Group psychoeducation in bipolar disorder and its influence on the cognitive representation of illness and basic personality dimensions : a control group study

Aims: The study aims to determine whether participation in structured group psychoeducation has an influence on the cognitive representation of illness and whether the basic personality traits are mediating factors in the process of its potential change. Method: Initially, the study included 40 consecutive patients with the DSM-IV diagnosis of bipolar disorder: the first 20 were included in the study group and the following 20 in the control group. To take part in the study, all patients had to be in functional remission. The final statistical analysis includes 14 patients from each group. Cognitive representation of illness was presented in terms of the following variables: acceptance of illness, locus of health control, general self-efficacy, hope for success, and beliefs about the condition. The intervention used was a structured group psychoeducation program. It comprised eight 90-minute meetings that combined workshops and lectures. Both groups were tested at three points in time (before intervention in the study group, after the intervention, and 6 months later). Results: In the group who took part in the psychoeducation program, statistically significant positive changes were observed in the internal locus of health control, problem-solving, sense of self-efficacy and beliefs about bipolar disorder directly after the end of the program. Conscientiousness was identified as a partial mediator for change in the group in terms of the ability to problem-solve. Conclusions: Psychoeducation can have a positive effect on variables connected with cognitive representation of illness. Some personality variables can have an influence too. Both findings require further assessment in studies on larger groups, where clinical data should also be included in the analyses

Positive Experience Training - the new therapeutic proposal in the complex depression treatment : part I

Celem artykułu jest zaznajomienie Czytelnika z metodą Treningu Pozytywnych Doznań. Artykuł zawiera informacje o podstawowych założeniach prezentowanej metody, omówione zostały zasady przeprowadzania zajęć. Autorzy podają również informacje o wskazaniach i przeciwwskazaniach oraz efektach terapeutycznych metody. Trening Pozytywnych Doznań omówiony został także w kontekście innych podejść terapeutycznych, ze szczególnym uwzględnieniem podejścia poznawczo-behawioralnego. Przedstawiono dodatkowo kontekst filozoficzny oraz nawiązania TPD do hedonizmu Epikura.Positive Experience Training is our proposal to name the German therapeutic concept (Genusstherapie) created and developed by Dr. Rainer Lutz from Marburg University. The method aims at developing the ability to find and perceive pleasant sensual experiences, which are believed by its author as being important in treatment and prevention o f psychiatric disorders. The article informs about the concept and tries to introduce Polish terms specific for the method. The main principle of "euthymie" therapy, as the method is often named, is the statement that each therapeutic approach to depression treatment must include elements promoting development of and sustaining behaviours directed towards pleasant experiences. The article contains information on basic principles of the method, especially on the so-called "hedonistic rules" , which are general psychological hints on dealing with pleasant experiences. Rules o f conduction with the information on the order of senses being worked on, the number and the duration of meetings, the size and the character of a group, the choice of sensual stimuli and behaviours of therapists are presented. The authors also give information on indications, contraindications and therapeutic effects of the method. Positive Experience Training was also discussed in the context of other therapeutic approaches especially the cognitive-behavioural approach. A philosophical context and references to Epicure’s hedonism were presented

Positive Experience Training - the new therapeutic proposal in the complex depression treatment : part II

Trening Pozytywnych Doznań je s t koncepcją terapeutyczną, której podstawowym założeniem jest rozwój umiejętności odbioru przyjemnych doznań zmysłowych, istotnych w terapii i prewencji zaburzeń psychicznych. Artykuł w szczegółach opisuje przebieg spotkań poświęconych poszczególnym zmysłom z uwzględnieniem rodzaju używanych "rekwizytów" stanowiących źródło przyjemnych bodźców, sposobu ich prezentacji, aktywności i zachowania się terapeutów. Przedstawiono także obserwacje i wnioski dotyczące przebiegu terapii oraz je j oddziaływania na zachowanie i stan psychiczny pacjentów. Praca omawia również korzystny wpływ, jaki Trening Pozytywnych Doznań wywiera na prowadzących zajęcia terapeutów poprzez wzmacnianie zachowań, uwzględniających istotną rolę pozytywnych doznań i przyjemności w codziennym życiu.Positive Experiences Training is the therapeutic concept, in which the basic principle is the development o f all abilities to perceive pleasant sensual experiences, which are important in therapy and prevention of psychiatric disorders. It is a fixed element of the complex treatment of depression in the Depression Treatment Ward of Psychiatry Department of Collegium Medicum Jagiellonian University in Kraków. In- and out- patients participate in the therapeutic meetings. The meetings take place once a week and last 45-90 minutes. The therapeutic cycle consists of 10 meetings. Two meetings are devoted to each sense. The senses are discussed in specific order- smell, touch, taste, eyesight, and hearing- taking into account their accessibility for the depressive patients. The article gives a detailed description of the therapeutic meetings devoted to each sense with the inclusion of stimuli being used as the source of pleasant experiences, the way of presenting them and the activities and behaviour of therapists. The observations and conclusions concerning the course of therapy and its influence on behaviours and psychiatric status of patients were presented. The article also presents the positive influence that the Positive Experience Training exerts on therapists by strengthening behaviours, which take into account the positive role of pleasant experiences and pleasure in everyday life

