The author presents her reflections on the relationship between technical possibilities of contemporary genetic diagnostics of mental disorders and their social perception on the one hand, and on the other hand-communities' attitude towards people with mental disorders or mental retardation. Special attention is pa id in the paper to the unexpected or neglected effect of new trends in eugenics on the way human dignity is defined and its practical implications. (Ed.)
The development of non-public outpatient health care facilities seen also in psychiatry requires that this phenomenon should be analysed using available routinely collected statistical data.
Aims: To determine the degree of privatisation and to compare activities of public and non-public mental health out patient facilities.
Material and method: The analysed data were obtained from 661 routine report forms MZ-15 concerning psychiatric care accessibility, staffing, the population treated, and provided services. Results: Differences between the two types of facilities were found in almost all of the analysed dimensions of their activity. As regards accessibility, staffing and characteristics of the treated population the differences were small, while considerable differences pertained to regional development of privatisation. Non-public outpatient psychiatric facilities were found to prevail in three districts: Pomeranian, Warmia-Masurian, and Wielkopolskie.
Discussion: The differences in the degree of privatisation of outpatient psychiatric services resulted .from the policy of the Regional Sick Funds. Namely, in regions in which advantageous terms of contracting for psychiatric services had been provided the degree of privatisation was rather high.
Conclusions: In Poland every third, and in some districts every other psychiatric outpatient facility is a non-public one. In the category of non-public outpatient clinics significantly more numerous are those which provide treatment to a small percentage of patients with schizophrenia or other disorders from this spectrum.
In the 1990s there was a rapid development of com munity-based psychiatric care and rehabilitation provided within the framework of social welfare institutions in Poland. Three new forms of psychiatric care have been available to persons with mental disorders: community self-help houses, specialist nursing services (since 1995), and occupational therapy workshops (since 1992).
Aims: Collection of basic information about community self-help houses functioning in Poland.
Material and method: A questionnaire "HOUSE 2001" was mailed to 315 community self-help houses existing in the country; 307 of them responded and participated in the survey.
Results: Over 12,000 persons entered the programme of specialist nursing services provision, and over 10.000 participated in occupational therapy workshops in the year 2002. Over 9.000 patients participated in rehabilitation programmes provided by community self-help houses; 47% o[the participants had chronic mental disorders, and 53% were mentally disabled. Detailed results of the survey concerning qualifications of the staff, contents of the programme, and organisation of community self-help houses are presented.
Discussion and conclusions: Development of these new forms of social support may contribute to a better quality of assistance provided to persons with mental disorders or mental disability.
Negative attitudes encountered by patients with schizophrenia may result from people's individual experiences and prejudices as well as from popularisation of a distorted image of schizophrenia in mass media.
Aim: To assess how often and in what way persons suffering from schizophrenia are presented in the press influencing the public opinion.
Material and method: In website archives of selected newspapers („Gazeta Wyborcza", „Rzeczpospolita") and weeklies („Wprost", „Polityka", „Newsweek" – Polish edition) that have a considerable impact on the public opinion in Poland, 408 articles published in the year 2002 and containing target words "schizophrenia", or "schizophrenic" were found and analysed.
Results: Examples of schizophrenia-related quotations were categorised into several thematic groups, presenting schizophrenia in the context of disease fine arts, metaphor; something contradictory/illogical, and social pathology. The analysis has shown that irrespective of the context, schizophrenia-related passages very often described negative characteristics of somebody or something, and pertained to a socially pathological, shocking or somehow threatening situation.
Discussion: A considerable discrepancy can be seen between the declared and practically demonstrated in publications attitude towards schizophrenic patients, frequently described as a social evil, burden, and threat. The negative stereotype of the disease is reinforced by utterances of persons well known to the public who identify schizophrenia with a lack of logic in behaviour or activity, Propagation of such negative attitudes toward those suffering from schizophrenia contributes to their discrimination.
Conclusions: Acting on behalf of improvement of schizophrenic patients' condition must include efforts aimed at elimination of negative stereotypes affecting these patients.
Insight into public attitudes towards various forms of mental disturbance may be a big help in the development of educational programs and public campaigns aimed at modifying existing stereotypes.
Objective. The purpose of this study was to find out how the onset of schizophrenia is reflected in public opinion and what methods of intervention are preferred.
Subjects and method. As part of a larger survey conducted by CBOS on a representative random-address adult sample of Polish society (N= l003) in December 1999 respondents were given descriptions of typical behaviours which experts conceive to be signs of the onset of schizophrenia and a list of forced-choice questions concerning their qualification and possible interventions.
