Archives 1992-2013

2005, volume 14, issue 2

Symposium

Occupational burnout

Marta Anczewska, Piotr Świtaj, JOANNA ROSZCZYŃSKA
Postępy Psychiatrii i Neurologii 2005; 14 (2): 67-77

Objectives. To present an overview including the history and definitions of the burnout syndrome, current views on theoretical models of this phenomenon, its dynamics and structure, as well as its prevalence and methods of measurement.

Review. Professional helpers employed in the so-called social services, using social skills as the main tool in their work, are at risk for job stress and symptoms of the burnout syndrome. The syndrome manifests itself by emotional exhaustion, instrumental attitude towards one 's partners in the interaction at workplace, and a tendency to negatively evaluate one 's own work, professional skills and achievements.

Conclusions. Thefocus on the burnout syndrome is not only of cognitive value, but also is likely to draw attention to its detrimental effects on the individual, the employing organization and the society. Moreover, possibilities of burnout prevention are expected to emerge from the research into this problem.

Symposium

Occupational burnout, or about

ANNA KAROŃ-OSTROWSKA
Postępy Psychiatrii i Neurologii 2005; 14 (2): 79-82

Background. Occupational burnout is discussed in the paper as an existential problem, on the grounds of works of two eminent humanists - a philosopher and a psychiatrist.

Review. Józef Tischner, a priest and professor of philosophy, in his philosophical analyses dealt with the individual, his fears and pain, with human hope, freedom and dignity - in the subject's encounter with another human being. Professor Antoni Kępiński, his bosom friend, was a "master in describing human experience ". A special attention was drawn to the problem of "being lost in the relationship with self and the world", and to "losing hope and withdrawing into fear".

Symposium

Theses about transcendence, metaphysics and subjectivity

WIERA PARADOWSKA, RYSZARD PARADOWSKI
Postępy Psychiatrii i Neurologii 2005; 14 (2): 83-85

Background. The paper presents a metaphysical perspective for understanding the reasons of occupational burnout, with a particular emphasis on the concept of subjectivity.

Review. The third element of existence is commonly called transcendence - i.e. something that transgresses, or goes beyond. According to philosophy, transcendence is neither God's domain, nor the domain of a single human being that strives for his/her needs and goals. The only thing any man can be sure of is: "I exist, but there also exists something that is not myself". From the viewpoint of metaphysics a choice is possible consisting in mutual recognition ofsubjectivity, mutual recognition by selfand non-self that the two are mutually equivalent, being at the same time something more than usable objects.

Symposium

Forms ofpatients' violent behaviour vs. occupational burnout in the staff ofpsychiatric services

MAGDALENA SARIUSZ-SKĄPSKA
Postępy Psychiatrii i Neurologii 2005; 14 (2): 67-77

Background. On the grounds of the current literature and reported research findings an overview is presented of factors conductive to patients' aggression, and of various forms of their violent behaviour.

Review. Multiple factors determining violent behaviour ofpsychiatric patients have held broad interest of researchers and clinicians for many years. Both verbal and physical violence as an infringement of human and worker 's rights, as well as the risk of being exposed to such violence are included among the most powerful factors making one 's workplace unhealthy and repulsive. Aggression and violence in psychiatry are a controversial issue, as it is more and more often emphasised that besides dangerous behaviours ofsome patients, organisational errors are at fault. On the other hand, violence experienced in psychiatry is regarded as an "occupational risk", said to be "always the way" in this sort of work. Immediate and long-term effects of patients' violent behaviour on the staff ofpsychiatric care facilities are discussed.

Conclusion. The problem of "triggering" violent behaviours in psychiatric facilities requires utmost attention.

Symposium

Cognitive appraisal and competence as determinants of burnout in helping professions

HELENA SĘK
Postępy Psychiatrii i Neurologii 2005; 14 (2): 93-98

Background. A model approach to burnout presented in the paper may be useful in preventing the phenomenon.

