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Purpose: Basic indices of reliability, validity, and feasibility of the Polish language version of the Satisfaction with Life Domains Scale (SLDS) were assessed - this is one of the self-assessment measures of the subjective quality of life., Methods: The combined database included 1,246 people from previous studies on stigma (n = 316) and recovery (n = 110), and individuals seeking psycho-social support (n = 820). Apart from SLDS, other measures of life functioning, experiences of stigma and discrimination, factors of personal recovery, and self-rated and clinician-rated psychopathology were used., Results: The SLDS results were characterized by a good item performance and high internal consistency (α = 0.92). Significant improvement in life satisfaction was noted, while maintaining some correlational stability in the re-test. Satisfaction with life did not depend on gender, education and age, but on diagnostic qualification (mental problems < somatic diseases) and methodological qualification (patients > persons seeking support). The direction and strength of the correlation of SLDS scores with a number of social, personal and clinical variables supports its theoretical validity, as does the principal components analysis indicating both the value of a one- and three-dimensional solution (satisfaction with social conditions, living conditions and interpersonal relationships). The feasibility of SLDS is also indicated by the low frequency (< 2.8%) of no responses in the surveyed population., Conclusions: The basic psychometric indicators of the Polish language version of the SLDS confirm its satisfactory reliability and validity as well as a sufficient level of feasibility for various clinical and research aims., Competing Interests: Absent., (Copyright © 2023 Institute of Psychiatry and Neurology.)

Objectives: The aim of the presented research is to characterize the operating Mental Health Centers (MHCs) and to provide a preliminary assessment of the implementation process of the pilot program model in the area of psychiatric care in Poland., Methods: The study uses the Polish version of the German questionnaire, which covers four areas: (1) basic conditionsof the model project/pilot program; (2) characteristicsof the organizational structure of the treatment entity; (3) statistical characteristics of the services provided;(4) specific features of the psychiatric care system in model regions/pilot program Mental Health Centers., Results: Nineteen of the 27 Mental Health Centers completed the survey. The centers have 428 beds in day units and 1,971 beds in inpatient units. Most of the centers (15 of 19) work with subcontractors and all are publicly funded. Eight centers were established by psychiatric hospitals and 11 centers were constituted at psychiatric wards within multi-specialist hospitals. The medical services provided by the centers mainly include psychiatry and psychotherapy. In 2019, the centers provided medical services to a total of 65,614 patients; 8,432 patients received at least three forms of treatment., Conclusions: The first full year of MHC operation in the pilot program indicates the expected direction of change in psychiatric care - achieving a significant level of implementation of community care standards. The survey needs to be repeated to verify this direction. A limitation of the study was the lack of survey responses from 30% of MHCs. In the future, we should aim for at least 90% of completed surveys.

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models ( n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Schwarz, Cechnicki, Godyń, Galbusera, Biechowska, Galińska-Skok, Ciunczyk, Ignatyev, Muehlensiepen, Soltmann, Timm, Peter, Balicki, Wciórka and Heinze.)

To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions - activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits.

Most healthcare systems struggle to provide continuity of care for people with chronic conditions, such as patients with severe mental illness. In this study, we reviewed how system features in two national health systems (NHS) - England and Veneto (Italy) - and three regulated-market systems (RMS) - Germany, Belgium, and Poland -, were likely to affect continuing care delivery and we empirically assessed system performance. 6418 patients recruited from psychiatric hospitals were followed up one year after admission. We collected data on their use of services and contact with professionals and assessed care continuity using indicators on the gap between hospital discharge and outpatient care, access to services, number of contacts with care professionals, satisfaction with care continuity, and helping alliance. Multivariate regressions were used to control for patients' characteristics. Important differences were found between healthcare systems. NHS countries had more effective longitudinal and cross-sectional care continuity than RMS countries, though Germany had similar results to England. Relational continuity seemed less affected by organisational mechanisms. This study provides straightforward empirical indicators for assessing healthcare system performance in care continuity. Despite systems' complexity, findings suggest that stronger regulation of care provision and financing at a local level should be considered for effective care continuity., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: The purpose of this study was to evaluate the impact of anti-stigma training led by people who had previously experienced mental health crises (i.e., "experts by experience") on various aspects of participants' attitudes towards the people with mental illness., Methods: The three-hour workshops were attended by 185 people; the training was held in 17 groups, with 3-19 people in each (11 on average). Almost half of the participants (45.4%) were employees of the mental health care system. The participants were asked to fill out a set of questionnaires immediately before and after the training, which evaluated the following aspects of their attitudes: social distance, stigmatizing attributions, beliefs about self-determination/ ability to attain important life goals by people with mental illness, and also beliefs about the social value of people with mental illness. The respondents were asked to complete the same set of questionnaires again online a month and six months after the training. The data were analyzed based on a piecewise latent trajectory model., Results: Out of the 185 people who participated in the workshops, 115 (62.2%) filled out the questionnaires a month after, and 87 (47.0%) six months after the training. The analyses showed an improvement in all four measures of attitudes expressed directly after the training. In three out of the four examined aspects of attitudes (intensity of social distance, stigmatizing attributions and beliefs about self-determination of people with mental illness) the positive impact of the training continued after six months., Conclusions: The results provide preliminary empirical evidence that the structured antistigma intervention under evaluation, using the elements of education and interpersonal contact can be an effective tool for improving social attitudes towards people with mental illness.

