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Despite the fact that along the last 100 years a number of diagnostic systems and clinical models of schizophrenia have been proposed, defining this psychiatric disorder in a manner acceptable in both clinical and research settings remains one of the most difficult tasks in psychiatry. While the description of symptoms and signs of the disorder has remained mainly unchanged over the years, the way in which the authors have articulated the varied phenomenological manifestations has been different across periods. Great strides that have been made in recent years have brought about a convergence on a definition of the illness as well as methods of assessment that are acceptable to workers from research centres across the world. The structured interviews brought an organizational focus to the traditional psychiatric interview that provided a strict format and directions to the interviewer, which enables systematic assessment of all the criteria necessary for a diagnosis according to the given diagnostic system. Having a consensually shared set of diagnostic criteria as well as structured assessment devices helped to ensure a more common unit of analysis in research across the world. Though most workers would hail the operationalization of diagnostic criteria as an advance in psychiatry, there remain concerns about the impact that the quest for increased diagnostic reliability might have on validity. Given that the ultimate goal of any diagnostic system is to provide insights into the aetiology, pathophysiology and treatment of the disorder, examining various alternative diagnostic constructs and their validity is still an important area of schizophrenia research.

Teaching psychiatry concerns mainly education of students studying medicine and clinical psychology, but it also concerns professional training the people specializing in psychiatry and in other fields of medicine. Since the requirements that medical professionals are obliged to meet are ever higher, it is essential to provide highest possible quality of teaching and to do so to use the best possible teaching models. One of the modern educational models is Problem Based Learning (PBL). Barrows' and Dreyfus' research as well as development of andragogy had major impact on the introduction of this model of teaching. There are favourable experiences of using PBL in teaching psychiatry reported, especially in the field of psychosomatics. Problem Based Learning gradually becomes a part of modern curricula in Western Europe. For this reason it is worth keeping in mind PBL's principles and knowingly apply them into practice, all the more the reported educational effects of using this method are very promising.

The aim of the article is a presentation of the possible manner in which cost reduction of psychiatric treatment could be achieved by introducing a day hospital system. Based on literature, a similar improvement in clinical and social outcome between both partial and full hospitalization was shown. The comparison of costs in the studied models of treatment demonstrated a probable level of savings assessed at 20-30% for the day treatment. The presented data obtained from the epidemiologic registry of Lower Silesian district showed a significant increase of hospital admissions of mostly non-psychotic patients--the most cost-saving group of mental dysfunctions while treated in a day hospital. As the cited articles concerned, studies conducted in other countries where the economic environment differs from the Polish one--there is a need of cost comparison between day hospital and inpatient treatment in the country.

Aim: The goal of the present study was to examine whether contemporary psychopharmacotherapy (atypic neuroleptics) can have an impact on the patient's compliance and limit coercion (involuntary admission to hospital, coercive measures)., Method: 71 adult inpatients with diagnoses of the schizophrenia spectrum (F20 group according to ICD-10) admitted to psychiatric hospital were observed. 41 of them were treated with atypic neuroleptics before hospitalization and 30 with typical ones. Data about their pharmacotherapy before hospitalization, compliance, history of disease and coercion used during hospitalization were gathered and analysed by means of chi square Pearson's and Mann-Whitney's tests., Results: There were no significant differences in non-compliance, the type of admission to hospital and frequency of coercion measures used during hospitalization between groups of patients receiving atypic and typical antipsychotics. However, the group with atypic neurolepitics was nearly significantly more adherent to therapy than the typical ones., Conclusions: Results of the study did not confirm the impact of atypic neuroleptics on compliance and coercion connected with admission to hospital. A long-term study with an increased number of patients is needed to confirm the results of this study.

