Archives 1992-2013

2008, volume 17, issue 4

World Psychiatry Forum

Steps, challenges and lessons in developing community mental health care

Graham Thornicroft, Michele Tansella, Ann Law
Postępy Psychiatrii i Neurologii 2008; 17 (4): 273-279

This paper summarises our own accumulated experience from developing community-orientated mental health services in England and Italy over the last 20-30 years. From this we have provisionally concluded that the following issues are central to the development of balanced mental health services: (a) services need to reflect the priorities of service users and carers; (b) evidence supports the need for both hospital and community services; (c) services need to be provided close to home; (d) some services need to be mobile rather than static; (e) interventions need to address both symptoms and disabilities; and (f) treatment has to be specific to individual needs. In this paper we consider ten key challenges that often face those trying to develop community-based mental health services: a) dealing with anxiety and uncertainty; (b) compensating for a possible lack of structure in community services; (c) learning how to initiate new developments; (d) managing opposition to change within the mental health system; e) responding to opposition from neighbours; (f) negotiating financial obstacles; (g) avoiding system rigidities; (h) bridging boundaries and barriers; i) maintaining staff morale; and (j) creating locally relevant ser-vices rather than seeking „the right answer" from elsewhere.

Original article

The mentally retarded in long-term inpatient care in the years 1992-2005

Ludmiła Boguszewska, Elżbieta Słupczyńska-Kossobudzka, Walentyna Szirkowiec
Postępy Psychiatrii i Neurologii 2008; 17 (4): 291-296

Objectives. Exploration of trends in the prevalence of long-term inpatient care provision to the mentally retarded and an attempt at explanation of territorial differentiation in this respect.
Method. The following three subgroups were surveyed in the population of the mentally retarded in consecutive years: mental hospital inpatients with at least one-year hospital stay, residents of nursing homes (DPS) registered there at the end of year, and those staying at the end of year in long-term residential care/treatment facilities (ZOL). Four independent variables were taken into account in the analysis of causes of territorial differentiation; in the correlational analysis the Spearman rho coefficient was used.
Results. Mental retardation prevalence in the population of children and adolescents has systematically decreased in the years 1992-2005, from 38 to 22 per 100 000population. In the adult population the rates have decreased only slightly, from 76 to 74. A considerable territorial differentiation in the prevalence rates was found: in the children's population the highest rates were 4.5 times higher than the lowest ones, while in the adult population the difference was almost threefold. The prevalence rates were not related either to the accessibility of community self-help facilities or the size of rural population in the province, but were associated to some extent with the economic situation in the region.
Conclusions. Over the 14 years under study the prevalence of mental retardation among children and adolescents has decreased by 42%o, and remained rather stable in the adult population. The prevalence rates were relatively the lowest in the provinces of Lodz and Silesia, and the highest in the Opole and Warmian-Masurian provinces. The territorial differentiation depends to some extent on the economic situation of a given province inhabitants.

Original article

Individual networks of social support among long-term patients with mental disorders participating in a community-based rehabilitation program

Paweł Bronowski, Maryla Sawicka, Sylwia Kluczyńska
Postępy Psychiatrii i Neurologii 2008; 17 (4): 297-303

Objectives. Lack, loss, or poverty of the individual's social network are regarded as important factors in the pathogenesis of mental disorders. The aim of the study was to assess the quality of individual social support networks in the long-term mentally ill participating in a community-based rehabilitation program.
Method. Participants in the study were 103 long-term patients with mental disorders provided with a community-based rehabilitation program. They were not hospitalized at the time when the research was conducted. The following instruments were used: the Questionnaire and Map of Social Support by Bizoń; The Social Maintenance Inventory by the same author, and an individual semi-structured interview designed for the purposes of this study.
Results. Individual social support networks are rather limited, consisting of 10 people on the average. The most numerous category of persons regarded by the patients as a part of their individual support systems were "therapists ". On the average over 4 members of individual networks originated directly from the therapeutic facilities attended by our respondents.
Conclusions. Participation in a local program of support and rehabilitation has a both quantitative and qualitative positive effect on individual social support systems of the mentally ill. Contacts with therapists and other participants of the program significantly influence the size of individual systems. Accessibility of many support functions reported by the respondents allows to regard local rehabilitation programs as an effective mechanism aiding the patients in functioning and providing them with assistance in coping with difficult situations.

