Joanna Rymaszewska

Types of depression more frequent in bipolar than in unipolar affective illness: results of the Polish DEP-BI study.

Background: The aim of the study was to assess the relative frequency of various kinds of depression in patients with bipolar and unipolar affective illness. The study was performed in the framework of the DEP-BI project aimed at assessing the prevalence of bipolar disorders among depressive outpatients treated by psychiatrists in Poland. Methods: Eight-hundred and eighty patients (237 male, 643 female) participated in the study. The patients were classified into the following diagnostic categories: bipolar affective illness type I, type II, bipolar spectrum disorder and unipolar affective illness. The various kinds of depression in each group were assessed by means of a semistructured questionnaire added to the diagnostic interview. Results: In the group of bipolar patients, a significantly higher frequency of psychotic depression in male compared to female patients was observed. Male bipolar patients compared with unipolar depressed ones had significantly more episodes of psychotic depression (odds ratio, OR, 4.29) and atypical depression (hypersomnia and hyperphagia; OR 2.82), and those with bipolar spectrum had more episodes of treatment-resistant depression (OR 2.56). Female bipolar patients compared with unipolar depressed ones had significantly more frequently an early onset of depression (before 25 years; OR 2.95) and postpartum depression (OR 2.48). On the other hand, the percentage of agitation, irritability, distractibility, thought racing and panic attacks during depression was not different in patients with bipolar and unipolar affective illness either in males or females. Conclusions: Some kinds of depression occur with a higher frequency in patients with bipolar compared to unipolar affective illness. The occurrence of a given type of depression may constitute an aid for the diagnosis of bipolar illness. The results of this study did not confirm the concept of bipolar mixed depression based on the presence of anxiety symptoms occurring during the depressive episode. The limitation of our study may be the lack of formal criteria or a structured interview to assess the symptoms occurring during depressive episodes.

A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research.

Abstract.Objective:As the use of “day hospitals” increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e. g. randomised controlled) single- or multi-site trials assessing specific models of day hospital care.Method:Using a self-developed structured questionnaire, the European Day Hospital Evaluation (EDEN) study group carried out national surveys of the characteristics of day hospitals for general psychiatric patients in Germany, England, Poland, the Slovak Republic and the Czech Republic, during the period 2001–2002.Results:Response rates varied from 52 to 91%. Findings show that day hospitals have no consistent profile of structural and procedural features. Similarities across countries focus on three main issues: on average, consideration of concepts oriented toward providing acute treatment are equivalent; disorders associated with disabled functioning in everyday life, high risk of somatic complications, and need for behaviour control are excluded to a comparable degree; and some core therapeutic activities are consistent with the main approaches of social psychiatry. Identified according to self-rated conceptions and extended with data from individual hospital’s statistics on the clientele in 2000, three clusters of limited selectivity subdivide the services. One category focuses mainly on rehabilitative tasks; two categories are oriented toward providing acute treatment as an alternative to inpatient care, but combine this either with rehabilitative tasks or with equal additional functions of shortening inpatient treatment and providing psychotherapy. The distribution of services across these three clusters varies significantly in the five European countries.Conclusion:Future day hospital studies should always clarify the type of services being assessed. To fully consider the impact of their results, the current national and international health policy environment of these services should be taken into account. Such surveys require enhanced methodology, however, in order to identify clear, distinct categories of services characterised by overlapping programme functions, and to increase the generalisability of valid results from single- or multi-site trials.

Anserine and carnosine supplementation in the elderly: Effects on cognitive functioning and physical capacity

The aim of this study was to investigate the potential beneficial effects of dietary anserine and carnosine (CRC) supplementation on cognitive functioning and physical activity of the elderly. The fifty-six subjects (65+) were allocated to the CRC group or placebo group at a 1:1 ratio. The double-blind procedure was used. Data were collected at the baseline and after 13-weeks of supplementation. In the follow up procedure fifty one subjects took part. Chicken meat extract (CME) containing 40% of CRC components (2:1 ratio of anserine to carnosine) was administered 2.5 g per day which allowed to rich the level of 1g CRC in dipeptides supplement. The cognitive function, physical capacity, body measurements, blood pressure and heart rate (HR) were assessed. After supplementation Body Mass Index (BMI) decreased significantly (p<0.05) in the CRC group performance comparing the placebo group. In two of six Senior Fitness Test the scores increased significantly (p<0.05) in CRC group comparing to the placebo group. The perceived exertion differed significantly (p<0.05) at the baseline and after follow up at the CRC group. The mean values of the Short Test of Mental Status (STMS) scores showed the significant (p<0.04) increase only in CRC group, in the subscores of construction/copying, abstraction and recall. Conducted anserine and carnosine supplementation in the elderly brings promising effects on cognitive functioning and physical capacity of participants. However, further studies are needed.

Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders.

Introduction:Rheumatism has been treated using whole-body cryotherapy (WBCT) since the 1970s. The aim of this study was to assess the efficacy of WBCT as an experimental, adjunctive method of treating depressive and anxiety disorders.Materials and Methods:A control (n=34) and a study group (n=26), both consisting of outpatients 18–65 years old with depressive and anxiety disorders (ICD-10), received standard psychopharmacotherapy. The study group was additionally treated with a series of 15 daily visits to a cryogenic chamber (2–3 min, from –160°C to –°C). The Hamilton’s depression rating scale (HDRS) and Hamilton’s anxiety rating scale (HARS) were used as the outcome measures.Results:After three weeks, a decrease of at least 50% from the baseline HDRS-17 scores in 34.6% of the study group and 2.9% of the control group and a decrease of at least 50% from the baseline HARS score in 46.2% of the study group and in none of the control group were noted.Conclusions:These findings, despite such limitations as a small sample size, suggest a possible role for WBCT as a short-term adjuvant treatment for mood and anxiety disorders.

Prevalence of insomnia in Poland — results of the National Health Interview Survey

Background: Sleep disturbances are one of the most common underdiagnosed and undertreated health problems among the adult population. Objectives: The aim of the study was to assess the prevalence of sleeping problems and their relation to sociodemographic characteristics in the Polish population, based on the results of the National Health Interview Survey carried out by the Central Statistical Office in 1996. Methods: A stratified sampling scheme, involving two steps, was used. Standardized prevalence ratios (SPRs and their 95% confidence intervals) were calculated. Assessment of sleep-related problems was based on six questions. A representative Polish sample (47 924 non-institutionalized, adult respondents) was interviewed. Results: Nearly one-fourth of Polish inhabitants suffered from insomnia. The percentage was significantly higher among women (28.1%) than among men (18.1%). The prevalence of insomnia increased with age and was highest in divorced respondents. Respondents of both sexes with higher educational levels suffered from insomnia less often than individuals with lower levels of education. The problem of insomnia applies in a similar degree to inhabitants of both rural and urban regions. About one-twentieth of inhabitants of Poland experienced recent sleep deterioration related to problems. It was associated positively with age, female gender and lower education. About 20% of the population get up not rested in the morning, women significantly more often than men, urban residents more often than rural ones. Conclusions: Sleep-related problems are common and the results are comparable with those from other countries. The findings have important implications, such as the necessity of better education of the public community about the identification and possibilities of treatment of sleep disturbance.

Test Your Memory (TYM) as a screening instrument in clinical practice – the Polish validation study

Objectives: The Test Your Memory (TYM) test is a short, self-administered screening cognitive instrument designed for the detection of Alzheimers disease (AD). The study was aimed to examine the Polish version of TYM as a screening instrument in Polish clinical practice. Method: In this study 199 patients were assessed whereas 131 patients with AD and mild cognitive impairments (MCI) and 94 healthy control subjects took part in the final analysis. The sensitivity and specificity of the TYM test were evaluated among the AD group and healthy control group. The TYM test was compared to other neuropsychological tests, such as Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), DemTect and Verbal Fluency Test (FAS). Results: The average TYM score in healthy control group: 45.4, 40.9 in the MCI patients and 23.4 in AD patients. The Polish version of the TYM test showed good correlation with other neuropsychological instruments among AD patients. Participants aged ≥75 and those with primary education performed significantly worse in TYM. The TYM achieved the best differentiation between AD and the healthy control group for ≤39 cut-off with a sensitivity and specificity of 91% and 90%, respectively. Conclusion: The Polish version of the TYM test is a useful instrument and may be seen as an alternative to the MMSE screening test in clinical practice in patients with dementia. However, the normative data suggested that the age and the level of education of the respondents should be considered as important factors affecting the interpretation of the final score.

The Quality of Life and Psychological, Social and Cognitive Functioning of Patients with Acromegaly

Acromegaly is a rare and chronic disease, most often caused by a pituitary adenoma. Excessive secretion of the growth hormone (GH) leads to hepatic secretion of insulin-like growth factor-1 (IGF-1), which in turn causes characteristic changes in the patients appearance, many skeletal deformities and metabolic disorders. In addition to somatic symptoms, acromegalic patients demonstrate psychosocial and personality deficits, as well as common co-occurrence of mental disorders. There are few studies investigating acromegaly in Poland. In recent years, the concept of quality of life has become fundamental to understanding health problems. Studies dealing with acromegaly likewise tend to include assessments of quality of life of patients suffering from this endocrinopathy.

The role of depressive and anxiety symptoms in the evaluation of cardiac rehabilitation efficacy after coronary artery bypass grafting surgery.

