Questionnaire for the Perception of Psychotherapy Process by the Psychotherapist (QPPP) - a preliminary presentation of a research tool. / Kwestionariusz postrzegania procesu psychoterapii przez psychoterapeute (KPPP) ­ wstepna prezentacja narzedzia.

OBJECTIVES: The emotional reactions of therapist in the treatment process constitute the core of therapeutic work, but they are poorly represented in research area. The article presents the results of work on the creation of a new tool the Questionnaire for the Perception of Psychotherapy Process by the Psychotherapist (QPPP). METHODS: The Questionnaire containing 267 statements assessing cognitive, affective and behavioural reactions of psychotherapists in interaction with a specific patient was uploaded on the website. The link to the website, together with a request to complete the questionnaire, was sent to the members of the Psychotherapeutic Societies. The study involved 159 therapists, working mainly psychodynamically (91.95%). The analysis of basic descriptive statistics of test items and exploratory factor analysis by principal components method with varimax rotation were used. RESULTS: The work resulted in creating a tool consisting of 75 items grouped into 6 scales: Positive cooperation with the patient, Therapist burdened with commitment, Therapist in the centre of negative interest, Therapist with no room for intervention, The overwhelmed/overloaded therapist, The helpless/disengaged therapist. High alpha-Cronbach reliability of all distinguished factors was demonstrated at the level from 0.79 to 0.94. The data analysis also made it possible to create initial sten standards for therapists working in the psychodynamic approach. CONCLUSIONS: A tool was developed to assess emotions of therapist in relation to client. QPPP contains generally understandable terminology, independent of the therapist's dominant modality. The questionnaire can have many practical applications - both scientific and clinical.

Relationship of metabolic parameters with the course of the first episode of psychosis - preliminary research. / Zwiazek parametrów metabolicznych z przebiegiem pierwszego epizodu psychozy ­ badania wstepne.

OBJECTIVES: Cardiometabolic syndromes are the most common causes of complications shortening life expectancy in patients treated for mental disorders, especially schizophrenia. However, how much cardiometabolic risk is related to lifestyle, side-effects of treatment or psychosis is not clear. The aim of this study was a prospective assessment of metabolic changes in young, initially somatically healthy patients diagnosed with the first acute episode of psychosis with no prior pharmacological treatment. METHODS: The study involved 15 young patients (average age of 19.95 ± 6.88 years). Analyses (laboratory and clinical) were performed at the time of admission and after 3 and 12 weeks and included morphology, lipid profile, glucose, inflammation markers, blood pressure (BP), and body mass index (BMI). The severity of clinical symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS), and the cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). The duration of untreated psychosis (DUP) was also measured. RESULTS: There was a significant increase in BMI, dyslipidemia, inflammation, and systolic blood pressure after 12 weeks from the start of the treatment, while cortisol level decreased. A negative correlation was observed between PANSS-P (PANSS positivescale) measurements and total cholesterol, PANSS total and low-density lipoprotein, as well as DUPand MoCA. High-density lipoprotein (HDL) correlated positively with DUP, cortisol, monocytes, and white blood cells in the first week. CONCLUSIONS: The results of the study indicate a relationship between the development and treatment of the first acute episode of psychosis and the results of laboratory tests that are indicators of the development of metabolic stress in patients.

Overweight and obesity risk factors in children aged 3-7 years: a prospective study in the city of Kraków.

BACKGROUND: Early identified factors determining overweight and obesity in childhood may be important for preventive purposes. AIM: To evaluate the influence of the commonly accepted and hypothetical risk factors for overweight/obesity and their mutual relations, using the method of classification trees. SUBJECTS AND METHODS: The data were collected during anthropometric surveys carried out in 2010 in Kraków, Poland. The study involved 1042 pre-school children aged 3-7 years. BMI was calculated for all subjects classified as underweight, normal body weight and overweight, according to the IOTF cut-offs. In order to determine the correlation between genetic, environmental and lifestyle factors and the child's BMI, this study used information from a questionnaire filled in by the mothers. RESULTS: Relatively high birth weights, relatively long times of breastfeeding and father's obesity were conducive to the appearance of overweight and obesity in boys. Other overweight risk factors included alcohol consumption by the mother, her low education level and a relatively low mother's age at birth. Among girls, factors leading to overweight included high birth weight, high father's BMI and family situation reported as below very good by their mothers. It was found that a moderate duration of breastfeeding is conducive to a normal weight of children at pre-school age, although in boys this regularity is better documented. CONCLUSIONS: The biological, social and lifestyle factors related to the child's mother significantly determined the child's BMI.

