The Satisfaction with Life Domains Scale as an instrument for assessing quality - a psychometric evaluation.

Purpose: Basic indices of reliability, validity, and feasibility of the Polish language version of the Satisfaction with Life Domains Scale (SLDS) were assessed - this is one of the self-assessment measures of the subjective quality of life. Methods: The combined database included 1,246 people from previous studies on stigma (n = 316) and recovery (n = 110), and individuals seeking psycho-social support (n = 820). Apart from SLDS, other measures of life functioning, experiences of stigma and discrimination, factors of personal recovery, and self-rated and clinician-rated psychopathology were used. Results: The SLDS results were characterized by a good item performance and high internal consistency (α = 0.92). Significant improvement in life satisfaction was noted, while maintaining some correlational stability in the re-test. Satisfaction with life did not depend on gender, education and age, but on diagnostic qualification (mental problems < somatic diseases) and methodological qualification (patients > persons seeking support). The direction and strength of the correlation of SLDS scores with a number of social, personal and clinical variables supports its theoretical validity, as does the principal components analysis indicating both the value of a one- and three-dimensional solution (satisfaction with social conditions, living conditions and interpersonal relationships). The feasibility of SLDS is also indicated by the low frequency (< 2.8%) of no responses in the surveyed population. Conclusions: The basic psychometric indicators of the Polish language version of the SLDS confirm its satisfactory reliability and validity as well as a sufficient level of feasibility for various clinical and research aims.

Mental Health Centers. Preliminary evaluation of the pilot program implementation process. / Centra Zdrowia Psychicznego. Wstepna ocena procesu wdrazania modelu pilotazowego.

OBJECTIVES: The aim of the presented research is to characterize the operating Mental Health Centers (MHCs) and to provide a preliminary assessment of the implementation process of the pilot program model in the area of psychiatric care in Poland. METHODS: The study uses the Polish version of the German questionnaire, which covers four areas: (1) basic conditionsof the model project/pilot program; (2) characteristicsof the organizational structure of the treatment entity; (3) statistical characteristics of the services provided;(4) specific features of the psychiatric care system in model regions/pilot program Mental Health Centers. RESULTS: Nineteen of the 27 Mental Health Centers completed the survey. The centers have 428 beds in day units and 1,971 beds in inpatient units. Most of the centers (15 of 19) work with subcontractors and all are publicly funded. Eight centers were established by psychiatric hospitals and 11 centers were constituted at psychiatric wards within multi-specialist hospitals. The medical services provided by the centers mainly include psychiatry and psychotherapy. In 2019, the centers provided medical services to a total of 65,614 patients; 8,432 patients received at least three forms of treatment. CONCLUSIONS: The first full year of MHC operation in the pilot program indicates the expected direction of change in psychiatric care - achieving a significant level of implementation of community care standards. The survey needs to be repeated to verify this direction. A limitation of the study was the lack of survey responses from 30% of MHCs. In the future, we should aim for at least 90% of completed surveys.

Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland.

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.

Healthcare system performance in continuity of care for patients with severe mental illness: A comparison of five European countries.

Most healthcare systems struggle to provide continuity of care for people with chronic conditions, such as patients with severe mental illness. In this study, we reviewed how system features in two national health systems (NHS) - England and Veneto (Italy) - and three regulated-market systems (RMS) - Germany, Belgium, and Poland -, were likely to affect continuing care delivery and we empirically assessed system performance. 6418 patients recruited from psychiatric hospitals were followed up one year after admission. We collected data on their use of services and contact with professionals and assessed care continuity using indicators on the gap between hospital discharge and outpatient care, access to services, number of contacts with care professionals, satisfaction with care continuity, and helping alliance. Multivariate regressions were used to control for patients' characteristics. Important differences were found between healthcare systems. NHS countries had more effective longitudinal and cross-sectional care continuity than RMS countries, though Germany had similar results to England. Relational continuity seemed less affected by organisational mechanisms. This study provides straightforward empirical indicators for assessing healthcare system performance in care continuity. Despite systems' complexity, findings suggest that stronger regulation of care provision and financing at a local level should be considered for effective care continuity.

International classification of diseases/disorders diagnosis and International Classification of Functioning, Disability and Health activity/participation limitation among psychiatric patients: a cross-sectional and exploratory study.

To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions - activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits.

The evaluation of the impact of anti-stigma training led by "experts by experience" on participants' attitudes towards persons with mental illness. / Ocena wplywu szkolen antystygmatyzacyjnych prowadzonych przez "ekspertów przez doswiadczenie" na postawy uczestników wobec osób chorujacych psychicznie.

