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Findings confirm earlier work in North American samples showing a substantial cross-cultural consistency in motives for choosing psychiatry as a discipline. A strong, early interest and curiosity among these students, often present in the premedical and preclerkship years, suggests some benefit in targeting this group for recruitment.

An inventory of institutional constraints perceived as limiting therapeutic choices was developed and completed by psychiatrists working in Italian public mental health services. Constraints considered most limiting were social and institutional pressures toward social control, violence risk assessment and prevention, and lack of control over workload. The total mean score of the perceived constraints instrument was significantly negatively correlated with ratings of perceived freedom in therapeutic choices and with overall job satisfaction. Reliability was good (alpha = 0.85). Addressing perceived constraints may result in more choice options to reach therapeutic goals in a collaborative framework with patients, and improve job satisfaction.

The authors present some of their experiences concerning psychiatric consultation in a 1,800-bed university hospital. Particular evidence is given to the development which the physician-psychiatrist relationship has had in the long run. The experiences refer to the consultation work carried out in the Department of Medicine, in the Division of Cardiology and in the Hemodialysis Unit.

Using a "psychotherapeutic attitude", as a criterion and measure of the psychiatrist's involvement in clinical relationship (with the "trial identification" according to Fliess), some phenomenological and epistemological considerations are offered about diagnostic assessments, as a synchronous and diachronous recognising process. Inspired by Gehlen's notion of "exoneration" (i.e., the reducing and focusing of the perceptive experience as applied to the wealth of the perceptible), this paper examines how the mind of a skilled diagnostician might work. Three levels are explored: firstly, "the symbolic perception", where perceptive/ emotional data derived by "trial identification" and worked through during one's professional experience, automatically selects wide fields of allusions (e.g., in the psychopathological prefigurations, suggested by the "contact"); then, we consider the "exoneration" of scientific hypothesis, which allows the psychiatrist to give a scientifically recognisable form to the first diagnostic outlines gathered in the interpersonal communication; and thirdly, the holistic reflection is examined, which returns the doctor's focus to the patient's individual problems, after going through different and, at times, very high inference levels. It is not a question of phases, but of varyingly interwoven moments in the mind of the skillful clinician, which are based on the dialectics of identification/separation.

The authors deal with the psychological and psychopathological implications connected with cervicobrachial neuralgia and low-back pain. In particular they propose a classification of the various pathologies pertaining to cervicobrachial neuralgia and low-back pain of nonneoplastic organic etiology. In the last part of the present paper the authors touch on the broader issues of patient handling and the role of psychiatric consultation.

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