Ewelina Soroka, Kamila Dziwota, Justyna Pawęzka and Marcin Olajossy
Does better insight associated with the process of recovery mean a stronger sense of mental illness stigma? This article presents the relationship between a multidimensional construct, which is the insight and the phenomena of stigma and self-stigma of patients diagnosed with schizophrenia. It is well known that the term insight contains: a sense of illness, the patient's attitude to its symptoms, explanation of the causes of the illness, attitude to the rationale of treatment and awareness of the risk of relapse. On the other hand, self-stigma occurs when the patient internalizes and refers to himself/herselfnegative and stigmatizing social attitudes, conditioned by the presence of conventionalbeliefs, strengthened by the media, and this weakens the process of recovery.
How much does good insight strengthen the patient on the way to fuller social functioning, and how much does it imprint stigma of mental illness and weaken its positionin society? The authors of the paper are discussing the subject of insight and stigma from the patient's perspective, over the patient’s attitude towards the diagnosis of schizophrenia, the process of recovery and the aspect of hope - important in recovery. These study of construct insight shows that the relationship insight-recovery-stigma is a multi-dimensional plane, dependent on various factors, that needs constant deepening and complementing with further research.
Aleksandra Siek, Agata Makarewicz, Łukasz Łobejko, Anna Gralewska, Joanna Tomaka, Justyna Szymańska-Piekarczyk, Jakub Siembida and Hanna Karakuła Juchnowicz
Introduction: Trichotillomania is a mental disorder characterized by a repetitive and compulsive hair pulling, classified in ICD-10 to a group of habit and impulse disorders, and in the DSM-5 to the group of obsessive-compulsive disorders.
Aim: The aim of the study is to present on the basis of case study:1). the importance of traumatic family experiences in releasing as well as maintaining the symptoms of Trichotillomania, 2). comprehensive medical care, the application of which has resulted in a beneficial therapeutic effect.
Results: In the described case of 16-year-old patient, Trichotillomania was triggered by traumatic events related to lack of support and family stabilization resulting from parental disputes and grandfather’s death, when she was 11 years old. The subsequent years of her life, in spite of the divorce of her parents and their separate residence, abounded in periods of turbulent quarrels between the parents in which she was involved. Each time this type of incident was associated with the recurrence of behavior associated with Trichotil-lomania, the course of which was more severe with the occurrence of self-harm and suicidal thoughts.
Conclusions: 1. In the described case, traumatic events and pathological relations of the immediate family members were not only thetriggering factor, but also maintaining the Trichotillomania symptoms. 2. In accordance with the guidelines of Trichotillomania Learning Center-Scientific Advisory Board (2008), the use of a comprehensive treatment including both the patient - individual psycho-therapy (especially cognitive-behavioral therapy) and pharmacotherapy, as well as her family (family psychotherapy, family mediation, workshops for parents), brought about positive therapeutic effects.
Introduction: The purpose of this study was to examine whether the combination of atypical and typical antipsychotic medications is related with metabolism and cognitive functions in the same manner and degree as taking medications of one kind only, i.e. atypical or typical.
Material and methods: The participants of the study comprised of 91 adults with diagnosed mental illness (F-20-F69). The participants were divided into groups on the basis of the kind of administered medications: T+A (typical and atypical medications), A (atypical medications), T (typical medications), P (antidepressants, sedatives, normothymic/antiepileptic drugs). In the study, Short Test of Mental Status (STMS), Verbal Fluency Test (VFT), Rey Auditory Verbal Learning Test (RAVLT) were used for the purpose of examining cognitive functions.
Results: The kind of antipsychotic medications taken by the patients did not differentiate the group in relation to BMI (p<0.13), nor in relation to the level of general cognitive function (p<0.72) or verbal fluency (p<0.34). Both atypical antipsychotic medications and the combination of atypical and typical medications were related to the occurrence of abdominal obesity (p<0.01). An increase in waist circumference decreased an ability of abstract reasoning (p<0.005). When it comes to the body mass index, waist circumference negatively correlated with the delayed memory (p< 0.03, p<0.004).
Discussion: Both the combination of atypical and typical antipsychotic medications and atypical medications are associated with the occurrence of abdominal obesity. The deposition of fat tissue in the abdomen negatively correlated with an ability to learn.
Conclusions: The future studies might explain the interactions between antipsychotic medications, obesity and cognitive function.
Katarzyna Jusiak, Żaneta Brudkowska, Maria Gołębiowska, Justyna Morylowska-Topolska, Beata Gołębiowska, Michał Próchnicki, Agnieszka Próchnicka and Hanna Karakuła-Juchnowicz
Introduction: Until recently, oxytocin was mainly associated with the pathophysiology of childbirth and sexual functions, but lately this hormone has become the object of interest to psychiatry and psychology due to the significant influence of oxytocin on human behavior in the field of social and emotional functioning. Current scientific research focuses on the participation of oxytocin in the pathogenesis and therapy of mental disorders.
Aim: The aim of the paper is to present, on the basis of available literature, the significance of oxytocin for various psychological functions, with particular emphasis on the influence of oxytocin on the course and clinical picture of schizophrenia.
