Psychiatria polska最新文献

In the Polish legal system, each medical procedure requires patient's consent. Exemptions from the obligation to obtain such a consent are limited by the legislator to exceptional situations, i.e., when the delay caused by the procedure for obtaining consent would pose a threat to patient's life, serious injury, or serious health impairment. Undergoing addiction treatment is also voluntary. Exceptions to this principle are stipulated by a legal act. People who abuse alcohol and therefore break down family life, demoralize minors, avoid the obligation to meet the needs of their families, or systematically disturb peace or public order, may be obliged to undergo addiction treatment in an inpatient or outpatient treatment centre on condition that they are addicted to alcohol. A patient who fails to report to the medical entity designated by the court to execute the decision on the obligation to undertake addiction treatment may be brought to this entity by the police. In the context of the obligation to obtain a consent for treatment by a person against whom a court decision containing an obligation in this respect has been issued, there are discrepancies in the application of law provisions. In some medical entities, this results in the forced continuation of addiction treatment by a given patient in hospital, as discharge from the hospital depends on a court order issued in this regard, not on the consent of the patient himself/herself. In other medical entities, patients are not admitted for treatment due to the lack of such a consent, despite the court's obligation in this respect. The article confirms that a specific practice of applying the law, which downgrades the role of the patient's consent in the therapeutic process, has negative consequences for the effectiveness of the therapy.

The development of treatment methods for nicotine dependence has progressed slowly because people with psychiatric disorders are usually excluded from participating in clinical trials. There are several therapeutic options to support smoking cessation, including psychological and pharmacological interventions, which should be offered to smokers with mental disorders. The first step in helping tobacco smokers and nicotine-dependent individuals is the assessment of smoking intensity and confirmation of nicotine dependence. Currently, we have several methods of treating nicotine dependence - starting from education and psychotherapy, through pharmacotherapy and replacement therapy, and ending up with obtaining gradual progress with the application of harm reduction. Pharmacological treatment options include nicotine replacement therapy, varenicline or bupropion. The effectiveness of such interventions can be improved by providing anti-smoking therapy under psychiatric treatment and promoting harm reduction as an acceptable initial therapeutic goal. The harm reduction strategy is an approach that should be taken into account individually, particularly in the case of individuals unable to stop smoking, patients with limited insight into their illness, patients experiencing an exacerbation of their illness and persistently uncooperative patients. In this paper, recommendations of the Polish Psychiatric Association on the diagnostics and different treatment methods for nicotine dependence in patients with psychiatric disorders are presented.

Objectives: Evidence suggests that decreased dopamine secretion in mesocorticolimbic pathways could predispose to increased susceptibility to substance addiction. It has been proposed to define such a phenomenon as the reward deficit syndrome (RDS). Dopaminergic projections of the reward system receive glutaminergic projections from cortex. Research indicates that a reduction in the stimulating glutamatergic transmission on the dopaminergic system could represent an alternative phenotype of RDS. Potential source of this type of abnormality is glutamate reuptake which depends on excitatory amino acid transport proteins (EAAT) function. The most important of them is EAAT2, polymorphisms of which have been linked to several mental disorders.

Methods: We analyzed the genetic and psychometric data of 125 young adults (n = 125) for the effect of the rs4354668 polymorphism of the SLC1A2 gene for EAAT2 on the risky or harmful drug use (RHDU). After exploratory analysis we used logistic regression models to assess the probability of RHDU in individual groups.

Results: In the final model T/T variant of rs4354668 was significantly associated with a lower probability of RHDU occurrence compared to G/G variant (OR: 0.021; 95% CI: 0.001 - 0.275; p = 0.009). Other significant predictors of RHDU were smoking status and risky or harmful drinking of alcohol.

Conclusions: The results obtained may indicate a possible relationship of the risk of harmful drug use with variants of the rs4354668 polymorphism of the SLC1A2 gene for EAAT2. Subjects with the T/T variant of this polymorphism appear to be less at risk of developing drug use disorders.

Objectives: The aim of this article is to introduce the Polish adaptation of the Developmental Crisis Questionnaire (DCQ-12). In Poland, there is currently no tool for measuring the quarterlife crisis, hindering empirical exploration and cognitive understanding of this phenomenon. The DCQ-12, developed by Petrov and colleagues, serves as an age-independent measure of adult developmental crisis for research and applied purposes.