Review. In social services where the quality of professional interaction with the client, patient, student, etc. determines the level of professional help, it is this very aspect that simultaneously decides about a high degree of burdening with the occupational role requirements. Occupational stress, job stress, and the stress of a specific interaction may result in a burnout phenomenon. Helping is tiresome and with time may lead in some people to a set ofsymptoms including psychophysical and emotional exhaustion, distancing up to the feelings of depersonalisation and cynicism, as well as to a decreased job satisfaction and underrating of one's professional achievements. This may be called also a syndrome of maladjustment to job stress under conditions of insufficient competence for coping with the burden of work and a lack of organisational or social resources. In the cognitive-competence model of burnout an emphasis is laid on the subjective appraisal of the experienced job stress, and of one's resources in coping with the job requirements. Research findings indicate that it is this perceived lack of competence that is pivotal for the burnout syndrome. Interventions aimed at raising awareness of this occupational hazard do not reduce by themselves the risk of burnout.

Conclusions. The work on raising awareness of one's motivation and professional goals is most important, as same as the training of professional competencies and coping skills, or instilling a belief that the risk of burnout can be prevented in early stages of the syndrome development. At the time of particular systemic difficulties assistance in improving the system of care delivery and job organisation in these professions plays also a significant role.

Original article

Hospitalization dynamics in patients with affective disorders in the years 1997-2001

Ludmiła Boguszewska, Walentyna Szirkowiec, Elżbieta Słupczyńska-Kossobudzka
Postępy Psychiatrii i Neurologii 2005; 14 (2): 107-99

Objectives. To estimate the dynamics of hospital admissions for affective disorders in various socio-demographic fractions.

Methods. Differences were analyzed between the years 1997 and 2001 in the total number of admissions, and in the number of first admissions by the diagnostic categories of affective disorders. Three independent variables were taken into account: age, sex, and place of residence (urban v. rural area). Comparisons were made using two rates: the number of patients per 100.000 of either general population, or population with characteristics under study.

Results. In the years 1997-2001 the frequency of hospital admissions has increased by 39%, with a similar rate for the first admissions. The most frequent causes of hospitalization were recurrent depressive disorders and depressive episodes. The highest hospitalization rates were noted in the 45-45 age range. Women were hospitalized twice as often as men. While inhabitants of urban areas were more frequently hospitalized than those living in rural areas, the difference disappeared in the 45-54 age group. During the 5-year period under study the highest increment in the number of hospital admissions was found in the group aged 45-54, being higher among women as compared to men, and among urban area dwellers as compared to inhabitants of rural areas.

Conclusions. The largest increment in the number of hospital admissions was noted in the categories of depressive episodes and recurrent depressive disorders, especially severe.

Original article

Cognitive processes in evaluation of speed and efficacy of antidepressant treatment in depression

STANISŁAW PUŻYŃSKI, Iwona Koszewska, EWA HABRA, SŁAWOMIR FORNAL, Dorota Bzinkowska, DOROTA GRĄDZKA, Antoni Kalinowski, JUSTYNA MORAWIEC-PILIPIUK, Barbara Remberk, Łukasz Święcicki, Jarosław Torbiński
Postępy Psychiatrii i Neurologii 2005; 14 (2): 107-113

Objectives. The speed of action of antidepressants was assessed in terms of their effect on cognitive processes and clinical symptoms of the depressive syndrome.

Methods. 43 patients diagnosed with depressive syndrome in the course of affective disorder were examined during antidepressant treatment. The psychological evaluation included the Vienna Battery Tests (simple reaction time, RT with choice, tests for alertness and perseveration). The patients' clinical state was assessed using the MADRS scale. In the sample under study 8 patients were identified who responded well to treatment on the 28th day of therapy, as well as subgroups receiving I or II generation antidepressants.

Results. No significant improvement of cognitive processes was found in the course ofpharmacotherapy of depression between treatment days 0 and 28. A significant reduction in depressive symptoms severity as measured by the MADRS scale was not associated with a significant improvement of cognitive processes measured using the Vienna Test Battery. Changes of cognitive functions were not an early predictor of pharmacological treatment efficacy. Negative correlation was found on day 21st between the MADRS scores and performance on the reaction time tests in the group ofpatients who demonstrated a significant improvement of their clinical state on 28th day of treatment. Lack of improvement during the first three weeks of treatment (as measured by MADRS scores) does not preclude an improvement on day 28th of therapy.

Conclusions. The psychological tests used to assess improvement of cognitive processes in the course of pharmacotherapy of depression during the first four weeks of treatment turned out to be insufficiently sensitive. Classical antidepressants did not differ from the new generation pharmaceuticals as regards their effect on cognitive processes.