Original article

The Rorschach PTI (Perceptual-Thinking Index) by J.E. Exner in the assessment ofparents of patients with paranoid schizophrenic and of healthy children

Anna Hunca-Bednarska
Postępy Psychiatrii i Neurologii 2008; 17 (4): 305-312

Objective. An attempt was made in this study to establish whether in a novel and anxiety-inducing situation symptoms of cognitive disorders could be found in verbal responses of parents of children with paranoid schizophrenia.
Method. The Rorschach projective test was used, where the respondent was asked what he actually saw in the inkblots and what they resembled. Contrary to appearances, the situation of free description of stimuli devoid of connotative meaning may be stressful. The responses were analyzed using the PTI index developed by J.E. Exner to measure perception and thought disorders. Respondents were 31 couples with a child suffering from paranoid schizophrenia and 21 parental couples with a healthy child.
Result. While there were no significant intergroup differences in the total number of responses generated overall the test, parents of schizophrenic children produced significantly fewer responses adequate to the inkblots and significantly more inadequate ones, thus manifesting less precise perception. Moreover, their PTI scores were significantly higher. The latter result was due mostly to the performance of mothers of schizophrenia children. Their verbal responses differed from these of healthy children's mothers with regard not only to the perceptual aspect, but also to thinking - the former group scored higher on the so-called special scores, and used bizarre logic.
Conclusions. The parents of children with paranoid schizophrenia revealed a significantly less precise perception and scored significantly higher on the PTI index than did the parents of healthy children. While there were no significant differences between fathers in the two groups, the mothers of ill children as compared to those of healthy offspring not only had significantly higher PTI scores and less precise perception, but also revealed some peculiarity of thought processes.

Original article

Health locus of control, self-efficacy and optimism in patients with multiple sclerosis

Magdalena Agnieszka Wrzesińska, Katarzyna Opuchlik, Józef Kocur
Postępy Psychiatrii i Neurologii 2008; 17 (4): 313-318

Objectives. The aim of the study was to evaluate health locus of control as well as self-efficacy and optimism levels in patients with multiple sclerosis.
Methods. Participants in the study were 42patients (15 M, 27 F) aged 20-56 (mean age 39.43 years), diagnosed with multiple sclerosis (MS). The parameters and traits under study were assessed using the Multidimensional Health Locus of Control Scale, Generalized SelfEfficacy Scale, and Life Orientation Test.
Results. A majority of the MS patients shared belief that their health depends on other people, especially on medical staff. Almost 60% of the examined patients had a strong sense of self-efficacy, while 42.8% - a high optimism level.
Conclusions. External health locus of control was found to predominate among MS patients. In most cases their sense of self-efficacy was strong, and a majority manifested a high level of optimism.

Original article

The usefulness of the ESMS instrument for the assessment of community care

Jolanta Skiba, Katarzyna Prot
Postępy Psychiatrii i Neurologii 2008; 17 (4): 319-325

Objectives. The aim of the study was to assess the ESMS questionnaire usefulness for the description of community care in Poland.
Method. Five Mobile Community Teams were surveyed using a short version of the ESMS-b questionnaire. They were compared with regard to their structure and functioning, as well as the catchment areas served. Moreover, the organization mental health services provision in their respective areas was compared.
Results. The Mobile Community Teams were found to differ not only in their structure and functioning, but also in respect of sociodemographic characteristics of the regions in which they work.
Conclusions. The ESMS questionnaire used in the pilot study allows to compare various regions in Poland in terms of the Mobile Community Team structure and range of mental health services provided. The instrument shows the existing shortages of the community mental health services available in Warsaw.

Original article

Cognitive functions among patients diagnosed with diabetes

Monika Talarowska, Antoni Florkowski, Krzysztof Zboralski, Piotr Gałecki
Postępy Psychiatrii i Neurologii 2008; 17 (4): 327-336

