Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not ‘excessive’ relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessiveness requirement.

Data come from the World Health Organization World Mental Health Survey Initiative. A total of 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs) were assessed with the Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-5 criteria for GAD were compared to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates.

Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs. Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones, and less about personal or non-specific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms.

Individuals with non-excessive worry who meet all other DSM-5 criteria for GAD are clinically significant cases. Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis.

Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries.

The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009–2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population.

The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00–3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06–2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08–2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86–2.94).

In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes.

Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning.

Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4–1.6) and suicidality (OR = 1.5–2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD.

These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.

Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.

The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.

Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.

Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.

To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries.

People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables.

In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS.

This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.

Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.

Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.

Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.

An undiagnosed bipolarity may be one of the reasons connected with treatment resistance in major depressive disorder. In recent years, the tools have been introduced helping to assess the bipolarity such as the Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ). The objective of the study was to compare scores of bipolarity measured with these scales between patients with treatment-resistant and treatment non-resistant depression within the framework of all-Poland multi-center study TRES-DEP.

One-thousand and fifty-one patients recruited from 150 outpatient psychiatric clinics in Poland and fulfilling DSM-IV criteria for single or recurrent major depressive episode were studied. Five-hundred and sixty-nine patients were identified as having treatment-resistant depression on account of non-obtaining remission in recent depressive episode after minimum of two courses of adequate treatment with antidepressant drugs. They were compared with 482 patients with non-treatment-resistant depression. All patients were assessed using the structured demographic and clinical data interview, as well as the Polish version of HCL-32 and MDQ

Patients with treatment-resistant depression scored significantly higher compared with non-resistant depression both on HCL-32 and MDQ (11.9+8.3 vs 8.5±7.7 and 4.3±3.5 vs 2.7±2.9, respectively). Independent risk factors of treatment resistance were scoring of14 or higher on HCL-32, and 6 or higher on MDQ.

Higher scoring by patients with treatment-resistant depression on both HCL-32 and MDQ may suggest a possible association between bipolarity and worse response to antidepressant drugs in patients with major depressive disorder.

The Delphi exercies carried out in Poland constituted part of DEMoB.inc project founded by EC and conducted within 10 European countries. Polish part of Delphi exercise fulfils major method's assumptions and aims to define items of long-term psychiatric care in recovery model of treatment.

Delphi method has not been widely applied in research across Poland. Method is characterized by defined panel of experts (EP), information flow, regular feedback and participants’ anonymity. Delphi has proven prognostic potential in health care, social sciences, new technologies and policy forecasting. However informality of EP selection and limited complex forecasts with multiple factors and downward responses-rate tendencies in following rounds constitute its crucial shortcomings. Criticized basic statistics has been lately overcome by implementation of sophisticated fuzzy logic theory. Three stages Delphi exercise has been carried out in four groups of respondents: service users, carers, advocates and professionals. Wide range of EP representatives has promoted indication of diverse elements of care within partner sites.

Polish mental health care network varies from developed European countries. Out of 11 initially appointed domains only 2 (SPHRandA; SMA) have been underrepresented. Advocates achieved significant consensus in the largest number of items: 23 out of 104 which covered 9 domains whereas professionals in the lowest number: 11 out of 130 which covered only 4 domains. Moreover domains supported with advocates’ opinions fully overlapped with domains pointed by service users. The surprising outcome might be due to diversity of professions in “professional group”, differences in occupational responsibilities and work experience.

Schizophrenia is complex and clinically heterogeneous psychiatric disorder that has an evidenced genetic basis. Several reports indicate a possible role of the activation of the immune system in the pathogenesis of schizophrenia. CD28 is a molecule expressed on T-cells that provides the major co-stimulatory signal required for activation of immune response. For many years now, it has been strongly advocated that biological underpinnings of schizophrenia should be investigated with respect to subpopulations of subjects defined by homogenous symptomatology.

To investigate the association of polymorphism of the CD28 gene (T17int3C) with respect to schizophrenia symptomatology.

105 patients diagnosed with schizophrenia according to ICD-10 criteria and 380 controls were included in the study. The patients were diagnosed using the Operational Criteria for Psychotic Illness checklist (OPCRIT). Based on confirmatory factor analysis on OPCRIT items performed by Serretti et al. (2004), in our study we considered five factors of symptomatology (mania, positive symptoms, disorganization, depression and negative symptoms).

There was significant difference in distribution of genotypes between patients with schizophrenia with co-occurring manic symptoms and without co-occurring manic symptoms (respectively CC and/or TC: 23% vs. 47%, TT: 77% vs. 53%, p=0,040). There was also difference in distribution of genotypes between patients with schizophrenia with co-occurring depressive symptoms and without cooccurring depressive symptoms (respectively CC and/or TC: 24% vs. 47%, TT: 76% vs. 53%, p=0,043).

We have shown that CD28 gene polymorphism might increase risk for affective (depressive and/or manic) symptom dimension in schizophrenic patients.

