Liebe und andere Gefühle auf der Bühne des therapeutischen Theaters. 40 Jahre Erfahrung in der Arbeit mit Menschen mit Schizophrenie.

The use of drama therapy in the treatment of people with schizophrenia in a theatre group has a tradition of almost 40 years in Krakow. The preparation of performances and appearances in front of an audience requires the components known from social skills training. In this work, a brief description of the development of "Psyche" theatre and its place in a community-based comprehensive treatment programme is described, using Shakespeare's "A Midsummer Night's Dream" as an example. The casuistry of a patient, serves as an illustration to reflect on the importance of the role in the play for the subsequent in-depth individual psychotherapy. The authors emphasise the attractiveness of the public performances in a Krakow theatre, which serve as opportunities for encounters with young people. They have enormous educational value in reducing prejudice against mentally ill people.

Premorbid social relationships and the course of schizophrenia in a 20-year follow-up study. / Relacje spoleczne przed wybuchem choroby a przebieg schizofrenii przez okres 20 lat.

OBJECTIVES: An important dimension indicating a growing risk of psychosis outbreak and its subsequent unfavorable course is deteriorating social functioning, especially the lack of sufficient social relationships. The aim of the study was to evaluate the association of the quality of social contacts and the scope of support system before the onset of the illness with treatment outcomes in clinical and social dimension in various time intervals of the 20-year illness course. METHODS: During the first hospitalization, an 80-person group living in Krakow and suffering from schizophrenia was selected, diagnosed according to DSM-IV-TR criteria and examined six times: at admission and discharge during first hospitalization, after 3, 7, 12 and 20 years. The analysis involved 55 persons (69% of the group included to the study) who went through all the examinations over a period of 20 years. Two-factor analysis of variance was used with one grouping factor (social contacts) and one repeated measures factor (follow-ups) for the results of GAF, BPRS, DSM-III Axis V and a series of simple linear regressions for the associations between these outcome indicators and the Surtees' Index of Social Support. RESULTS: Satisfactory, positive contacts before the outbreak of the illness translated, especially after 20 years, into better general and social functioning and fewer symptoms, especially negative ones. Awider social support before the outbreak was associated with better general and social functioning of patients and lesser severity of general, positiveand negative symptoms; however, in this last case the effect disappeared after 20 years. CONCLUSIONS: The quality and scope of social contacts before the outbreak of the illness, especially satisfactory relationship in non-familial milieu, are an important prognostic factor of amany-year beneficial clinical and social course of psychoses from the schizophrenia group.

The influence of early psychosocial intervention on the long-term clinical outcomes of people suffering from schizophrenia. / Wplyw wczesnej psychospolecznej interwencji na odlegle kliniczne wyniki leczenia osób chorujacych na schizofrenie.

OBJECTIVES: To compare the treatment outcomes of DSM-IV-TR schizophrenia patients in either a Community Treatment Program or an Individual Treatment Program (CTP vs. ITP). The assessment was made after the first hospitalization, and then after three and twelve years. METHODS: Participants were randomly assigned to CTP (experimental) and ITP (traditional) group, with 40 people in each group. 67 people (84%) participated in all three assessments. The socio-demographic and clinical indicators were the same for both groups. In the first three years only the CTP group participated in day-care treatment, patient and family psychoeducation and community treatment. Later, both groups received this treatment. The following tools were used: Anamnestic and Catamnestic Questionnaire, the GAF scale, the BPRS LA and Lehman's Quality of Life Interview. RESULTS: It was only after twelve years that there was a significant beneficial improvement in the mean GAF score in the CTP group (p = 0.036), which was comparable with the results obtained by Watt and Shepherd for the course of the illness in favorable remission cases (p = 0.038). The difference in the number of relapses was also significantly in favor of the CTP group only after 12 years (p = 0.045), as was the difference in the number of rehospitalizations (p = 0.013). The general severity of symptoms was found to be significantly lower for the CPT group after 3 (p = 0.008) and 12 years (p = 0.030), whereas it was significantly lower in the case of positive syndrome only after 3 years (p = 0.044). CONCLUSIONS: 1. A greater number of favorable differences were identified for the CTP group at the twelve-year point than at the conclusion of the experiment. 2. The three-year delay in introducing psycho-social treatment was associated with a poorer long-term outcome for the clinical course of schizophrenia.

The significance of the personality traits of schizophrenic patients and their therapists for the therapeutic relationship. / Znaczenie cech osobowosci pacjenta chorujacego na schizofrenie i jego terapeuty dla relacji terapeutycznej.

