Health behaviours of patients with affective disorders: a cross-sectional study

BACKGROUND

Severe mental disorders, including affective disorders (AD), are associated with high rates of physical illnesses that lead to premature patient death. Excess somatic comorbidity may be partially explained by lifestyle factors. This study aimed to investigate the health behaviours (HBs) of patients with AD in comparison to the HBs of patients with type 2 diabetes (T2D) and healthy controls (HCs) and to examine associations among HBs and sociodemographic and clinical factors, subjective quality of life and health status, and health locus of control.

METHODS

The sample consisted of 108 patients with AD, including 60 with bipolar disorder (BP) and 48 with unipolar disorder (UAD). Analyses included comparisons with a subgroup of AD individuals, patients with T2D and HCs matched in age and sex. The Health Behaviour Inventory was used to evaluate the overall levels of HBs and 4 HB categories. To identify independent determinants of health behaviours, a multivariate linear regression analysis was performed with factors identified as significant in bivariate analyses.

RESULTS

Most AD patients had a low level of HBs (40%), followed by moderate (35%) and high levels (25%), and there were no significant differences in HBs between the BP and UAD groups. Compared with the T2D and HC groups, the AD group had a significantly lower level of overall HBs and lower levels of HBs in one of the categories. Independent predictors of overall HBs were quality of life (β = 0.28, p < 0.001), age (β = 0.27, p = 0.002), and depressive symptoms (β = 0.23, p = 0.008). A total of 30% of the variance in HBs was explained.

CONCLUSIONS

These findings emphasise the need for a systematic assessment of single and multiple health behaviours to provide better care for patients with AD and reduce the potential adverse effects of an unhealthy lifestyle.

Neuropsychological performance facilitates emotion recognition in bipolar disorder

Aim of the study

In bipolar disorder (BD), evidence for both cognitive impairment and deficit in emotion recognition has been found. Several investigations indicate that cognition and face processing can be interrelated. In this study, we assessed the correlations between cognitive functioning and emotion recognition (face expression) in patients with BD during an acute manic and depressive episode as well as in remission using a large battery of neurocognitive tests.

Subject or material and methods

Twenty-four manic subjects, 21 with bipolar depression, and 22 euthymics, age-, sex-, and education-matched were included. Cognitive functions were assessed by the Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT, Stroop Color-Word Interference Test (SCWT), California Verbal Learning Test (CVLT), Benton Visual Memory Test (BVRT), Rey-Osterreich Complex Figure Test (ROFT), d2 test and Verbal Fluency Test (VFT). For emotion recognition, the Penn Emotion Recognition Test and Penn Emotion Discrimination Test were employed.

Results

In mania, performances on selected measures of the WCST, TMT, SCWT, CVLT, ROFT, d2 test, and VFT, achieved 19 positive correlations with better recognition of happiness. In depression, conducting these tests obtained 20 correlations with finer recognition of sadness. In remission, such performances acquired 18 correlations with greater identification of sadness (10 replicated those obtained in depression).

Discussion

Better emotion recognition in manic patients concerns mostly happiness, while in depression and remission, mainly sadness.

Conclusions

Better neuropsychological performance can facilitate emotion recognition. We hypothesize that the identification of sadness could be considered a biological marker of mood disorders.

Are yoga and physical activity determinants of quality of life in Polish adults? a cross-sectional study

OBJECTIVES

Yoga is an ancient form of physical activity (PA) that encompasses meditation, stretching and breathing techniques. Although the benefits of PA and associated lifestyle interventions are clear, we here addressed the paucity of evidence regarding the specific relationship between yoga and quality of life (QOL) in adults in Poland. We hypothesised that participation in PA and yoga could result in a positive impact on QOL.

DESIGN

Cross-sectional, self-administered questionnaire-based survey. Both the quantitative and qualitative variables were statistically compared. Multivariate analyses were performed using linear regression. Results were determined based on age, sex and education level; a p<0.05 was considered significant.

SETTING

Questionnaires were delivered to participants online, at high schools and universities, and in elderly communities in Poland.

PARTICIPANTS

714 polish citizens aged over 18 participated in the study; there are no specific entry and exclusion criteria besides age.

RESULTS

Statistically significant differences (p<0.05) were observed between the QOL of the physically active group (PAG) and non-PAG (N-PAG). Meanwhile, yoga practice was revealed to have a significant effect on QOL; QOL was found to be statistically higher (p<0.001) in the PAG with yoga (PAG-Y) (4.29±0.66) than in the N-PAG (3.83±0.92) and PAG without yoga (4.07±0.68).

