K. Krysta

2779 – Patients with obesity hypoventilation syndrome and mental disorders

Objective Obesity hypoventilation syndrome is a multifactorial clinical condition developing in obese people. The symptomatology of the disease is dominated by disorders of breathing during sleep, and hypoventilation leading to chronic hypercapnia with underlying metabolic and hormonal disorders leading to complications of the cardiovascular disease. Methods Here we describe a case of a patient treated for many years because of pulmonary hypoventilation syndrome accompanied by obesity and metabolic syndrome followed by a reduction in blood oxygen tension. Results Despite the exacerbation of the underlying disease (parameters on admission 66mmHg pCO2, pO2 29mmHg, SaO2 43%) our patient showed no signs of a mental disorder. Slight short-term memory problems, decreased mood and drive relevant to the degraded state of somatic were present. During the hospitalization, the use of oxygen therapy led to the improvement of blood parameters, however the mental state became more complicated. The patient started to develop symptoms of delirium with a delusional interpretation of reality. Despite administered pharmacotherapy and further improvement in respiratory parameters (at discharge pCO2 62mmHg, pO2 59mmHg, SaO2 89%) the patients cognitive dysfunctions showed no further improvement and delusions of persecution were still present. This required further psychiatric care alongside with patients somatic treatment. Conclusions A strong link exists between disorders of cognition, and chronic respiratory failure (hypoxia with concomitant hypercapnia). This may be also accompanied by psychiatric symptoms, which may become difficult to treat even if the somatic parameters are successfully improved.

P02-128 - Depression and life quality in patients with eating disorders - A two year follow up

Introduction The symptoms of depression are often found in patients suffering from eating disorders. Aims The aims of this research were to find out if depression in patients with eating disorders (ED) like anorexia nervosa (AN) or bulimia nervosa (BN) is an additional condition accompanying the ED diagnose, or if it is an integral element being part of emotional problems related to maturation. The estimation of patients’ social condition is also considered in comparison to matched group with no ED diagnose. Methods Subjects: Group B - 19 females diagnosed, age 12 – 24; group C - matched control group of 30 healthy females, group F - 19 patients out of group B examined in a follow up research two years after hospital treatment. Tools used: Beck Depression Inventory (BDI), Life Quality Questionnaire (Q), Body Mass Index measurement (BMI). Results BDI results: depression symptoms are more intense in the early phase of the treatment of ED (group B) than in the follow up -group F (two years after hospitalization) and also more intense than in group C (controls). Q Questionnaire shows no differences between groups B, C, and F. Conclusions Depression is an additional condition in patients diagnosed with ED mostly in the early phase of the treatment. No differences have been found in the social condition between groups B, C, and F.

Changes in the Concept of Vocational Rehabilitation of People with Intellectual Disabilities in Poland

Introduction The problem of employment of people with intellectual disabilities is present in many countries. The literature on this topic draws attention to the fact that the improvement of the situation in this area is conditioned by changes in government policies, practices of employers and adequate preparation to undertake professional duties by persons with intellectual disabilities. Objective The objective of this review was to explore the changes in vocational rehabilitation forms in Poland. Methods The analysis of documents and accessible literature was done. Results As one of the ways to solve this problem since 1991 in Poland the so called Workshops of Vocational Therapy have been created. According to the regulations the Workshops were designed for adults with intellectual disabilities, aged over 16 years with a total incapacity of gaining an employment, for which occupational therapy was a form of social rehabilitation. The further step in this process was the establishment of Vocational Activation Centers, with which high hopes were associated. They were expected to be an intermediate link in the creation of career paths from rehabilitation forms ultimately to open labor market. In practice it turned out that the creation of these Centers in Poland has been too slow. Conclusions This raised the necessity to change the attitude from the concept of matching the participant to work and to the new environment, which frequently ends as a trauma, to the concept of matching jobs to people. New initiatives and new rehabilitation programs are developed based on this attitude.

