Postepy psychiatrii neurologii最新文献

Purpose: Posttraumatic stress disorder (PTSD) is still-underdiagnosed and often accompanied by other psychiatric disorders affecting treatment and outcomes.

Case description: Here we present a case report of a 28-year-old female patient with comorbid PTSD, major depressive disorder (MDD), and anorexia nervosa (AN). The patient had been treated with various medications and attended trauma-focused psychotherapy. Because none of these treatments yielded satisfying improvement, the patient was referred for electroconvulsive therapy (ECT). We had to overcome challenges such as the patient's false assumptions about ECT, the simultaneous use of benzodiazepines and the management of the side effects of ECT. The symptoms of MDD and PTSD improved after 12 treatment sessions.

Comment: Our report suggests that ECT may be a safe and effective method for treating patients with PTSD and comorbid MDD and AN.

Purpose: Scleroderma is a multisystemic disorder characterised by inflammatory and vascular anomalies, and excess fibrosis. Progressive systemic sclerosis (PSS) mainly progresses with skin, joint, lung, heart, and kidney involvement. Involvement of cerebral vessels is rare in both localised scleroderma and PSS. Transient ischemic attack and stroke are rare complications of scleroderma.

Case description: We present a 60-year-old stroke patient with localised scleroderma presenting with impaired speech, forgetting words, and occasional temporary memory loss.

Comment: In the case we present, no pathology was found in the clinical and laboratory tests performed in terms of ischemic risk factors. Skin findings included contracture, skin biopsy results, and antibody positivity related to scleroderma. Given the current pathogenesis of scleroderma, the patient was suspected of having a stroke.

Purpose: Tolosa-Hunt syndrome (THS) is a rare cause of painful ophtalmoplegia with different clinical manifestations. It is described as a unilateral periorbital headache with concomitant dysfunction of at least one out of the IIIrd, IVth and VIth cranial nerves due to the granulomatous inflammation of periorbital structures, but no underlying cause has been established.

Case description: We present six patients referred to the Neurology Department due to a unilateral headache with ipsilateral paresis of at least one cranial nerve responsible for eye movements. The THS diagnostic criteria of the International Headache Disorders Classification (ICHD-3) were applied and analysed. Few patients had atypical clinical manifestations according to these criteria.

Comment: Diagnosing THS may prove very challenging. There is a lack of specific markers for the disorder, whereas diagnostic criteria leave a wide area for misdiagnosis. The diagnostic approach should be focused on the exclusion of other pathologies because typical steroid therapy may prove fatal in otherwise benign cases.

Purpose: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with paresthesias and pain in the hand and wrist. CTS is also associated with insomnia and excessive daytime sleepiness (EDS) resulting from the nocturnal exacerbation of symptoms. The Boston Carpal Tunnel Questionnaire (BCTQ) was developed for the assessment of therapeutic outcomes. It consists of two subscales: the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). The aim of this study was to perform an adaptation and validation of the Polish language version of BCTQ (pBCTQ). A second aim was to investigate the influence of treatment of CTS on insomnia and EDS.

Methods: The validation of the pBCTQ followed the widely accepted recommendations. In our consecutive sampling survey 130 patients with CTS filled out the pBCTQ, EQ-5D-5L quality of life questionnaire, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS). 26 of them filled out pBCTQ once again, two weeks later, and 35 filled out the pBCTQ and other items after therapy.

Results: The pBCTQ showed good internal consistency: 0.91 for SSS and 0.93 for FSS (Cronbach's α). The test-retest reliability showed an intraclass coefficient of 0.69 for SSS and 0.55 for FSS. Both subscales correlated also with nerve conduction studies (NCS) as well as with the EQ-5D-5L, AIS, and ESS. After therapy, both subscales and AIS significantly decreased. Improvement was also seen in the NCS and EQ-5D-5L, but not in the ESS.

Conclusions: The pBCTQ is a reliable, valid, and responsive tool for measuring the outcome of CTS. Therapy for CTS leads to the improvement of concurrent insomnia but may not change daytime sleepiness.

Purpose: Multiple sclerosis (MS) and systemic lupus erythematosus (SLE) are two autoimmune diseases that are relatively common, especially in women. However, it is extremely rare for them to coexist in a single patient (only 18 cases have been recorded worldwide). Both affect the nervous system and may manifest in identical ways. This creates significant difficulties, both in terms of diagnosis and choice of appropriate therapy.

Case description: A 54-year-old female patient with quadriparesis, superficial sensory disturbance and gait and balance disorders was diagnosed with primary progressive MS according to McDonald's criteria. The magnetic resonance images were typical for MS. Previously, in 2013, she was diagnosed with SLE, treated successfully, and is currently in remission. After excluding neuropsychiatric lupus, ocrelizumab treatment was administered, with good clinical results.

Comment: Adequate differentiation (magnetic resonance imaging, analysis of cerebrospinal fluid, clinical observation) as to whether the patient's symptoms are related to MS or to SLE nervous system involvement is the basis for proper diagnosis and treatment.

Purpose: Even though the term "functional analysis" (FA) is prevalent in the current behavioral literature, the concept and process have roots in the early days of basic research in behavior analysis. Furthermore, the methodology developed in the field of FA has been one of the most significant advances in research on challenging behaviors over the past four decades. The current article reviews the history of the term "functional analysis" and research related to experimental FA. The aim is to summarize what the field of behavior analysis has learned about this powerful methodology.

Views: FA is considered a gold standard of functional assessment. However, several arguments about limitations relating to methodological issues in FA and its ecological validity have been put forward. Some of these shortcomings include constraints on the time available for assessment, the risk posed by severe problem behavior, and the inability to exert tight control over environmental conditions.