CONCLUSIONS

The study shows that both regular PA and yoga practices could improve QOL; however, PAG-Y produced higher QOL scores than PA of other types. This outcome may be explained by the impact of physiological and psychological aspects within yoga practice. These results suggest that this unique combination impacts health more positively than other kinds of PA alone.

Development and Psychometric Properties of the Caregiver Burden Scale in Polish Caregivers of Stroke Patients

Purpose

Most stroke patients require long-term care of their family members. Excessive care burden entails several negative consequences; therefore, the severity of the burden should be periodically assessed. For this purpose, valid multidimensional measures are needed. Our study, which is a part of a larger research project, aims to translate and evaluate the psychometric properties of the Polish Caregiver Burden Scale (CBS) in relation to construct validity and internal consistency in caregivers of the patients after stroke.

Patients and Methods

The sample of this cross-sectional observational study consisted of 366 informal caregivers to consecutive first-ever stroke survivors. The five-factor Polish CBS and the Hospital Anxiety and Depression Scale (HADS) were administered during the home visits at three to six months after patients’ hospitalisation. Exploratory (EFA), confirmatory (CFA) factor analyses and a net analysis were performed to investigate the internal structure and a factorial construct validity of the CBS. Correlation analyses between the CBS and the HADS were carried out to examine convergent validity. Cronbach’s alpha and item-total correlation were applied to assess internal consistency.

Results

Three out of five factors identified by EFA were similar to the original indices of the CBS, while the remaining two deviated from the original structure of the CBS. The CFA five-factor model represented an acceptable fit (confirmatory fit index, CFI = 0.96, root mean square error, RMSEA = 0.04) but only after a modification. All subscale scores of the CBS were positively correlated with the HADS, supporting the convergent validity. Cronbach’s alpha coefficients for the overall scale (0.92) and all subscales (0.72–0.87) except one (0.69) and item-total correlation results indicated good internal consistency.

Conclusion

The Polish version of the CBS showed acceptable internal consistency and good convergent validity. Factorial validity and structural integrity were partially supported. The interrelationships between the CBS subdomains, their partial mutual contamination, and the scale’s non-orthogonal structure should be considered when interpreting the results of further studies using this version of the scale.

Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO₂ and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO₂, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO₂ level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO₂ of -1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0-4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

The impact of FFP3 respirators on the blood saturation

This study aims to investigate whether wearing a filtering facepiece class 3 respirators with personal protective equipment (FPP3/PPE) during work in the intensive care unit (ICU) affects the blood saturation (SpO2), the heart rate (HR), and the well-being of health care workers (HCWs). This preliminary study included a group of 21 volunteers (including 16 females (76%), with a median age of 23 years). Each worker served as his own control and performed the test two times: they wore the FFP3/PPE and did not wear it for a three-hour shift in the ICU. The working with an FFP3/PPE compared to not working with an FFP3/PPE caused a significant, but within normal ranges, influence on the level of SpO2 with a mean decrease of - 1.43%. The highest reduction in the SpO2 was - 2.29% and occurred after 150 min of work. All of the score scales of the well-being markers increased consecutively but moderately during the shift while wearing the FFP3/PPE. We assume that a 3-h shift rhythm is a safe and reliable solution, i.e., three hours of working in the FFP3/PPE in the ICU, followed by rest or working without an FFP3/PPE.

Neuropsychological exponents for the driving ability in remitted bipolar patients

Background

Bipolar disorder (BD) is associated with cognitive deficits regardless of the phase of the disease. Medications used in treatment are an additional factor that may affect cognitive performance. Poor cognitive performance can significantly affect a patient's ability to drive.

Aim of the study

This study aims to explore cognitive functions relevant for safe driving in the group of remitted bipolar patients.

Method

Patients with BD in remission (n = 33) and healthy volunteers (n = 32) were included. Selected psychometric tests for drivers were carried out using computer software: called Specialistic Diagnostic Platform (SPD): The Cross-over Test (COT) version with free tempo (COT-F) and tempo of 50 tasks per minute (COT-50) and the Signal Test (ST). Moreover, the following neuropsychological tests were used: Rey Auditory Verbal Learning Test (RAVLT), Stroop Color-Word Test (SCWT) part A and B, and Trail Making Test (TMT) version A and B.

Results

In comparison with healthy controls bipolar patients in remission had poorer outcomes for some cognitive parameters and longer reaction times in both tests for drivers and neuropsychological tests. Additionally, we found a significant correlation between the time of performance of neuropsychological tests and the time of psychometric tests for drivers.

Conclusion

Patients with BD performed worse in several cognitive domains assessed by tests for drivers and neuropsychological tasks. These deficits can affect the speed of the patient's motor reactions while driving.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Background

Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.

