Objective - To compare psychiatric bed usage for major psychiatric illness in a fully community-centred psychiatric service (South Verona, Italy) with usage in a more conventional hospital-centred service (Canberra, Australia). Design - Registers of hospital admissions for schizophrenia and major affective illness in the three years 1986, 1987, 1988 were examined at each site. The characteristics, socio-demography and rates of admission, the duration of index admission and the rate of readmission in the subsequent twelve months were compared. Results - The community-centred service (South Verona) admitted fewer patients with schizophrenic and major affective illness but they appeared more severely ill, stayed longer and were more likely to be readmitted. The hospital-centred system (Canberra) used hospitals for a wider range of severity of major illness including good prognosis illness. Hospitalisation in Canberra was briefer and readmission less frequent. It appears that the hospital centred service was more willing to use beds for the initiation or stabilisation of treatment. The community based service did not lead to shorter hospital stay or less frequent readmission. Differences in the treated psychiatric morbidity in the populations overshadowed the effect of design of the service on usage. This difference in morbidity, concentrated in the younger age group, remains unexplained.

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Objective - In view of the lack of both a tradition and research, or systematic reflections, on the issue of health care for demented patients, and taking into account the many initiatives set up also in Italy to search for new models of care for old demented people, we feel it can be of some interest to suggest some thoughts on the issue. The ultimate objective of this paper is to stimulate a debate and further contributions on the eveluation of psychogeriatric services and effective «styles of care». Method - A review of the literature (MEDLINE) starting from 1980 with the keywords quoted below has been performed. Then, due to the need for tackling (or, at least, listing) a wide range of subjets — from the organisation of the internal space in the institutional setting, to the interpersonal aspects and the use of psychotropic drugs — we referred to other various sources of information. Results and conclusions - Reflections on care needs of elderly demented people identify, first of all, a priority: in psychogeriatrics, more studies on services are needed. Secondly, the crucial role of the interpersonal domain and of the spatial organisation comes up. Finally, it is clear that the valuable anti-institutional strategies and culture produced by the social psychiatry need, for psychogeriatrics, to be reframed especially regarding the value of the autonomy of the patient (vs the dignity of disability), of his/her involvement in an active life (vs the «respect of apathy») and his/her re-socialisation (vs a different balance between stimulation and protection).

Objectives - (I) To review the studies which investigated the frequency of psychiatric disorders among primary care attenders, using a standardized psychiatric interview as the case finding instrument; (II) to discuss the factors possibly explaining the different results found; (III) to highlight the central role of international multicenter collaborative studies, carried out in primary care settings. Method - the studies were reviewed, which were published in international journals between 1970 and 1993. The studies were located through a computerized search of the databases MEDLINE and Psychological Abstracts; in addition, the reference lists of the studies located in this way were examined and international journals were manually scanned in order to avoid possible omissions. Finally, the annotated bibliography, edited by Wilkinson (1985), was examined, since it included the studies having psychiatric focus, carried out in primary care and published between 1977 and 1985. Results - Thirty papers were traced, but 9 were excluded since they duplicated results or because of methodological limitations. So far, the overall frequency of psychiatric disorders among primary care attenders has been investigated using standardized procedures in 13 countries only. The frequency of psychiatric disorders ranged between approximately 10% and 50%. The possible reasons accounting for the differe- nces between the studies were discussed in the light of three factors: I) the research design and study characteristics; II) the reliability and comparability of different diagnostic categories and classificatory systems; and III) the different organization of health services across countries. Conclusions - In the light of the difficulties faced when the findings of independent studies, carried out in different countries or even in the same country, are compared, the central role of in- ternational multicenter collaborative studies conducted in this field is suggested.