Objective: Hope is a key component of personal recovery. There is limited evidence regarding the association of hope with the level of functioning in individuals with psychosis. It is also not clear which dimensions of hope are most strongly related to clinical recovery. Thus, this study aims to explore the relationships of hope and its dimensions with various indicators of clinical recovery such as overall psychopathology, depression and global functioning among people with psychotic disorders., Method: The Integrative Hope Scale (IHS; Schrank, Woppmann, Sibitz, & Lauber, 2011) was administered to 110 people with psychotic disorders. Multiple regression analysis was used to investigate the associations of the IHS total score and its four subscales (i.e., Trust and Confidence, Lack of Perspective, Positive Future Orientation, and Social Relations and Personal Value) with overall psychiatric symptoms, depression, and general functioning., Results: A total level of Hope was not associated with overall psychopathology or global functioning; however, it showed a significant negative relationship with severity of depression. A stronger feeling of a Lack of Perspective turned out to be associated with more severe depression and a greater intensity of psychopathological symptoms. The relationships of the remaining dimensions of Hope with the indicators of clinical recovery were found to be nonsignificant., Conclusion and Implications for Practice: The findings suggest that combining Hope-enhancement strategies with interventions targeting symptoms may increase the effectiveness of rehabilitation programs for people with psychosis. They also point to the sense of a Lack of Perspective as the aspect of Hope most strongly related to clinical recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Purpose: To examine the roles of loneliness and clinician- and self-rated depressive symptoms as predictors of the subjective quality of life (QoL) in psychosis., Methods: This cross-sectional study was conducted on a sample of 207 patients diagnosed with psychotic disorders. They were assessed with self-reported measures of QoL, loneliness and depression and with clinician-rated measures of depression and overall psychopathology. Multiple indicators multiple causes (MIMIC) modeling was used to analyze the data., Results: Both loneliness and depression turned out to be independent predictors of impaired QoL. However, once loneliness was accounted for, the effect of depression on QoL was markedly reduced and the effect of loneliness proved to be visibly larger. Self-rated depression was found to be more strongly associated with QoL than clinician-rated depression. Each type of depression measure explained a unique amount of variance in QoL. Depression moderated the relationship between loneliness and QoL in such a way that the negative effect of loneliness on QoL weakened with the increasing intensity of depressive symptoms., Conclusions: Therapeutic programs aiming to enhance the QoL of people with psychotic disorders should incorporate interventions targeting both loneliness and depression and need to be tailored to the clinical status of patients. The emphasis on alleviating loneliness should be placed first of all in the case of those with low levels of depression, among whom the negative impact of loneliness on QoL is especially strong. Researchers should be aware that the method chosen for assessing depressive symptoms in models predicting QoL in psychosis matters.

Purpose: To elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC)., Methods: A cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL., Results: The proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = -0.06, SE = 0.02; 95% CI (-0.11, -0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL., Conclusions: Self-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment.

Stigmatization can exert a variety of pernicious effects on the lives of persons with mental illnesses. The purpose of this study was to explore factors related to the psychosocial impact of stigma among 229 people receiving psychiatric treatment: 123 with schizophrenia [International Classification of Diseases, 10th Revision (ICD-10): F20] and 106 with affective disorders (ICD-10: F31-F33). In the whole sample, the factors most prominently associated with a greater impact of stigma on personal and family life were schizophrenia diagnosis, current inpatient treatment, actually experienced stigma and self-stigma. However, the patterns of predictors varied between the two diagnostic categories. For the schizophrenia group, only self-stigma significantly contributed to a stronger stigma impact. In the affective group, a more severe impact of stigma was significantly predicted by inpatient status and experienced stigma. Anti-stigma programs should address the specific features of stigmatization associated with various psychiatric diagnoses.

