THE ROLE OF MUSIC THERAPY IN THE TREATMENT OF OBESITY AND METABOLIC SYNDROME - PSYCHOLOGICAL AND MEDICAL CONTEXT.

Music therapy is a therapeutic method used in dealing with people suffering from various somatic and mental disorders. The pa¬per discusses the current state of knowledge about the use of music therapy in the management of people suffering from obesity. Attention was paid to the possible positive effect of music therapy on weight control. It also reviews the literature of controlled clinical trials conducted over the past 10 years on the importance of music therapy in the treatment of obesity. These studies show that music therapy can have a positive effect on both weight loss and maintaining an adequate caloric supply of food. The small number of studies, however, does not allow to formulate precise conclusions and unambiguous conclusions. The issue of the ef¬fect of music therapy on the clinical condition of patients suffering from obesity requires further research.

The role of music therapy in the treatment of patients with type 2 diabetes.

Music therapy is a therapeutic method used to help people suffering from various somatic and mental disorders. The paper discusses rational premises for the use of music therapy in the management of patients suffering from type 2 diabetes. Attention is drawn to the possible positive effect of music therapy on the control of emotions, mood, stress levels and glycemic control. The literature of controlled clinical trials conducted over the past 10 years on the importance of music therapy in the treatment of diabetes has also been reviewed. These studies demonstrate that music therapy may have a positive effect on the management of subjects with type 2 diabetes. However, the small number of studies does not allow to formulate precise and unambiguous conclusions. The issue of the impact of music therapy on the clinical condition of patients suffering from type 2 diabetes requires further research exploration.

Is asthma with hypersenitivity to non-steroidal anti-inflammatory drugs is a risk factor for depression?

The respiratory tract disease exacerbated by non-steroidal antiinflammatory drugs (NSAIDs) is characterized by the Widal triad, which includes the presence of bronchial asthma, hypersensitivity to NSAIDs (acetylsalicylic acid) and chronic eosinophilic rhinitis and sinusitis (frequently also coincident with nasal polyps). Idiosyncratic hypersensitivity to NSAIDs in the course of bronchial asthma affects approximately 15% of patients. AIM: The aim of the study is to assess depressiveness and severity of anxiety in the population of patients with partially and poorly controlled asthma. MATERIALS AND METHODS: A group of 48 patients with partially and poorly controlled bronchial asthma without hypersensitivity to NSAIDs was selected, as well as 42 patients with partially and poorly controlled bronchial asthma hypersensitive to NSAIDs. All the patients underwent an asthma control test. To assess depression, the Beck Depression Scale - BDI II was used. When assessing anxiety as a trait and anxiety as a state, the Spielberger's STAI - State and Trait Anxiety Inventory - was used. RESULTS: The mean age in the group with no hypersensitivity to NSAIDs was 51 +/- 15 years and did not differ with statistical significance from the group of patients hypersensitive to NSAIDs, where it was 50 +/- 14 years. The mean level of depression in the group without hypersensitivity was 15 +/- 9, and in the hypersensitivity group 23 +/- 8 and the difference reached the level of statistical significance p<0.005. Moreover, anxiety as a state was lower in the group without hypersensitivity compared to the group with hypersensitivity (the result expressed in sten scores: 6 +/- 2 versus 7 +/-2, p<0.001). Anxiety as a trait was 5 +/- 2 in both groups and there was no inter-group difference. CONCLUSIONS: Subjects with partially and poorly controlled bronchial asthma and hypersensitivity to NSAIDs have a higher severity of depression and anxiety compared to those with partially and poorly controlled asthma without hypersensitivity to NSAIDs. In that group, anxiety as a state is also greater than in the group without hypersensitivity to NSAIDs.

Astma jako choroba psychosomatyczna.

In psychosomatic diseases, the damage to organs is overlaid with symptoms induced by a mental factor. Bronchial asthma is a chronic bronchitis, often of an allergic etiology, accompanied by attacks of dyspnea, which can be induced by severe stress. The mechanism involves induction of a bronchospasm, dependent on the cholinergic system, by cold air. Another aspect is the relationship of bronchial asthma with the development of mood disorders. The mechanism of such depression is the product of the psychogenic factor and the effect of inflammatory mediators on the central nervous system. The mental factor plays an important role in the clinical picture of bronchial asthma. However, this issue requires further research, especially regarding the use of psychotherapy in the management of a patient suffering from bronchial asthma.

Evening chronotype as a bipolar feature among patients with major depressive disorder: the results of a pilot factor analysis.

