Acute Stress Disorder among 2022 Ukrainian war refugees: a cross-sectional study.

Introduction: Fleeing from war can be terrifying and result in Acute Stress Disorder (ASD), a mental health condition that can occur in the first month after a traumatic event. The study aimed to identify the prevalence of ASD among Ukrainian refugees and identify its risk factors to create a profile of the most vulnerable refugees. Methods: This cross-sectional study of 637 Ukrainian war-displaced persons and refugees in 2022 used the Acute Stress Disorder Scale. Results: The prevalence of ASD among participants was high (93.5%). Several factors increasing the risk of developing ASD in the sample were identified, e.g., witnessing Russian attacks (OR 2.92, 95% CI 1.26-6.78), insufficient financial resources (OR 3.56, 95% CI 1.61-7.91), and feeling of loneliness in the host country (OR 3.07, 95% CI 1.58-8.69). Pre-existing depression and the death of a close person, among others, were found to significantly (p < 0.05) exacerbate the ASD symptoms. At the same time, neither age, the distance traveled, time spent on fleeing the country, nor the type of companionship during refuge (escaping alone, with children, pets or the older adults) correlate with the severity of symptoms. Conclusion: The study shows extreme levels of trauma among Ukrainian war refugees and displaced persons. Knowledge regarding ASD vulnerabilities in the present conflict may facilitate prompt and adequate psychological help. Since ASD can be an antecedent of PTSD and several autoimmune disorders, these results may also serve as a predictor of future challenges for Ukrainian society.

Praecox feeling among Polish psychiatrists: a grounded theory study. / Poczucie praecox wsród polskich psychiatrów: badanie metoda teorii ugruntowanej.

OBJECTIVES: The study aims to identify the sources and components of the so-called praecox feeling (PF) from the perspective of Polish psychiatrists who experience it and can verbalize it. METHODS: Qualitative analysis based on the grounded theory method, conducted on a set of open-ended statements provided by psychiatrists (N = 103) who described their feelings strongly suggestive of a diagnosis of schizophrenia in a nationwide survey. RESULTS: For most respondents (80.58%) PF stems from patients' behaviors and states but none of the identified PF components dominate clearly over others. Physicians referred most often (44.66%) to the patients' affect and emotional states, particularly shallowness and emotional coldness (22.33%). One in four (25.24%) referred to the patients' utterances, including incoherence and detachment of content from reality (14.56%), and indicated formal disorders of mental processes (22.33%). A post-hoc analysis showed that the main cross-sectional topic of the PF was the feeling of patients' separation from the surrounding reality and other persons (raised by 52.42% of respondents). The level of psychiatric expertise does not affect PF's contents. Physicians who can verbalize it consider it reliable for diagnosing schizophrenia more often than those who use PF in their practice but cannot verbalize it (82.52% vs. 67.62%, chi2 p = 0.007, φc = 0.186). CONCLUSIONS: PF is a complex and ambiguous phenomenon experienced by residents and specialists alike. It has mostly to do with affectivity and perceived detachment from reality. Further analysis may positively influence the ability of psychiatrists to articulate and apply PF in the diagnosis of schizophrenia.

Cognitive biases as an adaptive strategy in autism and schizophrenia spectrum: the compensation perspective on neurodiversity.

This article presents a novel theoretical perspective on the role of cognitive biases within the autism and schizophrenia spectrum by integrating the evolutionary and computational approaches. Against the background of neurodiversity, cognitive biases are presented as primary adaptive strategies, while the compensation of their shortcomings is a potential cognitive advantage. The article delineates how certain subtypes of autism represent a unique cognitive strategy to manage cognitive biases at the expense of rapid and frugal heuristics. In contrast, certain subtypes of schizophrenia emerge as distinctive cognitive strategies devised to navigate social interactions, albeit with a propensity for overdetecting intentional behaviors. In conclusion, the paper emphasizes that while extreme manifestations might appear non-functional, they are merely endpoints of a broader, primarily functional spectrum of cognitive strategies. The central argument hinges on the premise that cognitive biases in both autism and schizophrenia spectrums serve as compensatory mechanisms tailored for specific ecological niches.

The rhythm of chemotherapy and the felt experience of time: a front-loaded phenomenological retrospective cohort study.

