The clinical complexity of patients with acromegaly.

OBJECTIVES: The main aim of the study was to investigate the factors related to the biopsychosocial complexity in the group of patients with acromegaly with different disease activity. METHODS: A cross-sectional observational study was performed. First, a linguistic adaptation of the INTERMED - self-assessment questionnaire (IMSA) and after that the assessment of the biopsychosocial complexity among patients with acromegaly and the factors which relate to the complexity was made. The following tools were used to assess: biopsychosocial complexity: The INTERMED -self-assessment (IMSA); quality of life: The World Health Organization Quality of Life - BREF (WHOQoL) and Acromegaly Quality of Life questionnaire (AcroQol); mental state: The General Health Questionnaire - 28 (GHQ-28). RESULTS: The final analysis included 71 patients. According to the principal component analysis the mental state (GHQ-28) and the quality of life (AcroQol) are the most important factors related to the clinical complexity among patients with acromegaly. In the model created by a stepwise regression analysis for the total IMSA score higher growth hormone (GH) concentration, longer illness duration, and better general quality of life were included as the protective factors of the clinical complexity. By contrast, a high score in the severe depression subscale of GHQ-28 was a factor of higher clinical complexity. CONCLUSION: The mental state and quality of life are the most important determinants of the clinical complexity in the group of patients with acromegaly whereas the biochemical normalization is of lesser importance.

Transcranial magnetic stimulation (TMS) in treatment of psychiatric disorders - review of current studies. / Przezczaszkowa stymulacja magnetyczna (TMS) w terapii zaburzen psychicznych ­ aktualny przeglad badan.

Current progress of basic and clinical science creates background for new therapeutic appliances of brain stimulation methods in disorders of central nervous system. This review describes present state of knowledge regarding practical aspects of one of those methods - transcranial magnetic stimulation, TMS. The review was based on contemporary literature on use of transcranial magnetic stimulation in various diseases, particularly including present recommendations and guidelines as well as systematic reviews, published after year 2000. TMS is a quite novel, non-invasive, well tolerated treatment method with alow amount of transient adverse effects and complications. Development of new therapeutic protocols makes it possible to introduce this procedure in new groups of patients, including a wide range of mental disorders such as depression, bipolar disorder, schizophrenia, also cognitive function disorders and posttraumatic stress disorder. In Poland it is still hardly available, though more and more clinical centers start to perform this kind of therapy, providing proper equipment and trained personnel.

Personality Factors Crucial in Internalized Stigma Understanding in Psychiatry.

Objective: The main purpose of this research was to establish the relationship between personality traits and internalized stigma in individuals living with severe mental illness. Additionally, the study aimed to identify individual differences that could be used to develop the theoretical socio-cognitive-behavioral equation model of internalized stigma. Methods: A total of 114 patients with diagnosis of nonorganic psychotic disorder or uni- or bipolar affective disorder took part in this study. The Internalized Stigma of Mental Illness (ISMI) scale, Eysenck Personality Questionnaire Revised (EPQ-R) and NEO Five-Factor Inventory (NEO-FFI) were administrated among all participants. Results: Patients presenting higher levels of neuroticism scored higher on the ISMI scale. Otherwise, those with higher levels of extraversion, openness to experience and conscientiousness had lower ISMI scores. With the use of multivariate linear regression, neuroticism, openness to experience and conscientiousness showed the strongest associations with internalized stigma. Conclusions: Intrapersonal factors such as personality traits might explain individual differences in responses to the stigmatization process. Moreover, sociodemographic conditions such as the place of residence and level of education can play a mediating role in reducing the level of internalized stigma. Adequate psychosocial interventions should consider demographics and personality traits when engaging patients with mental illnesses in activities aimed at understanding and accepting the disorders.

Clinical complexity - where to find it and how to use it. / Kompleksowosc kliniczna ­ gdzie ja znalezc i jak ja wykorzystywac.