OBJECTIVES: To analyse: 1) the associations between the therapists' and patients' assessments of the relationship, 2) the relationship between the personality traits of the therapists the personality traits of the patients and their assessments of the relationship, 3) the relationship between age, sex and the personality traits of both groups and their assessment of the relationship. METHODS: 34 patients in long-term psychotherapy and their 11 therapists were investigated. The Dyadic Therapist-Patient Relationship Questionnaire, The Costa and McCraeea's NEO-FFI Personality Inventory, Pearson coefficients of correlation and the regression analysis were used. RESULTS: The therapists' sense of professionalism was associated with the patients' acceptance of them (p=0.032). Therapists in whom the traits of Extroversion and Openness were more prominent accepted their patients more often (p=0.006; p=0.041), felt more professional (p=0.000; p=0.023) and more rarely felt uncertain in the relationship (p=0.013; p=0.048). Patients in whom the trait of Conscientiousness was more prominent more rarely rejected therapists (p=0.004) or perceived them as uncertain (p=0.007). A higher level of Neuroticism in patients was associated with greater uncertainty in the relationship on the part of therapists (p=0.039). CONCLUSIONS: 1) Extroversion and Openness of therapists are associated with their attitude to patients 2) Conscientiousness and Neuroticism of patients are associated with their perception of therapists as well as with therapists' experience of the relationship 3) There is a positive influence on the therapeutic relationship when the patient is younger and the therapist older and female.

The predictive validity of expressed emotions (EE) in schizophrenia. A 20-year prospective study.

BACKGROUND: The level of expressed emotions in the family (EE) and components thereof (emotional over-involvement EOI, and critical comments CC) have been found to be related to treatment outcomes in psychotic patients. One point of interest is the dynamic of various outcomes in relation to initial EE, CC and EOI levels. METHOD: 43 individuals with diagnosis of schizophrenia were assessed at 1, 3, 7, 12 and 20-year follow-ups. The EE indicator was evaluated during the index hospitalization. Outcome indicators included: number of relapses, number and duration of in-patient rehospitalizations, and severity of psychopathological symptoms. RESULTS: 1) A high EE indicator was associated with a higher number of relapses in every follow-up and differences between the groups with low and high EE indicators proved significant after 3, 7, 12 and 20 years of the illness. 2) A high EE indicator was associated with a higher number of rehospitalizations after 3 and 7 years, and showed as a clear trend after 12 and 20 years. 3) A high level of CC was associated with a higher number of relapses. 4) The severity of positive symptoms increased only in the group with high CC. 5) The negative syndrome was not associated with EE, EOI or CC. CONCLUSIONS: The EE indicator may be considered a valid prolonged predictor of relapses and rehospitalizations. A high level of CC was associated with a higher number of relapses and intensification of the positive syndrome in both the short-term and long-term course of the illness.

[The effect of two predictors' interaction on short- and long-term treatment outcomes of schizophrenia]. / Wplyw interakcji dwóch predyktorów na wczesne i odlegle wyniki leczenia schizofrenii.

OBJECTIVES: To monitor the effect of interaction of duration of untreated psychosis (DUP) and expressed emotion (EE) on treatment outcomes in schizophrenia. METHODS: 56 individuals diagnosed with schizophrenia were assessed at 4 time points. The number of relapses, the number and duration of rehospitalizations and the severity of symptoms were assessed at index hospitalization and at 3, 7 and 12-year follow-ups. RESULTS: No correlation was found between DUP and EE measured at index hospitalization. Over the 12-year period the number of rehospitalizations for individuals with short DUP and low EE did not increase, as opposed to those with short DUP and with high EE. In the group with long DUP, the number of rehospitalizations increased irrespectively of EE level. The positive syndrome in the group with short DUP and high EE was less severe than in individuals with long DUP and high EE. Analogous differences appeared in the group with low EE. CONCLUSIONS: 1) No correlation was found between DUP and EE at index hospitalization. 2) Number of rehospitalizations and intensity of positive symptoms proved to be associated over time with the interaction of DUP and EE. 3) Long-time observation and multiple assessments allow to obtain more reliable results.

Prognostic value of duration of untreated psychosis in long-term outcome of schizophrenia.