Objectives. The aim of the study was to examine differences in cognitive functioning of patients with type 1 and type 2 diabetes as compared to healthy controls.
Method. A total of 99 participants aged 18 to 55 were individually submitted to a neuropsychological assessment of cognitive functions using a number of methods. The sample included patients with type 1 (n =31) or type 2 diabetes (n =31), and a comparison group of volunteers without diagnosed diseases that might affect cognitive functions (n = 37). The assessed dependent variables included attention, visual and auditory memory, short- and long-term memory, learning, working memory, executive functions, visuomotor coordination, abstract thinking, and verbal fluency.
Results. Statistically significant intergroup differences were found with respect to the cognitive functions measured. Cognitive functioning efficacy of patients with diabetes was significantly lower than that of non-diabetic controls.
Conclusions. 1) Patients suffering from diabetes as compared to the controls manifested significantly inferior cognitive performance regarding: the speed and efficiency of visuomotor coordination, visual and auditory memory effectiveness, learning ability, concentration of attention, verbal fluency, working memory and executive functions. 2) Patients with type 1 diabetes scored significantly lower than the comparison group in respect of the efficiency and speed of visuomotor coordination, as well as long-term auditory memory. 3) Patients with type 2 diabetes as compared to healthy controls revealed a significantly inferior cognitive performance concerning: abstract thinking, efficiency and speed of visuomotor coordination, verbal fluency, long- and short-term auditory memory, working memory, and executive functions.

Original article

Long-term patients in inpatient mental health facilities and residential care units in the years 1992-2005

Ludmiła Boguszewska, Elżbieta Słupczyńska-Kossobudzka, Walentyna Szirkowiec
Postępy Psychiatrii i Neurologii 2008; 17 (4): 337-346

Objectives. To establish trends in the prevalence of long-term care provision; an attempt to explain the causes of this phenomenon territorial differentiation, and seeking an answer to the question concerning the so-called trans-institutionalization, i.e. whether psychiatric patients are transferred from mental hospitals to residential care facilities and nursing homes.
Method. The long-term patient populations studied in consecutive years comprise three subgroups: patients hospitalized for at least a year at a mental hospital or psychiatry department, patients staying at nursing homes at the end of year, and those staying at residential care/treatment facilities at the end of year. In the analysis of causes of territorial differentiation 7 independent variables were taken into account, and Spearman's rho coefficient was used to establish correlations.
Results. The prevalence rates of long-term psychiatric inpatients have increased from 66 to 81 per 100 000 population in the years 1992-2005. The contribution of inpatient treatment facilities has decreased from 43%o to 11%o, while the proportion of nursing home residents has risen from 57% to 74%o; many patients have been transferred to long-term residential care/treatment units. The prevalence rates show a considerable territorial differentiation: the highest rates often are twice as high as the lowest ones. The territorial differentiation to some extent depends on the size of rural population in the province, but is not related either to the economic situation in the region or to accessibility of the following facilities: day hospitals and mobile community teams, community self-help homes for the mentally ill, nursing homes for the aged, and shelters for the homeless.
Conclusions. The prevalence rate of long-term inpatients has increased by 21%o over the 13 years under study. The so-called transinstitutionalization is obviously progressing. The lowest prevalence rates are noted in the Mazovian and Pomeranian regions, while the highest - in the Łódzkie and Świętokrzyskie provinces. The prevalence is to a small degree only associated with the size of rural population in a given province.

Original article

Effectiveness of light treatment in bipolar vs unipolar affective disorder

Łukasz Święcicki, Waldemar Lechowicz, Dorota Bzinkowska, Marek Dąbrowski, Jarosław Torbiński
Postępy Psychiatrii i Neurologii 2008; 17 (4): 347-351

Objective. To assess the effectiveness of light therapy in two groups of patients with bipolar or unipolar affective disorder.
Method. 51 consecutive patients with affective disorder referred to light treatment were qualified - 37 diagnosed with bipolar, and 14 with unipolar affective disorder (by ICD-10 criteria). Assessments were made at baseline and at treatment completion at 14 days. The Hamilton Depression Rating Scale - 21-item version (HAMD-21), Clinical Global Impression (CGI), and the self-report Beck Depression Inventory (BDI) were used, along with the measurement of simple and choice reaction time.
Results. After the 14-day light treatment a significant improvement was found in both groups. However, the range of improvement was statistically larger in bipolar patients, which may be due to a higher incidence of seasonal mood disorders in this group.
Conclusions. Light treatment, in monotherapy or as an augmentation, is an effective method of therapy for both bipolar and unipolar affective disorder. In the treatment of bipolar patients light therapy is significantly more effective than in those with unipolar disorder. To address the cause of this difference further research is needed.

