Archives 1992-2013

2012, volume 21, issue 4

World Psychiatry Forum

Positive mental health: is there a cross-cultural definition?

George E. Vaillant
Postępy Psychiatrii i Neurologii 2012; 21(4): 229–250

Seven models for conceptualizing positive mental health are reviewed: mental health as above normal, epitomized by a DSM-IV's Global Assessment of Functioning (GAF) score of over 80; mental health as the presence of multiple human strengths rather than the absence of weaknesses; mental health conceptualized as maturity; mental health as the dominance of positive emotions; mental health as high socio-emotional intelligence; mental health as subjective well-being; mental health as resilience. Safeguards for the study of mental health are suggested, including the need to define mental health in terms that are culturally sensitive and inclusive, and the need to empirically and longitudinally validate criteria for mental health.


Psychiatric inpatient treatment – tasks and costs, in particular regarding patients with comorbid somatic and mental disorders

Maria Załuska, Elżbieta Kobrzyńska-Żochowska, Agnieszka Dyduch, Marek Balicki, Urszula Zaniewska-Chłopik, Maja Kszczotek, Bertrand Janota, Renata Żurko, Stanisława Kalużna
Postępy Psychiatrii i Neurologii 2012; 21(4): 251–257

Objectives. To estimate the prevalence of comorbid physical and mental disorders as well as their treatment costs in the total cost of services provided on a psychiatric ward of a general hospital.
Method. On the grounds of medical records the number of patients treated for comorbid physical and mental disorders and of those receiving only psychiatric treatment over the period of 12 months (in the year 2008) was calculated in three general hospitals in Warsaw (Bielański, Wolski & Bródnowski). An increase in medical costs incurred by treatment of physical disorders in patients of the psychiatric ward at the Bielański Hospital was calculated as a percentage of the purely psychiatric treatment cost. On these grounds the increase in personal costs of treatment of patients with comorbidities was estimated. Using the person-day cost for delivery of services contracted in the year 2008 and the percentage of psychiatric patients with comorbidities treated on the ward, the amount of underestimation of the actual person-day cost of treatment on the ward was calculated as a percent of the contracted person-day cost.
Results. Between 46.9% and 53.3% of patients treated on the wards under study had a comorbid physical disease. The most frequent conditions included cardiovascular, metabolic and endocrine diseases, alimentary tract and pulmonary disorders. The average medical cost of one person-day for the patient with a comorbid physical illness was by 23.6% higher than that for the patient receiving psychiatric treatment only. The average underestimation of only medical and personal costs per one patient treated on the ward amounted to 36.98% of the person-day cost offered in the contract by the National Health Fund (NFZ).
Conclusions. Since the costs of services delivered on psychiatric wards of general hospitals are underestimated, it is necessary to change the principles of contracting such services. Approximately 47%-53% of patients treated on psychiatric wards in general hospitals suffer from comorbid physical diseases increasing the total costs of their treatment by 23.6%. The increased costs of services delivery on psychiatric wards should be accounted for in the NFZ contracts in order both to establish new psychiatric wards in general hospitals, and to maintain the already existing ones.

Original article

Therapeutic relationship factors as perceived by the mentally ill and their therapists – results of a study in mental health community-based care and outpatient clinic settings

Małgorzata Sosnowska, Katarzyna Prot, Agnieszka Chojnowska, Jan Kobayashi, Krystyna Nurowska, Antoni Kalinowski, Alfreda Ruzikowska, Beata Kasperek-Zimowska
Postępy Psychiatrii i Neurologii 2012; 21(4): 259–267

Objectives. To examine the relation between therapeutic relationship and continuity of extra-hospital mental health care.
Method. Two groups participated in the study: 64 patients and 10 professionals from the Community Mental Health Team (CMHT), and 25 patients and 9 professionals from the Outpatient Mental Health Clinic. The patients had been diagnosed with psychotic spectrum disorders according to the ICD-10 criteria. Symptom severity was measured using the PANSS, therapeutic relationship – by means of the STAR scale, while continuity of care was assessed with a questionnaire developed by the authors and based on a Canadian program. In the statistical analysis Spearman's rank correlation and the Kruskal-Wallis test were applied.
Results. Therapeutic relationship was rated higher by professionals if mental health care was provided to the patient by the same person (provider continuity). Therapeutic relationship with patients manifesting less severe psychotic symptoms was rated higher by professionals in both types of settings, i.e. in the community-based and outpatient care. Moreover, professionals perceived less emotional difficulties in their work with patients diagnosed with more numerous psychotic symptoms. Older patients tended to give higher ratings of the therapeutic relationship and some of its dimensions, such as "positive co-operation" and "positive interventions". Higher ratings of their interventions provided to the patients were given by older psychiatrists and therapists.
Conclusions. Provider continuity is important for professionals' assessment of therapeutic relationship in general and of its aspects such as "positive cooperation" and "positive effects of intervention".

