Archives 1992-2013

The aim of the study was to compare effectiveness of mobile community teams and traditional outpatient psychiatric care provision to patients with chronic psychoses, schizophrenia mostly. Participants were 107 patients (randomly assigned to either experimental or control conditions), and their family members. All the participants were examined thrice: at baseline, at 10 months and at 22 months. Effects attained after 22 months of community-based care were found to be significantly better than those of the traditional care on the majority of measures used in the study. The following indicators evidenced a higher effectiveness of care provided by mobile community teams: duration of hospitalization, four areas of social functioning (general, interpersonal contacts, independence, work), patients' satisfaction with services, patients' troublesome behaviors, and family burden. Effectiveness of mobile community teams was not found to be higher on the following measures: number of hospital admissions, and three areas of social functioning (withdrawal, recreation, pro-social activities). Effects of mobile community teams' work were evidently better after 22 months than these at 10 months, especially as regards family burden, troublesome behaviors and duration of hospitalization – at 10 months there were no intergroup differences, while at 22 months a significantly higher improvement was attained in patients receiving community-based care than in those provided with traditional outpatient care.

The aim of the study was to check to what extent the very good effects attained after a year by a mobile community team could be maintained over the next three years. Participants in the study – 58 patients diagnosed with schizophrenia mostly – were assessed thrice: prior to their entering the program, at 12 months of their participation in the program, and at a three-year follow-up. After the four years of their receiving community-based care levels of improvement as high as after the first year were found to be maintained on two measures: satisfaction with treatment and frequency of hospitalizations. On the other hand, in the remaining evaluative measures, i.e. all areas of social functioning, duration of hospitalization, and self-rated family burden due to patient's behavior, the same pattern was found: a marked improvement after the first year of community care provision was followed by a deterioration at the three-year follow-up. Nevertheless, the improvement at the follow-up was significant in relation to the baseline levels.

In the focus of the authors' attention is the relation between psychopathological pattern of schizophrenia and the patients' quality of life. This relationship was studied in a group of 66 patients diagnosed with schizophrenia (by the DSM-III criteria) and followed up for 7 and 12 years since their first hospitalisation. Psychopathological picture of schizophrenia was described using the BPRS in the Californian revision, while quality of life was measured using the QOL scale by Lehman. Discussing their research findings the authors point to a different pattern of relationships between the psychopathological picture on the one hand and subjective and objective evaluation of the patients' quality of life on the other hand.

In the report an attempt was made to evaluate effectiveness of olanzapine administration to schizophrenic patients. Effectiveness of the medication was assessed on the grounds of changes in the patients' cognitive functioning after three months of the treatment. Participants in the study were relatively young patients receiving treatment at the Institute. This atypical neuroleptic was found to be effective even in the first, relatively short stage of treatment. Improvement was noted not only as regards positive and negative symptoms severity, but above all in positive changes in the patients' cognitive functioning.

The aim of the study was to explore relationships between sense of coherence (SOC) and perceived power in families with an adult child – healthy or with mental disorders. Using questionnaire techniques 124 families with a healthy adult child and 45 families with a mentally ill child were examined. Global SOC was found to be significantly lower in mentally ill children than in healthy ones, while the adult child's power in the family was self-rated similarly in both groups studied. Mothers from clinical families ascribed less power to the child than did mothers from healthy families. Fathers asked in the two groups about the expected extent of their children's power differed: fathers of mentally ill children would give them more power than fathers of healthy children. Moreover, in healthy families the child's global sense of coherence turned out to be the higher the more power he/she had. In schizophrenic families the psychotic child's SOC was related to his/ her power as perceived by the mother: the greater extent of the child's power in maternal perception, the stronger was his/her sense of coherence.

Perception of facial emotions and facial recognition were assessed in the following groups: S – non-chronic schizophrenic patients (n = 50), CS – chronic schizophrenics (n = 50), R – right brain-damaged patients (n = 30). L –left brain-damaged patients (n = 30), and H – healthy controls (n = 50). In the study MMSE, PANSS, Facial Emotion Labelling and Recognition Tests, and Facial Recognition Test were used. Patients from R group and schizophrenic patients revealed deficits of both facial emotion perception and facial recognition. These deficits were getting more severe with the duration of schizophrenic process. The facial recognition deficit was significantly smaller than that in facial emotion perception.

