Krystyna Górna

Attitudes of patients with schizophrenia and depression to psychiatric research: a study in seven European countries

BackgroundRelatively few studies have examined how patients with schizophrenia and depression view psychiatric research and what influences their readiness to participate.MethodsA total of 763 patients (48% schizophrenia, 52% depression) from 7 European countries were examined using a specifically designed self-report questionnaire [“Hamburg Attitudes to Psychiatric Research Questionnaire” (HAPRQ)].ResultsMost patients (98%) approved of psychiatric research, in general, at least “a little”. There was a tendency to approve psychosocial rather than biological research topics (e.g. research on the role of the family by 91% of patients compared to 79% in genetics). Reasons to participate were mainly altruistic. Only a minority (28%) considered monetary incentives important. Patients wanted extensive background information and a feedback of the results; both were significantly more expressed by schizophrenia as compared to depressive patients, although these findings need to be interpreted with care because of age and gender differences between the diagnostic groups.ConclusionWhile patients expressed discerning views of psychiatric research, only few differences were apparent between the two diagnostic groups. Patients’ research priorities are not the same as those of many professionals and funding bodies. Their demonstrated critical appraisal should inform future research ensuring an increased patient role in the research process.

Caregiving burden and its determinants in Polish caregivers of stroke survivors.

Introduction Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization. Material and methods Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregivers sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden. Results Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients’ functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patients gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden. Conclusions Clinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients’ dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.

Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

Symptoms of depression among adults in rural areas of western Poland

OBJECTIVE To measure the intensity of depressive symptoms in the populations residing in rural areas of western Poland, and to delineate the putative association between the intensity of depression and selected socio-demographic and clinical factors. MATERIALS AND METHOD The study covered 445 adults recruited from one family physician practice in the rural area of Wielkopolska region. The following tools were applied: Beck Depression Inventory (BDI), the WHO WHOQoL-Bref quality of life assessment scale, and a socio-demographic and clinical questionnaire elaborated by the authors. RESULTS Depressive symptoms were observed in approx. 30% of the patients. The intensity of symptoms correlated with age, female gender, and inversely correlated with the quality of life. There was no association between depressive symptoms and level of education (counted as years of education), number of somatic illnesses, and family burden of psychiatric disorders. CONCLUSION Symptoms of depression were noted in approx. 30% of patients who consulted their family physician. The Beck questionnaire is a simple tool whose application could decidedly improve the recognition of depression. It is worth taking note of factors that may be connected with the intensity of depressive symptoms - gender, the number of diagnosed somatic illnesses, and the quantity of drugs administered.

Northwick Park Dependency Score — a New Scale for Use in Nursing Practice

Introduction. Evaluation of functional limitations in patients with ischemic stroke is essential in planning suitable nursing care. The main aim of all nursing procedures taken is to ensure the safety of patients, to provide the best, individualized care fulfilling patients’ needs and to support recovery process, considering the necessary number of nursing staff and time needed for these procedures. A tool helpful in the process of diagnosis and planning care is the Northwick Park Dependency Score — NPDS. Aim. The aim of the present study is to describe the Polish version of this scale and to assess its usefulness by comparing the NPDS with the Barthel Index — considered the “golden standard” for assessing patient’s disability and dependency. Material and Methods. The study included 100 elderly ischemic stroke patients aged 60 to 99 years (mean 76.1, SD 9.07). To assess patient’s dependency and thus the need of nursing care, the NPDS Scale was used. Functional status of patients was assessed with the Barthel Index, and the neurological state using the NIHSS. Results. Most items in NPDS, are similar to the items of the BI. However, the NPDS includes additional important questions regarding cognitive functions, communication and behavioral dysfunctions. It allows to estimate the number of nursing staff and their scope of competences necessary for providing care as well as time needed for particular nursing activities. There is a strong correlation between individual modules in the NPSD and the BI sales (r ≈ 0.90). Nevertheless, these are not interchangeable. The high correlation coefficient confirms the validity of the Polish version of the NPDS. Conclusions. NPDS is a simple and useful tool in nursing care allowing to plan the activities based on objective indicators. Despite many similarities it is not a substitute for the popular Barthel Scale. Therefore, the NPDS should be promoted in the nursing environment as a possible work tool. (JNNN 2018;7(1):4–11)

Is Venlafaxine More Effective than Escitalopram and Nortriptyline in the Management of Painful Symptoms in Patients with Major Depression