The Stages of Recovery Instrument (STORI; Andresen et al., 2006) was used among 110 patients with psychosis. Recovery stages relationship with attribution, the way of experiencing illness and its phase and symptoms were analyzed. The samples were drawn from treatment facility including in-patient unit. The subgroups of recovering patients were identified: moratorium (27%), awareness (32%), preparation (30%) and rebuilding (11%). The achievement of higher stages of the recovery was correlated with: less severe symptoms of psychosis (with the exception of anxiety and depression, which have no impact on the stages of recovery), medical attribution (I am ill), integrative attitude toward the experience of psychosis, and the absence of involuntary hospitalizations. The logistic regression analysis model indicated the independent significance of the medical attribution, the integrating attitude toward psychotic experience and the remission of symptoms. Other clinical variables and social characteristics did not differentiate between the stages of recovery in any significant way. No juxtaposition as such was found between the processes of recovery and being ill, but rather a complementary relation. Recovery has been found to be enhanced by the remission of psychotic symptoms, medical attribution and integrative attitude toward the experience of psychotic crisis., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Aim: The article presents lifetime (LT) prevalence of common mental disorders (CMD) in accordance with the DSMIV classification, based on assessment of representative population sample of 10,081 Poles aged 18-64., Methods: Computer based WHO CIDI3.0 was adapted for the Polish population according to WMH protocol. The survey was performed by certified and supervised interviewers., Results: Out of the 18 CMDs analyzed the most common was alcohol abuse, significantly more often in males (18.6%) than in women (3.3%), (p<0.01). The second most common disorder was panic, also more frequent in women (8.5%) than in men (3.9%), (p<0.01). Similarly, depression occurred in women (4.0%) two times more often than in males (1.9%), (p<0.01). GAD, agoraphobia, panic, specific phobia (p<0.01), and dysthymia (p<0.05) were also more prevalent in women. On the other hand, alcohol abuse, alcohol and drug dependence (p<0.01), and hypomania (p<0.05) were more common in males. For most analyzed disorders significantly higher prevalence was found in the older age groups. Social phobia, specific phobias, and drug abuse occurred most often in men from the youngest group. No significant differences related to age were found for the prevalence of hypomania both in men and women., Conclusions: Indices of prevalence obtained in the EZOP Poland study differ from the indices of prevalence of mental disorders described earlier in other countries. Lower values were found in Poland for affective disorders and some anxiety disorders. Only alcohol abuse was diagnosed more often than in other studies using similar methods except Ukraine, where this disorder was diagnosed with similar frequency.

Background: Stigmatisation is a source of chronic stress and a major barrier to recovery for people with mental illnesses. The internalisation of stigma can have a negative impact on an individual's social relations and lead to feelings of loneliness and depression., Aim: This research is aimed at testing the hypothesis that the internalised stigma of mental illness contributes to the intensification of depressive symptoms indirectly, through its impact on feelings of loneliness., Methods: A total of 110 individuals with diagnoses of psychotic disorders (International Classification of Diseases-10th Revision (ICD-10): F20-F29) were assessed with measures of internalised stigma, loneliness, depression, positive and negative symptoms and global functioning. The ordinary least squares regression was used for data analysis., Results: After adding loneliness to the regression model, the initially significant impact of internalised stigma on depressive symptoms disappeared. As expected, loneliness proved to be a full mediator in the relationship between stigma and depression., Conclusion: The study findings provide useful insights into the mechanisms of the harmful effects of stigma on people with mental illness. Internalised stigma and loneliness should be considered important targets for interventions aiming to promote recovery., (© The Author(s) 2013.)

This study explored the role of the sense of coherence (SOC) in predicting the scope and impact of stigma experiences in 229 patients with schizophrenia or affective disorders. Findings revealed that SOC significantly predicted lower levels of stigma, accounting for 13% of the variance in stigma experiences and 4% of the variance in stigma impact, over and above that explained by background characteristics, diagnosis and the psychiatric symptoms of the participants., (© 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Patient compliance influences results of treatment of mental disorders. The study compares four measures of treatment adherence., Methods: 103 subjects were examined in the early remission from an acute psychotic (schizophrenic or schizoaffective) crisis. Compared was patient's compliance assessed by two simple scales: 5-point POP (patient's self-rating) and 7-point POK (clinician's rating) as well as by two composite questionnaires: the Drug Attitude Inventory (DAI-10) and the Medication Adherence Rating Scale (MARS). The ROC curve was used to compare sensitivity and specificity of DAI-10 and MARS scores as predictors of simple ratings., Results: The percentage of patients who complied ranged between 42.8% to 62% (20.4-26.2% with stringent criteria applied). The POK shows a stronger correlation with the POP (0.50) than with the results of DAL-10 (0.30) or MARS (0.32). The POP correlated low with DAI-10 (0.23) and MARS (0.32). The correlation between MARS and DAI-10 was relatively high (0.67). Their reliability (Cronbach's a coefficient) only moderately exceeded the satisfactory level (DAI-10: alpha = 0.76) or approximated it (MARS: alpha = 0.61). Area under the curve (AUC) suggested comparable and significant diagnostic value of the DAI-10 and MARS. Scores extending 7.5 points indicated their optimal relation between sensitivity and specificity in predicting the clinician or patient ratings., Conclusions: Approximately one in two (one in four assuming the more demanding criteria) of the subjects complied with treatment recommendations. The correlation between the results of the questionnaires was relatively high, though moderate between the simple ratings. DAI-10 and MARS showed moderate reliability, sensitivity and specificity.