Review article

Advances in research on quality of life in chronic illness

Wanda Sobczyk, Magdalena Gugała, Rafał Rola
Postępy Psychiatrii i Neurologii 2008; 17 (4): 353-356

Objectives. To present advances in the quality-of-life research methodology in chronic illness.
Review. In most countries the problem of quality of life (QoL) in chronic conditions becomes particularly important since this population of patients is growing due to the development of treatments and medical techniques on one hand, and to the increasing life expectancy on the other. The paper presents the generally accepted definition of the Health-Related Quality of Life, (HRQoL), its determinants, as well as generic and specific HRQoL assessment scales used in research on various chronic conditions. Moreover, questionnaires for the evaluation of cognitive deficits and mood disorders frequently associated with somatic diseases are discussed. An analysis of research findings obtained in multi-center studies using physical and psychosocial functioning assessment scales is presented, allowing to evaluate the importance and effect of primary and secondary mental disorders concurrent with somatic conditions on the patients ' quality of life.
Conclusions. Research methodology and interpretation of multifactorially determined relationships concerning QoL in patients with chronic illness still require some corrections that might contribute to an improvement of not only treatment efficacy, but also management and economics of medical care.

Review article

Neuroimaging in schizophrenia - new techniques, new possibilities

Marta Gawłowska, Jolanta Rabe-Jabłońska, Piotr Gębski
Postępy Psychiatrii i Neurologii 2008; 17 (4): 357-363

Objectives. The aim of this study is to present the currently available methods of neuroimaging as well as the possibilities they open up in the diagnostics of schizophrenia, monitoring its course, and seeking potential causes of the disease.
Review. There are two predominant pathogenetic hypotheses for schizophrenia: neurodevelopmental, proposing that schizophrenia is caused by abnormal processes during the central nervous system maturation, and neurodegenerative, considering the illness to result from atrophic/degenerative processes within the CNS structures. schizofrenięizophrenia has been regarded so far mainly as a condition due to grey matter abnormalities, while white matter irregularities were supposed to be of minor importance.
Conclusions. A majority of research findings obtained with the most recent neuroimaging techniques confirm that the development of schizophrenia symptoms is caused by abnormalities in the course of the CNS maturation. More and more attention is devoted to white matter as the structure that might possibly have a crucial role in the pathogenesis of schizophrenia symptoms.

Review article

Compliance - a relic of the past or a useful term

Karolina Friemann, Jacek Wciórka
Postępy Psychiatrii i Neurologii 2008; 17 (4): 365-375

Objectives. To discuss the meaning and usage of the term "compliance" and of alternative concepts.
Review. The term "compliance " is presented along with related notions such as adherence, cooperation or concordance, discussed with an emphasis on critical opinions about these concepts. The term "compliance " is at present widely criticized due to its evidently paternalistic flavor. As a result of studies on this clinical phenomenon a number of more modern models of the patient-doctor relationship have been proposed. They are overviewed in the paper, with particular attention paid to the "shared decision making" model. Difficulties and challenges associated with redefinition of the doctor's role are outlined.
Conclusions. Compliance has to a large extent failed as a theoretical construct serving to explain and understand patients' behaviors at the stages of treatment initiation and continuation. However, it will most likely remain in further use as a convenient measure of effectiveness of more modern models of the therapeutic relationship.

Review article

Venous thromboembolism prevention and treatment in stroke patients

Jan Bembenek
Postępy Psychiatrii i Neurologii 2008; 17 (4): 377-383

Background. Venous thromboembolism (VTE) is a serious complication of immobilization after stroke. Knowledge about VTE symptoms is necessary to initiate early treatment. The aim of this article is to overview recent approaches to this issue.
Views. Many methods, including laboratory tests and imaging techniques, are used in VTE diagnostics. Both pharmacological and mechanical methods are used in the prevention of this post-stroke complication. The treatment of VTE requires knowledge of appropriate management procedures. Since the first articles that appeared in the 1970s many new papers on VTE in post-stroke patients have been published.
Conclusions. In stroke patients the risk of VTE complication should be considered. Adequate prevention methods, early detection and proper treatment of venous thromboembolic complications reduce mortality rate.