Methods

The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.

Results

Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.

Conclusions

Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Polish version of the Self-evaluation of Negative Symptoms (SNS)

OBJECTIVES

The aim of the study was to create a Polish version of the Self-evaluation of NegativeSymptoms (SNS) scale, to assess its internal consistency, and to make correlations between the SNS scores and the Brief Negative Symptom Scale (BNSS) scores in the group of patients with schizophrenia.

MATERIAL AND METHODS

The procedure of Polish adaptation of the French-language version of the SNS scale, comprising 20 items organized in 5 subscales: asociality, blunted affect, alogia, avolition and anhedonia, was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women) with severity of symptoms on the Positive and Negative Syndrome Scale (PANSS) 56±16 points, receiving unchanged pharmacological treatment in the last 3 months.

RESULTS

The Polish version of the SNS scale was accepted by the author of the scale, Professor Sonia Dollfus. The reliability analysis showed high values of the Cronbach's alpha coefficient for the whole scale (0.91) and for the subscales (0.61-0.85). The SNS and its subscales showed significant correlations with the total BNSS score and with the scores of the BNSS subscales, which confirms the validity of the scale.

CONCLUSIONS

A statistically significant level of consistency of the whole scale and its individual domains with the results of the clinical assessment with the BNSS, speaks for the adequacy of the self - assessment of negative symptoms by a patient with schizophrenia. Good psychometric properties of the Polish version of the SNS obtained in the study can indicate its usefulness in the research on negative symptoms conducted in Poland.

Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study

INTRODUCTION

This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms.

METHODS

Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale.

RESULTS

At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61).

LIMITATIONS

The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results.

CONCLUSIONS

(1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients' mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.

Is Venlafaxine More Effective than Escitalopram and Nortriptyline in the Management of Painful Symptoms in Patients with Major Depression?

BACKGROUND

Conflicting data regarding the efficacy of antidepressants of different mechanism of action on unexplained painful physical symptoms (UPPS) in depression have been published so far.

OBJECTIVE

The aim of this study was to compare the impact of escitalopram (ESC), nortriptyline (NOR), and venlafaxine (VEN) on UPPS in patients with major depression.

MATERIALS AND METHODS

Sixty patients, participants in the GENDEP study, with a diagnosis of depression according to the ICD-10 criteria were randomly assigned to treatment with ESC (10-30 mg, mean dose 15.2, standard deviation [SD]±9.2) or NOR (50-150 mg, mean dose 106.2, SD±8.2). Additionally, 30 patients who were treated with VEN (75-225 mg, mean dose 181.3, SD±8.8) were included. Before inclusion (day 0) and throughout the study (days 14, 28, 42, 56), the severity of pain was monitored using the visual analog scale.

RESULTS

The patients treated with ESC, NOR, and VEN did not differ in the intensity of pain at days 0, 14, 28, 42, and 56.

CONCLUSION

Our results do not support the hypothesis suggesting the superiority of VEN over ESC and NOR in the management of UPPS in major depression.

Evaluation of the quality of life of postmenopausal osteoporotic and osteopenic women with or without fractures

INTRODUCTION

Most studies concerned with the quality of life (QoL) of women with reduced bone mineral density (BMD) focus on patients with vertebral and non-vertebral fractures. Our objective was to evaluate QoL among patients with reduced BMD regardless of their fracture history compared to women with normal BMD.

MATERIAL AND METHODS

Eighty-five patients in the study group were classified as osteoporotic, with BMD results measured by densitometry and expressed by T-score ≤ -2.5 SD, 122 women were osteopenic, with -2.5 < T-score ≤ -1.0 SD, and 97 subjects were assessed as normal, with T-score > -1.0 SD. Mean ages of women according to groups were 59.90, 57.67 and 55.68, respectively. Assessment of life quality was conducted using the Polish version of the QUALEFFO-41 scale.

RESULTS

The ratings in the assessment (QUALEFFO-41) of QoL were lower for osteoporotic and osteopenic women than for the normal BMD group with regard to pain (p = 0.006), social function (p = 0.001), health perception (p = 0.001), and mental function (p = 0.001). For total QUALEFFO-41 the associated factors were: secondary and higher education (OR = 0.49; 95% CI: 0.29-0.82), self-perceived deformity of the back (OR = 4.09; 95% CI: 1.88-8.93), previous fractures (OR = 2.52; 95% CI: 1.09-5.82), reduced height (OR = 2.48; 95% CI: 1.13-5.39) and anxiety (OR = 1.42; 95% CI: 1.21-1.66).

