Archives 1992-2013

2011, volume 20, issue 4

World Psychiatry Forum

Personality and psychopathology

Thomas A. Widiger
Postępy Psychiatrii i Neurologii 2011; 20(4): 227–231

Personality and psychopathology can relate to one another in three different ways: personality and psychopathology can
influence the presentation or appearance of one another (pathoplastic relationships); they can share a common, underlying
etiology (spectrum relationships); and they can have a causal role in the development or etiology of one another. Each of these
possible forms of interrelationships considered in this paper.

Original article

Neuropsychological assessment of inhibitory control impairment in selected cognitive and motor functions after cerebral stroke

Krzysztof Jodzio, Daria Biechowska, Edyta Szurowska, Dariusz Gąsecki
Postępy Psychiatrii i Neurologii 2011; 20(4): 251–257

Background. Neuropsychological consequences of cerebral stroke include among others various self-control defi cits that not only impair the patients' emotional and personality functioning, but also disorganize the course of their cognitive and motor activities. The aim of the study was to assess the frequency, clinical characteristics and neuroimaging correlates of inhibitory control impairment in selected cognitive and motor functions following brain stroke.
Method. Two groups of participants were studied. The clinical group consisted of 65 patients after unilateral ischemic cerebral stroke. They were included on the grounds of their medical history and CT and/or MRI scans. The time from onset was less than a month. The control group consisted of 25 healthy volunteers. The participants' inhibitory control level was assessed using two popular tasks, i.e. an experimental version of the Stroop Color-Word Test (SCWT) and a standardized go/no-go task (GNG) that required the subjects to perform confl icting motor responses.
Results. Inhibitory control dysfunction was found in 54 patients (i.e. 83% of the clinical group), who failed to complete at least one of the two tasks. One-way repeated-measures ANOVA with post hoc Tukey's test indicated that patients with a selective damage site in the posterior part of the brain performed the tasks within the normal range, i.e. at the same level as did the healthy controls. Moreover, their performance was signifi cantly superior to that of patients with damage either to the frontal lobe (FRL) or to subcortical structures (SUB). It was only the patients with FRL or SUB damages whose performance on the GNG task was diagnostically lower than their SCWT scores.
Conclusions. Inhibitory control dysfunction affecting the performance of automated verbal and motor sequences was a very frequent symptom of cerebral stroke. There were individual differences in disinhibition specificity and severity. The most severe symptoms were noted in patients with frontal lobe damage or in those with damage to some specific subcortical structures such as the striatum or thalamus and their cortical connections.

Original article

Some positive aspects of coping with chronic illness in patients with multiple sclerosis

Marlena Kossakowska, Luiza Zemła-Sieradzka
Postępy Psychiatrii i Neurologii 2011; 20(4): 259–267

Objective. The aim of the paper was to compare patients with chronic multiple sclerosis (MS) and retained motor functions (mean EDSS score = 4.88) with healthy controls for selected aspects of personal growth.
Method. Participants in the study were 30 MS patients and 30 healthy controls who responded to self-report questionnaires measuring various aspects of personal growth: readiness for self-growth attainment, life satisfaction, the meaning of life, spirituality level (including religiousness, harmony and ethical sensitivity aspects), and positive affectivity level.
Results. The study suggests that MS patients have some psychological benefi ts from experiencing their illness, namely, as compared to healthy controls they perceive life as more meaningful, declare higher religiousness, and tend to experience positive emotions more intensely. Moreover, the fi ndings show that MS does not affect either these patients' readiness to strive for personal growth, or their reported life satisfaction, ethical sensitivity and harmoniousness levels.
Conclusions. Coping with the stress of chronic illness gives MS patients a chance for a good quality of life with their condition.
Therapy of MS patients focused on striving for personal growth stands a good chance of success due to positive aspects of coping with illness.

Original article

Patients’ attitudes to own illness and reasons behind their decision on surgery for asymptomatic life-threatening disease

Teresa Rzepa, Michał Goran Stanišić
Postępy Psychiatrii i Neurologii 2011; 20(4): 269–276

Purposes. The diagnosis of an asymptomatic life-threatening disease is a diffi cult experience for the patient who is requested to make a decision whether to undergo treatment that carries the risk of complications and death. The patient's decision-making process concerning the surgery is seldom based on the same premises as the doctor's recommendation. The aim of the study was to assess whether the patient's strong initial emotional reaction may lead to his/her rational decision over surgery for the asymptomatic life-threatening disease.
Method. The study involved two groups of inpatients (N=50), scheduled surgery of either asymptomatic abdominal aortic aneurysm (AAA) or asymptomatic internal carotid artery stenosis (ICA). A self-report questionnaire used in the study measured one psychosocial and three psychological categories: (1) self-image and attitude towards own life, (2) attitude towards illness, (3) attitude towards surgery, (4) attitudes of the social environment towards the patient and his/her disease. The statistical analysis was performed using the chi2 test.
Results. Patients with asymptomatic ICA stenosis represented a more positive attitude towards themselves than did AAA patients (p<0.05). In the latter patient group the primary source of information about the disease and its treatment was the primary care physician. The patients with ICA stenosis more often consulted other doctors to get a second opinion and to verify their information about the disease (p<0.05). Consequently, there were differences as regards the motives behind the patients' decision about surgery (p<0.001).
Conclusions. The initial strong emotional reaction leads to a rational decision on surgery, although the decision-making process is completely different in patients with AAA and ICA stenosis, depending not only on the affected site, but also on possible consequences of treatment refusal. The patients' attitudes toward self and the disease are different according to the disease location and type of the possible outcome. The fi ndings allow to develop appropriate strategies aimed at obtaining the patient's informed consent to surgical treatment of severe asymptomatic life-threatening diseases.

