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..:: PSYCHIATRIA POLSKA 2/2003 ::..
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numer: 2
wydany: 2003-04-01


Psychiatria Polska 2/2003

Aktualne problemy psychiatrycznej opieki zdrowotnej - 2002  217
Current problems of psychiatric health care - 2002  217
Stanisław Pużyński
The paper is a presentation of the most important and actual psychiatric health care problems in Poland: the financial situation of hospitals, the risks faced by the out-patient psychiatric care, maintaining the legal issues of the psychiatric patients, the situation of forensic psychiatry and legal-psychiatric expertise, post-graduate training, the level of diagnosis and therapy, availability of psychotropic drugs. Attention is paid to the importance of giving the programme of psychiatric health protection a status of evident value and that this programme should become a government (national) programme.

Cechy osobowości osób chorujących na zaburzenia jedno- i dwubiegunowe  225
Personality traits in patients with unipolar and bipolar disorder  225
Magdalena Sariusz-Skąpska, Czesław Czabała, Dominika Dudek, Andrzej Zięba, Szymon Rduch
Aim: To compare the personality traits as described by H. Eysenck in persons with unipolar and bipolar disorder and healthy persons. Method: 60 patients with a diagnosis of uni- and bipolar disorder were studied with the Eysenck Personality Questionnaire (EPQ-R). Results: It was noted that there are significant differences amongst the groups in their neuroticism and extraversion but no differences were noted in the domain of psychoticism. Patients diagnosed as having unipolar disorder have a significantly higher level of neuroticism and a lower level of extraversion than those having bipolar disorder. These domains also differentiate the affective disorder patients from healthy individuals. Conclusions: The knowledge about the individual characteristic personality traits of patients with affective uni- and bipolar disorder can be important for the diagnostic and therapeutic processes in these disorders, therefore further study on these characteristics is necessary.

Porównanie osobowości pacjentów z zaburzeniami lękowymi i somatyzacyjnymi przed leczeniem i po leczeniu psychoterapią  235
The comparison of the personality of anxiety disorder patients and somatization disorder patients before and after psychotherapy  235
Agnieszka Klimowicz
Aims: The comparison of personalities of somatization disorder patients and anxiety disorder patients before and after intensive, complex, integrative psychotherapy. Methods: The 16 PF of R.B.Cattell was used in the study. 200 adults, both sexes, 100 patients in each diagnostic group were studied. Groups were similar in the terms of age, level of education and civil state. Patients performed the test twice, before and after psychotherapy. Results: Before the treatment the groups differed significantly (p<0,05) as to the ego strength and intelligence - these were lower, and tension - higher in the somatization group. Neuroticism, which was increased in comparison with the statistical norm in each diagnostic group, was higher in the somatization disorder group. After the treatment there was no significant difference between groups and the neuroticism decreased to the statistical norm. Conclusions: Results point out the relation between neuroticism and functional disorders.

Poszukiwanie specyficznych powiązań zmian osobowości ze zmianami nasilenia objawów w zaburzeniach somatyzacyjnych i lękowych - badanie porównawcze  247
Seeking the specific connections between personality changes and symptom changes in somatization disorders and anxiety disorders - a comparative study  247
Agnieszka Klimowicz
Aim: The comparison of the relations between personality changes and main symptom changes observed during complex integrative psychotherapy in 100 somatization patients and 100 anxiety disorder patients. Method: Two self-descriptive measures - the 16PF of R.B.Cattell and the Symptom Checklist "O" were used in the study. The second measure chosen for the study was a 14-scale screen for the presence of functional disorder' symptoms and 5 scales referring to phobias, general anxiety, somatizations and conversions. Questionnaires were fulfilled twice - before and after psychotherapy. Results: It was observed that the main symptoms in the group of anxiety disordered patients  decreased with the increase of sociabiliy (r=0,36 p< 0,001), activity and withstanding difficult situations (r=0,35, p<0,001) self-confidence (r=0,21, p<0,05) and the reduction of submission (r=-0,36 p< 0,001), however the main symptoms in the somatization disorder group lowered with the growth of the ego strenght  (r=0,44 , p< 0,001; r=0,41 p<0,001) and the reduction of  imaginative sensitivity (r=- 0,31, p< 0,01). Conclusions: The results point out to the differences in the connections of the symptoms of functional disorders with the personality and confirm clinical reports on differences between somatization patients and neurotic patients.

Charakterystyka osobowościowa kandydatów do służby w policji  259
Personality characteristics of police candidates  259
Marek Blajer, Krzysztof Kucia, Adam Klasik, Halina Mac-Blajer
Aim: The aim of the present study is an attempt to study personality characteristics of police volunteers and to determine the correlation between their age and personality features. Method: A number of 106 persons have been investigated, between them 12 women and 94 men in the age from 19 to 35 years. A set of standardised psychological tests has been used as a diagnostic tool, e. g. Eysenck Personality Inventory, MMPI, Raven's Test and Similarities and Vocabulary subscales from the Wechsler Adult Intelligence Scale. The analysis of these correlations has been conducted by the use of the Pearson's correlation ratio. Results and conclusions: In the investigated group the IQ results were witihin an average range. The analysis of the personality profiles delivered by the MMPI-test has proved that it is impossible to determine any concrete personality disturbances in police volunteers. Results achieved in the Eysneck's test eliminate the test as a diagnostic tool useful in the qualification of police volunteers no correlation has been found between age of the volunteers and their personality features.