CONCLUSIONS

It seems necessary to evaluate QoL of women with reduced BMD before fractures occur, to aid development of health education aiming to reduce the incidence of osteoporosis and prevent fractures.

Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia

OBJECTIVES

The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.

METHODS

Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4-6 years (T3), and 7-11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients' psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.

RESULTS

Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.

CONCLUSIONS

Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke

OBJECTIVES

To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden.

METHODS

Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors.

RESULTS

Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers' sense of coherence and amount of time spent caregiving at Time 1, and with caregivers' anxiety at Time 2.

CONCLUSIONS

A significant proportion of the caregivers experienced considerable burden in the post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers.

PRACTICE IMPLICATIONS

Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving.

Symptoms of depression among adults in rural areas of western Poland

OBJECTIVE

To measure the intensity of depressive symptoms in the populations residing in rural areas of western Poland, and to delineate the putative association between the intensity of depression and selected socio-demographic and clinical factors.

MATERIALS AND METHOD

The study covered 445 adults recruited from one family physician practice in the rural area of Wielkopolska region. The following tools were applied: Beck Depression Inventory (BDI), the WHO WHOQoL-Bref quality of life assessment scale, and a socio-demographic and clinical questionnaire elaborated by the authors.

RESULTS

Depressive symptoms were observed in approx. 30% of the patients. The intensity of symptoms correlated with age, female gender, and inversely correlated with the quality of life. There was no association between depressive symptoms and level of education (counted as years of education), number of somatic illnesses, and family burden of psychiatric disorders.

CONCLUSION

Symptoms of depression were noted in approx. 30% of patients who consulted their family physician. The Beck questionnaire is a simple tool whose application could decidedly improve the recognition of depression. It is worth taking note of factors that may be connected with the intensity of depressive symptoms - gender, the number of diagnosed somatic illnesses, and the quantity of drugs administered.

Caregiving burden and its determinants in Polish caregivers of stroke survivors

INTRODUCTION

Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization.

MATERIAL AND METHODS

Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver's sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden.

RESULTS

Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients' functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patient's gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden.

CONCLUSIONS

Clinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients' dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.

The prevalence of antipsychotic polypharmacy in schizophrenic patients discharged from psychiatric units in Poland

BACKGROUND

The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates.

METHODS

Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale.

RESULTS

At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%.

CONCLUSIONS

The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.

[Social functioning and quality of life in schizophrenia patients --relationship with symptomatic remission and duration of illness]

AIM

The assessment of social functioning and subjective quality of life in relation to symptomatic remission in schizophrenia patients after a first psychiatric hospitalization, as well as the analysis of connection between intensity of psychopathological symptoms and the level of functioning and quality of life, taking into account the status of remission and duration of illness.

METHODS

Sixty-four patients were assessed, at 13 months (1st examination) and at mean 8 years (2nd examination) after the first hospitalization, and compared with two control groups of healthy persons. The following scales were used: Positive and Negative Syndrome Scale (PANSS), Social Functioning Scale (SFS), WHO Quality of Life (WHOQoL--Bref) scale and Global Assessment Scale (GAS).

RESULTS

At first examination, the score of SFS domains was not significantly different between patients in remission and without remission while the score of most domains of WHOQoL was significantly higher in patients with remission. At second examination, the scores of both SFS and WHOQoL were significantly higher in patients with remission and did not differ significantly from healthy persons. In both examinations, significant correlations between PANSS and SFS and WHOQoL scores were found, especially in patients without remission.

CONCLUSIONS

At mean 8 years after first psychiatric hospitalization, 2/3 of the patients with schizophrenia did not get a symptomatic remission and had worse social functioning and quality of life compared to patients with remission and to healthy controls. Psychopathological symptoms correlated significantly with social functioning and quality of life, especially among patients without remission.

Quality of life among the elderly with locomotor disabilities in Sweden and Poland in the 1990s

PURPOSE

To estimate the proportion of locomotor disabilities in two elderly populations in Sweden and Poland, respectively. To estimate the perceived quality of life (QoL) in the disabled groups in samples from each country using a model developed by Carol Estwing Ferrans.

METHODS

The study comprised three parts: an epidemiological screening test for identification of individuals with a locomotor disability, an analysis of background data of importance and home visits with evaluations of quality of life and functional capacity. Home visits were made using the Quality of Life Index, (QLI) of Ferrans and Powers and a functional scale, the Standardized Practical Equipment (SPE). Data were collected for the period 1991-1996.

