Psychiatria polska [journal]
- The usfulness of the SLUMS test for diagnosis of mild cognitive impairment and dementia. [JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):457-472.
To compare Polish version of the The Saint Louis University Mental Status Examination test (SLUMS) to generally used psychometric screening tools for detecting mild cognitive impairment and dementia.The total number of 58 nursing home residents were divided into 3 groups: 1) people showing no symptoms of dementia, 2) people with mild cognitive impairment and 3) people with suspected dementia. The Saint Louis University Mental Status Examination (SLUMS), Mini Mental State Examination (MMSE), Short Test of Mental State (STMS) and Test Your Memory (TYM) were administered for comparison.Mean age was 81.7 ± 8.62. Regarding the education, 37.9% of the sample was educated at the primary school level, 31% completed high school and 22.4 % had higher education. The SLUMS internal consistency was 0.7031. The mean of total SLUMS score was 23.3 in no demented residents, 19.3 among those identified as having cognitive impairments and 13.1 residents with suspected dementia. The statistical analysis illustrated that SLUMS differentiate the dementia residents from those considered as having cognitive impairment (p = 0.01), as well as from non demented participants (p = 0.0001). Moreover, it seems to be useful for detecting mild cognitive impairment in non demented participants (p=0.017), while MMSE does not offer such a possibility (p = 0.51).The SLUMS is not just another screening tool that can complement the range of existing cognitive tests in Polish clinical practice, but according to statistical analysis it demonstrates superior capabilities in the screening diagnosis compared to the most famous scale used in Poland - MMSE.
- Autotelic vs instrumental motivation of doctors and their medical specialty choice in relation to sense of coherence. [JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):445-455.
Analysis and comparison of two types of motivation (autotelic and non-autotelic) which are behind the choice of medical specialisation by doctors in relation to their sense of coherence.Questionnaire method was used in the study. The study included a group of 86 graduates of the Faculty of Medicine of the Jagiellonian University, who have completed postgraduate internships at the Department of Haematology and Oncology, Department of Gynaecology of the Jagiellonian University and the L. Rydygier hospital in Krakow in 2010-2012. Statistical analyses were performed using the IBM SPSS Statistics 21. The level of significance was alpha = 0.05.It has been shown that doctors are more frequently characterised by the autotelic type of motivation. It has also been proven that there is a relationship between the male sex of the surveyed doctors and their autotelic type of motivation. Moreover, it has been demonstrated that there is a correlation between the comprehensibility component of the sense of coherence and the male sex. It has been also demonstrated that there is a correlation between meaningfulness component of the sense of coherence and the choice of surgical specialisation.Autotelic motivation prevails when choosing a medical specialty and this tendency is more noticeable in men than in women. The meaningfulness component of SoC plays a regulatory role in making career decisions related to the greater physical and mental pressure put on doctors. The observed differences in the types of motivation and the size of the components of the sense of coherence in groups of surveyed doctors - men and women - encourage further observations of these relationships on a larger population.
- Psychiatric wards in general hospitals - the opinions of psychiatrists employed there. [JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):431-443.
The world literature is reporting economic destabilisation of psychiatric wards in general hospitals related to the new rules of financing (managed care). The aim of this paper is to analyse the literature on psychiatric wards in general hospitals, and to know the opinions of psychiatrists employed in these wards in Poland regarding organisational model and the stability of these wards.The 18-items Likert-type questionnaire was send to 83 psychiatric wards in Poland and published on the website psychiatria.pl.50 psychiatrists from psychiatric wards in general hospitals in 11 provinces had responded. The prevailing number of respondents positively assessed: the organisational model of the ward, implications for therapy arising from its location in the general hospital and the relationships with colleges of other specialties. However, they assessed negatively: the working conditions, stability of employment, the mode of treating the psychiatrists by the management of the hospital, and the interest of the authorities in these wards. The majority of respondents (72%) prefer to work in integrated stationary/ambulatory services, and postulates (86% of respondents) that the psychiatric wards in general hospitals should be guaranteed permanent status in the mental health system.The psychiatrists employed in the psychiatric wards in general hospitals in Poland evaluate this organisational model positively. However, the destabilisation of economic foundations of these wards reported in the world literature was also reflected in the results of a survey conducted in Poland. There is a need to develop standards for the organisation and financing departments of psychiatry in general hospitals providing them stable status in the healthcare system in Poland.
- Lower urinary tract symptoms, nocturia and overactive bladder in patients with depression and anxiety. [REVIEW, JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):417-430.