Review article

Neurotrophins - the state-of-the-art knowledge

Adam Wysokiński, Wojciech Gruszczyński
Postępy Psychiatrii i Neurologii 2008; 17 (4): 385-390

Objective. In the article recent literature on neurotrophins is overviewed from the perspective of genetics, neurobiology, psychiatry and neurology, and major views on the subject, widely accepted at present, are discussed.
Review. Neurotrophins are a group of nerve growth factors participating in the processes of neuro- and synaptogenesis. Deficiencies of particular neurotrophins may lead to an abnormal development of the nervous system structures and to increased neuronal susceptibility to damage by physical and chemical factors, as well as by long-term stress exposure.
Conclusions. Neurotrophins play a crucial role in the etiopathogenesis of numerous mental and neurological disorders and therefore they remain one of the most important issues in experimental and clinical research.

Review article

Socio-demographic risk factors for suicide in schizophrenia: review of literature

Marta Makara-Studzińska, Anna Koślak
Postępy Psychiatrii i Neurologii 2008; 17 (4): 391-394

Objective. To present current views on socio-demographic risk factors for suicide in schizophrenia.
Review. Research results show that male schizophrenic patients are more likely to commit suicide than female, and also that young adults are more prone to commit suicide. White people are more at risk of committing suicide. Several studies indicated an increased suicide risk among patients living alone and not being in a relationship. Having children does not seem to affect suicide risk in schizophrenia, although some studies suggest a protective role of this factor. However, childlessness increases the probability of attempting suicide by women in the course of schizophrenia. In the light of current research findings unemployment is also regarded as a risk factor. Some authors indicate that college or university education is related to a higher risk of suicide.
Conclusions. Identification of the patient's risk factors can be crucial for predicting and preventing suicide in individual cases.

Case report

Psychosis or fantasy: a case report on psychosis-like symptoms in a female patient neglected in childhood

Sławomir Murawiec, Magdalena Kotlicka-Antczak
Postępy Psychiatrii i Neurologii 2008; 17 (4): 395-401

Objectives. The aim of the paper is to discuss diagnostic problems in patients presenting with symptoms that can be seen by clinicians as either psychotic, dissociative, or resulting from personality disorders. In an early deprivation of the child's psychological needs, a defense mechanism may be used: namely, the child may create an extensive fantasy world to satisfy the deprived needs. If such fantasies are still experienced and verbalized in adulthood, the individual may be diagnosed with psychotic disorders.
Case report. The patient, a woman whose psychological needs had not been satisfied in childhood, continued to verbalize her fantasies and manifest dysfunctional behaviors in adulthood. This resulted in her recurrent psychiatric hospitalization with the diagnoses of schizophrenia, borderline personality disorder, obsessive compulsive disorder and addictions. Her symptoms did not constitute any consistent clinical picture that would precisely fit a particular ICD-10 or DSM-IV diagnostic category.
Conclusion. In the psychiatric classification systems there is no diagnostic category that would univocally correspond to such cases.

Case report

Echinococcosis of central nervous system - diagnostic difficulties: two case reports

Anna Bochyńska, Jadwiga Strojanowska-Malicka, Wanda Lipczyńska-Łojkowska, Mirosława Derejko, Maria Bielawska, Danuta Ryglewicz
Postępy Psychiatrii i Neurologii 2008; 17 (4): 403-406

Objective. Echinococcosis is a rather seldom detected parasitic disease affecting the CNS in 2%o of cases only. Diagnostic difficulties occur if presentations in neuroimaging assessment are atypical, as in this disease serological tests can be negative for a long time since the onset of clinical symptoms.
Cases. Two patients with echinococcosis are described: a 53-year-old man with an isolated cerebral form of echinococcosis and an atypical brain MRI scan showing disseminated focal lesions, and a woman aged 18, with an ophtalmic form of the disease and disseminated neurological signs.
Commentary. Echinococcosis continues to be seen in Poland. Isolated intracerebral forms of this disease are very rare. The diagnosis should be based on neuroimaging findings, as well as serological test results and cerebrospinalfluid analysis. Oral treatment is an alternative method in non-operative cases.

Case report

Three years of maintenance electroconvulsive therapy in recurrent depressive disorder: a case report

Magdalena Drozdek, Krzysztof Kucia, Grzegorz Giemza, Aneta Sikora
Postępy Psychiatrii i Neurologii 2008; 17 (4): 407-409

Objective. The authors would like to answer question unsatisfactory efficacy of maintenance the electroconvulsive therapy at the present patient.
Case. A 62-year-old woman suffering from somatic diseases. We have observed the recurrence of the severe depressive episode with psychotic symptoms in spite of has continued the electroconvulsive therapy for the last three years.
Commentary. We have revealed a reactive factor as the base of each recurrence.