Neurotic personality traits and associated dysfunctional attitudes as factors predisposing patients to suicidal ideations at the end of intensive psychotherapy. / Nerwicowe cechy osobowosci i zwiazane z nimi dysfunkcjonalne postawy pacjentów jako czynniki predysponujace do wystapienia mysli samobójczych pod koniec intensywnej psychoterapii.

OBJECTIVES: To determine the relationshipsbetween personality traits typical for neurotic disorders and dysfunctional attitudes declared by patients without suicidal ideations (SI) prior to treatment and SI at the end of an intensive psychotherapy with a predominant psychodynamic approach in the day hospital for neurotic, behavioral, or personality disorders. MATERIAL AND METHOD: KO "O" Symptom Checklist for assessing SI, Neurotic Personality Questionnaire KON-2006 for evaluation of neurotic personality characteristics and patients' attitudes, and a Life Questionnaire, all completed by a group of 680 patients of a day psychotherapy ward, treated for the first time. Statistical analysis encompassed 466 non-SI patients, 4% of whom had SI at the end of treatment. RESULTS: A number of attitudes have been identified in patients who were significantly predisposed to SI at the end of intensive psychotherapy: physical aggression towards relatives (p < 0.001), grandiose fantasies (p = 0.043), resignation tendencies (p = 0.022), resignation feeling associated with the experience of loss of life opportunities (p = 0.037), and being guided mainly by intuition (p = 0.035). It was also observed that declaring certain attitudes was significantly associated with less than average chance of SI at the end of treatment. CONCLUSIONS: In patients who declared these attitudes, there was a higher risk of SI at the end of the psychotherapy cycle than in the remaining patients (10-30% vs. 4%), which indicates the presence of specific dysfunctions of personality, in the case of which intensive psychotherapeutic work requires particular caution -it can trigger emotional stress leading to SI instances. It can be assumed that SI are the result of the reconstruction of defense mechanisms while working on insight, confrontation with the causes and consequences of the patients' own physical aggression towards the loved ones, the realization of the size of their grandiose thinking and the insight into its function, and the insight into the causes of resignation attitudes.

Sense of coherence and hypertensive target organ damage. / Poczucie koherencji a powiklania narzadowe nadcisnienia tetniczego.

OBJECTIVES: This study was designed to compare the level of sense of coherence in hypertensive patients with arterial stiffness or leftventricular hypertrophy and in hypertensive individuals without such health complications. METHODS: The study group consisted of 93 participants. All of them were asked to undergo the following procedures: clinical assessment, echocardiography (to diagnose hypertensive cardiac damage), pulse wave velocity measurement (to assess vascular damage) and psychological testing (to measure their level of comprehensibility, manageability, meaningfulness, and sense of coherence). RESULTS: Patients with hypertensive vascular damage (high pulse wave velocity) had higher levels of comprehensibility and sense of coherence than other hypertensive subjects. At the same time, there were no significant differences in the level of sense of coherence (and all of its dimensions) between individuals with and people without hypertensive left ventricular hypertrophy. CONCLUSIONS: The findings of this study suggest, that the sense of coherence may not be strongly associated with good somatic health. They may also contribute to the discussion about diagnostic usefulness of the SOC-29 method as a single tool. We believe that the level of sense of coherence should be taken into consideration in further studies on the development of hypertensive TOD.

Changes in ego strength in patients with neurotic and personality disorders treated with a short-term comprehensive psychodynamic psychotherapy. / Zmiany w zakresie sily ego u pacjentów z zaburzeniami nerwicowymi i zaburzeniami osobowosci leczonych krótkoterminowa kompleksowa psychoterapia psychodynamiczna.

OBJECTIVES: Analysis of changes in ego strength in the course of group psychotherapy in patients treated with neurotic and selected personality disorders (F40-F61, ICD-10). METHODS: 82 patients (61 women and 21 men) participated in the study. They underwent intensive short-term group psychotherapy treatment in a day hospital for neurotic and behavioural disorders. The assessment of the patients' personality functioning was carried out at the onset and the end of the psychotherapy. The assessment was reported as a value on the ego strength scale by means of the MMPI-2 questionnaire. RESULTS: The comparative analysis with the use of the t-Student test for related measurements, which was carried out for the measurement of ego strength values at the onset and the end of the therapy, demonstrated a statistically significant positive change both for the entire examined group and the groups which considered the gender and diagnosis distribution. CONCLUSIONS: Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy results in obtaining the desired changes in the personality functioning manifested through the increase in ego strength.

Progression of suicidal ideation to suicidal behavior from a perspective of selected suicidological models. / Progresja mysli samobójczych do zachowan samobójczych w swietle wybranych modeli suicydologicznych.

