A 45-year follow-up study of juvenile schizophrenia. Part III: Clinical picture and effect of the first hospitalization in the context of disease course and long-term social functioning of patients. / 45-letnie badania katamnestyczne schizofrenii mlodzienczej. Czesc III: Obraz i efekt kliniczny pierwszej hospitalizacji a pózniejszy przebieg choroby oraz dlugoterminowe funkcjonowanie spoleczne pacjentów.

OBJECTIVES: Research on predictors of adolescent schizophrenia, especially that based on long-term follow-up, is rare in the literature. In our analysis, we examine the relationship of the clinical picture and effect of the first hospitalization with clinical and social indicators of the disease. METHODS: A total of 69 patients at an average age of 16 years (time point 0), hospitalized due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals), were re-evaluated for clinical and social parameters 45 years after their initial hospitalization (time point 2 - personal examination of 21 individuals). RESULTS: The clinical picture of the first episode of schizophrenia in terms of autism, apathy and abulia symptoms, splitting symptoms, formal thought disorders, catatonic symptoms, hebephrenic symptoms, delusions, hallucinations, and total severity of the schizophrenic psychopathology as a whole, as well as the effect of the first hospitalization (measured by the level of improvement, insight, and relational abilities), revealed numerous and various correlations with both the symptomatic picture and clinical course of schizophrenia and distant social functioning of the subjects. Variables of the greatest prognostic value were: initial autism and the level of clinical improvement, insight, and the ability to establish relationships, as measured at the end of the first hospitalization. CONCLUSIONS: Negative symptoms during the first episode of schizophrenia and the quality of improvement in the areas of symptoms, insight, and the ability to establish relationships, achieved during the first hospital stay, turned out to be significant prognostic factors in juvenile schizophrenia.

A 45-year follow-up study of adolescent schizophrenia. Part IV: Clinical status and level of social adaptation 5 years after the first hospitalization in the context of illness course and long-term social functioning of patients. / 45-letnie badania katamnestyczne schizofrenii mlodzienczej. Czesc IV: Stan kliniczny oraz poziom adaptacji spolecznej 5 lat po pierwszej hospitalizacji a pózniejszy przebieg choroby oraz dlugoterminowe funkcjonowanie spoleczne pacjentów.

OBJECTIVES: Research on predictors of adolescent schizophrenia, especially those based on long-term follow-up studies, is rare in the literature. In our analysis, we examine the relationship of the clinical status and level of social adaptation 5 years after the first hospitalization with clinical and social indicators of the illness course. METHODS: 69 patients at the average age of 16 years (time point 0), hospitalized due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals), were re-evaluated for clinical and social parameters 45 years after their initial hospitalization (time point 2 - personal examination of 21 individuals). In addition to the personal survey, other methods of data collection were used, including hospital queries. RESULTS: The clinical picture of schizophrenia 5 years after the first hospitalization described by the severity of psychopathology, as well as other parameters of the clinical status (e.g., insight, clinical improvement, relational abilities, GAF), revealed numerous and various correlations both with the symptomatic picture and clinical course of schizophrenia 45 years after the first hospitalization as well as with distant social functioning of the subjects. In the analyses, high prognostic significance was also revealed by the level of psychotic relapse, the presence of auto-aggressive tendencies, and the quality of school and professional adaptation assessed at time point 1. CONCLUSIONS: he level of functioning achieved by the patient in clinical and social areas during the first 5 years after their initial hospitalization proved to be an important prognostic factor in adolescent schizophrenia.

A 45-year follow-up study of adolescent schizophrenia. Part I: Premorbid values of psychological and relational indicators in the context of illness course and long-term social functioning of patients. / 45-letnie badania katamnestyczne schizofrenii mlodzienczej. Czesc I: Przedchorobowe wartosci wskazników psychologicznych i relacyjnych a pózniejszy przebieg choroby oraz dlugofalowe funkcjonowanie spoleczne pacjentów.

