Specific problems dealt with by psychiatry of childhood and adolescence are presented by the author. Particular tasks and difficulties of this clinical area are outlined and inadequacies of development of this branch of psychiatry in Poland are pointed out. (Eds.)
Speech disorders in children with early and late infantile autism are analyzed in the paper. There are developmental speech disorders specific for each of the two types of autism. An analysis of speech development pathology suggests that pathogenesis of these two forms of autism is different. Assessment of speech disorders in autistic children has both diagnostic and prognostic value.
The first part of the paper deals with: (a) symptoms of anorexia nervosa, (b) symptoms of cachexia resulting from self-starvation, (c) metabolic disorders and pathophysiological complications in patients suffering from anorexia nervosa. Next, the state-of-the-art views on treatment of anorexia nervosa are presented, with the emphasis on the need for a comprehensive therapeutic program aimed at a better nutrition of the patients, amelioration of their metabolic and pathophysiological disorders, as well as at their increased sense of autonomy, accelerated formation of self-identity, and improved self-esteem. The role of individual and group psychotherapy and of family therapy is stressed. Pharmaceuticals administered in the treatment of anorexia nervosa are discussed. The necessity for the treatment continuation after the patient's discharge from the hospital is pointed out.
On the grounds of the author's clinical experiences concerning the implementation of systemic therapy in an adolescent psychiatry ward, and on the basis of the research literature a differentiation is made between the constructivist and holistic systemic models of inpatient psychiatric facility. Only the latter model implementation seems to be feasible in a psychiatry ward for acute cases, serving a specified catchment area.
Adolescencja, jako jedna z faz cyklu życiowego rodziny wymaga realizowania przez wszystkich członków systemu rodzinnego specyficznych zadań rozwojowych. Trudności w ich realizacji zwiększają niebezpieczeństwo pojawienia się symptomów chorobowych lub zachowań objawowych u dziecka w wieku dorastania. Można wyodrębnić kilka ich specyficznych funkcji, zależnych od charakterystyki rodziny, często bez związku z rozpoznaniem psychiatrycznym. W trudnej sytuacji choroby psychicznej adolescenta rodzina radzi sobie zgodnie ze swą wcześniejszą charakterystyką. Istotne znaczenie mają także pozarodzinne elementy systemu wielorakiego osadzenia pacjenta młodzieżowego.
The aim of this study was to look for relationships between panic attacks, panic disorder and other anxiety disorders (according to DSM-IV criteria) in 60 persons (30 children aged 5-14, and 30 adolescents aged 15-18). The subjects and their mothers or carers were examined with a structured interview based on DSM-IV criteria for diagnosing panic attacks and panic disorder. Medical and especially psychiatric records of Ss were analyzed for causes of panic attacks and panic disorder. All the Ss underwent physical and neurological examination, and – in some eases – also additionally a laboratory cheek-up or CT of the brain. 45% of Ss, especially those with general anxiety disorder at present, were found to have suffered from panic attacks and panic disorder in the past. 18.3% of the Ss had suffered from panic disorder, while panic attacks (usually situationally determined or preceded by hyperventilation) had occurred in 26,7% of them. The relationship between panic disorder in the past and current general anxiety disorder seems to be an interesting finding requiring further study.
In a questionnaire survey a group of experts were asked to rate the diagnostic value of 79 different indices used for the assessment of cerebral pathology in children and adolescents. Statistical analysis of the ratings yielded a set of the most useful indices of "organicity" or brain damage.
An attempt was made by the authors to develop a diagnostic procedure for the assessment of cerebral pathology and mental disorders resulting from brain damage in children and adolescents. For this purpose a two-stage verification of various indices of brain damage was carried out.
Prevalence of organic factors, developmental mental disorders, and mental disorder rates among relatives were compared in two groups of patients aged 7-14 and 15-19 years. Pathology of pregnancy and delivery, as well as organic factors in infancy were found significantly more often in the younger age group, while organicity in the school age was more frequent in the adolescent group. Developmental mental disorders (including eating disorders, sphincter dysfunction, psychomotor hyperactivity, fragmentary deficits, and behavior disorders) were significantly more frequent in the 7-14 age group. Familial incidence of mental disorders was significantly more often noted in adolescents, while alcohol abuse and dependence tended to run in families of the younger children.
