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Archives of Psychiatry and Psychotherapy
Issue 2 July 2005
Content

Krystyna Górna, Krystyna Jaracz, Filip Rybakowski
Social functioning in first-episode schizophrenia: 1-year follow-up study      5
Summary: The aim of the study was to compare social functioning of first-admitted schizophrenic patients with healthy controls and evaluate the influence of different variables on social abilities of patients, 1 month after hospitalization (T1) and in 1 year follow-up (T2). A group of 86 schizophrenic patients: 52 male and 34 female; age 25.5; ą 5.8 and a control group of matched 52 male and 34 female subjects were enrolled. Social Functioning Scale (SFS), Positive and Negative Syndrome Scale (PANSS), Global Assessment Scale (GAS) and demographic questionnaire were used. In both T1 and T2 we found similar levels of SFS score in patients (T1- 103.7; T2- 105.5), significantly lower than in healthy controls 117.0 (range 98.6-130.1) (p@lt0.001). In longitudinal analysis, better pre-admission functioning was associated with improvement of Independence Performance. In cross-sectional analysis, better social functioning was associated with the female sex, higher but not academic education, activity before admission, and better functioning in pre-admission period. In regression analyses (the 5-dimensional model of schizophrenia) T1 SFS was explained by negative (39%) and 1% with positive symptoms. In T2 SFS only negative symptoms explained social functioning (36%). Social functioning in schizophrenia is disturbed from the onset of the disease and is influenced mainly by current negative symptoms. Protective effect of female sex, higher education and pre-admission functioning can be observed.
Bogusław Borys, Mikołaj Majkowicz
Coping with stress in those who have experienced a traumatic situation      21
Summary Does the traumatic experience influence the choice of a particular coping style? If yes, which style is preferred by those who experienced trauma? Answering these two essential questions is the aim of this paper. The authors have accepted the assumption (Holman, Silver), that the individuals who experienced trauma prefer past temporal orientation and they present a higher level of distress. The authors investigated two groups. The experimental group consisted of 46 victims of the Gdańsk Shipyard concert hall fire. The control group comprised the 41 individuals who never experienced any trauma. Two psychological methods were used. CISS - Endler and Parker, which measures coping styles, as well as the STAI - Spielberger and al., which was the second method applied, measuring the level of anxiety as an essential distress indicator. The results show, that individuals who experienced trauma, presented a significantly higher level of anxiety and that the victims of trauma prefer the emotional coping style. The difference between the groups is statistically significant. There is also an indirect conclusion (based on these results), which confirms the above mentioned assumption.
 