Original article

Delusion or no delusion? Psychiatrists classifying verbal messages of patients with a prior history of psychotic disorder as delusional or non-delusional judgments

Sławomir Murawiec
Postępy Psychiatrii i Neurologii 2011; 20(4): 277–282

Background. Whether patients' verbal messages are classified by psychiatrists as delusional or non-delusional judgments may depend, at least to some extent, on their definition of "delusion". The definition currently in force may be insufficiently precise. While enabling to accurately categorize delusions in the acute phase of psychosis, it does not allow to distinguish delusions from inadequate or bizarre cognitive judgments in the period following a successful antipsychotic treatment. The aim of the study was to assess whether current understanding of delusions by practicing psychiatrists ensures that they unambiguously classify their patients' verbal messages as delusional or non-delusional judgments.
Method. Participants in the study were 62 psychiatrists (58% with second degree specialty in psychiatry), who responded to a questionnaire presenting a hypothetical case. They were asked then to answer a series of questions: firstly, to classify the presented patient utterances as delusional or non-delusional, and secondly, to predict the patient's response to pharmacological treatment.
Results. All the interviewed psychiatrists classified the patient's verbal messages in the acute psychosis as delusional, while these from the post-treatment period were classified as delusions by 73% of the respondents and as non-delusional by the remaining 27%. In the latter group (classifying the post-treatment verbal output as delusional), a considerable percentage of respondents predicted a different response to pharmacotherapy on the grounds of the patient's utterances produced in the acute stage of psychosis and in the post-treatment period.
Conclusions. The definition of delusions currently in force is not precise and requires further clarification.


Narration in psychiatry – theory, applications, relationship to mental he

Agnieszka Chrzczonowicz
Postępy Psychiatrii i Neurologii 2011; 20(4): 283–289

Objective. The aim of the paper was to explore the role of narrative in psychiatry, with the focus on the relationships between mental health and the way self-narration is created.
Views. Definitions of narration and self-narration were presented, as well as the ways these constructs can be understood in psychiatry. Possible applications of narration/narrative in psychiatry were outlined, in such domains as research, diagnostics, and therapy. Theories and research projects proposing an answer to the question "What is a "good", or mental-health-promoting narrative?" were reviewed. The following essential criteria of a "good" narration were described: coherence, clear structure, comprehensibility, dialogicality, and distinguishing the main character.
Commentary. The criteria discussed in the paper provide an important rationale that allows to differentiate between narratives typical of good functioning and dysfunctional ones that accompany mental disorders. At the same time the criteria exemplify how the knowledge of narration can be used in psychiatry.

Clinical notes

Rehabilitation of patients with the pusher syndrome

Emilia Mikołajewska
Postępy Psychiatrii i Neurologii 2011; 20(4): 291–296

Objective. The aim of the article is to present the diagnostics and rehabilitation of patients with the pusher syndrome on the grounds of the author's experience.
Review. The pusher syndrome is known in neurology and neurorehabilitation as a disorder of body orientation in the coronal plane. The main cause of the pusher syndrome is brain damage due either to stroke or to other factors. The major features of the syndrome include: (1) leaning toward the contralesional hemiparetic side, and (2) resistance to external attempts at posture correction toward midline. No detailed reports on treatment of the disorder are available in the literature. The rehabilitation approach outlined in the paper was found to be effective and useful in clinical practice. After a relatively short-term rehabilitation following the presented regimen patients with the pusher syndrome regained their ability to adopt the correct upright position. It seems particularly important since in the classical model of rehabilitation of patients with CNS damage the pusher syndrome is not recognized, so it is neither diagnosed nor appropriately treated.
Conclusions. Misdiagnosis of the pusher syndrome may lead to misinterpretation of the patient's behavior, so inappropriate therapy may be provided, making the process of rehabilitation longer and less effective. Further clinical research into the pusher syndrome is needed.

Case report

Post-stroke apathy syndrome – case report and review of the literature

Jan P. Bembenek, Joanna Szutkowska-Hoser
Postępy Psychiatrii i Neurologii 2011; 20(4): 297–301

Objectives. Although constituents of the apathy syndrome including decreased activity, initiative and interests are relatively often seen in post-stroke patients, this syndrome is seldom diagnosed. A case of this syndrome is reported in the paper.
Case report. Relatively isolated apathy syndrome in a post-stroke patient is described, and a review of the relevant literature is presented.
Commentary. Apathy considerably impairs the patient's post-stroke functioning. At present there are scarce literature data concerning effectiveness of rehabilitation of patients with this disorder.