Objective – Starting from research on environmental factors that influence schizophrenia, the author speculates on innovations that could reduce the occurrence of the illness, improve its course and enhance the quality of life of sufferers and their relatives. Results – Ranging from education about obstetric risks to a stigma-reducing campaign, the suggestions could be of interest, not only to clinicians, but also to advocates, policy-makers and communications specialists. Conclusions – Several of the suggestions, which would be innovative in the United States, are already established features of Italian mental health care. These features include social enterprises, family support payments and a disability pension system without severe disincentives to work.

Objective – To provide a multidimensional description about the pattern of patients recovered in some Psychiatric Rehabilitation Sevices, as emerging from identification of similar groups regarded the total severity. Design and Setting – A cross-sectional survey has been conducted on patients recovered in 4 Northern-Italy Psychiatric Rehabilitation Services. A statistical bottom-up analysis (Principal Components and Cluster Analysis) has been performed. Main outcome measures – Any patient has been evaluated using a questionnaire with well-known rating scales (BPRS-psychiatric rating, Katx index and IADL index, IDS index of comorbidity) together with informations on sex, age, social and economic state, psychiatic history, therapeutic devices and staff involvement. Results – We analyzed 455 patients. 267 (58.7%) male and the mean age is 58.517.9. After statistical analysis, 4 clusters of patients has been found: the first group (106 patients) is younger, descrided as not seriuosly compromised, mostly with psychotic problems; the second (96 patients, most of them woman with diagnosis of demetia) is much older, with serious problems of indipendency and comorbidity. The third (82 patients) and fourth (171 patients) group show intermediate patterns. The level of care requested by these groups has been provided. Conclusions – Our results show the usefulness of sophisticated statistical methods to describe patients recovered in psychiatric rehabilitation services. Moreover, our findings could be useful as good proposal to the people involved in this field, planning an active intervention in this area.

Objective – To present three probabilistic models (Poisson, negative binomial, Waring) to analyze the distribution of the number of contacts of patients followed using a psychiatric case register. Design – Longitudinal to obtain the distribution of the number of contacts (during 91 days following that of the first contact) observed on patients followed using the South-Verona Psychiatric Case Register during the period 1/1/79-31/12/91. Results – There were a total number of 6913 contacts on 3454 subjects. The chi-square test for the goodness of fit yields a significant result both for the Poisson distribution (3580 with 6 degrees of freedom, p < 0.001) and for the negative binomial distribution (65.47 with 18 degrees of freedom, p < 0.001); on the other hand a non significant result was obtained for the Waring distribution (25.31 with 19 degrees of freedom, p = 0.151). Conclusions – The Poisson distribution gave a very poor fit for the distribution of contacts. The negative binomial distribution could be employed to analyze the pattern of contacts when the right tail of the distribution is not important. The Waring distribution is the best of the three presented. Moreover, the variance of the Waring distribution can be decomposed in three components: a random component, a component which accounts for endogenous factors and another component which accounts for esogenous factors. Therefore the Waring distribution is useful when one wants to make comparisons between psychiatric case registers of the same country or of different countries.

Objective – To assess the reliability and to describe the categories and the procedure to apply the VRMICS/P (Verona-Medical Interview Classification System/Patient). Setting – The interviews used for the reliability study were audio taped. Five general practitioners (GPs) working in two general practices in South-Verona recorded their consultations. Sample – 50 interviews selected randomly from 120, 10 for each GP. The selection criterion for the participating patients was a GHQ-12 score of 3 and the consultation for a new illness episode. Main outcome measures -The VR-MICS/P classifies patients' verbal behaviours into 21 categories, 15 of them are defined by form (cue or statement) and content. Procedure – Two trained raters classified 50 interviews. Before applying the classification system each interview is divided into units which are numbered to define doctor's and patient's sequence of speech. Results – The reliability of VR-MICS/P was satisfactory (Kappa 0.85). Similarity Index (Dice, 1945) for categories varied between 0.71 and 0.94. Reliability for form and content classification was satisfactory too (Similarity Index between 0.81 and 0.89 and between 0.84 and 0.94, respectively). Conclusions – The VR-MICS/P is a reliable measure for describing patients' verbal behaviours during medical interviews. It can be used together with the VR-MICS/D (Verona-Medical Interview Classification System/Doctor; Saltini et al., 1998) to describe the medical interview, the quality of doctor-patient interview and can be used as a measure of patient centredness.