Cognitive Behavioural Assessment Research Articles

Individual factors enhance poor health-related quality of life outcome in multiple sclerosis patients. Significance of predictive determinants

BackgroundIndividual factors in multiple sclerosis (MS) patients may modify the reliability of health-related quality of life (HRQOL) assessment. Knowledge of these effects may enable physicians to identify patients at risk for poor perceived health. ObjectiveTo investigate what individual factors may interact with MS symptoms and their severity to modify the reliability of HRQOL assessment; to explore the predictive values of the significant variables identified. MethodsHRQOL was assessed in 57 patients by the 36-Item Short Form Health Survey (SF-36). The Physical Component Summary and Mental Component Summary were dichotomized and applied as dependent variables for logistic regression analysis. The Functional Independence Measure (FIM), Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Cognitive Behavioral Assessment (CBA) and specific individual factors were tested as independent variables. Two-way contingency tables were used to calculate the predictive values. ResultsUnemployment, smoking, and night waking were the most significant individual factors. Introversion, physical pain and difficulty falling asleep were also significant. EDSS-total ≥2, EDSS-pyramidal ≥2, FIM ≤123, FSS ≥5, depressive manifestations and bowel/bladder dysfunction were significant MS-related determinants. Sensitivity and specificity differed widely for each variable. ConclusionsIndividual factors have relevance in HRQOL assessment. Their identification may help physicians construct the patient's risk profile. Sensitivity and specificity add weight to the significance of variables.

Efficacy of Combined Cognitive-Behavior Therapy and Hypnotherapy in Anorexia Nervosa: A Case Study

A 22-year-old female diagnosed with anorexia nervosa received brief psychotherapy within a span of 1.5 months. Detailed cognitive-behavioral assessment was done and eating attitude was rated. Intervention of eating behavior and cognitive restructuring were initiated along with regular practice of self-hypnosis with ego-strengthening suggestions. Age regression was done to identify conflicts. Significant improvement in eating attitude was noted after 8 sessions without relapse at 3 months. Details of the psychotherapy are discussed.

Psychological Correlates in Subjects with Hereditary Angioedema (HAE)

Objectives: Hereditary Angioedema (HAE) is a rare serious medical condition caused by a deficiency of C1-inhibitor, due to mutations in its structural gene. The disease appears clinically as cutaneous swelling of the extremities, face, genitals, and trunk, painful swelling of the gastrointestinal mucosa and life threatening laryngeal edema. In this study we evaluated in HAE patients and in the relative controls the psychological status and gender differences to verify if there is a link between disease and mental status. Methods: We studied “psychological stress”, using the Cognitive Behavioural Assessment 2.0 (CBA-2.0), in a total of 70 patients with confirmed HAE from different Italian Hospitals (41 women, 29 men; aged 17 to 78). Results: The analysis of the majority factors of CBA-2.0 tests indicates a clear difference between male and female patients; in fact, women perceive more intensively than men the different signs of the disease (have more consciousness of the consequences that this illness provokes in their life). Conclusion: Our data indicate that HAE is associated with emotional factors that can also complicate the clinical status of patients.

EPA-0356 – Tuberous esclerosis complex and psychiatric comorbidity: two case reports

Introduction Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported. Objectives We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described. Methods Patient 1 Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication. Patient 2 Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective. Results Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses. Conclusions Psychiatric comorbidities are well described in literature. About 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.

Assessing depression in cardiac patients: what measures should be considered?

It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients' wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

The Cognitive Behavioral Assessment (CBA) Project: Presentation and Proposal for International Collaboration

Aims: The main aim of this paper is to describe almost 30 years of work on psychological assessment using CBA, a research team, and to propose collaboration with Latin countries. Methods: The acronym CBA stands for Cognitive Behavioural Assessment and indicates both an overall approach to clinical assessment and a series of tests. Five general principles formed the basis on which the team developed their questionnaires: (1) assessment is not a passive collection of information, but an active process similar to problem-solving; (2) horizontal integration of questionnaires with other assessment methods; (3) vertical integration and hierarchical structure of assessment questionnaires; (4) idiographic perspective; (5) computer support. Results: The paper briefly presents the most important tests: CBA-2.0, a broad-spectrum Battery for patients who need counselling and/or psychotherapy; CBA-H (Hospital) for both in-patients and out-patients suffering from physical illnesses; CBA-SPORT for professional athletes; CBA-Y (young people) for adolescents and young adults; CBD-VE (treatment benefits) to assess the effectiveness of psychological treatment. Conclusion: These questionnaires have produced over 100 research works, published in Italian journals or presented in conferences. In the near future, we expect important, radical changes and hope to create an international research milieu.