Methods: This research was conducted online by an external company specializing in research panels. The sample comprised a total of 1,176 subjects. To assess the psychometric properties of the scale, internal structure analyses, including exploratory and confirmatory factor analyses, were performed as well as validity assessment.

Results: Statistical analyses indicated that the Polish adaptation of the DCQ-12 is a reliable tool for examining the severity of the quarter-life crisis and its components. The obtained results confirm the tool's structure, with psychometric properties in the Polish study comparable to the original data. The Cronbach's α for the entire scale was 0.78 which suggests that the reliability of the questionnaire is satisfactory and acceptable.

Conclusions: The Polish version of the DCQ-12 demonstrated good psychometric properties.Its utilization in therapeutic practice can be particularly beneficial and provide insights into specific aspects of the quarter-life crisis.

Objectives: The aim of this pilot study was to compare the level of empathy, temperament and character traits before and after 6 months of treatment in a group of patients staying in a psychiatric day care unit in groups with different (internalising vs. externalising) disorder types.

Methods: The study was conducted in a group of 44 patients (33 girls and 11 boys), aged 15-20, treated between 2016 and 2021 in the Clinical Day Care Unit of the Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Krakow. 40% of the adolescents had externalising disorders and 60% had internalising disorders. The Davis Empathy Scale and the Cohen Empathy Scale were used in the study, as well as the Cloninger' Temperament and Character Inventory (TCI).

Results: Six months of treatment in a day care unit resulted in statistically significant changes in the "Fantasy" scale from the Davis Empathy Scale, in the "Reward dependence", "Self-directedness" and "Self-transcendence" subscales on the Temperament and Character Inventory in the group of adolescents with internalising disorders. In the group of adolescents with externalising disorders, there were changes at the level of statistical trend in the values of the "Fantasy" scale and the "Harm Avoidance" scale of the Temperament and Character Inventory.

Conclusions: The obtained results are in line with the available data in terms of differences in temperament and character profiles between types of mental disorders and constellations of traits that are unfavourable for mental health, such as low self-directedness, harm avoidance and reward dependence.

Objectives: Virtual reality (VR) is growing in popularity in treating various psychiatric disorders, including psychotic ones. However, no studies have been published on mindfulness interventions aided by virtual reality in psychotic patients to date.

Methods: 25 patients with schizophrenia or schizoaffective disorder were assessed at three time points with 4-week intervals using the six-item Positive and Negative Syndrome Scale (PANSS-6), Quick Inventory of Depressive Symptomatology (QIDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), and the Addenbrooke's Cognitive Examination III (ACE-III). Additionally, the intensity of seven emotions was rated using the Visual Analog Scale (VAS) before and after each training session.

Results: The subjects achieved a significant reduction in symptom severity after completing mindfulness training. This was reflected by the PANSS-6 total score, as well as by the subscales for negative and positive symptoms. A significant increase in cognitive functioning (ACE-III scores) was also found. No significant changes in these measures were observed when only the standard intervention was used.

Conclusions: Our study indicates good feasibility of the developed mindfulness intervention in VR in schizophrenic patients. The results indicate potential benefits in terms of lessening of the symptoms and improvement in cognition.

Electroconvulsive therapy has been a method used in psychiatry since 1938 and despite its rather turbulent history, it is still the most effective method of treating severe mental disorders. Despite its high efficiency and good safety profile, patients with catatonia usually require a large number of treatments. It entails a long hospitalization time and the necessity to repeatedly induce general anesthesia. In 1966, Blachly proposed to induce more than one seizure during a single anesthesia. According to this method, the patient was to be constantly monitored (ECG, EEG) during a series of electroconvulsions, which consisted of two to even eight treatments. For simplicity, the method is called multiple-monitored ECT (MMECT). The work is based on the medical history of a patient diagnosed with catatonic schizophrenia. Due to the insufficient effect of single treatments, we decided to use the MMECT method, which was performed in series of three treatments, twice a week. Thanks to the therapy, catatonic symptoms remitted. Studies in various patient populations have shown that MMECT reduces hospitalization time, the duration of acute symptoms, and the patient's total exposure to anesthetics and muscle relaxants. As the above case shows, MMECT can potentially be considered as a safe treatment alternative in patients that require a large number of treatments, resistant to standard forms of therapy.