Method: Available articles from the Medline / PubMed database were analyzed, which were searched using keywords: oxytocin, schizophrenia, therapeutic use of oxytocin, social cognition, positive symptoms, negative symptoms and time descriptors: 2013-2017. There are included articles published in Polish and English.
Results:The research results carried out so far suggest that oxytocin plays a significant role in modulating complex socio-emotional behaviors in schizophrenic patients. The existing research results also indicate a relationship between the dysregulation of the oxytocinergic system and the pathophysiology of schizophrenia. Many of the studies prove that there is a relationship between the level of oxytocin in the patients' blood plasma and the severity of the disease symptoms. Recent genetic studies indicate a possible relationship between polymorphism of oxytocin genesand polymorphism of oxytocin receptor genes and the risk of developing schizophrenia.
Conclusions: Contemporary research on the therapeutic potential of oxytocin and its influence on the functioning of schizophrenia patients seem to be very promising and may contribute to increasing the effectiveness of treatment of schizophrenia and possibly other mental disorders, which in turn will improve the quality of life of patients in cognitive, social and emotional functioning.
Ewelina Drzał-Fiałkiewcz, Agata Makarewicz, Mateusz Walczak, Aleksandra Walczak, Małgorzta Futyma-Jędrzejewska, Gustaw Kozak, Piotr Frończuk and Hanna Karakuła-Juchnowicz
Introduction: Non-Suicidal Self-Injury (NSSI) is the deliberate injury to one’s own body intended to cause mental or physical harm to oneself. In view of the growing scale of the NSSI, especially among young people without identifying any other psychiatric disorders, the disorder was included in both DSM-5 and ICD10 as independent diagnostic entity. Many etiopathogenetic hypotheses and research tools assessing various aspects of NSSI have been developed.
The aim of the work is to present and discuss the most commonly used scales for NSSI assessment.
Method: A review of available literature was made using the databases Medline / PubMed, using the key words: “self injury”, “self-mutilation”, “non-suicidal,”, “NSSI”, “self-harm” and time descriptors: 2005-2017
Results: Available tools were divided into three groups: I- scale of self-assessment made by the patient, II- assessment made by the clinician, and III- auxiliary scale.
Conclusions: None of the available scales covers the complexity of the NSSI phenomenon. For the overall NSSI assessment, several NSSI assessment tools are suggested, taking into account both self-assessment scales and clinical evaluation.
Michał Hys, Nikodem Skoczeń, Ewelina Soroka and Marcin Olajossy
New achievements within structural and functional imaging of central nervous system offer a basis for better understanding of the mechanisms underlying many mental disorders. In everyday clinical practice, we encounter many difficulties in the therapy of eating disorders. They are caused by a complex psychopathological picture, varied grounds of the problems experienced by patients, often poor motivation for active participation in the treatment process, difficulties in communication between patients and therapeutic staff, and various biological conditions of eating disorders. In this paper, the latest reports on new concepts and methods of diagnosis and treatment of anorexia nervosa have been analyzed. The selection of the analyzed publications was based on the criteria taking into account the time of publication, the size of research cohorts, as well as the experience of research teams in the field of nutritional disorders, confirmed by the number of works and their citations. The work aims to spread current information on anorexia nervosa neurobiology that would allow for determining the brain regions involved in the regulation of food intake, and consequently that may be a potential place where neurobiochemical processes responsible for eating disorders occur. In addition, using modern methods of structural imaging, the authors want to show some of the morphometric variations, particularly within white matter, occurring in patients suffering from anorexia nervosa, as well as those evaluated with magnetoencephalography of processes associated with the neuronal processing of information related to food intake. For example as regards anorexia nervosa, it was possible to localize the areas associated with eating disorders and broaden our knowledge about the changes in these areas that cause and accompany the illness. The described in this paper research studies using diffusion MRI fiber tractography showed the presence of changes in the white matter pathways of the brain, especially in the corpus callosum, which indicate a reduced content of myelin. These changes probably reflect malnutrition, and directly represent the effect of lipid deficiency. This leads to a weakening of the structure, and even cell death. In addition, there are more and more reports that show the normal volume of brain cells in patients with long-term remission of anorexia. It was also shown that in patients in remission stage there are functional changes within the amygdala in response to a task not related symptomatologically with anorexia nervosa. The appearing in the scientific literature data stating that in patients with anorexia nervosa there is a reduced density of GFAP + cells of the hippocampus and increased expression of vimentin and nestin, is also worth noting.
Ewelina Soroka, Inga-Ujma Lesiczka, Magdalena Tracz, Bernarda Bereza and Marcin Olajossy
Refractoriness affects about 25% of patients treated with antipsychotics, and it is a very big challenge for clinicians. The most commonly accepted definition of refractoriness is: lack of satisfactory clinical response to treatment with at least two antipsychotic drugs, from different groups, carried out at therapeutic doses and for a sufficiently long period.
Aim : The aim of the study is to analyze the case of a patient diagnosed with schizophrenia.
Methods: Analysis of medical records, available literature from recent years on treatment-refractory and super-refractory schizophrenia.