Socio-cultural context of eating disorders in Poland.

BACKGROUND: The goal of this study was to assess the relationship between sociocultural factors and clinical eating disorders during the intensive process of Westernisation in Poland that occurred after 1989. The study population included girls diagnosed with an eating disorder according to DSM-IV criteria (n = 47 anorexia nervosa restrictive type [ANR], n = 16 anorexia binge/purge type [ANBP], n = 34 bulimia nervosa [BN], n = 19 eating disorder not otherwise specified [EDNOS]) who received consultation for the first time between 2002 and 2004 in the Department of Clinical Child and Adolescent Psychiatry, University Hospital, Kraków, Poland. The study included an age-matched normal control group [NOR] of 85 schoolgirls from Kraków. METHODS: Relationships between two given qualitative features were investigated using the chi-square test or Fisher's exact test. Correspondence analysis was applied to graphically explore the relationship. The Kruskal-Wallis test with the Bonferroni was performed to compare quantitative results across groups. RESULTS: Objective sociodemographic variables and responses to the 62-item Questionnaire of Socio-cultural Context were measured. The mothers of ANBP and BN patients were less professionally active than mothers of ANR patients and NOR subjects. Subjective socio-cultural factors were more relevant for the BN group than the ANR group. Questionnaire responses in the ANBP group were more similar to those in the BN group than to those in the ANR group. The most unambiguous and specific characteristic of the ANR group was a sense of belonging to the middle class. Variables that differentiated the BN group from the NOR group included the importance attached to thinness treated as an expression of power and control over one's self, as well as a multifaceted negative evaluation of one's own family, including a negative assessment of the position of women and parental lack of concern for appearance and principles of nutrition. All patients, regardless of diagnosis, identified with other people with similar problems and considered anorexia and bulimia to be a major issue of their generation and social environment. CONCLUSIONS: The results of this first in Poland exploratory study of socio-cultural context of eating disorders indicate the importance of both objective and subjective socio-cultural factors in eating disorders in the group studied.

[Worrying behaviour in pre-school children aged three to seven years: a factor analysis of the results of a questionnaire]. / Niepokojace zachowania u dzieci przedszkolnych w wieku 3-7 lat--analiza czynnikowa wyników kwestionariusza.

AIM: The aims of the study were: 1) the assessment of the interaction between the factors specified for behavioural problems observed in pre-school children based on a factor analysis and 2) the assessment of the relationship the specified factors have with the age and gender of the study group. METHOD: A factor analysis based on a Principal Component Analysis of the main results of a Disturbing Behaviour Questionnaire (DBQ) completed by pre-school teachers, which includes categories of behaviour observed among pre-school age children that provoke the greatest concern among parents, guardians and educators. MATERIAL: Nine-hundred and sixty-one children aged from 2.7 to 7.9 years (mean: 5.4; SD 1.13) from randomly chosen pre-schools in all districts of Krak6w. RESULTS: Based on a screen plot, as well as on a substantive analysis of the results, a decision was taken to employ a four-factor analysis (Lagging behind, Excessive behaviour, Eating-avoidance and Overeating) explaining 68% of the common factor variance. A very high Cronbach's alpha value was returned for the reliability of the individual scales. The conducted analysis of the relationship of the scales with age and gender indicated a greater intensity of disturbing behaviour in boys for the Lagging behind factor, the Excessive behaviour factor and the overall scale for the Disturbing Behaviour Questionnaire (DBQ). These were the scales, along with the Eating-avoidance scale, that were found to be related to age. A greater intensity of disturbing behaviour was found to occur in the younger children. The relationship between the Overeating and Excessive behaviour scales that was found among girls but not among boys indicated that--even at such a young age--the characteristics associated with eating in the context of gender were already present. CONCLUSIONS: The authors consider that the coherence of the results obtained and their consistency with other studies ofpre-school age children provide a sound platform for further analyses using the questionnaire described above.

Perception of transgenerational family relationships: comparison of eating-disordered patients and their parents.