OBJECTIVES: Research on predictors of adolescent schizophrenia, especially those based on long-term follow-up studies, is rare in the literature. In our analysis, we examine the relationship between the premorbid functioning of the respondents and clinical and social indicators of the illness course. METHODS: 69 patients at the average age of 16 years (time point 0), hospitalized due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals), were re-evaluated for clinical and social parameters 45 yearsafter their initial hospitalization (time point 2 -personal examination of 21 individuals). RESULTS: Premorbid indicators of mood, life drive, emotional expression, level of social withdrawal, intelligence, anxiety, development of sexual and aggressive drive, and family and extra-family relational life revealed numerous and various correlations with both the symptomatic picture and clinical course of schizophrenia as well as distant social functioning of the subjects. Variables of the greatest prognostic value were: the emotional attitude of "moving away from" people and the world, and rich relational life outside the family of origin. These variables revealed opposite correlations, especially with the severity of negative symptoms, the level of late insight and regression, the quality of professional life and GAF scores, with the correlations of rich relational lifeto be assessed as positive and the correlations of attitude of "moving away from" as negative. The harmonious development of drive as well as high intelligence also proved to be significant. The correlations of both of these variables have proved beneficial both in clinical and social terms. CONCLUSIONS: The so-called premorbid personality described by several indicators turns out to be an important prognostic factor in juvenile schizophrenia.

A 45-year follow-up study of adolescent schizophrenia. Part II: Age of disease onset, type of onset of the disorder and presence of developmental burden in the context of disease course and long-term social functioning of patients. / 45-letnie badania katamnestyczne schizofrenii mlodzienczej. Czesc II: Wiek zachorowania, typ poczatku zaburzenia i obecnosc obciazen rozwojowych a pózniejszy przebieg choroby oraz dlugoterminowe funkcjonowanie spoleczne pacjentów.

OBJECTIVES: Research on predictors of adolescent schizophrenia, especially that based on long-term follow-up studies, is rare in the literature. In our analysis, we examine the relationships of the age of disease onset, type of onset of the disorder and the presence of developmental burden with clinical and social indicators of the disease course. METHODS: A total of 69 patients hospitalized at an average age of 16 years (time point 0) due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals) were re-evaluated for clinical and social parameters 45 years after initial hospitalization (time point 2 - personal examination of 21 individuals). Besides personal examination, other methods of data collection were also used, including hospital queries. RESULTS: The hidden type of onset of schizophrenia revealed numerous and various correlations with both the symptomatic picture and the clinical course of schizophrenia, and with distant social functioning of the subjects, translating into a classical Bleuler symptomatic picture, weaker response to treatment, and worse functioning in personal and professional life. The presence of significant separations in childhood proved to be a factor conducive to insight and less intense psychopathology in the distant course of schizophrenia. The family burden of schizophrenia correlated with the catatonic picture in the future and with more hospitalizations and earlier death. CONCLUSIONS: The hidden type of onset of schizophrenia is the most important predictor of its later course.

The role of psychopathology in perceiving, reporting and treating intermittent claudication: a systematic review.

INTRODUCTION: The aim of this systematic review is to investigate the association between mental health and intermittent claudication (IC) perception, reporting and treatment in subjects with peripheral artery disease (PAD). EVIDENCE ACQUISITION: Literature searches of experimental and observational studies published until February 1st, 2016 were conducted using the following electronic databases: Medline/PubMed and Embase. The selection criteria for the studies included a population of patients diagnosed with peripheral artery disease who reported symptoms of intermittent claudication and were assessed for any psychopathological states (depression, anxiety, mood and personality disorders), which in turn were analyzed with regard to the following: IC severity, symptom perception and reporting, patients' quality of life, treatment compliance and its effectiveness. The risk of bias was assessed using Cochrane Collaboration's tool and the Newcastle Ottawa Scales. The strength of recommendations was graded according to GRADE system. EVIDENCE SYNTHESIS: The literature search identified 1598 citations, of which 13 studies with varying risk of bias were included in the review. Depression, anxiety, and personality types were described in more than 800 patients with peripheral arterial disease who suffered from intermittent claudication. With regard to IC perception and reporting, individuals with higher levels of depression had lower levels of pain acceptance, were more dissatisfied with their function and control over function and had a poorer quality of life. In the case of the type D personality, the results were not consistent. Studies assessing the influence of psychopathology on IC severity and treatment also showed discrepant results. Some studies indicated no differences between type D and non-type D patients with regard to the Ankle Brachial Index as well as pain free (PFWD) and maximal walking distances (MWD). On the other hand, others revealed that type D and depressed patients terminated 6MWT prematurely due to the onset of symptoms and experienced a greater annual decline in 6-minute walk distance, fast walking velocity and short physical performance battery. With regard to treatment adherence, patients with no mental problems made the best recoveries. Hostility, aggressiveness and affect-liability were the greatest obstacles to compliance. CONCLUSIONS: Mental disorders might influence the way in which the symptoms of the disease are reported, coped with, and treated. However, the results of the review preclude recommending a routine psychological examination as one of basic diagnostic procedures in patients with peripheral artery disease suffering from IC.

Does the family "need" depression? A pilot study of family consultations. / Czy rodzina "potrzebuje" depresji? Badania pilotazowe konsultacji rodzinnych.