RESULTS

In the population part of the study, with 1,380 respondents (78%) comprising elderly Swedish persons, 288 reported a locomotor disability. This can be compared with 425 among 1,045 respondents (52%) in a Polish elderly group. The tests at the home visits (Sweden, n = 89; Poland, n = 84) showed that both men and women in the Swedish group reported significantly higher scores for the total QLI (max. 30.00) with men reporting 26.68 points compared to 19.73 and women reporting 21.39 points compared to 19.40 and for three of the four subscales. Also, the Polish group scored lower for balance and mobility (SPE).

CONCLUSION

The study provides an important view of the life situation measured with the QLI tool and the SPE for elderly persons with locomotor disorders in Sweden and Poland during the mid-1990s. The results are congruent with epidemiological reports on the poor health situation in Poland, particularly during that time. A new investigation among the elderly with locomotor disorders in the two countries today might provide different results.

Quality of life in multiple sclerosis

An overall aim of treatment in multiple sclerosis is to lower the negative impact of the disease on functioning and quality of life of patients. Therefore, a measurement of functioning and quality of life should be included in the evaluation of the effectiveness of treatment. The most commonly used quality of life questionnaires, either generic or specific, were presented in this paper,. Information about clinical and functional status is useful in the interpretation of the quality of life assessment results. Because of that, instruments for the assessment of depression, cognitive functions, functional ability and fatigue in multiple sclerosis were also described.

Quality of life and social support in patients with multiple sclerosis

BACKGROUND AND PURPOSE

The aim of the study was to evaluate quality of life (QoL) in multiple sclerosis (MS) patients and to assess the relationship between QoL and social support taking into account key clinical factors and other sociodemographic variables.

MATERIAL AND METHODS

Two hundred and ten MS patients (150 women and 60 men) aged between 21 and 59 years were evaluated; the MS group was compared with 108 healthy controls. QoL (MSQOL-54), disease severity (Expanded Disability Status State, EDSS), social support (Social Provisions Scale, SPS), mood (Beck Depression Inventory, BDI) and basic clinical and demographic data were assessed.

RESULTS

Disease severity was mild (EDSS < 4) in 85% of patients, and depressive symptoms (BDI > 13) were present in 41% of patients. Mean physical health composite of MSQOL-54 was 53.6 ± 20.7 and mean mental health composite was 60.0 ± 19.8. MS patients scored significantly lower than healthy subjects. Mean SPS was 78.2 ± 10.9 (range, 6-96) which indicated high social support. In bivariate analysis, social support correlated significantly with the majority of MSQOL domains; in multivariate analysis, however, this relationship was not significant. Emotional well-being was the main predictor of QoL, in both physical and mental domains.

CONCLUSIONS

MS influences QoL but to a greater extent in the physical than the psychological domain. The role of social support in QoL is generally positive but its protective function may be weakened when interacting with other factors. Depression is the main predictor of QoL when adjusted for other factors. Thus, treatment of mood disturbances might significantly improve QoL in MS patients.

Quality of life of post-stroke patients and their caregivers

With improvements in health care, more people survive stroke but many have to cope with the physical, psychological, social and functional sequelae, resulting in increased personal and public costs. Cerebral stroke causes a significant deterioration of the patient's functioning and worsening of her/his quality of life. Long-term disability caused by stroke is a common problem in all countries and its incidence increases markedly with advancing age. The assessment of the Quality of Life could be as well the evaluator of sequelae of stroke as an indicator of the effectiveness of the post-stroke rehabilitation. In this review article, the contemporary state of art in assessment of the post-stroke Quality of Life has been presented. The emphasis was placed on participation in terms of personal factors and environmental factors of post-stroke persons and their caregivers.

[Stroke incidence, case fatality and mortality--current trends and future prognosis]

In Europe, since the 40's of the previous century the tendency of decreasing number of stroke cases has been observed. In Poland, epidemiological data concerning the stroke have shown relatively stable index of stroke incidence and stroke mortality rates in the last few decades. The decline concerns mostly early poststroke mortality which results directly in the increase of the number of people who have recovered from stroke. However, the index of post-stroke mortality is still higher in Poland than in other European countries and the USA. The prognosis referring to the incidence in next years, caused by demographic alterations related to the increasing number of elderly people, is not optimistic. Significant increase of population at the age of 65 and more is going to contribute to the increase of the number of new stroke cases in Poland and other European countries. This fact becomes a challenge both for hospitals, care-giver agencies and patients' families.

