Jerzy Sobański

Traumatic childhood sexual events and secondary sexual health complaints in neurotic disorders

Summary Aim. Assessment of the association between self-reported sexual complaints and recalled childhood sex- ual adversities in a sample of psychotherapy patients. Material and methods . Coexistence of memories concerning traumatic events and minor sexual adver- sities and the currently present symptoms were analyzed on the basis of KO0 Symptom Checklist and Life Inventory completed prior to treatment in the day hospital for neurotic disorders. Questionnaires from 3929 psychotherapy patients were analyzed. Logistic regression analyses were performed on biographi- cal and symptom items. Odds ratios for men and women were determined separately. Results . Associations between sexual adverse events, and current sexual health complaints, as estimat- ed by OR coefficients, showed to be statistically significant. In the subgroups of patients who reported two categories of sexual adversities e.g. were both punished for masturbation and were not educated about sex, the risk of sexual complaints was further increased. Discussion. Both self-reported traumatic sexual events and sexual problems are quite common in the patient population and are strongly associated. Our study has replicated others findings in a large sam- ple of outpatients suffering from neurotic disorders. Conclusions . Deficits in sex education, the trauma of incest, punishment for sexual play or masturba- tion, or too early or unwanted sexual initiation, are important risk factors of sexual symptoms accompany- ing neurotic syndromes. Results strongly suggest that studies focusing on the effects of sexual traumatic events should take into consideration the co-occurrence of multiple adversities. sexual traumatic events / neurotic disorders / sexual problems / risk factors

Changes in intensity of neurotic symptoms that are associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day-hospital for the treatment of neurotic and behavioral disorders

OBJECTIVESnAnalysis of associations between changes in the intensity of neurotic symptoms and reduction of suicidal ideation (SI) or lack of SI reduction, in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital.nnnMETHODSnSymptom Checklist KOO and Life Inventory completed by 461 women and 219 men treated in the psychotherapeutic day hospital due to neurotic, behavioral or personality disorders between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved.nnnRESULTSnThe reduction of neurotic symptoms intensity was greater in patients of both genders who improved in terms of SI than in those who did not. This referred to global intensity of neurotic symptoms (OWK coefficient) in both genders (p<0.001), as well as to the majority of the neurotic symptoms subtypes in both genders (p<0.05): Phobic disorders, Other anxiety disorders, Obsessive-compulsive disorders, Conversions and dissociations, Autonomic disorders, Somatization disorders, Neurasthenia, Avoidance and dependence, Sexual dysfunctions, Dysthymia; and in case of women (p<0.05): Hypochondriasis, Depersonalization and derealization, Impulsiveness and histrionism and Non-organic sleep disorders.nnnCONCLUSIONSnThe results show effectiveness and comprehensiveness of intensive psychotherapy as a treatment method that leads to improvement in terms of both SI and neurotic symptoms. This suggests that the applied therapy may be effective in preventing suicidality in this group of patients. The observed associations also point in favor of hypothesis on similarities in etiopathogenesis of and partly identical personality-related factors predisposing to SI and neurotic disorders.

Pain and tactile dissociation, derealization and depersonalization symptoms in women and recalled traumatic events in childhood, adolescence and early adulthood

INTRODUCTIONnThe symptoms of dissociation, depersonalization and derealization are often associated with exposure of patients to mental and physical injuries, usually occurring in childhood. Most of these observations were carried out in populations of patients with various disorders (posttraumatic, conversion-dissociation, personality disorders - especially borderline), who reported their exposure to adverse life circumstances through questionnaire interviews.nnnAIMnAssessment of the risk associated with various traumatic events in childhood and adolescence concerning the symptoms of pain and tactile dissociation, depersonalization and derealization.nnnMATERIAL AND METHODnThe coexistence of the earlier life circumstances and the currently existing symptoms was examined on the basis of KO 0 Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders.nnnRESULTSnIn the group of 2582 women, patients of a day hospital for neurotic and personality disorders, the symptoms of pain and tactile dissociation, depersonalization and derealization were present in 24-36 % of patients, while the maximum severity of these symptoms reported approximately 4-8 % of patients. The studied patients reported the exposure during childhood and adolescence (before 18yo) to numerous traumatic events of varying severity and frequency, including hostility of one parent (approximately 5% of respondents), the sexual initiation before 13yo (1%), worse than peers material conditions (23%), harassment of the family of origin (2%), reluctance of their peers (9%). Conducted regression analysis showed illustrated by the coefficients OR (odds ratios) a statistically significant relationship between the majority of the analyzed symptoms and many of the listed events, such as being regarded as worse than siblings, mothers anger in the situation of the patients disease in childhood, lack of support, indifference of parent, poverty and worseness of the family of origin, inferior position in the classroom and the school grades, total sexual unawareness, incest or its attempt.nnnCONCLUSIONSnThe symptoms of dissociation, depersonalization and derealization occurred in significantly more patients reporting burdening life events - difficult situations in childhood and adolescence. Therefore, in clinical practice in patients presenting such symptoms, regardless of diagnosis (e. g. a specific neurotic disorder), we can expect revealing information about such events.