Machine learning-based identification of suicidal risk in patients with schizophrenia using multi-level resting-state fMRI features

Background: Some studies suggest that as much as 40% of all causes of death in a group of patients with schizophrenia can be attributed to suicides and compared with the general population, patients with schizophrenia have an 8.5-fold greater suicide risk (SR). There is a vital need for accurate and reliable methods to predict the SR among patients with schizophrenia based on biological measures. However, it is unknown whether the suicidal risk in schizophrenia can be related to alterations in spontaneous brain activity, or if the resting-state functional magnetic resonance imaging (rsfMRI) measures can be used alongside machine learning (ML) algorithms in order to identify patients with SR. Methods: Fifty-nine participants including patients with schizophrenia with and without SR as well as age and gender-matched healthy underwent 13 min resting-state functional magnetic resonance imaging. Both static and dynamic indexes of the amplitude of low-frequency fluctuation (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity as well as functional connectivity (FC) were calculated and used as an input for five machine learning algorithms: Gradient boosting (GB), LASSO, Logistic Regression (LR), Random Forest and Support Vector Machine. Results: All groups revealed different intra-network functional connectivity in ventral DMN and anterior SN. The best performance was reached for the LASSO applied to FC with an accuracy of 70% and AUROC of 0.76 (p < 0.05). Significant classification ability was also reached for GB and LR using fALFF and ALFF measures. Conclusion Our findings suggest that SR in schizophrenia can be seen on the level of DMN and SN functional connectivity alterations. ML algorithms were able to significantly differentiate SR patients. Our results could be useful in developing neuromarkers of SR in schizophrenia based on non-invasive rsfMRI

Comorbidity of depressive and anxiety disorders

Autorzy omówili problem współwystępowania zaburzeń lękowych i depresyjnych. Choć lęk jest jednym z najczęstszych objawów towarzyszących depresji, to w klasyfikacjach International Statistical Classification of Diseases and Related Health Problems (Tenth Revision) i Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) nie wymienia się go wśród kryteriów diagnostycznych zaburzeń depresyjnych. Łączne występowanie omawianych zaburzeń wiąże się z poważniejszym przebiegiem klinicznym oraz większym ryzykiem przerwania leczenia. Duża depresja najczęściej współwystępuje z zaburzeniem lękowym uogólnionym. Jest ona również najczęstszym powikłaniem zaburzenia obsesyjno-kompulsyjnego. Patogenezę współwystępowania zaburzeń depresyjnych i lękowych tłumaczą modele: neurohormonalne, monoaminergiczne i psychologiczne. Dostępnych jest stosunkowo niewiele danych na temat terapii zaburzeń lękowych i depresyjnych występujących łącznie. Strategie terapeutyczne stosowane w tej grupie chorych można podzielić na sekwencyjne i równoległe. Psychiatria 2010; 7, 5: 189-197The authors present the problem of comorbidity of anxiety disorders and depressive disorders. Although anxiety is one of the most common concomitant symptoms of depression, International Statistical Classification of Diseases and Related Health Problems (Tenth Revision) and Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) classifications do not mention it among diagnostic criteria of depressive disorders. Comorbidity of those medical states is associated with more severe clinical course and greater drop-out risk. Generalized anxiety disorder is the most common comorbid anxiety disorder accompanying major depressive disorder. The latter is - on the other hand - the most prevalent complication of obsessive-compulsive disorder. Pathogenesis of the comorbidity of anxiety disorders and depressive disorders is explained by neuroendocrine, monoamine and psychological models. Data on the comorbid anxiety and depressive disorders is relatively scarce. Therapeutic strategies used in these conditions can be divided into sequential and concurrent ones. Psychiatry 2010; 7, 5: 189-19

Group psychoeducation in bipolar mood disorders : the influence on the cognitive representation of the illness : the results of the program "Taming the bipolar affective disorder"

Aim. To assess the influence of group psychoeducation in bipolar disorder on selected aspects of cognitive representation of illness. Method. 51 patients with bipolar diagnosis were included in the study, and 24 were included in the final statistical analysis. The participants took part in 8 meetings of group psychoeducation. The assessment of selected aspects of cognitive representation of illness, i.e. acceptance of illness, health locus of control, generalized self-efficiency, hope for success, therapeutic compliance, beliefs about bipolar disorder was conducted with validated questionnaires before, after, and 18 months after receiving psychoeducation to register possible changes. Results. Statistically significant increase in acceptance of illness, perceived self-efficiency, hope for success, therapeutic compliance, and positive modification of beliefs about bipolar mdisorder were detected. The observed change occurred right after the intervention, but it was not sustained during the follow-up. Conclusions. Psychoeducation may exert a positive influence on virtually important cognitive variables, which seem to be clinically important. This influence may disappear with time, thus the interventions should either be repeated or the duration of intervention should be prolonged. The study shows new possible research directions in the field of searching for the mechanism of action of psychoeducation in bipolar disorder, as well as of its active components