Objective – This article attempts to provide an overview of different methods of analysis of information on service utilization from different approaches. Methods – A systematic review of the studies of pattern of care is done. The analysis of pattern of care has been divided into three different approaches: cross-sectional, longitudinal and dynamic. Results – In cross-sectional studies, information on utilization is based on the total number of contacts with mental health services during a given period. In the second approach, called longitudinal, survival analysis is applied considering the interval of time between each contact. The third type of analysis, called here the «dynamic» approach, involves the application of mathematical models based on the Markov chain to analyse the probability of change from one type of contact to another. Conclusions – We emphasise the need for further studies designed to analyse data from psychiatric case registers with standardised models for mental health services utilization analysis.

Objective – The aim of this study is to evaluate the presence of triggering life-events for the onset of Obsessive–Compulsive Disorder in women (OCD). Design – Clinical controlled study. Setting – Service for depressive and anxiety disorders; Department of Neuroscience, Psichiatric Unit, University of Turin. Methods – The study compares twenthy-nine women with OCD (DSM-IV criteria) with twenthy–nine healthy control women matched for demographic features and with twenthy-ni– ne women with Bulimia Nervosa (DSM-IV criteria) matched for age, age at onset, education and marital status. All patients were assessed with the Clinical Structured Interview for DSMIII-R (SCID) and with the Interview for Recent Life Event by Paykel. Moreover, OCD patients were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and bulimic patients with the Eating Disorder Inventory (EDI). Results – The study demonstrates that the only specific life event that is significantly associated with the onset of OCD is “having a new born child” No significant differences in frequency and severity of stressing life events were found in the three groups. Conclusions – The results confirms the findings of our previous study: post partum is the only risk factor for the onset of OCD in female population, compared to healthy control. Furthermore, this research points-out the importance and the specificity of this association showing that post partum is not a risk factor in all psychiatric disorders.

Objective – This study aimed to describe: a) the interventions received by patients with schizophrenia attending Italian mental health services (MHS); b) the relatives' burden and social network and the professional support received by the families. Design – The study has been carried out in 30 MHS, randomly selected and stratified by geographic areas and population density. 25 patients with a DSM–IV diagnosis of schizophrenia and 25 relatives were recruited in each MHS. Family burden was evaluated in relation to: a) geographic area; b) interventions received by the patients; c) social and professional sup– port received by the families. Main outcome measures – a) patients: Brief Psychiatric Rating Scale (BPRS) and Disability Assessment Interview (AD); b) key-relatives: Family Problems Questionnaire (QPF) and Social Network Questionnaire (QRS); c) interventions received by the patients and their families: Scheda di Rilevazione degli Interventi – Pattern of Care Schedule (SRI). Results – Data on 709 patients and their key-relatives were collected. In the two months preceding the data collection, 35% of patients attended rehabilitative programmes; 80% of the families were in regular contact with the MHS and 8% received family psychoeducational interventions. Family burden was higher in Southern than in Central and Northern Italy. This difference disappeared when rehabilitative interventions and family support were provided. Conclusions – This study highlights that the situation of the families of patients with schizophrenia is more burdensome in Southern Italy and is greatly influenced by the type of interventions provided by the MHS.

Objective – Aim of the study was to investigate the psychometric properties of the Italian version of the Drug Attitude Inventory (DAI) by exploring its construct validity. Setting – 90 voluntary admitted patients with DSM III-R Schizophrenic (n.72) and Schizoaffective (n.18) disorders, age range between 18 and 50 years, treated with typical antipsychotics, able to participate in the study, were selected. Design – Exploratory factor analyses with alpha factoring and maximum–likelihood methods with Varimax Rotation were used to analyse DAI scores. Results – Extraction methods found 7 factors which explained 62.5% of the total variance. The first 2 factors could be labelled as “subjective response to treatment” construct and factors 3 to 7 as “attitude to medication” contruct. Conclusion – Although preliminarily, the Italian version of the DAI seems to maintain the original psychometric properties and it can be used easily to get a valid measurement of the patients' attitude to neuroleptic medication.

Objective – The aim of the study was to show, trough the calculation of the direct costs of supports and treatments actually provided by a NHS Mental Health Department, the presence of associations between four diagnostic groups (schizophrenia, affective psychosis, paranoia and neurotic disorders) and their overall and items (community care, rehabilitation facilities and in-patients services) costs. Setting – Mental Health Department and CSM “Scalo” (NHS Mental Centre), AUSL “Citta di Bologna”, Emilia-Romagna Region. Design – Yearly direct costs were calculated for a sample (n = 75) of all patients (N = 745) who during 365 days had more than four contacts with CSM and also for four randomised diagnostic groups (n = 30 per group). Main outcome measures – We calculated unit costs of 15 types of services provided by CSM, selected according to the yearly number of services provided and the time spent by each health professional, and the in patient-cost per all days spent in a public or private sector hospital for psychiatric care. Results – The statistic analysis, performed with the help of the Kruskal-Wallis test, showed significantly higher overall costs for the schizophrenic patients than the sample-group and the neurotic disorders-group; besides a significant difference in the item costs for rehabilitation facilities was found between the schizophrenic group and the paranoia, neurotic disorders groups and the sample one, whereas no significant differences in costs of inpatients services and drugs administration were tested between the groups. Conclusions – The results of our study allow to demonstrate that there are cost differences between the diagnosis (direct costs are highest for schizophrenic patients and lowest for those with neurotic disorders) and that the costs evaluation can be used to ensure appropriate provisions to Mental Health Department for support and treatment of a wide range of psychiatric disorders.

Admission to an Italian Forensic Hospital (OPG) results in formal exit from psychiatric care provided by NHS community based psychiatric services. The length of stay in such facilities is often perceived as a factor negatively affecting the opportunity for reintegration in the community. Method – Factors predicting length of stay in OPG were investigated by means of a survival analysis carried out on a cohort of 118 inmates of three OPGs (Castiglione delle Stiviere, Reggio Emilia and Montelupo Fiorentino), who represent the whole forensic population from 3 different geographical areas at 30.06.97; all discharges occurred in the following 18 months were examined. Results – In survival analyses conducted on individual predictors, five variables predicted a longer stay: type of offence (homicide: 706.6 weeks vs. 307.1 for minor offences and 194.7 for grievous bodily harm, log-rank =31.8, p >0.001), type of admission (RR=0.98, CI 95% 0.97-0.99, p>0.001), the diagnosis of schizophrenia (621.9 weeks vs. 398.9 weeks or less for other diagnoses; log rank=9.08, df=3, p=0.028), BPRS thought disturbance score (RR=0.89, CI 98% 0.81-0.98, p>0.01), hospital of stay (314.6 weeks in Montelupo Fiorentino vs. 706.6 for Reggio Emilia and 621.9 for Castiglione delle Stiviere; log-rank = 9.64, df=2, p>0.001). In a Cox linear regression model three significant factors were selected: type of offence, type of admission, diagnosis of schizophrenia. Conclusions – Judicial factors are relevant in determining the length of stay in OPG. The diagnosis of schizophrenia seems to play an independent role in predicting a longer stay.