Jacek Gierus

Cognitive impairment in schizophrenia across age groups: a case–control study

BackgroundThe potential dynamics of cognitive impairment in schizophrenia is discussed in the literature of the field. Recent publications suggest modest changes in level of cognitive impairment after first psychotic episode. Present article attempts to explore cognitive differences between patients and controls across age groups and differences between age groups in clinical group.MethodsOne hundred and twenty-eight hospitalized patients with schizophrenia (64 women and 64 men) and 68 individuals from the control group (32 women and 32 men) aged 18–55 years were examined. The patients were divided into age groups (18–25, 26–35, 36–45, 46–55). Both groups were examined using Wisconsin Card Sorting Test, Rey Auditory Verbal Learning Test, Rey Osterrieth Complex Figure Test, Trail Making Test (A and B), Stroop Test, verbal fluency test and Wechsler digit span.ResultsPatients with schizophrenia obtained significantly lower scores versus the control group in regard to all the measured cognitive functions (Mann–Whitney U; p < 0.05. Most deficits were present in all age groups, however, statistically important impairment in executive functions (WCST) were present only in “older” groups.ConclusionsPatients with schizophrenia obtained less favourable results than the control group in all age groups. Deficits regarding executive functions do not seem to be at a significant level among the youngest group, whereas they are more noticeable in the group of 46–55-year-olds. Executive functions are significantly lowered in the group aged 36–45 in comparison to the “younger” groups. The level of cognitive functions shows a mild exacerbation in connection with age, whereas cognitive rigidity proved to be related to the number of years spent without hospital treatment.

The Montreal Cognitive Assessment as a preliminary assessment tool in general psychiatry: Validity of MoCA in psychiatric patients.

OBJECTIVE The aim of the presented research was to obtain the initial data regarding the validity of Montreal Cognitive Assessment (MoCA) in diagnosing cognitive impairment in psychiatrically hospitalized patients. METHOD The results in MoCA obtained from 221 patients were analyzed in terms of proportional participation of patients with particular diagnosis in three result ranges. In 67 patients, additional version of the scale was also used. Comparative analysis of average results in particular diagnostic groups (organically based disorders, disorders due to psychoactive substance use, psychotic disorders, neurotic disorders and personality disorders) was also carried out, as well as an analysis of the scales accuracy as a diagnostic test in detecting organic disorders. RESULTS The reliability of the test measured with between tests correlation coefficient rho=0.92 (P=.000). Significant differences between particular diagnoses groups were detected (J-T=13736; P=.000). The cutoff points of 23 turned out to have a satisfactory sensitivity and specificity (0.82 and 0.70, respectively) in diagnosing organically based disorders. The area below the receiver operating characteristic curve (AUC=0.854; P=.000) suggests that MoCA has a satisfactory value as a classifier. CONCLUSION The initial data suggest MoCAs high value in prediction of future diagnosis of organically based disorders. The initial results obtained in particular group of diagnoses support construct validity of the method.

Differences in Assessment of Suicidal Tendencies in Men and Women: A Pilot Study

Suicidal behaviors in psychiatric patients are one of the main challenges in current clinical practice. The aim of this study was to investigate the gender differences in suicide risk for psychiatric patients in Poland and the influence of life satisfaction in different stages of life on suicidal tendencies. A descriptive-exploratory approach to inquiry was used for this study. Sixty patients aged 16-67 (45% males and 55% females) answered the demographic-descriptive questionnaire, the Suicide Behaviors Questionnaire-Revised (SBQ-R) and the Cantril Self-Anchoring Striving Scale (CSASS). The results suggest that women turned out to show higher risk of suicidal behavior than men (p<0.001). Moreover, women displayed strong negative correlation between suicide risk and the anticipated life satisfaction in the future (rho=-0.542), while men displayed negative correlation between suicide risk and the pre-illness level of functioning (rho=-0.638). The findings suggest that different therapeutic approaches for each gender should be applied in suicide prevention process.

[The Montreal Cognitive Assessment 7.2--Polish adaptation and research on equivalency].

AIM The Montreal Cognitive Assessment is a screening test for diagnosis of Mild Cognitive Impairment- MCI. Only one version of the method was available in Poland so far. In order to assess progression of cognitive impairment, or to diagnose effectiveness of therapy, two equivalent version of method are needed. English additional version 7.2. was translated and culturally adapted to sustain reliability of the assessment. Then equivalency of both Polish versions was investigated. This paper examines whether both Polish versions of MoCA are equivalent, and describes the process of its cultural adaptation. METHODS 66 psychiatric patients (37 men, 29 women) with different levels of cognitive impairment were examined using both Polish versions of MoCA. Both versions were administered randomly to patients with no time interval in between. RESULTS No significant differences (p=0,601) for total MoCA scores were found between first version of Polish MoCA, and alternate version. Equivalency measured by correlation coefficient Spearmans rho correlation coefficient (rho=0,926) proved to be high. CONCLUSIONS Both Polish versions of MoCA are equivalent, and can be useful in repeated measurement of progress in cognitive impairment or in testing of the effectiveness of treatment.

An Introduction to the Model of Crisis Intervention Procedure for Borderline Patients (CIP-BP): A Case Study

ABSTRACT Borderline personality disorder is highly associated with suicidal behaviors. The authors of the current case study present the introduction model of original Crisis Intervention Procedure for Borderline Patients (CIP‐BP) which is a method focused on restoring emotional balance, reducing the severity of symptoms and the risk of suicidal behavior, as well as developing optimum solutions for further action. Its aim is to enable the patient to regain control of their emotional memory, increase autonomy and restore important interpersonal relations by using the original resources of this person. The procedure aims at providing nursing personnel with a practical tool to effectively avert the crisis and prevent further decompensation of BPD patients. Further pre‐post study is required to determine the effectiveness of the procedure. HIGHLIGHTSPatients with borderline personality disorder are at high risk of suicide death due to severe experiencing of crises.Preventing suicidal behaviors in borderline personality disorder patients is a difficult challenge for nursing personnel.A practical tool for nurses is required to effectively avert the crises of borderline personality patients.

The Development and the Structure of the Verbal Suicide Scale (VSS) – Measuring Attitudes Toward Suicide in the Group of Patients Hospitalized in the Psychiatric Unit

AIM The assessment of suicidal risk is one of the most difficult diagnostic challenges. The aim of present article is to report the process of development and preliminary validation of the Verbal Suicide Scale. MATERIAL AND METHOD A total of 121 psychiatric inpatients aged 19-67 anonymously completed Verbal Suicide Scale (VSS). The study took place in the Clinic of Psychiatry, Medical University of Warsaw in Mazovia Specialist Health Center in Pruszków, Poland. RESULTS Factor analysis validated the three factor structure. Cronbachs alpha reliability for each factor was satisfactory: 0.876 for scale 1, 0.700 for scale 2 and 0.710 for scale 3. CONCLUSIONS VSS is a short instrument for evaluating the attitude toward suicide and can be a useful tool in mental health nursing practice. Further research and analyses are required to refine the theoretical and external reliability of the method.