Original article

Needs of patients with mental health problems from perspective of the patients and their carers

Magdalena Ciałkowska-Kuźmińska, Andrzej Kiejna
Postępy Psychiatrii i Neurologii 2012; 21(4): 269–275

Objectives. To compare the patients' needs (met, unmet and general) seen from perspective of the patient and his/her carer.
Method. Participants in the study were 60 patients receiving treatment in inpatient mental health facilities, as well as 60 key carers indicated by the patients. They all were asked to assess the patient's met, unmet and general needs using the Camberwell Assessment of Need, Short Appraisal Schedule (CANSAS).
Results. Carers systematically perceived more needs of their charges in all areas than did the patients themselves. A number of statistically significant relationships were found between met, unmet and general needs identified by the patients and their carers. Illness duration as well as the patient's age and gender were related to his/her perception of particular need categories. Female carers noticed more unmet needs of their charges.
Conclusions. In the process of an individual treatment plan development and evaluation not only the needs reported by the patient, but also these identified by his/her key carer should be taken into consideration. In the psychiatric therapeutic process the patients' treatment should be supplemented by interventions aimed at their caregivers. The aforementioned discrepancy between the patients' and their carers' assessment of patient needs should be one of important topics to be discussed in the treatment process; besides, it should become an outcome criterion in the evaluation of systemic interventions in psychiatry.

Review article

Needs of patients with mental disorders – psychological vs. psychiatric perspectives

Magdalena Ciałkowska-Kuźmińska, Andrzej Kiejna
Postępy Psychiatrii i Neurologii 2012; 21(4): 277–282

Aim. To outline differences between psychological and psychiatric approaches to needs of persons with mental health problems.
Review. As regards the psychiatric perspective on individual needs, it is seldom based on psychological concepts of needs and motivation. It can be clearly seen not only in the description of psychopathological symptoms, but also in the design of instruments used to measure the needs of this patient group. However, psychological approaches may be very useful helping to understand the individual's motivation and behavior with regard to psychiatric treatment.
Conclusions. Awareness of the differences between psychiatric and psychological views on individual needs seems important, the more so that a systematic assessment of patient needs may be useful in the evaluation of the therapeutic process in psychiatry.

Review article

Neurocognitive correlates of pediatric diabetes type 1

Joanna Fryt, Władysława Pilecka
Postępy Psychiatrii i Neurologii 2012; 21(4): 283–291

Objective. The article presents current directions in research on neurocognitive correlates of type 1 diabetes in children.
Review. Research findings concerning cognitive functioning in children with diabetes are presented, including impairments of memory, attention, executive functions, and behavioral control. Moreover, risk factors for such impairments of children' functioning are outlined, such as hypo-, hyperglycemia and early onset of illness.
Conclusions. Better understanding of neurophysiologic mechanisms underlying cognitive dysfunctions, of their impact on diabetic children' daily functioning and on attaining optimal illness control seems to be of major clinical importance.

Review article

Posttraumatic growth in children and adolescents – research perspectives

Paulina Kwarta, Joanna Grzelińska, Tadeusz Pietras
Postępy Psychiatrii i Neurologii 2012; 21(3): 293–297

Objectives. To present the state-of-the-art in research on the phenomenon of posttraumatic growth in children and adolescents.
Review. One of the areas both in research and clinical practice in the field of posttraumatic growth, besides the assessment of post-traumatic stress disorder (PTSD), are positive effects of trauma. The paper presents the most recent directions in research on posttraumatic growth in children and adolescents.
Conclusions. An overview of the literature suggests new research perspectives in the field of post-traumatic growth in children and adolescents.

Review article

Therapeutic effects of the Social Cognition and Neurocognition Training (SCNT) in brain stroke patients

Ewelina Wilkos, Marta Giguere, Maryla Sawicka, Katarzyna Kucharska
Postępy Psychiatrii i Neurologii 2012; 21(4): 299–305

Objective. To present an interdisciplinary rehabilitation program focused on neurocognitive skills and social functioning - the Social Cognition and Neurocognition Training (SCNT).
Review. The SCNT is based on the cognitive-behavioral therapy model. Its structure is similar to that of such therapeutic programs as the Social Cognition and Interaction Training (SCIT), Cognitive Remediation Therapy (CRT) and Metacognitive Training. The aim of the SCNT is to help brain-damaged patients in restoration of empathy and attribution processes, and to improve their neurocognitive functions, i.e. attention, memory, thinking and meta-cognitive skills.
Conclusions. Provision of parallel training in neurocognitive and social cognitive skills is assumed to produce positive changes of cognitive, emotional and social nature that may subsequently lead to an improvement in the patients' quality of life [1]. Development and refinement of therapeutic methods in the management of post-stroke patients seems of crucial importance considering the high rates of both stroke incidence in the Polish population and disability among stroke survivors.

Case report

Foramen magnum meningioma

Tadeusz Mendel, Teresa Wierzba-Bobrowicz, Tomasz Stępień, Radosław Michalik, Renata Poniatowska
Postępy Psychiatrii i Neurologii 2012, 21(4): 307–312

Aim. A case of a very rare meningioma localization in the posterior fossa (at the foramen magnum) is presented.
Case report. The patient, a 66-year-old woman suffering from headaches and vertigo, was submitted to MRI examination which revealed a meningioma localized at the foramen magnum. Further observation was recommended. However, since the patient's neurological symptoms were aggravating, a subtotal resection of the meningioma was performed 4 years later. The diagnosis of transitional meningioma was confirmed by neuropathological examination.
Comment. Neurologists and neurosurgeons relatively often see patients with meningiomas in their clinical practice. However, doubts frequently arise whether asymptomatic or oligosymptomatic patients should receive conservative or rather surgical treatment. Sometimes it is difficult to decide whether such patients should be persuaded to submit to a surgery immediately, or the surgery should be postponed until they develop disquieting clinical and neurological symptoms.