In una recente intervista (Pincus & Ferris, 1993), Nancy C. Andreasen, nuovo editor dell' American Journal of Psychiatry (AJP), ha ricordato come la proposta di adottare il metodo della blind review, cioè della revisione degli articoli inviati per la pubblicazione da parte di referee ai quali non viene reso noto il nome degli autori, venga riproposta ad ogni riunione del Comitato Direttivo dell'AJP. Finora, dice Andreasen, il Comitato si è sempre espresso in senso contrario, sostanzialmente per due motivi: il primo è che alcune Unità di Ricerca ed alcuni gruppi sono noti per essere più rigorosi di altri e questa «autorevolezza» è utile al referee per prendere una decisione; il secondo dipende dalla difficoltà di fare una review veramente blind, in quanto lo stile, la bibliografia e altri elementi spesso rendono possibile o addirittura facile l'identificazione degli autori del lavoro. Ciò non è giusto per quelli che invece non vengono identificati.

Il problema di assicurare una valutazione equilibrata e non distorta degli articoli inviati potrebbe più semplicemente essere risolto: a) facendo in modo che la revisione «in aperto» da parte dei referee sia fatta da persone non solo competenti, ma anche disinteressate, attendibili e note per la loro correttezza; b) garantendo ampia possibilità di accesso alla pubblicazione anche ai gruppi «minori» o agli autori che lavorano fuori dalle istituzioni più note, purché ovviamente i loro articoli soddisfino gli standard di qualità della rivista in questione. Il punto cruciale, dunque, è la scelta dei referee, scelta che spetta quasi sempre al direttore della rivista.

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 - To set out the author's views of the role of epidemiology in social psychiatry and to illustrate this role with reference to affective disorders. Method - Review of work carried out in two areas; the bearing of gender and of age on rates of affective disorder. Results - The use of sociodemographic categories to define high risk groups suggests that affective disorder may be related strongly to role satisfaction and that age may have a pathoplastic effect on the form of disorder that overrides all but the strongest social influences. Conclusions - Epidemiology is an essential tool of the social psychiatrist, but its main strength is in clarifying the nature of the questions to be asked and suggesting new lines of investigation.

Objective - The present study was conducted to determine the excess of mortality in long-term psychiatric inpatients. Setting - Psychiatric hospital, Bologna, Italy. Design – Retrospective study on a cohort of 264 chronic psychiatric inpatients, followed up for ten years since January 1981. Mortality measures were computed by psychiatric diagnosis, length of stay and «still resident at follow-up/discharged» condition. Main measures – Standardized mortality ratios were computed with reference to the mortality by age of the population resident in Bologna in the years 1981- 1991. Presence in the cohort was expressed in person/years. Results – The excess of deaths in the cohort was 2.89 (CI 95%: 2.12-3.86) for males and 2.38 (CI: 1.66-3.31) for females. A remarkable excess of deaths for both sexes was observed in the class of age 15/44 (18.33 for males, CI 9.14-32.81; 60 for females, CI: 21.91-130.6 ) and in association with a diagnosis of personality disorder/alcohol abuse (11.25 for males, CI: 5.13-21.36; 5 for females, CI: 1.35-12.8). Length of stay and age of patients were inversely associated with SMRs. Conclusion – The present study confirms that the excess of mortality is high in psychiatric long-term inpatients and that it may be concentrated in younger classes of age, first years after admission and in subjects with diagnoses of personality disorder/alcohol abuse.

Objective. - To test by means of ROC analysis the performance of the Symptom Questionnaire (SQ) of Kellner and Fava against an interview designed for making DSM-III diagnoses in 517 subjects. To analyse the trend of SQ scores at 3 months, 1 year and 2 years after the first interview in a sample of 112 persons. Design. - Cross-sectional and longitudinal analysis of the distributions of SQ scores in DSM-III cases and in non-cases. Setting. - General practice, hospital medical wards and emergency departments of Regione Emilia Romagna. Main outcome measures. - Symptom Questionnaire, Bech Mini-compendium to formulate DSM-III diagnoses. Results. - The SQ reached high sensitivity and specificity levels (80%, 76% in general practice, 86%, 74% in hospital medical wards, 83%, 85% in emergency departments with the cut-off scores of 24, 24 and 26, respectively). SQ scores show a similar trend in cases and in non-cases, with a significant drop at three months. Conclusions. - The SQ seems to be an adequate screening tool in the above-mentioned settings, but its length and the assistance sometimes needed during the compilation make its use in the emergency departments problematic.

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).

The characteristics of the area utilizying the service, the tipology and the organization of the psychiatric services in the Liguria region of Italy are described with the same methodology employed for four other locations in Italy where a psychiatric case register is operative. This information gathering system officially began in March 1987, when the Regional Council decided to entrust the organization of this project to the Institute of Applied Medical Services of the University of Pavia. The source of the data collected is represented by the psychiatric services facilities operating in the Liguria Region. These include 20 territorial Mental Health Services (SSM), 9 Psychiatric Units in General Hospitals (SPDC) and 2 ex-psychiatric hospitals (PSS). The psychiatric case register is compiled in all Psychiatric Services of the Region by collecting data on charts; futhermore, in 12 of the Mental Health Services, in 2 of the Psychiatric Units in General Hospitals and in the ex-psychiatric hospitals this information has also been computerized. Data collection began in 1988, and in the first regional verification of the functionality of this system took place the following year. Results regarding the utilization of territorial services reveal annual prevalence rates that range from 200-500 per 100.000 inhabitants. As far as interventions involving hospitalization are concerned, SPDC and PSS data were analyzed separately. This analysis confirmed the situation described in the literature, namely that there is an excess of diagnoses of psychosis, most of all among males admitted to Psychiatric Units in General Hospitals and females admitted to ex-psychiatric hospital. Age-specific grouping of these results further revealed that most of these patients are elderly, especially the women.