Intrapartum analgesia as a condition of human satisfaction at hospital

The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia) called the A group, and the control group (women who refused it) called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y) scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment) scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

Understanding Personality and Predicting Outcomes: The Utility of Cognitive-Behavioral Probes of Approach and Avoidance Motivation

Approach and avoidance motivation may represent important explanatory constructs in understanding how individuals differ. Such constructs have primarily been assessed in self-reported terms, but there are limitations to self-reports of motivation. Accordingly, the present review concentrates on the potential utility of implicit cognitive-behavioral probes of approach and avoidance motivation in modeling and understanding individual differences. The review summarizes multiple lines of research that have documented the utility of such probes to the personality-processing interface. Although multiple gaps to our knowledge exist, and are acknowledged, the value of such implicit cognitive-behavioral assessments is emphasized both in modeling multiple sub-components of approach and avoidance motivation and in showing that such tendencies matter in ways that transcend momentary experiences or manipulations.

Cognitive decline in Dravet syndrome: Is there a cerebellar role?

The aim of the study was to perform a detailed assessment of cognitive abilities and behaviour in a series of epileptic patients with Dravet syndrome (DS) in order to establish a possible cerebellar-like pattern. Nine children with DS without major behavioural disturbances and with cognitive abilities compatible with the assessment of specific cognitive skills (IQ>45) were enrolled in the study, in parallel with another group of nine epileptic patients (cryptogenic or symptomatic with minor brain injuries) consecutively admitted into the hospital matched for chronological age and IQ. All cases underwent neurological examination, long term EEG monitoring, neuroimaging and genetic analysis as well as a neuropsychological assessment including specific cognitive skills. On neurological examination 8 of the 9 DS patients had cerebellar signs, which were mild in six and more severe in the other two cases. DS patients had a constant discrepancy between verbal and performance items scales (verbal better than visual-spatial) that was not found in the control group. As to specific cognitive competence, the DS patients differ from the control group in the pattern of cognitive defects involving four main areas of cognitive abilities (a) expressive language with relatively spared comprehension, (b) visual-spatial organization, (c) executive function defects, (d) behavioural disorders. The pattern of cognitive difficulties found in DS patients is consistent with what is reported in literature as cerebellar cognitive syndrome and may account for a possible cerebellar origin (at least as co-factor) of the cognitive decline observed in DS patients, as suggested by other clinical and experimental studies.

Randomized trial comparing Internet-based training in cognitive behavioural therapy theory, assessment and formulation to delayed-training control

ObjectiveThere is a need for effective, scalable methods of training clinicians in evidence-based interventions, particularly for populations with significant barriers to accessing traditional methods of training (e.g., developing economies, non-English speaking geographically dispersed populations). Hence this study examined the effectiveness of Internet-based training (IBT) in cognitive behavioural therapy (CBT) theory, assessment and formulation for participants in Russia with limited previous knowledge or training in CBT. MethodParticipants (N = 63) were randomized to either immediate IBT (approximately three hours over the course of one month) or a delayed training control group. Participants were assessed immediately prior to and following the training/delay on (a) standardized role-play of a CBT assessment and (b) ability to construct CBT formulation of the role-play ‘patient’. In addition the feasibility and acceptability of the training was assessed. ResultsResponses indicated that translated and subtitled IBT training was perceived by participants to be feasible and acceptable. Following the training those allocated to IBT scored significantly higher on measures of CBT assessment and formulation skills (between group effects sizes of d = 0.77–1.10) than those allocated to the control group. Participants reported IBT to be a feasible and acceptable form of CBT dissemination. An adaptation of the CTS used to rate a standardized role-play assessment demonstrated good inter-rater reliability. ConclusionsIBT may be an effective and scalable method of CBT dissemination with particular potential for training CBT skills in populations with significant barrier to accessing traditional methods of training.