Objective: There is a scarcity of well validated measures of the subjective experience of the stigma of mental illness. The aim of this paper was to evaluate the psychometric properties of the Stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ)., Methods: A secondary analysis of the data from two cross-sectional studies using the CESQ was conducted in order to assess the factor structure, internal consistency and concurrent validity of the Stigma subscale. Sample 1 included 373 diagnostically heterogeneous patients (65% had psychotic disorders) and Sample 2 included 136 patients with schizophrenia., Results: Since none of the factor models of the original 9-item scale was satisfactory, it was shortened by removing two psychometrically weakest items. The abbreviated 7-item scale proved to be a one-dimensional instrument, with good estimates of internal consistency. Its concurrent validity was partly confirmed by demonstrating negative correlation with quality of life and positive correlations with self-rated psychopathological symptoms. However, contrary to theoretical expectations, the stigma score was not associated with global functioning and clinician-rated symptoms., Conclusions: The psychometric properties of the Stigma subscale of the CESQ may be improved by shortening the instrument. Although the reliability and validity of the abbreviated version were partly established, further research is needed to explore in particular its test-retest reliability and concurrent validity., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Aim: The aim of this study is to evaluate the relationship between clinical and neuropsychological measures of language disorders as well as characteristics of the mental condition of patients diagnosed as having schizophrenic disorders., Method: There were 45 persons with schizophrenic disorder (acc. ICD-10) examined with The Positive and Negative Syndrome Scale (PANSS), the side effect rating scale (UKU), Wisconsin Cards Storting Test (WCST), verbal fluency task, Ruff's Test, "Similarities" --WAIS-R subtest, 10 graphics of The Thematic Apperception Test (TAT). Patient's speech was evaluated independently by two diagnosticians using Thought, Language and Communication Scale (TLCS)., Results: Time since the onset of illness and the number of hospitalisations were associated with total TLCS scores and with most of the WCST indicators. Total amount and most of the particular language disorders correlated positively with total PANSS scores. Total amount of language disorders was connected with the number of trials, which were necessary to complete the first category and also with the global scores obtained in "Similarities". There were also many correlations between particular language phenomenons and results of several neuropsychological tests., Conclusions: Correlation between psychopathological evaluation of language disorders according to TLCS and evaluation of the schizophrenic syndrome score is found to be significant. The psychopathological rating of general and particular language disorders shows significant correlations with some indicators of executive function, verbal and nonverbal fluency and the ability for abstract thinking.

Stigmatization is commonly recognized as one of the main barriers to recovery and to social inclusion of people with mental illnesses. This exploratory study investigated the frequency, type, and sources of actual stigma and discrimination experiences among Polish psychiatric patients. A total of 442 people, treated in various psychiatric health care facilities in Warsaw, were interviewed with the use of the Consumer Experiences of Stigma Questionnaire (CESQ). Qualitative data regarding sources of experienced stigma were also obtained. The respondents reported relatively frequent experiences of stigmatization in everyday situations and interpersonal relations, but they seldom complained of any specific instances of discrimination. The most frequently reported source of stigma was employers and supervisors at work, followed by family, and general community members. Implications of the findings for clinical practice and policy are discussed.

Aim: The Bech-Rafaelsen Mania Rating Scale (BRMAS) and Young Mania Rating Scale (YMRS) are both popular rating scales for mania. Until now BRMAS has not had a Polish language version BRMAS, although it may be particularly useful because of its twin depression (melancholia) rating scale (BRMES). No attempt of evaluation of the scales were made in Poland until now. Attempts to compare their worth are rare in the literature. The aim of this study was to evaluate and compare the two scales., Method: Thirty-five patients hospitalised for mania in the course of affective, schizophrenic and organic disorders were assessed by means of two mania rating scales (BRMAS, YRMS), as well as with clinical global impression (CGI) scale, and its parallel versions for mania (CGI-M) and treatment adverse events (CGI-SE). Two rating scales for psychotic syndromes (PANSS, KOSS-S) was also used. Patients were assessed three times. First three diagnosticians evaluated simultaneously and independently the patients' mental state, and then--after one and two weeks--one of them. As reliability measures, inter-rater, test-retest, and internal consistency indices were analysed. As validity measures, a clinical meaning of descriptive characteristics of the scales (external validity), and a comparison with alternative tools for mania rating (criterion, diagnostic validity) were performed. Specificity and sensitivity of BRMAS and YMRS in relation to clinical criterion of severe mania (CGI > or = 5) was analysed by means of ROC curve. As feasibility measure observations made during assessments were used., Results: BRMAS and YMRS revealed satisfactory convergence between assessments of the three diagnosticians (Spearman's rho > 0.72, no significant difference in non-parametric Friedman test), repeatability after a week (rho > 0.52) and internal consistency (Cronbach's alpha for BRMAS > 0.86, for YMRS > 0.73). Profile and dynamics of symptoms in the three successive assessments (each week) depicted changes consistent with expectations, which proved external validity of the scales. Mutual, high correlations between the BRMAS and YMRS (rho > 0.90), between them and CGI-M scale (rho >77), and between them and some meaningful items of psychosis rating scales (PANSS, KOSS-S) may be a mark of their diagnostic validity. ROC for both scales revealed similar, extensive areas under curve (AUC > 0.947; p < 0.000). BRMAS score above 24 points predicted severe mania with 92% sensitivity and 91% specificity. By analogy, YRMAS score above 29 points allowed this diagnosis with 83% sensitivity and 91% specificity. Practically no difficulties in application of the scale under study were noted., Conclusions: Both compared mania scales revealed satisfactory indices of reliability and validity. They are also feasible tools. However limited size of the group under study has not allowed more penetrating analysis, particularly that of validity. This is why the study requires continuation.