In recent years increased indices of bipolarity in treatment-resistant depression were found. The objective of the study was to assess and compare Mood Disorder Questionnaire (MDQ) positive screen between patients with treatment-resistant (TR) depression and non-treatment-resistant (NTR) depression and identify significant predictors of MDQ positive screen.

The population studied included patients aged 18-65 who had a diagnosis of first or recurrent major depressive disorder. Each psychiatrist included 5 consecutive patients, from all the patients he is treating, where the depressive episode was assessed as treatment-resistant (study group) and 5 consecutive patients with a non-treatment-resistant episode (control group). The symptoms of bipolarity were assessed by the MDQ. A positive screen of MDQ showing the features of bipolarity requires seven or more items be endorsed, at least several of the items co-occurred, and the symptoms caused at least moderate psychological impairment. One thousand and fifty-one patients entered the study: 570 in treatment-resistant group and 481 in non-treatment-resistant group.

The percentage of patients having MDQ positive screen was significantly higher in the treatment-resistant than in the non-treatment-resistant group (13.7% vs. 5.6%, respectively, p< 0.001). Significant predictors of MDQ positive screen identified in logistic regression were: family history of bipolar disorder (OR=4.04, p< 0.001), early onset of first major depression (< 20 years) (OR=3.27, p=0.001), and incomplete last remission (OR=3.11, p< 0.001).

Our results may suggests bipolar diathesis in treatment- resistant depression.

Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in psychiatric institutions. Research constitutes a part of international project funded by European Commission.

Polish language version of QuIRC has been tested in 20 psychiatric units across 3 districts in Poland. Selected facilities differed in employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.

Manager of only 1 out of 21 units refused to participate in interview. QuIRC usage was simple but time-consuming. The most common hardships in data collection referred to numbers of staff and trainings the employees participated in. It might be due to round-the-clock care in Polish units and common work in the shift system. Moreover ward managers in Poland in vast majority of the units were medical doctors and the facilities’ economics was often obscure for them. Development of web version of the toolkit will facilitate its implementation in research projects but as well internal assessments for units’ own purposes.

Negative affect and somatization are closely linked to symptoms of neurotic disorders. Negative affect consist of different negative emotions e.g. anxiety and hostility.

The study included a total of 52 inpatients of the day care clinic, 13 men and 39 women, aged 20-56 years. They suffered from neurotic, somatoform and personality disorders. All the patients participated in the group psychodynamic psychotherapy. The therapy lasted 12 weeks, there were 2 sessions of 1.5 hour every working day. The patients were examined before, immediately after and 3 months after the therapy. Negative affect, somatization and general psychological distress were assessed with SCL-90-R, GHQ-30 and PSE (a part of SCAN 2.0) questionnaires.

Mean values of anxiety and depressive symptoms, somatic symptoms and general psychological distress changed in like manner. They dropped of about 1/3 of initial value during the therapy and then stayed stable for 3 months after the therapy. Differences between first and second as well as third assessment were statistically significant whereas between second and third assessment were not. A pattern of change in hostility (SCL-90-R subscale) was different. Mean value of hostility did not change significantly during the therapy and then dropped significantly 3 months later.

Anxiety and hostility could be triggered separately and it is important to assess them both in terms of improvement. Short psychodynamic group psychotherapy is effective in reducing symptoms of anxiety, depression and somatization, but not effective in reducing hostility assessed 3 months afterwards.

Fibronectin(FN) is a multidomain adhesive glycoprotein present in connective tissue on cell surfaces in insoluble fibrilar form.

Because of reported experimental evidences for a very large elasticity of the FN molecule and in view of the hypothesis that conformational changes precede its function, we were interested in analyzing: 1)the eventual appearance of macromolecular form of fibronectin, 2) the expressions of the cellular, collagen, fibrin, and C-terminal fibronectin domains in the blood plasma of Alzheimer's(14 patients, mean age 70.2+/-6.5), vascular dementia patients(24 patients, mean age 73.1+/-5.3), and age-matched control(30 subjects, mean age 73.4+/-7.4).

The fibronectin domain concentrations were determined by ELISA using panel of domain-specific monoclonal antibodies. Western immunoblotting by the use a monoclonal antibody was performed to analyze the FN molecular forms.

Immunoblotting pattern of plasma fibronectin of both dementia groups and age-matched group consisted of two FN bands(220-230 kDa), and some of them showed additionally of 2-3 macromolecular bands having molecular masses 260 and 350 kDa. However, the appearance of macromolecular fibronectin forms(260 and 350 kDa) happened more frequently in Alzheimer's dementia(85% of samples)than in samples with vascular dementia(50%) as well as in age-matched control(53%).Among the analysed domain expression on fibronectin, only the concentration of the C-terminal fibronectin domain(747.1+/-79 ug/ml)was significantly higher(p<0.004)than that in age-matched control group(635.7+/-120ug/ml, whereas its level was negligible different in vascular dementia(659.2+/-137ug/ml).

