Background — By the mid-1960s, the importance of socio-economic status for schizophrenia had been demonstrated in terms of differences between social-class groups in prevalence and incidence rates, illness course and outcome, and treatment experience. In the causation – selection debate, however, opinion had swung in favour of the selection hypothesis. Aims — To reassess evidence on the social-class distribution of schizophrenia in Britain, and to compare this body of research with population-based studies of schizophrenia risk in socially disadvantaged ethnic minorities. Method — Systematic review of medical and psychological data-bases. Results — Epidemiological research, while confirming the importance of premorbid social decline, has also provided support for the environmental ‘breeder’ hypothesis. High psychosis rates have been confirmed in ethnic minori-ties; in particular among Afro-Caribbean and other Black immigrants whose low social status cannot be accounted for by selective downward social drift or segregation. Conclusions — There are striking parallels, both in the epidemiology of schizophrenia and in social characteristics, between the lower-class indigenous groups highlighted by earlier psychiatric surveys and African-Caribbean populations in Britain's inner cities today. These similarities underline the need for a broader perspective in the search for environmental risk factors.

Declaration of Interest: none.

Aims — Patients with chronic viral hepatitis suffer from a high prevalence of psychiatric problems. Furthermore, the treatment for chronic viral hepatitis, with interferon (IFN) alpha, induces the occurrence of further psychopathological symptoms. The autors examined whether patients with a pre-existing psychiatric diagnosis had more severe IFN alpha-induced psychiatric adverse effects, and whether they were more likely to interrupt the IFN alpha therapy, compared with control patients with no pre-existing psychiatric diagnosis. They also examined the psychopharmacological management of the interferon-alpha-induced psychiatric side effects. Methods — The authors studied prospectively 60 patients with chronic hepatitis B or C in Cagliari, Italy. Patients underwent psychiatric assessment before starting interferon alpha and monthly throughout the therapy. Results — After adjusting for the baseline psychopathology, there was no statistically significant difference in interferon-alpha-induced psychiatric adverse effects between patients with a pre-existing psychiatric diagnosis and controls. There was also no evidence that psychiatric cases were more likely than controls to interrupt the IFN alpha therapy because of psychiatric side effects. Moreover, there was no difference in the psychiatric adverse effects severe enough to require psychopharmacological treatment. Finally, psychopharmaco-logical management successfully treated psychiatric symptoms induced by the IFN alpha. Conclusions — Patients with a pre-existing psychiatric diagnosis do not have a specific vulnerability to interferon-alpha-induced psychiatric adverse effects.

Declaration of Interest: none of the authors have conflict of interests in writing this paper; CM. Pariante is funded by the UK Medical Research Council and by the NARSAD and the Guy's and St Thomas Charity

Aim — To assess the association between socio-demographic characteristics and community attitudes towards mentally ill people. Method — We assessed a sample of 280 subjects, stratified for sex and age, which has identified using the electoral registers of Brescia. A letter was sent to everyone in order to introduce the future potential study participant to the topics of the public attitudes towards mental illness and it included an invitation to take part in the study. After, 280 subjects were contacted by telephone. Finally, 174 persons, who expressed their willingness to collaborate, were visited by a team of four trained interviewers. The instruments used were: a semi-structured interview; the Community Attitudes to the Mentally III (CAMI) inven-tory, which is composed by 40 statements, concerning the degree of acceptance of mental health services and mentally ill patients in the community; and the Fear and Behavioural Intentions (FABI) inventory, which is composed by 10 items, concerning fears and behavioural intentions towards mentally ill people. 106 subjects refused to participate. Results — Factor analysis of the CAMI revealed three components Physical distance and fear, Social isolation and Social responsibility and tolerance. Factor 1 is associated with: people >61 years old; people being divorced/widowed/living separated; people who haven't participated in social or volunteer activities. Factor 2 is associated with: people > 41 years old; people being schooled at a level that's higher than elementary level; unemployed people. Factor 3 doesn't present any associations. Conclusions — The results of this study outline the need to: a) promote interventions focused to improve the general attitude towards people with mental illness; b) to favour specific actions in order to prevent or eliminate prejudices in subgroups of the population.

Declaration of Interest: in the last two years the authors have been paid by the IRCCS Centra San Giovanni di Dio Fatebenefratelli in Brescia (Italy), as employees and free professionals.

Aims — Empathy is an important basis of all provider-patient interaction, including general practice. Little has been known about the details of how general practitioners express empathy to their patients. In the present study, it was a main aim to carry out a detailed qualitative study of actual sequences through which empathy was achieved, by focusing on the form, function, and categorisation of such sequences. Methods — The study drew on the qualitative method of conversation analysis. Transcriptions of 77 British general-practitioner-patient interactions were analysed in detail in order to identify and characterise sequences in which empathy was achieved. Results — Four types of empathy were identified, described, and analysed: cognitive empathy, affective empathy, sharing empathy, and nurturant empathy. Although sequences involving empathy typically were brief and occurred relatively rarely, the analyses demonstrated that the sequences often concerned matters of great importance to the interactants. Conclusions — The study underlined the need to focus also on phenomena that occur relatively rarely in consultations. For this purpose, the method of conversation analysis was a useful tool.

Declaration of Interest: there was no conflict of interest.

Aims – Description of prejudice and stereotypes of mental illness in two samples with or without psychiatric Residential Facilities in their communities. It has been evaluated if the ongoing naturalistic relationship with the mentally ill was sufficient to modify the stigma of mental illness. Methods – The study has been carried out in 7 small towns with Residential Facilities and in 7 small towns without Residential Facilities on a sample of 560 people. Each respondent was asked to fill the Questionnaire on the Opinions about Mental Illness - General Population's version (QO-GP). Results – Data on 557 respondents (99.5%) were collected. The most frequent opinion in the general sample was to reject the possibility to admit patients to Psychiatric Hospital. The significance (p <.01) between the two samples was found for only 5 items that concern the “treatment-outcome”, while no difference was found about the stereotypes of mental illness. Conclusions – The results outline that the ongoing naturalistic relationship do not modify the stereotypes of mental illness, but only some aspects of prejudice (care and civil rights). As a consequence we need to plan structured, effective and more specific educational campaigns on mental illnesses.

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