Analysis of Relationship Between Cognitive Functions and Impulsivity in Patients Suffering From Schizophrenia

Introduction Schizophrenia is a mental disorder characterized by loss of cognitive skills. The level of cognitive impairment may affect the degree of impulsiveness, which is defined as a constant willingness to take risks, unplanned activities, rapid decision-making. Objective The objective of this study was to analyze the correlation between the level of cognitive functioning and impulsivity. Methods The total number of 32 patients (8 female and 15 male) were hospitalized for schizophrenia. They were examined with the Verbal Fluency Test, Trail Making Test (TMT A and B) and Barratt Impulsiveness Scale (BIS-11a). The results of the BIS-11a were converted to the BIS-11. Results The mean age of the patients was 34.9 (± 8.75). The average time from the end of education − 10 (± 8.4) years. A higher degree of correlation between abnormal responses in Verbal Fluency (parts measuring phonemic verbal fluency) and impulsiveness (r = 0.61, p = 0.04) was found. These correlation referred also to the impulsiveness resulting from the lack of planning (r = 0.67, p = 0.01), attention impulsiveness (r = 0.46, p = 0.04) and motor impulsiveness (r = 0.48, p = 0.03). The correlation between TMT and BIS (r = −0.1 part, Part B r = −0.25) was not significant (p> 0.05). Conclusion The above results are preliminary and the research project will be continued.

Lucid Dreaming: a Mysterious Phenomenon

Introduction Lucid Dream (LD) is a phenomenon occurring at the end of REM sleep and during which one is aware that one is dreaming. It is possible thanks to the activation of the dorsolateral prefrontal cortex reinforced by other cortical areas of the brain. As previous studies show, it is much more common among children and adolescents than among adults, as prevalence of LD relate to a degree of maturity of the CNS. Aim The study was designed to assess incidence of lucid dreaming among youth and compare it with the prevalence in general population. Materials and Methods A questionnaire about sleep hygiene, distinguishing also between past and present experiences of lucid dreaming, has been developed. It was distributed both in paper version and on-line. IP control has been introduced for the virtual participants. Timeline for material gathering covered 01/01-15/03/2014. Results Study confirmed that age has a significant role on lucid dreams appearance. Participants of the study with bad sleep hygiene (irregular time of sleeping, watching TV before going to sleep, hard to digest dinners) less frequently experienced lucid dreams. Women seems to be more interested in LD’s developing techniques, however there is a small knowledge about positive aspects of lucid dreaming among Poles. Conclusions Lack of knowledge about the phenomenon of lucid dreaming among the population may affect the results of future studies in this field.

Role of Cognitive Rehabilitation in Patients Suffering From Schizophrenia with a Comorbid Addiction to Amphetamine and Cannabis

Introduction An important element of the rehabilitation in schizophrenia is cognitive rehabilitation, aimed at the greatest possible reduction in deficits. Objective The aim of this study was to examine cognitive functioning in schizophrenic patients with a comorbid addiction to psychoactive substances participating in a cognitive rehabilitation program. Methods All recruited patients were men, aged between 20 and 45 years. They were examined in the initial period of the stay at the treatment center and after 4-7 weeks of hospitalization, after the stabilization of acute psychotic symptoms. During this time patients participated in the cognitive rehabilitation program. Cognitive function were assessed: Trail Making Test (TMT A & B), Stroop Test, and Verbal Fluency Test. Patients were divided into two groups according to abused substances: a) amphetamine users (n = 15), b) cannabis users (n = 11). As for the medication – 25 of 26 patients were treated with second generation antipsychotics. Results After the process of rehabilitation of cognitive functions of all gained patients gained a significant improvement. The type of abused psychoactive substance did not significantly affect cognitive functioning. However, amphetamine-dependent patients achieved better results in some of the cognitive tests. Cognitive rehabilitation does not affect the reduction of psychopathological symptoms. However, in patients addicted to amphetamines a decrease in the severity of these symptoms was found. Conclusions Cognitive rehabilitation exerts a positive effect on cognitive functioning of schizophrenic patients with concomitant dependence on psychoactive substances.

