Introduction: Nowadays more and more people struggle with mental problems associated with fast pace of life and overpowering stress. Individuals affected by mental disorders frequently apply ineffective methods of coping with stress, and their attitudes towards the disease in fact strengthen the psychopathological symptoms. The purpose of the present study was to compare disease perception and coping strategies for stress in Polish patients with various types of mental disorders.
Material and Methods: The study involved 123 patients with depressive disorders, anxiety disorders, schizophrenia, alcohol related disorders, subjects detained due to psychoactive substance-induced psychotic disorders and amnestic syndromes, staying at Mental Healthcare Centre. Measurements of the variables were carried out using COPE Inventory and Disease Perception Questionnaire.
Results: The type of mental disorder differentiated the group with respect to the use of strategies aimed at seeking instrumental and emotional support, planning, positive reinterpretation, focus on emotions and substance use. There are significant differences between patients in the approach to illness as a task, weakness and threat.
Conclusions: The results show that the type of mental disorder is important in the context of the strategies used for coping with stress and the patients' approach to their condition.
Introduction: Dissociative identity disorder, also known as multiple personality disorder, involves simultaneous manifestation of multiple alternative personalities in one human body. The disorder is still a puzzle to contemporary researchers. In comparison to the United States, where the detection rate of this disorder is growing, in Poland, it is still a niche issue, unknown to many scientists and clinicians. Rather alarmingly, this situation has remained the same for many years now.
Objective: The aim of the present study is to draw attention to the adaptive character of dissociative identity disorder as a defense mechanism in children who have experienced extremely traumatic events in early childhood. The work also sets itself the task of disseminating knowledge about multiple personality disorder in the Polish scientific community, with the hope of encouraging wider research in this area in Poland.
Material and Methods: To investigate this issue, we searched articles available in the PubMed, Google Scholar, and Polish Medical Bibliography (Polska Bibliografia Lekarska) databases for the years 1960–2018. The following search terms were used: multiple personality, dissociative identity disorder, dissociative identity disorder and children. On the basis of a meta-analysis of the available literature, we offer a general characterization of the disorder, describe its symptomatology, present several theories of its etiology and conclude it through the prism of its adaptive function.
Results and Discussion: From the analysis of the gather data, we can conclude that multiple personality disorder can be a broad variant of the child's defense mechanisms against extreme, traumatic events from childhood, which they try to cope with by creating alter personalities. Abused children create other representations of the Self to be able to rid themselves of suffering, a process that is necessary for them to survive and further develop mentally and physically.
Conclusions: There is no doubt that Polish research on this disorder is much needed. It could provide more information on the epidemiology, diagnosis, and treatment of multiple personality. In addition, a better understanding of the issue might bring us closer to the understanding of how the human mind works.
Olga Padała, Sebastian Masternak, Agata Makarewicz, Agnieszka Biała-Kędra and Kaja Karakuła
Aim: The aim of the study was 1) to report the case of a 15-year-old boy who developed kleptomania symptoms during methylphenidate treatment and 2) to review the available therapeutic options for kleptomania based on a literature search of Medline and Google Scholar databases (2000–2018).
Case report: For the past seven years a 15-year-old boy had participated in counselling at a psychological counselling centre because of school problems and upbringing difficulties, and had a five-year history of psychiatric treatment for ADHD. He was admitted to the Department of Psychiatry because of recurrent stealing episodes that occurred during methylphenidate treatment. During the hospitalization, the patient did not observe the therapeutic contract – he stole items from other patients. Pharmacotheraputic and psychotherapeutic treatment resulted in a partial improvement in impulsive behaviour. At discharge, he spoke critically of his previous conduct and expressed readiness to continue treatment in an outpatient setting.
Kleptomania has a very negative impact on a patient's overall well-being.
In the reported case, kleptomania developed during methylphenidate treatment.
Kleptomania should always be taken into account as a possible cause of stealing during a psychiatric examination, to avoid stigmatization of patients as criminals.
Pharmacotherapy and cognitive-behavioural psychotherapy focused on the development of strategies, which can help the patient to control the urge to steal, are important components of kleptomania treatment.
