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BackgroundBMI (body mass index) can be misleading regarding the level of adiposity in a normal-weight individual. Recently, a bioelectrical impedance analysis (BIA) method was developed that can measure body composition variables. The main objectives of this study were to use BIA to compare the body composition variables between chronic non-diabetic schizophrenic patients with normal weight and healthy individuals. The secondary objective was to compare the nutritional pattern of schizophrenia patients with that of matched healthy subjects, and to identify possible relationships between the content of different components of their diet and visceral adiposity.MethodsThe subjects were 52 normal-weight patients (33 males and 19 females) diagnosed with schizophrenia based on the DSM-IV and 45 (23 males and 22 females) BMI- matched controls. The patients had been receiving atypical or typical antipsychotic agents for at least one year before enrollment into the study but continuously for 3 months preceding the study and were psychiatrically stable. Body fat (kg), percent (%) body fat, fat-free mass, VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) were measured using the bioelectrical impedance analysis (BIA) method. Daily food rations (DFR) were quantitatively evaluated by a 24-h dietary recall method covering 3 days preceding the examination.ResultsIn normal-weight patients schizophrenia was significantly linked with higher VAT, VAT/SAT ratio and lower fat- free mass. Men had over 5 times and women over 2 times as much VAT as BMI matched groups. In women with schizophrenia and in their controls, the amount of magnesium, niacin and vitamin B6 in their diet inversely correlated with VAT, while in men lower zinc and vitamin C intake was related to higher visceral adiposity.ConclusionsOur study has shown that normal-weight patients with chronic schizophrenia have higher levels of visceral fat (VAT) than controls but similar volume of subcutaneous adipose tissue (SAT). Although no clear conclusion can be made regarding cause-and-effect relationships between the dietary content of food served to our patients and visceral obesity, we suggest that schizophrenia diet should be further investigated as a possible factor related to this type of obesity.

Patients dissatisfied with the quality of their marital relationship experienced an increased severity of postpartum depression symptoms. Greater satisfaction with relationship quality was expressed by women in formalized relationships.

BackgroundInteractions between the digestive system, brain functions and immunoglobulin G (IgG) mediated immunity against food antigens became recently a topic of growing interest in psychiatry research. Psychological stress can activate hypothalamic-pituitary-adrenal axis (HPA) with subsequent hypercortisolemia. It can also influence intestinal permeability and dynamics of IgG response. Major depression can by accompanied either by activation of inflammatory response or by immune suppression (e.g. decreased antibody production) where hypercortisolemia is a significant immune modulator.The aim of our study was to assess IgG immune response against 44 food products in depressed patients and controls along with markers of psychological stress, inflammation, psychometric and dietary parameters.MethodsSerum IgG concentrations against 44 food antigens, plasma cortisol, TNF-α, IL-6, IL-1b concentrations were measured and psychometric parameters were evaluated using Hamilton Depression Rating (HAM-D 17), Perceived Stress (PSS-10), and Symptom Checklist (SCL-90) scales in 34 depressed patients and 29 controls. Dietary parameters such as frequency of exposure to food antigens, appetite and weight change were assessed.ResultsThere was a significantly lower IgG concentration against dairy in depressed patients compared to controls (post hoc p < 0.05) when there was a high exposure (consumption) to dairy. Our research revealed a significant interaction of IgG concentration against dairy proteins and exposure to dairy between groups (F (2.63) = 3.92, p = 0.025, η2 = 0.12). There was no significant difference in mean IgG concentration against food antigens between patients and controls.We found increased concentration of cortisol in depressed patients (t (1.61) = 2.37, p = 0.02) compared to controls. Patients with melancholic depression had significantly higher (M rank = 21.27) concentration of cortisol (U = 41, p = 0.006), when compared with the non-melancholic group of patients (M rank = 12.16). Cortisol concentration significantly positively correlated with HAM-D 17 (r = 0.442, p = 0.009) and with phobias in SCL-90 scale in patients’ group (r = 0.531, p = 0.001). There was decreased concentration of TNF-α (t = 4.256, p < 0.001) in depressed patients compared to controls. IgG concentration of 38.63% food products positively correlated with TNF-α concentration in depressed patients compared to 9.09% of those in healthy controls.ConclusionsWe observed an immune suppression of IgG response to dairy proteins in depressed patients. Hypercortisolemia with involvement of decreased concentration of TNF-α might play a significant role in suppression of IgG response in depressed patients.

Purpose Modern neuroimaging techniques allow investigating brain structures and substances involved in the pathophysiology of mental disorders, trying to find new markers of these disorders. To better understanding of the pathophysiology and differential diagnosis of schizophrenia and bipolar disorder, this study was conducted to assess the neurochemical alterations in the frontal and temporal lobes in hospitalized patients with schizophrenia and bipolar disorder. Methods Twenty-one subjects with schizophrenia (paranoid and differentiated types), 16 subjects with bipolar I disorder (manic, depressive, and mixed episode), and 20 healthy subjects were studied. Magnetic resonance (MR) imaging and proton resonance magnetic spectroscopy (1H MRS) were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal and left temporal lobes. Results Glx/H2O (GABA, glutamine, and glutamate/nonsuppressed water signal) ratios were significantly increased in the left temporal lobe in schizophrenia, but not in bipolar disorder, compared with controls. Cho/H2O (choline/nonsuppressed water signal) ratios in the left frontal lobe had a tendency to increase in bipolar disorder and schizophrenia, relative to controls. A lower temporal lobe NAA/H2O ratio in mixed than in manic and depressive episode of bipolar patients was also found. No other significant differences were found among three studied groups as regards NAA, Cr, and mI ratios. Conclusions Our results partially confirm the role of a glutamatergic system in schizophrenia, however, only in a temporal lobe. We also point to the importance of the choline-containing compounds (marker of cellular density) in the frontal lobe of patients suffering from bipolar disorder and schizophrenia. We also found the deleterious effect of mixed bipolar episode on the integrity and functioning of the temporal lobe. Glutamatergic left temporal spectroscopic changes may potentially help in differential diagnosis of schizophrenia from bipolar disorder.

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.

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 cm 3 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/H 2 O) 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/H 2 O) 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.

Aim: To determine what significance psychotherapists attach to failure. Methods: The study group included 100 psychotherapists. A qualitative method (open questions) and a quantitative method (Self Confrontation Method by Hubert Hermans) were used. An analysis of psychotherapists' comprehension and experience of failure, and an analysis of emotions felt when succeeding or failing in psychotherapy were performed. Results: 94% of psychotherapists declared that they experienced failures in the course of their professional work. The failures were accompanied by particularly negative emotions and were quantitatively and qualitatively different from the emotions felt when a patient's therapy was completed successfully. A failure was most frequently (76 out of 100 psychotherapists) perceived as premature termination of treatment by the patient where therapy cessation was attributed in 70% of cases to factors within the patient's control. Psychotherapists evaluated their competences highly-they claimed to possess qualities predisposing them to an average success rate of 73%. They rated their job satisfaction at the level of 80%. Sixty-one percent of psychotherapists discussed their failures at counselling supervision meetings. Discussion: A tendency to preserve one's self-esteem and to strengthen one's self displayed by psychotherapists is evident in the process of analysing previously committed mistakes. Conclusions: Psychotherapists experience failures and they are most frequently inclined to attribute them to factors within patients' control.