Profiles of empathic sensitivity in students of the last year of medicine.

Developing the empathic attitude is one of the tasks of medical education as it affects the quality of therapeutic contact in the relationship between the doctor and the participant, conditioning the treatment process. According to Davis's concept, empathy is defined as an affective-cognitive reaction in the context of the other person's experience. AIM: Analysis of profiles of empathic sensitivity in students of medicine. Group: Male and female students of the fifth year of medicine who agreed to participate in an anonymous study (n = 153; M = 57, F = 96; mean age: 23 years). Tools: The Empathetic Sensitivity Scale (EES), which is the Polish tool for Davis's Interpersonal Reactivity Index (IRI) was used. The ESS includes three sub-scales: Empathic Care (EC), Personal Distress (PD) and Adopting Perspective (AP). RESULTS: The raw results were converted into sten scores and for sten scores for all three dimensions of empathetic sensitivity no differences were found between male and female students. Three clusters (1: n = 33%, 2: n = 39%, 3: n = 28%), which differ in terms of each distinguished indicator, were identified. CONCLUSIONS: The first cluster characterizes empathetic people, both in the affective and cognitive spheres, and those dealing well with unpleasant emotions in situations difficult to others. The second cluster characterizes participants with the ability to recognize the needs of others and to take into account their perspectives; the third cluster includes participants with a tendency to focus on own experiences emerging in response to other people's suffering but with the ability to understand a situation and show empathic concern for the other person. The most favourable profile - for a future doctor as well as for his participants - is the first cluster because the doctor, with his empathic sensitivity directed towardsthe other man, can deal with his own unpleasant emotions.

[Profile of moral reasoning in persons with bipolar affective disorder]. / Profil rozumowania moralnego osób z choroba afektywna dwubiegunowa.

AIM: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Forensic psychologist's considerations about the new law regulation in cases of sexual crimes]. / Uwagi psychologa sadowego o nowych regulacjach prawnych w sprawach o tzw. przestepstwa seksualne.

The article comments, from the perspective of a forensic psychologist, the changes which have been recently provided to the law regulations on sexual crime and the treatment of the sexual crime perpetrators. It appears that the new law regulations follow the right path, because they create the conditions for holistic and complex solutions in the sexual crime treatment matter. Unfortunately they are still rather incomplete and inconsistent. Their practical implementation is difficult because of the very demanding qualification criteria to the psychotherapy of sexual crime perpetrators, the existence of law criteria to the therapy, the narrow frame of the therapy goals and unclear rules of therapy constraint. Moreover, in Poland there is a lack of complex therapy models of sexual perpetrators, we have little experience in this kind of therapy and there is a deficiency of qualified specialists. Finally the relationship between the treatment of this kind of criminals in prison conditions and ambulatory therapy conditions isn't very clearly precise. On the other hand, a lot of improvements have been provided, such as: continuing the treatment after leaving prison, not only pharmacological treatment but also psychotherapy, the system of prevention. Despite of the strong attempts to promote the special role of pharmacological treatment of sexual crime perpetrators (,,chemical castration"), the new solutions promote a complex and interdisciplinary approach to this problem. In this article, the author described the current Polish experience in the therapy of sexual crime perpetrators and listed several rules of preparing the forensic-psychological expertise according to the described problem in context of new legal regulations.

[Personality disorders--different outlooks and attempts at their integration]. / Zaburzenia osobowosci--róine spojrzenia i próby ich integracji.

The paper presents different approaches to personality disorders. The authors critically discuss the contemporary categorical psychiatrie (medical) classification and also present psychological approaches with the special attention put to personality trait theories and stemming from them the Five Factor Model (FFM). Due to the coming time of the publication of a new revision of the American classification DSM- 5 the detailed description of the proposals for the new system has been presented. The authors included the most updated version which has just recently been published on the DSM-5 APA web site on 11h June 2011. The proposed changes go forward to the voices of critique of present solutions, and create a hybrid system which will incorporate some elements of the dimensional approach to personality disorders.