Results: A 53-year-old patient, a bachelor, suffering from paranoid schizophrenia with an extremely severe, non-remission course with drug resistance features. The patient's father and sister also suffer from severe paranoid schizophrenia. The patient became ill at the age of 22. Despite the high doses of clozapine, in a sufficiently long period of time, the patient maintained positive and negative symptoms, cognitive deficits and behavioral disorders. The patient was 14 times psychiatrically hospitalized, twice treated with electro-convulsive therapy, which did not bring results despite the combination of electroconvulsive therapywith psycho pharmacotherapy. In addition, the patient was addicted to benzodiazepines, administered during anxiety and anxiety attacks by the mother, during the described hospitalization, gradually discontinued. Patient after several attempts of committing suicide, with a tendency to self-destructive behavior. The illustrated case meets the criteria of super-refractory schizophrenia (SRS).
Conclusions: 1. The category of refractory schizophrenia encountered in the literature is not a separate diagnostic category - it does not exist in classification systems, therefore we consider the phenomenon / symptom of drug resistance - variously defined. 2. Social relations have a big impact on the functioning of the patient as well as the course of the disease and prognosis (the role of the family). 3. There are numerous methods for the potentiating of clozapine treatment, of which combining clozapine with EC therapy is effective and safe. The strategy for combining clozapine with EC is effective, but not in all patients.
This article explores the phenomenologically informed, theoretical and empirical research direction on self-disorders in the schizophrenia spectrum conditions. First, we describe the concept of ‘self’ that is operative in the concept of ‘self-disorders’ and we discuss how this self may be disordered or fragile in the schizophrenia spectrum. Second, we offer a detailed psychopathological presentation and discussion of 3 patients with schizophrenia. The vignettes provide paradigmatic examples of self-disorders in schizophrenia. Third, we summarize the main findings in the current empirical research on self-disorders. These findings consistently indicate that self-disorders constitute a crucial, trait phenotype of the schizophrenia spectrum.
Hanna Karakuła-Juchnowicz and Justyna Morylowska-Topolska
A defined and formed identity is the foundation of human mental functioning. The sense of one’s own existence as an individual, together with the conscious image of oneself, plays a fundamental role in regulating behaviors. The ability to see the limits of one’s own body is a significant milestone in human development, because it allows the development of a global sense of self, and that is the basis for the process of identifying one’s own identity.
The paper presents the contribution of Polish researchers (psychiatrists and psychologists) to understanding the phenomenon of the sense of self, identity, and their disorders with particular emphasis on schizophrenia.
Method: A review of the available literature by Polish authors on the subject was undertaken by searching the following data-bases: Polish Bibliography of Medicine, CEJS, NUKAT and National Library Database, using the keywords: identity, self, personality, schizophrenia, ego, within time frame: 1970–June 2017. The article includes only those works which made the original contribution of Polish authors to research on the issue of self and the sense of identity, with particular emphasis on their disorders in schizophrenia.
Results: The works of three Polish authors: J. Reykowski, J. Kozielecki and Z. Zaborowski deserve particular attention in the context of the definition of self and the sense of identity.
The works of A. Kępiński, in turn, have contributed to understanding the problem of disorders of self in schizophrenia. Kępiński’s psychopathological concept was based on the analysis and description of the pathology of self, the pathology of the boundary self–the world, disorders of time-space order and the hierarchy of values. In these terms, he considered the structure of the psychotic world, especially in schizophrenia and melancholy. In his opinion, schizophrenic psychosis manifests itself primarily in the form of the blurring of the boundary self–the world and the pathology of self.
The paper also presents the contribution of J. Zadęcki, M. Rzewuska, J. Wciórka, S. Steuden, M. Huflejt-Łukasik to understanding the disorders of the sense of self in schizophrenia.
Conclusions: The views of Polish authors presented in the paper are an interesting contribution to world literature on research into disorders of self in schizophrenia.
Josef Parnas, Paul Møller, Tilo Kircher, Jørgen Thalbitzer, Lennart Jansson, Peter Handest, Dan Zahavi, Hanna Karakuła-Juchnowicz, Justyna Morylowska-Topolska and Dariusz Juchnowicz
Skala EASE jest listą objawów do częściowo ustrukturalizowanego fenomenologicznego badania subiektywnych lub empirycznych nieprawidłowości (anomalii), które można uznać za zaburzenia podstawowej, „minimalnej” samoświadomości. EASE opracowana została na podstawie samoopisów otrzymanych od pacjentów chorujących na zaburzenia ze spektrum schizofrenii. Skala ma duże znaczenie dla opisu, diagnozy oraz diagnozy różnicowej zaburzeń ze spektrum schizofrenii. Prezentowana wersja zawiera istotne szczegółowe kwestie dotyczące zbierania wywiadu oraz opisy objawów psychopatologicznych (Podręcznik), arkusz wyników (Aneks A), listę pozostałych pozycji Skali stosowanych w czasie wywiadu (Aneks B) oraz porównawczą listę pozycji EASE/BSABS (Bonner Skala für die Beurteilung von Basissymptomen, Bońska Skala do Oceny Objawów Podstawowych) (Aneks C).