Archives 1992-2013

Reported are two cases of the so called "Near Death Experience" (NDE) following acute myocardial infarction with asystolia.

The paper presents three SM patients with concurrent mental disorders of various symptomatology-paranoid syndrome, anorexia nervosa, and depressive syndrome. The cases reported exemplify that the structure of mental disorders associated with SM may be most complex, leading to a number of diagnostic problems and doubts as to the choice of an appropriate therapeutic strategy.

A case is reported of a female patient suffering from borreliosis (the Lyme disease), in whom dementia was diagnosed erroneously. Subsequently symptoms of depressive syndrome were recognized and treated successfully.

Diagnostics and treatment in three patients hospitalised in psychiatric clinics due to mental disorders are presented. In all the cases hormonal disturbances (hypethyroidism and iatrogenic thyreotoxicosis) turned out to be the cause of the patients' mental disorders.

Diagnostic problems are described in a case of a 44-year-old women suffering from memory disorders with a sudden onset.

A case is reported of a 37-year-old woman with a long-lasting anxiety disorder and a history of both alcohol benzodiazepine anxiolytics abuse. In the course of pharmacotherapy thianeptine was administered with an almost immediate symptom relieffollowing. However, shortly (in a few months' time) the patient's "demand" for the drug has increased to 30 pills per day. During the next 2 years the patient manifested distinct symptoms of thianeptine dependence, with all the consequences. Various causes of this unusual situation (so far never reported in the literature) are discussed, including both the patient's characteristics and properties of the drug.

A case is presented of a female patient who had been a victim of sexual abuse in the course of her first episode of paranoid schizophrenia. In consequence of PTSD symptoms that developed during remission, the patient discontinued treatment with neuroleptics which was followed by an exacerbation of her psychotic disorder. Further successful treatment of schizophrenia was possible when the past trauma had been thoroughly discussed with the patient.

The paper presents a long and difficult diagnostic process in a young man whose hospitalization was preceded by a 3-year period of social dysfunction. During hospitalisation the patient remained for a long time in poor contact and social withdrawal. Symptoms observed were varying and atypical. It is only after several months of treatment that the patient manifested psychotic symptoms very rarely seen in clinical practice, and paranoid schizophrenia could be diagnosed.

Various mental disorders may develop in the course of treatment with exogenous glycocorticosteroid hormones. A case is reported of major depression with psychotic symptoms in a seventeen-year-old girl treated with Prednisone due to her first ever attack of nephrosis. Since the affective symptoms were severe, and the corticosteroid treatment could not be discontinued because of the risk of adrenal crisis, antidepressants (Mitrazepine) were administered.

The authors present a clinical description of a girl diagnosed with infantile autism. She had a developmental anomaly, an additional rib. Selected issues concerning etiology of autism are discussed in this context.

Psychological and somatic sequels of battering little children are presented on the grounds of two case reports.

The case of a 22-year-old suicide may show how important is moderation and consequence in diagnosing patients suffering from disorders that present an ambiguous clinical picture. Five different disorders were diagnosed in this patient in the course of his two-year treatment. Since the diagnoses and treatments applied were so changeable, the patient has lost faith in their usefulness, and by the same token – in possibility of his recovery. A psychological-psychiatric autopsy suggests that the picture of his condition fulfilled the schizotypic disorder criteria. However, the most accurate diagnosis seems to be that of somatopsychic schizophrenia – a nosological entity described by Bornsztejn, but withdrawn from classifications currently in force.

Long-term family therapy of a patient diagnosed with depressive disorders is reported in the paper. Therapeutic work on marital relationship in the transgenerational perspective has revealed the patient's deep conflicts with her mother – in consequence, individual therapy turned out to be necessary. An attempt was made to show a possibility of integrating various theoretical and practical perspectives in therapy of the patient and her family.

Establishment of the so-called therapeutic contract (i.e. negotiation of shared expectations of therapy, during the first session) is regarded as one of the therapist's crucial tasks. The authors discuss difficulties encountered in therapy of a case in which a series of sessions were held against the general rule, i.e. despite the lack of a therapeutic contract.

The authors describe marital therapy in a family in which the crisis started when the husband's unfaithfulness was revealed. A number of marital problems were disclosed in the course of therapy, first and foremost – a shaky balance between the need for closeness and uncertainty coupled with apprehension of closeness. The very fact of unfaithfulness and conflicts concerning the husband' sex-mistress turned out to be a key regulator of this marital relationship.

In the reported process of marital therapy alcohol dependence was found to be a symptom "wandering" from generation to generation and fulfilling certain functions. The authors emphasize the role of transgenerational transmission of alcohol abuse as a pattern of coping with personality problems and developmental crises occurring in the family life cycle.

Various forms of therapy were used during two years in the case of a female patient diagnosed with anorexia nervosa: hospitalisation, cognitive-behavioural individual psychotherapy, and genograme analysis. Only slight improvement of the patient's somatic, psychological and social functioning was attained. It is only group therapy in a homogeneous group of female patient with eating disorders turned out to be effective – a marked improvement of the patient's condition was attained so that she was capable of normal functioning in her environment.

Both acute and chronic stress as well as depressive disorders activate the axis: the limbic system-hypothalamus-pituitary-adrenal glands, resulting in an adrenergic arousal and hypercortisolemia, with metabolic and endocrine sequels and cardiovascular disorders. These mechanisms were found in the clinical picture of our patient. In her case symptoms of diabetes and hypertension subsided following treatment with antidepressants.

On the example of two patients with rich systems of compulsions therapeutic difficulties are discussed. The difficulties are related to the patients' different subjective concept of health and disease, as well as to the level of therapeutic intervention acceptable to them, and to these interventions efficacy. (Ed.)

New terminology and practice in disability certification were introduced by the Act of 26.08.1996 changing same earlier statutes concerning the social insurance and old-age pension scheme. Capacity to work is no longer the subject matter of certification, but only lass of such capacity in the period of employment. The new legal solutions are disadvantageous to the social group of the mentally retarded. These persons are deprived of the right to disability pension even though they have paid their social insurance rates for many years.

Diagnostic problems and ensuing difficulties encountered in psychiatric court opinions are presented in the paper. Different conclusions of psychiatric expertises issued in the years 1993-1997 are cited and reasons of the delay in the proper diagnosis establishment are discussed (the patient was diagnosed with mental disorder in the ninth psychiatric examination carried out in succession for the purposes of court expertise).

Despite a stable remission attained in several months, a patient with paranoid schizophrenia suspected of homicide of four persons has been hospitalized in detention centers for ten consecutive years. Authors discuss difficulties and efforts involved in quashing the preventive measure (i.e. releasing the patient).