Joanna Rog, Kaja Karakuła, Agnieszka Próchnicka and Hanna Karakula-Juchnowicz
Introduction: Schizophrenia is a chronic mental disease which significantly affects functioning and quality of life of patients. Lifestyle, including irregular eating habits, is a factor possibly intensifying symptoms of the disease and unwanted effects of pharmacotherapy. Due to positive effect on metabolic parameters demonstrated in numerous studies and participation in structure and functioning of central nervous system, omega-3 essential unsaturated fatty acids (EFAs) are the suggested form of schizophrenia cotheraphy.
Aim: The purpose of this paper was to evaluate EFAs (especially omega-3 family) consumption by individuals with schizophrenia and comparing contents of these acids in the diets of female and male patients.
Method: A study was conducted with the participation of 32 patients, recruited in the Psychiatric Outpatient Department of the Independent Public Clinical Hospital No. 1 in Lublin, with diagnosed schizophrenia. Data concerning the intake of EFAs was acquired in the course of 24-hour diet recall.
Results: Average intake of omega-3 EFAs in the examined population was 2.40 ± 2.85 g, of which only 201.6 ± 501.5 mg was constituted by EPA and DHA acids. The intake of omega-3 EFAs did not differ between men and women groups (p>0.05). Food rations of the 91% responders were characterised with the intake of EPA and DHA acids below the adequate intake level (AI).
Conclusions: Patients suffering from schizophrenia consume insufficient amounts of EPA and DHA acids. Evidence suggests that optimum intake of omega-3 EFAs could bring significant benefits for this group of patients. People suffering from schizophrenia should be attended with the care of a dietician, who will choose optimum strategy for supplying sufficient amount of nutrients in the diet.
Dominika Janeczko, Magdalena Hołowczuk, Anna Orzeł, Barbara Klatka, Małgorzata Neścior-Piech and Michał Dzikowski
Introduction: Schizoaffective disorder is described as a combination of symptoms of schizophrenia and mood disorder components. It is estimated that in 2009 in Poland over 30 thousands women were treated in outpatient care because of schizotypical disorders, also in 2009, over 5,5 thousands Polish women, were hospitalised because of the same reason.
Material and method: We searched through whole medical documentation of the patient, which were available at the Department of Psychiatry and Gynaecology. We mainly focused on the last hospitalization of the woman. We found research connected to our subject on Science Direct website.
Discussion: A 34-year-old woman was admitted to Department of Psychiatry, patient was 14 weeks pregnant. Family described her behaviour as verbally and physically aggressive and dysphoric which forced her parents to take woman to the hospital. It was her third hospitalization. Pharmacotherapy was insufficient to improve the mental state of the woman. Doctors decided to carry out a series of electroconvulsive treatments (10 procedures). When woman was 36 weeks pregnant, there was a leak of green amniotic fluid and it was necessary to perform a caesarean section. A newborn required mechanical ventilation, had decreased muscle tone and facial dysmorphic features, also defect of the atrial septum was found.
Conclusions: Pregnant women with psychiatric disorders should be all considered high risk. It means that they need multidisciplinary care – psychiatrist, gynaecologist, neonatologist or other specialists, in order to stay in a good condition mentally and physically during pregnancy.
Rafał Mazur, Sebastian Masternak, Michał Pająk, Nikodem Skoczeń, Ewelina Soroka and Marcin Olajossy
Introduction: Smoking is a huge medical and social problem in Poland, with as many as about 24% of Poles being addicted to nicotine. Approximately 6 million people worldwide die every year from conditions that are closely related to tobacco addiction, such as cancer and cardiovascular, metabolic or lung diseases. The difficulty in combatting nicotine dependence is largely due to the complex mechanism of this addiction. The motivation of a patient to quit smoking is of great importance in the difficult withdrawal process. Strengthening this motivation is one of the most important tasks of physicians and addiction therapists.
