Over the last 2 decades, discourse on the causes of schizophrenia was conducted almost entirely in terms of biological risk factors. This was probably the result of social trends in the research community, and in popular culture, as a wave of techno-optimism promised answers to big human questions in terms of small pixels and even smaller molecules. The human genome project inflated expectations further, and the pharmaceutical industry conspired with the desire of psychiatrists for scientific respectability. ‘Social factors’, whether at macro-societal or locality/family level, came to be seen as ‘fall-out’ from biological mechanisms, a kind of padding to our understanding of human disease. But changes are in the wind. New understandings of the influence of social factors on the long-term outcome trajectories of psychosis, their potential role in risks associated with migration, and recent findings from genetic high risk studies, are raising fresh questions about social factors and causation. This paper does not argue that the evidence (yet) is strong. But after 2 decades of often crudely articulated dualism, it is time once again for social experience to be integrated with more sophisticated theory development and hypothesis testing in the search for the causes of schizophrenia.

the author has received payments from various pharmaceutical companies to deliver lectures and support travel costs to conferences.

Aim — To point out the degree of satisfaction of psychotic patients and their family members in relation to the assistance given by the four Outpatient Mental Health Services in the Savona Department. Methods — patients with a diagnosis of psychosis were selected among those visited during the period from the 1st of January to the 30th of April 2002. VSSS—54 item, was utilized. Results — The analysis, conducted on 301 patients and 149 family members, highlighted: 1) a substantially positive assessment of the Services 2) the patients and their family members quite agreed on the evaluation of the different areas of satisfaction 3) Strong points: all the operators' human and professional skills 4) request of a better knowledge of the Service's programmes and more information to the public opinion 5) request of more collaboration with family doctors and other specialists 6) The worst criticism: the Service's response to night and holiday emergency. Conclusions — The patients and their family members reacted positively to the survey, that created more resistance on the part of the operators. The survey is not to be considered the final objective, but the point of departure for a new form of collaboration between the users and the operators.

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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.

the study has been supported by a Grant from MURST 60% to Prof. Mirella Ruggeri and Fondi 1% per la Ricerca Sanitaria Finalizzata 2001 Ministry of Health, to Professor M. Tansella.

Aims — To explore morale of psychiatrists and psychiatric nurses working in Community Mental Health Centres (CMHC) in an Italian Province, and identify influential factors. Methods — Thirty psychiatrists and 30 nurses working in CMHCs in Modena completed questionnaires on burnout, team identity and job satisfaction. They also answered open questions about different aspects of their work. Answers were subjected to content analysis. Regression analyses were used to identify factors that predicted morale across groups. Results — Psychiatrists had higher scores on emotional exhaustion and depersonalisation. There were no significant differences between the two groups in job satisfaction and job or role perception. Professionals reported positive relationships with patients as the most enjoyable aspects of their job, whilst team conflicts and high workloads were seen as most difficult to cope with. Multivariate analyses showed that being a psychiatrist and perceiving team conflicts as a main cause of pressure in the job predicted higher burnout. Conclusions — Simple open questions coupled with quantitative measures appear a promising tool to investigate morale of mental health professionals and identify factors determining morale. Research, training and service development should focus on relationship aspects both with patients and within teams to reduce burnout in CMHCs.

G.M.G. was employed by Modena local mental health service, but did not work in CMHCs. No other conflict of interest.

Aims — Evaluation of community residential facilities effectiveness in the Department of Mental Health of Desio (Milan). Method — Outcomes in symptoms, disability, family burden and quality of life were evaluated during one year through a longitudinal study, using a pre—test and post test design without control group. Results — Residential care is effective in reducing disability and symptoms, while it is not effective towards family burden. Quality of life is improved in some domains, but not in others (e.g. social and family relationships). Conclusions — Outcome assessment is feasible in residential facilities, following a multiaxial and multifactorial model. We need to clarify the goals of residential care, focussing on active components of the residential treatment.

the research project was funded by Department of Health of Regione Lombardia (DGR n. 37596 del 24.7.1998).