Coffee, but not caffeine, has positive effects on cognition and psychomotor behavior in aging

The complex mixture of phytochemicals in fruits and vegetables provides protective health benefits, mainly through additive and/or synergistic effects. The presence of several bioactive compounds, such as polyphenols and caffeine, implicates coffee as a potential nutritional therapeutic in aging. Moderate (three to five cups a day) coffee consumption in humans is associated with a significant decrease in the risk of developing certain chronic diseases. However, the ability of coffee supplementation to improve cognitive function in aged individuals and the effect of the individual components in coffee, such as caffeine, have not been fully evaluated. We fed aged rats (19 months) one of five coffee-supplemented diets (0, 0.165, 0.275, 0.55, and 0.825% of the diet) for 8 weeks prior to motor and cognitive behavior assessment. Aged rats supplemented with a 0.55% coffee diet, equivalent to ten cups of coffee, performed better in psychomotor testing (rotarod) and in a working memory task (Morris water maze) compared to aged rats fed a control diet. A diet with 0.55% coffee appeared to be optimal. The 0.165% coffee-supplemented group (three cups) showed some improvement in reference memory performance in the Morris water maze. In a subsequent study, the effects of caffeine alone did not account for the performance improvements, showing that the neuroprotective benefits of coffee are not due to caffeine alone, but rather to other bioactive compounds in coffee. Therefore, coffee, in achievable amounts, may reduce both motor and cognitive deficits in aging.

Confusion Assessment Method (CAM) Indicators When CAM Positivity in 647 Individuals Has Good Outcome

Huang and colleagues1 assembled the dream team of researchers of delirium in elderly adults to match features from the medical history, physical examination, and cognitive behavioral assessment with the four elements of the Confusion Assessment Method (CAM).2 We found this analysis highly useful. The main premise of their study was that the CAM is the criterion standard for identifying delirium in elderly adults. This clearly was true when the CAM was developed in 1990. In 2011–2012, this premise is no longer true in the acute geriatric unit of our hospital and we suspect in regions with a national health service providing acute care for elderly adults, such as Australia, where we work. This is no more surprising than saying that a prognostic system for pulmonary tuberculosis devised in 1930 before streptomycin, isoniazid, or rifampicin is not valid since antituberculous drugs were implemented. We analyzed 647 individuals with a mean age of 84 admitted to our acute care for the elderly unit in Australia from January 2011 to June 2012; 76% were admitted directly to the geriatric unit, and 11% were transferred 8 days or more after admission. Whenever an individual answered incorrectly during cognitive assessment, the remaining questions were given with a portable amplifier with headphones. This helps to exclude impaired hearing as the cause of inattention, disorientation, or poor memory. The 60 CAM-positive subjects (9.3%) had the same mortality at discharge and at 30, 90, 180, and 365 days and the same rate of returning home versus to a hostel (low-level care) or nursing home (high-level care) as the 587 CAM-negative subjects. In July 2012, a prospective randomized controlled trial comparing acute care for the elderly with general medicine for CAM-positive elderly adults was commenced in an emergency department (Central Coast Australia Delirium Intervention Study (CADIS; registered in ClinicalTrials.gov and Australian New Zealand Clinical Trials Registry)). In the general medicine group, the diagnosis of delirium is written in the medical chart every day, and a research assistant measures the delirium index and digit span daily, recording results in the medical chart so that the general medicine team can assess progress in treating delirium. CADIS will compare the CAM with the Regal criteria for grading delirium against two hard outcomes: mortality at discharge and 30, 90, 180, and 365 days and return home rate. The Regal method for grading delirium has many elements distinct from the CAM. First, it mandates assembling previous assessments from geriatricians, neurologists, neuropsychologists, psychiatrists, and others assessing cognition and behavior before the current illness.3 Finding the most recent measurement and calculating the difference from the current value is essential to distinguish delirium from dementia or other chronic cognitive disorders. Second, it mandates hearing assessment using the whisper test, followed by correction of hearing impairment using a portable amplifier with headphones.4 Third, it sets a specific target of at least 30% decline from a recent test in attention tests such as digit span forward. (If there is no recent test, then a minimum 30% improvement on resolution of delirium is required.) Rapid improvement is typically found within 7 days. Fourth, it mandates at least a 30% decline in selective instrumental activities of daily living (SIADLs), which include activities not affected by lower limb and mobility problems such as hip fracture or hemiplegic stroke. Examples of SIADLs are reading maps or a daily newspaper, performing crossword puzzles, and making change with coins. IADLs are a useful marker of functional cognition in dementia and mild cognitive impairment.5 Functional decline is an important element in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of dementia; functional decline is also important to distinguish delirium from psychosis without inattention. Other acute care for the elderly units should compare the outcomes of CAM-positive and -negative individuals and compare these with grade of delirium according to the Regal criteria. Presented in part at the Australian Delirium Society conference, Sydney, Australia, May 1, 2012, and the International Psychogeriatric Association Conference, Cairns, Australia, September 10, 2012. Conflict of Interest: Paul Regal declares no conflict of interest with employment, affiliations, grants, funding, honoraria, speaker's forum, consultancy, stocks, royalties, expert testimony, board membership, patents, or personal relationships. Author Contributions: Paul Regal was responsible for the study concept, study design, acquisition of subjects, data management, analysis, interpretation, and preparation of the manuscript. Sponsor's Role: No sponsor.