The occurence of macromolecular forms of fibronectin seems to be associated more frequently with Alzheimer's dementia. Increased concentration of C-terminal domain suggests some conformational alterations of fibronectin present in Alzheimer's samples.

Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in longer term mental health institutions. Research constitutes a part of international project funded by European Commission.

Polish version of QuIRC has been tested in 20 psychiatric units across 3 regions in Poland. Selected facilities differed in terms of employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.

Manager of only 1 out of 21 units refused to participate in interview. The most common difficulties in data collection were in relation to the number of staff and staff training. These difficulties may be due to differences in the work patterns and training of staff in Polish units compared to other countries. In comparison to international results important differences in preliminary assessments of long term mental health care were found in several areas probably due to the early stage of deinstitutionalisation process in Eastern Europe. Development of the web based version of the toolkit will facilitate its implementation in research as well as internal assessments for units’ restructuring purposes.

The evaluation of needs, satisfaction with services, social functioning and quality of life has been recognized as domains important for care planning and outcome assessment in care of persons with psychiatric disorders.

The aim of the study was to assess what are demographic, social and clinical variables associated with higher needs for care and to find out what are correlates among needs, satisfaction with services, social functioning, and quality of life.

The sample included 170 out-patients from psychiatric clinics with diagnosis F 2- 6 according to ICD-10. Demographic, social and clinical data were collected with special questionnaire. Several instrument were used: the Brief Psychiatric Rating Scale (BPRS), the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Client's Scale for Assessment of Treatment (CAT) – to assess satisfaction with services, the Groningen Social Disability Schedule (GSDS-II) and the Manchester Short Assessment of Quality of Life (MANSA).

Needs were positively related to patient age, being male, single, unemployed and to intensity of psychopathological symptoms. Unmet needs were negatively associated with satisfaction with services. Quality of life and social functioning were strongly related to number of met, unmet and total needs (quality of life and social functioning decreased as needs increased). The results showed that different variables as well as their satisfaction with services, social functioning and subjective quality of life are associated with patients needs.

Sleep disorders are significant problem in hemodialysis patients, contributing to psychosocial disability and decline in qualiy of life. Aim of this study was to assess the quality of sleep disorders in relation to various clinical and sociodemographic factors in patients undergoing hemodialysis.

The preliminary study group included 55 persons selected at random from 150 patients treated by hemodialysis. The mean age was 60,31±12,14, mean time of dialysis 3,49 ± 4,53 years. 20 women and 35 men were interviewed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) sleep disorders section and additional sociodemographic interview. In each case psychiatric examination has been performed. Medical comorbidity including restless legs syndrome (RLS), suffering from pain, blood and urine tests were analyzed for potential impact on sleep disturbance.

In studied group sleep disturbences did not show significant correlation with presence of mental disorders, somatic comorbidity other than RLS or most laboratory data (blood or urine tests). The following differences were observed:

1. 1. Positive correlation between overall sleep impairment, night wakefulness and nPCR index related to nutrition and metabolism (p-value 0.047),

2. 2. Greater sleep satisfaction in the group with higher calcium level before hemodialysis (p-value 0.045),

3. 3. Higher nightmares occurence in the group with lower calcium level before hemodialysis (p-value 0.023).

In the population of patients with end-stage renal disease after adaptation period to hemodialysis more important role in sleep disorders may play factors related to the somatic state and metabolism rather than psychiatric comorbidity.

World studies show associations between social consequences of carers’ involvement and level of individuals’ met and unmet needs.

In Poland not much interest has been put to studies of psychiatric patients’ needs and carers’ burden. Due to this fact most of care programmes have been developed on the basis of authors’ personal experiences or academic knowledge.

To obtain data regarding met and unmet patients’ needs and the impact on carers’ burden in Polish socioeconomic reality.

60 psychotic inpatients were examined with CSHI, BPRS and CANSAS. Their 60 direct carers’ personally completed IEQ, GHQ-12 and assessed own opinions about patients’ needs with CANSAS questionnaire. Patients unable to give informed consent, alcohol/drug dependent, mentally retarded/demented or with personality disorder were excluded along with patients below 18 and over 65 years of age.

The Pearson correlation coefficient, the Spearman’s rank correlation coefficient, Kendall’s tau coefficient.

Results show significant relation between duration of the disorder and number of unmet needs assessed by individuals. Patients’ met needs are positively associated with carers IEQ results - subscales tension and worrying. Carers evaluation of patients’ unmet needs correlates with their IEQ results - subscales tension, worrying and urging. Overall number of patients’ needs indicated by carers correlates positively with carers’ results of IEQ subscale - urging.

The higher rate of patients’ unmet needs the higher burden they are imposed to. Results of the study are important in planning of interventions towards psychiatric patients and their direct carers.