How do patients perceive ambulatory psychiatric care and what are their needs?

Introduction and objective. The quality of a doctor-patient relationship plays a vital role in all fields of medicine. In the case of psychiatry, this role is special as it provides the foundation for the whole therapeutic process. The aim of this study was to investigate the patient’s perspective on psychiatric visits: patient’s attitudes towards the psychiatrist, patient’s view of the patient-psychiatrist relationship, and the patient’s needs and expectations from this relationship. Materials and method. 615 psychiatric outpatients responded to the anonymous questionnaires connected with their attitudes towards the psychiatrist, evaluation of the doctor, and expectations from psychiatric care. The study was conducted in 10 out of 30 public centres for psychiatric care in north-eastern Poland. Results. Generally, the patients liked and positively evaluated their psychiatrists. Patient’s liking for the doctor was connected with the feeling that the doctor also liked the patient, as well as with perceiving the doctor as competent and willing to meet the patient. The longer the treatment with a particular psychiatrist and the rarer need to consult the doctor, the more positive attitude and evaluation of the doctor patients had. According to the patients, the most significant expectations were associated with both conversation with the doctor and receiving emotional support. Conclusions. The key phase for forming the patient-psychiatrist relationship was the first stage of cooperation in which patients created their attitudes towards the doctor without modifying them at further stages. Thus, further studies on learning and developing the ability to establish the relationship with the patient, inspiring the patient’s trust and making psychiatric appointments comfortable from the first meeting, will be highly valuable

Body image and maternal fetal attachment

Introduction: Pregnancy is the time of the most dynamic and visible changes in a woman's body. Some researchers have shown that woman's ability to adapt to changes in her body may affect the attitude towards her baby. Purpose: To study the relation between body image in pregnant women and the attachment to the unborn child. Materials and methods: 100 women in II trimester completed Maternal Fetal Attachment Scale (MFAS) and Body Image Questionnaire. Results: The analysis showed a significant relation between the attitudes towards the own body during pregnancy and the quality of the mother-child attachment. According to the research, the mothers who were strongly attached to the child were concurrently dissatisfied with bodily changes. Socio demographic variables (age, education, marital status, place of living), pregnancy-related variables (pregnancy planning, familiarity with child's gender, the level of preparation to maternity) and the variables related to the woman's body (BMI before pregnancy, severity of pregnancy complaints) had no impact on maternal-fetal attachment. Also, the attitude towards the own body was formed regardless of socio demographic variables and pregnancy-related variables. Significant relations between the attitudes towards own body and the variables associated with woman's body (BMI, pregnancy complaints) were observed. Conclusions: Woman's attitude towards the body and changes during pregnancy is a complex issue. According to the results of this study, it is possible to develop a positive bond with the child despite experiencing dissatisfaction with own body

Proton magnetic resonance spectroscopy changes in a longitudinal schizophrenia study: a pilot study in eleven patients

Beata Galińska-Skok,1 Agata Szulc,2 Aleksandra Małus,1 Beata Konarzewska,1 Urszula Cwalina,3 Eugeniusz Tarasów,4 Napoleon Waszkiewicz1 1Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland; 2Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszków, Poland; 3Department of Statistics and Medical Informatics, Medical University of Białystok, Białystok, Poland; 4Department of Radiology, Medical University of Białystok, Białystok, Poland Purpose: Investigation of the longitudinal effect of schizophrenia on changes in various brain-metabolite levels and their relationships with cognitive deficits that have not been fully explained yet.Methods: Five years subsequent to their first examination for their first episode of schizophrenia, eleven patients from an original group of 30 were reexamined. Their cognitive functions were assessed with the Wisconsin Card Sorting Test. Magnetic resonance imaging and proton magnetic resonance spectroscopy were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal lobe, left temporal lobe, and the left thalamus. The study had a naturalistic design, and patients were treated with various antipsychotics.Results: No significant statistical differences between the baseline and follow-up in N-acetylaspartate (NAA:creatine plus phosphocreatine [Cr] and NAA/H2O) levels were observed in any region of interest. We found a significant statistical correlation between 5-year difference in frontal NAA/Cr levels and duration of the last antipsychotic treatment in this period (R=0.908, P=0.012). We found a trend (P=0.068) toward lower choline-containing compounds (Cho/Cr ratio) in the temporal lobe over 5 years and a trend (P=0.079) in higher glutamate–glutamine–GABA (Glx/H2O) levels in the left thalamus. The patients showed social and clinical improvement at follow-up examination, and there were no changes in Wisconsin Card Sorting Test results.Conclusion: The observed tendency toward decline in choline ratio might have been due to decreased temporal cell density or impaired neuron-membrane or myelin functions. A tendency for higher Glx levels suggest the involvement of thalamus dysfunction in the chronic schizophrenia process. The lack of NAA decrease might have been due to effective antipsychotic treatment. Further longitudinal studies on large patient groups are required to confirm these metabolic changes in schizophrenia. Keywords: first-episode schizophrenia, proton magnetic resonance spectroscopy, longitudinal study, cognitive functioning, N-acetylaspartate, cholin

Variability and magnitude of brain glutamate levels in schizophrenia: a meta and mega-analysis.

Glutamatergic dysfunction is implicated in schizophrenia pathoaetiology, but this may vary in extent between patients. It is unclear whether inter-individual variability in glutamate is greater in schizophrenia than the general population. We conducted meta-analyses to assess (1) variability of glutamate measures in patients relative to controls (log coefficient of variation ratio: CVR); (2) standardised mean differences (SMD) using Hedges g; (3) modal distribution of individual-level glutamate data (Hartigan's unimodality dip test). MEDLINE and EMBASE databases were searched from inception to September 2022 for proton magnetic resonance spectroscopy (1H-MRS) studies reporting glutamate, glutamine or Glx in schizophrenia. 123 studies reporting on 8256 patients and 7532 controls were included. Compared with controls, patients demonstrated greater variability in glutamatergic metabolites in the medial frontal cortex (MFC, glutamate: CVR = 0.15, p < 0.001; glutamine: CVR = 0.15, p = 0.003; Glx: CVR = 0.11, p = 0.002), dorsolateral prefrontal cortex (glutamine: CVR = 0.14, p = 0.05; Glx: CVR = 0.25, p < 0.001) and thalamus (glutamate: CVR = 0.16, p = 0.008; Glx: CVR = 0.19, p = 0.008). Studies in younger, more symptomatic patients were associated with greater variability in the basal ganglia (BG glutamate with age: z = -0.03, p = 0.003, symptoms: z = 0.007, p = 0.02) and temporal lobe (glutamate with age: z = -0.03, p = 0.02), while studies with older, more symptomatic patients associated with greater variability in MFC (glutamate with age: z = 0.01, p = 0.02, glutamine with symptoms: z = 0.01, p = 0.02). For individual patient data, most studies showed a unimodal distribution of glutamatergic metabolites. Meta-analysis of mean differences found lower MFC glutamate (g = -0.15, p = 0.03), higher thalamic glutamine (g = 0.53, p < 0.001) and higher BG Glx in patients relative to controls (g = 0.28, p < 0.001). Proportion of males was negatively associated with MFC glutamate (z = -0.02, p < 0.001) and frontal white matter Glx (z = -0.03, p = 0.02) in patients relative to controls. Patient PANSS total score was positively associated with glutamate SMD in BG (z = 0.01, p = 0.01) and temporal lobe (z = 0.05, p = 0.008). Further research into the mechanisms underlying greater glutamatergic metabolite variability in schizophrenia and their clinical consequences may inform the identification of patient subgroups for future treatment strategies