Aim: To analyse psychometric value of the Polish version of the GEOPTE Scale, a self-rating scale measuring social cognition among persons suffering from schizophrenic psychoses., Method: Fifty patients with diagnosis of schizophrenia according to ICD-10 criteria were assessed by the scale under study. Analysis of its usefulness included: reliability (as internal consistency), validity - as content, construct, and diagnostic validity in relation to selected measures of mental state (CGI scale, PANSS), social (GAF scale, SOFAS), and cognitive functioning (WCST and N-back test), and feasibility of the scale - according to observed patients' coping with the task., Results: The scale revealed good reliability (Cronbach's alpha = 0.84) and observed feasibility. Descriptive characteristics of the scale's items an its principal component structure (two components interpreted as basic cognitive processes and social cognition) resembled findings of the Spanish Authors in the original study. It may be considered as proof of content and, to some extent, construct (factorial) validity of the scale. Criterion validity seems to be less certain. With exception of a weak correlation of the GEOPTE scale with social and occupational functioning (measured by SOFAS), no significant correlation were detected with other diagnostic validators applied in the study., Conclusions: Polish version of the GEOPTE scale seems to have satisfactory reliability and feasibility. Its validity remains uncertain and open for further study.

Aim: The aim of the study was to investigate the relationship between insight and cognitive function in patients diagnosed with schizophrenia. Insight into illness is a clinically important feature influencing clinical outcome and prognosis in schizophrenia. One ofthe most important and widely discussed in recent literature factors contributing to lack of insight is cognitive dysfunction, mainly that mediated by deficits in the frontal cortical systems. A number of studies, but not all, have observed correlations between unawareness in different insight dimensions and poor performance on working memory and executive function tests., Method: 102 individuals were included to the study, the SUMD scale (Scale for Assessment of Unawareness of Mental Disorder) was used to asses the insight, and the battery of the neuropsychological test was administrated to assess cognition., Results: The results indicate that only some of the insight dimensions were associated with neuropsychological assessment. The research confirmed some relationship between unawareness of effects of medications and memory functions and correlations between unawareness of social consequences of illness and executive functions. Relations between other insight dimensions and neurocognition was less clear, only unawareness of negative symptoms was related to the working memory test., Conclusions: Lack of insight in schizophrenia was moderately associated with cognitive functions. Unawareness of the effects of medication was related to the working memory and learning process, unawareness of social consequences of the mental disorder was related to executive functions. Unawareness of negative symptoms showed stronger associations with cognition than unawareness of positive symptoms or disorganization.

Aim: The aim of the study was an estimation of the rate of deletion 22q11.2 among psychiatric patients and an attempt at the assessment of the degree in which this rate is influenced by the coexistence of dysmorphic features and congenital defects., Methods: Cytogenetic examination was performed in 255 patients with psychosis. Patients were divided into two groups. Group I was composed of 61 patients with psychosis and at least two phenotypic features characteristic of 22q11.2 deletion syndrome (22q11DS), group II was composed of 194 patients with psychosis without phenotypic features of 22q11DS. Banding and fluorescence in situ hybridization (FISH) techniques were applied., Results: 22q11.2 deletion was found in 3/61 patients of group I (4.9%) and in 3/255 among all psychiatric patients (1.2%). This incidence was significantly higher than in the general population (p < 0.001). The frequency of the deletion was even higher among psychiatric patients revealing phenotypic features of 22q11DS: 3/61 (4.9%) (p < 0.0001). In all the cases with the deletion, the phenotype features were characteristic of 22q11DS. Three other psychiatric patients had sex chromosomes' aberrations: 47, XYY, 47, XXY and 47, XXX. Moreover one case of balanced translocation t(2;10) (q10; q10) was detected. Conclusions. (1) 22q11.2 deletion was found to be 40 times more common among psychiatric patients than in the general population; sex chromosome aberrations are also significantly more common than in the general population. (2) The presence of dysmorphic features and some congenital defects in psychiatric patients increases the rate of deletion 22q11.2 significantly.

Aim: Because of their importance both for pathogenesis or clinical aspects of the disease and for patients' social functioning, cognitive dysfunctions are nowadays often considered as basic characteristics of schizophrenic disorders. This study was aimed at evaluation of the correlation between some indices of disordered cognitive functioning on the one hand and some variables describing course and psychopathology of schizophrenic disorders on the other., Method: The study group consisted of 69 inpatients suffering from schizophrenia diagnosed according to both DSM-IV and ICD-10 criteria. Their mental state was rated by two clinical tools (scales: PANSS, KOSS). Also social functioning of patients in the year preceding current hospitalisation was rated by two scales (GAF, scale W). Cognitive dysfunctions were assessed by computer-aided tests from Dr. Schufried's Vienna Test System including measures of reaction time (RT), visual line pursuit (LVT), perseveration (PERSEV), and span of visual-spatial short term memory (CORSI). In statistical analysis simple nonparametric tests and rank correlation measures were applied., Results: Correlations were confirmed between cognitive dysfunctions and social functioning prior to hospitalisation, age, duration of illness and number of previous hospitalizations. Dysfunctions were less severe in first episode patients than in patients during relapses or the residuum stage of illness. Overall assessments of severity of illness do not correlate with cognitive dysfunctions, but detailed analysis of psychopathology revealed correlations of the latter with such psychopathological dimensions as deficit, disorganization and dysphoria. Reality distortion (positive) psychopathological dimension did not have any correlation with cognitive measures. All indices of cognitive dysfunction correlated with poorer outcome of treatment of the current episode. All correlations confirmed were only of weak or moderate level., Conclusions: Cognitive dysfunctions correlate rather with unfavourable characteristics of the course of the illness. Results of psychopathological assessment hardly correlate with neuropsychological measures--cognitive dysfunctions are related rather to deficit (negative), disorganisation or dysphoria dimensions of a schizophrenic syndrome than to productive (reality distortion, positive) dimension of the syndrome.

