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Psychiatria polska [journal]
- [Cognitive therapy of trauma related guilt in patients with PTSD]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):615-25.
Various aspects of guilt are frequent problems of patients suffering from PTSD, though they have been included into the diagnostic criteria for PTSD just in the present version DSM-5. Some studies indicate limitation of effectiveness of exposure therapy in PTSD patients with predominant emotions of anger or guilt. The aim of this paper is to present cognitive conceptualization of guilt in PTSD proposed by Kubany, and a treatment protocol resulting from this conceptualization. The clinical application of the protocol is illustrated with preliminary results of systematic observation of 8 patients with moderate to severe PTSD who were treated with cognitive therapy for guilt followed by a standard prolonged exposure protocol. The cognitive therapy of guilt can be a valuable supplement for treatment of PTSD. This protocol can also be an inspiration for therapists working with patients with dysfunctional guilt as a problem in other than PTSD disorders--like depression or adjustment disorders. In discussion the place of guilt in treatment according to different (PE-Foa et al.; CPT-Resick et al.; CT-Ehlers and Clark) trauma focused therapy approaches is addressed, and the need for further studies is underlined.
- [Dynamics of occupational and relational functioning of outpatients with mental disorders in two-year observation]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):599-613.
The aim of the project was to assess changes of occupational and relational functioning within 2 years period of ambulatory treatment of persons suffering from different mental disorders.Outpatients (n = 184) at the age of 18-54 from five diagnostic groups - according to ICD-10: psychotic disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6) were enrolled in the prospective study with 6, 12 and 24 months follow-up assessments. Functioning was evaluated by the Social and Occupational Functioning Assessment Scale (SOFAS) and the Global Assessment of Relational Functioning (GARF).In the whole group occupational and relational functioning improved during the two-year follow-up. At the time of recruitment to study the worst occupational functioning (SOFAS) was observed within the group schizophrenic patients and the best within neurotic group. In each diagnostic group SOFAS scores have improved over time. However, the groups F2 and F6 difference between the baseline and 24.months follow-up measurements was irrelevant statistically, whereas in the case of the other groups (F3, F4, F5) a significant increase were observed. In all diagnostic groups except F6 the relational functioning has improved. Taking into account the results of the entire cohort, there was no association between occupational functioning and relationships and age, sex. The occupational and relational functioning was, however, strongly associated with the presence of negative and depressive symptoms, number of days on sick leave and level of education.The results warrant further research, in-depth discussion on the recognition of occupational dysfunction, disability of social coping in relationships among people with mental disorders. The next step will be the introduction of appropriate after-effect in this regard.
- [Childhood sexual traumatic events and sexual life and relationship of a patient]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):573-97.
The assessment of links between traumatic events of sexual nature recollected from the past and patients' later functioning in sexual life and relationships.Comorbidity of memories of traumatic sexual events from childhood and adolescence in patients with the features of their current partner relationships was analysed on the basis of Live Inventory completed by 2,582 women and 1,347 men, undergoing treatment between the years 1980-2002, before they were admitted to a day ward of neurotic disorder department.The existence of numerous significant links was observed e.g. the information regarding incest or incest attempt experience was related with a significant risk ofa sexual life assessment as completely dissatisfying in women (OR = 2.71) and almost completely dissatisfying in men (OR = 2.38). Sexual initiation by rape was related with women's more frequent incidence of getting married as a result of social pressure (OR = 3.77) and a feeling of hatred towards a partner (OR = 5.41). Men and women who considered themselves completely sexually uneducated (before the age of 18) assessed their sexual life as completely dissatisfying (OR = 2.48 and OR = 2.07), which was similar to men who would get punished for masturbation or sexual plays by their guardians (OR=2.68).Traumatic events and circumstances relating to sexuality, indicated in the questionnaire interview, turned out to be connected with the risk of dysfunctions in a sexual life and relationship. The traumas included, among others, rape during initiation, early initiation, incest, but also unfavourable circumstances of less traumatic nature such as a lack of sexual education, punishment for masturbation, "mostly undesired initiation". Their likely effects were rooted in relationship dysfunctions: reasons for their formation, power division, instability, problems with resolving conflicts and, most of all, sexual life dysfunctions. The results were obtained on the basis of simple questionnaire questions, which allows for the recommendation that they be used in a routine interview.
- [Resilience and responses to the experience of trauma--a fascinating but difficult study area]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):563-72.
