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Difficulties in diagnosing early stagesof Huntington's chorea are presented. The authorsemphasise the importance of a careful interview andthe crucial role of genetic tests. (Ed.)
In their report on two cases of Wilson's disease the authors outline difficulties in diagnosingthis disease, as well as problems with appropriateadministration of neuroleptic drugs and differentiationof their effects. (Ed.)
The article presents diagnostic andtherapeutic management of a patient with chronicobturative respiratory disorder first diagnosed bya psychiatrist. The diagnosis was supported laterby pulmonological examination. This is one of thefirst cases in Poland that the CPAP apparatus wasused for diagnostic purposes.
The paper presents afemale patienthospitalised for mental disorder in the Child andAdolescent Psychiatry Department, Institute ofPsychiatry and Neurology. Diagnostic problemsand the process of arriving at the final diagnosisare described. Changes in this patient's psychologicalfunctioning turned out to be due to hormonaldisturbance, i.e. hyperthyroidism.
The paper presents two female patientswith mental disorders and confirmed cystsof septum pellucidum. In the first case paranoidsyndrome, mild retardation and epilepsy were diagnosed,while in the other –psycho-organic syndrome,as well as a history of depressive statesand epilepsy.
The role of early and comprehensivediagnosing causes of dementia symptoms is exemplified by three cases –such a diagnosisallows to undertake appropriate treatment. (Ed.)
A case is reported of dependence inducedby the so-called energy drink (Red Bull)containing guarana. After a short period of using thesubstance the patient developed complete dependence,including withdrawal symptoms. Having consumedthe drink and ethanol the patient had anepisode of acute psychosis with visual hallucinations.
The authors describe an insulin-abuser –the patient injected himself with overdosesof insulin or consumed considerable amountsof sugar to enhance its action. No other reason forhis insulin abuse was found than pleasure seeking.
A case is reported of a patient unsuccessfullytreated for "typical" schizophrenia inseveral centers. He had a poor tolerance for narcolepticsand in the course of their administrationexacerbation of his symptoms was noted. Eventhough no abnormalities were found in his first eegexamination, an analysis of circumstances in whichhis episodes had occurred has, lead to a hypothesisabout temporal epilepsy. This was confirmed bothby the second eeg examination, and by the effectivenessof appropriate treatment.
The paper presents the experienceof being affected by electric currents and magneticfields reported sometimes by psychotic patients.Several such cases are described. These delusionalphenomena are discussed in the context of the electromagneticsense.
The authors describe psychopathologicalstatus of a mother and her two daughters,all three suffering from psychotic disorders. Theirhealth status warranted a motion for their compulsoryhospitalization. Management of thesecases was described with reference to the MentalHealth Act, with emphasis on the dilemmas andrisks involved.
A brief overview of the literatureconcerning the problems of insight in various psychopathologicalsyndromes is presented, and thesignificance of insight in the process of treatmentis discussed. Particular attention is paid to insight indepressive syndromes. Various opinions in this matterare cited. The effect of insight on the course of illness, especially in first ever episodes of depression,is exemplified by two cases.
Three cases of depressive disordersof different aetiology with a suicidal attempt eachare presented. On resolution of coma these patientsdeveloped euphoric syndromes masking their depressivesymptomatology for a few weeks.
A case of a policeman's suicide is presented. Attention is drawn to specific factors leading to suicidal behaviour and to possibilities of prevention. (Ed.)
A case is presented of pseudocyesisin a female with exacerbation of recurrent depressivedisorder (in the course of a moderate depressiveepisode) and concomitant vascular dementia.
A case is reported of a 39-year-oldmale patient with panic attacks and hypochondriacal complaints predominating in the clinical picture.Due to his somatic complaints he sought helpof cardiologists, gastroenterologists and surgeons. The diagnosisof xyphoiditis was followed by surgical treatment, but the complaints persisted. The ease illustrated not only diagnostic difficulties, but also the need for a close co-operation between psychiatrists and other medical professionals in cases of anxiety disorder, so as to avoid exposing the patient to unnecessary diagnostic and therapeutic procedures.
A case is described representinga particular pattern of obsessive-compulsive symptoms including these of diseases belonging to theso-called DCD spectrum. Considerable difficultiesin continuation of multilevel therapy of this patientare due to the late beginning of appropriate treatment,as well as to his extremely bizarre behavioursand symbiotic relationship with his mother.
An earlier reported case of a femalepatient with dissociative amnesia is revisited. Hypothesesposed previously are verified and someadditional material explaining the causes of herpathology is presented.
A female patient with borderline personalitydisorder is described. The authors outlinepsychological mechanisms triggering her extremelydiverse behaviour patterns. Moreover, the issues of differential diagnosis in this type of disorder andtreatment approaches are discussed. (Ed.)
A case of a young man with dissociativedisorder and features of histrionic personality ispresented. The immediate reason for his hospitalization were episodes of lass of consciousness withtremor of the body, recurring during the past two years. These episodes had been diagnosed as epileptic fits, despite the lack of confirmed c.n.s. abnormalities.Difficulties in the differential diagnosis in such cases, as well as the need for experience and co-operationbetween medical professionals representing variousspecialties are emphasised. Psychotherapy is regardedhere as a crucial method of treatment, supported bylaw doses of antidepressants or neuroleptics.
A case of schizophrenia in a youngwoman is presented –the patient terminated herpharmacotherapy due to her initial intolerance ofmedication administered. Psychoeducation hascontributed to a change in her mother's attitudetoward the patient's illness. Consequently, it waspossible to begin art therapy with the patient.A significant improvement was attained in her contactwith her physician, insight in her illness, andher psychosocial functioning.
The course of therapy of a femalepatient with schizophrenia is described, with theemphasison the importance of educational interventions. (Ed.)
The paper presents two patients with neurotic disorders and a chronic somatic diseaseinvolving risk to life (systemic sclerodermaand hepatocirrhosis with esophageal varicose veins).Problems related to their treatment are discussed,with particular emphasis on therapy goals and difficultiesin the course of psychotherapy.
A case of a pilot is presented who has lost his ability to perform his profession in consequence of psychosocial trauma. After three-year psychotherapy he returned to his work.
The paper presents a female patientaged 28, suffering from chronic disorders of a mixed pattern including anxiety, obsessive-compulsiveand recurrent depressive symptoms, witha long-term, persistent course. The author describesan unusually rapid and relatively stable improvementof the clinical picture following an iatrogenicconvulsive fit evoked by Clomipramine administration.Attention is drawn to multidirectionalbehaviour changes inducing unexpected changes inthe patient's environment.
The paper presents the course ofschizophrenia in 27-year-old monozygotic femaletwins with similar symptomatology and response totreatment. In the treatment with risperidone in thedaily dose of 2-3 mg dyskinesia was noted. An ambivalent attitude towards this treatment has notbeen changed when the risperidone dose reached4 mg. In both patients hyperprolactinaemia over2500 mIU/L was found then, as well as galactorrheaand amenorrhea. The treatment with risperidonewas discontinued for this reason. Thetreatment and rehabilitation methods administeredin the years 1994-1999 are discussed. Routinemonitoring of prolactine levels prior to and duringthe treatment with risperidoneis recommended.
The authors analyse reasonsfor afemalepatient's refusal of appropriate treatment forher diabetes, despite the fact that her physical healthstatus has been systematically worsening for months,involving a risk to life. Possibilities ofmedical andlegal action in such a case are considered. (Ed.)