Original article

Subjective body image and sexuality in women with eating disorders

ANNA SAROL-KULKA, ZENON KULKA
Postępy Psychiatrii i Neurologii 2005; 14 (2): 107-115

Objectives. The aim of the reported study was to investigate the relationship between subjective body image and sexuality in women with eating disorders.

Methods. Participants in the study were 100 women: 50 with anorexia and 50 with bulimia treated in the Department of Neurotic Disorders in Warsaw, in the Clinic and Centerfor Treatment of Neurotic Disorders in Cracow, and in the Centerfor Treatment of Eating Disorders in Gliwice. They were examined using a Sexological Inventory (HRK) and Sexological Questionnaire (to assess sexuality and body image), Eating Disorders Inventory (EDI), and a clinical questionnaire to measure eating disorders.

Results. Women with anorexia more often assessed their body as totally unattractive than did those with bulimia. An analysis of correlations between body image variables and various aspects ofsexuality revealed the following relationships: anorectic women who did not accept their body had theirfirst kiss at an older age, less often had erotic dreams, started to be interested in the opposite sex and fell in love at a later age, less frequently had sexual contacts, and more often perceived negative aspects of their sexuality On the other hand, bulimic women who did not accept their body had less numerous relationships with men, less often experienced a needfor sexual contact and had sexual fantasies, more frequently experienced no excitation during sexual contacts, and after the intercourse felt tense or were angry with their partner.

Conclusions. (1) Negative body image in women with anorexia inhibited their sexuality more than was the case with bulimic women; (2) Negative appraisal of their own body resulted in a negation of their sexuality in anorectic women, and reduced libido in those with bulimia.

Original article

Plasma levels of Aß peptides in patients with sporadic Alzheimer's disease or mild cognitive impairment

Tomasz Sobów, Marcin Flirski, Paweł P. Liberski, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2005; 14 (2): 107-123

Background. Studies investigating plasma Aß levels in patients with sporadic Alzheimer's disease (AD) yielded discrepant results. Some authors reported no difference between plasma concentrations of Aß1-42 and Aß1-40 in sporadic cases of AD as compared to controls, while others found increased levels of Aß1-42 in at least some AD patients. The results of several recent studies suggest that elevated plasma Aß1-42 levels may be detected several years before the onset of symptoms, though the value of that effect in predicting progression to dementia in subjects with mild cognitive impairment (MCI) is unknown. Finally, it has been proposed that plasma Aß levels increase merely with age and are neither sensitive to nor specific for AD or MCI.

Method. Plasma levels of Aß1-40 and Aß1-42 were measured in 54 AD patients, 39 MCI subjects and 35 controls using a commercially available ELISA.

Results. Mean plasma Aß1-42 levels were significantly higher in the MCI group as compared to both AD patients (p<0.001) and controls (p<0.001). Levels of Aß1-40 did not differ between the groups. In contradistinction to some earlier reports no correlations were noted between Aß species levels and either age or MMSE scores. Employing the ROC curve analysis we found that the maximum accuracy in discriminating MCI subjects from both controls and AD subjects was achieved using the cut-off value of 3.8.

Conclusions. Although mean plasma levels of Aß peptides differentiate between AD, MCI and control subjects, their usefulness in differential diagnosis of AD is doubtful. Further studies are needed to establish the value of Aß levels in identifying patients with mild cognitive impairment and (possibly) in predicting their progression to clinically overt AD.

Review article

Violence in the male-female relationship

Marta Makara-Studzińska, Anna Grzywa, RENATA TUREK
Postępy Psychiatrii i Neurologii 2005; 14 (2): 131-136

Objectives. An analysis of available data on violence in the man-woman relationship and outlining the real picture, causes and consequences of intimate partner violence.

Review. Violence in close relationships termed in the English language literature on the subject "intimatepartner violence " occurs in every social class, in all cultures, all over the world. Men as often as women are perpetrators or victims. Women much more often than men experience physical violence from their partners and not infrequently are victims of systematic, long-term persecution. Women use mostly verbal violence towards their partners, shouting and hurling abuse, but resort to physical violence in self-defense only. It is not true that men are aggressive and women helpless. It should be remembered though that consequences of violence experienced by women are more severe - they more often sustain physical trauma and need medical help. Women also more often develop depression and have mental health problems.