Clinical complexity of a patient describes the complexity of issues faced by an individual in accordance with the biopsychosocial approach, the main focus of which is the assessment whether the patient experiences difficulties in the biological, psychological and social aspects of life and healthcare system. An effective, comprehensive assessment of apatient during the treatment process is crucial for efficient operation of Public Health Service. Thus, providing patients with an individual, holistic and comprehensive healthcare. Patients, who are not always able to seek help on their own, require assurance of complex help, effective diagnostics at the early stages of a disease and assistance with treatment coordination and continuation. Clinical complexity concerns patients of many fields of medicine but especially emergency medicine, internal medicine, geriatrics, psychiatry, and primary care. Lack of access to complex healthcare with biopsychosocial approach causes a great deal of patient dissatisfaction and reduces the quality of available therapeutic options. There are couple of tools that can be used in screening for clinical complexity, for instance: INTERMED platform, INTERMED Self-Assessment, INTERMED for the Elderly, INTERMED for the Elderly Self-Assessment, and the Probability of Repeated Admission. There are also effective intervention schemes which can be used to manage a complex patient care, such as: Case Management, Information Sharing or Self-Management. Screening tools and interventions combined together can be effective in providing patients with a well-organized, high quality healthcare with a patient-centered biopsychosocial approach.

Deep brain stimulation: new possibilities for the treatment of mental disorders. / Gleboka stymulacja mózgu (Deep Brain Stimulation) ­ nowe mozliwosci leczenia zaburzen psychicznych.

Deep brain stimulation (DBS) is a treatment method that is currently getting more and more attention from psychiatrists. It has proven to be efficacious and safe in the treatment of neurological disorders, mainly Parkinson's disease (PD), dystonia and essential tremor. DBS has very often contributed to successful treatment in cases that had proved resistant to all other methods of treatment. Nowadays treatment-resistant obsessive-compulsive disorder (OCD) is the main psychiatric indication for DBS. Many studies have focused on assessing the efficacy and safety of this method in different mental disorders, including depressive disorders, Alzheimer's disease, anorexia nervosa, Tourette syndrome, substance addiction or aggressive behaviors. Single cases of successful treatment in bipolar disorder, schizophrenia and post-traumatic stress disorder have also emerged in recent years. In this review the current state of knowledge on the applicability of DBS in psychiatry is presented, based on the available systematic reviews, clinical trials and case studies, as well as on neurophysiological and neuroimaging data.

Internalized stigma and its correlates among patients with severe mental illness.

PURPOSE: The aim of this study was to investigate the perceived level of internalized stigma among patients with severe mental illnesses and its relationship with demographic and clinical variables in Poland. PATIENTS AND METHODS: A study sample (n=114, mean age=42.46±14.1 years; 55% of females) consisting of patients with nonorganic psychotic disorders as well as unipolar and bipolar affective disorders was evaluated (58% of outpatients and 39% of inpatients). All patients filled in the Internalized Stigma of Mental Illness (ISMI) scale (maximum severity=4). The demographic and clinical data were collected. RESULTS: The study population demonstrated a mild level of internalized stigma (2.23±0.5). The highest score was observed in the alienation domain (2.63±0.8) and reflected moderate severity. The lowest score was noted in the stereotype endorsement domain (2.08±0.6). Moreover, the highest degree of internalized stigma was present in participants with unipolar affective disorder and was of moderate severity (2.46±0.6), while the level was moderate in the alienation domain (2.85±0.8). The level of vocational training education was the only variable associated with higher internalized stigma (P=0.02). There were no associations between gender, employment, and marital status and internalized stigma. The duration of the disease was the only clinical factor showing a significant positive correlation with stigma internalization (r=0.23; P=0.01). The number of hospital admissions and suicide attempts was not significantly correlated with internalized stigma. CONCLUSION: People with severe mental illnesses in Poland experience a mild level of self-reported internalized stigma. Internalized stigmatization was most strongly associated with alienation, which indicates the need for stigma assessment procedures followed by stigma intervention programs in daily clinical practice. This is in accordance with the trend of environmental "open door" psychiatry, which could be the first step to decrease the level of stigma and internalized stigma in psychiatric patients in Poland.

Areas of stigma and discrimination of mentally ill people among Internet respondents in Poland. / Obszary stygmatyzacji i dyskryminacji osób chorujacych psychicznie wsród respondentów internetowych w Polsce.

OBJECTIVES: The aim of this study was to investigate the public perception of mentally ill people, stigma of the mentally ill and distance towards them in Poland. METHODS: The study group was composed of 1,309 respondents who were interviewed using an authors' own survey, which was spread with the use of online media. RESULTS: The results indicate a high level of stigma of psychiatric patients in the subjective assessment of their appearance, intellect as well as respondents' sense of superiority over the patients. The stigma of a psychiatric patient is also resolutely demonstrated in the economic aspect, which results from respondents' unwillingness to employ, or even work with people affected by a disorder from the mental illness group. CONCLUSIONS: Undoubtedly, the fight against the phenomenon of stigma and discrimination against people affected by mental health problems is becoming one of the priorities in the field of mental health.