A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys.

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) definition of agoraphobia (AG) as an independent diagnostic entity makes it timely to re-examine the epidemiology of AG. Study objective was to present representative data on the characteristics of individuals who meet DSM-IV criteria for AG (AG without a history of panic disorder [PD] and PD with AG) but not DSM-5 criteria, DSM-5 but not DSM-IV criteria, or both sets of criteria. METHODS: Population-based surveys from the World Mental Health Survey Initiative including adult respondents (n = 136,357) from 27 countries across the world. The Composite International Diagnostic Interview was used to assess AG and other disorders. RESULTS: Lifetime and 12-month prevalence estimates of DSM-5 AG (1.5% and 1.0%) were comparable to DSM-IV (1.4% and 0.9%). Of respondents meeting criteria in either system, 57.1% met criteria in both, while 24.2% met criteria for DSM-5 only and 18.8% for DSM-IV only. Severe role impairment due to AG was reported by a lower proportion of respondents who met criteria only for DSM-IV AG (30.4%) than those with both DSM-5 and DSM-IV AG (44.0%; χ 21 = 4.7; P = 0.031). The proportion of cases with any comorbidity was lower among respondents who met criteria only for DSM-IV AG (78.7%) than those who met both sets (92.9%; χ 21 = 14.5; P < 0.001). CONCLUSIONS: This first large survey shows that, compared to the DSM-IV, the DSM-5 identifies a substantial group of new cases with AG, while the prevalence rate remains stable at 1.5%. Severity and comorbidity are higher in individuals meeting DSM-5 AG criteria compared with individuals meeting DSM-IV AG criteria only.

Causes of mortality in schizophrenia: An updated review of European studies.

BACKGROUND: The excess mortality in schizophrenia is still a phenomenon insufficiently studied on the cross-national level. It is important to analyse current studies on morality in schizophrenia since significant changes have recently taken place in psychiatric health care systems and guidelines of pharmacological treatment have been developed in European countries. SUBJECTS AND METHODS: This article reviews studies addressing mortality in schizophrenia in Europe that were published in English in the Pubmed database in 2009-2014. It aimed at determining countries where studies were conducted, methodologies and tools used, and current main mortality rates, as well as direction of causality in this group of patients. RESULTS: The recently published studies were conducted only in few European countries. The majority of data was obtained from general medical records and death records. The studies indicate that schizophrenia patients are characterized by higher mortality rate than the general population, with natural causes (cardiovascular diseases and cancers) and suicides predominating. The increasing mortality gap with significantly shorter life expectancy of patients with schizophrenia in comparison with the general population is considerable. CONCLUSIONS: Death records are a crucial tool in studies on mortality in schizophrenia patients; however they are insufficiently employed. Recent European reports do not show positive tendencies, indicating that standardized mortality rates in schizophrenia remain on the same level or even increase, particularly for deaths resulting from natural causes. Due to various methodologies used in studies, their direct comparison is difficult. This limitation warrants further discussion on methods used in future studies on schizophrenia mortality in Europe.

Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis.

BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients. METHODS: QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level. RESULTS: We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled. CONCLUSIONS: This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.

[The prevalence of common mental disorders in the population of adult Poles by sex and age structure - an EZOP Poland study]. / Rozpowszechnienie wybranych zaburzen psychicznych w populacji doroslych Polaków z odniesieniem do plci i struktury wieku - badanie EZOP Polska.

AIM: The article presents lifetime (LT) prevalence of common mental disorders (CMD) in accordance with the DSMIV classification, based on assessment of representative population sample of 10,081 Poles aged 18-64. METHODS: Computer based WHO CIDI3.0 was adapted for the Polish population according to WMH protocol. The survey was performed by certified and supervised interviewers. RESULTS: Out of the 18 CMDs analyzed the most common was alcohol abuse, significantly more often in males (18.6%) than in women (3.3%), (p<0.01). The second most common disorder was panic, also more frequent in women (8.5%) than in men (3.9%), (p<0.01). Similarly, depression occurred in women (4.0%) two times more often than in males (1.9%), (p<0.01). GAD, agoraphobia, panic, specific phobia (p<0.01), and dysthymia (p<0.05) were also more prevalent in women. On the other hand, alcohol abuse, alcohol and drug dependence (p<0.01), and hypomania (p<0.05) were more common in males. For most analyzed disorders significantly higher prevalence was found in the older age groups. Social phobia, specific phobias, and drug abuse occurred most often in men from the youngest group. No significant differences related to age were found for the prevalence of hypomania both in men and women. CONCLUSIONS: Indices of prevalence obtained in the EZOP Poland study differ from the indices of prevalence of mental disorders described earlier in other countries. Lower values were found in Poland for affective disorders and some anxiety disorders. Only alcohol abuse was diagnosed more often than in other studies using similar methods except Ukraine, where this disorder was diagnosed with similar frequency.

