more on the medical interview and on specific topics, such as cancer or hospital medical consultations., Conclusions: When studying interactions in general practice medicine, it is important to define the significant units of interaction which allow to identify a "patient-centred approach", since this is relevant not only for obtaining reliable and complete medical and social data, but also for the recognition of patients with emotional disorders and their correct diagnosis. Listening to the patient and facilitating the expression of emotions is an important aspect of patient education too, as patients learn that talking about psychological problems to their physician is appropriate and may be therapeutic.

Objective: To asses the capacity of the Parental Bonding Instrument (PBI) to discriminate between normal subjects and clinical samples and between with different psychiatric diagnosis., Design: The present paper analyzes the studies published between 1979 and 1995, which have used the PBI in normal subjects and clinical samples and have reported the respective means and standard deviations obtained on the two PBI dimensions: affection and control. Multiple comparisons were carried out between the mean scores of affection and control of: 1) samples with the same psychiatric diagnosis (intragroup comparison); 2) samples with different psychiatric diagnoses (intergroup comparison); 3) normal subjects and clinical samples., Results: Of the 46 studies with normal and clinical subjects, 23 studies were selected for the analysis, reporting means and standard deviations and specifying the diagnostic criteria. Samples with the same psychiatric diagnosis had similar affection and control scores. With the exception of bipolar affective disorders and avoidant personality disorders, the prevalent parental style was for all diagnostic groups the affectionless control style. Within the affectionless control style, the PBI discriminated between panic attacks, borderline personality and drug addiction but not between schizophrenia, unipolar depression and anxiety disorder. The PBI discriminated also between normal subjects samples and samples with anxiety disorder, schizophrenia, bipolar affective disorder, personality disorder and drug addiction respectively., Conclusion: The results confirm previous suggestions from single studies that the perceived parental style as measured by the PBI can be considered a good predictor for the presence of psychiatric disorders excluding panic attacks, avoidant personality disorders and unipolar affective disorders. Although the different diagnostic groups do not differ in their perceived parental style (affectionless control), significant differences between some diagnostic groups within this category suggest that the PBI might have some specificity as well.