It is well-known that chemotherapy brings about various adverse physical effects such as fatigue, nausea, or vomiting, and that it lowers mental well-being. It is less known that it desynchronizes patients with social environment. This study explores the temporal aspects and challenges of chemotherapy. Three groups equal in size and distinguished according to weekly, biweekly, and triweekly treatment schemes, each independently representative in terms of sex and age of the cancer population (total N = 440) were compared. The study found that chemotherapy sessions, regardless of their frequency, patients' age, and the overall length of treatment, have a very large effect on changing the felt pace of time from flying to dragging (Cohen's d = 1.6655). Most patients pay more attention to the passing of time than before treatment (59.3%), which has to do with the disease (77.4%). They also experience the loss of control over time, which they subsequently attempt to regain. The patients' actual activities before and after chemotherapy, however, are mostly the same. All these aspects create a unique 'chemo-rhythm', in which the significance of the type of cancer and demographic variables is negligible, and the mere rhythmic nature of treatment plays a central role. In conclusion, patients find the 'chemo-rhythm' stressful, unpleasant and difficult to control. It is vital to prepare them for it and help to reduce its adverse effects.

Psychotic disorders of space and time - A contribution of Erwin W. Straus.

This paper presents and discusses a manuscript by one of the core founders of phenomenological psychopathology, Erwin W. Straus, concerning psychotic disorders of space and time (see attached Supplementary material). Written in June 1946, the manuscript is published for the first time as supplementary material to this paper. It is a clinical case-study of a patient with psychotic depression from Henry Phipps Clinic. It contains themes known from both Straus' earlier and later work on lived time and mental illness, in particular a critique of physicalism in psychology, a vindication of primary sensing, a description of the spatiotemporal unity of lived experience, and the notion of temporal becoming. However, it is the only work by Straus that explores in such detail a patient's case and shows how the lived experience is spatiotemporally structured and intrinsically related to affectivity, embodiment, and action. The manuscript is yet another piece of evidence of Straus' significance in developing the field of phenomenological psychiatry in both Germany and the United States.

Chemotherapy, clocks, and the awareness of death: A quantitative phenomenological study.

Following a previous phenomenological study of lived time in ovarian cancer, this research aims to find how the frequency of chemotherapy affects orientation in time (the so-called "chemo-clock") and the awareness of mortality of service users with various cancers. For this purpose, a variation of a front-loaded phenomenological method that combines scientific hypothesis testing with phenomenological insights of both conceptual and qualitative nature was developed. The study is based on a purposive quota sample of 440 participants representative of the Polish cancer population in terms of sex (m:f ratio 1:1) and age (m > 65 = 61%; f > 65 = 53%) and undergoing chemotherapy for at least a month. The exposure environmental factors of interest are temporal: the frequency of chemotherapy [weekly (N = 150), biweekly (N = 146), and triweekly (N = 144)] and time since the beginning of treatment. The study confirms the relevance of the "chemo-clock"-participants use the pace of hospital appointments for orientation in time, and significantly more often when in triweekly treatments (weekly 38%; biweekly 61%; triweekly 69.4%; V = 0.242, p < 0.001, while neither age nor time since the beginning of treatment differentiate the usage of calendar categories and the "chemo-clock"). Simultaneously, chemotherapy increases their awareness of finitude, which again correlates neither with age nor time since the beginning of treatment but is significantly stronger in those with lower chemotherapy frequencies. Lower treatment frequencies are thus associated with its increased significance in terms of its impact on how people with cancer measure time and whether they increasingly consider their mortality.

Mental Health Experts as Objects of Epistemic Injustice-The Case of Autism Spectrum Condition.

This theoretical paper addresses the issue of epistemic injustice with particular reference to autism. Injustice is epistemic when harm is performed without adequate reason and is caused by or related to access to knowledge production and processing, e.g., concerning racial or ethnic minorities or patients. The paper argues that both mental health service users and providers can be subject to epistemic injustice. Cognitive diagnostic errors often appear when complex decisions are made in a limited timeframe. In those situations, the socially dominant ways of thinking about mental disorders and half-automated and operationalized diagnostic paradigms imprint on experts' decision-making processes. Recently, analyses have focused on how power operates in the service user-provider relationship. It was observed that cognitive injustice inflicts on patients through the lack of consideration of their first-person perspectives, denial of epistemic authority, and even epistemic subject status, among others. This paper shifts focus toward health professionals as rarely considered objects of epistemic injustice. Epistemic injustice affects mental health providers by harming their access to and use of knowledge in their professional activities, thus affecting the reliability of their diagnostic assessments.

How to Minimize the Impact of Experts' Non-rational Beliefs on Their Judgments on Autism.