BACKGROUND Conflicting data regarding the efficacy of antidepressants of different mechanism of action on unexplained painful physical symptoms (UPPS) in depression have been published so far. OBJECTIVE The aim of this study was to compare the impact of escitalopram (ESC), nortriptyline (NOR), and venlafaxine (VEN) on UPPS in patients with major depression. MATERIALS AND METHODS Sixty patients, participants in the GENDEP study, with a diagnosis of depression according to the ICD-10 criteria were randomly assigned to treatment with ESC (10-30 mg, mean dose 15.2, standard deviation [SD]±9.2) or NOR (50-150 mg, mean dose 106.2, SD±8.2). Additionally, 30 patients who were treated with VEN (75-225 mg, mean dose 181.3, SD±8.8) were included. Before inclusion (day 0) and throughout the study (days 14, 28, 42, 56), the severity of pain was monitored using the visual analog scale. RESULTS The patients treated with ESC, NOR, and VEN did not differ in the intensity of pain at days 0, 14, 28, 42, and 56. CONCLUSION Our results do not support the hypothesis suggesting the superiority of VEN over ESC and NOR in the management of UPPS in major depression.

P-364 - Differences in cognitive function between elderly and middle age people

Introduction and objectives The human body changes with age. How do these changes influence brain functions? The objective of this study was to analyze differences in cognitive status between elderly and middle age people. Material and methods One hundred non-demented adults (29 M, 71 F) aged 46 - 88 years (mean 65.6; SD 11.0) living in rural regions of Poland entered the study. They were divided into two groups: people 40 - 65 years old (58,76; SD 5,74) and more than 65 years old (mean 73.8; SD 5.2). Dementia screening was performed using Mini Mental State Examination (MMSE). Cognitive functions were assessed by means of Stroop Test and Trail Making Test. Demographic, socioeconomic, clinical and lifestyle data were collected with the help of the semi-structure questionnaire. Data were collected by face to face interview. Results The elderly group scored significantly worse on the cognitive tests, compared to the middle aged group. They had significantly worse results in MMSE, made significantly more mistakes in Stroop test part B, TMT part A and B. In the elderly the time needed to complete of both parts of Stroop test was significantly longer than in the younger group. Also there were significant correlation between the participants’ age and the time to complete the tests in each of these two groups. Conclusions Cognitive functions worsen with age which may be associated with the deterioration of the functioning of older people. The study is being continued in order to identify factors that may influence cognitive ageing.

P03-58 - Determinants of social functioning in first-episode schizophrenia. A prospective follow-up study

Objectives Comparison of social functioning of first-admitted schizophrenic patients with healthy subjects and evaluation of the influence of several socio-demographic and clinical variables on social abilities of patients, 1 month (T1), 13 months after hospitalization (T2) and 4-6 years after T1 (T3). Methods A group of 74 schizophrenic patients: 46 male and 28 female; age 24.7 ± 6.7 and a control group of matched 52 male and 34 female subjects were enrolled. Social Functioning Scale (SFS), Positive and Negative Syndrome Scale (PANSS), Global Assessment Scale (GAS) and socio-demographic questionnaire were used. Results In all examinations SFS scores in the patients (T1 - 103.4; T2- 104.4; T3- 107.0), were significantly lower than in the healthy controls - 117.0 (p Conclusions Social functioning in schizophrenia is disturbed from the onset of the disease and may be mildly improved in the intermediate follow-up. The duration of untreated illness and severity of symptoms after the first admission, are the independent significant determinants of social functioning in early course of schizophrenia.

P03-70 - Prospective study of correlation between psychopathological symptoms and quality of life of patients with first episode of schizophrenia

Objectives Analysis of correlation between psychopathology and quality of life (QoL) of schizophrenic patients during 4-6 years after the first psychiatric hospitalisation. Methods Study population included 74 patients. They were assessed at fixed time-points: 1 month and 13 months after the hospitalisation and 4-6 years after the first examination (T1, T2 and T3, respectively). The following instruments were used to assess symptoms, objective and subjective QoL: PANSS (5-factors), Social Functioning Scale (SFS) and WHOQOL. Results At T1, the mean PANSS score was 62.4. Significant deterioration was noticed in all groups of symptoms, with the exception of cognitive functions. The greatest deterioration was observed in the negative symptoms and depression/anxiety. At T1, the mean SFS score was 103.4, while mean overall subjective QoL scored 3.3. During the follow-up period, significant improvement of SFS was noticed, with no meaningful change in WHOQOL and concomitant exacerbation of symptoms. QOL was particularly compromised by negative symptoms and depression/anxiety. Correlation between SFS and negative symptoms varied from -0.61 to -0.76, while those between SFS score and depression/anxiety - from -0.40 to -0.66. Correlation between subjective QoL and negative symptoms as well as depression/anxiety ranged from -0.31 (environment) to -0.64 (physical domain). To a large extent, symptoms were responsible for variance in both SFS and WHOQOL scores. Conclusions 1) Clinical course of schizophrenia varied, depending on adopted criteria of evaluation. 2) Negative symptoms and depression/anxiety had a particularly deleterious influence on QoL. The role these symptoms varied, depending on time elapsed since the first hospitalisation.