Overview of literature: Nicotine replacement therapy (NRT) has been the most widely known way to break away from smoking addiction for many years now. It involves delivering nicotine to the body in ways that are less harmful than through tobacco smoke. As a consequence, the cravings for nicotine are reduced, making it easier for the patient to break with the addiction. Clinical trials have shown that the use of NRT is associated with a 50-70% increased chance of maintaining abstinence from smoking compared to placebo. There are many NRT products, including nicotine chewing gum, nicotine patches, lozenges, dissolvable nicotine sticks, or inhalers. Bupropion is a selective dopamine–noradrenaline reuptake inhibitor. This drug is one of the most commonly used in the pharmacotherapy of depression in the United States. At the same time, it has been found to have a positive effect on people trying to break up with the habit of smoking cigarettes. The mechanism of action remains unknown in this case, but studies clearly indicate the efficacy of bupropion, which is comparable to the efficacy of NRT. Varenicline is a partial agonist selective for α4β2 nicotinic acetylcholine receptors. It has a higher affinity for these receptors than nicotine. By stimulating them, it causes an increase in dopamine secretion (but to a lesser extent than cigarette smoking), helping in this way ease withdrawal symptoms.
Conclusions: Varenicline has higher efficacy than bupropion and NRTs. Simultaneous use of two NRT forms increases the effectiveness of this method to a level comparable to varenicline. Contrary to previous reports, it seems that varenicline does not increase self-aggressive behaviour and the risk of suicide. The effectiveness of antinicotinic drugs depends on the sex of the patient. For both sexes, the most effective drug is varenicline. It is slightly more effective in women than in men. By contrast, NRT and bupropion show greater therapeutic potential in men.
Joanna Niedziałek, Marta Pachla, Aleksandra Kordyga, Łukasz Proć, Ewelina Soroka and Marcin Olajossy
Introduction: Irritable bowel syndrome is a chronic gastrointestinal disease classified as a functional gastrointestinal disorder. It has been diagnosed on the basis of the so-called Rome IV criteria since 2016. The prevalence of IBS in the general population is about 10–20%, with most patients being women. The etiology of the syndrome is multifactorial and is associated with visceral sensory dysfunction, abnormalities of motor and secretory bowel function, a history of infectious diarrhea and abnormalities in gut microbiota, dysregulation of the brain–gut axis (the influence of the hypothalamic-pituitary-adrenal axis and sex hormones), genetic, psychosocial, and environmental factors, and the patient's personality traits. IBS patients may show differences in the structure and function of the brain when compared to healthy control individuals. Treatment of IBS involves the use of non-pharmacological interventions (psychotherapy, education, hypnotherapy, dietary modifications, regular physical activity) and pharmacotherapy (cholinolytic drugs, opioid receptor antagonists, tricyclic antidepressants, serotonin 5-HT3 receptor antagonists and 5-HT4 agonists).
Aim: The aim of the authors of this work is to draw attention to certain psychiatric aspects of the irritable bowel syndrome. It meets the criteria for a somatization disorder. Somatization is an important psychological factor directly related to the severity of IBS. It is estimated that the prevalence of psychiatric disorders among IBS patients ranges from 40% to 90% and is higher than in the general population. Affective disorders and anxiety disorders are the most commonly diagnosed.
Method: The article reviews the research and works available in the Google Scholar and PubMed databases combining the issue of IBS with psychiatric aspects, i.e. common for IBS and psychiatric disorders, etiopathogenesis, the concept of somatization in the context of IBS, and the coexistence of diseases and mental disorders with the irritable bowel syndrome.
Conclusion: Further research is needed to determine the causes of comorbidity of IBS and mental disorders.
Introduction: The specific character of Rorschach test responses of parents who had a child with schizophrenia has been reported many times. The analysis presented in this paper is focused on responses commenting on movement seen in the inkblots. According to Zygmunt Piotrowski, these responses reflect the prototypal role – self-concepts and a certain pattern of responding that can be understood as phenomena related to the concept of self.
Material and method: I used the Rorschach test to examine 32 couples of parents who had a child suffering from paranoid schizophrenia (as defined in DSM-IV) and 21 couples of parents who had only healthy children.
Results: Parents of schizophrenic children gave significantly fewer human movement responses than parents of healthy children, and some features of these responses give them a specific character. The groups of fathers differed from each other to a greater degree than the groups of mothers. The analysis of relationships between movement responses and shading (chiaroscuro) responses, which are regarded as a measure of anxiety, revealed significant associations in the case of some movement qualities. The exception was that movement quality which is referred to as blocked movement and blocked-posture movement in Piotrowski’s interpretive scheme. All movement qualities globally considered were significantly correlated with anxiety, the exceptions being the group of parents of healthy children and the group of all fathers.