  Agnieszka Stępień, Tomasz Hadryœ, Monika Kantorska - Janiec
Posttraumatic stress disorder (PTSD) as a result of the 1997 flood - incidence and clinical picture      29
Summary In this paper the incidence and the course of flood-related PTSD in the rural population of the southwest part of Poland will be presented. To serve this purpose, four villages located in the Nysa Klodzka basin were chosen. In 1997 these locations were devastated by the disaster unexpectedly and in considerable degree. The study included 97 eyewitnesses of the flood who had never had any personal contact with psychiatrists before the disaster and who had not reported any other significant stressful life events which could have been accounted for the PTSD. The intensity, risk and duration of trauma for all subjects were the same. None had received any psychological or psychiatric support after the flood. The examination took place 60-63 months after the event and was conducted by one trained psychiatrist at the homes of those affected after prior phone appointment. The interview was based on the Composite International Diagnostic Interview (CIDI), section A (sociodemographic data) and section N (PTSD symptoms). PTSD was diagnosed in 30.9% of those interviewed. Individuals displaying PTSD symptoms were mainly unemployed (39.2% of unemployed individuals had PTSD), with low educational level (42.9% of subjects with primary education had PTSD) and older. Men were more often affected (39.5%) than women (25.4%) and it proved to be associated with their low level of education and poverty. In 15.5% of those interviewed the fully developed PTSD was still present 60-63 months after the flood. The characteristics and patterns of the PTSD occurrence observed in the examined population are in concordance with world literature. Low level of education and low economic status of men could account for the high rate of PTSD diagnosis in this group rather than in women. None of the examined subjects confirmed having had short-lasting (less than a month) symptoms which precluded the diagnosis of acute stress reaction. This was probably due to the durability of the devastation caused by the flood and prolonged exposure to a chronic stressor.
Jerzy A. Sobański
Statistic analysis of the neurotic symptoms dynamics during intensive psychotherapy in a day hospital setting       41
Summary Aim: Analysis of the global neurotic symptom dynamics during intensive integrative psychotherapy in a day-hospital setting, and its relation to the treatment outcome. Method: 4345 symptom check-lists SCL"0", filled in by 319 patients treated in the years 1990-1998 were analysed. The studied group consisted of 235 women and 84 men suffering from somatization disorders, generalized anxiety disorder and dissociative disorders. Results: In groups of patients with different therapy outcome, different types of sequential changes of global symptom level ("GSL") were observed. Some phenomena like for example unchanged symptom level ("plateau") lasting for a few weeks, occurred with different frequency - related to the final therapy outcome. Decrease of the global symptom level below 200 points in women and 165 points in men often preceded global symptom exacerbation and occurred even in therapies with non-beneficial final results. Conclusion: Some aspects of the global neurotic symptom dynamics may be treated as additional markers of beneficial or non-beneficial therapy processes. Sequences of symptom decreases, as well as sequences of short increases were connected to better final results. Weekly measurements of the symptom level (with the use of checklists) may be useful for monitoring the psychotherapy process, but the decrease of the GSL to the values typical for the healthy population does not permit one to consider a patient as a "cured" one. Even decrease of GSL below 100 (women) / 82 (men) points was not always connected to its further stability.
 
  Iwona Chlebowska, Jan Aleksander Beszłej, Andrzej Kiejna, Magdalena Grzesiak, Krystyna Orzechowska-Juzwenko, Piotr Milejski
Sparteine oxidation rate in alcohol dependent patients      51
Summary Aim of the study: Assessment of the CYP2D6 isoenzyme activity in alcohol dependent patients based on sparteine oxidation rate. Material and methods: Oxidation rate of sparteine has been examined in a group of 102 patients with diagnosis of alcohol dependence and has been compared with a control group consisting of 160 volunteers. The assessment of oxidation rate of sparteine was carried out during the withdrawal syndrome. Results: Among the patients, 97.1% were classified as extensive metabolisers (phenotype EM) and 2.9% as poor metabolisers (phenotype PM). There was no statistically significant difference in proportions of EM's and PM's subgroups between patients and the controls. Significant differences were observed in the distributions of sparteine metabolic oxidation ratio (MR); a higher oxidation rate was noted in the studied group, in comparison with the controls. The length of the dependence period does not have any effect on the MR values. Conclusion: Patients who are in the midst of the alcohol withdrawal syndrome do not have a defected process of oxidation in the presence of CYP2D6 and as a result of this parameter, there is no need to reduce the dosage of drugs metabolized by this enzyme.
Astrid Thome
New aspects of Freud's concept of the death instinct      59
Summary In public and also often in discussions of the human sciences concerning violence a tendency prevails to refer to Freud's concept of the death instinct which ontologizes mans' destructiveness. This paper argues against the assumptions of the genuine destructive nature of man by taking into account new neurophysiologic research on how violence influences the functioning of the brain. The basic principles of Freud's death instinct - repetition compulsion and the "nirvana" principle - become thus understandable as dysfunctional reactions of the brain, i.e. an inner physiological response to violence and neglect in early childhood.
 
  Andrzej Kokoszka
The influence of Antoni Kępiński's ideas on Józef Tischner's philosophy and its psychiatric implications      65
Summary Some issues of the philosophy of Józef Tischner, who died in 2000, were inspired by psychiatric works of Antoni Kępiński. They are presented and discussed in this paper and include: recognition of experience of other men, phenomenon of hideout, phenomenon of mask, relation of power, society of dialogue, salvation dialogue. The opinions of Tischner on psychotherapy according to Kępiński are reviewed. The phenomenological description of value experience by Tischner was an inspiration for the concept of corrective experience of values, which is discussed.
 
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