Inter-rater reliability of the Disability Assessment Schedule (DAS, version II). An Italian study.

The paper describes a reliability study conducted on the Italian version of the Disability Assessment Schedule (DAS II). Thirty patients were included in the study. They were drawn from those who contacted the South-Verona Community Psychiatric Service. Each patient was assessed by two raters who were assigned to the roles of interviewer and observer in a balanced, randomized way. Several statistical indices of reliability were calculated for the interviewer-observer comparison. The interview showed an overall good reliability. The lowest values were found for those items where the social and cultural expectations on "normal behaviour" are more variable. Section 3 of the DAS was considered in general not applicable, and the authors opinion is that it should be reconsidered for its use in the Italian situation.

Service utilisation, social support and psychiatric status in a cohort of patients with schizophrenic psychoses. A 7 year follow-up study.

All persons (n = 60) who contacted the South-Verona Psychiatric Case Register in 1979 and received an ICD-9 diagnosis of 'schizophrenia or other functional non-affective psychosis' were traced in 1986. 41 patients (17 males, 24 females) living in the community were assessed on a number of measures of psychopathology, social functioning, social support and service use. There were two major types of contact during the follow-up period: long-term but not high use (n = 9); and neither long-term nor high use (n = 16). In addition, ten patients were out of contact and six were outside the catchment area. Social support was highly variable, but overall negative and positive factors were evenly balanced. Symptomatology and social functioning were largely unrelated to service use, but significantly and negatively correlated with social support (i.e., the greater the level of social support, the higher the level of functioning). Social support was unrelated to patterns of contact, but was negatively correlated with measures of service utilization (i.e., the greater the level of social support, the lower the dependency on hospital inpatient care). These findings point to the need for developing community-based mental health services which maintain and enhance the protective effect of the patient's social support network.

Hospital admission as first-contact with a community-based psychiatric service. A 2 year study in South-Verona.

The aim of this study was to understand the decision to hospitalize at the first contact, rather than utilize the other services of a community-based system of care. Using the South Verona Psychiatric Case Register, 46 first-contact patients admitted to hospital were compared to all other in-patients (n = 187) over a 2-year span with respect to socio-demographic characteristics, diagnosis (ICD-9) and symptoms (on the Present State Examination Syndrome Check List). Results suggested that first-contact hospitalized patients have significantly more neurotic depressive features. Alternatives to admission were investigated in only about one-third of depressive neurosis patients, compared to two-thirds of patients with other affective disorder diagnoses. In contrast, for patients with psychoses, admission is a second choice (except for patients with organic psychoses).