Polysubstance Use in Cannabis Users Referred for Treatment: Drug Use Profiles, Psychiatric Comorbidity and Cannabis-Related Beliefs

Background: Population-based surveys demonstrate cannabis users are more likely to use both illicit and licit substances, compared with non-cannabis users. Few studies have examined the substance use profiles of cannabis users referred for treatment. Co-existing mental health symptoms and underlying cannabis-related beliefs associated with these profiles remains unexplored.Methods: Comprehensive drug use and dependence severity (Severity of Dependence Scale-Cannabis) data were collected on a sample of 826 cannabis users referred for treatment. Patients completed the General Health Questionnaire, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire, and Positive Symptoms and Manic-Excitement subscales of the Brief Psychiatric Rating Scale. Latent class analysis was performed on last month use of drugs to identify patterns of multiple drug use. Mental health comorbidity and cannabis beliefs were examined by identified drug use pattern.Results: A three-class solution provided the best fit to the data: (1) cannabis and tobacco users (n = 176), (2) cannabis, tobacco, and alcohol users (n = 498), and (3) wide-ranging substance users (n = 132). Wide-ranging substance users (3) reported higher levels of cannabis dependence severity, negative cannabis expectancies, lower opportunistic, and emotional relief self-efficacy, higher levels of depression and anxiety and higher manic-excitement and positive psychotic symptoms.Conclusion: In a sample of cannabis users referred for treatment, wide-ranging substance use was associated with elevated risk on measures of cannabis dependence, co-morbid psychopathology, and dysfunctional cannabis cognitions. These findings have implications for cognitive-behavioral assessment and treatment.

Predictors of anxiety and depression in hematopoietic stem cell transplant patients during protective isolation

To examine in a sample of hematopoietic stem cell transplant patients assessed throughout protective isolation (i) levels of anxiety and depression and (ii) pre-isolation factors (socio-demographics, biomedical variables and personality traits), which might predict higher levels of anxiety and depression during isolation. The study used a longitudinal prospective design. Anxiety and depression were assessed in 107 participants by the State-Trait Anxiety Inventory and Self-rating Depression Scale at admission and weekly at fixed time points throughout isolation. Among pre-isolation factors, patients' psychological status was evaluated by the Cognitive Behavioral Assessment (2.0). Predictors were explored by random-effects models. One-tenth of the patients suffered from clinically significant anxiety and depressive symptoms at admission. Although the percentage of depressed patients increased more than twofold after 2 weeks of isolation, that of anxious patients did not significantly change over time. Female gender, higher anxiety and obsessive-compulsive symptoms, intratensive personality traits and lower performance status predicted higher depression during isolation. Anxiety and depression represent a relevant problem for hematopoietic stem cell transplant patients during isolation. Early detection of predictors, such as anxiety levels, obsessive-compulsive symptoms and performance status, could help prevent depression via targeted psychological intervention.

Characterization of human serum butyrylcholinesterase in rhesus monkeys: Behavioral and physiological effects

The effects of a large dose of human serum butyrylcholinesterase (HuBChE) were evaluated in rhesus monkeys using a serial-probe recognition (SPR) task designed to assess attention and short-term memory. Each monkey received an intravenous injection of 150mg (105,000U or 30mg/kg) of HuBChE 60min prior to testing on the SPR task. Concurrent with the cognitive–behavioral assessment, blood was collected at various time points throughout the study and was analyzed for acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities, anti-BChE antibody production and gross clinical pathology (i.e., complete blood count and clinical chemistry panel). HuBChE revealed a peak blood activity of 227U/ml at 5min after intravenous injection and a mean residence time of approximately 72h. No cognitive–behavioral decrements of any kind in SPR performance and no toxic signs in clinical pathology were detected in any of the blood assays during the 5weeks of observation. Anti-HuBChE antibodies peaked at about 14days after injection, with no concomitant behavioral changes. These results demonstrate the behavioral and physiological safety of HuBChE in rhesus monkeys and support its development as a bioscavenger for the prophylaxis of chemical warfare agent toxicity in humans.

