SERVICES FOR PATIENTS WITH INTELLECTUAL DISABILITY AND MENTAL HEALTH PROBLEMS IN POLAND

Background: Poland is a democratic, sovereign state in Central Europe, member of the European Union. The healthcare in Poland is delivered to patients mainly through a public contributor called the National Health Fund, supervised by the Ministry of Health. The care for people with disabilities, including intellectual disabilities in Poland is coordinated by the Governmental Program on Activities for People with Disabilities and their Integration with the Society. The system of care for people with intellectual disability in Poland is constitutionally guaranteed. The aim of this review was to analyze the different forms of care for persons suffering from intellectual disability and mental health problems in our country. Methods: Analysis of available documents on the policy and organizations of systems of services for this group of patients was performed. Results: Non-governmental organizations play an important role in taking care of people with disabilities. In Poland there are no special psychiatric services dedicated for patients with intellectual disabilities. The comorbid psychiatric disorders are treated in general psychiatric wards or hospitals or in outpatient settings. Offenders with intellectual disabilities in the penitentiary system are referred to therapeutic settings in wards for convicts with non-psychotic mental disorders and intellectual disabilities. Training of medical students and young doctors offers only very limited basic knowledge on intellectual disability within psychiatry curriculum. The is no separate specialty in mental health in intellectual disability within psychiatry. Conclusions: The main conclusion of this review is that the specialist working with persons suffering from intellectual disabilities in Poland face many challenges regarding the need to introduces positive changes in this field

ONE OF MANY LESSONS FROM THE EUROPEAN MENTAL HEALTH INTEGRATION INDEX

The Mental Health Integration Index developed by the Economist Intelligence Unit describes and explores the challenges of European countries of integrating people with mental illness into society and employment, within the European Union’s 28 Member States, plus Norway and Switzerland. Countries have been ranked according to estimation based on indicators of their degree of commitment to support those living with mental illness into society and employment. The Index is based on a list of indicators including the environment for those with mental illness, their access to medical help and services, their opportunities – specifically job-related - and the governance of the system, including human rights issues and efforts to combat stigma. The indicators were developed in consultation with a panel of independent experts on mental health. Key findings of the research are that Germany\u27s strong healthcare system and generous social provision put it at the top of the Index, with the UK and Scandinavian states not far behind. However, examples of best practice “islands of excellence” in integration are not limited to the leading countries and exists in all European Countries. The Index reveals also the discrepancy between perfect legislation and poor implementation of it in practice in many European countries. It proposes that the investment figure is a proxy for seriousness in establishing good policy and practice. According to the Index some reform plans including entire national mental health programmes are largely aspirational and are grossly under-funded. Moreover various levels of government responsible for the implementation of its component parts are largely ignoring its implementation. When we consider the legislation as an promise to professionals and people with mental health problems, this promise is largely unfulfilled. The is a need for strong leadership in mental health changes process, policy capacity and real financial investments in the way of The European countries to develop community based mental health services and system of care

Safe and effective use of benzodiazepines in psychiatric disorders and other comorbid conditions

