Chronic anorexia nervosa: Patient characteristics and treatment approaches. / Chronicznie chory pacjent z jadlowstretem psychicznym i jego leczenie.

Anorexia nervosa constitutes amajor challenge to medical practitioners, especially clinicians, due to a high rate of chronicity and a very serious risk of relapse. One of the underlying causes of this state of affairs is the ego-syntonicity of the disorder, which differentiates it from similar conditions, and which is responsible for the patient's denial and lack of motivation for treatment (resulting in frequent instances of therapy refusal or drop-out). The paper outlines different approaches to defining chronic anorexia nervosa. Thisform of anorexia and its therapeutic implications are discussed through the lens of clinicians and other medical professionals. Furthermore, the patients'experiences of chronic anorexia nervosa are described. The dilemmas concerning palliative care for this group of patients are addressed and treatment options and relapse prevention strategies are recommended, with a focus on the latest developments in this respect. The paper is concluded with an optimistic report of complete recovery from this diagnosis, including an analysis of the factors underlying the positive therapeutic outcome.

Modern approaches to the treatment of anorexia nervosa. "The third wave" of cognitive behavioral therapy. / Wspólczesne kierunki w leczeniu osób chorujacych na jadlowstret psychiczny. "Trzecia fala" terapii poznawczo-behawioralnej.

Anorexia nervosa (AN) is being considered one of the most difficult mental disorders to treat. The ego-syntonic nature of this mental disorder makes patients particularly reluctant to engage in or consent to treatment with relatively high drop-out rate. For all these reasons the treatment often takes a very long time, and the illness progresses to the chronic form, increasing the suffering of patients. Researchers have been discussing for many years how to provide these patients with measurable aid. Recent years have seen the emergence of arange of new treatment methods for eating disorders, including AN, that provide evidence of their effectiveness, especially in adults. Among them, of special note are those belonging to the third wave of cognitive therapy, mostly offered in the form of training programs. They are discussed in this paper in conjunction with evidence based therapy. This knowledge may help clinicians to decide how to complement traditional forms of treatment in outpatient and inpatient settings.

Contemporary psychotherapeutic interventions in patients with anorexia nervosa - a review. / Wspólczesne oddzialywania psychoterapeutyczne wobec pacjentów z jadlowstretem psychicznym ­ przeglad badan.

Due to its ego-syntonic nature, anorexia nervosa (AN) is considered one of the most difficult mental disorders to treat. Patients are often reluctant to accept treatment, while a large group of those who receive therapy have a poor prognosis. Unfortunately, despite suffering from physical and psychosocial impairment, patients with AN are often reluctant to receive any intervention whatsoever. Recent years have seen the development of many new treatment methods for eating disorders in general, and AN in particular. Therapy of anorexia nervosa requires a multidisciplinary approach based on the "cornerstone" of psychotherapy. Despite the growing body of studies and publications concerning psychological treatment of AN, there is still a dearth of high-quality randomized controlled trials which could serve as the basis for developing guidelines in this area.This paper offers a compendium of knowledge on treatment standards recommended for AN, as well as on psychotherapeutic paradigms and programs. Most of the therapies presented herein have been empirically proven effective. Therefore, the paper may facilitate the selection of the most appropriate treatment choices, whether in outpatient or inpatient settings.

Applications of the dot probe task in attentional bias research in eating disorders: a review

Recent years have seen an increasing interest in the cognitive approach to eating disorders, which postulates that patients selectively attend to information associated with eating, body shape, and body weight. The unreliability of self-report measures in eating disorders due to strong denial of illness gave rise to experimental studies inspired by research into anxiety disorders involving attentional bias, with the prevalent method being a modified color-naming Stroop task. Unfortunately, that tool was shown to exhibit many limitations, especially in terms of attentional bias measurement. Thus, researchers started to seek alternative methods of evaluating attention in persons with eating disorders. Along with the Stroop test and the Posner paradigm, one of the most frequently used methods is the dot probe task. This paper presents the dot probe protocol as well as the rationale underpinning its use, including its advantages and drawbacks. Furthermore, a modification of the task is proposed to enable the assessment of all components of attentional bias in patients with eating disorders. The paper also discusses practical implications of the modification for the treatment of these patients. For several years now there has been an increasingly widespread use of so-called attentional training employing, amongst others, the dot probe task, which may be modified for the purpose of reducing or eliminating of attentional biases in patients with eating disorders. Unfortunately, due to the absence of studies providing a reliable account of all types of attentional bias in eating disorders, this field of research lags considerably behind anxiety research and does not enable therapeutic applications (AU)

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Pitfalls in anorexia nervosa research: The risk of artifacts linked to denial of illness and methods of preventing them.

One of the most serious problems faced by researchers studying eating disorders is denial of illness in individuals with anorexia nervosa. Importantly, the term "denial" not only has different meanings, but in the case of anorexia nervosa its very nature still remains obscure. It is not even known whether it is deliberate or unintentional. Denial of illness in anorexic patients has serious consequences for evaluation of the reliability of information obtained from those individuals. Indeed, the most frequently used screening questionnaires, such as the Eating Attitudes Test (EAT) (Garner & Garfinkel 1979) and the Eating Disorder Inventory (EDI) (Garner et al. 1983), may not reflect the psychological state of the subjects due to distorted responses. The objective of this review article is to elucidate, at least in part, the nature of denial of illness in anorexic individuals and, importantly, to present methods for direct or indirect measurement of this variable. The authors emphasize the detrimental effect of denial of illness on the quality of information obtained from the patients and the notorious unreliability of self-report data. The final part of the paper contains suggestions as to methods of bypassing the pitfalls associated with the influence of denial of illness on the results of studies involving anorexic individuals; for instance, it is recommended that one should build an honest and trustful relationship with the patient. Last but not least, the focus is placed on the potential of experimental psychology, which offers tools producing robust data, resistant to deliberate distortion by patients.

[Use of artificial neural networks in clinical psychology and psychiatry]. / Wykorzystanie sztucznych sieci neuronowych w psychologii klinicznej i psychiatrii.

Artificial neural networks make a highly specialised tools in data transformation. The human brain has become an inspiration for the makers of artificial neural networks. Although even though artificial neural networks are more frequently used in areas like financial analysis, marketing studies or economical modelling, their application in psychology and medicine has given a lot of promising and fascinating discoveries. It is worth that artificial neurol networks are successfully used in the diagnosis and etiopathogenesis description of various psychiatric disorders such as eating disorders, compulsions, depression or schizophrenia. To sum up, artificial neural networks offer a very promising option of research methodology for modern clinical psychology and psychiatry. The aim of this article is only an illustration of the applications of artificial neural networks in clinical psychology and psychiatry.

[Pathological grief in standard classification systems and its prevention implications according to the Berlin Wisdom Paradigm]. / Patologiczna zaloba w standardowych systemach klasyfikacyjnych oraz dotyczace jej implikacje prewencyjne przy wykorzystaniu Berlinskiego Paradygmatu Madrosci.

The article emphasizes the place of pathological grief in psychiatric classification systems and suggests the need to precisely conceptualize pathological grief and diagnostic criteria which differentiate pathological bereavement from Major Depression and from "normal" mourning. In addition the article presents results of the Berlin Wisdom Paradigm Research and suggests possibilities of using these results in pathological grief prevention. Finally the article describes difficulties in therapeutic work with people who suffer from such a human condition as mourning for a loved one.