["Epidemiology of mental disorders and access to mental health care. EZOP - Poland" - research methodology]. / "Epidemiologia zaburzen psychiatrycznych i dostepnosc psychiatrycznej opieki zdrowotnej. EZOP - Polska" - metodologia badania.

AIM: Since the second half of the twentieth century, with the development of structured diagnostic tools, population based studies on epidemiology of mental disorders are carried out. A special role is played by World Mental Health Survey Initiative which brings together a group of countries from different continents in order to carry out research projects according to standard methodology using the Composite International Diagnostic Interview. Polish EZOP study, which was conducted in accordance with the guidelines of WMH joined that group. The project was implemented under the Norwegian Financial Mechanism and the Financial Mechanism of the European Economic Area. Its aim was to estimate the prevalence of mental disorders in the Polish population of adults, assess the distance to mental disorders and to obtain knowledge about the perception of psychiatric disorders and treatment. METHODS: The research tool was the Polish version of CIDI-WHO ver.3.0., which was developed for the project. The study was performed in accordance with the guidelines of WMH (cognitive interviews, interviewers training, standardization of field procedures) using electronic version of CIDI questionnaire (CAPI) within the 2-stages procedure in randomly selected representative sample of the Polish population aged 18-64. The quality of the study was systematically controlled and reported by MB SMG/KRC, and completed data (10,081 interviews) were sent to the Department-Centre of Monitoring and Analyses of Population Health NIPH-NIH. After the initial analysis data were sent to the analytical center of WMH, which applied additional cleaning tools and added new variables representing psychiatric diagnoses in DSM-IV and ICD-10.

Diagnostic validity Polish language version of the questionnaire MINI-KID (Mini International Neuropsychiatry Interview for Children and Adolescent).

OBJECTIVE: Since over forty years structuralized interviews for clinical and epidemiological research in child and adolescent psychiatry are being developed that should increase validity and reliability of diagnoses according to classification systems (DSM and ICD). The aim of the study is to assess the validity of the Polish version of MINI-KID (Mini International Neuropsychiatric Interview for Children and Adolescents) in comparison to clinical diagnosis made by a specialist in the field of child and adolescent psychiatry. MATERIALS AND METHODS: There were 140 patients included in the study (93 boys, 66.4%, mean age 11.8±3.0 and 47 girls 33.5%, mean age 14.0±2.9). All the patients were diagnosed by the specialist in the field of child and adolescent psychiatry according to ICD-10 criteria and by the independent interviewer with the Polish version of MINI-KID (version 2.0, 2001). RESULTS: There was higher agreement between clinical diagnoses and diagnoses based on MINI-KID interview with respect to eating disorders and externalizing disorders (κ 0.43-0.56) and lower in internalizing disorders (κ 0.13-0.45). In the clinical interview, there was smaller number of diagnostic categories (maximum 3 diagnoses per one patient) in comparison to MINI-KID (maximum 10 diagnoses per one patient), and the smaller percentage of patients with one diagnosis (65,7%) in comparison to MINI-KID interview (72%). CONCLUSION: Our study has shown satisfactory validity parameters of MINI-KID questionnaire, promoting its use for clinical and epidemiological settings. IMPLICATIONS AND CONTRIBUTION: The Mini International Neuropsychiatry Interview for Children and Adolescent (MINI-KID) is the first structuralized diagnostic interview for assessing mental status in children and adolescents, which has been translated into Polish language. Our validation study demonstrated satisfactory psychometric properties of the questionnaire, enabling its use in clinical practice and in research projects.

Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study.

PURPOSE: This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries. METHODS: Involuntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients' sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries' effect. RESULTS: The frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20-F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries' effect, the risk of being coerced was higher in Poland. Patients' sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model. CONCLUSIONS: The use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries' effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards.

Predictors of suicidality among Polish university students during COVID-19 pandemic.