OBJECTIVES: The bipolar spectrum concept has resulted in a paradigm shift that has affected both the diagnosis and therapy of mood disorders, with bipolarity becoming an indicator of treatment resistance in depression. Evening circadian preference has also been linked to affective disorders. The aim of our study was to confirm the relationship between the severity of depressive symptoms, bipolar features, chronotype, and sleep quality among patients with major depressive disorder. METHODS: A group of 55 individuals who were recruited from a mental health outpatient clinic completed the following psychometric tools: a Chronotype Questionnaire comprising morningness-eveningness (ME) and subjective amplitude of the rhythm (AM) scales, the Hypomania Checklist 32 (HCL-32), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Factor analysis identified two latent components, accounting cumulatively for 58% of variables: depressive symptoms (BDI and PSQI) and bipolarity (ME, AM, and HCL-32). After rotation, ME loading in the first factor increased the result to a significant level. The correlation between the two components was very low. CONCLUSIONS: Evening chronotype appears to be a bipolarity-related marker, with this relationship being independent of its link to depressive symptoms and sleep quality. Eveningness and high circadian rhythm amplitude may offer promise as diagnostic, prognostic, and therapeutic predictors.

Evening chronotype as a bipolar feature among patients with major depressive disorder: the results of a pilot factor analysis

Objectives: The bipolar spectrum concept has resulted in a paradigm shift that has affected both the diagnosis and therapy of mood disorders, with bipolarity becoming an indicator of treatment resistance in depression. Evening circadian preference has also been linked to affective disorders. The aim of our study was to confirm the relationship between the severity of depressive symptoms, bipolar features, chronotype, and sleep quality among patients with major depressive disorder. Methods: A group of 55 individuals who were recruited from a mental health outpatient clinic completed the following psychometric tools: a Chronotype Questionnaire comprising morningness-eveningness (ME) and subjective amplitude of the rhythm (AM) scales, the Hypomania Checklist 32 (HCL-32), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI). Results: Factor analysis identified two latent components, accounting cumulatively for 58% of variables: depressive symptoms (BDI and PSQI) and bipolarity (ME, AM, and HCL-32). After rotation, ME loading in the first factor increased the result to a significant level. The correlation between the two components was very low. Conclusions: Evening chronotype appears to be a bipolarity-related marker, with this relationship being independent of its link to depressive symptoms and sleep quality. Eveningness and high circadian rhythm amplitude may offer promise as diagnostic, prognostic, and therapeutic predictors.

Mental health indices may fully mediate the relationship between morningness-eveningness and disease control among adult asthma patients.

Objective: The aim of this study was to assess the association between morningness-eveningness and disease control with consideration of mental state as a mediator and the control of confounding factors among adult asthma patients.Methods: This is a cross-sectional study, which included a nonrandom sample of N = 66 patients from an outpatient unit with a confirmed asthma diagnosis, who gave an informed consent and completed a set of questionnaires: a survey comprising questions about sociodemographic and clinical characteristics, the Asthma Control Test (ACT), the Composite Scale of Morningness (CSM), and the General Health Questionnaire (GHQ-28). Mediation models were created separately for each GHQ-28 dimension (somatic symptoms, anxiety/insomnia, social dysfunction and depressive symptoms), for a total score and for four GHQ-28 dimensions together, considered as mediators.Results: Low morning affect was related to poor disease symptom control among patients with asthma. The effect was fully mediated by non-psychotic mental health indices. Evening-time preference was associated with a rise in asthma control, and mediated by somatic symptoms and anxiety/insomnia, when controlled for morning affect. Conclusions: The current study underlines the significance of assessment of both individual morningness-eveningness preference and mental health in the management of asthma symptoms.

Effect of haloperidol and amisulpride on the production of malondialdehyde in reaction to free radical attack on deoxyrybosis.

