Medical information for the general public, patients and their families is a current Public Health priority. What information can be given to a patient suffering from schizophrenia, whose understanding and judgement capacities are supposedly affected by this mental disease ? In the United States, 70 % of psychiatrists inform patients of schizophrenia and diagnosis of schizophreniform disorder, while in Japan less than 30 % do this. The lack of information given to the general public on the disease may contribute to reinforcing the difficulty in announcing the diagnosis. Indeed, the beliefs and attitudes of the patient, his/her family, the general population and health carers concerning the disease do not match up. However, the first two years seem to be a main issue for the subsequent evolution of the disease. No specific data on the attitude of French clinicians with respect to the announcement of the diagnosis is available. In the current legal context and in view of the advances in treatment, we have carried out a survey among French psychiatrists. It is an auto-questionnaire, transversal epidemiological, descriptive and analytical. The questionnaire was sent to a population of 12 958 psychiatrists. It comprised 48 questions : 7 referred to the socio-demographic and professional characteristics of the subjects, 22 to the attitude with respect to the announcement of the diagnosis to the patients, and the last 18 concerned the attitude with respect to the announcement of the diagnosis to the families. 1 691 questionnaires were returned by free post and analysed. The socio-demographic characteristics of the sample are close to those of French psychiatrists as a whole. The number of patients suffering from schizophrenia in the active flies of the psychiatrists is 24 % (+/- 21.4) on the entire sample. Approximately a third (37.8 %) of psychiatrists deem it necessary to announce the schizophrenia diagnosis and approximately two thirds (69.5 %) declare that they sometimes announce it. Among the patients suffering from schizophrenia in the active files of the psychiatrists who responded, approximately a third (34 %) were informed of their diagnosis. The main reasons for not announcing the diagnosis are firstly the "reticence to give a diagnosis label" and secondly "the functional incapacity of the patient to understand the concept". The alternative diagnosis term most commonly used is "psychosis", (46.5 %). However, 48.1 % of practitioners state that the announcement of a specific diagnosis allows a better therapeutic combination. Depending on the proportion of patients suffering from schizophrenia in their active file presented in two categories (< 10 % and > 10 %), psychiatrists significantly most frequently announce the specific diagnosis (17.3 % vs 25.3 %, p < 10(-3)). A statistically significant proportion of younger psychiatrists (44.4 vs 46.3, p < 10(-3)) with fewer years of practice (14.1 vs 15.8), more often believe that it is necessary to announce the diagnosis. The rate of response (13.5 %) for this type of survey seems high, which could indicate a high interest among psychiatrists with respect to this question. Our data showed the existence of a correlation between age, number of years in practice, type of practice and the proportion of patients suffering from schizophrenia in the active file on the one hand and the attitude of the psychiatrists with respect to the announcement of the diagnosis on the other hand. It is possible that the multi-disciplinary team work of public practice psychiatrists and the fact that they are more often confronted with schizophrenic disease facilitate the announcement of this diagnosis. In the survey population, the inability to give a diagnosis may be related to the questions of the practitioners about the capacity of the subjects to understand, the lack of precision of this diagnosis, the fear of disheartening the patients and the absence of curative treatment. The risk of suicide does not seem to be one of the main reasons given. Only a quarter of the patients were informed by the attending physician. The possibility of the information getting out without the wish of the practitioner exists. The multiplication of publications devoted to mental disorders, the easy access to information sources, the development of auto-questionnaires on psychiatric disorders represent as many parameters which should foster the reflection on the need, or not, to announce the diagnosis of schizophrenia. The use of alternative terms may create a problem due to the current evolution of the patients' rights related to information. Overall, the attitude of psychiatrists with respect to the announcement of the diagnosis to families is equivalent to that held towards patients. The rate of response (13.5 %) for this kind of survey seems high, which could indicate a high interest from psychiatrists for this question. This interest should be placed in the general context of current thinking on patient's rights and the access of patients to confidential medical files. The exact reasons not to announce the schizophrenia diagnosis most frequently remain difficult to ascertain. It would be desirable to study the reasons which lead two third of psychiatrists to be often or sometimes incapable of announcing this diagnosis even though they wish to. The method used, that of an auto-questionnaire survey comprises obvious limits. However, the image of a negative evolution seems to explain the reticence to give a specific diagnosis. In 1976, 1 patient out 5 was told of a cancer diagnosis. Seventeen years later, 4 patients out 5 were told of a cancer diagnosis. In this type of pathology, it is likely that the treat ment evolution has considerably facilitated the announcement of the diagnosis. However, at the same time the level of information and education of the general public has considerable increased. The concern with early screening partly explains the efforts devoted in this direction. The new treatment and care procedures seem promissing. An evolution comparable to that of cancer treatments could facilitate in the future the process consisting in announcing the diagnosis of a disease such as schizophrenia. An early treatment on these disorders can only be envisaged if the diagnosis is made earlier in the course of the disease. This objective can only be reached by an improvement in the level of information and education of the general public.