The non-autistic majority often judges people on the autism spectrum through the prism of numerous stereotypes, prejudices, cognitive biases, or, generally speaking, non-rational beliefs. This causes problems in autistic people's everyday lives, as they often feel stigmatized, marginalized, and they internalize deficit-laden narratives about themselves. Unfortunately, experts, including health or law professionals, are not entirely immune to these non-rational beliefs, which affect their decision-making processes. This primarily happens when a mix of background knowledge, overconfidence, and haste co-occur. The resulting decisions may impact autistic people, e.g., by determining eligibility for the state's therapeutical and financial support. This paper shows how simplified reasoning and inference may influence experts' (medical examiners or court expert witnesses) decision-making processes concerning autistic people. It also proposes particular clues and strategies that could help experts cope with this risk and avoid making biased decisions.

"As If There Are Two of Us": The Battle of Borderline Personality Disorder Diagnosis in Lived Time.

BACKGROUND: Although the experience of reception of borderline personality disorder (BPD) diagnosis was previously researched, the process of mental adjustment to this diagnosis remains both empirically and theoretically unexplored. Theoretical concepts describing the structure of lived time in borderline patients, which underlies adjustment to diagnosis, living with the diagnosis, and recovery from the disorder, namely, immediacy and instantaneity are not empirically verified. AIM: This study aimed to phenomenologically describe the process of mental adjustment to the diagnosis of BPD and to uncover its underlying temporal structure. METHODS: Semi-structured phenomenological interviews based on Giorgi's descriptive phenomenological psychological method and Cottle's Circles Test. The participants were 10 white, adult women diagnosed with BPD aged 20-32 years. RESULTS: The process of adjustment to BPD diagnosis comprises three following stages: (1) a cumulative feeling of inadequacy preceding the diagnosis, (2) the outburst of diagnosis, (3) a battle of Self fragments while adjusting to the diagnosis. Simultaneously, the diagnosis modifies the relationship between the self and illness in a way that previously scattered problematic issues become inscribed into the self as symptoms. At the same time, these symptoms are relatively separated from its "healthy" part. The temporal structure underlying this process is discontinuous. Particular temporal dimensions are distanced from one another, and the inner images of the past and present consist of unconnected, emotional peaks. The present resembles waking up from the lethargy of the past, while the future consists of two colliding scenarios - either being free of or in control of symptoms. CONCLUSION: Clinicians should pay more attention to the pathway of identification with BPD diagnosis and its underlying temporality. This is crucial for recovery and may allow adjusting therapeutic interventions to the patients' needs. Treatment should aim to enhance the patients' abilities to reflect upon their temporal experience to merge their fragmented narrative identity and better situate them in the recovery process.

The rhythm of chemotherapy and cancer patients' time perspectives.

Background: While it is well known that illnesses such as cancer modify the experience of time, the impact of the rhythm and length of treatment on patients' time perspectives remains unknown. Methods: A short version of Zimbardo Time Perspective Inventory and Transcendental Future Perspective Questionnaire as well as a demographic questionnaire on a convenience sample of 259 patients (66.8% female, mean age 52.36) with various cancers and undergoing chemotherapy with different frequencies (1, 2, 3 weeks) and mean time in treatment 23.4 months. Results: The temporal perspectives mean scores of cancer patients are: positive past 3.69, negative past 3.13, present hedonism 3.08, future 3.77, transcendental future 3.40. Patients tend only slightly to lose faith alongside the course of oncological treatment regardless of their age (ρ =  - 0.210, p < 0.01). The frequency of chemotherapy mildly differentiates temporal perspectives of patients regarding present hedonism and transcendental future: a weekly treatment is more disturbing than the triweekly one and no treatment in terms of hedonism, while patients not in chemo score significantly higher in transcendental future than patients in biweekly and triweekly chemo. Conclusions: The variations of treatment rhythm are less significant than predicted, although still relevant. Since most sociodemographic variables are of no relevance, cancer experience likely unifies temporal perspectives among people of different backgrounds.

Kinesthesia and Temporal Experience: On the 'Knitting and Unknitting' Process of Bodily Subjectivity in Schizophrenia.