Knowledge of free radicals has a huge impact on the development of medicine not only because of diseases caused by reactive oxygen species, but also because of their harmful role in the pharmacotherapy of various diseases. Hence, many researchers are looking for both the mechanisms responsible for induction of oxidative stress in the body, and an effective method to scavenge free radicals. AIM: The aim of our study was to test the in vitro antioxidant properties of two known neuroleptics - haloperidonol and amisulpride, which are commonly used in the treatment of schizophrenia. MATERIALS AND METHODS: The study took advantage of the properties of hydroxyl radical degrading deoxyrybosis to malondialdehyde (MDA). Fenton reaction was used to produce the free radical. For this purpose, deoxyrybosis was incubated under appropriate conditions with FeSO4 (0.5mM), EDTA (1mM), H2O2 (14mM) and haloperidol or amisulpride at 1, 5, 20 or 50 umol/l concentrations. A clean system (containing no medicines) was a positive control. Thiobarbituric acid (TBA) was subsequently added to the reaction mixtures in the presence of trichloroacetic acid. RESULTS: The study took advantage of the properties of hydroxyl radical degrading deoxyrybosis to malondialdehyde (MDA). Fenton reaction was used to produce the free radical. For this purpose, deoxyrybosis was incubated under appropriate conditions with FeSO4 (0.5mM), EDTA (1mM), H2O2 (14mM) and haloperidol or amisulpride at 1, 5, 20 or 50 umol/l concentrations. A clean system (containing no medicines) was a positive control. Thiobarbituric acid (TBA) was subsequently added to the reaction mixtures in the presence of trichloroacetic acid. CONCLUSIONS: The results demonstrated that both haloperidol and amisulpride inhibit the degradation of deoxyrybosis to MDA, so they show antioxidant properties under the test conditions.

The role of music therapy in the clinic of obstructive diseases of the respiratory system.

Music therapy is a relatively new area of therapeutic practice. In many ways, it is similar to psychotherapy and medical rehabilitation. The question arises whether it can be relevant in the management of patients with obstructive pulmonary diseases, which include asthma and COPD. As it follows from the treatment practice, therapeutic singing can improve breathing and coping with shortness of breath. Music therapy can be important in alleviating the mental symptoms associated with obstructive diseases such as anxiety disorders and mood disorders. Using Orff instrumentation to create a musical portrait solves the patient's intrapsychic and interpersonal problems. In conclusion, it should be stated that music therapy can be a valuable supplement to psychotherapy and physiotherapy. This claim, however, requires empirical verification.

The association between chronotype and suicidality among students of the medicine and psychology faculties - the mediating role of general mental health indices.

The aim of the present study was to evaluate whether anxiety and insomnia symptoms, somatic symptoms, and social dysfunction mediate the link between chronotype and suicidality, as depressive symptoms are known to do, among students of the faculties of Medicine and Psychology. Data from a total of 289 students were eligible for the analysis. The students completed the Suicide Behaviors Questionnaire - Revised, Composite Scale of Morningness, General Health Questionnaire. Single-predictor linear regression models were created to predict suicidality, with a subsequent mediation analysis. A preference toward eveningness was associated with an increase in suicidality Somatic symptoms, anxiety/insomnia, and depressive symptoms fully mediated the relationship between chronotype and suicidality. Depressive symptoms were found to present the strongest effect size of mediation. Social dysfunction was associated with both eveningness and suicidality, but did not play a mediating role. There might be a need to evaluate nonpsychotic mental health indices other than depressive symptoms when assessing the link between suicidality and chronotype among students of the faculties of Medicine and Psychology.

Bronchial asthma control degree and the temperament structure according to the Eysenck model.

INTRODUCTION: Asthma is a disease of a psychosomatic nature. The control of asthma is still poor in approximately 5% of patients, despite introduction of modern inhalant drugs and psychotherapeutic interventions. AIM: To evaluate whether the degree of bronchial asthma control is related to the characteristics of temperament according to Eysenck's concept. MATERIAL AND METHODS: The study was conducted on a group of 111 bronchial asthma patients and 44 healthy subjects. In all of them, the Eysenck temperament questionnaire was administered and the level of asthma control was determined. RESULTS: Increase in the scale of neuroticism was associated with an 1.83-fold increase in the likelihood of poor asthma control. Increase in the result on the psychoticism scale and lie scale of about one point was associated with a slightly smaller increased risk of poor asthma control (respectively: 1.49-fold and 1.61-fold). CONCLUSIONS: The structure of temperament of a person with poor control of bronchial asthma can be characterized. Patients with poor asthma control have a higher level of neuroticism, psychoticism and propensity to lie, compared with the healthy population and subjects with good or partial bronchial asthma control.

Music therapy and psychotherapy as non-pharmacological methods supporting therapy in medicine - similarities and differences.