BACKGROUND: Disturbances in various elements of transgenerational family functioning patterns are not uncommon in studies of eating disorders. We examined the relationship between patients' perception of autonomy and intimacy in their families of origin and that of their parents in their own families of origin. MATERIAL AND METHODS: The sample consisted of 112 girls who had a diagnosis of an eating disorder and their parents; 54 of the girls were diagnosed with anorexia nervosa restrictive subtype, 22 as anorexia nervosa binge/purge subtype, and 36 were diagnosed with bulimia nervosa. We had 2 control groups: 1 group consisted of 36 girls diagnosed with a depressive episode, dysthymia, or adjustment disorder with depressed mood and the other group was 85 female students from schools in Cracow, Poland and their parents. We used the the Family of Origin Scale to assess perception of family relationships. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS 20.0.PL; Chicago, IL, USA). RESULTS: There was a significant association between daughters' and fathers' perceptions of autonomy in their families of origin in all groups. There was no significant association between daughters' and mothers' perceptions in all groups. The strongest correlation was between the non-clinical sample of girls and their fathers and for the bulimic group. CONCLUSIONS: We did not detect any link indicating the specificity of transgenerational transmission of autonomy and intimacy in eating disorders. The results point to the importance of the father figure in studies of family systems, including the context of family transmission.

[The relationship between assessment of family relationships and depression in girls with various types of eating disorders]. / Zwiazek oceny relacji rodzinnych z depresja u dziewczat z róznymi typami zaburzen odzywiania sie.

AIM: The aim of the study was to assess the relationship between depressive symptoms and girls' assessment of their family relations in a group of (female) patients with a diagnosis of various subtypes of eating disorders in comparison with (female) patients with a diagnosis of depressive disorders (episode of major depression, dysthymia, adjustment reaction with depressive mood) and female students in Krakow, Poland schools. METHOD: Data from 54 (female) patients with a diagnosis of restrictive anorexia (ANR), 22 with a diagnosis of binge-purge anorexia (ANB), 36 with a diagnosis of bulimia (BUL), 36 with a diagnosis of depressive disorders (DEP) and a 85 (female) Krakow school students (CON) were used in the statistical analyses. There were no significant differences between age of the girls in studied groups. In analyses, results of the Polish version of the Beck Depression Inventory (BDI) and also the Family Assessment Questionnaire (KOR) were used. RESULTS: In the CON group, correlations attesting to a link between depressiveness and a negative assessment of the family were observed on all scales of the questionnaire with the exception of the Values and Norms scale. In the DEP group, such a dependence was ascertained on scales: Completing Tasks, Communication, Emotionality, Control, Defence, Positive Statements. In the case of the ANR group, no statistically significant relationship between results of the questionnaires was noted. In group ANB, correlations attesting to a link between depressiveness and a negative picture of the family were ascertained on scales: Communication and Defence. The same dependence was ascertained in the BUL group on scales: Completing Tasks, Emotionality, Emotional involvement, Control, General result, Negative Statements. CONCLUSIONS: An increase in depressiveness is linked in a significant way with a worsening assessment of the family relations amongst girls with a diagnosis of bulimia, depressive disorders and students.

[The effect of two predictors' interaction on short- and long-term treatment outcomes of schizophrenia]. / Wplyw interakcji dwóch predyktorów na wczesne i odlegle wyniki leczenia schizofrenii.

OBJECTIVES: To monitor the effect of interaction of duration of untreated psychosis (DUP) and expressed emotion (EE) on treatment outcomes in schizophrenia. METHODS: 56 individuals diagnosed with schizophrenia were assessed at 4 time points. The number of relapses, the number and duration of rehospitalizations and the severity of symptoms were assessed at index hospitalization and at 3, 7 and 12-year follow-ups. RESULTS: No correlation was found between DUP and EE measured at index hospitalization. Over the 12-year period the number of rehospitalizations for individuals with short DUP and low EE did not increase, as opposed to those with short DUP and with high EE. In the group with long DUP, the number of rehospitalizations increased irrespectively of EE level. The positive syndrome in the group with short DUP and high EE was less severe than in individuals with long DUP and high EE. Analogous differences appeared in the group with low EE. CONCLUSIONS: 1) No correlation was found between DUP and EE at index hospitalization. 2) Number of rehospitalizations and intensity of positive symptoms proved to be associated over time with the interaction of DUP and EE. 3) Long-time observation and multiple assessments allow to obtain more reliable results.

[The analysis of the bipolarity features in students of arts and the students of technology]. / Analiza cech dwubiegunowosci wsród studentów kierunków artystycznych oraz politechnicznych.