Conclusions. Violence in various forms is used by both sexes, but more often is abused by men. Little is known about the phenomenon offemale violence, this issue requires further study. Efficient implementation ofpreventive measures may help to reduce the scope of this problem, and may reveal its undisclosed "dark" side.

Review article

Stigma of mental illness

Piotr Świtaj
Postępy Psychiatrii i Neurologii 2005; 14 (2): 131-136

Objective. The problem of social stigmatization of the mentally ill is characterized in the paper.

Review. The basic theoretical assumptions of the stigmatization concept originating from the work by Erving Goffman, as well as their contemporary developments are presented in the paper. An emphasis was laid on the most comprehensive approach proposed by Link et al.. According to the authors, stigmatization can be recognized if there is a concurrence of labeling, stereotypy, exclusion, emotional reactions, loss of social status, and discrimination, as well as ruling of one social group by another. Major methods of investigating stigmatization in the mentally ill, its effects and the role of mass media in this process are discussed.

Conclusions. Mental illness can be regarded as one of the most powerful socially excluding stigmata. Social stigmatisation and discrimination of persons with mental disorders is a universal problem, ofparticular importance at present, since it hampers or even precludes implementation of the fundamental postulate of contemporary community psychiatry, i.e. social integration of the patients. This social context of mental disorders must be taken into account for their effective treatment.

Review article

The ways of neuroprotection in Parkinson 's disease as exemplified by rasagiline

Danuta Turzyńska, ANNA SKÓRZEWSKA, Alicja Sobolewska, Adam Płaźnik
Postępy Psychiatrii i Neurologii 2005; 14 (2): 131-136

Objective. The aims of the paper were: to present neurodegenerative factors involved in the pathomechanism of Parkinson 's disease, to outline the role of neuroprotection, and to evaluate antiapoptotic properties of rasagiline on the grounds of pre-clinical trials.

Review. Parkinson 's disease is one of the most widespread neurodegenerative disorders. An apoptotic mechanism of cell death is considered to predominate in Parkinson 's disease. In the process of apoptosis the mitochondrial membrane potential reduction is followed by opening of the mitochondrial permeability transition pore. These processes result in disturbance of mitochondrial Ca2+ homeostasis, release of cytochrome C, and activation of caspase 3, finally leading to cell death by apoptosis. At present new drugs are sought that would inhibit neurodegenerative processes at the molecular cell level. Rasagiline is a selective, irreversible, second-generation inhibitor of monoamine oxidase type B (MAO-B). Numerous pre-clinical trials suggest that this drug not only inhibits MAO-B enzyme, but also has neuroprotective and antiapoptotic properties. Regulating the mitochondrial membrane potential rasagiline affects the functions and expression of mitochondrial proteins, which eventually prevents neurodegeneration.

Conclusions. Both pre-clinical and preliminary clinical trials suggest that rasagiline is effective not only in the treatment ofParkinson 's disease symptoms, but also affects the pathomechanism underlying the developing condition.

Review article

Magnetic resonance spectroscopy in degenerative diseases of the central nervous system

Radosław Magierski, Tomasz Sobów, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2005; 14 (2): 155-163

Objectives. The paper presents a review of research findings concerning changes in cerebral metabolites in the most common neurodegenerative syndromes: Alzheimer 's disease, dementia with Lewy bodies, frontotemporal dementia, Huntington 's disease, and Parkinson's disease.

Review. In contemporary medicine imaging techniques are of utmost importance among dynamically developing investigation methods. Magnetic resonance imaging is the leading investigation technique. One of MRI applications is magnetic resonance spectroscopy, available in several forms. The most frequently used proton emission spectroscopy enables to measure the levels of cerebral metabolites: N-acetyloasparginate, choline and its derivatives, myoinositol, creatine and creatine phosphate, as well as the glutamate-glutamine complex.

Reflection

One-sided consciousness?

MAGDALENA ŚWITOŃ
Postępy Psychiatrii i Neurologii 2005; 14 (2): 165-167

Background. An attempt was made in the paper to answer the question whether mental illness, drug- or alcohol-induced intoxication, sleep, and hypnosis have anything in common. It was hypothesized that these may be similar states of the same consciousness.

Conclusions. In these states we deal with a more general case of brain activity that cannot be described, because appropriate tools are lacking. The latter can be sought for on the grounds of physics and mathematics.