Krystyna Jaracz

Post‐stroke quality of life and depression

Background: Studies on the determinants of the quality of life (QOL) after stroke bring differing results depending on the applied concept of QOL. This may lead to confusion about the contribution of various factors to the post-stroke QOL. Objective: The aim of the study was: (i) to investigate functional and psychological QOL in the individuals after the first ischemic stroke; (ii) to identify the most important correlates of QOL; and (iii) to examine the significance of depression among the other possible predictors of QOL. Methods: A hospital-based sample of 72 stroke patients was followed up to 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index and the Sickness Impact Profile. A multiple regression procedure was performed to examine relationships between QOL and the study variables. Results: In spite of good recovery, the psychological and functional QOL of the examined patients was impaired, although the negative impact of stroke was greater on the objective QOL than on the subjective QOL. Stroke-related impairment, depression, functional disability and marital status predicted 80% of the variance in the functional QOL. Emotional support, depression and functional disability explained 38% of the variance in psychological well-being. Conclusions: Depression and physical disability were the most important predictors of QOL after stroke since their impact on QOL was more robust in comparison to the remaining variables. For improving QOL, a comprehensive care for patients aimed at reducing physical dependence and ameliorating depressive symptoms could be recommended.

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.

Evaluation of the quality of life of postmenopausal osteoporotic and osteopenic women with or without fractures

Introduction Most studies concerned with the quality of life (QoL) of women with reduced bone mineral density (BMD) focus on patients with vertebral and non-vertebral fractures. Our objective was to evaluate QoL among patients with reduced BMD regardless of their fracture history compared to women with normal BMD. Material and methods Eighty-five patients in the study group were classified as osteoporotic, with BMD results measured by densitometry and expressed by T-score ≤ –2.5 SD, 122 women were osteopenic, with –2.5 < T-score ≤ –1.0 SD, and 97 subjects were assessed as normal, with T-score > –1.0 SD. Mean ages of women according to groups were 59.90, 57.67 and 55.68, respectively. Assessment of life quality was conducted using the Polish version of the QUALEFFO-41 scale. Results The ratings in the assessment (QUALEFFO-41) of QoL were lower for osteoporotic and osteopenic women than for the normal BMD group with regard to pain (p = 0.006), social function (p = 0.001), health perception (p = 0.001), and mental function (p = 0.001). For total QUALEFFO-41 the associated factors were: secondary and higher education (OR = 0.49; 95% CI: 0.29–0.82), self-perceived deformity of the back (OR = 4.09; 95% CI: 1.88–8.93), previous fractures (OR = 2.52; 95% CI: 1.09–5.82), reduced height (OR = 2.48; 95% CI: 1.13–5.39) and anxiety (OR = 1.42; 95% CI: 1.21–1.66). Conclusions It seems necessary to evaluate QoL of women with reduced BMD before fractures occur, to aid development of health education aiming to reduce the incidence of osteoporosis and prevent fractures.

The prevalence of antipsychotic polypharmacy in schizophrenic patients discharged from psychiatric units in Poland.

BACKGROUND The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. METHODS Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. RESULTS At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGAs olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. CONCLUSIONS The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.

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.

Course of Care of a Multiple Sclerosis Patient in the Context of Pharmacotherapy

Multiple sclerosis (SM) is an incurable, advancing, demyelinating illness with inflammatory background. It constitutes the most frequent cause of disability among young people, between 20 and 40 years of age. Despite the identification of multiple factors causing the disease, its pathomechanism has not been yet completely discovered. For this reason, finding an effective cure for multiple sclerosis continues to present a challenge (for modern scientists). The currently available treatment for SM aims to halt its progress and to minimalize complications related to the disease. The goal of the work was to provide an overview of the therapies currently available to those suffering from SM. Selecting an appropriate form of treatment and medication as well as preparing the patient and continuation of monitoring during the therapy constitute important elements of conducting an effective SM therapy. ( JNNN 2015;4(3):130–137)

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.