BACKGROUND: The aim of the research was to assess the prevalence of the bipolar spectrum features among students of a variety of faculties, by dividing them arbitrarily into 'art' or 'technology' cohorts. MATERIAL AND METHODS: 120 subjects were examined, including 57 students of arts, and 63 students of technology. The tools used included a basic socio-demographic questionnaire and the Hirschfeld Mood Disorder Questionnaire (MDQ). RESULTS: The bipolar spectrum features (as identified by the MDQ responses) were significantly more prevalent among the students of arts, as compared to the students of technology (28.2% vs. 4.8%, p < or = 0.001; OR = 7.8; CI 95%: 2.13-28.51; p < 0.01). Moreover, in comparison to the students of technology, the students of arts were more likely to: 1) report mood patterns of intermittent 'highs' and 'lows' (49.1% vs. 15.9%, p < or = 0.0001; OR = 5.11; CI 95%: 2.18-11.99; p < or = 0.001); 2) seek for psychiatric or psychological support (12.3% vs. 1.5%; p < or = 0.05; OR = 5.2; CI 95%: 1.79-15.21; p < or = 0.01); 3) have a history of utilisation of psychotropic medications (31% vs. 7.9%, p < or = 0.001; OR = 8.7; CI 95%: 1.03-72.9; p < or = 0.05). They were also more likely to use psychoactive substances (other than alcohol). CONCLUSIONS: The considerable prevalence of the bipolarity features (as measured by the MDQ), combined with higher prevalence of intermittent periods of elevated or depressed mood, higher likelihood of seeking for psychiatric or psychological treatment, and higher prevalence of using psychoactive medications/substances in the cohort of the students of arts indicate a significant association between artistic talents and creativity, and the bipolar spectrum disorders.

[Predictors of symptomatic improvement in eating disorders. Preliminary analysis]. / Predyktory poprawy objawowej w zaburzeniach odzywiania sie. Analiza wstepna.

AIM: The article discusses the preliminary results of a follow-up study carried out in 2009-2010 on former patients with a diagnosis of anorexia nervosa and bulimia nervosa, first seen in 2001-2004 at the Department of Child and Adolescent Psychiatry, the Jagiellonian University Medical College in Krakow. At that time they had been taking part in a research project, whose aim was to define the relationships among the psychopathological picture of eating disorders, self-image and family relations and also the influence of socio-cultural factors. The aim of the current study is to attempt to define factors influencing the course and prognosis of eating disorders in the studied group. METHOD: Results from the Eating Disorder Inventory Questionnaire (EDI) and the Polish version of Family Assessment Measure (KOR) in the first study were juxtaposed with the clinical state and parameters of psychosocial functioning of the studied women assessed on the basis of the follow-up study. RESULTS: In the studied group, 13 girls suffered from anorexia nervosa--restricting type, 6 from anorexia nervosa binge-eating/purging type, and 6 from bulimia. In the studied group, there was complete symptomatic improvement in 12 persons (48%), subclinical symptoms continued to be observed in 9 persons (36%), and 4 persons (16%) met full diagnostic criteria for eating disorders. The most favourable course was observed in the group with a diagnosis of anorexia nervosa restricting type. The least favourable was observed in the group with a diagnosis of bulimia. Results. In the studied group, 13 girls suffered from anorexia nervosa - restricting type, 6 from anorexia nervosa binge-eating/purging type, and 6 from bulimia. In the studied group, there was complete symptomatic improvement in 12 persons (48%), subclinical symptoms continued to be observed in 9 persons (36%), and 4 persons (16%) met full diagnostic criteria for eating disorders. The most favourable course was observed in the group with a diagnosis of anorexia nervosa restricting type. The least favourable was observed in the group with a diagnosis of bulimia. CONCLUSIONS: The occurrence of symptoms of binging and purging turned out to be a negative prognostic factor in the whole group of patients suffering from eating disorders. A smaller starting declared intensity of aspiring to slimness and level of dissatisfaction with own body by patients measured with the EDI, and satisfaction in the area of communication and emotional commitment on the part of the mother (of the patient) in her relationship with her husband (the father of the patient) measured with the KOR were positive prognostic factors. The significant overrepresentation of patients with a diagnosis of restrictive anorexia in the group of persons with clinical improvement may have an influence on the obtained results.

[Worrying behaviours of children in the assessment of kindergarten teachers in Kraków]. / Niepokojace zachowania dzieci w ocenie krakowskich nauczycieli przedszkolnych.

