Objective - In recent years an extensive literature has grown up around the concepts of subthreshold, subsyndromal, minor and brief recurrent affective disorder and their applications in population-based research. The aim of this short review is to examine the definitions and current status of these proposed categories with special reference to depression, and to assess their potential contribution to psychiatric epidemiology. Method - A Medline search was carried out for the period 1965-1999, based on the above four terms. Relevant references found in all identified publications were also followed up. Results - In great measure these constructs have been developed as a reponse to deficiencies in the DSM classification system and to a lesser extent in the ICD. The groups are all defined by having fewer criterial symptoms, or a shorter duration of symptoms, than the ‘official’ diagnostic categories. Use of these definitions has resulted in widely varying prevalence estimates. Conclusion - Improved methods are badly needed for classifying all those persons in the wider community who are in need of medical treatment and help for psychological disorder, but do not satisfy operational criteria laid down in the official guidelines. This cannot, however, be achieved simply by lowering operational thresholds in these systems. Further research on clinical and psycho-social characteristics of the common mental disorders is called for, and in many societies a favourable setting is that of primary health care, where a move towards pragmatic, comprehensive classification of community health problems is already under way.

Objective - Following the introduction of guidelines of rational drug use, the pharmacoepidemiology of psychotropic drugs was investigated in a sample of long-stay patients living in a Italian psychiatric hospital. Design - Aprospective, longitudinal two-year follow-up study was carried out. Information about sociodemographic and clinical characteristics of the inpatientpopulation, and about medications prescribed, was collected at baseline and after one and two years of follow-up. Setting - Three wards of the psychiatric hospital of Milan. Main outcome measures - Number of patients taking psychotropic drugs, number of patients taking more than one neuroleptic or benzodiazepine, mean neuroleptic dose, psychopatological status according to the Brief Psychiatric Rating Scale (BPRS). Results 70 patients were recruited and followed for two years. At follow-up a reduction in the number of patients taking neuroleptic drugs was recorded, together with a 50% decrease in the number of patients taking more than one neuoleptic. A reduction in the use of depot formulations was in addition shown. Patients taking benzodiazepines decreased of 50%. According to the BPRS, no psychopatological changes were observed during the study. Conclusions - These data suggest that education in psychopharmacology may guide towards a more rational use of drugs; longitudinal clinical audits should be implemented to monitor everyday practice.

Objective - This article describes the short-term and at 6 months follow-up results of an intensive cognitive-behavioural group treatment on subjects affected by Panic Disorder with or without Agoraphobia (DSM IV criteria). Design and Setting - We studied a group of 22 subjects treated in the public Centro Psico Sociale of Zogno (Bergamo) and valuated them with self-rated instruments inherent the life satisfaction (SF/36) and symptoms and ament (PAAAS; MSPS, STAI-X1, STAI-X2). The results indicate significant improvements at the end of treatment and at a 6 months follow up. Conclusions - We are studying the long-term results with others follow up valuations. The most important result, anyway, is the demonstration that also in an Italian public mental health centre, as in many foreign countries, is possible to treat patients affected by Anxiety Disorders with effectual and relatively low cost tecniques and that is possible to introduce objective results indicators in the routinary clinical activity.

Objective - The aim of this study was to verify the construct validity of the Italian version of Parental Bonding Instrument (PBI) a questionnaire which estimates the parental style as reported by the son or daughter. Method - The questionnaire was administered to a group of 102 students (62 males and 40 females) attending University of L'Aquila and to a sample of 128 patients (76 males and 52 females) consecutively admitted to a psychiatric unit for an index episode. We compared the means of the two factors (care, protection) separately for each parent in the two groups using a t-test for indipendent samples. After having estimated the internal consistency of items of each scale by calculating Cronbach's coefficient α, a factor analysis was performed for students and patients to find the structural factors of the questionnaire; then, we conducted a confirmatory factor analysis of the PBI items, for the students only, to evaluate the fit of the real items to models proposed in the literature. Results - The Italian version of the Parental Bonding Instrument, demonstrated the ability to discriminate between patients and controls; it showed an high internal consistency. The factor analysis identified a two factors solution which accounted for 44.6% and 44.3% of the variance of the mother's and father's PBI scores respectively for the group of students and it identified two factors which accounted for 49.3% and 46.6% of the variance in the group of patients. Conclusions - The psychiatric patients showed a low «care»-high «protection » confirming an association between the «affectionless control» pattern and psychiatric disorders.