In clinical practice suicidal ideation (SI) is one of the most commonly encountered symptoms in patients with mental disorders. Such encounter calls for diligent evaluation of suicidal risk. Although the risk factors are widely known, accurate estimation of suicidal risk remains one of the most difficult and most important tasks that clinicians face - especially considering recently collected data showing increase in suicide prevalence in Poland. More thorough estimation of suicidal risk in patients with SI requires taking under consideration not only suicidal risk factors but also factors that are more specific for progression of SI to suicidal behaviors (SB). The review presented in this paper consists of a range of suicidological theories that allow to select a number of groups of factors and mechanisms that are most specific for progression of SI to SB. These groups include: (1) transgression of fear of causing harm and pain to oneself, as well as disintegration of other protective barriers such as (2) decline of social integration with others, feeling of being alienated or abandoned, decline of sense of belongingness, lack of social support, (3) resignation from family and social obligations, (4) dismissing cultural or religious norms, (5) rejection of life goals, values and aspirations that were appreciated earlier, (6) narrowing down in perceived alternatives for suicide, i.e., "tunnel vision", feelings of helplessness and powerlessness, (7) devising in details and accepting simple suicidal plan, especially when such plan is being consolidated through rehearsals and as if "automatized", (8) impulsiveness, (9) accumulation of aggression that may be vented out as suicide, and finally (10) accessibility of means to commit suicide.

Changes in intensity of neurotic symptoms associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders. / Zmiany w nasileniu objawów nerwicowych wiazace sie z redukcja mysli samobójczych u pacjentów poddanych psychoterapii w dziennym oddziale leczenia nerwic i zaburzen behawioralnych.

OBJECTIVES: Analysis of associations between changes in the intensity of neurotic symptoms and reduction of suicidal ideation (SI) or lack of SI reduction, in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital. METHODS: Symptom Checklist KO"O" and Life Inventory completed by 461 women and 219 men treated in the psychotherapeutic day hospital due to neurotic, behavioral or personality disorders between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. RESULTS: The reduction of neurotic symptoms intensity was greater in patients of both genders who improved in terms of SI than in those who did not. This referred to global intensity of neurotic symptoms (OWK coefficient) in both genders (p<0.001), as well as to the majority of the neurotic symptoms subtypes in both genders (p<0.05): Phobic disorders, Other anxiety disorders, Obsessive-compulsive disorders, Conversions and dissociations, Autonomic disorders, Somatization disorders, Neurasthenia, Avoidance and dependence, Sexual dysfunctions, Dysthymia; and in case of women (p<0.05): Hypochondriasis, Depersonalization and derealization, Impulsiveness and histrionism and Non-organic sleep disorders. CONCLUSIONS: The results show effectiveness and comprehensiveness of intensive psychotherapy as a treatment method that leads to improvement in terms of both SI and neurotic symptoms. This suggests that the applied therapy may be effective in preventing suicidality in this group of patients. The observed associations also point in favor of hypothesis on similarities in etiopathogenesis of and partly identical personality-related factors predisposing to SI and neurotic disorders.

Changes in personality functioning as a result of group psychotherapy with elements of individual psychotherapy in persons with neurotic and personality disorders - MMPI-2.

AIM: The study of group psychotherapy influence on the personality functioning of patients on treatment for neurotic disorders and selected personality disorders (F4-F6 under ICD-10). METHODS: The study concerned 82 patients (61 women and 21 men) who underwent intensive short-term group psychotherapy in a day ward. A comprehensive assessment of the patients' personality functioning was carried out at the outset and the end of the psychotherapy utilising the MMPI-2 questionnaire. RESULTS: At the treatment outset the majority of the study patients demonstrated a considerable level of disorders in five MMPI-2 clinical scales (Depression, Hysteria, Psychopathic Deviate, Psychastenia, Schizophrenia) and moderate pathology in Hypochondria. In the Mania scale most patients obtained results comparable to the healthy population when the treatment commenced. Having undergone the psychotherapy treatment, the majority of the examined were observed to demonstrate positive changes in those areas of personality functioning which were classified as severe or moderate pathology. CONCLUSIONS: Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy leads to desirable changes in personality functioning.

Reduction of suicidal ideation in patients undergoing psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders and neurotic symptoms reported by them before the hospitalization.

