Archives 1992-2013

2013, volume 22, issue 1

World Psychiatry Forum

Issues and developments on the consumer recovery construct

Alan S. Bellack, Amy Drapalski
Postępy Psychiatrii i Neurologii 2013; 22 (1): 5–11

The consumer recovery model has had increasing influence on mental health practices in the United States, Western Europe, and several other countries. However, adoption of the model has reflected political decisions rather than empirical evidence of the validity of the model or its value for treatment services. The recovery construct is poorly defined, and until recently there has been no reliable and
valid measure with which to base a research program. We have developed an empirical measure that is well-suited for both research and clinical applications: the Maryland Assessment of Recovery in Serious Mental Illness (MARS). We briefly describe the MARS and present preliminary data demonstrating that recovery is not a simple by-product of traditional outcome domains, but seems to be a distinct construct that may have important implications for understanding consumers with serious mental illness and for evaluating the outcome of treatment programs.

Original article

Relationship of socio-demographic and clinical predictors with social networks in people suffering from schizophrenic psychoses

Andrzej Cechnicki, Anna Wojciechowska, Aneta Kalisz, Piotr Błądziński, Michał Skalski
Postępy Psychiatrii i Neurologii 2013; 22 (1): 33–40

Objectives. This report is a part of the Cracow prospective study on the course of schizophrenia. Links between socio-demographic and clinical factors on the one hand and the patient social network indicators on the other, as well as stability of the relationships found were examined at seven and twelve years of living with illness.
Methods. The study sample comprised 47 patients with the DSM-IV diagnosis of schizophrenia, assessed at two time points: at seven and twelve years from their index hospitalization. Social network indicators including the network scope, size of extrafamilial networks, and overall level of instrumental and emotional support outside the family were measured using the Bizoń Social Support Questionnaire. Major socio-demographic predictors of the future course of illness were assessed with a Prognostic Scale (modified from the Strauss-Carpenter Scale). The Expressed Emotion indicator was evaluated during the index hospitalization using the Camberwell Family Interview, and the Brief of Psychiatric Rating Scale was employed to rate symptom severity. Impact assessment was carried out using linear stepwise regression analysis.
Results. The constellation of socio-demographic and clinical factors under study explained 46% of the scope of the patient’s social network after 7 years of illness, and 32% after 12 years (both significant at p < 0.001). The figures for the scope of the extrafamilial social network were 25% (p = 0.003) and 24% (p = 0.005) at the 7- and 12-year follow-ups, respectively. High levels of social support were explained as follows: overall social support 36% and 33%, instrumental support 31% and 38%, emotional support 31% and 28%, respectively; all the values significant at p = 0.001. Finally, the predictors explained 17% (p = 0.012) and 19% (p = 0.016) of high levels of social support outside the family.
Conclusions. 1) Socio-demographic and clinical predictors explain between 17% and 46% of variability in social network indicators in short-term and long-term treatment outcomes. 2) Socio-demographic and clinical predictors offer the highest degree of explanation for the scope of the network, and the lowest degree of explanation for the scope of support outside the family. 3) It is most usually a higher education level, profound and satisfying social contacts outside the family prior to the onset of illness, and later age of onset in various configurations that contribute most to the explanation of positive social network indicators. 4) The amount of variability explained between the 7th and 12th years of illness is relatively stable.

Original article

Concordance between diagnoses based on the Composite International Diagnostic Interview (CIDI) and clinical diagnoses made by psychiatrists

Marta Welbel, Joanna Mikulska, Grażyna Świątkiewicz
Postępy Psychiatrii i Neurologii 2013; 22 (1): 41–50

Objectives. The aim of the study was to preliminarily assess concordance between diagnoses based on the Polish adaptation of the Composite International Diagnostic Interview (CIDI) and diagnoses made by clinicians-psychiatrists.
Method. Participants in the study were 139 patients of Mental Health Outpatient Clinics in Warsaw, and 152 subjects from the general population. Diagnoses produced using the CIDI were compared with these from the patients’ medical records, or – in the general population sample – with diagnoses made by psychiatrists using the Mini International Neuropsychiatric Interview (MINI).
Results. Diagnoses concerning categories of mood (affective) disorders as well as neurotic and stress-related disorders were compared. Moderated concordance prevailed both in the patient group and in the general population sample. In the latter group it was not possible to establish concordance levels for some disorder categories due to too few relevant diagnoses.
Conclusions. Considering a preliminary character of the study its findings seem promising and warranting further more detailed research in this area.

