This article describes the results of the WPA-WHO Global Survey of 4,887 psychiatrists in 44 countries regarding their use of diagnostic classification systems in clinical practice, and the desirable characteristics of a classification of mental disorders. The WHO will use these results to improve the clinical utility of the ICD classification of mental disorders through the current ICD-10 revision process. Participants indicated that the most important purposes of a classification are to facilitate communication among clinicians and to inform treatment and management. They overwhelmingly preferred a simpler system with 100 or fewer categories, and over two-thirds preferred flexible guidance to a strict criteria-based approach. Opinions were divided about how to incorporate severity and functional status, while most respondents were receptive to a system that incorporates a dimensional component. Significant minorities of psychiatrists in Latin America and Asia reported problems with the cross-cultural applicability of existing classifications. Overall, ratings of ease of use and goodness off it for specific ICD-10 categories were fairly high, but several categories were described as having poor utility in clinical practice. This represents an important focus for the ICD revision, as does ensuring that the ICD-11 classification of mental disorders is acceptable to psychiatrists throughout the world.
Objectives. The aims of the article are, firstly, to analyze the effect of different methods of post-stroke depression assessment on estimated prevalence rates of this condition, and secondly, to consider other possible factors contributing to significant discrepancies in the available epidemiological data.
Method. Data on prevalence of post-stroke depression (PSD) reported in 44 English-language papers indexed by the PubMed data-base were analyzed. The data were categorized with regard both to the type of diagnostic instruments used (clinical classification systems, diagnostic scales or self-report questionnaires) and populations studied (general population, inpatients, and discharged patients). The reported prevalence rates in these populations were compared controlling for the diagnostic instrument used.
Results. There were statistically significant differences in the PSD prevalence rates in the general population depending on the type of diagnostic tools used, ranging from about 14% (in terms of clinical scales), through almost 24% (by diagnostic criteria of classification systems), to almost 32% (self-report questionnaires). As regards the inpatient population, the highest PSD prevalence rates (over 39%),obtained using classification systems, were significantly higher than these estimated with the use of the remaining two types of diagnostic tools (both indicating slightly over 31%). In the population of discharged patients the lowest prevalence of PSD (over 5%) was indicated by classification systems. This rate was significantly lower than the concordant estimates of PSD prevalence (slightly over 31%) obtained from the other two diagnostic tools.
Conclusions. Self-report questionnaires, clinical scales and classification systems differ in their accuracy of the PSD assessment. In each of the three populations analyzed significant measurement differences were found between the three categories of diagnostic tools, which may result in the discrepancies in reported PSD prevalence rates. Thus, it seems desirable to assess the diagnostic accuracy of particular instruments, as well as the effect of time from stroke on PSD onset.
Objectives. For many people the Web is currently a key source of medical, health- and treatment-related information. Among other things, the Web allows two-way communication between information-seeking patients and medical professionals. The aim of this paper was to analyze a specific aspect of this mutual communication, i.e. questions asked on a special Website forum by patients who had experienced a psychotic breakdown.
Method. Content analysis was conducted of 91 questions asked in posts to a psychiatrist by users of the www.TacyJakJa (SuchAsMyself)website. The website is based on the guided self management principles. Questions can be asked to the expert on this website forum "After a psychotic crisis".
Results. The most frequently asked questions pertained to: classification of and coping with symptoms, issues of proper diagnosis, side effects of medication and fears about their possible emergence in the future, broadly defined psychoeducation, and general health status in the context of the disorder and its treatment.
Conclusion. Questions addressed to the website expert may be regarded as possible clues as to what contents should be taken into account both in the individual patient-doctor contact and in psychoeducational interventions.
Objectives. The aim of the study was to determine the relationship between symptom severity and both working memory and executive function integrity in two groups of patients: with depression or hypomania/mania.
Method. Participants in the study were60 inpatients from the province of Lodz, diagnosed with bipolar affective disorder by a psychiatrist using the ICD-10 diagnostic criteria. They were treated at the 2ndPsychiatric Clinic CSK or the Babinski Hospital. Thirty patients in the 18‒68 age range (mean age 46 years, 12 men and 18 women) fulfilled the criteria for depressive episode (the Hamilton Depression Rating Scale score >11), and 30 patients aged 23‒68 (mean age = 48 years; 12 men, 18 women) fulfilled the hypomanic or manic episode criteria (scoring on the Young Mania Rating Scale >11 points). In the neuropsychological assessment various types of working memory and executive functions were evaluated.