OBJECTIVES: The aim of the presented study was to analyse associations between drug-resistant depression and the way the illness is described by patients and members of their families. In particular, a hypothesis to be verified was that being ill may be a factor stabilising the family system, and consequently treatment of this kind of depression may encounter additional difficulties and enforce "drug-resistance" by "sustaining depression" by the family. METHODS: The study included 20 patients and their families. The consultations that were conducted with each of the families constituted data for the presented research. Initial results indicate an explicit association between the way the patient and his or her family define circumstances of the illness and treatment and the type of interactions between them that are manifested verbally and nonverbally. RESULTS: Results of qualitative analysis indicate that if a patient during consultation reflects on how to describe his or her situation and precipitating factors of the illness, it usually takes place in opposition to other members of the family of origin. On the other hand, if a patient manifests depressive symptoms, he or she assumes a dependent role, while the rest of the family express an attitude of warmth towards him or her. CONCLUSIONS: Drug resistance depression should be considered, also with the context of the patient's family.

Mental health of adults treated in adolescence with scoliosis-specific exercise program or observed for idiopathic scoliosis.

OBJECTIVE: To examine general mental health in adult males and females, who in adolescence participated in a scoliosis-specific therapeutic exercise program or were under observation due to diagnosis of scoliosis. DESIGN: Registry-based, cross-sectional study with retrospective data collection. METHODS: Sixty-eight subjects (43 women) aged 30.10 (25-39) years, with mild or moderate scoliosis (11-36° Cobb angle), and 76 (38 women) nonscoliotic subjects, aged 30.11 (24-38) years, participated. The time period since the end of the exercise or observation regimes was 16.5 (12-26) years. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ-28) scores were analyzed with the χ(2) and U tests. Multiple regression analyses for confounders were also performed. RESULTS: Intergroup differences of demographic characteristics were nonsignificant. Scoliosis, gender, participation in the exercise program, employment, and marital status were associated with BDI scores. The presence of scoliosis and participation in the exercise program manifested association with the symptoms. Higher GHQ-28 "somatic symptoms" subscale scores interacted with the education level. CONCLUSIONS: Our findings correspond to the reports of a negative impact of the diagnosis of scoliosis and treatment on mental health. The decision to introduce a therapeutic program in children with mild deformities should be made with judgment of potential benefits, risks, and harm.

[The significance of selected psychopathological and personality variables in the course of allergic and non-allergic asthma]. / Znaczenie wybranych zmiennych psychopatologicznych i osobowosciowych w przebiegu astmy oskrzelowej alergicznej i niealergicznej.

AIM: The aim of this study was to carry out a comparative analysis of selected psychopathological and personality variables in patients with allergic and non-allergic asthma, as well as an attempt to determine the significance and strength of these variables in the clinical picture of both forms of the disease. METHODS: In all patients structured anamnesis, basic spirometry, and dyspnea measure- ment were carried out. The level of anxiety was determined using Spielberger's questionnaire. The intensity of depression was evaluated with Beck's Inventory. Neuroticism and extroversion-introversion were assessed by Eysenck's Inventory. The I-E scale was used to determine the perception of the locus of control. RESULTS: The lack of significant differences in the area ofpsychopathological and personality variables was found between the two types of asthma. The gender differentiated patients with respect to psychopathology. The intensity of extroversion correlated with the duration of the disease. In the case of neuroticism, the clinical form of the disease was associated with blurring the differences between genders. The intensity of dyspnea and the spirometric results correlated with the psychological background of the disease. CONCLUSIONS: No significant differences in the area of psychopathology and personality dimensions between the groups of patients with allergic and non-allergic asthma were found although psychological variables are associated with the course of asthma in adults.

Locus of control and selected mental health variables in asthmatics: what are the associations with dyspnea?

INTRODUCTION: The literature provides ambiguous information concerning the associations between asthma and psychopathology. The concept of the locus of control (LOC) can shed some light on the psychosomatic aspects of asthma. OBJECTIVES: The aim of the study was to analyze the relationship between dyspnea perception and psychopathological symptoms in asthma. We also tested how a tendency to attribute the LOC affects the relations between psychopathology and dyspnea. PATIENTS AND METHODS: We examined 111 consecutive, unselected asthma patients, including 74 women and 37 men. The mean age was 49.79 ± 14.19 years, with no significant differences between sexes. There were mainly patients with level 2 (38.7%) and level 4 (35.1%) of asthma severity according to the Global Initiative for Asthma classification. Sociodemographic data were collected and the General Health Questionnaire (GHQ) by Goldberg and the Locus of Control questionnaire by Rotter were applied. The level of dyspnea was assessed by patients on the 10-point Borg scale. Spirometry tests were performed. RESULTS: Gender, education, and LOC differentiated patients according to psychopathological symptoms. There were no differences in psychopathology between the groups with different levels of asthma severity. In women, there was a significant correlation between intensity of dyspnea and higher scores on all GHQ scales; in men, the correlation was observed only for the depression subscale and the general scale. CONCLUSIONS: Psychopathological disorders are more significantly associated with subjective asthma symptoms than with asthma severity. Gender, education, and a tendency to attribute the LOC internally may be significant for this association.

