Archives 1992-2013

2002, volume 11, issue 3

Commonity psychiatry

The directions and methods of community psychiatry throughout the world, 1993-2000

Ludmiła Boguszewska, Elżbieta Słupczyńska-Kossobudzka
Postępy Psychiatrii i Neurologii, 2002, 11, 187-196

Three hundred and twenty one research reports were analyzed. The largest number of reports was published in 1996-1998. Most of them focused on the effects of intervention and only a few focused on process studies. Most of the research investigated the effects of intervention on patients, very rarely on the staff, health care system or the general public. Compared with later years, within the first three years covered by this review intervention was usually applied by community treatment taskforces, community support programs, day-care and crisis interventions. Within the next five years intervention was usually targeted at the managed health care system. The majority of the reviewed studies were methodologically correct.

Commonity psychiatry

Case management – A review of the world literature

Elżbieta Słupczyńska-Kossobudzka, Ludmiła Boguszewska
Postępy Psychiatrii i Neurologii, 2002, 11, 197-203

On the basis of their review of articles published in eight international journals in 1993-2000 the authors present a synopsis of case management. They discuss the major functions and models of case management as well as a synthesis of the findings of research on case management effectiveness and process. Case management is more effective than standard care on many measures, e.g., hospitalisation is shorter, satisfaction with services is greater, community services are used more economically and families are less burdened.

Forensic psychiatry

Traffic accident offenders in the criminal code and the literature – selected problems

ELŻBIETA BOGDANOWICZ, DANUT A HAJDUKIEWICZ
Postępy Psychiatrii i Neurologii, 2002, 11, 205-210

The current legal regulations concerning traffic accident offenders, i.e., art. 173, 177 and 178 of the criminal code, are presented. The authors also discuss the contingencies of accidents and accident behaviour of offenders on the basis of their review of the literature. In particular, they discuss the characteristic descriptions of reports given by drivers who fled from the site of the accident. They also discuss the problems involved in assessing so-called "post-accident shock".

Forensic psychiatry

Forensic-psychiatric opinions on traffic accident offenders

ELŻBIETA BOGDANOWICZ, Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii, 2002, 11, 211-222

Thirty-seven forensic-psychiatric opinions issued by the Department of Forensic Psychiatry, Institute of Psychiatry and Neurology in 1995-2001 and 72 opinions issued earlier in the same cases by other experts are analyzed. The material covers 37 male traffic offenders. Fifteen of the offenders (40%) fled from the site of the accident. Only three offenders qualified for the insanity defence and one offender was qualified legally unaccountable because of post-traumatic disturbances of consciousness. In six cases (20%) the former and latter experts disagreed because of different evaluations of the offenders' mental condition tempore criminis, mainly alcoholic intoxication and disturbances of consciousness. In our opinion these discrepancies of opinion were caused by careles.1•studying of the legal documentation. Differences in opinion on the presence or absence of "post-accident shock" concerned the intensity of acute post-traumatic symptoms. Proper evaluation of these symptoms requires more thorough analysis of the legal documentation in order to judge the behavior of offenders who flee the accident site. The greatest discrepancies had to do with evaluation of the offenders' capacity to stand before court and complete their term in prison (both of which had often been certified by incompetent psychiatrists).

Dementias

Dementia with Lewy bodies

Piotr Wierzbiński, Tadeusz Pietras, MACIEJ CIEBIADA, Andrzej Witusik, PAWEŁ GÓRSKI
Postępy Psychiatrii i Neurologii, 2002, 11, 223-235

Abnormal accumulation and dysfunction of synaptic proteins play an important role in the pathogenesis of several neurodegenerative disorders. Lewy bodies, the fibrous portion of which contains the protein α-synuclein, can be neurotoxic, analogous to the proposed toxicity of amyloid plaques in Alzheimer disease. Lewy bodies are found in degeneration of the brain stem and cortical neurons in Parkinson's disease and in dementia with Lewy bodies, which is the second most common cause of cognitive impairment in patients with dementia. Recent studies have shown that Lewy bodies are also present in multiple system atrophy. Dementia with Lewy bodies is characterised by attentional deficits, frontal-subcortical dysfunction, visual hallucinations, Parkinsonism, and fluctuation of cognition. Dementia with Lewy bodies is amenable to treatment with cholinesterase inhibitors.

Dementias

Dementia with Lewy bodies: Clinical picture, pathogenesis and therapy

Tomasz Sobów, MARCIN GORCZOWSKI, Radosław Magierski
Postępy Psychiatrii i Neurologii, 2002, 11, 237-246

Dementia with Lewy bodies (DLB) may be the cause of up to 20% of all dementias, giving way in frequency of causes only to Alzheimer's disease. The most typical symptoms of DLB are Parkinsonism, function of the cognitive functions and visual hallucinations. This clinical picture is often taken for "senile psychosis" (which encompasses cases of both acute and sub-acute hallucinatory and delusive syndromes with dementia and periodic disturbances of consciousness), an umbrella term probably concealing most undiagnosed cases of DLB. It is important from the clinical point of view that DLB be correctly diagnosed as a separate nosological unit and differentiated from Alzheimer's disease and dementia because DLB should be treated differently (it responds well to cholinesterase inhibitors and is hypersensitive to neuroleptics). The authors discuss the clinical picture, pathogenesis, differential diagnosis of DLB as well as current therapeutic indications.