[Group psychoeducation in the complex treatment of bipolar disorder--Cracow experiences]. / Psychoedukacja grupowa w kompleksowym leczeniu choroby afektywnej dwubiegunowej--doswiadczenia krakowskie.

AIM: To share our experience in introducing an original, structured group psychoeducational programme entitled "Familiarizing bipolar disorder" into the integrated complex treatment of bipolar disorder (BP). METHOD: The programme is partially based on the Barcelona Bipolar Disorders Program format and represents our proposal of a short, easily applied group psychoeducation. It consists of 8 meetings, conducted by a psychiatrist and a psychologist who are both trained in cognitive-behavioural therapy. Two groups of patients accomplished the programme so far. We would like to present our conclusions and qualitative observations. RESULTS: The patients noticed a change in a philosophical view on the bipolar disorder treatment (access to information, partnership between a doctor and a patient, appreciation of psychological aspects of bipolar illness), which is embodied by the psychoeducational approach. They welcomed our programme with enthusiasm and interest. Many questions were asked about different aspects of bipolar disorder, especially concerning pharmacotherapy, genetic and legal issues. Our participants assessed the number of sessions as optimal, but some of them insisted on devoting one more meeting to interactively discuss pharmacotherapy of BP. The programme revealed many other relevant issues concerning patients' attitudes toward bipolar disorder like: common presence of dysfunctional beliefs patients hold regarding their illness, unawareness of importance of mood stabilizer serum level examination, insufficient knowledge on hypomania or--in some cases--ignorance of a hypomania phenomenon. Moreover, patients appreciated the fact that the psychoeducational programme helped them to diminish the sense of stigma, shame, and the feeling of being different or worse. Finally we are amazingly impressed by the unsatisfied need existing in bipolar patients to share their fears, emotions and to be fully informed. CONCLUSION: Our observations support the statement, that the psychoeducational approach to BD is a crucial element of a complex treatment. It surely satisfies patients needs for information and may help to reformulate beliefs about their illness and its treatment. Further studies on the effectiveness and mechanisms of psychoeducational interventions are needed.

High or very high recidivism risk? The possibilities of recidivism risk assessment under the Polish SVP law (the Act of 22 November 2013). / Wysokie czy bardzo wysokie ryzyko recydywy? Mozliwosci oceny kategorii ryzyka recydywy sprawców na potrzeby Ustawy z 22.11.2013.

The paper presents an analysis of possibilities of performing recidivism risk assessment under the Act of 22 November 2013 on the treatment of people with mental disorders posing a threat to life, health or sexual freedom of others. The Act allows, among others, the post-penitentiary isolation of persons posing a threat. The risk assessment at "very high" level is one of the key elements taken into account in adjudication of this procedure.The first part presents basic information on the recidivism risk assessment procedure: types of risk factors and different approaches to recidivism risk assessment. Then, three main limitations related to the assessment under the Act were discussed. These are: (1) the problem of the scope of the predicted events, (2) the problem of differentiation between the upper sub-categories of recidivism risk, (3) the problem of the lack of full Polish adaptations of recidivism risk assessment instruments. In consequence of these limitations, the risk assessment under the Act has lower precision. The problem of the lack of Polish adaptations can be solved with validation of the appropriate instruments. However, the other two challenges result directly from the provisions of the Act and cannot be faced with its current form. Therefore main conclusion of the paper focuses on the need to take into account the discussed limitations by experts, officials participating in the proceedings and the institutions issuing decisions. Risk assessment should be based on the measurement of all types of recidivism risk factors, including primarily static and then stable dynamic ones.

[Complex expertise on the psychiatric health of a criminal]. / Kompleksowe opiniowanie o stanie zdrowia psychicznego sprawcy czynu zabronionego.