Aim: Scientific studies in psychiatry from a methodological point of view could be divided into correlational and experimental. Experimental studies are based on active selection of independent and dependent variables, attributing values of the independent variable to persons under study and measuring values of dependent variables. An example of the experimental study is a comparison of two therapeutic methods. Experiments are feeble to selection, informational and confounding bias., Method: This review comprises experimental papers published in journals: "Psychiatria Polska", "Postepy Psychiatrii i Neurologii", "Farmakoterapia w Psychiatrii i Neurologii", "Rocznik Psychogeriatryczny", "Wiadomości Psychiatryczne" oraz "Alkoholizm i Narkomania" from January 1998 to December 2002., Results: 11 experimental publications, 6 randomised, 2 probably randomised and 3 case-control studies were found. The smallest study included 14 persons, the largest 180 persons. The number of experimental groups varied from 2 to 4. 9 studies evaluated features of specific methods of therapy and rehabilitation, among them 6 evaluated efficacy of medications. 2 studies evaluated relations between psychopathological and physiological variables. Experiments were based on groups of patients with a diagnosis of schizophrenia (3), alcohol and drug dependence (2), depression (3), insomnia (1), bronchial asthma (1), and hypertension (1)., Conclusion: The review showed that experimental studies do not form a main-stream in Polish psychiatric journals.

The authors of this article on the basis "Uber die Klassifikation der Psychosen" analysis present the method of mental disorders' classification proposed by Carl Wernicke in 1899. Wernicke's classification was an alternative for other classification concepts existing in the 19th century. Carl Wernicke as one of the first noticed the impossibility of creating a classification based on etiology. Basing his classification concept on mental disorders localisation, he created an alternative opposed to classifications based on two main approaches: descriptive and etiological.

Abstract Background Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. Method The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. Results The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. Conclusions Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.

Abstract Background A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

Abstract Background This study aims to build a measure for assessing and reviewing the living conditions, care and human rights of people with longer term mental health problems in psychiatric and social care institutions. Protection of their human rights is imperative since impaired mental capacity secondary to mental illness can make them vulnerable to abuse and exploitation from others. They also constitute a major resource pressure for mental health services, social services, informal carers and society as a whole. Methods/Design This study uses an iterative methodology to develop a toolkit to assess internationally agreed domains of care that are considered most important for recovery. These domains are identified by collating results from: i) a systematic review of the literature on institutional care for this service user group; ii) a review of the relevant care standards in each participating country; iii) Delphi exercises in partner countries with mental health professionals, service users, carers and advocates. Common domains and cross-cutting themes are agreed by the principal researchers and an international expert panel. Items are developed to assess these domains and incorporated into the toolkit which is designed to be administered through a face to face interview with the institution's manager. The toolkit is refined in response to inter-rater reliability testing, feedback from interviewers and interviewees regarding its utility, and feedback from key stakeholders in each country about its ability to deliver information that can be used within each country's established systems for quality assessment and review. Cross-validation of the toolkit ratings against service users' quality of life, autonomy and markers of recovery tests whether it can deliver a proxy-measure of the service users' experiences of care and the institution's promotion of their human rights and recovery. The ability of the toolkit to assess the "value for money" delivered by institutions is investigated by comparing toolkit ratings and service costs. Discussion The study will deliver the first international tool for the assessment of the quality of institutional care for people with longer term mental health problems that is accurate, reliable, informative, useful and easy to use.

Background: Patients with psychoses have an increased risk of becoming victims of violence. Previous studies have suggested that higher symptom levels are associated with a raised risk of becoming a victim of physical violence. There has been, however, no evidence on the type of symptoms that are linked with an increased risk of recent victimization. Methods: Data was taken from two studies on involuntarily admitted patients, one national study in England and an international one in six other European countries. In the week following admission, trained interviewers asked patients whether they had been victims of physical violence in the year prior to admission, and assessed symptoms on the Brief Psychiatric Rating Scale (BPRS). Only patients with a diagnosis of schizophrenia or related disorders (ICD-10 F20–29) were included in the analysis which was conducted separately for the two samples. Symptom levels assessed on the BPRS subscales were tested as predictors of victimization. Univariable and multivariable logistic regression models were fitted to estimate adjusted odds ratios. Results: Data from 383 patients in the English sample and 543 patients in the European sample was analysed. Rates of victimization were 37.8% and 28.0% respectively. In multivariable models, the BPRS manic subscale was significantly associated with victimization in both samples. Conclusions: Higher levels of manic symptoms indicate a raised risk of being a victim of violence in involuntary patients with schizophrenia and related disorders. This might be explained by higher activity levels, impaired judgement or poorer self-control in patients with manic symptoms. Such symptoms should be specifically considered in risk assessments. [ABSTRACT FROM AUTHOR]