This paper proposes a phenomenological hypothesis that psychosis entails a disturbance of the two-fold process of the indication function of kinesthesia and the presentification function of touch that affects the constitution of bodily subjectivity. Recent functional connectivity studies showed that the increased synchrony between the right anterior insula and the default mode network are associated with psychosis. This association is proposed to be correlated with the disrupted dynamics between the pre-reflective and reflective temporal experience in psychotic patients. The paper first examines the dynamic nature of kinesthesia and the influence touch and vision exert on it, and then the reciprocal influence with temporal experience focusing on the body's cyclic sense of temporality and its impact on physiology and phenomenology. Affectivity and self-affection are considered in their basic bodily expressions mainly through the concepts of responsivity and receptivity. The overall constitutive processes referred to throughout the article are proposed as a roadmap to develop body-based therapeutic work.

Lived time in ovarian cancer - A qualitative phenomenological exploration.

PURPOSE: To explore lived time of women with ovarian cancer during chemotherapy. METHODS: Consensual qualitative research combined with descriptive phenomenology on a purposive sample of 9 middle-aged women (aged between 33 and 52 years, mean age 41.7) with ovarian cancer undergoing chemotherapy in an outpatient chemo center in a clinical hospital. Patients partnered in the design of the study by reviewing the research questions. RESULTS: Four essential temporal structures were uncovered, namely: 1) Explicit finitude - the vivid presence of the thoughts of one's limited lifespan and of time passing towards death. 2) Broken horizon - a sense of an overwhelming unpredictability of life that makes one living in the narrow present. 3) The paradoxes of the chemo-clock - treatment rhythm becoming a basis for the conceptualization of time while lived experience both decelerates and accelerates. 4) Happiness closed-off by regret - the past being distantiated yet present in the form of thoughts about actions that have not been accomplished and no longer can. CONCLUSION: The research shows unsecure lived time of participants, particularly anxiety concerning premature death and fear of the future due to harsh prognosis. The proposed hybrid method of collecting and analyzing data is an example of combining phenomenological and scientific-objectifying procedures. It can lead to wider replications in different populations with respect to type and stage of the cancer and treatment.

Psychiatrists Report Praecox Feeling and Find It Reliable. A Cross-Cultural Comparison.

Background: The psychopathological notion of the Praecox Feeling (PF) refers to an experience of strangeness and bizarreness that arises in a clinician during contact with a patient with schizophrenia. There is evidence that psychiatrists take advantage of this feeling in their diagnostic decisions despite the domination of an operationalized diagnostic approach. Methods: The article presents the results of a survey assessing the self-reported prevalence of the PF among psychiatrists in Poland and compares them with data from West Germany (1962), USA (1989), and France (2017) based on the same survey. Results: The study finds a consistent prevalence of reported feelings suggestive of the diagnosis of schizophrenia among psychiatrists of different cultural backgrounds and times. These feelings are independent of variables such as attitude toward schizophrenia, professional orientation, and professional experience and are considered reliable, even if not the most reliable, by the psychiatrists who have them. The study also finds that intersubjective phenomena, such as problematic affective attunement, gestures, and body language, are considered core to these feelings by the psychiatrists. Conclusions: The evidence confirms that psychiatrists' feelings about patients with schizophrenia are considered diagnostically relevant and calls for more deeply investigating the nature and diagnostic significance of these feelings. The article concludes with some speculations regarding the possible benefits of recognizing the PF in facilitating a psychotherapeutic encounter with psychotic patients.

"From chemo to chemo"-the temporal paradox of chemotherapy.

PURPOSE: To uncover the experience of time in women undergoing chemotherapy for ovarian cancer. METHODS: A combination of consensual qualitative research and Giorgi's descriptive phenomenology. RESULTS: The key phenomenon found and pre-reflectively organizing the patients' experience was the temporal paradox of chemotherapy-a sense of both acceleration and deceleration in between chemotherapy sessions that desynchronizes patients with the time of others. CONCLUSION: The experienced paradoxes concentrating around the timings of the chemotherapy treatments are of particular relevance for supportive care. It is particularly important to acknowledge the disturbing effect of the cyclical nature of chemotherapy.

Kazimierz Filip Wize (1873 - 1953) - a psychiatrist, a biologist, and a philosopher. / Kazimierz Filip Wize (1873 ­ 1953) ­ psychiatra, biolog i filozof.

