Objective – The project Output Standards of the Mental Health Department (MHD) of Reggio Emilia is set out to define outputs and quality standards and to guarantee transparence and to facilitate organizational improvement. Methods – The MHD started an interprofessional working group that defined theMHD outputs as long as process, quality peculiarities, indicators and standards for each output. The MHD Director validated the group results. Results – The MHD defined 9 outputs and its indicators and standardsand consequently modified its data registration system, the way to supply free and partially charged servicesand budget indicators. As a result, a new instrument for management and quality control has been provided. Conclusions – The A. maintains that to define outputs, indicators and standards will allow to compare several services of the Department, get them omogeneous and guarantee and improve quality.

Objective — The analysis aims to study patterns of care of patients in contact with 5 Psychiatric Services in Lombardy. Four patterns have been identified :long term-high users, non long term-high users, long term-non high users, non long term- non high users. Design — Data were provided by the regional Psychiatric Information System. The cohort of patients have been composed by 5,670 patients included in 1994 one year prevalence. Setting — Five Psychiatric Services (Merate, Treviglio, Crema, Desio, Castano Primo) with a total population of 610,184 inhabitants aged over 14. Main utilised measures — Some sociodemographic and clinical variables have been taken into consideration for a descriptive analysis; a multinomial logistic regression model was used to identify the characteristics of patients associated with different patterns. Results — Long term-high users were 5.3%, i.e. a mean rate of 4.9/10,000 residents over 14, and absorbed 60% of resources; the absence of a partner was associated in regression analysis with this pattern. Non long term-high users were 1.2%, i.e. a mean rate of 1.1/10,000 residents over 14, and absorbed 7.8% of resources; age below 45, unemployment, absence of a partner, severe mental illness and first contact with Psychiatric Services in the period 1985-1989 were predictive variables. Long term-non high users were 23.4%, i.e. a mean rate of 21.6/10,000 residents over 14, and absorbed 18.1% of resources; age below 45, unemployment, living alone, absence of a partner, severe mental illness and first contact with Psychiatric Services before 1990 were predictive variables. Non long term-non high users were 70.1%, i.e. a mean rate of 64.8/10,000 residents over 14 and, and absorbed 18.1% of resources. Conclusions — Data show that on the whole the activity of Psychiatric Services is addressed to most serious patients, though considerable differences between Psychiatric Services utilisation may be found. This study highlights the importance of a regional Psychiatric Information System, that allows the monitoring in time and in the regional territory of patterns of care.

Improving access and rational use of essential medicines at all levels of care is a global challenge. Key issues related to the provision and rational use of psychotropic medicines have recently been analysed by Padmanathan et al. who conducted a survey of the psychotropic medicines management cycle in Bihar, the third most populous state of India with approximately 104 million people, of whom 88.7% live in rural areas. It was found that availability, distance and cost were the main barriers to access and utilisation. Travelling was reported to be particularly problematic because it is expensive and may also be unfeasible for service users who are acutely ill. In this commentary, the results of this survey are discussed in view of their global policy implications for low-resource settings.

There is now growing evidence to suggest that the experience of psychosis may be so traumatic for some that it can lead to Post Traumatic Stress Disorder (PTSD)-type symptoms or post-psychotic trauma symptoms (PPTS). There is, however, less knowledge about what psychological interventions may be helpful in reducing these symptoms. Evidence from the literature, to date, suggests that of the seven studies that have addressed this issue only four were randomized controlled trials (RCTs). However, all these studies included less than 100 patients with the vast majority reporting positive results. Overall, it seems that although cognitive-behavioural treatment (CBT)-based psychological interventions appear to be efficacious in the treatment of PPTS, the studies are too small to draw any firm conclusions and should be subjected to larger good-quality RCTs. Further research will also need to establish the role of mediating variables such as shame and depression in the treatment of PPTS.