PURPOSE OF REVIEW: The main purpose of the study was to assess university students' mental health and identify factors associated with the risk of suicidal thoughts, plans, and attempts during coronavirus disease 2019 (COVID-19) pandemic and distance learning. RECENT FINDINGS: The study was conducted in spring 2021 and comprised 10 760 Polish students. The survey employed modified versions of the C-SSRS, CIDI, WHO-5, GAD-7, the PTSD checklist for DSM-5 and CAGE-AID Questionnaire and included questions about panic attacks, COVID-19-related information and sociodemographic characteristics. The correlates of suicidality were examined using a series of logistic regression analyses. Almost 40% students experienced any suicidal thoughts and/or behaviours in the previous month: passive ideations only (15.8%), active ideations only (7.1%), plans without attempts (15%), and attempts (1.4%). Following variables were related to the increased risk for suicide attempts: severe anxiety [odds ratio (OR) = 11.39; 95% confidence interval (CI): 1.44-90.26], panic attacks (OR = 3.21; 95% CI: 1.75-5.91), and COVID-19 hospitalisation (OR = 11.04; 95% CI: 1.17-104.59). Major depression was associated with passive and active ideations, suicide plans, but not with attempts (OR = 1.37; 95% CI: 0.45-4.13). SUMMARY: University students present a high level of adverse mental health and increased risk of STBs during COVID-19 pandemic. A suicide prevention program tailored to this population is needed during and after the pandemic.

[Physicians' opinion on the use of perazine in the treatment of mental disorders--results of the Delphi consensus study]. / Opinie lekarzy dotyczace perazyny w leczeniu zaburzen psychicznych--wyniki badania metoda delficka.

AIM: Currently, the use of first generation antipsychotics (FGA) is strongly limited. On the other hand, treatment with second generation antipsychotics (SGA) can not be applied in every patient. Therefore, there is an urgent necessity to obtain information about the knowledge and experience of clinicians with regard to safety and efficacy of pernazine, which represents the most widely used FGA in Poland. Due to a striking scarcity of studies on pernazine, authors designed and performed the study, which should provide physicians knowledge arising from daily practice of clinicians included in this study. METHODS: Analysis was performed basing on 142 opinions of 26 physicians who were experienced in the treatment with pernazine. The Delphi method, which relies on concluding from expert opinions was adopted in this study. A three-round Delphi was used in order to yield final conclusions. RESULTS: According to clinicians, pernazine is one of the most cost-effective and well-tolerated FGA. Furthermore, its different profiles of action (anxiolytic and sedative) enable to use pernazine in various indications, as well as in polypharmacotherapy. Referring to a long-term experience, clinicians emphasised the efficacy of pernazine and a high compliance with medication. CONCLUSIONS: Psychiatric treatment should be individualised taking into account not only clinical indices but also patient's preferences and expectations. According to clinicians pernazine is a safe and versatile medication for schizophrenia or other mental disorders and serves as the alternative for SGA.

Work Ability and Quality of Life in Patients with Rheumatoid Arthritis.

BACKGROUND: Reduced work participation has social implications (sickness absence, economic impact) and consequences for the individual patient (impoverishment, depression, limited social interaction). As patients with rheumatoid arthritis (RA) are more likely to experience job loss and/or at-work productivity loss and are at higher risk of sickness absence and, ultimately, permanent work productivity, consideration should be given to the association between work productivity or partial work capacity and quality of life (QoL). The aim of the study was to assess the relationship between QoL and the risk of work disability, as well as to estimate the risk of a future event and identify factors affecting the risk of work disability in RA inpatients. MATERIAL AND METHODS: This cross-sectional study included 142 inpatients (65 male) aged 47 (38-58) years, who met the established criteria for a diagnosis of RA and treatment with biologic drugs. Only standardized tools were used to examine the patients: WHOQOL-BREF, MFIS and AS-WIS. RESULTS: An analysis of the QoL scores on the WHOQOL-BREF demonstrated that the patients' QoL was lowest in the physical health domain and highest in the social relationships domain. The median WHOQOL-BREF total score in the group studied was 62.8, which indicates a moderate QoL. The median total score for the risk of work disability (AS-WIS) was 10.1, which indicates that the level of risk of work disability in the patients was higher than the average level reported in the literature. A multivariate analysis showed that the following were significant independent determinants of a higher risk of work disability: low QoL in the WHOQOL-BREF physical health (ß = 0.961; p = 0.029) and psychological health (ß = 1.752; p = 0.002) domains, being in a relationship (ß = 0.043; p = 0.005) and the use of opioids for pain (ß = 3.054; p = 0.012). CONCLUSIONS: RA patients presented with moderate QoL, moderate fatigue (MFIS) and high risk of disability (AS-WIS). There is an association between a high risk of work disability and lower QoL, especially in the physical and psychological health domains. The lower the QoL in those domains, the higher the risk of work disability. The identification of factors increasing the risk of work disability will help in planning tailored interventions to improve at-work productivity loss and thus prevent work disability.