Specific characteristics differentiating the adolescent therapeutic group from other groups are considered in the paper. Peer group functions in the developmental stage of adolescence are described, as well as difficulties encountered by the therapist in the course of group therapy of adolescent patients. The difficulties pertain mostly to their motivation to treatment and attitude towards the therapist.
The organization and treatment methods of a day hospital for children aged 3-8 years and of an inpatient ward for adolescents are described in the paper.
The case of 15-year-old Hanna served to illustrate methods used in the therapy of female patients treated for anorexia nervosa in the adolescent psychiatry ward in Toruń. The importance of a holistic approach was particularly emphasized.
Principles of functioning of an outpatient family therapy unit using the systemic approach, as well as characteristics of the patient population are presented in the paper. Rather more attention is paid to the treatment of eating disorders, i.e. to the condition relatively most frequent in patients treated in the unit. (Eds.)
Experiences and principles of functioning of a home hospitalization team for children and adolescents in Cracow are outlined in the paper. Their work is based on the systemic approach. Diversity of encountered problems and of necessary interventions is emphasized. (Eds.)
An attempt was made to describe the family situation of 9 adolescent patients hospitalized for mental disorders in Child and Adolescent Psychiatry Ward in Cracow. Specificity of this sample consists in a prolonged absence of a parent due to his/her economic emigration. Relationships were analyzed between the onset of the adolescent's problems and parental decisions concerning emigration, extension of their stay abroad, and return. (Eds.)
The paper presents patients' views on coercion in psychiatry as expressed in their responses to a questionnaire based on the Mental Health Act of May 1993. Patients' responses were analyzed in terms of concordance with the solutions accepted in a draft of the Act. Several categories of respondents were distinguished in the survey, including radicals, liberals, and those accepting medical or legal-administrative procedures of dealing with the patient admitted to and treated in a mental hospital without consent. Patients hospitalized in mental hospitals recognize a need for an increased range of recommendations for using coercion in psychiatry (as compared to these proposed in the draft of the Act). They support the medical model of psychiatric care, with its traditional solutions employed so far.
Opinions held by medical staff of psychiatric institutions on the use of coercion in psychiatry are discussed in the paper. The data were obtained using a questionnaire based on the draft of the Mental Health Act of May 1993. The staff of psychiatric hospitals are concordant with the Act provisions concerning coercion in psychiatry. However, they point to the necessity of more extensive recommendations for some coercive procedures. Neither radical nor liberal solutions were chosen by this group, while traditional, hitherto used ones were accepted by them. This is due to their adoption of the medical perspective in the question of psychiatric treatment.
Opinions on coercion in psychiatry held by 4th year students of Medical Academy in Wrocław are presented. In the study a questionnaire based on the Mental Health Act of May 1993 was used. The students' views were to some extent consistent with the provisions of the draft of this Act. However, they believe that under some conditions the recommendations for the use of coercive procedures in psychiatry should be wider. No radical or liberal attitudes were found in this group. The medical model of psychiatric patients' admission and treatment in a mental hospital without their consent was accepted by the students.
Views on coercion in psychiatry as expressed by medical staff of mental hospitals, psychiatric patients, and senior medical students are compared in the paper. These data were obtained using a questionnaire based on the draft of the Mental Health Act of May 1993. Ss' responses were analyzed for their concordance with the Act provisions, and a number of respondent categories were singled out: those holding liberal or radical views, and others, preferring the medical or legal-administrative models of psychiatric care. A marked concordance of opinions was found in all groups under study, as well as medicalization of attitudes, and the need for extending recommendations for the use of coercion in psychiatry beyond the limits proposed in the Act.
The author's doctoral dissertation is devoted to the phenomenon of phase inversion (from depressive to manic) in the course of treatment of bipolar affective disorder. 118 episodes of phase inversion were analyzed in 333 patients treated in the Department of Affective Disorders. (Eds.)
An overview of the literature on bruxism is presented. This little known condition may be of interest to dentists, neurologists, neurophysiologists and psychiatrists.