Scielo RSS <![CDATA[The European Journal of Psychiatry]]> vol. 19 num. 1 lang. <![CDATA[SciELO Logo]]> <![CDATA[<b>Monitoring the quality of an Italian public psychiatric service</b>: <b>A four dimensions study of the outcome</b>]]> Objective: Within the concept of the outcome of hea1th services, the user's satisfaction has to be integrated by other more objective measures of health and quality of life. Debra Srebnik and coworkers have proposed a Survey for Monitoring the Quality of Public Mental Hea1th Services (SMQPMHS), which covers the following dimensions: Satisfaction, Functioning, Quality of Life and Clinica1 Status. The research main goals were as follows: a) to study the psychometric properties of the Ita1ian version of the Survey, and b) to study possible differences between the outcome of psychiatric patients applying to our outpatient facilities vs. the American sample. Methods: The Italian version of SMQPMHS was proposed to all patients receiving care at 2 Italian outpatient psychiatric facilities over a period of 2 months. 291 subjects accepted to participate in the study and fi1led in adequately the questionnaire. Results: Mean scores of the 13 variables of the Survey were very similar to those observed in the Arnerican sample. A matrix of correlations between each variable and each of the others indicated adequate internal consistency. A principal component analysis supported the four-dimensions model of the Survey. Patients recently hospitalized showed a poorer Clinical Status and a lower Satisfaction. Patients unemployed at the time of the survey showed a poorer Clinical Status. Conclusions: The Italian version of SMQPMHS showed good psychometric properties, even though concurrent validity needs further study. No differences emerged between the present sample and the American sample. <![CDATA[<b>Database use in psychiatric research</b>: <b>An international review</b>]]> Objective: Whilst database use for the purposes of audit is well established amongst clinicians, their research potential has yet to be fully realised. This review provides an international perspective on research using databases in psychiatry, considering the advantages and constraints of their use. Method: Large databases used in psychiatric research were identified through a systematic search of MEDLINE and EMBASE databases. The types of research conducted with these databases were then grouped into categories for discussion. A narrative synthesis of results is presented, illustrated with examples. Results: Research identified included pharmacoepidemiology, perinatal, aetiological, suicidology and health service research. Conclusions: Databases have been used to address a range of questions in psychiatry, often by employing linkage between clinical and national administrative databases. The success of such research is not only dependent on appropriate methodology and database design, but also on clinician commitment to data entry. Further exploitation of linkage potential between databases is envisaged, alongside international development of clinical databases designed with the purpose of research in mind. <![CDATA[<b>The <i>ZARADEMP Project</i> on the incidence, prevalence and  risk factors of dementia (and depression) in the elderly community</b>: <b>I. The context and the objectives</b>]]> Background and Objectives: The public health dimension of the problem of dementia and depression in the elderly population is well documented, but epidemiological data are generally considered to be insufficient and, at times, contradictory. This paper identifies relevant research areas for the ZARADEMP Project, which follows the Zaragoza Study (or ZARADEMP 0) and is part of both EURODEM and EURODEP Studies. Methods: Review of the literature. Hypotheses emerging in previous studies of this research group. Results: The following relevant objectives to study in relation to dementia (and depression) have been identified: a) potential variations over time in the prevalence rate; b) provision of reliable estimations of incidence rates, specific for age and gender; c) data about the course and natural history of so called "mild cognitive deficit"; d) association between hypothesized risk factors and cases of dementia (and depression) and its most frequent subtypes; and e) testing of hypotheses related to the overlap between dementia and depression and, specifically, to what extent depression has an increased risk for DAT. Other objectives of the study are also reviewed, in particular the cross-cultural comparison of findings in Zaragoza and in other European cities incorporated in both EURODEM and EURODEP Studies. The importance of maintaining good, contemporary methodological standards is emphasized. Conclusions: A number of relevant research areas in the epidemiology of both dementia and depression in the elderly have been identified. Case-control studies based on incident cases of dementia of the Alzheimer's type (DAT) to adequately assess risk factors seem particularly timely. <![CDATA[<b>The<i> ZARADEMP Project </i>on the incidence, prevalence and  risk factors of dementia (and depression) in the elderly community</b>: <b>II. Methods and first results</b>]]> Background: There is a pressing need to identify environmental risk factors of dementia and depression in the elderly. Aims: To describe the methods and first results of the ZARADEMP Project, the first psychiatric study to document risk factors in incident cases of dementia (and depression) in a Southern European elderly population. Method: A three-wave (baseline and two follow-up waves) epidemiological study to identify incident cases of dementia (and depression) was completed in a representative sample population. Valid Spanish versions of case-finding instruments, including the Geriatric Mental State (GMS) were administered by standardized researchers. The incident cases, diagnosed by a panel of psychiatrists using DSM-IV criteria, will be included in a case-control study. Results: Response rate was acceptable (63.6% in Wave I, 87'2% in Wave II and 85'8% in Wave III), and 4,803 individuals completed Wave I. Diagnostic agreement was achieved in 91.4% of probable cases presented to the panel, and a total of 146 incident cases of dementia were identified. Conclusions: We feel confident that modern epidemiological requirements have been fulfilled and the statistical power in the calculations of risk will be acceptable. <![CDATA[<b>The effect of rehabilitation of schizophrenic patients on their family atmosphere  and the emotional well-being of caregivers</b>]]> Background: In family members with a schizophrenic patient emotional problems, stressful situations, significant life changes are often observed. On the other hand rehabilitation of these patients is an integral part of their aftercare and community tenure. Aims: In this study the effect of the participation of schizophrenic patients in rehabilitation programmes, on the atmosphere of their families and the emotional well-being of their caregivers are examined. Method: Sixty six caregivers of patients in rehabilitation (group A) were compared with seventy caregivers of patients, not attending any rehabilitation programme (group B), in terms of their family atmosphere and emotional well-being, assessed by the Family Atmosphere Scale and the CES-D scale respectively. Results: The family atmosphere of the patients who were participating in a rehabilitation programme was found to be more positive (higher degree of patient's acceptance, autonomy and compliance as well as fewer economic problems) than that of their counterparts, not in rehabilitation. Group A caregivers were also found to exhibit less depressive symptomatology. Conclusions: It seems that psychosocial rehabilitation and its vanous therapeutic activities has a positive impact on several components of family atmosphere of the participating patients and the emotional status of their caregivers.