The aim of the paper was to establish the type of mental disorders resulting in hospitalization of young people who had used certain psychoactive substances (PS). An analysis of medical records of all patients hospitalized during a year (1999-2000) at the Youth Psychiatry Department indicated that 42 patients in the age range 15 to 23 had used PS for at least a month and that according to ICD-10 criteria either harmful substance use or substance dependence syndrome were diagnosed in their case. Among youth hospitalized for mental disorders 21% had used psychoactive substances for over a month, most often cannabis (in over 2/3 of cases). Over a half of the cannabis users reported their using other psychoactive substances as well, usually alcohol. Young patients hospitalized for mental disorders who had used volatile solvents and opiates did not confirm their using other psychoactive substances. Among young patients hospitalized for mental disorders and using various psychoactive substances in the past most often psychotic disorders were diagnosed, with predomination of these from the schizophrenia spectrum (the latter occurred in this, category of patients almost 4 times more frequently than in the population of all patients).

199 psychiatric expert opinions issued after a period of inpatient observation in the years 1995-1996 and sent over to the Forensic Psychiatry Department of the Institute of Psychiatry and Neurology were analyzed in the study. Among 180 opinions concerning perpetrators acting under common alcoholic intoxication the most frequent offences were those against life and health (including homicide), followed by offences against property, the family, freedom, and public safety. Among 19 opinions concerning perpetrators in state of alcoholic intoxication other than the common one the highest percentage of offences were also those against life and health (including homicide), then against property, and sexual offences. A comparison of these findings with results reported by Uszkiewiczowa (1960) indicates that the rate of offences against life and health (including homicide) remained similar, while the proportion of offences against property, and above all – against the family, has increased. Since the time of the latter study the number of expert opinions questioning the perpetrators' accountability and motioning for the use of security measures has decreased significantly. A number of shortcomings and faults have been found in expert opinions concerning this group of offenders, especially as regards the description of symptoms of intoxication other than the common one, the use of dossier data, analyses and evaluations of alcohol abuse symptoms, and the model of drinking.

An analysis of 959 reports on physical restraint episodes that occurred in mental hospitals within 6 months was carried out. The results indicate that physical restraint in the form of immobilization using strait-jackets and belts was applied in 209 cases (i.e. ta 12.4% of treated patients). Among behaviours justifying the use of physical restraint aggression against others, self-aggression, violent destroying of property and motor agitation prevailed aver mostly therapeutic reasons, troublesome behaviours, escapes, and other. Out of 959 episodes: 54.2% were in accordance with the statutory regulations, 33.7% – in formal accordance, but tacking sufficient justification, 3.8% – contrary to the regulations, 4.1% – doubtful, while 4.2% – on the patient's awn request. Legitimacy of physical restraint was found to be accepted mechanically by the doctor ordering the use of physical restraint and by director of the hospital.

The authors present 18-year experiences in psychotherapy provided by a home treatment team in Bródno, a Warsaw residential district. Theoretical assumptions and rationale of their work are discussed, and these general principles are exemplified by particular cases. Problems emerging in therapy of patients with schizophrenia or other mental disorders are outlined and examples of interventions addressed towards patient families are given. (Ed.)

On the grounds of hitherto existing research findings an attempt was made in this paper to answer the question: what factors affect self-assessed quality of life in schizophrenic patients. The definition of quality of life and major scales measuring the construct were briefly presented. Analyzed factors were divided into several groups: those related to health status, to treatment received, and to socio-demographic characteristics. Reported research findings are not quite univocal. However, some regularities seem to emerge suggesting that a high quality of life can be attained in schizophrenic patients due to a number of factors: early treatment of the disorder, reduction of psychotic symptoms – especially negative ones, treatment of concurrent depressive and anxiety disorders, administration of atypical neuroleptics, shortening of the hospitalisation time, providing social support, rehabilitation and educational programs, as well as maintaining therapeutic relationship with the patient.

The rise and decline of the Division of Mental and Nervous Diseases and Forensic Psychiatry of the Warsaw Medical Society in the years 1864-1872 are outlined with reference to activities of the first scientific associations in Europe. (Ed.)