Trait and state anxiety in patients treated with intensive short-term group psychotherapy for neurotic and personality disorders.

OBJECTIVESnThe study aimed to determine the severity of trait and state anxiety in patients treated for neurotic and personality disorders with intensive, short-term group psychotherapy and to analyse the change of anxiety intensity in the course of treatment.nnnMETHODSn116 patients (81 females and 35 males) participated in the study. The measurement of anxiety intensity was conducted with the State-Trait Anxiety Inventory (STAI) at the beginning and at the end of treatment.nnnRESULTSnThe majority of patients (69% of the study group) demonstrated a high intensity of state anxiety at the beginning of the treatment with 47.4% being classified as very high. High intensity of trait anxiety was observed in 64.7% of participants (50.9% -very high). RCI (Reliable Change Index) and RCV (Reliable Change Value) indicated a significant change in state anxiety intensity in 62.1% of participants (48.3% - significant decrease, 13.8% increase). At the end of treatment more than a half of patients manifested medium and low intensity of both trait and state anxiety.nnnCONCLUSIONSnAt the beginning of psychotherapy the majority of patients demonstrated high intensity of both trait and state anxiety. In the course of therapy a considerable reduction of intensity of trait and state anxiety is observed. Significant deterioration in trait anxiety is observed in one out of every thirteen treated patients. Polish adaptation of STAI questionnaire is a useful tool for monitoring effectiveness of psychotherapy and may be successfully applied for screening and detailed diagnosis of neurotic and personality disorders.

Associations of selected lower urinary tract symptoms with biographical context in patients of a day hospital for neurotic disorders

OBJECTIVESnTo assess the correlation of subjectively estimated biographical context and lower urinary tract symptoms reported by patients with neurotic and personality disorders.nnnMETHODSnThis was a retrospective analysis of the biographical context of co-existence of urinary frequency and urinary incontinence reported by 3,929 patients in a day hospital for treatment of neurotic disorders. The symptom checklists KO 0 were completed by patients prior to any treatment.nnnRESULTSnUrinary frequency reported by patients in a day hospital for treatment of neurotic disorders was associated with the difficulties from their childhood and adolescence (i.e. with perception of inferiority with regard to ones family and among siblings, parents low education level), as well as the disparities in terms of sexual education and troubled relationships.nnnCONCLUSIONSnIn the studied group of patients with neurotic and personality disorders, selected lower urinary tract symptoms were associated with adverse life circumstances from childhood and adolescence (which can show the tendency towards regression and protracted character to experience of familys dysfunction due to feeling of being neglected or abandoned), as well as, to a larger or a smaller degree, their consequences - dysfunctions in adulthood, relationship/marriage, functioning at work and dealing with finances. These associations indicated the probable significance of experiencing these aspects of life in patients, not only in day hospitals or psychiatric hospitals which reported pseudo-urological complaints, but also in at least part of urological patients - going to hospitals due to neurotic disorders, particularly those occurring in a somatic form.

The orthogonal-oblique bi-level model of the Outcome Questionnaire (OQ-45.2): Polish adaptation based on factor analysis.

UNLABELLEDnAIM : The aim of this project was to conduct the cross-cultural factorial validation of the Outcome Questionnaire (OQ-45.2) using the Polish population.nnnMETHODSnData were obtained from day-patients (n = 211), inpatients (n = 234), outpatients (n = 137) and non-patients (n = 426). Statistical analyses included: parallel analysis, exploratory factor analysis, confirmatory factor analysis, correlation analysis, criterion equivalence, clinical significance and reliable change index, and test-retest.nnnRESULTSnStatistical analyses provided the strongest support for the bi-level model of the total score, five orthogonal (subscales specific for the Polish OQ, i.e. Social Conflicts and Addictive Behaviors; and original yet modified subscales, i.e. Symptom Distress, Interpersonal Relations, and Social Role), and two oblique factors (Somatization and Anxiety, Social Role 2). The psychometric properties of the Polish OQ were found to be adequate and similar to the original American OQ and its international adaptations. Specific for the Polish OQ cut-off scores for clinical significance were established. The role of cultural differences and the passage of time in the process of the cross-cultural validation were elaborated upon.nnnCONCLUSIONSnThe Polish version of the OQ 45-2 has been recognized as an instrument adequately measuring general functioning as well as specific areas of functioning of the individual (i.e. interpersonal relations; social role performance; social conflicts; symptom distress; somatization and anxiety; addictive behaviors). Results of this factorial analysis seem to be valuable for both clinicians using the OQ-45.2 and for creators of any psychotherapy outcome measure.