Anxiety, Depression and Cognition in Patients with Lupus Erythematosus

Introduction According to data from the literature, depression and anxiety are frequent complaints among patients with lupus erythematosus. Their etiology may be a direct manifestation of attachment of central nervous system through the process of sickness, as well as secondary reaction to the suffering because of chronic disease. However, on the basis of available data it is difficult to close relationship between their existence, seriousness and cognitive deficits. Objective The comparison between cognitive functioning of women being treated for systemic lupus erythematosus and healthy women. Methods 20 female patients aged 18-38 with SLE were tested. The Vienna Test System was used to assess cognitive function. All persons were also examined using a scale STAI assessing anxiety as a state and as a feature, and the Beck scale to evaluate the severity of depression. The control group consisted of 20 healthy women. Results All patients with systemic lupus erythematosus participating in the study showed abnormalities of short-term memory, attention and reaction time in comparison with healthy members of control group. Positive correlations were also found between the results of cognitive test results and the intensity of depression and anxiety. Conclusions Antidepressive and atianxiety treatment should be an important element of the therapy of patients with lupus erythematosus.

Excessive Exercise: a New Definition of Health

Absolutely unrealistic body images promoted by mass media seems to negatively affect behavior of different age groups, but is particularly evident among adolescents and young people. It results with low self-esteem, negative self-image, impaired contacts with peers, unhealthy diet and excessive exercise. The last two can also be accompanied by uncontrolled use of pharmacological agents, including prescription drugs, to achieve a desired body shape. Its not easy to distinguish between healthy and unhealthy exercise since both may share same attributes. In recent years media willing promote, variously defined, a ‘healthy lifestyle’ as defensive shield against various civilization diseases. There are also no doubts about positive effects of sport on variety of health indicators. The aim of the study is to answer whether its possible to examine social context of exercise addiction. In order to do this authors prepared original questionnaire that was disseminated among participants together with Exercise Addiction Inventory (EAI). Additionally, a special emphasis was placed on previous medical records, other addictions and possible negative consequences of the behavior. The study took place between May and October 2014.

EPA-0368 – Liaison psychiatry in poland - can we acchieve the successful holistic diagnosis? - survey

The decades bring increasing number of new medical specialties together with inevitable progress of medical science. This is caused by an expanding amount of knowledge, but remaining constant physical and intellectual capabilities of man. In the contrast to the time of Hippocrates, today you can not be an expert in every field of medicine. We need to consult with specialists in various fields to properly diagnose the patient. Without that often a definitive diagnosis is impossible. The objective of our survey was to check how often psychiatrists use the consultation with physicians in other specialties and whether there is a relationship between the place of work, academic degree, work experience in the profession and the amount of commissioned consultations. It was also important for us whether consultations affect the place of the final diagnosis. Most of the respondents are young doctors, specialists from large cities. They rarely consult with doctors of other specialties - 1/10 cases - take into account the recognition of these cases. However they are sceptical about the opinions of other psychiatrists. Proctologist, pathologist are specializations with which psychiatrists consult the least (> 76% did not cooperate). The most often they work with specialists in the field of neurology and internists. The key to diagnostic success is a holistic view of the patient, which consists of components of knowledge about somatic and mental disorders. It is necessary, therefore, possibly the most effective cooperation of doctors of various specialties.

EPA-0815 - Occurence of sleeping disorders in outpatients of department of psychiatry and psychotherapy - questionnaire study

Objective ’Heaven has given human beings three things to balance the odds of life: hope, sleep and laughter’ - said Immanuel Kant. Sleep disorders belong to the most common health problems of the modern society and they became one of the first reason for seeking medical attention. Insomnia involves any difficulties related to sleep, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors. Sleep disorders occur very often in clinical practice and have major effects on well being and overall health. Among last decades in Poland problem is still increasing. In 1992 - 24 % people in Poland had sleep problems, in 2012 they were present in 55% of population. Furthermore, sleep disorders are commonly associated with other medical problems as a reason, but also as a consequence creating a feedback loop. Methods An original questionnaire containing 23 questions was created. 49 respondents from the outpatient psychiatric clinic were recruited to the study. Results The survey revealed that the number of patients with deteriorated social or work functioning (19%) is lower among patients with mood disturbances (51%). Declared ways to manage sleep disturbances show that patients want to find immediate solutions without participation in long lasting therapy. The large population of respondents des not know the proper way to cope with sleep disturbances. There exist a need for an education campaign in Poland in order to decrease number of medication abuse and to promote behavioral therapy