The management of affective disorders in the community

Using two systems which routinely record information about the management of psychiatric disorders in the community (a drug prescription monitoring system and a psychiatric case register), a parallel study was conducted in South Verona on antidepressant prescriptions written by general practitioners (GPs) and on contacts for affective disorders with specialized psychiatric services, in 1983 and 1984. The extent of patient contact for affective disorders was approximately ten times greater at the GP level (in one year about 150 antidepressant prescriptions per 1000 adult inhabitants) than at the out-patient/community psychiatric service level. Similarly, the extent of patient contact at the latter level was approximately ten times greater than at the in-patient level. Patients with a diagnosis of affective disorder accounted for about 20% of the total number of patients contacting the specialized services in one year. The proportions of patients admitted to hospital, among those in contact with these services and assigned a diagnosis of depressive neurosis or a diagnosis of affective psychosis, were 34 and 33% (in 1983 and 1984) and 49 and 50% (in 1983 and 1984), respectively. There was a clear correspondence between monthly fluctuations in the extent of care for affective disorders provided at the two levels in 1984, but not in 1983.