Conclusions: The literature on the subject clearly shows that refinements have been aimed not only at improving some of the methodological characteristics of FA but also at adapting the strategy for real-world application. Practical functional assessment (known as interview-informed synthesized contingency analysis [IISCA]) is a contemporary approach to assessing and treating problem behavior. Recent research on IISCA offers empirical support for the practical functional assessment and skill-based treatment model, confirming that it can obtain sustainable and socially meaningful reductions in problem behavior. Nevertheless, more research is needed to address procedural variations in, and the utility and social validity of, IISCA.

Purpose: The purpose of this paper is to present to a community of behavior specialists, an overview of the subdiscipline of Organizational Behavior Management (OBM) in three aspects. First, OBM is a sub-branch of the larger field of Applied Behavior Analysis. It also has two other aspects: it can complement the traditional set of skills useful to behavior analysts or be one of the alternative careers for them.

Views: Behavior specialists predominantly, and especially in Poland, teach populations with special needs. Whether this is in special education, social assistance or select areas of health care, with young children with autism or adults with intellectual disability, this is where most behavior analysts work. At the same time, they often need to skillfully cooperate in teams, sometimes manage them or instruct people other than those with whom they are usually in contact, such as new team members, parents, and other specialists. OBM can be seen as a supplementary background that answers these needs. It is also a possible alternative career path, with a distinct client base and flagship journal, as well as specific procedures in behavior analysis, experts in the field and specialisms.

Conclusions: Different client populations, variations in instruction techniques and knowledge of response generalization all point to that conclusion that traditional behavior analysts might be largely at a disadvantage in the area covered by OBM: that of a management and team leading and training typically developing clients. Behavior analysts require a background in OBM, otherwise they might "reinvent the OBM wheel" or - which is worse - apply their experiences one-to-one with special populations and bring with them harmful assumptions.

Purpose: Description of the behavioural therapy of a patient after a subarachnoid haemorrhage from a ruptured aneurysm of the anterior communicating artery with an intracerebral haemorrhage, after aneurysm embolisation and left craniotomy, and after an ischemic cerebral stroke.

Case description: The author presents behavioural therapy techniques used in patient rehabilitation in all areas requiring improvement in the daily functioning of a disabled person. The course of selected therapeutic interventions is analysed and the effects of the interventions are assessed. The presented case is an example of successful behavioural therapeutic intervention that led to changes compared to the initial functional state of the organism. Thanks to the use of behavioural techniques, independent multi- profile patient functioning was achieved. Given the limited availability of health services, the focus on the therapy on evidence-based teaching makes them intrinsic to the patient's success.

Comment: The presented phases of therapy fully reflect the effective modification of behaviour patterns in a person after a subarachnoid haemorrhage from a ruptured aneurysm in the anterior communicating artery with an intracerebral haemorrhage, after aneurysm embolisation and left craniotomy, and after an ischemic cerebral stroke. The outcome of the applied behaviour approach seems to be significant enough to encourage the further development of the therapy for stroke patients regardless of the type of neurological disorders, functional difficulties, and age.

Purpose: The main purpose of the article is to present basic theoretical assumptions on Schema Therapy and its hypothetical application among adolescents suffering with anorexia nervosa.

Views: Anorexia nervosa is a very deadly mental disease, more frequently suffered by females than males, with the mean age of onset at approximately 14-15. Studies underline the relatively poor effectiveness of currently applied treatment methods and the need for new approaches that could be recommended for adolescent patients suffering with this disease. The results of studies conducted to date lead to the conclusion that Schema Therapy is a promising approach for this group. It is a transdiagnostic method of work that compiles elements known in other therapeutic approaches, aiming at an increase in the individual's awareness of their feelings and emotional needs, applied both in adolescent and adult groups of patients. Since the symptoms of eating disorders observed in adolescents are strongly connected with family systems it seems reasonable to use treatment techniques that rigorously address the unmet needs and rejected emotions of the individual.

Conclusions: Based on the data published so far it might be hypothesized that the techniques characteristic for Schema Therapy (e.g. imagery rescripting, chairwork, limited reparenting) could be eligible for use with adolescent patients with anorexia nervosa.They address unmet needs, rejected emotions, and early maladaptive schemas that are very frequent in patients with AN. Since the analysis presented provides only hypotheses and the discussion of theoretical aspects, empirical research in this area is needed.

Introduction: This study compared the effectiveness of different types of reinforcement (positive, negative, and a combination of both) in a self-management intervention program designed to increase water intake and walking.

Methods: Four university students participated in a self-management program to increase water intake and walking. Multiple baseline design across behaviors that included baseline (A) condition, positive reinforcement (B) condition, negative reinforcement (C) condition, and combination of both (B + C), was introduced. The participants received $2 every day they met the criteria during the positive reinforcement condition and no consequence if they failed to meet the criteria. In the negative reinforcement condition, $2 was subtracted for each day that the participant did not meet the criteria from the total amount of money available to the participant during that phase of the study. During the condition with positive and negative reinforcement, the participants received $2 every day they met the criteria. However, $2 was subtracted from the total for every day they did not meet the criteria.

Results: There was a clear increase from baseline to the first intervention phase across all the behaviors and participants, and the increase was maintained throughout the study. There were no differences in the effectiveness of different types of reinforcement applied in self-management intervention programs.

Conclusions: The study did show that implementing a relatively low-cost reinforcement contingency increased both exercise and water drinking. The results suggest that there are no consistent differences in the effectiveness of positive or negative reinforcement contingencies in self-management intervention.