Unlabelled: Attention dysfunction as assessed by standardised tests has often been reported in schizophrenic patients. Since many cognitive dysfunctions noted in these patients occur also in their close relatives, a supposition arises that they may be indicators not so much of transient states, but rather of a stable feature of cognitive functioning. This feature perhaps is transmitted from generation to generation and might contribute to the onset of the disease., Aim: A comparison of selected attention indicators in schizophrenic patients and their first-degree relatives with these in healthy controls without family history of schizophrenia., Method: Participants in the study were 99 patients diagnosed with schizophrenia (according to the ICD-10-DCR criteria) in an early period of remission, their first-degree relatives (N = 56), out of whom 42 were healthy and 14 had a history of psychiatric disorders, and a control group of participants (N = 42) unrelated to the subjects and with no psychiatric history. Several tests of the computer-aided Vienna Test Battery were used, and namely: the RT test measuring reaction time to simple visual or auditory stimuli, and LVT test measuring the accuracy and performance time in a task that consisted in visual tracking of lines, and required concentration of visual perception., Results: As compared to the controls, the patient group was found to manifest attention deficits in the form of longer reaction time to simple stimuli as well as increased performance time and decreased correctness of visual line tracking. The patients had also a somewhat longer reaction time to visual (but not auditory) stimuli, and their line tracking was inferior as compared to that of their healthy relatives. As regards the reaction time to simple stimuli, the latter did not differ significantly from the controls, but in the line tracking test which required more attention, their performance was significantly inferior to that of the control group.

Unlabelled: Working memory deficits are considered to play an important role affecting not only the pathogenesis but also the course of schizophrenia. Numerous studies of schizophrenic patients and their first-degree relatives suggest that this impairment may be an indicator of susceptibility to developing schizophrenia., Aim: A comparison of selected working memory indicators in patients with schizophrenia, their first-degree relatives, and healthy controls., Method: Participants in the study were 99 patients with the diagnosis of schizophrenia (according to the ICD- 10-DCR criteria) in an early period of remission, their healthy first-degree relatives (N = 42), relatives with a history of psychiatric disorder (N = 14), and a control group of participants (N = 54) unrelated to the subjects and with no psychiatric history. Selected tests from the computer-aided Vienna Test Battery were used, measuring: reaction time (RT) in a task that required choosing among complex stimuli of two modalities, a tendency to perseveration (PERSEV), and immediate visuospatial memory span (CORSI)., Results: Schizophrenic patients' performance was found to be significantly inferior to that of controls on all the cognitive tests related to working memory: they had a longer reaction time in forced choice tasks, elevated perseverative tendencies and reduced immediate visuospatial memory span. Moreover, healthy relatives of schizophrenic patients performed significantly poorer than did the controls both as regards perseverative tendencies and visuospatial memory scan. Schizophrenic patients did not differ significantly from their close relatives in the degree of visuospatial memory span impairment., Conclusions: The findings indicate that working memory deficits as assessed by the tests used in the study may be related to familial susceptibility to schizophrenia. Therefore, the dysfunction may be taken into account in the capacity of endophenotype of such susceptibility.

Unlabelled: A pair of auditory stimuli presented in a 0.5 second interval cause a reduction of the P50 auditory evoked potential (P50 AEP) amplitude after the second stimuli in the pair. In some, but not all studies, a clear deficit of such P50 AEP gating was observed in schizophrenic patients. It was present constantly irrespective of the clinical state. This deficit was also found in first degree relatives of schizophrenic patients. However the results of the studies, as well as their interpretation remain controversial., Aim: To differentiate between P50 AEP in groups of schizophrenic patients, their healthy first degree relatives, as well as those in the control group., Method: 50 schizophrenic patients (ICD-10 criteria (DCR)) in early clinical improvement phase, 26 healthy first degree relatives, as well sa 46 healthy individuals with no psychiatric illness in the self-report and family history. All those studied were stimulated with 120 pairs of auditory stimuli (clicks), each of duration 2 mseconds and a sound intensity of 73 dB, with a 500 msecond interval between the stimuli in a pair (S1 and S2) every 8 seconds. A high-end filter of 70 Hz and low-end filter of 10 Hz were applied. Bio potentials were recorded from the head apex, relatively to the mastoid process (A1 + A2). Eyeball-movement artefacts were registered from the Fp1-A1 and Fp2-A2 potentials. The registered bio potentials were evened on-line., Results: Relative (i.e. evaluated in relation to the potential after S1) lowering of the P50 potential after S2 was the most significant in the healthy control group (75%), in the other groups usually there was an increase in the S2 potential--higher in the schizophrenic patient group (-45%) and lower in their first degree relatives (-11%)., Conclusions: (1) Healthy individuals suppressed the neurophysiologic response to the second pair of auditory stimuli much more than the schizophrenic patients and their healthy families. (2) No difference was seen in the suppression of the response between the schizophrenic patients and their first degree relatives. The results are coherent with the idea of the dysfunction of the P50 gating having endophenotypic traits as far as schizophrenia goes.