[Quality of life after traumatic brain injury]

The majority of concepts of quality of life (QoL) include both objective and subjective dimensions. The objective aspect of QoL after traumatic brain injury (TBI) concentrates on patients' functioning in physical, psychological, social and cognitive domains. The subjective component refers to life satisfaction and individual evaluation of life as a whole or in the domains. The aim of this paper was to review research on QoL in TBI patients taking into account this bidimensional framework. The studies reviewed show that TBI has a significant, long-term impact on all QoL domains. Subjects with TBI score significantly lower than non-injured controls or normative groups. Traumatic brain injury has a more profound effect on the psychosocial domains than on the physical domain, which means that the impact of TBI is cumulative. Further research should focus on prognostic factors of QoL and on the role of rehabilitation in prevention of deterioration in QoL of patients and their caregivers.

[Prospective evaluation of the early course of schizophrenia in men and women after a first psychiatric hospitalization]

AIM

To evaluate prospectively the course of schizophrenia in men and women after a first psychiatric hospitalization in terms of socio-vocational situation, social functioning and psychopathological status.

METHODS

A study sample consisted of 74 patients (46 males, 28 females), examined 1 month (T. 1), 13 months (T. 2) after a discharge, and 4-6 years after T. 1 (T.3). The research instruments were: a questionnaire for socio-demographic data and information about the illness course, Social Functioning Scale (SFS) and PANSS.

RESULTS

During the follow-up period, the socio-vocational situation and psychopathological status has worsened. The percentage of patients unemployed or not studying increased by 26%, whilst those receiving a disability pension by 50%. Despite of the pharmacological treatment, symptoms severity increased, particularly in the group of negative symptoms and general psychopathology (p < 0.01). Social functioning showed a significant trend to improve but only in some domains. Between T. 1 and the last follow-up, there was an increase in total SFS and in 3 out of the 7 domains. This improvement was particularly noticeable in the group of female patients hospitalized before the age of 20 years (p < 0.05). Female patients, regardless of age of their first hospitalization, scored higher in the Independence performance domain.

CONCLUSIONS

(1) The early course of schizophrenia appears to be heterogeneous. This was reflected by the deterioration of socio-vocational situation and psychopathological status, and by a variability of the changes in social functioning. (2) This heterogeneity and non-parallel changes should be taken into account when planning and evaluating therapeutic interventions. (3) The early course of schizophrenia seems to be more beneficial for female patients.

Clinical and psychological correlates of poststroke fatigue. Preliminary results

BACKGROUND AND PURPOSE

Although poststroke fatigue concerns almost 60% of patients, still little is known about its pathogenesis and contributing factors. Therefore, the purpose of this study was to evaluate the severity of fatigue in terms of its impact on physical, psychological and social functioning as well as to determine the relation between fatigue and clinical, demographic and psychological factors.

MATERIAL AND METHODS

Patients (n = 50) with acute first-ever stroke admitted to the neurological department were interviewed at 3 months after discharge. Poststroke fatigue was assessed using the Polish version of the Fatigue Impact Scale. Neurological status was examined with the Scandinavian Stroke Scale, functional status with the Barthel Index, and emotional status with the Beck Depression Inventory. Styles of coping with stress were identified using the Coping Inventory for Stressful Situations. Sex, age, type of stroke and lesion location were documented as well.

RESULTS

Ninety percent of patients demonstrated high level of fatigue in physical functioning, 16% in the psychological domain, and 18% in the social domain. In the univariate analyses, impact of fatigue on patients functioning significantly correlated with age, lower mood, neurological and functional status, as well as with styles of coping. Emotion-oriented coping was associated with lower level of fatigue, whereas the reverse was found regarding task-oriented coping. In the multivariate analyses the emotion-oriented style of coping was the most important correlate of fatigue.

CONCLUSIONS

The causes of poststroke fatigue appear to be multifactorial. Psychological factors, especially coping strategies, might be an important area for future interventions.

Quality of life and depression in schizophrenic patients

PURPOSE

The aim of the study was to assess depressive symptoms, and to establish their influence on the subjective and objective quality of life (QOL) in schizophrenia patients.

MATERIAL AND METHODS

Seventy four subjects: 46 male and 28 female, aged 24.7 +/- 6.7 years, were enrolled for the study. World Health Organization of Life Instrument-Bref (WHO-QOL-BREF), Social Functioning Scale (SFS) and Calgary Depression Scale for Schizophrenia (CDSS) were used.

RESULTS

Severity of depressive symptoms showed moderate correlation with objective and strong correlation with subjective measures of QOL.

CONCLUSIONS

Detection and appropriate treatment of depressive symptoms in schizophrenic patients may affect their functioning and perception of own health.