OBJECTIVES: The purpose of this study was to evaluate the impact of anti-stigma training led by people who had previously experienced mental health crises (i.e., "experts by experience") on various aspects of participants' attitudes towards the people with mental illness. METHODS: The three-hour workshops were attended by 185 people; the training was held in 17 groups, with 3-19 people in each (11 on average). Almost half of the participants (45.4%) were employees of the mental health care system. The participants were asked to fill out a set of questionnaires immediately before and after the training, which evaluated the following aspects of their attitudes: social distance, stigmatizing attributions, beliefs about self-determination/ ability to attain important life goals by people with mental illness, and also beliefs about the social value of people with mental illness. The respondents were asked to complete the same set of questionnaires again online a month and six months after the training. The data were analyzed based on a piecewise latent trajectory model. RESULTS: Out of the 185 people who participated in the workshops, 115 (62.2%) filled out the questionnaires a month after, and 87 (47.0%) six months after the training. The analyses showed an improvement in all four measures of attitudes expressed directly after the training. In three out of the four examined aspects of attitudes (intensity of social distance, stigmatizing attributions and beliefs about self-determination of people with mental illness) the positive impact of the training continued after six months. CONCLUSIONS: The results provide preliminary empirical evidence that the structured antistigma intervention under evaluation, using the elements of education and interpersonal contact can be an effective tool for improving social attitudes towards people with mental illness.

Clozapine-induced myocarditis during co-administration of valproate: A case report. / Zapalenie miesnia sercowego indukowane klozapina w trakcie leczenia pochodnymi kwasu walproinowego: opis przypadku.

Clozapine, atypical antipsychotic drug, is widely used in patients with schizophrenia, for whom previous therapy was inadequate or not tolerated. Clozapine-induced myocarditis (CIM) is a relatively rare but potentially life-threatening complication of clozapine therapy; however, the underlying mechanism has not been so far well elucidated. Factors predisposing to CIM include a rapid dose titration, advanced age and co-administration of sodium valproate. In this paper, we present a case of a 22-year-old male patient with refractory schizophrenia who developed CIMduring low-dose clozapine treatment with co-administration of valproate and risperidone. On the basis of our case and literature review, we point out that during the first weeks of clozapine treatment patients should be actively, daily monitored for the presence of symptoms suggesting CIM. The low dose of clozapine and concurrent use of valproate are unique aspects of the report, adding new information to the discussion on safety of concomitant use of clozapine and valproate. Further investigation is required to better understand the role of co-administration of valproate and risperidone in the pathogenesis of CIM.

Hope and its dimensions in relation to clinical recovery: A cross-sectional study among people with psychotic disorders.

OBJECTIVE: Hope is a key component of personal recovery. There is limited evidence regarding the association of hope with the level of functioning in individuals with psychosis. It is also not clear which dimensions of hope are most strongly related to clinical recovery. Thus, this study aims to explore the relationships of hope and its dimensions with various indicators of clinical recovery such as overall psychopathology, depression and global functioning among people with psychotic disorders. METHOD: The Integrative Hope Scale (IHS; Schrank, Woppmann, Sibitz, & Lauber, 2011) was administered to 110 people with psychotic disorders. Multiple regression analysis was used to investigate the associations of the IHS total score and its four subscales (i.e., Trust and Confidence, Lack of Perspective, Positive Future Orientation, and Social Relations and Personal Value) with overall psychiatric symptoms, depression, and general functioning. RESULTS: A total level of Hope was not associated with overall psychopathology or global functioning; however, it showed a significant negative relationship with severity of depression. A stronger feeling of a Lack of Perspective turned out to be associated with more severe depression and a greater intensity of psychopathological symptoms. The relationships of the remaining dimensions of Hope with the indicators of clinical recovery were found to be nonsignificant. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The findings suggest that combining Hope-enhancement strategies with interventions targeting symptoms may increase the effectiveness of rehabilitation programs for people with psychosis. They also point to the sense of a Lack of Perspective as the aspect of Hope most strongly related to clinical recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Investigating the roles of loneliness and clinician- and self-rated depressive symptoms in predicting the subjective quality of life among people with psychosis.