OBJECTIVES: Analysis of associations between symptoms reported before the beginning of the hospitalization and reduction of suicidal ideation - or its lack - obtained until the end of the hospitalization in patients of the day hospital for the treatment of neurotic and behavioral disorders. METHODS: Symptoms Checklist KO"O" and Life Inventory completed by 461 women and 219 men treated with intensive integrative psychotherapy with predominance of psychodynamic approach in the day hospital due to neurotic, behavioral and personality disorders between 2005-2013. Percentages of patients reporting SI initially and at the end of the treatment were 29.1% and 10.2% respectively in women and 36.5% and 13.7% in men. The improvement in terms of initially reported SI was obtained by 84.3% of women and 77.5% of men. Among patients, those initially reporting SI were characterized by greater intensity of neurotic symptoms (p<0.001) and greater intensity of nearly all of 14 subtypes of neurotic symptoms(p<0.05). RESULTS: Among those reporting SI, subgroups of women with greater intensity of Obsessive-compulsive symptoms (p=0.003), Neurasthenia (p=0.005), Autonomic disorders (p=0.044) and women reporting episodes of uncontrollable hunger (p<0.01) had significantly lower chances of improvement in terms of SI than others. CONCLUSIONS: Patients initially reporting SI constituted approximately 1/3 in both genders and were characterized by greater intensity of neurotic disorders. Among those, women with particularly higher intensity of Obsessive-compulsive symptoms, Neurasthenia and Autonomic disorders and women reporting episodes of uncontrollable hunger seemed to suffer from SI that were more resistant to the psychotherapy. As such, those subgroups of women require special attention and diligent selection of the therapeutic methods.

Effectiveness of therapy in terms of reduction of intensity and elimination of suicidal ideation in day hospital for the treatment of neurotic and behavioral disorders.

OBJECTIVES: Analysis of changes in prevalence and intensity of suicidal ideation (SI) in patients who underwent an intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in the Day Hospital for Neurotic and Behavioral Disorders. METHODS: Symptom checklist KO"O" and Life Inventory completed by 461 women and 219 men who were treated in the day hospital due to neurotic, behavioral and personality disorders in 2005-2013. RESULTS: Patients initially reporting SI showed greater than others global intensity of the neurotic symptoms (p < 0.001 for both sexes) and greater intensity in almost all the neurotic symptoms scales. Improvement (elimination or reduction of intensity) in terms of SI was observed in 84.3% of women and 77.5% of men. The prevalence of SI-reporting patients decreased substantially from 29.1% to 10.2% in women and from 36.5% to 13.7% in men. CONCLUSIONS: The patients reporting SI before the commencement of psychotherapy constituted a large part of the studied population - approximately 1/3. They showed greater intensity of neurotic symptoms than those who were not reporting SI. Intensive psychotherapy in the day hospital was characterized by high effectiveness in terms of reduction and elimination of SI. Prevalence of SI in both women and men until the end of therapy decreased almost three times. Cases of improvement in terms of SI were several times more frequent than cases of deterioration in terms of SI (increase in its intensity or its occurrence at the end of therapy). Etiopathogenesis of SI and its methods of treatment require further research.

Complaints of neurotic patients that are of interest for a cardiologist.

BACKGROUND: Patients in various areas of medicine report symptoms that are unexplained by other medical reasons than psychological/psychiatric. Some of them urgently seek treatment due to cardiovascular complaints, mostly rapid heart rate, palpitations and chest pain. Typical cardiac investigations, usually showing no organic reasons for these conditions, bring little information about stressful life events and psychological predispositions of these patients. Identification of coexistence of "cardiac" symptoms with other symptoms typical for neurotic disorders and difficult life circumstances may facilitate not only psychiatric diagnosis but also evaluation by cardiologists, primary care physicians, and other specialists. AIM: To determine the psychosocial context of psychogenic "pseudocardiac" symptoms and their coexistence with other symptoms in patients with neurotic disorders. METHODS: Medical records of patients from the years 1980-2002 that included self-administered questionnaires transformed into an anonymised database were examined. An analysis of the relationship between symptoms reported in the Symptom Checklist and biographical circumstances described in the Life Inventory before admission to a psychotherapy day clinic for patients with neurotic disorders was performed using simple logistic regression with estimation of odds ratios and their 95% confidence intervals. RESULTS: The symptoms of tachycardia/palpitations and chest pain were very common, present in most subjects, and were significantly associated with such circumstances as suboptimal conflict solving by passive aggression or quarrels, uncertainty in the relationship, a sense of being inferior to the partner, and poor financial situation. In addition, these "pseudocardiac" symptoms were also associated with such childhood reminiscences as origin from a large low income family, feeling that the family of origin was inferior to others, and experience of parental hostility or lack of support. CONCLUSIONS: Physicians of all specialties who deal with patients experiencing pseudocardiac symptoms should expect their psychological background and perform a simple interview to identify the presence of adverse biographical circumstances described above. Identification and discussing these difficult experiences with the patients may help to convince them to seek psychological support or psychotherapy.