AIM: To assess the prevalence of emotional and behavioural problems among preschool children. METHOD: The Disturbing Behaviour Questionnaire (DBQ), which was drawn up on the basis of the opinions of parents and educators, was completed by kindergarten teachers in the following categories: Excessive crying (Cry), Motor awkwardness (Awk), Lagging (Lag), Excessive dependence (Excdep), Developmental delay (Del), Hyperactivity (Hyper), Hyperactivity with aggression (Hypag), Aggression (Ag), Auto-aggression (Aag), Strange Behaviour (Stran), Self-Isolation (Isol), Avoiding Eating (Aveat), Avoiding certain foods (Avfd), Overeat (Overeat), Compulsive eating (Compeat) using the following assessment scale: Absent; Very rare; Rare; Frequent; Very frequent; Always. SUBJECTS: 961 children aged 3 to 7 years from randomly selected kindergartens from all districts of Krak6w aged from 2.7 to 7.9 years (Mean: 5.4; SD 1.13). RESULTS: "Absent" was noted in 108 (11.3%) of children. 270 (28%) children answered "Always" or "Very frequent" in at least one category, including: Cry 4.2%, Awk 4.3%, Lag 4.3%, Isol 3.1%, Hyper 11.6%, Hypag 3.0%, Ag 1.2%, Aag 0.2%, Excdep 3.5%, Del 1.2%, Stran 1.3%, Aveat 6.4%, Avfd 8%, Overeat 1.3%, Compeat 0.6%. On the overall DBQ and 6 categories (Awk, Lag, Hyper, Hypag, Ag, Del) boys had statistically significantly greater intensity of problems. In terms of correlation of items on the DBQ with age, 6 items were observed to have a statistically negative relation with age (Cry, Isol, Excdep, Aveat, Avfd, Awk) as was the overall scale. Overall scale, Cry and Excdep turned out to be significant for both genders, Ag, Aveat and Avfd for girls, Awk for boys. DISCUSSION: A series of methodological and interpretational reservations and doubts need be taken into account when interpreting results.

Disordered eating among mothers of Polish patients with eating disorders.

BACKGROUND: The aim of this study was to assess attitudes towards eating as measured by the Eating Attitude Test (EAT26) among mothers of girls diagnosed with various types of eating disorders, in comparison with mothers of depressive girls and their relationship with daughters' results 14 years after the beginning of the Polish political and cultural transformation of 1989. MATERIAL/METHODS: The data of 68 mothers and their daughters were used in statistical analysis (anorexia nervosa restrictive type: 18, anorexia nervosa binge/purge type: 12, bulimia: 14, depression: 24). The mean age in the group of mothers was 43.5 (SD 5.3), daughters: 16.7 (SD 1.4). RESULTS: In the group of mothers, the results of EAT26 test were lower than results of the general population of Polish females or patients' mothers obtained in a different cultural context. Results from girls with an eating disorder diagnosis considerably exceed the mean result of Polish population studies of teenagers. There were no statistically significant differences between the EAT26 results of mothers of girls with various types of eating disorders and mothers of depressive girls. Sociocultural variables such as education and place of residence of mothers also did not differentiate the studied groups and did not have a significant influence on attitudes towards weight and body shape presented by the studied mothers. CONCLUSIONS: The obtained results may suggest that in the studied population, the social background of mothers and disturbances of their own mothers' attitudes towards weight and body shape were not an important and specific risk factor in the development of their daughters' eating disorders.

[Psychogenic determinants of bulimia nervosa]. / Psychogenne uwarunkowania bulimii psychicznej.

Eating disorders, especially bulimia, are considered to be the most sensitive barometer of the process of Westernisation and (partly for this reason) cultural, family and psychological factors seem to play a key role in their aetiology. The increase in their frequency can be linked with the significance that is ascribed to the body and eating in Western culture. Viewed from the psychodynamic perspective, eating disorders are treated as a formed by a culture symptomatic manifestation of dysfunction of very varied personality, neurotic and prepsychotic mechanisms. They are expressed through a person's attitude to their own body and eating. The relation between the body and food may be treated as a metaphor of the relation of the female patient with various aspects of herself and significant persons in her life. The mechanisms of arising of psychological bulimia and anorexia are convergent in this model. Differences in the clinical picture are linked with the strength of mechanisms of control. In the case of anorexia nervosa restrictive type, we are dealing with complete control over the body and eating as an expression of denial of various desires and impulses. In the case of bulimia nervosa and bulimic symptoms in anorexia nervosa, we observe the occurrence of alternate yielding to desires and impulses in the act of eating and a denial of yielding to them in vomiting and other compensatory behaviours. An attempt to understand the links between the individual bulimic psychopathology of the patient and functioning of the family system constitutes an important supplement to the above theories. Many authors draw attention to the similarity of functioning of families with anorexia and bulimia. Open and stormy expression of tension is typical for bulimic families, as are various traumas concerning children. The conceptions presented above should be considered to have practical significance in the course of therapy rather than as exhaustive descriptions of all determinants of eating disorders.