Biomedical subjects

Tomasz Hadryś

Publications and source records attributed to Tomasz Hadryś.

11 recordsLinked to original sources

PubMed2006

Bipolar or unipolar? - the question for clinicians and researchers.

BACKGROUND: Correct diagnosis and criteria of affective disorders is always a subject of interest to researchers and practitioners. METHODS: The study aimed at assessing frequency of various traits and symptoms of bipolar affective disorders (BP-I, BP-II, BP-S spectrum) in patients (n=246) treated for recurrent affective disorders (unipolar-UP). The analysis was based on criteria of affective disorders of Ghaemi et al. and Hirschfeld's Mood Disorders Questionnaire. RESULTS: UP was confirmed in 32.9% of individuals, whereas 19.5% were BP-I, 35% BP-II and 12.6% BP-S. UP patients were significantly more often professionally active than those with BP (37.2% vs. 22.7%). Duration of a disorder was significantly shorter and the number of depressive episodes lower in the UP group. In comparison with UP, BP-I were associated with the previous occurrence of unusual and/or risky behaviour (OR=24.5), excessive, irrational expenditure (OR=21.1), lack of a critical attitude with respect to social behaviour (OR=20.3), increased sex drive (OR=17.7), and excessive self-confidence (OR=12). BP-II were associated with a lack of criticism with regard to social behaviour (OR=12.7) and unusual and/or risky behaviour (OR=10). Spectrum BP were most strongly associated with short term hypomanic episodes, including drug induced episodes (OR=15.8) and lack of criticism (OR=11.8). Early onset of depression (before 25 years of age) increased the risk of all three types of BP (by a factor of 3 to 5). LIMITATIONS: This was a naturalistic study, in which treatment was uncontrolled. CONCLUSIONS: Results of the study are a voice in the discussion on too narrow criteria defining bipolar affective disorders.

Adolescent↗

PubMed2003

Depression and anxiety in coronary artery bypass grafting patients.

PURPOSE: Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients. SUBJECT AND METHODS: After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory. RESULTS: Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed. CONCLUSIONS: High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.

Aged↗

PubMedDate not supplied

[Comparison between a SCAN diagnosis and a clinical diagnosis].

The aim of this paper is to present comparison of clinical diagnoses and SCAN (Schedules for Clinical Assessment in Neuropsychiatry, version 2.1) diagnoses of patients treated in day care and inpatients wards. SCAN was translated at Medical University of Wrocław according to WHO permission. It is a part of multicenter study evaluating effectiveness of treatment in conventional psychiatric hospital and day hospital for acute psychiatric patients. Clinical diagnoses were made using ICD-10 classification system. Till now 56 patients were examined, 15 men and 39 women in age from 21 to 65 years old, median age 45 years old. Among them 31 patients were treated in day care wards, and 25 patients were treated in inpatients wards. During standard medical procedure diagnoses of 25 patients were classified into the block F2, and 19 patients into the block F3 of ICD-10 classification. Schizophrenia were diagnosed in 16 patients of, 19 patients had diagnosis of depressive disorder, and 21--of other mental disorders. Clinical diagnoses were in most of the cases single one; there were only 6 cases with double (comorbid) diagnoses. SCAN diagnoses were multiple, ranged from 1 to 12 (median 3) for one patient. Many concomitant SCAN diagnoses referred to tobacco use, sleep disorders, and somatoform disorders. Cohen's kappa coefficient for the block F2 was 0.78, for schizophrenia--0.62, for the block F3--0.42, and for depression--0.36. Results showed low agreement between clinical and SCAN diagnoses, particularly for mood disorders. The explanations of such discrepancies could be: no strict compliance with rules of ICD-10 by clinicians and avoidance of comorbid diagnoses by clinicians or errors in the SCAN coding algorithms. Further analyses are needed to characterize more precisely the sources of discrepancies.

Adult↗

PubMedDate not supplied

[Characteristics of psychiatric day hospitals in Poland--results of a questionnaire survey].

AIM: The survey was aimed at describing the characteristics and therapeutic means offered and the organizational structure of Polish day hospitals for adults as well the as characteristics of patients treated there. It was part of a wider international project carried out within a 5 EC Framework Program and focused on evaluation of costs and effectiveness of day hospital treatment when set against conventional stationary treatment in different European health care systems. METHOD: Data concerning the year 2000 were gathered using a self-designed questionnaire sent to respondents by post. The response ratio reached 65.2%. RESULTS: Based on the cluster analysis, three main types of day hospitals were recognized: 1. day hospitals focused on rehabilitation of chronic mental disturbances, improvement of social functioning and support, 2. day hospitals being alternative to stationary inpatient treatment, 3. day hospitals intended to continue out-patient treatment and psychotherapy. The number of treatment places, working hours and work-days in a week in polled institutions was constant. Most frequent reasons for not admitting a patient to a day hospital were: intensive suicidal tendencies and acute psychotic decompensation. The most numerous diagnostic groups of patients treated there were schizophrenia (32.2%) and affective disorder (17.4%). Only 18.6% of day hospitals employed a qualified psychotherapist, and 32.6% had a social worker. On the average, one treatment place was offered to 5 patients during a year. CONCLUSIONS: The profile of patients admitted to Polish day hospitals for adults is not arbitrarily defined with respect to diagnosis and severity of disorder. However, it is possible to distinguish day hospitals, which have their preferences: more to rehabilitate or more to treat patients. In the last 16 years there was a threefold increase of the number of patients treated in day hospitals due to affective disturbances.

