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Open access

Marta Kłak and Wioletta Karina Ozga

Abstract

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.

Open access

Marta Cudzik, Ewelina Soroka and Marcin Olajossy

Abstract

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.

Open access

Sara Tomczak, Hanna Gorejko and Wiktor Dróżdż

Abstract

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.

Open access

Anna Hunca-Bednarska

Abstract

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.

Open access

Anna Hunca-Bednarska

Abstract

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.

Open access

Joanna Niedziałek, Marta Pachla, Aleksandra Kordyga, Łukasz Proć, Ewelina Soroka and Marcin Olajossy

Abstract

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.

Open access

Rafał Mazur, Sebastian Masternak, Michał Pająk, Nikodem Skoczeń, Ewelina Soroka and Marcin Olajossy

Abstract

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.

Open access

Urszula Fałkowska, Katarzyna Adamczyk, Dorota Adamczyk, Ewelina Soroka, Véronique Petit and Marcin Olajossy

Abstract

Introduction: The development of biological sciences, as well as cultural and civilizational changes have led to the emergence of practice within the medicine of science, called psychiatry. Already at the turn of the 19th and the beginning of the 20th century, Karl Jaspers - a German scholar - father of psychopathology - in the work “Allgemeine Psychopathologie” crystallized his intuitions in the field of psychopathology, which classifies and describes states that are deviations from the physiological mental state of a human being.

Material and method: his paper reviews available literature to approximate the symptoms of the most interesting psychopathological syndromes in psychiatry such as: Clerambault syndrome, Otheller syndrome, Cotard syndrome, Ekboma syndrome and Folie à deux.

Results: A multitude of psychopathological syndromes results from the wealth of survival of psychiatric patients. They represent the delusions of different contents that develop in a primitive way or as a consequence of other types of disorders. Psychopathological teams have been inspiring the poets and directors for centuries. The relationship between psychiatry and culture, film and literature undoubtedly testifies to its interdisciplinary nature.

Discussion: Despite the passage of time, the descriptions of these syndromes with a rich historical description, symptomatology and criteria have not lost their relevance and are still a clinical reality.

Open access

Piotr Boguta, Dariusz Juchnowicz, Paulina Wróbel-Knybel, Agnieszka Biała-Kędra and Hanna Karakuła-Juchnowicz

Abstract

Introduction: Warfarin has been considered as a “gold standard” in the prevention and treatment of thromboembolic events since 1954. Since the introduction of direct oral anticoagulants in the last few years (NOAC-Non-Vitamin K antagonist Oral Anticoagulants) prescriptions volume for apixaban, edoxaban, dabigatran and rivaroxaban have been gradually surpassing warfarin. The benefits include: anticoagulation from day one, fixed daily dosing, elimination for the need of international normalised ratio (INR) monitoring, fewer interactions with food and co-administered medicines with reduced risk of bleeding and better overall life quality.

Objectives: Assessing evidence for the safe use of Non-vitamin K Oral Anticoagulants (NOAC) with Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitors (SNRI).

Method: Review of literature published between 2014 and 2016 was made using the key words: Selective Serotonin Reuptake Inhibitor, Serotonin and Noradrenaline Reuptake Inhibitors, apixaban, dabigatran, edoxaban, rivaroxaban, bleeding, interaction, depression with time description from 2014 to 2018. Evidence within the literature was then compared with guidelines from the National Institute for Health and Care Excellence (UK), British National Formulary (UK), Clinical Excellence Commission (Australia), Thrombophilia and Anticoagulation Clinic (USA) and Summaries of Product Characteristics (SPC).

Results: 1. Serotonin plays a critical role in maintaining homeostasis. Use of SSRI/SNRI compromises its platelet reuptake increasing risk of bleeding. 2. Increased tolerability and safety of NOAC over Warfarin, although caution is advised when NOAC is used with SSRI/SNRI with less evidence suggesting pharmacodynamic interactions. 3. It is not recommended to use NOAC with strong CYP and P-gp inhibitors.

Conclusions: With limited literature evidence, caution is advised when co-prescribed NOACs with SSRI/SNRI, especially with other cofactors and interacting medicines further increasing risk of bleeding.

Open access

Maryla Sawicka and Agnieszka Żochowska

Abstract

Positive psychology directs its research interests primarily to healthy people. The most important goal is to build a positive attitude towards yourself and the surrounding world. Recently, positive psychology has set a new area of research interest, which is clinical psychology. In recent years, several positive psychotherapy programs have been developed for people with schizophrenia experience. The article presents the latest trends in positive psychotherapy for people with schizophrenia. They involve taking into account the individual differences of each patient and the specificity of his / her psychopathology. As far as the therapeutic goals are concerned, there are interventions focused on strategies for enhancing positive emotions and wellbeing or the method of activating the strengths of character. Taking into account the methods of therapeutic work, they can be divided into training methods or those of the behavioral-cognitive psychotherapy as well as those that take into account the various aspects of meditation. The article presents the distribution of therapeutic programs in terms of the range of therapeutic goals in which the most important are: intensification of positive experiences, building of strengths of character and well-being. Therapeutic programs have been shown to focus not only on breaking down negative attitudes towards one’s own illness and life, but also on those that try to deal with the unsolved schizophrenia problem - negative symptoms.