Lower urinary tract symptoms (LUTS) remain highly prevalent worldwide, and are well known to negatively impact patients' quality of life, sleep and psychosocial wellbeing. Conversely, both depression and anxiety have been shown to have a negative effect on perception, development and prolongation of LUTS. This paper provides an overview of an association between the lower urinary tract symptoms, depression and anxiety. It also explores possible common mechanisms underlying the causes of both conditions. There has been a large body of evidence linking LUTS with anxiety and/or depression. Studies have documented not only a significant impact of LUTS on the psychosocial wellbeing, but also showed a strong negative effect of depression and anxiety on perception, development and prolongation of LUTS. High level of psychiatric morbidity has important implications on the appropriate management in patients with LUTS, as well as LUTS may have important implications on development and management of depression and anxiety. Therefore, clinicians should be aware of the bidirectional association between LUTS and anxiety and/or depression, as some patients may require a multidisciplinary approach and a combined treatment. The precise common mechanism underlying LUTS, depression and anxiety remain largely unknown and further research is needed to elucidate the underlying pathophysiological pathways.
- Relationship between diabetic neuropathy and occurrence of depression among diabetic patients. [REVIEW, JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):407-415.
Diabetes itself, by its nature, can aggravate the symptoms of depression. One of its main complications is peripheral diabetic neuropathy (PDN). Based on the literature the presence of the relationship between the PDN and depression is confirmed. The symptoms connected with instability while walking and reduction of everyday activities were the strongest predictors of the intensification of depression symptoms. The relationship between the neuropathic ulcers and depression is considered as ambiguous. Additional problems in diagnosis and evaluation is the polyetiologic character of the disease, damage to the nerve fibers of different thickness, variety of methods of the diagnosis and differences in the prevalence of diabetic neuropathy (26%-50%). The presence of the described differences may be connected with diagnostic methods and the fact of the modification of perceived symptoms such as pain by the depression itself. One of the results of difficulties in describing the relationships and diagnosis are problems, described in the literature, with the selection of patients requiring treatment of PDN.
- Overweight, obesity and cognitive functions disorders in group of people suffering from mental illness. [JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):393-406.
The aim of this study was to examine whether obesity affects cognitive functions in people suffering from mental illness.91 persons suffering from mental illness, including 51 women and 40 men took part in the study. Mean age of patients was 46 years. These persons were under constant psychiatric care, they were the participants of the daily support centre. Overweight and obesity was measured by Body Mass Index (BMI). Abdominal obesity was measured according to IDF guidelines and waist-hip ratio (WHR). Cognitive functions were examined using STMS, Verbal Fluency Test and Rey Auditory Verbal Test.Abdominal obesity was diagnosed in 70% of patients according to IDF guidelines and in 61% according to WHR, in women these results were respectively: 83% and 94%, while in men 62% and 32%. BMI distribution in the study group was respectively: obesity class II - 5 persons (5%), obesity class I - 26 persons (28%), overweight - 32 persons (35%), correct BMI - 27 persons (30%), underweight - 1 person (2%). There was a negative correlation between WHR, waist circumference and abstract reasoning, direct memory and delayed memory. BMI and body mass correlated negatively only with delayed memory. Number of medications taken by the studied persons showed a positive correlation with body mass and waist circumference. Negative correlations between cognitive functions and body mass, overweight and abdominal obesity was observed in women. In men these correlations were not observed, there were only correlations between cognitive functions and age.Obesity contributes to a decline in cognitive functions especially in direct memory and abstract reasoning.
- Family caregivers' experiences with healthcare services - a case of Huntington disease. [CASE REPORTS]
- Psychiatr Pol 2016; 50(2):375-391.
Despite a growing interest in the health and psychosocial consequences of caring for a person with Huntington's disease (pHD), little is still known about family caregivers of such patients in Poland. At the same time, while researchers focus on the needs, quality of life and caregiving burden, they frequently omit caregivers'experiences with healthcare services. This paper aims to report a study on the perception of healthcare services of family caregivers of pHD.The research was carried out between August and December 2014 among 55 family caregivers of pHD. The respondents were recruited via the Polish Huntington Disease Association and a discussion forum for pHD and their carers. The material was collected via semi-structured interviews and analysed using a content and thematic analysis of the transcripts.Four themes emerged during the interviews: 1) Lack of information on HD from physicians; 2) Negative experience with health professionals 3) Lack of emotional support, and 4) General dissatisfaction with healthcare services. Caregivers were frustrated by the lack of knowledge about HD from physicians and believed that they do not show enough empathy and support to caregivers. They also felt let down by the system and expressed general lack of trust in the standard of healthcare.This study revealed HD caregivers'complex needs for healthcare assistance and emotional support. For that reason health and social professionals should monitor caregivers' mental health, identify the sources of their distress and support effective strategies to cope with the stress.
