Identifying the burden of care on relatives of the mentally ill remains an integral part of research in community psychiatric services. The present study aimed to assess the level and extent of burden on relatives in South Verona (northeast Italy). The South Verona catchment area provides a comprehensive, community-based psychiatric service with minimal reliance on the hospital. Patients were selected from the South Verona Psychiatric Case Register and 40 of their relatives were interviewed using structured assessments measuring objective burden, patient behaviour, coping strategies, satisfaction and needs for services. Both positive and negative aspects of burden were apparent, 92% of relatives continued to maintain contact with friends/relatives, 72% had no change to their family income, and 52% could manage any household disruptions during a crisis. The main negative effects for relatives included reduced leisure activities (57%) and psychological problems (67%). The greatest burden was on relatives of patients who were male (P = 0.016), unemployed (P = 0.013) and diagnosed with psychosis (P = 0.041). The implications of employment for patients and its association with lower levels of caregiver burden are discussed.

Objective – The analysis aims to identify the main patterns of Psychiatric Services provided by Local Health Unities in Lombardy. Setting – Data were collected by regional psychiatric information system in Lombardy in 1992 and 1993, concerning resources and activity. Design – We developed Cluster Analysis based on previously selected indicators of facilities, staff and activity. Multivariate analisys was performed in order to eliminate redundancy of information. Results – Five clusters corresponding to different patterns of psychiatric services were identified. In the first cluster services are particularly concerned with admissions (in private hospital, as well); other community activities can be considered quite dull both in composition of teams and variety of therapy. In the unities of the second cluster we pointed out low rates of community activities (mainly inside and hardly diversified) and admissions as well. The third cluster is distingueshed by an intensive community activity (both in quantity and variety) and turning to private sector for admissions, maybe because of a lack of rehabilitative facilities. Unities belonging to the fourth cluster have got many structures and a lot of staff dedicated to the hospital activity and to a intense (but little diversified) community activity. In the fifth cluster psychiatric services have got many rehabilitative facilities and community staff are well diversified; the considerable (but little diversified) community activity is carried outside. Conclusions – The community psychiatric services in Lombardy are not homogeneous and it is possible to identify five different and well definied patterns. The cluster analisys is useful to follow up the model, using information system data.

Aims – To date only a few studies investigated the clinical reasons supporting and explaining non-classical antipsychotic prescriptions. The present study was carried out to develop concepts which help understand this phenomenon in a natural setting, giving emphasis to views of clinicians according to quali – quantitative research methodologies. Subjects – From the South-Verona Psychiatric Case Register all antipsychotic prescriptions issued during 2005 were extracted. Concurrent prescribing of two or more antipsychotics, prescribing antipsychotic drugs outside the licensed indications, and outside the licensed ranges of doses reported in the Italian National Formulary, were considered non-classical prescriptions. Reasons for non-classical prescriptions were collected by means of brainstorming sessions with clinicians. Non-classical prescriptions and the corresponding reasons were grouped according to whether they were “clinically sound” or “clinically not sound”. Results – During 2005 a total of 259 patients received 376 non-classical prescriptions. The most frequently reported reasons for non-classical prescribing were that prescriptions were inherited from another clinician with or without benefit, and that prescriptions were motivated by the need of reducing psychotic symptoms. More than 60% of these non-classical prescriptions were categorised as “clinically sound”. Clinically not sound prescriptions were related with negative clinicians’ views and opinions about the patient/clinician relationship. Conclusion – Clinically not sound prescriptions appeared just a reflection of a problematic doctor/patient relationship, where no individual treatment plan existed and psychiatric visits had the only goal of monitoring ongoing prescriptions.

Declaration of Interest: This study received no funding. We have no conflicts of interest.