Kwestionariusz IPP (Psychopatologia "Ja") Scharfettera w warunkach polskich  269
Scharfetter's EPP (Ego-Psychopathology) questionnaire in the Polish setting  269
Krzysztof Tyczyński, Jacek Wciórka
Aim: To estimate the basic indices of reliability, validity and feasibility of the Scharfetter's EPP questionnaire - a clinical tool for assessment of ego disorders according to the author's theoretical model. Method: A group of 180 adults of clinically and demographically different characteristics were examined including 78 patients with a diagnosis of schizophrenia, 51 patients with depression in the course of affective disorders according to the ICD-10 criteria and 51 healthy persons as a control group. A Polish version of the EPP questionnaire with a slightly modified method of evaluation of subjects' responses was studied. Psychopathology was evaluated with PANSS and KOSS scales and some aspects of the clinical course were noted. Results: A comparable percentage of positive responses was found between the EPP questionnaire in the original Scharfetter's Swiss group and the group under study. A high factor of internal consistency (Cronbach's alpha) both for the whole scale and its 5 dimensions were found. A relatively high correlation in the expected direction between the EPP and other psychopathology measures, as well as with basic characteristics of the course of the illness was established. Indices of disordered self-experience were significantly higher among patients with schizophrenia than with depression, and higher among both groups of patients then among healthy persons. Cluster analysis of EPP led to similar findings and allowed for distinguishing persons in the study into three clusters consisting mainly of: schizophrenic patients (highest profile), depressed patients (middle profile) and healthy persons (lowest profile). Conclusions: These preliminary, empirical evaluations of the Scharfetter's EPP questionnaire prove that its Polish version reveals rather satisfactory measures of reliability and validity, and observations suggest, that EPP can be successfully used in the clinical work with patients suffering from schizophrenia. The questionnaire indicates its clinical usefulness and prompts to further studies on the tool itself, as well as on the phenomenon of ego disorder for which it has been constructed.

Wartość pomiarowa skali CES-D do oceny depresji w populacji polskiej  281
Psychometric value of CES-D scale for the assessment of depression in Polish population  281
Ewa Dojka, Maciej Górkiewicz, Andrzej Pająk
Aim: The assessment of usefulness of the CES-D scale in the Polish population was studied. Method: 50 patients with depression and 150 healthy men and women selected from the general population were examined. In a group of depressed patients the results of the CES-D scale were compared with the Beck scale. The best CES-D cut-off score was defined. Sensitivity and specificity of the CES-D scale in the relation to clinical diagnosis of depression for healthy men and women and depression patients were calculated. Further factor analysis was done and the results were compared with results previously published for North American populations. Results: High reliability of the CES-D scale (Cronbach's á coefficient = 0,92), significant correlation (r = 0,79) and moderate agreement (Kappa Cohen coefficient = 0,44) with the Beck scale was reported. It seems that CES-D cut-off score of 16 is adequate for diagnosis of depression. Sensitivity and specificity of the CES-D scale in the relation to clinical diagnosis of depression were respectively 86% and 77%. Conclusions: Therefore it is well suitable for detecting depression in the Polish population and its results are similiar to those obtained for North American populations.

Skale samooceny nasilenia objawów schizofrenicznych: ocena trafności "Skali nastawień i nastroju" (PD-S), "Frankfurckiej skali samopoczucia" (FBS) oraz dwóch skal analogii wzrokowej  293
Self-rating scales in schizophrenia: assessment of validity of the Paranoid-Depressivity Scale (PD-S), the Frankfurt Self-feeling Scale (FBS), and two visual analogy scales  293
Ewa Schaeffer, Jacek Wciórka
Aim: To assess the validity of the Paranoid-Depressivity Scale (PD-S, Paranoid-Depresivitäts-Skala), the Frankfurt Self-feeling Scale (FBS, Frankfurter Befindlichkeitsskala), and of two visual analogy scales: the Sense of Illness Scale (WAC) and the Self-feeling Scale (WAS). Method: 210 patients with schizophrenia of various clinical courses. Diagnostic validity was evaluated by comparing the results of self-rating with clinical assessment using the CGI, KOSS-C, BPRS, and KOSS-W scales. Content validity was evaluated by analysis of the results' correlation with given clinical and social-demographic variables. Theoretical (construct) validity was evaluated through factorial analysis with Varimax rotation of the principal elements. Results: The correlation between the self-rating scales and the clinical assessment scales was moderate in the case of questionnaire scales and low for the visual analogy scales. Scales of a similar type were found to correlate to a very high degree. Correlation with clinical assessment depended significantly on the phase and degree of disorder - it was lower in periods of exacerbation and higher during remission. The results of the complex questionnaire scales en somme, correlate better with symptoms considered as typical for schizophrenia, than with others, whereas the isolated self-rating constructs (paranoid, depressive) correlate well with the appropriate dimensions of clinical assessment. There was no significant correlation between the clinical symptoms and dimensions, and the results of self-rating using the two visual analogy scales. Factorial analysis revealed that the internal structure of the basic constructs of the questionnaire scales (general attitude, mood, self-feeling) was based on a very rational concept, as well as the fact that the factors isolated have a rational foundation within the theoretical and clinical picture of schizophrenic disorders. Conclusions: The validity of self-rating scales remains a complex question; analysis of diagnostic, content and theoretical validity seems to confine this method to the role of a complementary, albeit interesting, diagnostic tool; the extent and importance of this role, however, is still to be investigated.