Adult↗

PubMedDate not supplied

[Course of the EDEN study by using participants' flow sheets].

UNLABELLED: The development of science allows us to take up new investigative challenges. Interpretations of results can be difficult if there is no adequate and complete information about investigative methods applied, course of trial and statistical analyses. The CONSORT group proposed a standardized diagram facilitating an accurate presentation of the randomised trial. The EDEN study is an example of the application of this method, where the studied groups, number of participants, and all procedures can be presented. It is helpful to prepare reports and find necessary data. The first part of the diagram describes the course of recruitment, the second part presents data necessary to estimate the course of the study and data about numbers of patients in each timepoint whilst the third part shows the assessment of caregivers. CONCLUSIONS: The analysis of the course and correctness of the study is legible if the flow diagram is used. It is useful to find the necessary data for statistical analyses at every stage of study. Permanent control of the study allow to avoid bias upsetting the course of the study and influencing its quality. It introduces comprehensible and straight forward presentation of the results.

Clinical Trials Data Monitoring Committees↗

PubMedDate not supplied

[Bipolarity among unipolar affective disorder patients--uniDEP-BI national multi-site study].

UNLABELLED: The main objective of the study was to evaluate the occurrence of bipolarity among outpatients with a recurrent major depressive disorder. METHOD: The uniDEP-BI study was conducted throughout Poland by 96 psychiatrists from 16 sites, who were trained in the study instruments. The sample was selected from the population of outpatients with at least one depressive episode (n = 880). The final study group included 246 working age adults (75.2% of females) treated for recurrent unipolar disorder. The study questionnaire consisted in the DSM-IV criteria of major depressive episode, (hypo)manic episode, criteria for bipolar spectrum disorder by Ghaemi et al. RESULTS: Unipolar mood disorder was confirmed in 32.9% cases, bipolar I disorder was found in 19.5%, bipolar II in 35% and bipolar spectrum disorder in 12.6% of the assessed patients. Patients with bipolar compared to the unipolar mood disorder had significantly more frequently a family history of bipolar disorder, short (hypo)manic episodes after antidepressive treatment, premorbid cyclo-, hyperthymic or impulsive (borderline type) personality, recurrent depressive episodes, atypical depressive symptoms, early onset of depression (< 25 yrs), distracted attention and panic attacks. Subjects with confirmed recurrent depressive disorder were significantly more often working (37.2% vs. 22.7%). Duration of the illness was significantly shorter and the number of previous depressive episodes was significantly lower in this group. CONCLUSIONS: The findings showed that the bipolarity features are more common among patients with unipolar mood disorders. It also points to a need of proper and deeper diagnostics of affective disorders and verification of rules and period of antidepressive and normothymic treatment.

Adult↗

PubMedDate not supplied

[Effectiveness of treatment in day hospital versus inpatient ward evaluated by patients' psychopathological symptoms and subjective quality of life (QoL) analysis].

AIM: The authors analyzed patients' psychopathological symptoms and subjective quality of life (QoL) for evaluating the effectiveness of treatment in day hospital versus inpatient wards. Analyses concerned patients from Wrocław and recruited within the framework of an EU funded multi-centre study EDEN. METHOD: 238 patients admitted to the Psychiatric Hospital in Wrocław were randomly assigned to treatment in either day hospital (n=l15) or inpatient ward (n=123). Patients were interviewed at 4 time-points comprising their stay in hospital. Differences between settings in terms of dynamics of psychopathological symptoms and subjective QoL were expressed in mean scores of BPRS subscales and MANSA. Two parameters of effectiveness were considered: the static--the score on the scale at a given time-point and average score level, and the dynamic--describing dynamics of changes (gradients). Statistical methods included ANOVA and ANCOVA with co-variables. RESULTS: In terms of manic and excitement symptoms inpatient wards proved to be more effective as measured at discharge, no differences in dynamics between settings were found. Day hospital was superior in alleviating negative symptoms during treatment but improvement in that respect was quicker in the inpatient ward. In terms of alleviating positive symptoms, the inpatient ward was more effective only at the beginning of the treatment. Day hospital was more effective in handling symptoms of depression and anxiety but only at the beginning of treatment. Dynamics of subsiding of the symptoms at the beginning of hospitalization was better for the inpatient ward. No differences in QoL in both settings were found. CONCLUSIONS: Taking into consideration the static and the dynamic parameters of effectiveness of treatment, the superiority of inpatient treatment over day hospital has not been, therefore, definitely proven.

Adolescent↗

PubMedDate not supplied

[Does contemporary pharmacotherapy limit coercion in psychiatry? Preliminary results].