- Elective cesarean section on psychiatric indications - the phenomenon analysis, report of two cases and psychiatric clinical recommendations. [REVIEW, JOURNAL ARTICLE]
- Psychiatr Pol 2016; 50(2):357-373.
In Poland, no guidelines concerning the mode of delivery in patients with psychiatric disorders have so far been developed. The most common psychiatric diagnosis discussed in the Polish literature in the context of the indications for the elective caesarean section is tokophobia. It was confirmed in recent studies that intense fear of childbirth, requiring medical interventions is an important predictor of postpartum depression. Other studies have shown that emergency delivery causes long lasting posttraumatic stress disorder symptoms. The aim of this paper is to discuss the different mental disorders, which may determine psychiatric indications for elective CS.A literature review and analysis of two cases. Review of the literature was made via MEDLINE and based on such a keywords as: mental health, mode of delivery, caesarean section, psychiatric indications for CS. In the analysis, papers based on population studies and essential because of the potential clinical decisions concerning psychiatric indications for CS were taken into account first.Psychiatric indications for the preferred type of delivery are determined individually. They are mainly based on the ability of the psychiatric patient to cooperate with obstetric staff during vaginal delivery. The second area of psychiatric indications is a strong fear of labour that results in the need for psychiatric consultation in the last trimester of pregnancy or the perinatal period.Antenatal care of women with mental disorders requires close cooperation between the obstetricians and psychiatrists specialised in the mental disorders due to somatic state. Such cooperation should lead to preventing both obstetric and psychiatric complications during the pregnancy and labour in women experiencing symptoms of mental disorders.
- Neuropathic pain after spinal cord injury resistant to conventional therapies - case report. [CASE REPORTS]
- Psychiatr Pol 2016; 50(2):345-355.
There are patients with neuropathic pain in whom the treatment is ineffective, despite the fact that is conducted with adherence to the current guidelines. In these patients alternative treatment methods such as hypnosis could be effective.The paper presents a case of a 58-year-old man with central neuropathic pain after cervical spinal cord injury. The conservative treatment with antiepileptics including gabapentoids), antidepressants (tricyclic and selective noradrenaline and serotonin inhibitor - SNRI) and opioids was not effective. In the pain management centre the celiac plexus stimulation and neuromodulation was performed, however, with no positive results. The patient was referred to the psychiatrist using hypnosis in his medical practice.The psychiatrist qualified the patient to pain treatment with hypnosis. After several hypnotic sessions the pain intensity score in numeric rating scale (NRS) decreased from NRS 7 to NRS 5 points and became acceptable for the patient.Hypnosis can be considered an effective method of neuropathic pain treatment in some patients.
- Psychiatric disturbances as a first clinical symptom of Wilson's disease - case report. [CASE REPORTS]
- Psychiatr Pol 2016; 50(2):337-344.
Wilson's disease (WD) is an inherited disorder of copper metabolism with wide spectrum of clinical symptoms, mainly hepatic or neurological. Psychiatric disorders occur less frequently and are not pathognomonic for WD. However, in almost 20% of cases they are in fact the first clinical manifestation of WD. The aim of this paper is to emphasise the importance of including WD in differential diagnosis of psychiatric disorders in young adults, as well as caution in initiating psychiatric treatment for patients with already established diagnosis of WD.Case report of a patient with primarily psychiatric manifestation of WD.The authors present the case of a 26-year-old patient treated for 3 years due to depressive syndrome who was diagnosed as WD in the differential diagnosis shortly after extrapyramidal symptoms developed. During the further WD treatment the manic episode occurred. The patient was treated with atypical neuroleptics and anxiolytics, with good psychiatric effect, but with severe neurological deterioration. However, long term use of valproic acid and olanzapine combined with continuation of anti-copper treatment and rehabilitation resulted in good psychiatric and neurological outcome.WD should be always considered in differential diagnosis of psychiatric disorders in young patients, especially if they present additional extrapyramidal or hepatic symptoms. It is also extremely important to remain cautious when drugs with high affinity to dopamine D2 receptors need to be initiated in patients already diagnosed with WD, as they may result in severe and often irreversible neurological complications.