Tomasz Hadryś

Objective To test whether a caregiver’s burden is associated with the patient’s psychiatric diagnosis and to find other predictors of family burden; to provide Polish data on the issue to international literature. Method Of 377 eligible subjects, 141 were interviewed on admission to the mental hospital using Brief Psychiatric Rating Scale, Manchester Short Assessment of Quality of Life, Groningen Social Disability Schedule and Client’s Sociodemographic and Clinical History Inventory. Their caregivers completed the Involvement Evaluation Questionnaire (IEQ). Subjects were grouped according to ICD-10 diagnoses: schizophrenia (n = 55), depression (n = 61), and anxiety and personality disorders (n = 25). Highly aggressive, suicidal and somatically unstable patients were excluded along with patients below 18 and over 65 years. Statistics included multiple regression analysis, ANOVA, Kruskal–Wallis and chi-square tests. Results Diagnostic groups differed with respect to sociodemographics, psychopathology and quality of life, but not with respect to mean level of social functioning. Despite between-group differences, the caregiver’s burden did not differ according to the diagnostic group. Of the four dimensions of burden, “worrying” and “urging” scored the highest. Majority of caregivers worried about their relative’s general health (82%), future (74%) and financial status (66%). Caregivers’ characteristics and not patients’ explained the largest proportion of the family burden variance (almost 23% for IEQ Tension). Higher burden seemed to be associated with the carer’s age, being a parent and number of hours spent weekly on caring for the ill relative. Lower burden was associated with the carers’ subjective feelings of being able to cope with problems and to pursue their own activities. Longer history of patient’s illness led to higher IEQ Tension. Polish caregivers were affected by their role in the same way as their counterparts abroad, but more of them were worried. Conclusions The caregiver’s burden seems to be independent of the patient’s diagnosis, but other factors contribute to the perceived burden, many of which are on the caregiver’s part. In Poland, the overall family burden may be attributed mostly to worrying about a mentally ill relative and his future. All caregivers may benefit from psychoeducation and family interventions usually planned for those caring for relatives with schizophrenia.

Long-term mental illnesses such as schizophrenia or affective disorders often impose a burden on the patients who suffer from it, as well as on their carers (relatives or friends). There are many instruments measuring family or caregiver burden. One of these instruments is the Involvement Evaluation Questionnaire (IEQ). The IEQ is a 31-item questionnaire which is completed by the caregiver. The IEQ contains 27 items that can be divided into four subscales (domains): tension (nine items), worrying (six items), supervision (six items) and urging (eight items). Two items appear in more than one domain. The items are scored on a 5-point Likert scale (never, sometimes, regularly, often and always). There is no full Polish adaptation of IEQ so far. The psychometric properties of the IEQ and its culture-profiled versions are satisfying and comparable. The IEQ, as a self-assessment instrument, is easy to administer and not time-consuming. The IEQ proved to be a reliable instrument for measuring caregiver consequences in mental healthcare.

To assess effectiveness of treatment in the day-care and inpatient wards within the Wrocław branch of the international multicenter EU-funded EDEN study. The authors analysed the number of rehospitalisations after discharge from the index hospitalisation as well as psychopathologic symptoms and subjective quality of life. Out of 1089 patients admitted to the mental hospital in Wroclaw, 238 were randomly assigned to either the day-care ward (n = 115) or the inpatient ward (n = 123). There were three interviews with patients: upon discharge, three and twelve months later. Scores of the extended version of Ventura's BPRS were used for representing the psychopathology level and for calculation of between-setting differences. Subjective quality of life was measured using the MANSA questionnaire. Statistical parameters of effectiveness (scores at given time-point, models adjusted for the scores at admission and for the duration of hospitalisation) were analysed. The frequency of rehospitalisations was also investigated. Statistical analyses after discharge were performed using the random multiple imputations method in consecutive time-points. There were no statistical differences between settings in the effectiveness of treatment three months after discharge. Interviews performed one year after discharged revealed a higher level of psychopathology in patients treated in an inpatient setting (p = 0.03) and it was confirmed by the model adjusted for the duration of hospitalisation (p = 0.04). Yet day-care ward patients had a higher number of rehospitalisations within one year after discharge. The absolute superiority of treatment in an inpatient ward over day-care setting in terms of its effectiveness was not confirmed using BPRS, MANSA scores and index of rehospitalisation.

The authors have made an effort to find the answer to the question what are the reasons for long hospitalizations in stationary wards and in the day hospital of the Wrocław Mental Health Care Centre? In order to achieve this goal the correlation of the SCAN questionnaire diagnoses and length of stay in the aforementioned settings was analyzed. Analysis included 220 patients treated in the Wrocław Mental Health Care Centre of which 111 patients were placed in day hospital and 109 in stationary wards. The correlation of length of stay in day hospital and in stationary wards with number of SCAN diagnoses in ICD-10 diagnostic groups was investigated. Duration of hospitalization was relatively long for both day hospital patients (150 days) and stationary ward patients (58 days). Contrary to expectations there was no correlation between the number of SCAN diagnoses and length of stay in the hospital. Patients who were diagnosed using SCAN as having affective disorders and anxiety disorder stayed in the hospital shorter despite the fact they had more comorbid disorders than patients diagnosed using SCAN as having psychotic disorders both in day hospital and in stationary wards. Examination using the SCAN questionnaire cannot be used as prognosis of the length of stay either in day hospital or in stationary wards. Duration of hospitalization depends mainly on the diagnostic category (anxiety and affective disorders are associated with shorter hospital stays than psychotic disorders) irrespective of the number of diagnoses a patient received. It also depends on local therapeutic traditions and preferences (dominance of long-term care and the rehabilitation model of treatment instead of active acute intervention aiming at quick discharge from the hospital).

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. 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. 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. 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.

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.

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. 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. 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. 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.

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. Data concerning the year 2000 were gathered using a self-designed questionnaire sent to respondents by post. The response ratio reached 65.2%. 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. 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.

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.