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.

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.

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 48 hr 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.

Aim: To assess the reliability of the Paranoid-Depressive Scale (PD-S, Paranoid-Depresivitäts-Skala), the Frankfurt Self-feeling Scale (FBS, Frankfurter Befindlichkeitsskala), and of two visual analogy scales of a sense of illness (WAC) and of self-feeling (WAS)., Material: 210 patients with schizophrenia of various clinical courses., Method: All patients in the study group were required to complete each scale twice (test-retest) at 48hr intervals, in order to assess each method's reproducibility. In addition, the two complex questionnaire scales were analysed for internal coherence., Results: Spearman's rho correlation coefficient for reproducibility was found to be very high for all the scales. Also, the Cronbach's alpha coefficient for internal coherence was found to be acceptably high for both complex questionnaire scales, with reference to the scales as a whole, as well as to their dimensions (paranoid and depression dimensions of the PD-S)., Conclusion: Patients suffering from schizophrenia can reliably use the above-mentioned scales.

Aim: The aim of the study was an evaluation of validity measures of the CASS (Clinical Assessment of Schizophrenic Syndromes)--a new multi-purpose and multi-level clinical diagnostic instrument consisting of a diagnostic questionnaire (CASS-D) allowing to analyze a diagnosis of schizophrenia according to DSM-IV and ICD-10 criteria as well as of three rating scales designed for description and intensity evaluation of schizophrenic syndromes on the global (CASS-G), dimensional (CASS-P, a profile of 13 basic dimensions) or symptomatological (CASS-S, a set of 31 symptoms) level., Subjects: 194 inpatients consecutively admitted to the Department within approximately 6 months were assessed twice (at the start and end of their hospitalization) by 12 trained diagnosticians., Method: Several measures of validity were analyzed. Results obtained by means of CASS were compared with results of the SANS/SAPS, BPRS, and PANSS as reference rating scales (diagnostic validity). Characteristics of frequency, intensity, dynamics and specificity of scale items were used to analyze content validity. Factorial structure of CASS scales was applied as a measure of construct validity., Findings: Diagnostic validity of the new instrument seems to be confirmed by its very high correlation coefficients with rating scales recognized as international standards: BPRS, PANSS, and SANS/SAPS. Reasonable characteristics of frequency, intensity, dynamics and specificity of individual items (dimensions, symptoms) and sum scores of CASS scales and relationships between their values strongly suggest their content validity. Both sum (CASS-P, CASS-S) and global (CASS-G) scores of scales under study revealed some specificity--they had significantly higher values in patients with schizophrenia than in patients with other diagnoses. It allows to distinguish in a schizophrenic syndrome described by CASS components which are specific and not specific for this disorder. The latter have been left also in the final version for their practical and clinical importance. Construct validity of the CASS was studied separately for different scales (CASS-P, CASS-S) and different groups (all or only schizophrenic patients) by means of several factor analyses, and performed along identical statistical procedure (principal component method of extraction with criterion eigenvalue > 1, followed by Equamax rotation). Resulting solutions could be interpreted reasonably and consistently with contemporary attempts to find adequate factorial models of intrinsic structure of schizophrenic syndrome. Thus they support confidence for constructive aspect of the CASS validity., Conclusions: Ultimately, results obtained in the study suggest that the CASS may be considered as an instrument with some promising indices of diagnostic, content and construct validity, which may be potentially useful for clinical and research purposes.

Unlabelled: The CASS (Clinical Assessment of Schizophrenic Syndromes) is a new multi-purpose and multi-level clinical diagnostic instrument consisting of a diagnostic questionnaire (CASS-D) allowing for analysis of a diagnosis of schizophrenia according to DSM-IV and ICD-10 criteria, as well as of three rating scales designed for description and intensity evaluation of schizophrenic syndromes on the global (CASS-G), dimensional (CASS-P, a profile of 13 basic dimensions) or symptomatological (CASS-S, a set of 31 symptoms) level., Aim: The paper presents a rationale and construction principles of the tool followed by a study of its reliability and sensitivity as well as by preliminary attempt to normalize its results., Subjects: Twelve trained diagnosticians assessed twice (at the start and end of their hospitalization) 194 inpatients admitted consecutively, within approximately 6 months, to the Department., Method: Results of the CASS were compared with results of the SANS/SAPS, BPRS, and PANSS assessments playing the role of standard, reference instruments., Findings: High agreement coefficients (kappa) were calculated between a diagnosis of schizophrenia based on unoperationalized (clinical) criteria and operationalized diagnoses based on the CASS diagnostic questionnaire including ICD-10 and DSM-IV diagnostic criteria and algorithms. In the case of both complex (many-item) CASS scales (CASS-P, CASS-S) high reliability measures (internal consistency according to Cronbach's alpha) were found. Characteristics of frequency, intensity and dynamics of the CASS individual symptoms, dimensions and of syndrome as a whole were consistent with expectations based on clinical experience. Direct indices of clinical improvement calculated from CASS-G, CASS-P or CASS-S scores obtained at two time-points (admission, discharge) correlated fairly highly with more direct measures based on diagnosticians' clinical global impressions made when summing the results of treatment at discharge from the hospital. This finding suggests that CASS scores may sensitively register changes in patients' mental state during hospital stay and treatment. On the base of empirical distributions of CASS scales, a normalization (sten-scales) was proposed which may be useful for comparison of results obtained in differing groups of patients. Analysis of percentile and sten distributions of the CASS-P and CASS-S pointed out that patients with a diagnosis of schizophrenia had higher mean scores than patients with other diagnoses. This observation as well as above mentioned reasonableness (consistency with clinical experience) of a picture and dynamics of schizophrenic syndromes revealed in CASS assessments may be treated as preliminary assumptions of its content validity., Conclusions: Results of the study suggest that CASS has satisfactory measures of reliability and sensitiveness. They allow for a preliminary normalization of its scales and prompt to study its validity.