Results. No relationship was found between severity of depressive symptoms and integrity of working memory and executive functions. On the other hand, higher severity of manic symptoms was associated with impairments of executive functions and of various aspects of working memory. However, these relationships were curvilinear, which suggests that low levels of manic symptoms may improve the patient's cognitive functioning, and only higher severity of mania leads to cognitive impairments.
Conclusions. Cognitive functioning seems to be significantly related to severity of manic symptoms, being unrelated to the severity of depressive symptoms.
Objective. To review studies and theories dealing with narrative in psychotic disorders.
Review. Research fi ndings indicating the presence of specifi c disturbances in narratives of people with psychotic disorders are reported in the paper. A new approach to these disturbances provided by the dialogical Self theory is outlined. Narrative therapy techniques applied in psychotic disorders are discussed. Moreover, new developments such as the perspective of recovery and the social context of narration in psychoses are considered.
Conclusions. The review shows that narration is being more and more widely used in order to better understand persons with psychotic disorders and to provide them with more effective therapy. Also narrative techniques are increasingly more often used in analyses. The transition from monologue to dialogue both in the individual, and social contexts is emphasized.
Objectives. The paper is aimed at a brief review of pathophysiology, prevalence and typical radiological fi ndings of vascular anomalies in the brain. The following defects are discussed: developmental venous anomaly (DVA), cavernous malformation (CM), arteriovenous malformation (AVM), intracranial pial arteriovenous fi stula (AVF), and capillary telangiectasia (CTS).
Review. Vascular anomalies in the brain are more and more often incidentally discovered nowadays due to the growing frequency of imaging examinations of the head. These intracranial vascular changes may be asymptomatic and uncomplicated, but some of them increase the risk for acute intracranial hemorrhage, seizures, or focal neurological defi cits.
Conclusions. Developmental venous anomalies (DVA) are at present the most often identifi ed vascular malformations in the CNS, occurring in 0.48‒2.56% of individuals. A majority of DVAs and CTSs produce no symptoms. Patients with arteriovenous malformation (AVM), cavernous malformation (CM), or intracranial pial arteriovenous fi stula (AVF) are at an increased risk of hemorrhage, seizures, or focal neurological defi cits. Morphology of these malformations in imaging examinations may indicate an increased risk of bleeding.
Objectives. The aim of this article is to discuss epidemiological problems connected with non-traumatic intracerebral hemorrhages (ICH). Non-traumatic ICH strokes constitute around 10% of all cerebral strokes, while the remaining are subarachnoid hemorrhage strokes (about 5%), and ischemic strokes (about 85%).
Review. The article presents an overview of risk factors and causes for intracerebral hemorrhage in the context of their epidemiological impact. Although hemorrhagic strokes occur approximately five times less often than do ischemic strokes, the mortality rates for intracerebral hemorrhages remain alarmingly high.
Conclusions. Under the circumstances, the need for a thorough epidemiological analysis of major risk factors for hemorrhages becomes vital, so that the incidence of intracerebral hemorrhages might be reduced through preventive actions.
Objective. A case is presented of paranoid syndrome with diagnostic diffi culties concerning etiopathogenesis, and particularly – suspected neuroborreliosis.
Case report. In a 29-year-old patient with paranoid syndrome neuroborreliosis was suspected since his disorder had been resistant to neuroleptic treatment and neurological symptoms developed. Laboratory tests confi rmed the presence of the IgG and IgM antibodies against Borrelia burgdorferi. His pharmacotherapy was modifi ed with a good clinical outcome.
Commentary. The clinical picture of paranoid syndrome with concomitant flu-like symptoms and/or neurological disorders suggests a potential neuroinfection with Borrelia burgdorferi, therefore diagnostic tests should be performed for neuroborreliosis.
Objective. To present doubts concerning legality of consent to psychiatric hospitalization expressed by a totally incapacitated patient.
Case report. The 38-year-old totally incapacitated female was brought to the admission room of a mental hospital because of physical violence used against her by her father (who was also her legal guardian). In 1998 the patient motioned the court for a change of her legal guardian, however, her claim has never been processed. Due to the ensuing legal doubts, an application was fi led in the guardianship court to establish whether the patient's admission to the psychiatric ward had been legal. The proceedings revealed a number of irregularities.
Commentary. Total legal incapacitation is not always in the best interest of the patient. Inadequate control over the legal guardianship system may lead to malpractice.