Money matters: does the reimbursement policy for second generation antipsychotics influence the number of recorded schizophrenia patients and the burden of stigmatization?

PURPOSE: In Poland, non-compliance with the reimbursement policy for second-generation antipsychotics (SGA) manifested in prescribing SGA for patients with psychotic disorders other than schizophrenia may result in serious financial penalties. In this study, we aimed at investigating whether the implementation of the reimbursement policy for SGA contributed to increasing the number of patients with a diagnosis of schizophrenia relatively to the number of patients with a diagnosis of other psychotic disorders in outpatient clinics. METHODS: We analyzed data from Yearbooks of Mental Health that were published by the Institute of Psychiatry and Neurology, Warsaw, Poland in the years 1989­2009 registering the number of patients treated for various mental disorders in public facilities in Poland. Temporal trend analysis of the annual number of patients with a diagnosis of psychotic disorders, who were treated at outpatient clinics, was performed. RESULTS: We found a statistically significant increase in the total number of recorded schizophrenia patients treated at outpatient clinics, as well as in the number of patients treated for the first time at outpatient clinics for schizophrenia. These changes overlap with the implementation of the reimbursement policy for SGA. CONCLUSION: Our results suggest that the restricted reimbursement policy for SGA altered the diagnosing process in Poland. It seems that these alterations may have serious social consequences. Given that a diagnosis of schizophrenia is more stigmatizing than a diagnosis of other psychotic disorders, it might be assumed that schizophrenia over-diagnosing, possibly due to reimbursement reasons, add to the enormous burden associated with stigmatization.

European studies on the prevalence of dementia in the elderly: time for a step towards a methodological consensus.

OBJECTIVE: The aim of this study was to discuss methodological limitations in studies on the prevalence of dementia across European countries with particular attention to post-EURODEM studies. METHODS: Two people independently focused on an iterative literature search for studies published in the years 2000-2012 using the following keywords: 'dementia', 'Alzheimer', 'incidence', 'prevalence' that were cross-linked with names of European countries. After that, the results obtained were compared and publications in English were included in a subsequent analysis. RESULTS: We included 26 studies published in the years 2000-2012. The majority of epidemiological studies come from Spain and Italy. The past decade has not provided prevalence rates from a considerable number of countries. There is also a lack of nationwide surveys on the prevalence of dementia. Predominantly, epidemiological studies on the prevalence of dementia follow a two-stage approach that consists of a screening phase and a subsequent confirmation of dementia. However, several differences, particularly with regard to the neuropsychological instruments used, still exist and contribute to inconsistent prevalence rates. CONCLUSIONS: Although the EURODEM study was a milestone in the epidemiology of dementia in Europe and provided several future directions for research, methodological limitations are apparent in a number of European studies on the prevalence of dementia and require particular attention. In particular, a variety of diagnostic instruments requires unification for future studies. On the other hand, given the lack of epidemiological studies from a number of countries and the increasing prevalence of dementia, the need for population-based surveys should be emphasized.

Coping Styles, Mental Health, and the COVID-19 Quarantine: A Nationwide Survey in Poland.

Background: The outbreak of the novel coronavirus COVID-19 that began from March 2020 is yet to be contained. Consequences of the ongoing pandemic may have a negative impact on the mental health of affected individuals. This particularly refers to those quarantined. Since the COVID-19 pandemic is currently one of the biggest health issues worldwide, a higher demand emerges for research concentrating on the worsening of psychological well-being among the general and the quarantined population, as well as on individual coping strategies that may moderate the occurrence of psychopathologies. Method: Data were collected within the first weeks of the COVID-19 pandemic in Poland. Participants represented quarantine (+) and quarantine (-) groups. Quarantine (+) group, different from quarantine (-), consisted of people who experienced it themselves or someone close to them did after contacting an infected individual. To measure psychopathological symptoms a General Health Questionnaire (GHQ-28) was used. For measuring PTSD symptoms, the Impact of Event Scale-Revised (IES-R) was used. This study followed the coping strategies manifested among the participants using the MiniCope questionnaire. Results: A total of 2,036 individuals participated in this study. Quarantine (+) individuals had significantly higher total and subscales GHQ-28 scores (anxiety, insomnia, and somatic symptoms) as well as a higher IES-R arousal score. The quarantine (+) individuals were more likely to use self-distraction as a coping strategy. This research identified positive and negative correlations between presented coping styles and manifested psychopathology. Conclusion: This nationwide study suggests occurrence of negative effects on mental health due to the COVID-19 pandemic and quarantine. It is observed on most of the measured psychopathological symptoms. The present research provides a line of action that should be followed in the future in case of another epidemic and in the event restrictions like quarantine have to be introduced again.

Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders.

INTRODUCTION: Rheumatism has been treated using whole-body cryotherapy (WBCT) since the 1970s. The aim of this study was to assess the efficacy of WBCT as an experimental, adjunctive method of treating depressive and anxiety disorders. MATERIALS AND METHODS: A control (n=34) and a study group (n=26), both consisting of outpatients 18-65 years old with depressive and anxiety disorders (ICD-10), received standard psychopharmacotherapy. The study group was additionally treated with a series of 15 daily visits to a cryogenic chamber (2-3 min, from -160 degrees C to -110 degrees C). The Hamilton's depression rating scale (HDRS) and Hamilton's anxiety rating scale (HARS) were used as the outcome measures. RESULTS: After three weeks, a decrease of at least 50% from the baseline HDRS-17 scores in 34.6% of the study group and 2.9% of the control group and a decrease of at least 50% from the baseline HARS score in 46.2% of the study group and in none of the control group were noted. CONCLUSIONS: These findings, despite such limitations as a small sample size, suggest a possible role for WBCT as a short-term adjuvant treatment for mood and anxiety disorders.

[Can short-term exposure to extremely low temperatures be used as an adjuvant therapy in the treatment of affective and anxiety disorders?]. / Czy krótkotrwala ekspozycja na skrajnie niskie temperatury moze byc pomocna w leczeniu zaburzen depresyjnych i lekowych?

AIM: The aim of the research was to assess the effect of whole-body cryotherapy (WBCT) on the symptoms observed in a group of patients suffering from affective and anxiety disorders and their own subjective assessment of life satisfaction. METHOD: The study group was given short-term exposure (120-180 sec.) to temperatures between -110 degrees C and -160 degrees C on each working day for a period of 3 weeks (a total of 15 treatments). Both the study group (n=26) and control group (n=34) were observed at the beginning and the end of this 3 week interval. Standard psychopharmacological treatment was carried out in both groups, independently of whether cryotherapy was used or not. Hamilton's scales of depression and anxiety were used, together with the life satisfaction scale. RESULTS: A statistically significant larger improvement, together with a better mean state after 3 weeks, was observed with respect to 11 of the 14 components of the anxiety scale in the study group compared to the control group (except symptoms associated with the gastrointestinal and genitourinary symptoms and behaviour at interview). A larger improvement, together with a better mean state after 3 weeks, was observed with respect to 12 of the 16 components of the depression scale (except digestive, sexual life hypochondria, body weight and criticism) and 6 of the 11 components of the life satisfaction scale (physical well-being, physical condition, domestic activity, professional activity, personal interests and general satisfaction from life) in the study group. CONCLUSIONS: Cyclic short-term whole-body exposition to extremely low temperatures significantly reduced the severity of depressive and anxiety symptoms and increased the life satisfaction.

[Psychoprophylaxis in patients after coronary artery bypass graft operations]. / Psychoprofilaktyka wobec chorych poddanych operacji pomostowania naczyn wienicowych.

The paper presented problems of quality of life and psychosocial functioning of patients following coronary artery bypass grafting operations. Possibilities of psychoprophylactic effects towards these patients and its efficacy were described.

[Relations between psyche and soma in coronary disease]. / Choroba wiencowa--zwiazki somy oraz psyche.

The authors of the paper have presented the relations between psyche and soma on the example of coronary disease ranging from the elements of Plato's philosophy to the results of the latest studies. Various aspects of the interdependences between psychiatric status and somatic ailments have been discussed, biological factors as well as psychological ones. The necessity of the interdisciplinary, holistic approach to the patient has been emphasized that is a great challenge both to the psychiatrist and other specialists.