The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems.

BACKGROUND: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. METHOD: The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. RESULTS: The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. CONCLUSIONS: Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.

Mental disorder in Polish families: is diagnosis a predictor of caregiver's burden?

OBJECTIVE: To test whether a caregiver's burden is associated with the patient's psychiatric diagnosis and to find other predictors of family burden; to provide Polish data on the issue to international literature. METHOD: Of 377 eligible subjects, 141 were interviewed on admission to the mental hospital using Brief Psychiatric Rating Scale, Manchester Short Assessment of Quality of Life, Groningen Social Disability Schedule and Client's Sociodemographic and Clinical History Inventory. Their caregivers completed the Involvement Evaluation Questionnaire (IEQ). Subjects were grouped according to ICD-10 diagnoses: schizophrenia (n = 55), depression (n = 61), and anxiety and personality disorders (n = 25). Highly aggressive, suicidal and somatically unstable patients were excluded along with patients below 18 and over 65 years. Statistics included multiple regression analysis, ANOVA, Kruskal-Wallis and chi-square tests. RESULTS: Diagnostic groups differed with respect to sociodemographics, psychopathology and quality of life, but not with respect to mean level of social functioning. Despite between-group differences, the caregiver's burden did not differ according to the diagnostic group. Of the four dimensions of burden, "worrying" and "urging" scored the highest. Majority of caregivers worried about their relative's general health (82%), future (74%) and financial status (66%). Caregivers' characteristics and not patients' explained the largest proportion of the family burden variance (almost 23% for IEQ Tension). Higher burden seemed to be associated with the carer's age, being a parent and number of hours spent weekly on caring for the ill relative. Lower burden was associated with the carers' subjective feelings of being able to cope with problems and to pursue their own activities. Longer history of patient's illness led to higher IEQ Tension. Polish caregivers were affected by their role in the same way as their counterparts abroad, but more of them were worried. CONCLUSIONS: The caregiver's burden seems to be independent of the patient's diagnosis, but other factors contribute to the perceived burden, many of which are on the caregiver's part. In Poland, the overall family burden may be attributed mostly to worrying about a mentally ill relative and his future. All caregivers may benefit from psychoeducation and family interventions usually planned for those caring for relatives with schizophrenia.

[Results of a Polish national survey--physician's opinions on the physical health of schizophrenic patients]. / Wyniki ogólnopolskiego badania--opinie lekarzy dotyczace zdrowia somatycznego pacjentów ze schizofrenia.

AIM: In view of the fact that schizophrenia is a disorder increasing the risk of mortality and development of somatic disturbances, the presented study was undertaken with the aim to analyse to what extent psychiatrists assess the somatic condition of their patients diagnosed with schizophrenia. METHOD: The participants of a nationwide study ordered by Bristol-Myers Squibb and carried out by a survey agency were 404 physicians. The study was based on a specially devised questionnaire, administered to doctors in June and July 2009. Responses from 184 psychiatry specialists were obtained during the conference "Psychiatry 2009" held in Krak6w, whereas the remaining respondents were questioned at their workplaces. The questionnaire consisted of ten questions concerning various aspects of somatic health, control of health parameters and effects of pharmacological treatment on the condition of schizophrenic patients. RESULTS: The majority (73.05%) of the respondents were found to consider the somatic condition of their patients as important or very important. In the opinion of 70.54% of the physicians, metabolic disturbances were the most significant aspect of somatic health. Doctors in private practice paid more attention to sexual and endocrine system dysfunctions than those employed in hospital wards. Most psychiatrists performed physical examinations and checked laboratory parameters "almost on every visit". CONCLUSIONS: The questioned physicians appreciate the importance of somatic condition assessment in schizophrenic patients and check the important laboratory parameters regularly. Taking into account the essence of the problem, establishing closer cooperation in this area with first-contact physicians should be considered. In view of definitely positive opinions expressed by psychiatrists, concerning their involvement in the evaluation of the somatic condition of schizophrenic patients, asking the patients themselves whether that meets their needs in this respect would render the obtained results more objective.