The notion of resilience, which attempts to explain the phenomenon of positive adaptation (coping) of people exposed to adversities or traumatic events, is becoming a significant area of research in Poland. It is a complex and multidimensional notion, on the borderline between genetics, neurophysiology, anthropology of culture, sociology, medicine, political science, developmental psychology and psychiatry. The phenomenon of resilience is interactive (as it combines the experience of trauma with adaptation to it), it is difficult to measure and it raises serious methodological concerns. They tend to be so significant that some researchers consider resilience to be a construct of dubious scientific value. Such a view seems to be overly critical, however it indicates the magnitude of methodological difficulties. This article discusses some of them: problems with definitions and terminology, measurement difficulties associated with the interactive nature of resilience, the need to search for complex interactions between biological, psychological, social and environmental factors (rather than overly simplistic focus on individual factors which support good adaptation). The methodological issues have been divided into the following research areas: the nature of traumatic experiences, response to trauma, factors which impact the reporting of the reaction to trauma, developmental problems.
- [Life without childhood--parentification of women with ACoA syndrome]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):553-62.
The aim of the study conducted on 110 women (55 research group, 55 control group) was to answer the question: If and what kind of parentification (role reversal in the family) do women with Adult Children of Alcoholics (ACoA) syndrome experience in comparison to women who did not experience parent's alcoholism in childhood?The following methods were applied in the study: a questionnaire prepared for screening children of alcoholics Children of Alcoholics Screening Test (CAST) by John Jones and Joanne Pilat, and a questionnaire to examine parentification Filial Responsibility Scale for Adult (FRS--A) created by Gregory Jurkovic and Alison Thirkield.The results have shown that in comparison to women who did not experience parental alcoholism in childhood, women with ACoA syndrome have more often experienced parentification and a sense of injustice in the past. Currently, these women also experience this feeling more frequently.The analysis of the results of this study could serve as valuable clues for the therapeutic work with women who are Adult Children of Alcoholics.
- [An interaction between a polymorphism of the serotonin transporter (5HTT) gene and the clinical picture of adolescents with combined type ofADHD (hyperkinetic disorder) and youth drinking]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):541-51.
The combined type of ADHD and alcohol dependence are two different disorders. Research demonstrate that 45-55% of patients diagnosed with ADHD also suffer from comorbid substance abuse, and 11-55% of patients diagnosed with substance abuse suffer from undiagnosed ADHD. Alcohol is by far the most widely used psychoactive substance in the European culture. The serotonin transporter (5HHT) gene has been implicated as one of the candidate genes in both disorders in recent molecular genetic research.The aim of the present study was to seek a common clinical and biological marker for hyperkinetic disorder and youth drinking.The study was conducted between 2008 and 2012. The sample consisted of 100 combined type ADHD patients: 51 adolescents youth drinking and 100 individuals without mental disorders or addiction in a population-based group. The 5HHT gene polymorphism was examined using PCR (Polymerase Chain Reaction). Statistical analysis was conducted with STATISTICA.PL software (version 5.0.97) licensed by StatSoft, Inc. USA.A preferential trend for the "s" short allele of the investigated 5HHT gene polymorphism was observed in all the groups of adolescents compared to the population-based group of adults without alcohol dependence (p = 0.01).Based on the conducted study a provisional conclusion may be drawn that the presence of the short "s" allele of the 5HTTgene polymorphism may be a prognostic factor of impulsivity in ADHD and of predisposition to alcohol dependence.
- [Effectiveness of alcohol prevention program for pre-adolescents]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):527-39.
The aim of this research was to assess the delayed effects of a two-year alcohol prevention program implemented in Polish primary schools.The program comprised two curricula implemented the school and in family houses: Program Domowych Detektywów and Fantastyczne Mozliwości. Both curricula were the Polish versions of two American school-based prevention programs which belonged to Project Northland. The initial study sample (N = 802) comprised 10 to 11 years old pupils (fourth and fifth-grade) from eight primary schools in Warsaw. Schools were randomly assigned to the intervention (n = 421) and the reference group (n = 381). A self-completion questionnaire was administered to students four times: at the baseline, seven, fifteen and twenty seven months after.The program had an expected influence on the students' attitudes, knowledge and resistance skills towards alcohol. The effects on the participants' initiation of drunkenness and their first experience in alcohol use with their peers have also been reported. Most of the positive effects remained significant over time.The effectiveness of the program, as shown by the outcome evaluation, supports an argument for its wide implementation in Polish schools. Further progress in the field of alcohol and drug prevention in Poland depends on overcoming the existing barriers in this area of public health.