Non-pharmacological methods such as music therapy and psychotherapy are increasingly used in psychiatry and somatic medicine as adjuvant therapies. This trend is due to the crisis of scientific knowledge, the development of postmodern philosophy and the existential confusion of the man. Also, shifting the treatment from hospitals to the social environment of the patient creates an area and provides an opportunity for non-pharmacological methods of therapy. Unlike pharmacological therapy, the effectiveness of psychotherapy and music therapy in particular has not been extensively investigated. This is due both to the lack of financial resources to be assigned for such studies and to the impossibility to evaluate the effectiveness of these therapies using the double-blind method. The lack of strong evidence of the effectiveness of nonpharmacological therapies often results in the omission of these methods in the treatment and the risk of application of ineffective or harmful methods. Only cognitive behavioral therapy has been supported by a fairly reliable assessment of effectiveness, due to the care of the community of professionals associated with this trend for scientific evaluations. In music therapy, like in psychotherapy, we have the phenomenon of setting, transference, countertransference and resistance. In both methods, therapeutic contact is included and determines the framework duration of the therapy. The language of music therapy is much less unambiguous and yielding much more possibilities of interpretation than the language of psychotherapy. Both these areas of therapy, however, are intersecting, and it is impossible to delineate a border between them. Further research into the effectiveness of these evolving methods is all the more necessary as the growing crisis of trust in science, the lack of new effective medications and the dominance of postmodern concepts in public discourse increasingly draw attention to the environmental context of the disorders, their social nature and the possibility of therapy in the social environment of the patient away from the excessive number of medical procedures.

The -463G/A and -129G/A myeloperoxidase-encoding gene polymorphism in chronic obstructive pulmonary disease.

INTRODUCTION: Neutrophils are involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Myeloperoxidase is an important bactericidal granulocytic enzyme. It is of interest to question whether or not the polymorphic variants of the myeloperoxidase-encoding gene are associated with the risk of developing COPD. MATERIAL AND METHODS: The study determined the risk of COPD development in 186 COPD patients and 220 healthy subjects in the context of two selected polymorphic sites of the promoter region of the myeloperoxidase-encoding gene. RESULTS: It has been demonstrated that the AA genotype of locus -463 in the myeloperoxidase-encoding gene increases the risk of developing COPD (OR: 2.87; CI: 1.651-4.997). This genotype also correlates with a higher gene expression in patients (0.56 ± 0.12 vs 0.31 ± 0.18 in patients with AG genotype and 0.29 ± 0.17, p < 0.01 in those with GG genotype). In healthy indivi-duals, the AA genotype was also characterized by increased expression of the myeloperoxidase-encoding gene (0.41 ± 0.16 vs 0.29 ± 0.15 for AG genotype, p < 0.01 and 0.25 ± 0.16 for GG genotype p < 0.01). Patients with the AA genotype had a significantly higher gene expression than healthy subjects with this genotype. CONCLUSIONS: The polymorphic site -129 of the myeloperoxidase-encoding gene was unrelated to the development of COPD. The gene expression did not differ for the individual genotypes. Our studies indicate that the polymorphism of the myeloperoxidase--encoding gene may be related to chronic obstructive pulmonary disease.

The coincidence of diabetes mellitus and asthma, their probable causal relationships and therapeutic opportunities.

Both the epidemiological data and the everyday medical practice demonstrate the coincidence of various types of diabetes mellitus (DM) in patients with asthma. Specific correlations between the risk of DM in pregnancy, asthma and the consequences of these diseases to the mother and her baby are also explored. The discussion concerning, on the one hand, the impact of asthma-related inflammatory condition on the metabolism of carbohydrates, and, on the other, the presence of chronic hyperglycemia and inflammatory markers observed in patients with asthma, is still ongoing. In the case of asthma and type 1 diabetes mellitus (T1DM), a correlation with the dysfunction of the immune system and the genetic background has been suggested, and in the case of type 2 (T2DM), the vital role of obesity and insulin resistance (IR) to promote excessive proinflammatory immune response. The data indicate that both asthma and DM affect mutually their clinical presentations, including the prognostic values and therapeutic possibilities. The ongoing controversy concerning the effective and safe anti-asthma and hypoglycemizing therapy does not allow for a definitive therapeutic consensus in this group of patients, despite the suggested role of metformin and hyperglycemizing effects of glucocorticoids. Therefore, the objective of the presented paper is a review of the knowledge in the field of DM and asthma coincidence, their probable causal relationships and therapeutic opportunities.

The paradigms of contemporary psychiatry.