BACKGROUND: The goal of this prognostic study was to investigate whether the duration of untreated psychosis (DUP) may have a prognostic value with regard to the further course of the illness. MATERIAL/METHODS: Fifty-eight patients (77% of the original study group) diagnosed with DSM III schizophrenia and later re-diagnosed with DSM IV T-R were assessed at 4 time points. Number of relapses, average time of inpatient treatment, number of inpatient readmissions, and severity of psychopathological symptoms were assessed at 1-, 3-, 7- and 12-year follow-ups. DUP information was obtained by clinical interview with patients and their families. The severity of symptoms was assessed using BPRS-SA, UCLA version. RESULTS: Increases in the number of relapses at follow-ups were more prominent in the group with a longer DUP (p<0.001). Decreases in the results of BPRS (symptom improvement) were more prominent in patients with a shorter DUP. The latter had significantly lower results than patients with a long DUP at each assessment except the index hospitalization (p equalled, respectively: 0.449; 0.002; 0.012; 0.034 and 0.014). Decreases in positive symptoms were greater in patients with a short DUP--significant at all except the 7-year follow-up (p equalled respectively: 0.230; <0.001; 0.011; 0.214; <0.001). CONCLUSIONS: 1) A positive correlation was found between DUP and the dynamics of general and positive symptoms and the number of relapses. 2) There was no significant relationship between DUP and the dynamics of negative symptoms, whereas the relationship between the time and number of re-hospitalizations was marginally significant.

Anticipated and experienced stigma among people with schizophrenia: its nature and correlates.

BACKGROUND: In recent years, there has been a growing awareness of the stigma experienced by people with mental illnesses and their families. The aim of this study is to assess the amount of stigma anticipated and experienced by schizophrenia patients in one region of Poland and to examine how these figures relate to socio-demographic and clinical correlates. METHOD: Subjective stigmatisation was assessed using the Inventory of Stigma Experiences of Psychiatric Patients. The mental health centres in Malopolska selected for the study were facilities representative of the whole region as regards location and type of treatment. Out of 250 patients contacted, 202 participated in the study, resulting in a response rate of 80.8%. RESULTS: The majority of respondents anticipated discrimination in interpersonal contacts (58%) as well as in the area of employment (55%). The most common experiences of discrimination in interpersonal interactions were the feeling of rejection by other people (87%) and having had an interpersonal contact broken off (50%). Participants living in highly urbanised areas more frequently anticipated exclusion of the mentally ill from the labour market, and older participants more often expressed the view that the mentally ill may have difficulties with access to institutions. The experience of structural discrimination was associated with lower education levels, living in a city, unemployment, being female, and being separated or widowed. The experience of rejection in interpersonal interaction was associated with lower education levels and more hospitalisations, and the experience of a negative public image of the mentally ill with unemployment and more hospitalisations. CONCLUSIONS: (1) In southern Poland, people with schizophrenia both anticipated and experienced the strongest stigma in the domains of interpersonal relationships and employment. (2) Anticipated stigma, contrary to experienced stigma, shows hardly any correlation with patients' specific socio-demographic and clinical characteristics.

[The prospective assessment of the influence of duration of untreated psychosis (DUP) on the course of schizophrenia]. / Prospektywna ocena wplywu czasu nie leczonej psychozy na przebieg schizofrenii.

AIM: This study is a part of a prospective schizophrenia research project run in Krak6w. The general objective of the project is a long-time observation of people with schizophrenia, starting from the first episode through the years of living with the illness, the assessment of treatment results and predictors. The goal of this study was to investigate whether the level of DUP before the first admission may have a prognostic value in regard to the further course of the illness. METHOD: Four indicators of treatment results were observed: the number of relapses, the overall time of inpatient hospitalisations, the number of inpatient hospitalisations and the severity of psychopathological symptoms assessed in 3, 7 and 12 years since the first hospitalisation. DUP was estimated during a clinical interview with a patient and his/her family at the index admission. The severity of symptoms was assessed with BPRS-SA, the UCLA version. RESULTS: The increase of the number of relapses in follow-up assessments was more prominent in the group with longer DUP (p < 0.001). The decrease of the results of BPRS (symptom improvement) was more prominent in patients with short DUP. They had significantly lower results compared to patients with long DUP at each assessment except the index hospitalisation (p equaled respectively: 0.449; 0.002; 0.012; 0.034 and 0.014). The decrease of positive symptoms was larger in patients with short DUP - significant in all except the 7-year follow-up (p equaled respectively: 0.230; < 0.001, 0.011; 0.214; <0.001). CONCLUSIONS: (1) A relationship was found between the duration of untreated psychosis and the dynamics of general and positive symptoms and the number of relapses. (2) There was no significant relationship between the duration of untreated psychosis and the dynamics of negative symptoms, whereas the relationship between the time and number of re-hospitalisations was on the brink of statistical significance. (3) A replication of some and the lack of confirmation of other long-time results observed by other researchers prompts us to conclude that there still is a need for further studies concerning the duration of untreated psychosis