Objective – 450 million people are estimated to suffer from neuropsychiatric conditions; approximately 10–20% of all children seem to have one or more mental or behavioural problems. Mental and neurological conditions account for 31% of all disability in the world. In epilepsy alone less than 25% of those affected receive treatment. In developing countries only a quarter of people suffering from schizophrenia receive treatment. Urgent action is needed to close the treatment gap and to overcome barriers. Governments need to take action with other partners to address these barriers and provide mental health services to those in need. Results – The World Health Report provides 10 recommendations for countries to begin taking action. These actions are divided into three scenarios: for countries with a very low level of mental health resources, for those with a medium level and for those with a high level of resources. Conclusions – The Report allows every nation to recognize itself in one of three scenarios and to adopt and implement die appropriate actions.

Objective – In vivo structural magnetic resonance imaging (MRI) studies have evaluated the brain anatomy of various psychiatric disorders, allowing the investigation of putative abnormal brain circuits possibly involved in the patophysiology of psychiatric disorders. Here we reviewed the structural MRI literature in mood and anxiety disorders. Methods – All anatomical MRI studies evaluating mood and anxiety disorder patients were identified through a comprehensive Medline search conducted for the period from 1966 to January 2002, and a manual search of bibliographic cross-referencing complemented the Medline search. Results – Differential patterns of anatomical brain abnormalities appear to be involved in subtypes of mood disorders, with hippocampus and basal ganglia being abnormal in unipolar disorder, and amygdala and cerebellum in bipolar disorders, suggesting that these two mood disorders are biologically distinct. As for anxiety disorders, orbital frontal regions and basal ganglia have been reported to be anatomically abnormal in obsessive-compulsive disorder, temporal lobe was found to be abnormally reduced in panic disorder, and abnormal hippocampus shrinkage was shown in posttraumatic stress disorder. Conclusions – The structural MRI findings reviewed here suggest abnormalities in specific brain regions participating in proposed neuroanatomic models possibly involved in the pathophysiology of mood disorders and anxiety disorders. Nonetheless, available MRI studies have suffered from limitations related to relatively small patient samples and involvement of medicated patients, and were largely cross-sectional investigations. Therefore, longitudinal MRI studies involving more sizeable samples of drug-free patients, patients at first episode of illness or at high risk for mood or anxiety disorders, associated to genetic studies, are likely to be extremely valuable to separate state from trait brain abnormalities and to characterize further the pathophysiology of these disorders.

Objective – The analysis aims to study the packages of care in the public Departments of Mental Health by diagnosis and service utilisation intensity. Design – Data on community, hospital and residential contacts were provided by the Regional Psychiatric Information System. The sample has been composed by 55518 patients residents in Lombardy and treated in public Departments of Mental Health. Setting – The public Departments of Mental Health in Lombardy. Main outcome measures – Fifteen packages of care were defined according to researchers' experience; the package “community care only” has been divided in five sub–packages; for every package the care weight has been attached. Results – Four packages of care (“community care only”, “hospital care plus community care”, “hospital care only” “community care plus day centre care”) represented 95% of the patients. Three quarter of the patients were treated only in the community setting, without hospital, residential and day centre contacts in the year. Heavier patients (patients with more than 5000 care weight) represent only 4%. Residential care is the heavier setting (36% of the total weight), while schizophrenia is the diagnosis with mayor impact on the community services (59% of the total weight). Of the patients treated only in the community setting one third receives only psychological and psychiatric visits, while two thirds integrated community care. Conclusions in community care the mixed packages represent the exception not the rule. More complex or heavier packages are addressed to severe mental illness patients.

Objective – To evaluate potential differences in socio-demographic and clinical characteristics (obsessivecompulsive symptomatology, axis I and II comorbidity) between OCD adults with an early age at onset (≤18 years) and later onset, (≤18 yrs). Design – Clinical controlled study. Setting – Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin. Methods – We included 149 subjects with a principal diagnosis of OCD (DSM-IV) and a Y-BOCS total score ≤ 16 All patients underwent a semistructured clinical interview aimed at investigating sociodemographic characteristics and clinical features of the disorder. Lifetime Axis I comorbidity, according to DSM-IV criteria, was investigated with a structured interview following Othmer & Othmer guidelines (1994; 1999). Personality disorders were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Results – 39 patients referred age at onset of OCD before 18 years (earlyonset group) and 110 patients at 18 years or later (later-onset group). Significant differences were found between the two groups: early-onset subjects are characterized by a preponderance of males, a chronic course of illness and a strong association with Schizotypal Personality Disorder. Discussion – When subtyping OCD according to age at onset we found significant differences which suggest a possible heterogeneity of the disorder. Our results seem to confirm that early-onset OCD may represent a more severe subgroup, with clinical characteristics such as the chronic course and the high association with Schizotypal PD which are significant in order to apply specific therapeutic strategies.

Objective – Cognitive Behavioural Therapy for the treatment of Social Phobia has proved effective through several controlled trials and meta-analyses. In spite of this the CBT has not spread in clinical field yet. Therefore our aim was to verify the effectiveness of the CBT in a public mental health service and to compare our results with those described by experimental research. Design and setting – Partecipants were 11 public mental health center clients, with a primary diagnosis of Social Phobia (according to DSM-IV criteria). The transportability of CBT to a common clinical setting was examined comparing treatment outcome data, at the end of the treatment and at a six months follow up, with results described in controlled efficacy studies. We employed self completion rating scales relating to both general health conditions and life satisfaction (SF36) and trend of symptoms (LSPS). Moreover we recorded the Clinical Global Impression (CGI) and Patient's Global Impression (PGI). Results – Despite differences in setting, clients and treatment providers, both the magnitude of change from pre treatment and maintenance of change at a six months follow up were comparable with the parallele findings in the efficacy studies. Conclusions –. The results attest the effectiveness of CBT even in a public mental health center setting so, in consideration of the fact that social phobia is a very common disease and involve high degree of severity, chronicity and disability, we hope that this effectual and relatively cheap therapy will be routinely applied in public mental health services.

Aims – Taking the scientific literature on psychotherapy as a starting point, the paper suggests a few remarks for the debate over psychological treatments in the mental health services in Italy. Methods – A survey of reviews and papers on process and outcome of psychological treatments and on psychotherapeutic practice in mental health services. Results – The paper examines some organizing hypotheses in order to increase psychological treatments supplies. Conclusion – The practicability of such solutions requires on the one hand more attention for empirically supported psychological treatments in mental health professionals training and, on the other hand, that various health services become able to be different in their treatments supply.