Perception of lower urinary tract symptoms by psychiatrists in mentally affected atients

OBJECTIVESnLower urinary tract symptoms (LUTS) are highly prevalent and costly condition worldwide. Numerous studies have demonstrated their negative impact on health-related quality of life (HRQL), as well as on physical and mental health. The co-existence of LUTS and psychiatric symptoms is common and has been described by psychiatrists, urologists and gynecologists. However, data are lacking regarding the perception of urological symptoms by psychiatrists in their day-to-day clinical practice.nnnMETHODSn31-question survey was designed to learn what is the perception of LUTS among psychiatrists. Survey link was sent by email to all psychiatrists registered to the Polish Association of Psychiatry via the associations email lists. The SurveyMonkey website was used as a platform where responses were collected and stored.nnnRESULTSn953 physicians completed the questionnaire. Majority of investigated psychiatrists only occasionallyask their patients about voiding dysfunctions. Respondents estimated the frequency of voiding dysfunctions in their patients as moderately frequentwith a 10-30% prevalence. However, discrepancies between different subgroups of psychiatrists have been noted. Furthermore, psychiatrists may not be fully aware of the effects of psychiatric treatment (psychotherapy/pharmacotherapy) on LUTS improvement, as well as possible deteriorations of voiding dysfunctions with psychiatric disorder progression.nnnCONCLUSIONSnThis survey showed that the perception of urological symptoms by psychiatrists in their patients may be limited. Therefore, it is necessary to adequately inform and educate psychiatrists in terms of the impact of urological symptoms on patientsmanagement, prognosis and quality of life.

Occurrence of selected lower urinary tract symptoms in patients of a day hospital for neurotic disorders

OBJECTIVESnTo assess the occurrence of selected lower urinary tract symptoms in the population of patients with neurotic and personality disorders.nnnMETHODSnThis was a retrospective analysis of occurrence, co-existence and severity of two selected lower urinary tract symptoms in 3,929 patients in a day hospital for neurotic disorders. The KO O symptom checklist was used to measure the study variables.nnnRESULTSnAlthough the symptoms associated with micturition are not the most prevalent symptoms of neurotic disorders, neither are they the most typical ones, the prevalence of urinary frequency referring to the last week before psychotherapy evaluated among the patients of a day hospital, was approximately 50%. Involuntary micturition, a symptom with a significant implication on the self-esteem and social functioning was much less common; it was reported by approximately 5% relatively healthy and young group of patients. Major bother from urinary frequency was reported by 9-14% of patients, whereas from involuntary micturition by only 0.6%-1% of the surveyed patients.nnnCONCLUSIONSnSelected urological symptoms seem to be prevalent among the patients with neurotic and personality disorders, and are independent of the specific diagnosis or patients gender. Their co-existence with other symptoms of neurotic disorders reported by the patients indicates their strongest relationship with the somatoform, dissociative, sexual and agoraphobic disorders.

The crossroads of gastroenterology and psychiatry – what benefits can psychiatry provide for the treatment of patients suffering from gastrointestinal symptoms

Introduction Gastrointestinal symptoms are very common in the general population. Many of them coincide with mental disorders (especially with neuroses, stress-related disorders, somatisation disorders, autonomic dysfunction, and anxiety) that are associated with psychological trauma, conflicts, and difficulties with interpersonal relationships. Aim Assessment of the association between gastrointestinal complaints and stressful situations in relationships, among patients admitted to day hospital for neurotic and behavioural disorders. Material and methods Analysis of the likelihood of co-occurrence of abdominal symptoms and stressful situations, reported by patients before admission, in a large group of subjects treated with psychotherapy. Results Gastrointestinal symptoms were highly prevalent in the studied group (they were reported by 40–50% of patients). The most common complaints in women were: loss of appetite (52%), nausea (49%), and constipation and flatulence (45%). In men the most prevalent symptoms were: loss of appetite (47%), heartburn (44%), and flatulence (43%). Functional gastrointestinal symptoms (especially vomiting in cases of nervousness in females or heartburn in males) were significantly associated with greater likelihood of current difficulties in interpersonal relationships, such as conflicts with partner/spouse or parent. Conclusions The results suggest that in many cases symptoms of anxiety disorders or somatisation disorders coexisted with irritable bowel syndrome and functional dyspepsia.