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.

Social cognitive and neurocognitive deficits in inpatients with unilateral thalamic lesions - pilot study.

BACKGROUND: The essential role of the thalamus in neurocognitive processes has been well documented. In contrast, relatively little is known about its involvement in social cognitive processes such as recognition of emotion, mentalizing, or empathy. THE AIM OF THE STUDY: This study was designed to compare the performance of eight patients (five males, three females, mean age ± SD: 63.7±7.9 years) at early stage of unilateral thalamic lesions and eleven healthy controls (six males, five females, 49.6±12.2 years) in neurocognitive tests (CogState Battery: Groton Maze Learning Test, GML; Groton Maze Learning Test-Delayed Recall, GML-DR; Detection Task, DT; Identification Task, IT; One Card Learning Task, OCLT; One Back Task, OBT; Two Back Task, TBT; Set-Shifting Task, S-ST) and other well-known tests (Benton Visual Retention Test, BVRT; California Verbal Learning Test, CVLT; The Rey-Osterrieth Complex Figure Test, ROCF; Trail Making Test, TMT part A and B; Color - Word Stroop Task, CWST; Verbal Fluency Test, VFT), and social cognitive tasks (The Penn Emotion Recognition Test, ER40; Penn Emotion Discrimination Task, EmoDiff40; The Penn Emotional Acuity Test, PEAT40; Reading the Mind in the Eyes Test, revised version II; Toronto Alexithymia Scale, TAS-20). METHODS: Thalamic-damaged subjects were included if they experienced a single-episode ischemic stroke localized in right or left thalamus. The patients were examined at 3 weeks after the stroke onset. All were right handed. In addition, the following clinical scales were used: the Mini-Mental State Examination (MMSE), Spielberger State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI II). An inclusion criteria was a minimum score of 23/30 in MMSE. RESULTS: Compared with the healthy controls, patients revealed significantly lower scores in CVLT, GML-DR, and VFT. Furthermore, compared to healthy controls, patients showed significantly delayed recognition of "happiness" in EmoDiff40 and significantly worse performance on Reading the Mind in the Eyes Test, revised version II. Neuropsychological assessment demonstrated some statistically significant deficits in learning and remembering both verbal and visual material, long-term information storing, problem solving, and executive functions such as verbal fluency. CONCLUSION: Patients at early stage of unilateral thalamic stroke showed both neurocognitive and social cognitive deficits. Further research is needed to increase understanding about diagnosis, early treatment, and prognosis of patients with thalamic lesions.

[Neurocognitive and social cognition deficits in patients with anorexia nervosa]. / Deficyty neuropoznawcze i spolecznego poznania u pacjentów z jadlowstretem psychicznym.

In the first part of the article the authors present a set of the actual concepts explaining problems of cognitive functions and social cognition currently observed in patients with anorexia nervosa (AN). It is possible; through the neuroimaging research, to get better understanding of the brain specifics in these individuals. Even though, the AN remains a disease with very complex and multifactorial etiology which remains a huge medical challenge. Currently, popular is the view that takes into consideration the integrating role of the insula and subcortical structures (such as hippocampus, amygdala, thalamus) in the regulation of cognitive and emotional processes in people suffering from AN. There is still an open problem, however, of the selection of therapeutic interventions targeting these deficits. The second part of the article presents the attempt to describe deficits in neurocognitive and social cognition in people with AN occurring prior to illness, during and after the recovery. Particular attention has been paid to the most frequently described in the literature--neurocognitive deficits such as rigidity of thinking, weak central coherence, and deficits in social cognition, including mental processes of perception and expression of emotions, disorders of the theory of mind (ToM) and empathy. The results of previous studies, their scarcity in Poland, do not give a satisfactory answer to the question whether the above mentioned disorders are a feature of endophenotype or condition in an episode of the disease. Research point to the more permanent nature, which may be more resistant to therapeutic modifications.

[The newest therapeutic directions in the rehabilitation of patients with mental disorders]. / Najnowsze kierunki terapeutyczne w rehabilitacji pacjentów z zaburzeniami psychicznymi.

In this paper, the authors attempted to present the comprehensive literature review on the newest therapeutic interventions such as cognitive remediation therapy (CRT), mindfulness-based cognitive therapy (MBCT), social cognition and interaction training (SCIT), and acceptance and commitment therapy (ACT) which appeared promising whilst their implementing among schizophrenic patients, patients with anxiety disorders, eating disorders, and affective disorders. In the presented work particular attention was focused on two kinds of psychotherapeutic interventions: social cognitive trainings and cognitive remediation therapy (CRT) and their effectiveness in the rehabilitation process of schizophrenic patients. The growing body of research based on application of the above mentioned techniques in psychiatric population gives remarkable hope to improve quality of cognitive and psychosocial therapeutic interventions and to set up both complex and comprehensive therapeutic programme for patients with mental disorders.