Individualized, transdiagnostic approaches to complex presentations: a case study

Cognitive behavioural therapy is an evidence-based approach to helping people resolve their mental distress. Cognitive behavioural therapy practitioners are often encouraged to adapt their interventions according to the person's diagnosis. However, this approach can be too simplistic. This paper aimed to reflect on working with complex clinical presentations and to explore how transdiagnostic approaches can be effectively integrated into standard cognitive behavioural interventions. To achieve these aims, a case study of cognitive behavioural therapy assessment and treatment was presented. The interventions used are described in detail. The move away from a diagnostic-led intervention to a transdiagnostic perspective based on the individualized formulation is described. Reflections on the process are discussed and the overall approach used is evaluated with recommendations made to enhance future clinical practice.

P-1335 - Sexual dysfuction and psychological correlates. Data from a pilot study

Introduction Erectile dysfunction (ED) and premature ejaculation (PE) are common disorders among italian male population aged between 18 and 65 years old (prevalence rate: 20–25%). Several studies demonstrate that the early treatment of the psychological conditions, frequently associated to ED and PE, can positively influence the prognosis. Aim To evaluate the psychological correlates of sexual dysfunction using a standardized instruments.Methods. 46 male patients aged between 18 and 65 years old affected by EP (60,87%) and DE (47,83%) were administered the Cognitive Behavioural Assessment (CBA 2.0). Analysis of data was carried out using an automatic scoring and creating a graphic profile. Results The 28,26% of the participants showed an high score (> 95th percentile) at the STAI X-1 suggesting the presence of trait anxiety; the 39.16% of the subjects reported experiences of social and emotional maladjustment and concomitant introversive personality traits at EPQ schedule (85–@95th percentile at subscales E and P) and depressive mood at scale 8 (questionnaire D). Finally, the 32.60% did not present psychological conditions. Conclusions According to the literature, our findings demonstrates an high frequency of psychological distress in patients affected by sexual dysfunction (67%). The use of CBA 2.0 migth represent an useful tool for the diagnosis and early treatment of this kind of population.

Translating Research for Professional Development and Effective Clinical Practice With Older Adults

This paper offers a commentary on the articles in the special series on cognitive behavior therapy with older adults (Carmin, 2012-this issue), noting the commonalities found across discussions of diagnostic interviewing and cognitive-behavioral assessment and treatment for late-life insomnia, depression and suicide risk, PTSD, and OCD. These case studies demonstrate best practices in the application of cognitive-behavioral strategies for assessment and intervention with a diverse range of older adults. Clinicians can improve the effectiveness of their work with aging clients by expanding their skills in assessment and managing interprofessional relationships in integrated health-care settings. Reflected by the papers in this series, ongoing professional development and research attention are both essential as clinicians from the mental health disciplines increase provision of CBT with older adults. Treatments for specific disorders and problems will also benefit from the growing literature on successful aging, and the application of positive psychology in our future collaborations with older adults and their care partners.

Psychological Risk Factors for Graft Rejection Among Liver Transplant Recipients

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio = 1.1; P < .05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

Cognitive functioning and behaviour of epileptic children in parents' assessment

Background and purposeCognitive functioning and behaviour of chronically ill children are affected by many factors, including anxiety due to hospitalization, persistent symptoms of sickness and adverse side effects of medications. The aim of this work was to seek out parents' opinion concerning cognitive functioning and behaviour of children with epilepsy. Material and methodsThe study comprised 156 children with epilepsy aged 7–18 and treated in the Department of Developmental Neurology at Karol Marcinkowski Poznan University of Medical Sciences and in an outpatient clinic. The research tool used was the questionnaire Quality of Life in Childhood Epilepsy (QOLCE) completed by parents. Assessment of cognitive functioning and behaviour was based on the analysis of the areas V (cognitive processes) and VII (behaviour). ResultsParents assessed children's functioning in the areas of cognitive processes and behaviour at a similar level – 55 points. In the area of cognitive processes, concentration while performing some tasks and reading was assessed as the worst. A significant difference in caregivers' assessment was found according to age, frequency of seizures and duration of disease. In the area analysing the child's behaviour, parents indicated getting angry easily and not being upset by other people's opinions. The display of aggression towards others got the lowest number of comments. ConclusionsThe children's functioning was assessed by parents as rather poor in both analysed areas. Parents of children treated with polytherapy noticed more difficulties in cognitive functioning and behaviour than parents of children treated with one medication.