PURPOSE: To examine the roles of loneliness and clinician- and self-rated depressive symptoms as predictors of the subjective quality of life (QoL) in psychosis. METHODS: This cross-sectional study was conducted on a sample of 207 patients diagnosed with psychotic disorders. They were assessed with self-reported measures of QoL, loneliness and depression and with clinician-rated measures of depression and overall psychopathology. Multiple indicators multiple causes (MIMIC) modeling was used to analyze the data. RESULTS: Both loneliness and depression turned out to be independent predictors of impaired QoL. However, once loneliness was accounted for, the effect of depression on QoL was markedly reduced and the effect of loneliness proved to be visibly larger. Self-rated depression was found to be more strongly associated with QoL than clinician-rated depression. Each type of depression measure explained a unique amount of variance in QoL. Depression moderated the relationship between loneliness and QoL in such a way that the negative effect of loneliness on QoL weakened with the increasing intensity of depressive symptoms. CONCLUSIONS: Therapeutic programs aiming to enhance the QoL of people with psychotic disorders should incorporate interventions targeting both loneliness and depression and need to be tailored to the clinical status of patients. The emphasis on alleviating loneliness should be placed first of all in the case of those with low levels of depression, among whom the negative impact of loneliness on QoL is especially strong. Researchers should be aware that the method chosen for assessing depressive symptoms in models predicting QoL in psychosis matters.

The relationship between internalized stigma and quality of life among people with mental illness: are self-esteem and sense of coherence sequential mediators?

PURPOSE: To elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC). METHODS: A cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL. RESULTS: The proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = -0.06, SE = 0.02; 95% CI (-0.11, -0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL. CONCLUSIONS: Self-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment.

Exploring Factors Associated with the Psychosocial Impact of Stigma Among People with Schizophrenia or Affective Disorders.

Stigmatization can exert a variety of pernicious effects on the lives of persons with mental illnesses. The purpose of this study was to explore factors related to the psychosocial impact of stigma among 229 people receiving psychiatric treatment: 123 with schizophrenia [International Classification of Diseases, 10th Revision (ICD-10): F20] and 106 with affective disorders (ICD-10: F31-F33). In the whole sample, the factors most prominently associated with a greater impact of stigma on personal and family life were schizophrenia diagnosis, current inpatient treatment, actually experienced stigma and self-stigma. However, the patterns of predictors varied between the two diagnostic categories. For the schizophrenia group, only self-stigma significantly contributed to a stronger stigma impact. In the affective group, a more severe impact of stigma was significantly predicted by inpatient status and experienced stigma. Anti-stigma programs should address the specific features of stigmatization associated with various psychiatric diagnoses.

[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.

The stages of recovery in relation to the other subjective and objective aspects of psychosis.

The Stages of Recovery Instrument (STORI; Andresen et al., 2006) was used among 110 patients with psychosis. Recovery stages relationship with attribution, the way of experiencing illness and its phase and symptoms were analyzed. The samples were drawn from treatment facility including in-patient unit. The subgroups of recovering patients were identified: moratorium (27%), awareness (32%), preparation (30%) and rebuilding (11%). The achievement of higher stages of the recovery was correlated with: less severe symptoms of psychosis (with the exception of anxiety and depression, which have no impact on the stages of recovery), medical attribution (I am ill), integrative attitude toward the experience of psychosis, and the absence of involuntary hospitalizations. The logistic regression analysis model indicated the independent significance of the medical attribution, the integrating attitude toward psychotic experience and the remission of symptoms. Other clinical variables and social characteristics did not differentiate between the stages of recovery in any significant way. No juxtaposition as such was found between the processes of recovery and being ill, but rather a complementary relation. Recovery has been found to be enhanced by the remission of psychotic symptoms, medical attribution and integrative attitude toward the experience of psychotic crisis.

Loneliness mediates the relationship between internalised stigma and depression among patients with psychotic disorders.

BACKGROUND: Stigmatisation is a source of chronic stress and a major barrier to recovery for people with mental illnesses. The internalisation of stigma can have a negative impact on an individual's social relations and lead to feelings of loneliness and depression. AIM: This research is aimed at testing the hypothesis that the internalised stigma of mental illness contributes to the intensification of depressive symptoms indirectly, through its impact on feelings of loneliness. METHODS: A total of 110 individuals with diagnoses of psychotic disorders (International Classification of Diseases-10th Revision (ICD-10): F20-F29) were assessed with measures of internalised stigma, loneliness, depression, positive and negative symptoms and global functioning. The ordinary least squares regression was used for data analysis. RESULTS: After adding loneliness to the regression model, the initially significant impact of internalised stigma on depressive symptoms disappeared. As expected, loneliness proved to be a full mediator in the relationship between stigma and depression. CONCLUSION: The study findings provide useful insights into the mechanisms of the harmful effects of stigma on people with mental illness. Internalised stigma and loneliness should be considered important targets for interventions aiming to promote recovery.

The sense of coherence as a predictor of the scope and impact of stigma experiences among people with mental illness.

This study explored the role of the sense of coherence (SOC) in predicting the scope and impact of stigma experiences in 229 patients with schizophrenia or affective disorders. Findings revealed that SOC significantly predicted lower levels of stigma, accounting for 13% of the variance in stigma experiences and 4% of the variance in stigma impact, over and above that explained by background characteristics, diagnosis and the psychiatric symptoms of the participants.

The Stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ): a psychometric evaluation in Polish psychiatric patients.

OBJECTIVE: There is a scarcity of well validated measures of the subjective experience of the stigma of mental illness. The aim of this paper was to evaluate the psychometric properties of the Stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ). METHODS: A secondary analysis of the data from two cross-sectional studies using the CESQ was conducted in order to assess the factor structure, internal consistency and concurrent validity of the Stigma subscale. Sample 1 included 373 diagnostically heterogeneous patients (65% had psychotic disorders) and Sample 2 included 136 patients with schizophrenia. RESULTS: Since none of the factor models of the original 9-item scale was satisfactory, it was shortened by removing two psychometrically weakest items. The abbreviated 7-item scale proved to be a one-dimensional instrument, with good estimates of internal consistency. Its concurrent validity was partly confirmed by demonstrating negative correlation with quality of life and positive correlations with self-rated psychopathological symptoms. However, contrary to theoretical expectations, the stigma score was not associated with global functioning and clinician-rated symptoms. CONCLUSIONS: The psychometric properties of the Stigma subscale of the CESQ may be improved by shortening the instrument. Although the reliability and validity of the abbreviated version were partly established, further research is needed to explore in particular its test-retest reliability and concurrent validity.

[Four measures of treatment compliance among patients recovering from psychotic episodes--a comparative study]. / Cztery miary przestrzegania zalecen u chorych po przebytym epizodzie psychotycznym--porównanie.

OBJECTIVES: Patient compliance influences results of treatment of mental disorders. The study compares four measures of treatment adherence. METHODS: 103 subjects were examined in the early remission from an acute psychotic (schizophrenic or schizoaffective) crisis. Compared was patient's compliance assessed by two simple scales: 5-point POP (patient's self-rating) and 7-point POK (clinician's rating) as well as by two composite questionnaires: the Drug Attitude Inventory (DAI-10) and the Medication Adherence Rating Scale (MARS). The ROC curve was used to compare sensitivity and specificity of DAI-10 and MARS scores as predictors of simple ratings. RESULTS: The percentage of patients who complied ranged between 42.8% to 62% (20.4-26.2% with stringent criteria applied). The POK shows a stronger correlation with the POP (0.50) than with the results of DAL-10 (0.30) or MARS (0.32). The POP correlated low with DAI-10 (0.23) and MARS (0.32). The correlation between MARS and DAI-10 was relatively high (0.67). Their reliability (Cronbach's a coefficient) only moderately exceeded the satisfactory level (DAI-10: alpha = 0.76) or approximated it (MARS: alpha = 0.61). Area under the curve (AUC) suggested comparable and significant diagnostic value of the DAI-10 and MARS. Scores extending 7.5 points indicated their optimal relation between sensitivity and specificity in predicting the clinician or patient ratings. CONCLUSIONS: Approximately one in two (one in four assuming the more demanding criteria) of the subjects complied with treatment recommendations. The correlation between the results of the questionnaires was relatively high, though moderate between the simple ratings. DAI-10 and MARS showed moderate reliability, sensitivity and specificity.

[Language disorders and cognitive functions in persons with schizophrenic disorders]. / Zaburzenia jezykowe a inne wybrane funkcje poznawcze u osób chorujqcych na zaburzenia schizofreniczne.

AIM: The aim of this study is to evaluate the relationship between clinical and neuropsychological measures of language disorders as well as characteristics of the mental condition of patients diagnosed as having schizophrenic disorders. METHOD: There were 45 persons with schizophrenic disorder (acc. ICD-10) examined with The Positive and Negative Syndrome Scale (PANSS), the side effect rating scale (UKU), Wisconsin Cards Storting Test (WCST), verbal fluency task, Ruff's Test, "Similarities" --WAIS-R subtest, 10 graphics of The Thematic Apperception Test (TAT). Patient's speech was evaluated independently by two diagnosticians using Thought, Language and Communication Scale (TLCS). RESULTS: Time since the onset of illness and the number of hospitalisations were associated with total TLCS scores and with most of the WCST indicators. Total amount and most of the particular language disorders correlated positively with total PANSS scores. Total amount of language disorders was connected with the number of trials, which were necessary to complete the first category and also with the global scores obtained in "Similarities". There were also many correlations between particular language phenomenons and results of several neuropsychological tests. CONCLUSIONS: Correlation between psychopathological evaluation of language disorders according to TLCS and evaluation of the schizophrenic syndrome score is found to be significant. The psychopathological rating of general and particular language disorders shows significant correlations with some indicators of executive function, verbal and nonverbal fluency and the ability for abstract thinking.