[The need of qualitative research in psychiatry]. / O potrzebie badan jakosciowych w psychiatrii.

The authors present basic information about qualitative research along with its theoretical frame as a useful approach in the study of many issues in the area of psychiatry and psychotherapy. According to the authors, the quantitative methodology--dominant in psychiatry nowadays--seems insufficient to address all issues to be studied in this area. After a short introduction of the theoretical background of qualitative research, the authors present methods of collecting and analysing qualitative data and possible ways of using them in practice. In psychiatry, there are many complex psychotherapeutic methods used, their effects depending on many conditions, such as feelings and actions of patients and therapists. Hence, qualitative methods--which enable researchers to study the complexity of human interactions--seem to be well suited for psychiatric research. However, the authors conclude, the reason for choosing one or the other method should be practical rather than ideological; the methods indeed very often complete, rather than exclude each other, in research practice.

Multi-couple reflecting team: preliminary report.

The aim of therapeutic help in marital crisis is to break the vicious circle of mutual hurtful accusations. The method that the authors present below involves a group of couples working within a closed cycle of meetings. In the course of successive group meetings, the various couples act as reflecting teams (RTs) for each other. This achieves two objectives: the couple recounting their crisis receives nonthreatening feedback, which helps them to implement positive changes and break out of the self-perpetuating destructive interaction. In addition, the couples acting as the RT learn nonjudgmental, nontheorizing and affirmative communication.

[The position of psychooncology in contemporary psychiatry]. / Miejsce psychoonkologii we wspólczesnej psychiatrii.

Growing evidence indicates that it is not possible to understand carcinoma taking into account only the biological basis, without the psychological and social aspects of the disease. Contemporary psychooncology represents a holistic approach to the disease, integrating theoretical models, clinical and sociological observations as well as current scientific data. Psychooncological research concentrates on the influence of psychological factors on the risk of developing cancer (the model of "personality promoting carcinoma" and the model of "loss and depression"), on psychological processes as predictive factors in the course of an already existing illness and on psychological distress during diagnosis and treatment of the cancer.

Psychopathology and personality factors modify the perception of dyspnea in asthmatics.

We studied the relationship between the intensity of dyspnea and psychopathological and personality dimensions in 74 women and 38 men (mean age 49.7 years) with asthma. The women had higher values for the following variables: depression, anxiety-trait, and neuroticism, and they proved to have a greater external control location than the men. After checking the spirometry results, body mass index (BMI) and gender, it was found that dyspnea correlated with anxiety-trait and anxiety-state, neuroticism, and depression. In the men, anxiety-trait modified the relationship between dyspnea and the duration of the disease. This effect was not found in the women. A high level of anxiety-trait seems to be responsible for the escalation of dyspnea during the progression of the disease in men, whereas low anxiety may protect them against the increase of dyspnea. FEV(1), BMI, and anxiety-trait were predictors of dyspnea.

[Manfred Cierpka Questionnaire usefulness in the analysis of perception of familiar support in patients with acute leukaemia]. / Wykorzystanie kwestionariusza Manfreda Cierpki w analizie wsparcia rodzinnego u pacjentów z ostra bialaczka.

AIM: The mechanisms of the impact of family support on somatic diseases are still unclear and they are subject of research. Especially little is known about the role of family relations. This study discusses the meaning of social support in somatic disorders, particularly acute leukaemia in the context of family functioning. The aim of the study is the evaluation of usefulness of the Manfred Cierpka questionnaire as the assessment tool examining social support for leukaemic patients. METHOD: The study included 36 subjects, 21 men and 15 women, with diagnosis of acute leukaemia. The level of depression symptoms was Manfred Cierpka questionnaire usefulness in the analysis of perception of familiar support in patients with acute leukaemia by the set of questionnaires. The level of disease symptoms was estabilished on the basis of several clinical variables and procedures, during a one year course of the disease. Family functioning and functioning of the patient within the family were evaluated by family assessment questionnaire of Cierpka. RESULTS: The result of the overall family functioning assessment in the subgroup with depressive symptoms was significantly worse than in the group without depression. There was no such difference in self assessment of the patients' functioning in the family. The scores of the family assessment questionnaire does not differentiate the group according to severity of the illness and one year mortality. CONCLUSION. The Manfred Cierpka questionnaire is helpful as an assessment method of subjective perception of family support for leukaemic patients. The results of the family functioning questionnaire are related to the sustaining of depressive symptoms in the course of the disease. It may indicate the usefulness of early family intervention in the specific group of patients.