Patients experiencing psychoses and in need of antipsychotic agents may be exposed to a higher risk of myocardial infarction (MI) than the general population. As there have been no randomised studies investigating this association, a recent systematic review and meta-analysis included all observational studies that compared the incidence of MI among patients receiving antipsychotics v. no treatment. It found nine studies and calculated that the odds (risk) for developing MI were 1.88-fold higher in antipsychotic users compared with individuals who had not taken antipsychotic drugs. In this commentary, the results of this systematic review are discussed in view of their clinical implications for everyday clinical practice.

Aims – Characteristics of patients living in residential care facilities and the availability of mental hospital- and residential beds in Italy and The Netherlands were compared to assess whether differences in the process of deinstitutionalisation have influenced the composition of their residential patient populations. Methods – Data from the Dutch UTOPIA-study (UTilization & Outcome of Patients In the Association of Dutch residential care providers) and the Italian PROGRES-study were used. Results – Dutch residents were more likely to suffer from substance or alcohol abuse than Italian residents. The latter were more likely to suffer from schizophrenia or a related disorder, less likely to have experienced mental hospital admissions and showed an overall shorter duration of stay in residential care facilities. Contrary to our expectations Dutch residents, who still have good access to long stay beds in mental hospitals, are not less disabled than Italian residents. Finally, the number of beds in residential care facilities per 10,000 inhabitants in the Netherlands is twice (6) as high as in Italy (3). Conclusions – The Italian and Dutch deinstitutionalisation processes have resulted in a different availability in the number of residential beds. However, it did not influence the overall level of functioning of both residential populations.

Declaration of interest: An unconditional grant was received from the Alliance of the 22 Dutch independent residential care providers.

The author offers a perspective on the perceived conflicts of interest that influence scientific collaborations between academic psychiatry and the pharmaceutical industry. The author holds the position that the merits of a particular study should be judged based on the quality of the scientific methodology rather than on the credentials of the investigators or the source of funding.

Objective – The aim of the study was to investigate the attitudes in the decision making process for admitting patients compulsorily under the Italian Law 180/78. Setting – A group of psychiatrists (n=81) working in the area of Cagliari (Sardinia, Italy). Main outcome measures – Three case–vignettes describing different hypothetical clinical situations: 1) a man with depression and psychotic symptoms; 2) a woman with a possible first episode of psychosis; and 3) a man with a history of substance abuse and bipolar disorder. Each vignette was followed by a list of 11 factors reported in the literature as important in the decision to admit compulsorily (current mental state, severity of the disease, dangerousness to self or others, psychiatric history, likely response of the mental state to the medical treatment, age and gender of the patient, owning a home, occupational status, social support available). Psychiatrists were asked: a) whether they would admit the patient compulsorily; and b) to rate 11 factors from the most to the least important in their decision.

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.

Objective – Epidemiological and clinical studies indicate that 10–50% of primary care patients suffering from clinically relevant psychiatric distress are not diagnosed by their physician and only a minority of them receive an appropriate treatment. The improvement of physicians' ability to detect mental distress and psychiatric disorder, in their routine clinical activity, represents a crucial point to reduce the social impact of mental illnesses, prevent their worsening and chronicity and, eventually, relieve mental health services of an excessive burden of care and costs. The aim of this article is to examine a number of factors which intervene in the process of detection of mental distress by the physician. Then, we will examine factors related to the management of psychiatric disorders most commonly co-occurring with physical illness in general health care sector. Method – The method used for this review was essentially a recension of the literature concerning detection and treatment of psychiatric disorders in primary care settings, having in view to see the factors connected with these processes. Results – Among factors intervening in the process of identification of mental distress in primary care settings, both the characteristics of the physician and the characteristics of the patient should be taken into account. Primary care physicians and psychiatrists are being asked to work together more frequently in this era of community care. The principal aim of such invoked collaboration is the amelioration of quality of care and reduction of costs for mentally ill patients. An important issue within this collaboration is the referral by primary care physicians to specialist services.