Objective - assessment of the burden perceived by a sample of key-relatives of schizophrenic patients. Design - Observational study of key-relatives of patients with a PSE-CATEGO diagnosis of active paranoid schizophrenia. Assessment of possible correlations between the family burden, the patients' symptoms and disabilities, as well as the relatives attitude of overinvolvement and criticism. Setting - Inpatient and outpatient psychiatric units of the Department of Psychiatry of the First Medical School, University of Naples. Subjects - 25 patients, with a diagnosis of active paranoid schizophrenia, according to ICD-9 diagnostic criteria, minimun illness history 1 year, at least one previous admission, living with at least one adult relative. Main outcome measures - Standardized assessment of patients clinical status and social disability and of relatives clinical status attitude and perceived burden. Results - The burden, both objective and subjective, was found to be present to a marked or very marked degree in more than 50% of the inteviewed relatives. A marked effect of the patients illness was observed especially on relatives social contacts and leisure activities. Also the attitudes of criticism and overinvolvement were detected in the great majority of the relatives. 52% of the relatives, when assessed by the PSE-9, received a psychiatric diagnosis. The objective burden was found to be associated with some «negative» symptoms and deficits of social functioning in the patients. Finally, significant correlations were observed between the objective and subjective dimensions of the burden and the relatives attitudes of hypercriticism toward the patients. Conclusions - The present study seems to be relevant both from the epidemiological point of view and for psychiatric care planning.

Objective - Assessment of the «duration» of interventions in community services, or rather, of the time between subsequent contacts in community psychiatric services in Lombardy in 1990. The Authors relate the «duration» either to the different professional positions and to some variables, like resources and activities, obtained by the Regional Psychiatric Information System. Design - Descriptive analysis of data stored in the computerized database of the Regional Psychiatric Information System. The «duration» has been calculated on the basis of the ratio between working hours delivered by community services and the number of contacts provided in 1990. After trimming the observations, the «duration» has been related to other variables such as structure, staff and activities. Setting - 52 Regional Psychiatric Unit in Lombardy whose catchment area includes 99 Local Sanitary Districts (USSL) for a total population of 7.600.000 inhabitants. Results - A strong variability of «duration» has come out in differents USSL and for different professional competences. The «duration» is reduced by the increase of patients admitted to the Service, by the number of interventions and by the number of rooms available in the Unit. On the other hand, considering the working hours as a variable, the relation is not linear. Conclusion - Even though this index doesn't concern the quality of interventions, it can represent an useful starting point to evaluate community services. The «duration» seems to be an useful quantitative index to delineate the efficiency of services or rather the capability to provide interventions, saving resources or to deliver as many interventions as possible with such resources.

Objective - To investigate the rate of DSM-IIIR main affective disorders in a sample (52) of elderly medical patients consecutively admitted to a geriatric ward; to look for risk factors associated with depression; to compare the rate of depression with the one detected in community controls (117 subjects). Design - All consecutive patients admitted during January-February 1990 were assessed with a standardized psychiatric interview (Geriatric Mental State Examination) and with the Mini-Mental State Examination. Setting - The IV Geriatric Division (ward and day-hospital), Ospedale Civile Maggiore of Verona, which cares for elderly affected by medical illnesses. Main outcome measures - Depression was diagnosed according to the main DSM-IIIR categories for mood disorders. Results - Overall, an affective disorder was diagnose in 25% of the subjects (major depression 5,7%, dysthymic disorder 3,8%, n.o.s. depression 13,4%, adjustment disorder with depressive mood 1,9%). This rate was significantly higher when compared with the prevalence detected in community controls (25% vs. 11,1%). Older age, female sex, physical disability and distressing events were not associated with affective illness, while the lack of social support was significantly associated with depression. Conclusions - Elderly medical patients turned out to be an high risk group for depression, which deserves psychiatric screening and specific treatment.

Objective and Setting - The mortality of patients admitted to the General Hospital Psychiatric Ward of Pavia, Italy was studied for the period 1.1.1986-31.12.1991. Main outcome measures - Mortality was assessed using the standardized mortality ratio. The number of observed deaths was compared by sex, age group and cause of death with the number of expected deaths if the general population mortality of the same area were applied to our sample. Results - The result of this comparison was that the mortality through inpatients was three times higher than that of the general population. This overmortality has been observed with respect to natural causes of death as well as to unnatural causes. Particularly deaths from circulatory diseases, mental disorders and deaths by injuries and poisoning are overrepresented in both sexes.

Objective - To collect data on the interface between general practice and psychiatry in Southern Italy and to shed light on attitudes, opinions and behaviours of general practitioners regarding psychological/psychiatric problems. Design - Postal questionnaire survey on the management of patients with psychological/psychiatric problems and on its correlation with demographic and other professional characteristics of the partecipant physicians. Setting - General practices in Bari (a Southern Italy's town). Main outcome measures - Comparison between responders and total population using chi-square test and percentages of answers to the different questions. Results - 20% of practition- ers returned the questionnaire, with a significantly higher number of those who specialized than in the total population. Training activities in psychiatry, demanded by 94% of the sample practitioners, are quite regularly pursued by no more than 13% of them actually. 56% report a 10-30% psychiatric morbility in their practices. Only 19% do agree to regard law 180 as «a real advancement in psychiatric care». 53% use to refer to the pychiatrist less than 10% of their psychiatric patients (60% of these showing anxious-depressive symptoms). 25% of psychosomatic disorders are prescribed an antispasmodic drug while «cerebroactive» and «tonic» (non-specific) compounds are respectively used in 75 and 23% of cases of psychic fatigue and poor cognitive performance. Conclusions - The data obtained may be not easily applied to the general source population due to the low percentage of responders. According to the sample, the perception of the difficulties in the management of psychic disturbances (which are still very common in the everyday practice), the demand for larger opportunities of specific training and of co-operation with psychiatrists (differently from the presently poor interaction) and the need of a greater rationalization of pharmacological treatments seem worth being underlined.