OBJECTIVES The aim of this study was to evaluate the efficacy of early 3-week cardiac rehabilitation (CR) in terms of the reduction of negative psychological symptoms, and to determine which factors predispose patients to worse rehabilitation results in this regard. METHODS The study involved a random group of 50 patients (11 women and 39 men) who had undergone coronary artery bypass grafting, with a mean age of 63.3 (± 7.2) years. The following screening tests were used: Beck Depression Inventory, State-Trait Anxiety Inventory and Acceptance of Illness Scale. The pulse rate during the first session of physical training was recorded (t(1) P), and after training the patients assessed their level of exertion (t(1) E) on the Borg Scale (BS). The same procedure was repeated at the end of the rehabilitation (t(2) P, t(2) E). RESULTS Among the psychological parameters examined at t(1) (at baseline), the strongest relationship with poor acceptance of illness after 3 weeks of rehabilitation was indicated by the level of depression (P < 0.001), with a slightly lower correlation with the state anxiety and the trait anxiety results (P = 0.005 and 0.027, respectively). A relationship was also found between the severity of depression in t(1) and the level of exertion measured by the BS at the end of rehabilitation (P = 0.007). Before rehabilitation, depressed patients exhibited higher levels of both trait and state anxiety (P = 0.009 and 0.018, respectively). After rehabilitation in the depressed subgroup, there was no improvement in the subjective assessment of exertion or reduction of state anxiety. Sex and co-morbidities also had considerable importance in the context of CR efficacy. The women showed more severe depressive symptoms (P = 0.01), a higher personality tendency to anxiety (P = 0.036) and poorer results of rehabilitation (in relation to the level of exertion after physical training and the intensity of state anxiety symptoms). There was no reduction of state anxiety in patients who suffered from at least two co-morbidities. CONCLUSIONS The presence of severe anxiety-depressive symptoms before rehabilitation has an effect on its outcome. Psychiatric symptomatology should be diagnosed as early as possible and patients should receive additional therapeutic support.

Influence of whole body cryotherapy on depressive symptoms - preliminary report.

Background: Cryotherapy has a long tradition in somatic medicine. Yet we know very little about its impact on psyche and mood disturbances in particular. Therefore there is a real need for scientific investigations into this problem. Objective: The study reported here was an initial approach to whole-body cryotherapy (WBCT) as a potential treatment modality for depression and was expected to provide rough data helping to design a future project with extended methodology, larger sample groups and longer follow-up. Methods: Twenty-three patients aged 37–70 years gave informed consent to participate in the study. Ten WBCT procedures (160 s, −150°C) were applied within 2 weeks. Participants were recruited from depressed day hospital patients. Antidepressive medication was not ceased. Symptoms were rated at the beginning and end of this intervention using the 21-item Hamilton Depression Rating Scale (HDRS). Changes in scores were analyzed in the group of patients for every item separately as well as for the sum of all items for each patient. Results: Almost for each individual HDRS item, the overall score for all patients together was significantly lower after WBCT. This means that all symptoms, except for day–night mood fluctuations, were presumably positively influenced by cryotherapy. The HDRS sum-score for each patient after WBCT was lower than that of the baseline and reached statistical significance in a paired samples t-test. Every patient was therefore considerably relieved after WBCT. Conclusions: It appears that WBCT helps in alleviating depression symptoms. Should this be confirmed in the extended study we are currently implementing, WBCT may become an auxiliary treatment in depression.

A survey of geriatric psychiatry training across Europe.

BACKGROUND Training, practice, and continuing professional development in old age psychiatry varies across Europe. The aims of this study were to survey current practice and develop recommendations to begin a debate on harmonization. METHODS A survey was sent out to 38 European countries via email. The survey was sent to members of the European Association of Geriatric Psychiatry (EAGP) Board, members of the World Psychiatric Association, and key old age psychiatrists or other psychiatrists with a special interest in the area for countries where old age psychiatry was not formally a specialty. RESULTS Through a process of networking, we identified a key individual from each country in Europe to participate in this study, and 30 out of 38 (79%) representatives responded. Training programs and duration varied between countries. Eleven countries reported that they had geriatric psychiatry training programs and most of these required geriatric psychiatry trainees to complete mandatory training for two years within old age psychiatry. Representatives from ten countries reported having specific Continuing Professional Development (CPD) for old age psychiatrists at consultant level. CONCLUSION There is a clear indication that the recognition of geriatric psychiatry as a specialist discipline in Europe is on the rise. The training procedures and processes in place vary considerably between and sometimes within countries. There are several options for harmonizing old age psychiatry training across Europe with advantages to each. However, support is required from national old age psychiatry bodies across Europe and an agreement needs to be reached on a training strategy that encompasses supervision, development, and appraisal of the knowledge and skills sets of old age psychiatrists.