[The effect of music therapy on anxiety level in hospitalized asthmatic patients]. / Wplyw muzykoterapii biernej na poziom leku u chorych hospitalizowanych z powodu astmy oskrzelowej.

The role of music therapy as a supportive treatment is not well defined. The music therapy cannot be estimated as the isolated method it is often only the part of the complex therapy. The aim of this study was to evaluate the influence of music therapy on anxiety level in hospitalized asthmatic patients. The patient group was consisted of 36 patients with bronchial asthma (23 women and 13 men). In all patients we evaluated the level of anxiety (attribute and state) according to Spielberger and intensity of dyspnoe according to Borg scale at the first day of examination and after 10 days of rehabilitation program. Moreover we performed spirometry. The respiratory rehabilitation program included: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles. The duration of music therapy lasted 15 min. After 10 days rehabilitation with or without music therapy we found the reduction of anxiety (state) (p<0.0001). However we did not observe the difference between two studied groups with or without music therapy in diminishing of anxiety (p = 0.55). In conclusion, we believe that the music therapy can play important role in treatment of somatic disease but our study did not confirm its additive positive meaning in patients with bronchial asthma.

[Family assessment measures by Manfred Cierpka]. / Kwestionariusze Manfreda Cierpki do Oceny Rodziny.

In the first part of the paper, authors describe some research tools for the assessment of family functioning, concentrating mainly on self-report questionnaires of the family members. Advantages and methodological limitations of such methods are discussed. Several questionnaires of self-report type are described such as e.g. the Family APGAR, Family Environment Scale, Mc Master Family Assessment Device, as well as Family Assessment Measure (FAM) of Skinner and Steinhauer. Manfred Cierpka Family Assessment Measures are a modification of this last questionnaire. In the second part of the paper authors present in details Cierpka Family Assessment Measures. They describe seven dimensions of the family functioning such as task accomplishment, role performance, communication, emotionality, affective involvement, control and values and norms. Family Assessment Measures consist of three questionnaires such as General Scale, Dyadic Scale and of Self-Rating Scale. General Scale focuses on how individual member views the family as a whole, The Dyadic Scale assesses specific relationship dyads within the family and Self-Rating Scale addresses how an individual member views his or her functioning within the family. At the end, psychometric properties of these questionnaires are presented, as well as the general description, how they should be used in the process of the assessment of the family for research and in clinical practice of family therapy.

[Some psychometric attributes of the Family Assessment Questionnaires]. / Niektóre psychometryczne wlasnosci Kwestionariuszy do Oceny Rodziny.

In this article we present some of the more important findings from research aimed at the validation and normalisation of the Family Assessment Questionnaire (Dyadic Questionnaire, Family Questionnaire, Self-Estimation Questionnaire), which is the Polish adaptation of Manfred Cierpka's and Gabriele Frevert's "Familienboegen". In the presented study 1511 individuals from 557 families took part. Of these 658 individuals (including 162 children) came from 248 families which had no clinical health or adjustment problems, while 853 individuals (including 305 children) came from 309 families with problems due to schizophrenia, anorexia nervosa, coronary heart disease or family crisis. A new method of analysing raw results from the questionnaire scales was formulated and verified. This method was based on the criterium of sufficient satisfaction regarding the aspect of family life measured by the scale. The original scales of all the questionnaires (Task Completion, Role Performance, Communication, Emotionality, Affective Involvement, Control, and Values and norms) were characterised by average or low reliability; the general scales were characterised by high reliability (the Dyadic Questionnaire with very high reliability). As a result of factor analysis new scales were created with acceptable or high reliability. These were the scale of Positive statements, the scale of Negative statements in the dyadic and family questionnaires, and the scales of kindness, care and resentment in the Self-Estimation Questionnaire. The general scales and the factor scales generally significantly differentiated between the sub-samples selected due to the type of family problems present and relationship. On the other hand the 7 original scales did so only sporadically or weakly. Better results were obtained by families without health or adjustment problems while the worst results were obtained by families in crisis.