Skale samooceny stanu psychicznego w schizofrenii: ocena praktyczności "Skali nastawień i nastroju" (PD-S), "Frankfurckiej skali samopoczucia" (FBS) oraz dwóch skal analogii wzrokowej  315
Self-rating scales in schizophrenia: assessment of the practical applicability of the Paranoid-Depressivity Scale (PD-S), the Frankfurt Self-feeling Scale (FBS), and two visual analogy scales  315
Aim: To assess the practical feasibility of the Paranoid-Depressivity Scale (PD-S, Paranoid-Depresivitäts-Skala), the Frankfurt Self-feeling Scale (FBS, Frankfurter Befindlichkeitsskala), and two visual analogy scales of: sense of illness (WAC) and self-feeling (WAS). Method: 210 patients with schizophrenia of various clinical courses. All patients in the study group were required to complete each scale twice, at 48hr intervals. For statistical analysis, two sets of data were singled out (1) the relationship between refusal/inability to complete the scale repeatedly and the selected clinical variables; (2) observations made by the doctor, while the patient was completing the scales. Results: Statistical analysis revealed, that clinical factors like restlessness, autism, maladaptation, recurrence/remission and lower educational status imply a significantly lower readiness of the patient towards completion of self-rating scales. The visual analogy scales were those more readily - and easily - completed by the patients; their interpretation, however, is difficult. Given this, the authors of this paper decided to shorten the questionnaire scales, which reducing the whole to aspects of vital diagnostic relevance. Whether this operation would influence the scales' diagnostic value, required ex-post analysis, which was subsequently performed. Summary analysis revealed that the application of the shortening of the PD-S and FBS had no significant impact on these scales' reliability and validity indices; furthermore, it resulted in a significant decline in the number of ambiguities and thus improved the comprehensiveness of the questionnaire's structure. Also, a significant increase in concordance between the self-rating results and the clinicians' diagnoses was observed. Conclusions: Visual analogy scales are the more readily and easily applied in practice; a comprehensive interpretation is, however, virtually impossible. On the other hand, the PD-S and FBS are the more difficult for the patients to complete, due to their length, but their interpretation does not constitute a major problem. Ex-post analysis reveals, that shortening the complex questionnaires to their core aspects does not affect their psychometric value negatively; in fact - the contrary. The latter statement, however, requires verification in prospective studies.

Radzenie sobie ze stresem w różnych grupach służb ratowniczych  337
Coping in various rescue groups  337
Bogusław Borys, Mikołaj Majkowicz, Helena Majkowicz
Aim: The main purpose of this study was checking if the above mentioned groups differentiate from each other according to the coping styles used by them; if yes, what does it depend on? Method: The Authors studied three groups of rescue services, representing three different formations. There were: Firemen, Ambulance services members and Policemen (preventive troops). A few well known psychological methods were used, among them: CISS - Coping Inventory for Stressful Situations (in Polish adaptation), State - Trait Anxiety Inventory (in Polish adaptation) and Eysenck's - Maudsley Personality Inventory (in Polish adaptation). Results: The obtained results allowed to formulate some important conclusions. There were no statistically significant differences among the groups as far as the two coping styles were concerned - task and avoidance oriented. Emotionally oriented coping style is the one in which there are statistically significant differences between the researched groups. The Firemen group has the highest score in the emotional coping style. Conclusions: Using the coping styles (the most effective too), depends mostly on the personality traits. It means that personality traits should be an essential condition in the way of accepting new members of rescue groups. The personality traits, beside the professional training, are responsible for effective coping in extremely difficult situations.

Wykorzystanie sztucznych sieci neuronowych w psychologii klinicznej i psychiatrii  349
The use of artificial neural networks in clinical psychology and psychiatry  349
Małgorzata Starzomska
Summary: Artificial neural networks make a highly specialised tools in data transformation. The human brain has become an inspiration for the makers of artificial neural networks. Although even though artificial neural networks are more frequently used in areas like financial analysis, marketing studies or economical modeling, their application in psychology and medicine has given a lot of promising and fascinating discoveries. It is worth that artificial neural networks are successfully used in the diagnosis and etiopathogenesis description of various psychiatric disorders such as eating disorders, compulsions, depression or schizophrenia. To sum up, artificial neural networks offer a very promising option of research methodology for modern clinical psychology and psychiatry. The aim of this article is only an illustration of the applications of artificial neural networks in clinical psychology and psychiatry.