Original article

The effect of the Reimbursement Act on therapeutic management and pharmacotherapy costs in psychiatry to date as exemplifi ed by selected drug groups

Aleksandra Komorowska, Piotr Grzybała, Bogdan Falkiewicz, Anna Smaga
Postępy Psychiatrii i Neurologii 2013; 22 (1): 51–59

Objectives. Regulations introduced in 2012 have significantly influenced the health care market in Poland. The aim of the paper was to outline the effects of these changes on patients, physicians and the National Health Fund (NFZ), and particularly on therapies administered by psychiatrists, i.e. on antipsychotic and antiepileptic medications.
Method. Prescription data are derived from the RECEPTometr Sequence service database including almost 10% of prescription drugs sold by pharmacies. At present this amounts to about 44 million product prescriptions. Another source of quantitative data were NFZ reports concerning the value and number of packages of reimbursed drugs, published on NFZ websites.
Results. The more strict control mechanisms introduced by the Reimbursement Act [1] and the actually increased risk of being fined for prescription drug reimbursement errors resulted in alteration of physicians’ medication prescribing behavior (mostly as regards reimbursed drugs). This is one of factors contributing to reduced NFZ expenditures in the area under study. These NFZ savings are mostly paid for by a lower availability of medication to patients due to a number of changes: altered co-payment categories in limit groups, new (lower) reimbursement limits, and penalization of unwarranted reimbursement. At the same time the changes introduced by the Act may lead to a more careful than before decision making about reimbursed pharmacotherapy.
Conclusions. In the year 2012 as compared to 2011 the mean patient drug payments have increased in the medication categories under study. The increased patient charges result directly from the Reimbursement Act provisions (i.e. from altered co-payment categories or from new algorithms for the calculation of reimbursement limits), but also from a change in physicians’ drug-prescribing behavior. Afraid of being fined, physicians much more often decide to prescribe drugs fully covered by the patient.

Review article

Sleep disorders among children and adolescents – selected issues

Bogna Andrzejczak, Agnieszka Gmitrowicz
Postępy Psychiatrii i Neurologii 2013; 22 (1): 61–66

Objectives. The aim of this paper is to briefly review sleep disorders occurring among children and adolescents.
Review. In clinical practice sleep disorders are seen by doctors of various specialties, including child and adolescent psychiatrists, since the onset of some sleep problems may occur in this age group. This paper presents sleep disturbances according to the International Classification of Sleep Disorders (ICSD-2). Some diagnostic categories most prevalent in this population are described in more detail, e.g. the obstructive sleep apnea syndrome, confusional arousals, sleepwalking, sleep terrors, delayed sleep-phase syndrome, narcolepsy and sleep disorders associated with mental disorders.
Conclusions. Sleep disorders affect the functioning of children and adolescents, often impairing their quality of life. Understanding of sleep problems, and in particular diagnostics of specific sleep disorders in children and adolescents should elicit increasing interest among physicians, since these conditions - if left untreated or misdiagnosed - may become consolidated and persist in adulthood.

Review article

Leon Wernic as a supporter and promoter of eugenics

Teresa Rzepa, Ryszard Żaba
Postępy Psychiatrii i Neurologii 2013; 22 (1): 67–74

Objective. In this article we present the work of Marek Leon Wernic, MD, well-known in Poland and abroad as a venereologist and popularizer of eugenics.
Review. M.L. Wernic (1870-1953) was a Polish physician specialist in dermatology and venereology who advocated the principles of eugenics and healthy lifestyle. The major scientific achievements of Dr. Wernic were in the following three fields: venereology, eugenics and health system organization in Poland. He believed eugenics to be a convenient method of solving such social problems as hereditary diseases, prostitution, and crime. He published many scientific papers in Polish professional journals including “The Medical Journal”, “Review of Dermatology and Venereology”, “Medicine”, “Eugenics in Poland”. He was a Board Member of the International Union Against Venereal Diseases, President of the Polish Dermatological Society Warsaw Branch, Deputy President of the International Eugenics Union, co-founder and President of the Polish Eugenics Society, a honorary member of the Kalisz Hygiene Society. He was deeply committed to introducing in Poland legislation targeted on eugenics, and to requirement of mandatory serologic tests for syphilis in the case of marriage planning couples, pregnant women, and children. He also strived to implement generally available free of charge STD testing and treatment in Poland.
Commentary. Debate on some eugenics methods serving to improve the quality of life in the community seems to be still valid.

Review article

Classifications of mental disorders by Adolf Rothe (1832-1903)

Ryszard Kujawski
Postępy Psychiatrii i Neurologii 2013; 22 (1): 75–85

Objective. The article presents classifications of mental disorders published by a Polish psychiatrist, Adolf Rothe (1832-1903).
Review. Rothe proposed three classifications for the following purposes: statistic reports (published in the 1860s, 1870s and 1880s), forensic psychiatric expert opinions (1879), and to be used by psychiatrists in clinical practice (1885).
Commentary. Rothe’s classifications were modeled on the solutions applied in Germany by Wilhelm Griesinger and Heinrich Schüle. Adolf Rothe adapted them to the Polish tradition and psychiatric nomenclature. His classifications described categorization of mental disorders in accordance with psychiatric practice in that period. The development of the Polish version of the Griesinger classification in 1861 is described in the paper. The present author proposed to name the adaptation „The Warsaw Classification”.