[Psychiatric rehabilitation in Poland. Polish literature review from 1990-2007]. / Rehabilitacja psychiatryczna w Polsce. Przeglad pismiennictwa polskiego 1990-2007.

This article provides a comprehensive overview of contemporary psychiatric rehabilitation and community psychiatry tendencies in Poland. On the basis of articles published in the years 1990-2007 in renowned Polish-language journals (Polish Psychiatry, Advances in Psychiatry and Neurology), an attempt was made to establish mainly directions in polish community psychiatry. Authors review the present situation and intoduce a synthesis of statistical analyses, local experiences and outcome researches on psychiatric rehabilitation for people with long-term mental illness. Improvement in many areas of provided medical services and in integration process community-based psychitric care forms is needed. Moreover, it is necessery to create a comprehensive national program of chronic mentaly ill persons' rehabilitation based on individual and community resources. It is necessary to analyse unfavourable phenomena which occured in the psychiatric care system (marginalization, stigmatization of chronic mentaly ill persons, istitutionalization or transitutionalization). The mentioned phenomena show tendencies towards rejection of the de-centralization of health service.

[Assessment of types and incidence of aggression among patients admitted due to aggressive behaviours]. / Ocena czestotliwosci i rodzaju agresji u pacjentów hospitalizowanych z powodu zachowan agresywnych.

AIM: The aim of the study was the assessment of types and incidence of aggressive behaviours amongst psychiatric patients with violent acts marked in the referrals. METHODS: 107 patients with aggressive or autoaggressive behaviours admitted to the General Hospital of Mental Disorders in Lubiaz and 37 controls without aggressive acts in referrals were examined. Two-way data analysis of the qualified individuals was performed. Firstly, the group was divided into 3 subgroups depending on marked or not marked aggressive behaviours in referrals as well as violent acts reported during index admission. Subsequently the group was divided into 2 subgroups consisting of individuals with aggressive behaviours during hospitalization and patients without reported violent acts, both regardless of aggressive behaviours marked or not in the referrals. In each group, The Brief Psychiatric Rating Scale (BPRS) was used. The type, gravity and number of aggressive behaviours were assessed with the "Overt Aggression Scale" (OAS). RESULTS: During the study, 34% of the participants presented aggressive behaviours. Over 80 % of aggressive acts were observed during the first week of hospitalization. 84% of the patients with aggressive behaviours during index admission presented similar behaviours during previous hospitalizations. CONCLUSIONS: The study corroborates the hypothesis that aggressive behaviours among patients admitted to the psychiatric hospital due to aggression are very frequent and predominantly observed in the early stages of hospitalizations. Identified important and predictive factors of possible aggressive behaviours are: violent acts marked in the referrals, treatment in the psychiatric hospital without consent and aggressive behaviours during previous hospitalizations conformed in the medical reports.

[Comparison between the day-care ward and the inpatient ward in terms of treatment effectiveness based on the analysis of psychopathologic symptoms, subjective quality of life and number of rehospitalisations after discharge]. / Efektywnosc leczenia na psychiatrycznym oddziale dziennym, w porównaniu z oddzialem stacjonarnym, na podstawie analizy objawów psychopatologicznych, subiektywnej oceny jakosci zycia oraz czestosci rehospitalizacji po zakonczeniu leczenia.

AIM: To assess effectiveness of treatment in the day-care and inpatient wards within the Wroclaw branch of the international multicenter EU-funded EDEN study. The authors analysed the number of rehospitalisations after discharge from the index hospitalisation as well as psychopathologic symptoms and subjective quality of life. METHODS: Out of 1089 patients admitted to the mental hospital in Wroclaw, 238 were randomly assigned to either the day-care ward (n = 115) or the inpatient ward (n = 123). There were three interviews with patients: upon discharge, three and twelve months later. Scores of the extended version of Ventura's BPRS were used for representing the psychopathology level and for calculation of between-setting differences. Subjective quality of life was measured using the MANSA questionnaire. Statistical parameters of effectiveness (scores at given time-point, models adjusted for the scores at admission and for the duration of hospitalisation) were analysed. The frequency of rehospitalisations was also investigated. Statistical analyses after discharge were performed using the random multiple imputations method in consecutive time-points. RESULTS: There were no statistical differences between settings in the effectiveness of treatment three months after discharge. Interviews performed one year after discharged revealed a higher level of psychopathology in patients treated in an inpatient setting (p = 0.03) and it was confirmed by the model adjusted for the duration of hospitalisation (p = 0.04). Yet day-care ward patients had a higher number of rehospitalisations within one year after discharge. CONCLUSIONS: The absolute superiority of treatment in an inpatient ward over day-care setting in terms of its effectiveness was not confirmed using BPRS, MANSA scores and index of rehospitalisation.