Results. Respondents preferred interpretations accentuating the transitory nature and non-morbid determination of the presented behaviours. Only one respondent in five qualified the behaviours as morbid. Psychological support by close relatives or professionals specialising in coping with difficult problems were the most frequently indicated methods of intervention. Psychiatric counselling was less popular: However, if the question was formulated so as to suggest the onset of mental disease, psychological and psychiatric counselling in an out-patient setting were the most frequently indicated methods of intervention. Respondent seldom chose hospital treatment, especially involuntary treatment. Conclusion. The process of defining the onset of schizophrenia and its treatment in psychiatric terms are not salient in social perception. This may lead to delay in seeking professional help.
The burning mouth syndrome (BMS), i.e. a burning sensation in the oral mucose in the absence of clinically observable changes of the oral mucose, is a disease of uncertain etiology. It is suggested that BMS is concurrent with anxiety and depressive disorders that may be due to the chronically experienced pain, or that the condition is a somatic form of anxiety or depression.
Aims: Firstly, to assess the type and frequency of coexisting mental disorders in patients diagnosed with the BMS. Secondly, an attempt was made to determine a) temporal relation between the presence of painful BMS symptoms and the onset of mental disorders, and b) differences in the nature and course of the condition between BMS patients with and without mental disorders.
Subjects and method: Participants in the study were 74 patients diagnosed with BMS. They were submitted to a psychiatric examination, with particular attention paid to the assessment of anxiety and depression levels, as well as to pain severity. In subsequent analyses the group of BMS patients with mental disorders was compared to that without such disorders.
Results and discussion: Coexisting mental disorders (in the form of anxiety or depression) were noted in over a half of the BMS patients. No temporal connection was found between painful BMS symptoms and the onset of mental disorders. As regards demographic characteristics, BMS patients with mental disorders did not differ from those without mental disorders.
Aim: The goal o( the paper was to elaborate and characterise the problem of occupational rehabilitation of schizophrenic patients.
Review: The description of conditions of the development of theory and practice of this particular form of rehabilitation is a result of integration of the general theory, methodology and principles of psychiatric rehabilitation with the specific problem of social and occupational integration of the mentally ill diagnosed with schizophrenia. In order to attain the so-formulated goal an analysis of theoretical issues was carried out, as well as an analysis of empirical studies indicating the key role of mentally ill persons' employment in the rehabilitation practice. In the review a particular attention was paid to the theory underpinning the integrated model of rehabilitation proposed by Dörner; to the Cook and Razzano concept of occupational activation of the mentally ill, the model of supported employment promoted by Bond, and a number of studies into the employment of patients with schizophrenia.
Conclusions: The essence of the contemporary approach to occupational rehabilitation of people suffering from schizophrenia consists in ensuring their right to employment and in shaping their workplace so that they would be capable of performing their job. Apart from their disease, unemployment is the crucial factor leading in these patients to a loss of motivation to change their life situation and contributing to their social isolation. An important task in occupational rehabilitation is to promote and support special projects of work and employment (so-called "social businesses"). The latter are created by nongovernment organisations whose aim is to propagate socio-economic integration of the mentally ill. The development of socio-economic projects of the "third sector" in this light becomes a social movement that is, or should be, characterised by embedding in the community, striving to provide mutual support, and by voluntary participation. The function of such activity includes also the maintenance of the community's integrity by stimulating development and supporting every manifestation of interpersonal help.
Aim: An attempt was made in the paper to systematise the existing knowledge about the role of various factors, and especially – the family, in the psychiatric patient s return to the community.
Review. A number of factors are presented and discussed in succession – characteristics of the patient and his/her illness, of the psychiatric facility and the social environment with which the family system has contacts, and especially, the ways of coping with stress typically used by the family.
Conclusions. The role of all the above-described factors in the patient s return to the community seems to be very important. However; the systemic perspective points to an exceptional role of the family in this respect, and especially to the meaning the patient ascribes to stressful situations, or in other words - to the significance of the illness-related "family story".
Koro is an acute anxiety state with an accompanying sensation of shrinking of genitals and a belief about being faced with imminent death due to their complete disappearance. This syndrome is classified among culture-bound mental disorders. Its prevalence is the highest in South-Eastern Asia, but there is a continually rising number of reports about similar cases among patients with different cultural backgrounds. On the grounds of the literature (mostly case reports) the state-of the-art knowledge about the koro syndrome is summarized in the article. Similarities and differences between the endemic and occasional forms of the syndrome are discussed, as well as its concurrence with other mental or somatic disorders, nosological doubts concerning the syndrome and its psychopathological symptoms, possible accompanying urological complications, its place in current classifications of mental disorders, patient characteristics, and the treatment.
