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Background. Organic brain damage is traditionally an excluding criteria for a psychiatric diagnosis of mental illness. In fact, however, the neurobehavioral disturbances exhibited by many CHI patients, especially those who have been comatose for more than a month, are strikingly similar to the symptoms of Type II schizophrenia. The authors propose to use the term "post-coma paraschizophrenia" to describe these disturbances and discuss their negative impact on the quality of life of CHI patients.
Material and methods. The experimental group (Group CHI) consisted of 15 CHI patients, 7 males and 8 females, ranging in age from 17 to 58, treated in the Department of Medical Rehabilitation at the Cracow Rehabilitation Center and the Rehabilitation Clinic at the Bydgoszcz Medical University. All these patients had incurred a closed-head injury resulting in a coma lasting at least one month. He control group (Group SCHI) consisted of 15 patients diagnosed with Type II schizophrenia, matched by age, sex, and level of education to the patients in Group CHI, under treatment in the Psychiatry Department at the Wroclaw Medical University and the Bydgoszcz Medical University. The data reported were based on clinical observation, patient and family interviews, standard neuropsychological tests, the Frontal Behavioral Inventory, and the Quality of Life Scale for Patients with Traumatic Brain Injuries.
Results. Standard neuropsychological tests showed similar dysfunctions in general intelligence and memory, with a tendency in both groups to lower scores in non-verbal parameters. Some interesting qualitative differences in performance are presented. All the CHI patients showed significant signs of frontal syndrome, with a profile resembling fronto-temporal dementia, while the test results from the SCHI patients were more similar to those associated with severe clinical depression. All of the patients in the CHI group exhibited at least some of the symptoms traditionally regarded as indicative of schizophrenia. Positive (formative) symptoms of schizophrenia were found much more often in the patients from Group SCHI, whereas the percentages for the occurrence of particular negative (defective) symptoms are quite similar in both groups.
Conclusions. Patients with closed-head injuries may present with quasi-psychotic symptoms, here termed "post-coma paraschizophrenia". Among the most significant common features of the two syndromes are disorganized behavior, apathy, and disturbances of executive functions. Post-coma paraschizophrenia, which mostly remains untreated because of the lack of neuropsychiatric diagnosis, has a significant negative on the quality of life of CHI patients, and should receive further attention in both theoretical research and clinical practice.
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Background. This article presents an evaluation of the strategic approach to managing rehabilitation for patients with high spinal cord injuries. The strategic approach is founded on the assumption that particular rehabilitation procedures should be applied in accordance with a strategic plan, which is developed in terms of the overarching goal of rehabilitation, understood as enabling the appropriate mechanism of adaptation and compensation. Consistent pursuit of this goal, instead of merely reacting to successive crises and problem situations as they arise, enables the patient to achieve greater independence, and thus a better quality of life. In order to adjust the strategic plan to the individual needs of the patient, it is developed in a series of steps: 1) comprehensive analysis of the patient's current status and situation; 2) establishment by negotiation of a target situation (overarching goal); 3) selection of subordinate goals leading systematically to the realization of the overarching goal; 4) establishment of a schedule for the realization of subordinate goals; 5) regular monitoring of goal performance and performobility.
Material and methods. The effectiveness of the strategic approach was evaluated in a clinical experiment involving 68 patients wit tetraplegia, who underwent surgery subsequent to spinal cord injury (SCI) at the level of the cervical vertebrae (C2-C7), and were treated in the centers represented by the authors. The patients were divided by matching for age and sex into two groups: a control group (K) of 34 patients whose rehabilitation was conducted without reference to a strategic plan, and an experimental group (E)of 34 patients who had such a plan. The methods used to measure the outcomes obtained by the patients in rehabilitation included clinical observation, the Polish version of the standard Functional Independence Measure (FIM), and a Self-Evaluating Scale of Progress in Rehabilitation. The patients were tested twice, once before beginning rehabilitation, and again 6 months later.
Analysis of results. In both group similar progress was recorded in certain parameters of the FIM scale, which points up the effectiveness of the therapeutic procedures used in comprehensive rehabilitation; in group E, however, much greaterprogress was noted in terms of functional independence and psycho-social functioning. The patients from group E were much more content with the results they had achieved in rehabilitation.
Conclusions. The results reported here justify the assertion that the strategic approach to the rehabilitation of patients with high cervical SCI makes the most of the benefits provided by the procedures applied, without the necessity to make fundamental changes in procedures or employ additional personel, acquire new equipment, etc. The strategic approach helps the patient attain better results in becoming independent, and gives grounds for greater satisfaction with the results obtained in rehabilitation, which in run increases motivation to take an active part in exercises and other procerdures. It also assures the patient the basic right to make fundamentally important decisions in the course of his own treatment, which is consistent with the Patient Bill of Rights and the requirements of 21st-century medicine.
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This work is an attempt at a cybernetic analysis of the process of treatment of neurotic disorders. This approach is based on the consideration of a patient as an object of control. Assuming that the neurosis is an expression of some imbalance in an organism, the process of treatment is reduced to the exertion of influence on the system thrown out of balance (i.e., the patient) so that its homeostasis with the environment is restored. Thus the treatment of neurotic disorders consists of the use of negative feedback, both internal (those within the patients organism) and external (those within the system created by the interaction of patient and environment).