Quality of life in Polish respondents: psychometric properties of the Polish WHOQOL-Bref

The aim of this study was to examine the validity and reliability of the Polish WHOQOL - Bref in a sample of 908 respondents. The Bref is a generic quality of life (QoL) instrument designed for cross - cultural use. Correlational and multivariate analyses confirmed the relevancy of individual items and domains supporting the construct validity of the scale. Multiple regression analyses of the domain scores with two overall questions (dependent variable) showed that all four domains made a significant contribution in explaining the variance in overall QoL. The psychological domain made the strongest contribution (unstandardized B coefficient = 0.10, r2 = 0.41), followed by the social, environmental and physical domains. When overall health satisfaction was considered as the dependent variable, the physical domain contributed most strongly (unstandardized B coefficient = 0.21, r2= 0.43) followed by the psychological and environmental domains. Exploratory factor analyses resulted in a four factors solution with 24 items explaining 49.6% of the cumulative variance. Confirmatory factor analyses lended marginal support for the goodness of fit of the four-domain model. The physical domain was found to be strongest in differentiating between unhealthy and healthy subjects, followed by psychological and social domains. Acceptable internal consistency was shown with Cronbach's alpha coefficients being greater than 0.70 for all domains with the exception of the social domain. Further exploration of the scales validity and conceptual clarity need further testing in Polish and international samples.

[Current possibilities of assessment of quality of life in multiple sclerosis]

An overall aim of treatment in multiple sclerosis is to minimize the negative impact of the disease on functioning and quality of life of patients. Therefore, a measurement of functioning and quality of life should be included in the evaluation of the effectiveness of treatment. In this paper, the most commonly used quality of life questionnaires, either generic or specific, are presented. The information about clinical and functional status are useful in the interpretation of the quality of life assessment results. Therefore, the instruments for the assessment of depression, cognitive functions, functional ability and fatigue in multiple sclerosis are also described.

[The role of social support in the quality of life after stroke. A review of selected experimental research]

Surviving of a stroke may be considered as a major stressful life event. Neurological and functional deficits often lead to a loss of independence, social alienation, depression and deterioration of the quality of life. Earlier correlational studies have shown that social support may mediate responses to stroke and improve patients' quality of life. The aim of this article was to review randomized controlled trials (RCTs) concerning the role of professional social support in the quality of life after stroke. The vast majority of the RCTs published in the last decade did not show any positive impact of support on the psychosocial consequences of a stroke. It does not mean, however, that professional support is necessarily ineffective. The reviewed RCTs may fail to detect benefits because of some methodological and theoretical limitations. There is a need of further research but more attention should be given to a power analysis, selection of an appropriate outcome measure and standardisation of a study procedure. It is also important to found research deliberately on existing social support theories.

Burnout, stress and styles of coping among hospital nurses

PURPOSE

The evaluation of professional burnout among hospital nurses and the analysis of correlations between burnout and a subjectively perceived stress and coping styles.

MATERIAL AND METHODS

A study sample consisted of 227 nurses from general medical, neurological and psychiatric hospital wards. A set of 3 questionnaires was used, including Maslach Burnout Inventory (MBI), Coping Inventory for Stressful Situations (CISS) and Subjectively Perceived Stresss (SPS).

RESULTS

Average and high level of burnout in the emotional exhaustion (EE), depersonalisation (D) and personal accomplishment (PA) was present at 71%, 39.8% and 77% of nurses respectively. A significantly higher level of burnout was noted in the subgroup of general medical nurses. The diferences involved the total MBI score and the results of the subscales EE and D (p < 0.01). A significant correlation has been found between the subjectively perceived stress and the level of burnout (r = 0.51, p < 0.01). Significant correlations has been found between MBI scores and CISS scores. Correlation between burnout and a task oriented coping was negative and correlation between burnout and emotion oriented coping was positive.

CONCLUSIONS

The level of stress influences the professional burnout among nurses. There is a diversity in the level of burnout depending on the specialization at work, which is not accompanied by a similar diversity in the subjectively perceived stress. The correlation between burnout and a coping style is rather weak, but statistically significant.

Objective and subjective quality of life in schizophrenic patients after a first hospitalization

PURPOSE

There is no single, universally accepted definition of quality of life (QOL). Both subjective and objective information is necessary to assess QOL. The aim of the study was to evaluate in cross-sectional and prospective manner objective and subjective quality of life in schizophrenic patients 1 month after hospitalization and in one year follow-up.

MATERIAL AND METHODS

A study sample consisted of 86 schizophrenic subjects: 52 male and 34 female; age 25.5; +/-5.8 (range 17-47) and control group of matched 52 male and 34 female subjects were enrolled. Subjective QOL scale (WHOQOL-BREF), Social Functioning Scale (SFS) and structured questionnaire were used. Patients were evaluated 1 month (T1) and 13 months (T2) after a discharge from the hospital.