Dementias

Fronto-temporal dementia

Piotr Wierzbiński, Tadeusz Pietras
Postępy Psychiatrii i Neurologii, 2002, 11, 247-257

A number of distinct clinical syndromes have been described that are associated with both frontal and temporal lobes and have non Alzheimer pathology. The nosological status of fronto-temporal dementia has been a matter of controversy, in view of the clinical manifestations and distribution of the nature of histopathological change. Fronto-temporal dementias include fronto-temporal dementia, progressive nonfluent aphasia, semantic dementia, and lobar degeneration and motor neuron disease. There are two morphological forms: Pick's disease and dementia tacking neuropathology. Although most fronto-temporal dementias are sporadic, familial fronto-temporal dementia linked to chromosome 17 q21-22, which is characterized by prominent filamentous tau inclusion, is caused by multiple tau gene mutation. Filamentous deposits made of tau protein are typical for the most of fronto-temporal dementia's clinical and morphological forms.

Dementias

Mitochondrial DNA mutation as a risk factor of dementia – a new paradigm

Tadeusz Pietras, Andrzej Witusik, PAWEŁ GÓRSKI
Postępy Psychiatrii i Neurologii, 2002, 11, 259-269

Mitochondria have a pivotal role in cell metabolism, being the major site of ATP production via oxidative phosphorylation. They have a critical role in apoptotic cell death; and they also contribute to human genetics since mitochondria have a functional genome separate from that of nuclear DNA. Recent observations suggest that the accumulation of point mutations of mitochondrial DNA may be important in the pathogenesis of dementia. The increasing formation and release of reactive oxygen species by failed respiratory chain enzymes induces lipid peroxidation process, apoptosis and subsequent cell death, and promotes protein aggregation and accumulation in the central nervous system. These changes induce neurodegeneration of brain and promote progress of dementia.

Dementias

Elevation of serum Schiff bases in patients with dementia

ALEKSANDRA MUSIAŁ, Tadeusz Pietras
Postępy Psychiatrii i Neurologii, 2002, 11, 271-281

Increased oxidative stress may accompany disease of the central nervous system including dementia. The brain is especially susceptible to damage mediated by reactive oxygen species because it has a high rate of oxygen consumption and contains large amounts of readily oxidisable substrates, such as polyunsaturated fatty acids. Indices of systemic oxidative stress, including serum lipid peroxidation may be greater in dementia than in normal ageing. Study groups consisted of 30 patients with dementia and 18 healthy age-matched controls. Ali patients underwent neuropsychological testing and qualified for the study on the basis of history, physical examination, complementary laboratory tests, and brain computed tomography scan. Serum levels were assessed for the following lipid peroxidation products: conjugated dienes, lipid peroxides, thiobarbituric acid reactive substances, and Schiff bases. There were two statistically significant differences in serum levels of lipid peroxidation product between the study groups. Lipid peroxides were significantly lower (0,34±0,03 absorbance units/ml versus l, 12±0,96, p=0,0055), while Schiff bases were significantly higher in the subjects with dementia (589,4±267,3 arbitrary fluorescence units/ml versus 329,0±107,5 in healthy, p=0,000282). Cognitive impairment did not correlate with levels of lipid peroxidation products.

Other psychogeriatric problems

Neuroleptic malignant syndrome in a psychogeriatric ward practice – case reports

Stefan Krzymiński, WIOLETTA GIEMZA-URBANOWICZ, EWA KRAJCER-GRETSCHEL, MAŁGORZATA BARHAM, RENATA BŁASZCZYK
Postępy Psychiatrii i Neurologii, 2002, 11, 283-292

The article, based on a review of the literature, presents seven cases of neuroleptic malignant syndrome (NMS) among patients of s psychogeriatric ward. These cases make up 2.36% of all patients (3.29% men and 1.95% women) exposed to neuroleptic medication. The diagnosis of NMS was established according to DSM-JV, Levenson's and Caroff's et al. criteria.

Other psychogeriatric problems

Driving by subjects with diagnosed Alzheimer’s disease

WIOLETTA GIEMZA-URBANOWICZ
Postępy Psychiatrii i Neurologii, 2002, 11, 293-300

In Poland driving license are issued for life. There are no regulations or restrictions in connection with physical or mental disease, also as far as the ageing of drivers is concerned. The results of the studies received up to now, which were carried out in many countries, regarding the estimation of the risk of motor crashes by ageing drivers or patients with Alzheimer's disease (AD), are ambiguous. Therefore the question of driving by a person with AD is first of all the problem of the nearest family and the physician.

Case report

Bilateral thalamic infarction as a reason for persistent apathy and ocular movement disturbances – report on two cases

Małgorzata Wiszniewska, ANDRZEJ CHMIELECKI, IWONA MACIEJEWSKA-PIWAR
Postępy Psychiatrii i Neurologii, 2002, 11, 301-305

Isolated bilateral thalamic infarction is a rare type of cerebral ischaemic stroke. The predominant symptoms in infarction involving the nucleus medialis thalami bilaterally are: prominent loss of psychic self-activation, apathy, hypersomnia. There may also be disturbance of the eye movements without evidence of midbrain involvement on the CT. The authors observed two patients with ischaemic strokes in both paramedian thalamic regions. The initial stale of the stroke was serious in both patients (they demonstrated cerebral coma). Within a few days of recovering consciousness these patients were apathetic with hypersomnia without psychic self-activation. They presented depression and symptoms including vertical gaze palsies which are typical of the midbrain syndrome. Despite pharmacotherapy and rehabilitation the apathy and the disturbances of eye movement did not improve after half a year.