Background: Legislation and practice of involuntary hospital admission vary substantially among European countries, but differences in outcomes have not been studied.Aims: To explore patients' views following involuntary hospitalisation in different European countries.Method: In a prospective study in 11 countries, 2326 consecutive involuntary patients admitted to psychiatric hospital departments were interviewed within 1 week of admission; 1809 were followed up 1 month and 1613 3 months later. Patients' views as to whether the admission was right were the outcome criterion.Results: In the different countries, between 39 and 71% felt the admission was right after 1 month, and between 46 and 86% after 3 months. Females, those living alone and those with a diagnosis of schizophrenia had more negative views. Adjusting for confounding factors, differences between countries were significant.Conclusions: International differences in legislation and practice may be relevant to outcomes and inform improvements in policies, particularly in countries with poorer outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Psychiatria Polska is the property of Editorial Committee of Polish Psychiatric Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psychiatria Polska is the property of Editorial Committee of Polish Psychiatric Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psychiatria Polska is the property of Editorial Committee of Polish Psychiatric Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Kiejna A, Wojtyniak B, Rymaszewska J. Prevalence of psychiatric morbidity in Polish population – national health interview survey. The aim was to evaluate the prevalence of psychiatric morbidity in Polish population. The national health interview survey was based on entire non-institutionalized Polish population by means of randomized, stratified (urban and rural census tracks) two-stage method (over 39 000 respondents). Prevalence of psychiatric morbidity was based on General Health Questionnaire-12. Psychiatric morbidity was noted in almost 1/4 of women and 1/5 of men in Poland, with small differences between urban and rural population. Every 10th woman reported such complaints at the age up to 25 years and every second above 75 years of age. Divorced and widowed respondents, irrespective of gender, have psychiatric disorders more frequently than compared groups. Higher prevalence of psychiatric morbidity was noted in out of work and especially disabled persons. The higher the level of education, the lower the frequency of psychiatric morbidity was observed. Presented survey enabled to evaluate prevalence of psychiatric morbidity in Polish representative sample. Findings should trigger more extended epidemiological studies. The requirement for epidemiological investigations increases in reform-awaiting health care system in Poland, for at least one reason that the improvement of the quality of services is closely associated with a detailed recognition of the problem. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The associations between mental disorders and cancer remain unclear. It is also unknown whether any associations vary according to life stage or gender. This paper examines these research questions using data from the World Mental Health Survey Initiative. Methods: The World Health Organization Composite International Diagnostic Interview retrospectively assessed the lifetime prevalence of 16 DSM-IV mental disorders in face-to-face household population surveys in nineteen countries (n=52,095). Cancer was indicated by self-report of diagnosis. Smoking was assessed in questions about current and past tobacco use. Survival analyses estimated associations between first onset of mental disorders and subsequently reported cancer. Results: After adjustment for comorbidity, panic disorder, specific phobia and alcohol abuse were associated with a subsequently self-reported diagnosis of cancer. There was an association between number of mental disorders and the likelihood of reporting a cancer diagnosis following the onset of the mental disorder. This suggests that the associations between mental disorders and cancer risk may be generalised, rather than specific to a particular disorder. Depression is more strongly associated with self-reported cancers diagnosed early in life and in women. PTSD is also associated with cancers diagnosed early in life. Conclusion: This study reports the magnitude of the associations between mental disorders and a self-reported diagnosis of cancer and provides information about the relevance of comorbidity, gender and the impact at different stages of life. The findings point to a link between the two conditions and lend support to arguments for early identification and treatment of mental disorders. [Copyright &y& Elsevier]

The authors present epidemiological data regarding the mental health of prisoners in Polish penitential units. No such assessment has yet been made in an Eastern European country. The process of deinstitutionalization is not as rapid or advanced in Poland as in Western countries. The following question arises: is there as a large proportion of prisoners with mental disorders as in other countries? On the basis of the studies carried out, it may be stated that in Poland a significant number of such cases are underdiagnosed. However, a relatively large number of disorders related to substance abuse are observed, most commonly alcohol abuse. [ABSTRACT FROM AUTHOR]