RESULTS

In both T1 and T2 we found similar levels of SFS score and subjective measurement of QOL in patients, which were significantly lower than in healthy controls.

CONCLUSIONS

This study showed that both objective and subjective quality of life are significantly decreased directly after hospitalization, and they are relatively stable in 1-year follow-up.

[The role of social support on the quality of life of patients with schizophrenia]

The importance of social support for mentally ill people has been increasingly emphasized in recent years. This has resulted from studies showing that family and professional support plays an important role in preventing rehospitalizations and in improving quality of life of patients with schizophrenia. This article presents and analyses the findings of current research concerning the effectiveness of social support in rehabilitation programmes as well as highlights the problem of matching the type and quantity of social support provided to the patients' needs and to the phase of the disease.

The life situation and functional capacity of the elderly with locomotor disability in Sweden and Poland according to a model by Lawton

A quadripartite concept, the Good Life for older people, was developed by the American psychologist M. P. Lawton and forms the theoretical framework of this study. Ninety Swedish and 93 Polish subjects, aged > or = 60 years who had reported locomotor disturbances in selected samples from the two countries, took part in the study. Interviews were performed using the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) and functional testing was done using the Standardized Practical Equipment (SPE). The Polish elderly scored lower in most domains of the PGCMAI, which meant a worse life situation according to the Good Life model. On the SPE, scoring was lower in the Polish group, mainly on items related to balance and mobility. There was a logic convergent validity between the PGCMAI and the SPE in the whole group. The somewhat more complicated life situation for the Polish elderly has to be further analysed.

Quality of life in stroke patients

OBJECTIVES

To describe global and domain-specific quality of life (QOL) after stroke and to identify the factors that are important for post-stroke QOL.

MATERIAL AND METHODS

A hospital-based sample of 72 stroke patients was followed up for 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index. Regression analysis was performed to identify the variables that best predicted QOL.

RESULTS

The overall QOL of stroke patients was relatively good, although worse than that of subjects in a comparison group. The highest QOL was found in the 'Family' domain, and the lowest in the 'Health and functioning' domain. Emotional support, depression and functional disability were three separate variables explaining 38% of the variance in QOL.

CONCLUSIONS

Strengthening of family support, treatment of depression and reduction of physical dependence may be the decisive factors in improving post-stroke QOL.

[Quality of life of women after ischemic stroke]

OBJECTIVES

Stroke is an important cause of morbidity and mortality in postmenopausal women. The aim of the study was to evaluate functional and psychological quality of life in women after a first-ever stroke as well as to identify independent predictors of post-stroke quality of life.

DESIGN

Cross-sectional and correlational study.

MATERIAL AND METHODS

A group of 46 women (mean age 67.1 yrs) after a first-ever ischemic stroke was followed up for 6 months after the onset of the stroke. Quality of life was assessed with the Polish versions of Sickness Impact Profile and Quality of Life Index. The variables studied were neurological and functional status, depression, lateralization, age, gender, marital status, education, living arrangement, emotional support.

RESULTS

The study has shown that the quality of life of investigated women was significantly worse than that of subjects' from a comparative group. Neurological status, depression and emotional support was the most important correlates of quality of life.

CONCLUSIONS

Rehabilitation focused on fostering physical independency, treatment of depression and strengthening social support may be decisive factors in improving post-stroke quality of life.

Post-stroke quality of life and depression

BACKGROUND

Studies on the determinants of the quality of life (QOL) after stroke bring differing results depending on the applied concept of QOL. This may lead to confusion about the contribution of various factors to the post-stroke QOL.

OBJECTIVE

The aim of the study was: (i) to investigate functional and psychological QOL in the individuals after the first ischemic stroke; (ii) to identify the most important correlates of QOL; and (iii) to examine the significance of depression among the other possible predictors of QOL.

METHODS

A hospital-based sample of 72 stroke patients was followed up to 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index and the Sickness Impact Profile. A multiple regression procedure was performed to examine relationships between QOL and the study variables.

RESULTS

In spite of good recovery, the psychological and functional QOL of the examined patients was impaired, although the negative impact of stroke was greater on the objective QOL than on the subjective QOL. Stroke-related impairment, depression, functional disability and marital status predicted 80% of the variance in the functional QOL. Emotional support, depression and functional disability explained 38% of the variance in psychological well-being.

CONCLUSIONS

Depression and physical disability were the most important predictors of QOL after stroke since their impact on QOL was more robust in comparison to the remaining variables. For improving QOL, a comprehensive care for patients aimed at reducing physical dependence and ameliorating depressive symptoms could be recommended.