Benzodiazepiny są grupą leków psychotropowych stosowanych w leczeniu stanów lękowych, bezsenności i innych zaburzeń psychiatrycznych. Należą do najczęściej przepisywanych leków w Polsce i na świecie. Benzodiazepiny wykazują działanie uspokajające, nasenne, antydepresyjne, przeciwdrgawkowe, a także obniżają napięcie mięśni szkieletowych. Działają poprzez zwiększenie przekaźnictwa w neuronach GABA-ergiczych. Krótkotrwałe stosowanie tych leków jest bezpieczne i skuteczne. Ich długotrwałe używanie wiąże się jednak z niebezpieczeństwem wzrostu tolerancji i rozwoju uzależnienia. Pierwszy lek z tej grupy chemicznej zsyntetyzował w roku 1955 Leo Sternbach. Najczęstsze wskazania do stosowania benzodiazepin to: zaburzenia lekowe — lęk uogólniony i napadowy, bezsenność, napady drgawkowe, alkoholowy zespół abstynencyjny, leczenie zaburzeń świadomości. Poszczególne leki z tej grupy różnią się czasem działania, odmiennym metabolizmem, działaniem klinicznym, co powoduje, że część z nich działa silniej przeciwlękowo, a inne wykazują silniejsze działanie nasenne lub przeciwdrgawkowe. W różnym stopniu też działają zwiotczająco na mięśnie szkieletowe. Prawidłowe stosowanie leków z grupy benzodiazepin jest bezpieczne, ale ich nadużywanie może prowadzić do uzależnienia. Ważne jest, aby z włączeniem leku u pacjenta wiązała się odpowiednia psychoedukacja mająca na celu jego bezpieczne, skuteczne stosowanie i zapobieganie rozwinięciu się zespołu uzależnienia.Benzodiazepines are a class of psychoactive drugs used to treat anxiety, insomnia, and other psychiatric disorders. Theyare among the most frequently prescribed drugs in Poland and worldwide. Benzodiazepines have a sedative, hypnotic,antidepressant, anticonvulsant and myorelaxant action. They act by increasing GABA-ergic transmission. A short-termuse of these drugs is safe and effective. However, their long-term use is associated with an increased risk of a developmentof tolerance and dependence. The first drug of this chemical group was synthesized in 1955 by Leo Sternbach.The most common indications for the use of benzodiazepines include anxiety disorders - generalized anxiety and panicdisorder, insomnia, seizures, alcohol withdrawal, treatment of disorders of consciousness. Particular drugs of this groupvary in their duration of action different metabolism, clinical effect, which means that part of them have more anxiolyticpotency and others exhibit more pronounced hypnotic or anticonvulsive action. They are also diversified as myorelaxants.A proper use of agents known as benzodiazepines is safe, but their abuse can lead to addiction. It is important thatwhen the drug is administered to the patient, a suitable psychoeducation is provided aimed at the safe and effectiveuse, prevent the development of a dependence syndrome

PSYCHIATRIC COMORBIDITY IN OLDER ADULTS WITH INTELLECTUAL DISABILITY

Background: The population of older adults with intellectual disability (ID) is large and growing due to a significant increase of life expectancy caused by improvements in health and social care. Multimorbidity is highly prevalent in this population and comorbid psychiatric disorders are especially frequent. Subject and methods: The aim of this article is to review the prevalence and consequences of psychiatric comorbidity in the population of older adults with ID. We therefore performed a literature search of studies relevant to adults with ID, published since January 2006, using the following keywords: intellectual disability and comorbidity, intellectual disability and mental disorders, intellectual disability and polypharmacy. Results: Psychiatric comorbidity is frequent among patients with ID and correlates with older age. Mental disorders are present in up to 40% of older adults with ID and the most prevalent are challenging behaviour, depression, anxiety and dementia. Patients with ID and at least one co-morbid mental disorder are at a high risk of polypharmacy. Importantly, psychiatric comorbidity was found to significantly increase service use and costs of care. Conclusions: Further investigation of the population of older adults with ID is needed, with special attention to development of clear treatment guidelines in order to effectively manage co-morbid mental illnesses and physical health problems

PSYCHIATRIC COMORBIDITY IN OLDER ADULTS WITH INTELLECTUAL DISABILITY

Background: The population of older adults with intellectual disability (ID) is large and growing due to a significant increase of life expectancy caused by improvements in health and social care. Multimorbidity is highly prevalent in this population and comorbid psychiatric disorders are especially frequent. Subject and methods: The aim of this article is to review the prevalence and consequences of psychiatric comorbidity in the population of older adults with ID. We therefore performed a literature search of studies relevant to adults with ID, published since January 2006, using the following keywords: intellectual disability and comorbidity, intellectual disability and mental disorders, intellectual disability and polypharmacy. Results: Psychiatric comorbidity is frequent among patients with ID and correlates with older age. Mental disorders are present in up to 40% of older adults with ID and the most prevalent are challenging behaviour, depression, anxiety and dementia. Patients with ID and at least one co-morbid mental disorder are at a high risk of polypharmacy. Importantly, psychiatric comorbidity was found to significantly increase service use and costs of care. Conclusions: Further investigation of the population of older adults with ID is needed, with special attention to development of clear treatment guidelines in order to effectively manage co-morbid mental illnesses and physical health problems