- [Disturbances of social cognition in schizophrenia and bipolar disorder--similarities and differences]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):515-26.
In the first part of the article, two aspects of social cognition, such as the Theory of Mind (ToM), i.e. the ability to infer about mental and affective states of other people, having both cognitive and perceptive aspects as well as empathy, i.e. the ability to understand other person's perspective and take an emotional response of the observer to the affective state of the other person, were presented. Next, research on social cognition in schizophrenia and bipolar disorder (BD) has been reviewed, and the disturbances, observed in these two illnesses were compared, with particular emphasis on studies investigating social cognition in both schizophrenia and BD. The results of studies show that ToM disturbances occur both in schizophrenia and BD patients, however, in schizophrenia they are of greater severity. As for empathy, patients with schizophrenia have significant disturbances of recognizing emotions, as well as of cognitive and affective empathy. Patients with BD do not have abnormalities in cognitive empathy, have lesser disturbances of emotion recognition disorder compared with schizophrenia and show a connection between disturbances of affective empathy and the course of the disease (time period after manic or depressive episode). Further exploration of these issues seems important in order to determine to what extent the disturbances of social cognition can influence social and professional life of patients. It is also a potential area for therapeutic interventions supportive to pharmacotherapy.
- [Mentalization and theory of mind in borderline personality organization: exploring the differences between affective and cognitive aspects of social cognition in emotional pathology]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):503-13.
This article addresses the problem of explaining emotional pathology (levels of personality organization) using the concepts of theory of mind (ToM) and mentalization. Although these terms are used interchangeably to describe the "ability to interpret the behavior of others in terms of mental states," they do not have identical status in emotional disorders. ToM refers to a "cold" knowledge, whereas mentalization requires the activation of relational and emotional representations, as well as processing of emotional experience (whether reflection or defense). The aim of the study was to compare the cognitive (ToM) and affective (mentalization) aspects of "understanding the behavior of others in terms of mental states" in the clinical group--consisting of patients with borderline personality organization (N = 30); and the control group (N = 30).The Borderline Personality Inventory was used as a diagnostic questionnaire for the organization of personality, the Strange Stories Test was employed to measure ToM, and the Mental States Task instrument measured mentalization.With respect to mentalization, different patterns of results were obtained: the activation of overwhelming mental states and primitive defenses in the clinical group; as well as the inhibition of the recognition of mental content by defenses, such as denial and suppression of emotions, in the control group. No differences were observed in ToM between groups.In explaining the personality organization levels, only the affective, and not the cognitive, aspects of "understanding the behavior of others in terms of mental states" are significant. People with borderline personality organization, as well as healthy individuals, use "cold" knowledge about internal states. However, the activation of relational and emotional representations triggers different mental states in both groups.
- [Profile of moral reasoning in persons with bipolar affective disorder]. [English Abstract, Journal Article]
- Psychiatr Pol 2014 May-Jun; 48(3):489-502.
The subject of the research presented in this paper was to analyze the relationships between bipolar disorder (BD) and the profile of moral reasoning according to the concept of James Rest.86 persons took part in the research, including 43 bipolar patients and 43 healthy individuals. To measure the severity of depression and mania symptoms the following scales were used: Hamilton Rating Scale for Depression (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS) and Young Rating Scale for Mania (YMRS). Profile of moral reasoning was defined on the basis of the results obtained in the Defining Issue Test (DIT) by James Rest.Statistical analysis showed that there is a relationship between bipolar disorder (and its phases) and the profile of moral reasoning: bipolar patients significantly less often than healthy individuals chose answers indicating the postconventional thinking (p = 0.000) - and more often - answers indicating stage 3 and those belonging to the anti-institutional thinking index (p = 0.000). There was also a relationship shown between the development of moral reasoning and the phase of bipolar disorder: patients in mania less often than persons in euthymia chose answers indicating the final stage of moral thinking (p = 0.050). There were no significant differences between the results of patients with a depressive episode and the results of patients in mania and between the results of patients with a depressive episode and the results of patients in euthymia.The results suggest that the psychological state of the individual may have an impact on the process of moral reasoning - bipolar disorder may to some extent influence the way of thinking about moral dilemmas. The collected data also seem to emphasize the specificity of the manic phase which is especially worth exploration when conducting further studies.