Discussion: The smaller number of human movement responses found in the group of parents of schizophrenic children may attest to these people’s lower psychological maturity, which is associated with a less distinctly formed prototypal role. Moreover, certain specific features of these responses can be interpreted as a sign of difficulties in expressing this role. The cooccurrence of movement responses with shading responses, which are treated as a sign of anxiety, was not always consistent with expectations; this should be considered a reason to reflect on the psychological meaning of these responses and on the possible return to Rorschach’s original views.
Conclusions: The results of the study suggest lower maturity in the case of parents of schizophrenic children, manifesting itself in a less strongly developed prototypal role and certain difficulties in expressing this role. Based on the analysis of the cooccurrence of movement responses and responses commenting on the shading present in the inkblots, it is possible to conclude that there is a need for a new psychological interpretation of these responses.
Introduction: The theoretical basis for the present article is Zygmunt Piotrowski’s concept of prototypal role. This role is understood as a self-concept and as a mechanism guiding and stabilizing relations with the environment. The concept of prototypal role can be regarded as similar to the concept of self.
It is possible to assess the prototypal role by analyzing the movement responses obtained during an examination using the Rorschach test. Empirical data suggest that patients with schizophrenia have an insufficiently developed or peculiarly formed prototypal role and experience certain difficulties in expressing this role.
Material and method: The number of 32 individuals with schizophrenia and 21 healthy individuals were examined using the Rorschach test. Apart from the analysis of movement and posture responses; responses interpreting the shading (chiaroscuro) visible in the inkblots were taken into consideration. Responses of the latter kind are considered to be a measure of anxiety.
Results: There found no differences in the most significant variables, the number of human movement responses was not lower in the group of subjects with schizophrenia, and the number of human movement responses not adequately reflecting the form of the inkblots was not higher in schizophrenic individuals. Some of the movement qualities distinguished by Piotrowski were significantly correlated with anxiety, but these associations were not always consistent with the predictions.
Discussion: Data analysis revealed no specificity in the development of prototypal role in schizophrenic individuals; difficulties in the expression of this role were not frequent and occurred mainly in schizophrenic women as compared to healthy ones. More differences occurred between schizophrenic women and schizophrenic men, what may attest to the influence of gender on the experience of adaptation to disease.
Conclusions: The analysis of movement responses and shading responses provides the basis not so much for differentiating health and disease as for better insight into the very psychological significance of movement and shading responses.
Introduction: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease with undetermined etiology. Due to diverse symptomatology, it requires a thorough differential diagnosis, with consideration of conversion disorders. The presented thesis describes a case of a young man hospitalized in the Department of Psychiatry in order to verify the possible psychogenic basis of his symptoms, which previously were considered to be a manifestation of neurological disease with an unfavorable prognosis.
Aim: The aim of the thesis is to raise the issue of a multidisciplinary approach to diagnostic process in medicine, as well as taking into account the legitimacy of including psychiatrists, psychologists, and psychotherapists in diagnostic teams.
Case study: We present a case report of a man who has been experiencing progressive feeling and walking problems for the past several years, which originally suggested a neurological or rheumatological disease. Earlier observations and medical tests had led to a diagnosis of amyotrophic lateral sclerosis. After several years, the diagnosis was excluded, and the patient was referred to the Department of Psychiatry to determine the possible psychogenic basis of his symptoms. Diagnostic methods used during the patient’s hospitalization confirmed the conversational nature of his symptoms, and both pharmacological and psychotherapeutic treatment caused reduction of severity of his symptoms and allowed him for a gradual return to independent functioning.
Conclusion: Analysis of the collected data, including patient’s life history and a course of his treatment, indicates the validity of a holistic approach to medical problems, which implies the inclusion of specialists in the field of psychiatry, psychology, as well as psychotherapists in diagnostic teams. Such a multidimensional view of the patient and the source of his symptoms may allow for faster diagnosis and may also contribute to reducing the risk of making mistakes such as an incorrect assessment of factors triggering the disease process.