MENTAL STATE AND ITS PSYCHOPHYSICAL CONDITIONS IN PATIENTS WITH ACUTE LEUKAEMIA TREATED WITH BONE MARROW TRANSPLANTATION

Background: Acute leukaemia and bone marrow transplantation (BMT) as a method of its treatment are great psychological stressors, which are responsible for anxiety and depression in the group of patients. The aim of the study was to assess the patients’ mental state and its psychophysical predictors before and after BMT. Subject and method: The study was of a longitudinal and self-descriptive character. The questionnaires: LOT-R, AIS, Mini-Mac, CECS, RSCL and HADS were filled by 60 patients with acute leukaemia before and after BMT. Results: There were no essential statistical differences between the severity of anxiety and depression before and after BMT but the pattern and the power of various mental state predictors changed in the course of the hospitalization. Anxiety before transplantation was greater when the psychological stress and the strategy of “anxious preoccupation” were stronger and the strategy of “fighting spirit” and the level of generalized optimism were weaker. The factors explained 51% variations of anxiety before transplantation. After BMT 77% variations of anxiety were explained, which were associated with a high level of distress at the end of the hospitalization, higher level of anxiety before transplantation, weaker strategy of “fighting spirit” before transplantation and stronger strategy of “anxious preoccupation” after BMT. Before transplantation 36% variations of depression were explained and estimated as weaker “fighting spirit” and worse “global life quality”. The essential predictors of depressive symptoms after transplantation, explained by 81% variations of depression, were weaker “fighting spirit” before transplantation, stronger “anxious preoccupation” after transplantation, worse “global life quality” after transplantation and higher level of anxious and depressive symptoms on admission to hospital. Conclusion: The psychological and pharmacological interventions, which reduce anxiety, depression and “anxious preoccupation” as well as enhance “fighting spirit”, should be introduced before BMT to improve the patients’ mental state

PROBLEMS ASSOCIATED WITH THE USE OF SOCIAL NETWORKS - A PILOT STUDY

Background: The definition of addiction is that it is an acquired, strong need to perform a specific activity or continued use of mood alerting substances. Increasing discussion about the development of Internet addiction, which like other addictions, have their roots in depression, impaired assessment esteem and social anxiety shows that it affects all users of the global network, regardless of gender or age. The aim of the study was to assess the impact of social networking on the ongoing behavior of respondents- the first step of a study on the possibility of dependence on social networks. Subjects and Methods: The study was based on an authors questionnaire placed on popular polish websites on February 2013. Questions related to the types and frequency of specific activities undertaken by the private profiles of users. Results: The study involved 221 respondents, 193 questionnaires were filled in completely and correctly, without missing any questions. 83.24% admitted to using social networking sites, 16.76% indicated that they never had their own profile. An overwhelming number of respondents are a member of Facebook (79.17%), specialized portals related to their profession or work were used by only 13.89%, Our-class (6.25%) and Twitter was a primary portal for one person only. Nobody marked a participation in dating services. Conclusion: There is a big difference between the addiction to the Internet and addictions existing within the Internet; the same pattern applies to social networking. There is a need to recognize the "social networking" for a particular activity, irrespective of Facebook, Twitter and Nasza-Klasa, which are commercial products

