Michał Mielimąka

Complaints of neurotic patients that are of interest for a cardiologist.

BACKGROUNDnPatients in various areas of medicine report symptoms that are unexplained by other medical reasons than psychological/psychiatric. Some of them urgently seek treatment due to cardiovascular complaints, mostly rapid heart rate, palpitations and chest pain. Typical cardiac investigations, usually showing no organic reasons for these conditions, bring little information about stressful life events and psychological predispositions of these patients. Identification of coexistence of cardiac symptoms with other symptoms typical for neurotic disorders and difficult life circumstances may facilitate not only psychiatric diagnosis but also evaluation by cardiologists, primary care physicians, and other specialists.nnnAIMnTo determine the psychosocial context of psychogenic pseudocardiac symptoms and their coexistence with other symptoms in patients with neurotic disorders.nnnMETHODSnMedical records of patients from the years 1980-2002 that included self-administered questionnaires transformed into an anonymised database were examined. An analysis of the relationship between symptoms reported in the Symptom Checklist and biographical circumstances described in the Life Inventory before admission to a psychotherapy day clinic for patients with neurotic disorders was performed using simple logistic regression with estimation of odds ratios and their 95% confidence intervals.nnnRESULTSnThe symptoms of tachycardia/palpitations and chest pain were very common, present in most subjects, and were significantly associated with such circumstances as suboptimal conflict solving by passive aggression or quarrels, uncertainty in the relationship, a sense of being inferior to the partner, and poor financial situation. In addition, these pseudocardiac symptoms were also associated with such childhood reminiscences as origin from a large low income family, feeling that the family of origin was inferior to others, and experience of parental hostility or lack of support.nnnCONCLUSIONSnPhysicians of all specialties who deal with patients experiencing pseudocardiac symptoms should expect their psychological background and perform a simple interview to identify the presence of adverse biographical circumstances described above. Identification and discussing these difficult experiences with the patients may help to convince them to seek psychological support or psychotherapy.

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.

Are all the former Siberian deportees with posttraumatic stress disorder patients at risk for unsuccessful aging

Multimorbidity was shown to be related to various unfavorable health‐related outcomes and unsuccessful aging. In Poland, mass deportation of Polish citizens from the Soviet‐ occupied regions deep into the isolated territories of the former Soviet Union, took place from February 1940 to June 1946. The deportees and their children, frequently born on exile, were exposed to chronic stress, psychological and physical violence, extreme climate conditions, abject poverty and famine, infectious and parasitic diseases, and arduous physical labor, all in all, together resulting in cachexia and a wide range of psychiatric and medical stress‐related disorders. However, there has been a limited data on posttraumatic stress disorder (PTSD) and its health and emotional consequences in those who had been deported due to political reasons, as most of the available research has been focused on war veterans or former Nazi camp prisoners. The aim of this study was to assess the frequency of multimorbidity and geriatric impairments in the group of the older Polish deportees to the former Soviet Union who still suffer from posttraumatic stress disorder. The presented results are a part of research on PTSD in the elderly people who or whose relatives had been persecuted for political reasons, and who had been deported to the remote regions of the former Soviet Union in their childhood, or were born in Siberia or Kazakhstan as a child of the deportees; the details of the project were described elsewhere. In brief, the respondents took part in medical (geriatric and psychiatric) and psychological assessment. Posttraumatic stress disorder was diagnosed by a psychiatrist according to the criteria of the Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. The geriatric part included history taking with the use of a detailed questionnaire (incl. questions about 15 chronic diseases), review of past medical records and currently taken drugs, physical examination, and geriatric assessment, conducted by the medical doctors trained in geriatrics. Multimorbidity was defined as the simultaneous presence of two or more health conditions in an individual. Questions about history of chronic pain, falls, dizziness, hearing or vision impairment, memory complaints, and functional dependence were included in the questionnaire. Depressive symptoms were diagnosed according to the Hamilton Rating Scale for Depression; frailty syndrome with the use of the Canadian Study of Health and Aging

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.