Diagnostic and symptomatological profiles of schizophrenic syndromes diagnosed according to ICD-10 and DSM-IV were compared. For this reason a group of patients fulfilling at least one of these sets of criteria was created and then diagnostic and symptomatological profile was compared between those who fulfilled the ICD-10 and those who fulfilled DSM-IV criteria. 105 inpatients hospitalized in acute phase of their first or one of consecutive episodes were included--102 of them had fulfilled ICD-10, and 90 DSM-IV criteria of schizophrenia. Diagnostic concordance between the two systems of criteria was high (83%). Differentiation of diagnostic profile (i.e. difference between frequency of fulfilling the specific requirements of ICD-10 or DSM-IV criteria) of the symptoms in these two groups was not significant, expert of 6-month criterion of duration of illness, which was significantly less frequently valid in ICD-10 syndromes group. A comparison of symptomatological profiles (i.e. frequency and intensity of symptoms) of schizophrenic syndromes diagnosed by ICD-10 or DSM-IV criteria and described by several rating scales (PANSS, SAPS/SANS, KOSS-S) did not show any significant differences. Results suggested that despite of different ways of defining the schizophrenic syndromes in both diagnostic systems, disorders manifested in the groups of patients created by means of them are very similar in psychopathological picture. This seems to be a significant change in comparison to more prominent differences contrasting the previous versions of the diagnostic systems (i.e. ICD-9 and DSM-III-R).

The aim of the study was the evaluation of concordance between rating and self-rating of attitudes toward psychotic disorders in one hundred patients (72 of them with diagnosis of schizophrenia). At discharge from the hospital patients were examined by two scales: Experience of Illness Scale (for rating) and My Experience of Illness Scale (for self-rating). Moderate concordance of results of rating and self-rating of the overall patients' attitude was noted. The higher concordance was found on dimension of evaluation of the illness experience, lower on dimension of reflectiveness to disease experience, and the lowest one on dimension of identification of the disease with self. Two different scales, simultaneously used, seem very beneficial because they reflected attitudes from two different perspectives, creating more complete a picture.

Basic indices of reliability and validity of a preliminary version of the new tool for "Clinical Assessment of Schizophrenic Syndrome" (CASS) was evaluated. Six experienced psychiatrists working in two teams examined the mental state of 49 patients with clinical diagnosis of schizophrenia, in the majority of them confirmed by the criteria of DSM-IV and ICD-10 (one of the teams examined 25 patients, the other-24). Each diagnostician rated the patients' mental state independently, by means of three-level rating permitted by the CASS-CASS-G (global), CASS-D (dimensions), and CASS-S (symptoms)--as well as by means of BPRS and PANSS scale included in the study as international standard scales for validity testing. Statistical analysis of the results confirmed that the scales under study allow to obtain results which could be characterized, with few minor exceptions, by high concordance coefficients (Kendall's W) high internal consistence coefficients (Cronbach's alpha) and high correlations (as measured both by Pearson's and Kendall's rank correlation coefficients taub) with internationally appreciated standard scales. It suggests reliability and validity of the CASS to the degree which could be considered as encouraging to continue the study on this instrument.

Under the so-called "clinical experiment" a procedure is meant allowing investigation of some more individual clinical issues, which are difficult to standardize. In investigation of patients' attitudes toward their schizophrenic illness utilizing of this procedure may both broaden the scope of information (beyond what is to achieve during clinical interview) and deepen it (beyond what is attainable by standardized methods of investigation). Examples of two kinds of clinical experiments used in an investigation of 100 schizophrenic inpatients' attitudes toward their experience of illness were presented. The first one, drawing "I--illness", analyzed spatial relations between image and "self" and "experience of illness" drawn successively on the same sheet of white paper. It seemed to be useful in studying the degree of identifying the illness with the patient's self. The "sheet test" proposed a trial to execute an action toward a white sheet of paper symbolizing the patient's experience of illness. It was useful in evaluating--particularly in emotional sense--the patient's whole attitude toward his or her experience of illness. Some empirical results confirming validity and usefulness of such experiments were presented. They point that such kind of clinical experiments may valuably supplement the other more standardized methods of investigation of the patients' attitudes.