AIM: The goal of the present study was to examine whether contemporary psychopharmacotherapy (atypic neuroleptics) can have an impact on the patient's compliance and limit coercion (involuntary admission to hospital, coercive measures). METHOD: 71 adult inpatients with diagnoses of the schizophrenia spectrum (F20 group according to ICD-10) admitted to psychiatric hospital were observed. 41 of them were treated with atypic neuroleptics before hospitalization and 30 with typical ones. Data about their pharmacotherapy before hospitalization, compliance, history of disease and coercion used during hospitalization were gathered and analysed by means of chi square Pearson's and Mann-Whitney's tests. RESULTS: There were no significant differences in non-compliance, the type of admission to hospital and frequency of coercion measures used during hospitalization between groups of patients receiving atypic and typical antipsychotics. However, the group with atypic neurolepitics was nearly significantly more adherent to therapy than the typical ones. CONCLUSIONS: Results of the study did not confirm the impact of atypic neuroleptics on compliance and coercion connected with admission to hospital. A long-term study with an increased number of patients is needed to confirm the results of this study.

Adult↗

PubMedDate not supplied

[Patients' opinions on psychiatric hospital treatment].

AIM: Qualitative analysis of acute psychiatric patients' subjective opinions on the conditions and effects of their hospital treatment. Presentation of patients' expectations in this respect and the follow up of the opinion changes taking place during hospital stay. METHOD: Patients' opinions were obtained in open questions which were part of the Clients' Scale for Assessment of Treatment (CAT) performed twice during the study: one week after admission and at discharge. Answers were analyzed using a qualitative approach and odds ratio. RESULTS: An overwhelming part of the respondents pointed to the positive aspects of psychiatric hospitalization (92% of those interviewed) and less than a half (42%) pointed to its negative aspects. The most important sources of positive cognitions about hospital stay were: a relationship with the ward staff, the forms of treatment introduced, relationship with other patients, overall atmosphere and sense of security and empathy. Almost 3/4 of the interviewed patients were convinced about a favourable outcome of treatment and care. Amongst elements of treatment that were helpful to the patients, pharmacotherapy was named most frequently. Patients' activity understood as occupational therapy and interpersonal contacts was an important component of the stay in the hospital and treatment. Most patients felt that no changes in the ward routine were necessary. CONCLUSION: It is important to take into consideration the patients' opinions and expectations towards therapy, ward conditions and work organization while planning mental health care. The presented results are a part of a complex investigation and might inspire to expanded research in this field.

Adult↗

PubMedDate not supplied

[SCAN system--semi-structured interview based on diagnostic criteria].

This paper presents the main features of contemporary diagnostic systems which are implemented into the SCAN--modern and semi-structured diagnostic interview. The concepts of further development of the classifications, rationale for operationalized diagnostic criteria and for the divisional approach to mental diagnoses will be in focus. The structure and components of SCAN ver. 2.1 (WHO), i.e. Present State Examination--10th edition, Item Group Checklist, Clinical History Schedule, Glossary of Definitions and computer software with the diagnostic algorithm: I-Shell, as well as rules for a reliable use of diagnostic rating scales, will be discussed within the scope of this paper. The materials and training sets necessary for the learning of proper use of the SCAN, especially training sets for SCAN Training Centers and the Reference Manual--a form of guidebook for SCAN shall be introduced. Finally the paper will present evidence that SCAN is an instrument feasible in different cultural settings. Reliability and validity data of SCAN will also be dealt with indicating that SCAN could be widely used in research studies as well as in everyday clinical practice facilitating more detailed diagnostic approach to a patient.

Diagnosis, Differential↗

PubMedDate not supplied

[Study of compatibility of psychiatric diagnoses with ICD-10 diagnostic criteria using the SCAN questionnaire].

AIM: Authors aimed at testing whether psychiatrists in their diagnostic process obeyed strict ICD-10 diagnostic criteria. Diagnoses made by psychiatrists at discharge were compared with those of SCAN ver.2.1 on admission. METHODS: Diagnoses obtained by SCAN I-Shell program were compared with clinical diagnoses obtained by psychiatrists in the psychiatric wards according to ICD-10 criteria on 3 levels: diagnostic group (Fc), diagnostic class (Fcc), and diagnostic category (Fcc.c). Validity assessment was obtained with Cohen's Kappa coefficient, sensitivity, specificity and Yule's Y coefficient. RESULTS: On the diagnostic group level, Cohen's kappa was 0.14-0.65, Yule's Y 0.57-0.71. Sensitivity 0.69-0.95 and specificity 0.41-0.94. In psychotic disorders group F2 kappa was 0.65, Yule's Y 0.71, sensitivity 0.69, specificity 0.94. In affective disorders group F3 kappa was 0.31, Yule's Y 0.57, sensitivity 0.95, specificity 0.41. In neurotic disorders group F4 kappa was low 0.14, Yule's Y 0.62, sensitivity 0.95, specificity 0.50. CONCLUSIONS: The study showed a higher level of agreement between SCAN and clinical diagnoses in the group of psychotic disorders with exception of schizoaffective disorders, and lower agreement rates in the group of affective and neurotic disorders where the number of SCAN diagnoses outweighed that of the clinical ones. It could be the result of systematic faults in the coding of diagnoses.

Adult↗