Case report. Additionally a case is reported of the koro syndrome in a Polish patient – to our best knowledge, for the first time in the Literature. It is a further evidence for the ethnic and cultural diversity of patients suffering from this condition.
Comment. We agree with the postulate set forth by other authors – that against the traditional views, koro should be regarded as a universal disorder of multi-factorial etiology, occurring all over the world.
Aims. The paper presents defects in testator's declaration of will that - according to the provisions of Article 945 Par. 1 Item 1 of the Civil Code – result in invalidity of the will.
Review. The defects consist in the testator's state excluding his conscious decision making or discretion of decision and declaration of will, in the result, in particular, of mental illness, "mental retardation" or other; even transient disturbance of psychological functions listed in Article 82 of the Civil Code. Both in the case of an ordinary will and will in a non-standard form, the court instructs an expert psychiatrist to assess whether the testator's condition enabled him/her to make the decision and declare their will consciously and freely or whether this was excluded. Since the Civil Code does not pro vide any intermediate states of the testator, the court expert cannot recognise any limitations of testamentary capacity. In the case of will made in an emergency situation the court may instruct the expert psychiatrist (sometimes psychologists are appointed for the purpose) to assess whether at the time of making the will in a non-standard form the testator was under apprehension about his/her imminent death.
Conclusion. The knowledge of these issues is necessary to avoid errors in court expertises.
Aim. The author presented conclusions from four court opinions prepared by successive expert psychiatrists (in that number two teams of experts from research centers). The expertises have contributed to protraction of proceedings in cases concerning invalidation of will.
Case reports. The experts did not take into account the errors made by their predecessors and recognised limited freedom of decision making and declaration of will, which is not provided for by regulations in testamentary cases. The third team, under the pressure of the court, declared that the limitations are equivalent to the exclusion of freedom of decision making. However; the fourth team assessed the mental status of the testatrix in a different way, namely stating that her capacity of conscious decision making had been limited so much that it was practically excluded, but limitations of her freedom of decision making had been insubstantial, if any.
Conclusions. In testamentary cases court experts must be aware of the nature of legal regulations concerning testamentary matters, the entire material in a given case must be thoroughly analysed and assessments should be made with caution, but reliably and after careful consideration.
Aim. To present difficulties involved in IQ assessment that are of importance for expert psychiatrists when determining the degree of the subject's accountability in forensic psychiatric expertise.
Case report. A case is described of a 44-yearold patient submitted to forensic psychiatric observation and examinations on the outpatient basis on several occasions. Since the quantitative results of the examinations conducted so far were different, they resulted in various diagnoses with different legal consequences.
Comment. Psychological diagnosis is not identical with psychometric assessment. In the IQ assessment the subject's functioning level must be taken into account. In the paper an attempt was made to indicate significant factors that may affect the IQ assessment.
Aim. The Mental Health Act specifies conditions under which the patient has the right to treatment. Moreover; the Act provides legal grounds for community-based psychiatric care delivery. One of tasks of the latter is to help persons with mental disorders who cannot or do not wish to receive psychiatric treatment despite clear medical indications. The aim of the article is to outline discrepancies between some regulations of the Act and feasibility of their implementation in practice.
Case reports. Five "typical" cases are described of patients who cannot be referred to treatment or placed in a nursing home despite indications in agreement with the provisions of Articles 29 or 39 of the Act, since Article 30 of the same Act requires that to ally motion brought forward to the court a certificate should be enclosed – and the certificate must be issued by a physician "employed in a public health care facility".
Comments. Due to specific features of their illness, it is often impossible for community psychiatry patients to obtain such a certificate. In the light of the law in force it is unfeasible to start their treatment without their consent. It follows from our experience that such a situation leads to their social degradation or deterioration of their illness, and sometimes even to premature death of these patients. In its current formulation the Act does not protect their interests.
Many impressions of the book "Compendium medicum auctum" appeared between the years 1703 and 1789. It was a summary of medical knowledge coming from the 18th century – but not anachronic and having many readers in the next century. It was addressed to educated laymen interested in medicine, but could serve also as a guide to a physician, as it presented the management of various diseases supplemented by numerous prescriptions. The article deals with the "psychiatric" part of the book, including the classification of mental disorders, prognoses and treatment methods of that time.