PSYCHOLOGICAL DISTRESS AND SOCIAL FACTORS IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE LUNG DISEASE

Chronic respiratory diseases which embrace asthma and chronic obstructive pulmonary disease (COPD) are common in the population. In a large number of cases they are diagnosed very late. Statistics of deaths, especially in the case of COPD, are underestimated because morbidity and mortality can be affected by other comorbid conditions, for example cardiovascular disease. Asthma and COPD impair not only physical functioning of patients but also affect their psychological state. Mood disorders and cognitive function impairment are more often observed in this group than in the general population. It has been proven that the coexistence of psychological dysfunction significantly worsens the functioning of patients (affects, among others, their work, family and social lives) and has an impact on the course of the treatment of the somatic illness. First of all, patients with cognitive deficits have greater problems in applying treatment recommendations. Accordingly, it seems to be important to pay more attention to the problem of mental disorders in patients with obstructive lung diseases. There is a clear need for a multidisciplinary approach that will enable prevention, early detection and effective treatment of the psychological disorders in that group of patients

OCCURENCE OF SLEEP ABNORMALITIES AMONG PEOPLE WITH MENTAL DISORDERS - QUESTIONNAIRE STUDY

Background: Sleep disorders belong to the most common health problems in modern society. The aim of this study was to analyze and determine different factors, which have an impact on the occurrence of sleep abnormalities among people with mental illnesses. Subject and methods: An original questionnaire containing 23 questions was created. 49 respondents from an outpatient psychiatric clinic were recruited to the study. Results: The results indicate that the majority of respondents have the frequency of sleep disturbances more than 3 times per week. In 36% of them the length of sleep was not sufficient enough, and nearly half of the patients reported waking up at night. Sleep disturbances resulted in the appearance of several symptoms (tiredness – 66%, lower motivation and lack of energy – 51%, decreased mood - 45%, attention deficits and memory deterioration – 45%, irritability – 43%). Only 19% of them declare a deterioration of their social and vocational functioning. The majority of patients sleep more than 6 hours, but the patients consider this amount of sleep as not sufficient. The methods to cope with reported sleep problems are: most of respondents (68%) take hypnotics, 4% of respondents drink alcohol before going to sleep, 4% try to solve the problem with sex or masturbation. 9% reported talking about this problem with family member and/or friends. The other 13% of the respondents do not try to make any efforts to manage their sleep disturbances. Conclusion: The questionnaire confirmed that sleep disturbances are common in mental disorders and the problem of insomnia has a negative impact on mood and quality of life for the majority of the patients who we studied

OCCURENCE OF SLEEP ABNORMALITIES AMONG PEOPLE WITH MENTAL DISORDERS - QUESTIONNAIRE STUDY

Background: Sleep disorders belong to the most common health problems in modern society. The aim of this study was to analyze and determine different factors, which have an impact on the occurrence of sleep abnormalities among people with mental illnesses. Subject and methods: An original questionnaire containing 23 questions was created. 49 respondents from an outpatient psychiatric clinic were recruited to the study. Results: The results indicate that the majority of respondents have the frequency of sleep disturbances more than 3 times per week. In 36% of them the length of sleep was not sufficient enough, and nearly half of the patients reported waking up at night. Sleep disturbances resulted in the appearance of several symptoms (tiredness – 66%, lower motivation and lack of energy – 51%, decreased mood - 45%, attention deficits and memory deterioration – 45%, irritability – 43%). Only 19% of them declare a deterioration of their social and vocational functioning. The majority of patients sleep more than 6 hours, but the patients consider this amount of sleep as not sufficient. The methods to cope with reported sleep problems are: most of respondents (68%) take hypnotics, 4% of respondents drink alcohol before going to sleep, 4% try to solve the problem with sex or masturbation. 9% reported talking about this problem with family member and/or friends. The other 13% of the respondents do not try to make any efforts to manage their sleep disturbances. Conclusion: The questionnaire confirmed that sleep disturbances are common in mental disorders and the problem of insomnia has a negative impact on mood and quality of life for the majority of the patients who we studied