Reduction of suicidal ideation in patients undergoing psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders and their neurotic personality traits measured before the hospitalization.

AIM: Analysis of associations between initial neurotic personality traits and subsequent reduction of suicidal ideation (SI) - or lack of such reduction - obtained until the end of hospitalization in patients who underwent the course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach. METHODS: Symptom Checklist KO"O", Neurotic Personality Questionnaire KON-2006 and Life Inventory completed by 461 women and 219 men hospitalized in the day-hospital due to neurotic, behavioral and personality disorders between 2005-2013. At the stage of qualification 134 women and 80 men reported SI, of whom subsequently 84.3% and 77.5% respectively improved. RESULTS: Women with prominent Tendency to risk-taking (p=0.002) and Impulsiveness (p=0.038) constituted subgroups with decreased chances of improvement in terms of SI, while men with prominently elevated level of Envy (p=0.041) and women who seemed to have difficulties in expressing anger adequately (p<0.05) had increased chances of SI reduction. CONCLUSIONS: Initially prominent Tendency to risk-taking and Impulsiveness may coexist with SI of increased resistance to psychotherapy. Thus, those subgroups require special attention and diligent selection of therapeutic methods. Also, it is probable that focusing therapy at the above-mentioned personality components may increase effectiveness of SI treatment. Reducing SI during psychotherapy appears to be highly effective especially in women with difficulties in expressing anger adequately and in men with prominently elevated level of Envy, which suggests adequacy of this treatment choice and of targeting those difficulties during psychotherapy.

Changes in neurotic personality profile associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders.

AIM: Analysis of associations between changes in neurotic personality profile and reductionof suicidal ideation (SI) - or lack of such reduction - defined as its elimination or reduction of its intensity in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach. METHODS: Symptom Checklist KO"O", Neurotic Personality Questionnaire KON-2006 and Life Inventory completed by 461 women and 219 men treated due to neurotic, behavioral or personality disorders in a day hospital between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. RESULTS: Patients who improved in terms of SI obtained significantly greater reduction of global neurotic personality disintegration (neuroticism) than others (p<0.0005 in women and p=0.015 in men). Associations were found between improvement in terms of SI and greater reduction of many neurotic personality traits (p<0.05) in both genders: Negative self-esteem, Impulsiveness, Sense of alienation, Demobilization, Difficulties in emotional relations, Lack of vitality, Sense of lack of control, Sense of guilt, Difficulties in interpersonal relations, Sense of being in danger, Exaltation, Ponderings; and only in women: Feeling of being dependent on the Environment, Asthenia, Difficulties with decision making, Conviction of own resourcelessness in life, Deficit in internal locus of control and Imagination. indulging in fiction. CONCLUSIONS: The results confirm effectiveness of intensive psychotherapy as a treatment method that leads to comprehensive improvement encompassing reduction of neurotic personality disorders (neuroticism) and of majority of neurotic personality traits, as well as SI reduction. The revealed associations weigh in favor of hypothesis on neuroticism as SI predisposing factor in patients with neurotic, behavioral and personality disorders.

Are neurotic personality traits and neurotic symptoms intensity associated with suicidal thoughts reported by patients of a day hospital for neurotic disorders?

AIM: Analysis of prevalence and intensity of suicidal thoughts and their associations with neurotic personality traits as well as neurotic symptoms intensity in patients participating in qualification for hospitalization in a day hospital for treatment of neurotic and behavioral disorders. METHODS: The results of Symptom Checklist KO"0", Neurotic Personality Questionnaire KON-2006 and Life Inventory of 1063 patients (739 women and 324 men), admitted to psychotherapy in a day hospital because of neurotic, behavioral and personality disorders. RESULTS: In the population of patients coming for treatment in the day hospital, the presence of suicidal ideations (SI) was common (reaching one-third of the respondents) and was regardless of the respondents'gender associated with significantly higher global symptom level (OWK) and significantly greater global neurotic personality disintegration (XKON) as well as significantly higher values of most of the neurotic personality inventory scales. None of the neurotic personality traits reduced the risk of suicidal ideation nor was associated with low SI arduousness. CONCLUSIONS: Day hospital patients reporting SI are a subgroup burdened with more severe neurotic disorders and comorbid personality disorders. Thus, the persons reporting in symptom questionnaires willingness to take one's own life, although relatively frequently encountered, deserve special attention due to the greater severity of their symptoms.