Kazimierz Filip Wize (1873-1953) was a Polish multidisciplinary scholar, a microbiologist, a lepidopterologist, a psychiatrist, and a philosopher. He was an avid promoter of care of the mentally ill. After defending a Ph.D. in medicine in Munich (Germany) in 1899, Wize specialized in bacteriology at the Pasteur Institute in Paris. In 1907 he defended his second Ph.D. in philosophy in Leipzig. Soon, Wize became an internationally active scholar and a prolific writer, working especially on esthetics and the philosophy of medicine. For Wize, philosophy of action was a bridge between abstract academic philosophy, practical ethics, and the philosophy of medicine understood as an art and a science. Later in his life, Wize moved back to practicing medicine, and in the 1930s he specialized in psychiatry. The new field enabled him to apply his esthetic concepts to the treatment of patients and become a pioneer of art therapy. Music, painting, and dance, Wize argued, are a means to achieve serenity and freedom and play an important part in the process of recovery. Much later, Wize witnessed the extermination of psychiatric patients in Poland during a Nazi T4 action.

Reassessing "Praecox Feeling" in Diagnostic Decision Making in Schizophrenia: A Critical Review.

The "Praecox Feeling" (PF) is a classical concept referring to a characteristic feeling of bizarreness experienced by a psychiatrist while encountering a person with schizophrenia. Although the PF used to be considered a core symptom of the schizophrenia spectrum, it fell into disuse since the spread of operationalized diagnostic methods (Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases systems). In contemporary research on schizophrenia, it remains largely unaddressed. This critical review investigates the evolution of the PF in historical and contemporary literature and presents an exhaustive overview of empirical evidence on its prevalence in clinical decision making, its reliability and validity. The review demonstrates that the PF is a real determinant of medical decision making in schizophrenia, although, without further research, there is not enough evidence to sustain its rehabilitation as a reliable and valid clinical criterion. PF-like experiences should not be opposed to any criteriological attitude in diagnosis and would be clinically useful if the conditions of descriptive precaution and rigorous epistemology are maintained. The aim of teaching clinical expertise is to transform this basic experience into a well-founded clinical judgment. Finally, the article discusses the possible relevance of the PF for basic science and clinical research according to a translational approach inspired by phenomenology.

Karl Jaspers: The Icon of Modern Psychiatry.

December 2015 and March 2016 issues of the American Journal of Psychiatry contain a debate focusing on the legacy of Emil Kraepelin, widely considered one of the founders if not the iconic founder of modern scientific psychiatry. The authors, Eric J. Engstrom and Kenneth S. Kendler, challenge the so-called neo-Kraepelinian view of Kraepelin and argue that the true, historical Kraepelin was far more inclined towards scientific psychology, less reductionist and brain-centric, and more skeptical nosologically than his later followers apparently believe. Commenting upon this paper, Rael D. Strous, Annette A. Opler, and Lewis A. Opler do not question these claims per se, but rather recall and emphasize historical facts that the paper regrettably omitted: Kraepelin's avid promotion of degeneration theory, eugenics, racism, and anti-Semitism as well as his mentoring of several of the most prominent Nazi-collaborating psychiatrists. Strous, Opler and Opler go on to suggest that it is now time for psychiatry to unburden itself of any iconic indebtedness to Kraepelin. The authors of the current paper agree, and propose to replace Kraepelin with the psychiatrist Karl Jaspers, MD (1883-1969) as the proper iconic founder of present-day and future psychiatry. Acknowledging our debt to Jaspers can usher in a fully humanistic and scientific psychiatric practice that can flourish as a medical discipline that is respectful of and of service to patients, beneficial for research, multiperspectival and methodologically pluralistic.

Lived Time Disturbances of Drug Addiction Therapy Newcomers. A Qualitative, Field Phenomenology Case Study at Monar-Markot Center in Poland.

The aim of this study was to qualitatively assess the disturbances of lived time in individuals with multiple drug dependencies. The research was conducted at Monar-Markot Center for Humanitarian Aid in Roznowice (Poland) in 2014 through direct, non-disguised observational study in a therapeutic community setting. Overall, 10 clients with multiple drug dependencies forming a newcomers group participated in. They previously abstained from usage for negligible periods of time. The measurements included participant observation of collective time regimes at the center; group discussions; written accounts by clients; Zimbardo Time Perspective Inventory; semi-structured interviews. It was found that the clients experienced difficulties in following a strict therapeutic temporal regime, and they also showed a concomitant need to accelerate time as it passed. They also suffered an unpleasant domination by traumatic past within lived time. Their time horizons appeared significantly shortened and their planning capacity impaired, while a distant (dissociated) future was fantasized about in a realistic manner. Altogether, their disturbances of lived time consisted of the propensity to overemphasize their past dimensions at the expense of their future, while a gap between a close and a distant future appeared.