Archives of Psychiatry and Psychotherapy 2/2003

Tullio Scrimali, Liria Grimaldi
Fineo & Tantalo. A complex systems-oriented cognitive approach in the treatment of patients with eating disorders: Part two - Practice  3
Summary
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) described 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.

Hanna Jaklewicz
The dynamics of infantile autism.  Longitudinal studies  15
Summary
Aim: Children with diagnosis of autism were estimated at the age of 3, 5, 7 using the diagnostic criteria elaborated on DSM-III-R basis [1, 2]. Material and method: 28 children diagnosed to be autistic were involved into the longitudinal studies. The criteria were taken from DSM-III-R. 18 children in the early stage of autism were chosen. The development of disorders has been observed since the period infancy among these children. The other group consisted of 10 children in the late stage of autism. The development of autism in the group was proceeded by normal development of the child till the 12-18 months of life. The research was conducted in 3rd, 5th and 7th year of life. 3 areas of developments were taken under consideration: social relations' (A), verbal vs. non-verbal communication (B), activity and interests (C). In the estimated group (A, B, C) 5 criteria were achieved, each in a 5-grade scale, 1 meaning the lack of symptom and 5 meaning the higher intensity. At the age of 3 the intensity of disorders on the three evaluated areas of development did not differentiate children in early and late stage of autism. Results: The future development of children in the early stage of autism was not successful. Visible difference was seen at the age of 5. Children in the late stage of autism developed in all 3 areas of investigation. At the age of 7, children in the late stage of autism seemed to gradually "withdraw from autism". Conclusion: Longitudinal studies conducted on autistic children confirmed the hypothesis about the age of child's life, when the first symptoms of disorders showed, being an important predictor of the autism development dynamic.

Józef Zając, Andrzej Kiejna, Joanna Rymaszewska, Adrian Sieradzki
Reform of medical services and changes of some patients movement coefficients in a psychiatric hospital  25
Summary
Selected empirical data relating psychiatric hospital morbidity from Lower-Silesian province in years 1998-2000 was analysed. Official statistics became the main source of information about occurrences and epidemiological processes, because of lack of population studies from psychiatry domain. Three limitations of such inferences was pointed: - inter-regional moving of patients; - imperfection of procedures connected with accumulation of empirical material; - influence of various administrative factors. These last exert essential influence on changes of patients' movement coefficients in hospitals during implementation of Health Care reform in Poland. Number of admitted patients in general and for first time increased, simultaneously time of stay in hospital grew shorter.  No reasons have been found, for of which these observed changes would be able to have reference in real epidemiological processes, quality of treatment. These changes are rather caused by realised reform, and precisely adaptative mechanisms of the subjects to Health Insurances requirements.

Raymond Battegay
The group-as-a-whole concept in the interpretation in group psychotherapy  33
Summary
In the course of the European history of civilisation there gradually occurred a shift from "We" to "Ego" (Elias,1987). From a psychological point of view, therefore, it is no longer indicated to treat a therapy group as a oneness. If a We-representation (a self enlarged by the other group members - a "narcissistic group-self") develops in each member, this means that each of the members comes to an - individually different - image of the group. Every participant, therefore, wants to be understood as an individual with its own specific experience. "Group dreams" may come up in group psychotherapy, which reflect not only the unconscious dynamics of the concerned individual, but also, through the co-presence of other members in the dreams of a participant, the interactions he or she has with others. Only as long as at least some individuality in a group remains does the collective merit to be called a group. If the members are too much prone to a narcissistic-fusional collusion with others it is the task of the therapist to sensitise them for their personal co-responsibility for the free exchange of fantasies and opinions in the group.

Agnieszka Mazur, Izabela Chojnowska-Ćwiąkała
Dynamics of autistic disorders in a thirteen-year-old boy - a case study  43
Summary
This article presents the case of a thirteen-year-old boy suffering from autistic disorders. Special attention is paid to the occurrence of social and communicative deficiencies combined with cognitive disturbance which limit a possibility of the autistic person to conduct a normal life. The inability to attain the coherence between various development aspects connected with different disharmonies is presented. There are distinctive disorders in respect to socialisation. The difficulties in understanding and anticipating the social environment complexity may disturb the dynamics of behaviour and release the tendency to social withdrawal, isolation and passiveness.

Andrzej Cechnicki
The quality of life of schizophrenic patients, part two: construct, intercorrelations and explanation factors  53
Summary
Aim: The study analyses the quality of life of schizophrenic patients: the construct, interconnections and explanation factors. Method: Subjective and objective indicators of the quality of life were examined isochronally with Lehman's questionnaire in a homogeneous group of sixty-six schizophrenic patients, diagnosed according to DSM-III, seven years after their first hospitalisation. The research was carried out between 1992 and 1994. Results and conclusion: With those schizophrenic patients who throughout the seven-year follow-up period participated in the psychosocial treatment programme, a positive assessment was observed as to both subjective and objective indicators of the quality of life. The achieved results vary in different domains (either subjective or objective indicators of the quality of life), which gives little warrant to any general assessment. In the Polish population of schizophrenic patients, religion and family prove to be of enormous importance for the surveyed. In all Polish researches on the quality of life there should appear a tendency to standardise the indicators of the quality of life, as well as questionnaires, in order to enable comparative research in many medical centres and a critical evaluation of the employed models.

Richard D. Chessick
An unfinished didactic novel. Chapter 6: Ephesus  65