Archives of Psychiatry and Psychotherapy 1/2003
Psychiatrists looking at biology. What are they expecting? 5
The aim of the study is a reflection on a new perspective for psychiatry created by new integrated research on early human development and interaction of its determinants.
Tullio Scrimali Liria Grimaldi
Fineo & Tantalo. A complex systems-oriented cognitive approach in the treatment of patients with eating disorders: Part one - Theory 15
Eating disorders comprise one of the most complex and problematic psychiatric disorders that exist. There is, however, a significant lack of empirically validated literature outlining definitive models that explain the aetiology, pathogenesis, psychopathology and treatment of this devastating disease cluster. The purpose of this paper is to describe a complex systems-oriented cognitive approach addressing the psychopathology and treatment of eating disorders. The authors studied patients with eating disorders over the course of many years at the University of Captain Medical School (Italy), Department of Psychiatry and report the results of this research in two separate articles. The first article (Part One) describes general aspects of eating disorders including epidemiology, aetiology, pathogenesis and psychopathology as observed in this population. Part Two will present a unique model of evaluation, treatment and therapeutic approaches for patients suffering from eating disorders. The prevalence of pathological eating disorders is rapidly increasing in all developing countries. The increases may be explained in part to the impact cultural, social, economic and historical variables have on populations vulnerable to the disease. These and other variables such as parenting style were analysed and the results are discussed. A complex systems-oriented cognitive model concerning the psychopathology of eating disorders was developed and will be discussed in detail. The model identifies, defines and explains the biological, behavioural, cognitive, emotional and relational components explaining the psychopathogenesis and structural framework resulting in eating disorders.
Renata Górna, Andrzej Kiejna
Assessment of short-term neuropsychologic changes after normothermic versus hypothermic coronary artery bypass grafting 31
Aim: Coronary artery bypass grafting (CABG) is one of the main methods of treatment of coronary artery disease. Neuropsychological testing is a sensitive method for quantitative assessment of cognitive dysfunctioning following cardiopulmonary bypass. The aim of the present clinical study was to evaluate the neuropsychologic changes in CABG patients, operated with normothermic or hypothermic cardiopulmonary bypass (CPB). Method: Neuropsychological changes were assessed in 33 first-time CABG patients before and 3-10 days after surgery. Patients underwent CABG with hypothermic (H, N=17) or normothermic (N, N=16) CPB with standard anaesthesia. Neuropsychological performance was assessed using a well-established battery of 10 tests. A neuropsychological test battery includes: Digit Span- subtest of WAIS-R (PL), the Trail Making Test, Raven Test, Benton Visual Retention Test, The Bourdon Test, Verbal Fluency -"Supermarket", Verbal Fluency - F-A-S, Turm von Hanoi, Rey Auditory Verbal Learning Test, Digit Symbol- subtest of WAIS-R (PL), Raven's Progressive Matrices. All patients completed the test for: perception, attention, immediate and delayed verbal and visual memory, visual and verbal learning, problem-solving strategies, abstraction, recognition, word fluency, visual- motor co-ordination and psychomotor speed. For comparison, the incidence of decline using the 1,5 standard deviation (at least in 2 tests) was also calculated. Results: Comparing the reliable change and SD methods, statistically significant differences in the incidence of decline were observed in 6 of 10 neuropsychological measures. Patients' scores showed a significant deterioration in concentration of attention, immediate verbal memory, psychomotor speed, visuoconstructive tasks and verbal learning. Neuropsychological deficits were found in 66,7% of patients after surgery. Post-operative deficits were not associated with the method used (normothermy or hypothermy).
The quality of life of schizophrenic patients. Part one - research results in the psychosocial treatment programme 45
Aim: The article presents the results of several years of study concerning a group of schizophrenic patients who were embraced by the psychosocial treatment programme throughout the seven years of the follow-up period. Method: A homogeneous group of sixty-six schizophrenic patients, diagnosed according to DSM-III, was examined isochronally with Lehman's quality-of-life questionnaire seven years after their first psychiatric hospitalisation. The internal relations in the quality-of-life model were analysed as well as the factors influencing its explication. Results: It was observed that these domains which are subjective indicators of the quality of life are strongly, positively and extensively interrelated and that they correlate with general satisfaction with one's life, in contrast to the objective domains. The subjective assessment of general satisfaction with life is positively correlated with general objective assessment of the quality of life, but particular, both subjective and objective, domains of the quality of life are partly related and partly independent from one another. General satisfaction with one's life is best explicated by a gamut of factors: subjective satisfaction with religious life, employment, social contacts and the female gender.
What psychotherapy is and is not: an essay on redefining of the term 59
Aim: The primary intent of this paper is to discuss the concept of "psychotherapy" and to suggest an adequate definition in the reference to social phenomena of healing, helping, psychosocial influences on an individual's mind and interhuman relationship. The definition proposed in this text reduces the concept of psychotherapy to the process of treatment based on psychosocial influences aimed at correcting disturbed psychic and subsequently behavioral and somatic functions. As with treatment, psychotherapy targets only patients - individuals who have been definitively diagnosed with a specific disease or disorder and should be indicated exclusively in accordance with the current knowledge of psychopathology designating the goal of change. Psychotherapy may be conducted by physicians as well as by other medical practitioners, such as clinical psychologists, social workers, nurses, but under the condition of particular supplementary education. The term "psychotherapy" is often used to describe various procedures of helping healthy individuals through psychosocial stressors, which can include emotional support, multi aspects of personal development, and improvement of social skills not withstanding. This differs from psychotherapy's basic goal, as well as the quality of influences and relationship. To describe these procedures, the term "psychosocial help" is proposed. Conclusion: The true notion of psychotherapy involves much more of a medical perspective and knowledge of treatment. It also entails a complex process that differentiates it from the concept of "psychosocial help."
Richard D. Chessick
An unfinished didactic novel. Chapter 5: Hattusas 69