Psychiatry is a medical discipline that uses to the equal extent biological sciences as well as humanities and social sciences. Among specialists, the division into the so-called humanistic and biological psychiatrists is still maintained. The paper is an attempt of a paradigmatic approach to contemporary clinical and theoretical psychiatry.The humanistic paradigm of psychiatry presumes that every psychological and behavioral disorder is a social construct. It depends on culture whether the specific phenomenon is classified as a norm or a pathology. In the biological world, we have only certain phenomena, and their pathologization and depathologization are a product of culture.The neurocognitive paradigm of psychiatry assumes that the functioning of the brain is responsible for the development of mental disorders. Such disorders may be neurodevelopmental, functional or neurodegenerative in nature. In addition, psychopathology, although it derives from tradition, benefits nowadays from the apparatus of conceptual cognitive psychology and cognitive science. Our attempt to systematize the paradigmatic fundamentals of psychiatry is the first attempt at systematization of the foundations of modern psychiatry with an indication of its distinctiveness from other medical sciences.

Music therapy as a complementary form of therapy for mental disorders.

AIM: Music therapy is an important complement to the non-pharmacological methods used in the treatment of psychiatric and behavioral disorders. The paper discusses the mutual similarities between psychotherapy and music therapy, indicating the importance of transference, countertransference, resistance and contract in both methods. The differences in the tools used in these two treatment methods have been highlighted. The controversy associated with the process of educating music therapists and psychotherapist in Poland has also been discussed. The paper also reviews the latest research works on the effectiveness of music therapy in the treatment of psychiatric disorders. A meta-analysis of six papers listed in the Cochrane database concerning the application of music in the treatment of dementias has clearly demonstrated the beneficial effects of listening to music on relaxation and behavior, as well as cognitive functioning of the patients. A meta-analysis of studies on the effectiveness of psychotherapy in the treatment of schizophrenia was also published in 2017. It included 18 studies with a total of 1215 participants. The short-, medium- and long-term effects of music therapy were evaluated. There was a positive effect of music therapy on the functioning of schizophrenia patients in comparison with standard care. The analyzed data demonstrated good effects of music therapy on negative symptoms, on quality of life and on social functioning in comparison with the control group. Regular listening to music reduced auditory hallucinations in schizophrenic patients and improved the quality of their life. The positive effect of music on the brain in schizophrenia was confirmed by functional magnetic resonance imaging. Music interferes strongly with the internal speech in man and with the productive symptoms which are likely to be attention disturbances in the auditory modality. Also in 2017, the results of meta-analysis of music in the treatment of depression were published. Nine studies were included, with a total of 421 studied subjects. The addition of music therapy to the standard treatment proved to improve significantly the functioning of patients in the short-term perspective. Music therapy also reduced the slow-flowing anxiety accompanying depression. However, the long-term impact of additional music therapy was difficult to assess due to the ambiguity of the results of various studies. The combination of music therapy with cognitive behavioral therapy was studied in 155 adolescents with symptoms of social anxiety. The combination of both methods proved to be more effective than the use of cognitive behavioral therapy alone. Further, a meta-analysis of three other studies clearly indicates the effectiveness of music therapy in reducing the severity of symptoms of postnatal depression. The above observation is all the more valuable that the use of medications in nursing mothers poses a major problem in the care of pregnant women and neonates. The beneficial effect of music therapy has also been shown recently in working with individuals exposed to severe stress, who developed post-traumatic stress disorder. In conclusion, it should be stated that music therapy is a valuable and undervalued method of non-pharmacological support for patients with various psychiatric disorders.

Type D personality and the degree of control of bronchial asthma.

INTRODUCTION: Poor asthma control is probably associated with both biological and psychological factors. Type D pattern of behavior is characterized by negative emotionality and inhibition in social relationships. It was previously found to be associated with cardiovascular diseases. AIM: To evaluate the correlation between the degree of asthma control and the severity of the components of type D behavior pattern. MATERIAL AND METHODS: The research was conducted on a group of 117 subjects with bronchial asthma. The control group consisted of 32 healthy subjects. The degree of bronchial asthma control was determined using the Asthma Control Test. The D pattern of behavior was measured using the DS-14 questionnaire. RESULTS: The risk of type D behavior pattern, defined as scoring at least 10 points in both scales (Negative Emotionality and Social Inhibition), was higher in subjects with uncontrolled asthma than in healthy individuals (OR = 5.19; 95% CI: 1.74-15.44), those with partial control of asthma (OR = 6.04; 95% CI: 1.87-19.52) and subjects with good control of asthma (OR = 8.46; 95% CI: 3.09-23.16). The severity of depressiveness correlated positively with the number of infections in the past year. Negative emotionality correlated positively with the number of infections and social inhibition. CONCLUSIONS: Type D pattern of behavior may be associated with diagnosis and severity of asthma. Due to its link to poor control of asthma symptoms, a high level of negative emotionality among patients with asthma might be of particular interest to the clinicians.