The development of psychiatry and psychology has brought about a situation in need of newer evaluation of the surroundings in which the justice department tries to use specialist knowledge of the processes governing human psychic life and health. The lacking of clear criteria between the competencies of psychiatrists and psychologists is a certain standard in dealing with the disturbed or mentally ill persons. This is a result of the application of a multidisciplinary approach towards the patient in the area of diagnosis, therapy and rehabilitation. The advancing psychiatric and psychological knowledge has a difficulty in findings its way to forensic psychiatry and psychology. However, owing to the fact that current legal regulations require complex psychiatric-psychological opinions to be formulated, it is worthy to take a closer look at the issue. The fore-mentioned model has its benefits and its flaws. The compiling of the complex opinion may bring about the risk of "mixing up" of the contents as used by the various experts and cause certain methodological problems. From another perspective it would appear that it is impossible to refrain from applying the newly developing interdisciplinary links. Positive experiences with the DSM classification give a strong argument to the sensibility of this approach. The author analyses the bases for cooperation between the psychiatric-psychological expertise which arises from the rules and regulations of the penal law and the code of penal conduct. They pertain to the rules of being able in body and mind and the application of the so called security measures. The model of psychiatric-psychological cooperation taken up by the law-giver does not pertain fully to the essential competencies of psychiatry and psychology and is not a compact consequential solution.

Polish project of a Sex Offenders Registry - a mental health professionals' perspective. / Polski projekt rejestru sprawców przestepstw na tle seksualnym - perspektywa specjalistów ds. zdrowia psychicznego.

The paper discusses the governmental draft of the Act on counteracting threats of sexual offences. It assumes the creation of the Registry of Sex Offenders in a version with a limited access and a version available to the public. The registry is supplemented with a publically available map of sexual crime threats, which includes the places of sexual offences and the places of residence of offenders. Criticising the proposed solutions, the authors point out the lack of integration with other interventions conducted in Poland against sex offenders, noncompliance with the recommendations of the most important expert circles in the field, as well as the research results showing the lack of effectiveness of the planned measures to reduce sexual offences. Anumber of negative consequences of making the sex offenders'data available to the public was also highlighted in the form of a clear deterioration of social rehabilitation prognoses, additional stigmatisation, as well as social exclusion of the offenders themselves and the victims of sexual violence. The summary emphasises the need to counteract the problem of sexual offences in a systematic way and the need to diversify the interventions undertaken against the offenders, depending on the level of risk of sexual recidivism.

[Current state and perspectives of forensic psychiatry in Poland]. / Aktualny stan i perspektywy psychiatrii sadowej w Polsce.

The paper is an attempt to describe the current state of affairs and perspectives in Polish forensic psychiatry in relation to the EU rules and standards on dealing with psychiatric patients who break the law. Basic dilemmas and rules of forensic psychiatry are presented which allow for the formulation of a specific meta-model which in turn will enable further reforms and improvement of Polish forensic psychiatry. The author also analyses new opinion formulation rules in accordance with the criminal justica act of 1997. New legal regulations introduced solutions which improved the earlier legal regulations. This includes the role of the psychologist together with the psychiatrist, when deciding on the person's accountableness. Limiting detention use only in the cases of non-accountable offenders is an unfavourable action which is against European standards and makes it difficult for many psychiatrically ill offenders to obtain therapeutic help or adequate rehabilitation.

[Psychological consequences of moderate to severe cranio-cerebral injuries: dysexecutive syndrome. Preliminary report]. / Aspekty psychologiczne nastepstw sredniociezkich i ciezkich urazów czaszkowomózgowych: zespól zaburzen funkcji wykonawczych (dysexecutive syndrome). Doniesienie wstepne.

The late sequel of cranio-cerebral trauma are common causes of decreased mental capability and pathology localized in frontal lobes which can cause the dysexecutive syndrome (the individual has a goal but has difficulty in generating or activating the appropriate goal directed behavior). We analysed 58 patients, random-chosen, treated in the Neurotraumatology Department in Kraków after craniocerebral injury. Among them, 6 patients were found who scored more than average in DEX questionnaire. It was shown that diagnosis of DEX enables use of neuropsychological rehabilitation, which can improve final outcome.