This year, we observe sixty's anniversary of the article by a British psychiatrist, Geoffrey Hartigan, demonstrating, for the first time, the possibility of preventing of the recurrence of mood disorders by using lithium salts. Herein, a history of prevention of recurrences of mood disorders both worldwide and in Poland will be presented concerning both lithium and other mood-stabilizing drugs. The merit for verifying the prophylactic lithium effect in the 1960-1970s should be given to Danish researchers, Mogens Schou and Poul Baastrup. In Poland, the first paper on prophylactic lithium appeared already in 1971. In the 1970s, French researchers showed prophylactic activity of valproic acid amide, and Japanese researchers - carbamazepine. In the 1980th, studies on valproic acid amide were performed in the 2nd Psychiatric Clinic of the Institute of Psychiatry and Neurology led by Prof. Pużyński. Since the mid-1990s, 2nd generation of mood-stabilizing drugs has been introduced, including some atypical antipsychotics (clozapine, olanzapine, quetiapine, aripiprazole, risperidone) and anticonvulsant drug, lamotrigine, showing prophylactic activity in bipolar mood disorder. The studies on lithium resulted in the identification of factors connected with its prophylactic efficacy as well as the antisuicidal, antiviral, and neuroprotective effects of this drug. From a sixty-year perspective following Hartigan's article, it seems that his pioneering concept on the possibility of pharmacological influence on the course of mood disorders was fully confirmed. Current Polish recommendations on pharmacological prophylaxis of mood disorders were presented in the books "Standardy leczenia niektórych zaburzeń psychicznych" and "Psychofarmakologia kliniczna", both published in 2022.

Objectives: The aim of the pilot study was to compare the level of empathy among adolescents treated in a psychiatric day unit in groups with varied age, gender and type of disorder (conduct and emotional disorders and depressive-anxiety disorders).

Methods: The study was carried out in a group of 117 adolescents (69 girls and 48 boys) aged 13-20, treated in the Clinical Day Unit of the Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Kraków between 2016-2021. The Davis Empathy Scale and the Cohen Empathy Scale were used for the study.

Results: Girls scored significantly higher compared to boys on the Cohen and Davis Empathy scales and on the Davis subscale: Personal Distress. Statistically significant interactions were observed for the factors of gender and age, as well as age and disorder type. Older boys had statistically significantly higher scores on the Davis Empathy Scale compared to younger boys, while the reverse pattern was observed for girls (non-significant). Older patients with conduct disorders had significantly lower Cohen's Empathy Scale scores compared to younger patients; the opposite pattern was observed in the group of patients with anxiety-depressive disorders (non-significant).

Conclusions: Girls exhibit higher levels of affective and cognitive empathy than boys. The intensity of empathy increases with age in the group of boys, while for girls the obtained differences are not statistically significant. The intensity of empathy is significantly lower in the group of older adolescents (versus younger) with conduct and emotional disorders. Among depressive-anxiety disorders, the opposite pattern was noted (non-significant). The unique results obtained indicate a different trajectory of empathy development in the group of patients with conduct disorders and with depressive-anxiety disorders.

This article presents the trait of sensory processing sensitivity (SPS), its characteristics, assessment tool and association with psychiatric disorders based on an analysis of the literature on SPS since 1997. An overview of research on SPS in several relevant contexts is presented: evolutionary/adaptive, socio-cultural, temperamental/personality, and biological, taking into account the influence of genetic factors and the activity of specific areas of the central nervous system involved in processing emotional and cognitive stimuli. High sensitivity of sensory processing is an innate trait, biologically determined and modulating developmental processes, occurring in 20-35% of the general population regardless of gender. It is characterized by deeper processing of stimuli, ease of overstimulation, strong emotional reactions and empathic bonds, as well as sensitivity to subtleties in the surrounding world. SPS can be associated with susceptibility to the development of a wide range of psychiatric symptoms and disorders, including depressive and anxiety disorders, social phobia, alexithymia, burnout, internalizing and externalizing disorders and selective mutism in children.