Changes in the immune system - the key to diagnostics and therapy of patients with non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common pathologies of that organ. The development of the disease involves a variety of mechanisms, including insulin resistance, oxidative stress, endoplasmic reticulum stress, endotoxins from the intestinal flora and genetic predispositions. Additionally, clinical data suggest that the presence of NAFLD is associated with excessive activation of the immune system. For practical purposes, attention should be paid to the moment when the subjects predisposed to NAFLD develop inflammatory infiltration and signs of fibrosis in the liver (non-alcoholic steatohepatitis - NASH). Their presence is an important risk factor for hepatic cirrhosis, hepatic failure, and hepatocellular carcinoma, as well as for the occurrence of cardiovascular events. Regardless of the diagnostic methods used, including laboratory tests and imaging, liver biopsy remains the gold standard to identify and differentiate patients with NAFLD and NASH. The search for other, safer, cheaper and more readily available diagnostic tests is still being continued. Attention has been drawn to the usefulness of markers of immune status of the organism, not only for the diagnosis of NASH, but also for the identification of NAFLD patients at risk of disease progression. Despite the effectiveness of medication, no recommendations have been established for pharmacotherapy of NAFLD. Data indicate the primary need for non-pharmacological interventions to reduce body weight. However, there is evidence of the applicability of certain drugs and dietary supplements, which, by their effect on the immune system, inhibit its excessive activity, thus preventing the progression of NAFLD to NASH.

Type A Behavior Pattern, Impulsiveness, Risk Propensity, and Empathy as Predictors of Dyspnea and Number of Infections in Men with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.

BACKGROUND Stress and psychological factors can induce dyspnea in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess selected elements of the clinical presentation of COPD in the context of the severity of type A pattern of behavior, impulsiveness, and tendency for empathy. MATERIAL AND METHODS This was a cross-sectional study. The study group consisted of 179 men with COPD and the control group consisted of 31 healthy male smokers. In all patients, the number of infectious exacerbations over the past year, the result on the dyspnea scale (MRC), and the FEV1-to- predicted FEV1 ratio was assessed. The A pattern of behavior was measured using the Type A scale. To measure impulsivity, risk propensity, and empathy, the IVE impulsivity questionnaire was used. RESULTS An increase in the number of infectious exacerbations was associated with an increased score on the Type A scale, an increase in risk propensity, and a decrease in impulsivity score. Increased severity of dyspnea was associated with an increase in Type A behavior pattern score and an increase in the risk propensity score. CONCLUSIONS Type A behavior pattern and risk propensity are independent predictors of the number of infections in the last year and of the subjective severity of dyspnea among men with COPD and healthy male smokers.

[Inadequacy of the paradigms of special education to subjects with severe and profound grade intellectual disability - the need for pragmatic realism in psychiatry and special pedagogy]. / Nieadekwatnosc paradygmatów pedagogiki specjalnej wobec osób z niepelnosprawnoscia intelektualna w stopniu znacznym i glebokim ­ potrzeba pragmatycznego realizmu w psychiatrii i pedagogice specjalnej.

People with severe and profound grade disabilities are the subject of interest in psychiatry, clinical psychology and special pedagogy. Unfortunately, the paradigmatic approach to special education based on postmodern philosophy is in contrast to the biomedical approach that is based on the positivist and Cartesian models. The paper is an attempt to systematize the similarities and differences between the humanistic approach and the modern biomedical model, which, despite the apparent differences, do not differ so much from each other. Work with a person disabled intellectually in the severe or profound degree is governed by the principles of methodical realism, taking into account to an equal extent the principal deficits, the concomitant diseases, limitations and the social context. The deeper the impairment and disability is, the smaller is the role of the humanistic paradigm in work with the client in the medical management and educational process. Changing the paradigms of special pedagogy has drawn attention to the social context of disability, separating, however, special pedagogy from modern medicine and psychology, cognitive-oriented and psychometry-based. The postmodern paradigm has become an ideology, which makes it difficult to work with deeply disabled people. Only the multidirectional approach including a variety of paradigms makes it possible to provide integrational aid to people with severe and profound grade intellectual disabilities. Working with such a disabled person should take into account equally the biomedical and humanistic aspects.