[Delphi application in medical science teaching]. / Zastosowanie metody Delphi w dydaktyce w zakresie nauk medycznych.

Teaching constitutes part of a psychiatrist's work. The essential determinants of best practice in psychiatric education as well as proven teaching methods are still lacking. The authors have presented the application of the Delphi technique to under- and postgraduate teaching programmes in diverse fields of medical knowledge. The Delphi method is based on systematic and anonymous refinement of expert opinion on defined scientific issues. The conventional approach of the method relies on questionnaires filled in by chosen experts in at least 3 or 4 rounds. Answers are assessed quantitatively and qualitatively during subsequent rounds in order to refine and specify opinions and--when expected--to achieve consensus. Innovative methods of the Delphi analysis have been presented. Patients' and physicians' opinions as well as electronic methods have been applied in curricula development. Both the positive experience of practical Delphi method application and methodological flexibility might be useful in construction of modern teaching programmes in psychiatry.

[What is the Delphi method? Strengths and shortcomings]. / Czym jest metoda Delphi? Zalety i ograniczenia.

This article provides a condensed discussion and explanation of the Delphi method. This technique is used for problem solving and decision making. The Delphi Method was originally developed during the cold war by the U.S. Intelligence think tank, the RAND Corporation, Santa Monica, California in the 1950's and 1960's. It was designed for use on complex or ambiguous problems that exceed the capabilities of a single person. Most researchers make distinctions between the conventional Delphi and the policy Delphi. The last decades have seen increasing interest in the use of Delphi in a wide range of health-care applications. The Delphi method has been applied in a wide range of European Commission funded research projects, e.g. in EUNOMIA and DEMoB.inc projects. The Delphi method is characterized by the following features: anonymity of responses from panel experts, asynchronicity, controlled feedback and statistical description of responses. The objective of most Delphi applications is the reliable and creative exploration of problems or the production of suitable information for decision making.

[European measure of best practice for people with long-term mental illness in institutional care--DEMoB.inc]. / Europejska miara jakosci uslug opieki zinstytucjonalizowanej dla osób z przewleklymi zaburzeniami psychicznymi--DEMoB.inc.

The article depicts the international scientific project-DEMoB.inc. which aims to develop a European tool kit for assessing quality of care provided by long-term psychiatric and social care facilities. Positive aspects of rehabilitation of people with profound and chronic mental disturbance, as well as health care system shortcomings leading to patients' social exclusion, abuse and violation of basic human rights have been shown. While describing the six phases of the research, special attention has been paid to the first one based on the Delphi method. The implementation of the method in the development the tool kit's international core and local "clip-ons" as well as its general characteristics have been presented. Association between tool kit assessments and patients' quality of life, autonomy, markers of recovery as well as the MANSA and the Resident Choice Scale have been described. Economic analysis--value for money (VfM), the CSRI scale and potential dissemination activities on an international and local level have been proposed.

[Problem based learning (PBL)--possible adaptation in psychiatry (debate)]. / Nauczanie oparte na rozwiqzywaniu problemów (PBL)--moiliwosci zastosowania w psychiatrii (artykul dyskusyjny).

Teaching psychiatry concerns mainly education of students studying medicine and clinical psychology, but it also concerns professional training the people specializing in psychiatry and in other fields of medicine. Since the requirements that medical professionals are obliged to meet are ever higher, it is essential to provide highest possible quality of teaching and to do so to use the best possible teaching models. One of the modern educational models is Problem Based Learning (PBL). Barrows' and Dreyfus' research as well as development of andragogy had major impact on the introduction of this model of teaching. There are favourable experiences of using PBL in teaching psychiatry reported, especially in the field of psychosomatics. Problem Based Learning gradually becomes a part of modern curricula in Western Europe. For this reason it is worth keeping in mind PBL's principles and knowingly apply them into practice, all the more the reported educational effects of using this method are very promising.