Aim. An overview of current knowledge on unreal musical perceptions is followed by an analysis of 75 cases of this disorder reported (except for one case) in the literature. Unreal musical perceptions, usually called hallucinations, according to the literature more frequent in females and in the elderly, are associated with hearing impairment and brain dysfunction, especially of the non-dominant hemisphere. Prognosis is considered to be uncertain.
Sample and methods. In the analysis of 75 cases of musical hallucinations and parahallucinations reported in mostly the English-language publications in the years 1975-2002, the nature of these patients' mental disorders and organic changes, characteristics and type of their musical perceptions, as well as treatment methods and their efficacy were taken into account.
Results. Five groups of unreal musical perceptions can be distinguished: these related to mental disorders (depression especially), to diseases of the central nervous system, idiopathic, drug-induced, or associated with a severe somatic illness. In all the analysed groups females and individuals with some hearing impairment predominated. A third of the patients were aged under 60 years. Brain lesions were situated in both hemispheres and. in the brain stem. Good results of treatment were attained in 75% of female and almost 90% of male patients.
Conclusions. Only in same cases musical perceptions could be recognised as hallucinations due to the patient's lack of insight into their unreal nature. In a majority of cases the presence of insight indicated that such perceptions were parahallucinations (hallucinoids), or sensory automatisms.
Aim. To check which patient characteristics influence the efficacy of care provided by mobile community teams.
Subjects. Participants in the study were 136 patients diagnosed with schizophrenia or schizoaffective psychosis.
Methods. Efficacy measures consisted in the degree of change in 3 areas (social functioning, family burden, duration of hospitalisation). Two groups of predictors were taken into account: the first included socio-demographic characteristics, while the other one the baseline level of efficacy measures regarded as independent variables.
Results. Social functioning and family burden have improved both in patients with severe and in those with mild deficits in these areas. Hospitalisation length decreased significantly only in patients who had been previously hospitalised for a long time. As regards sociodemographic variables, age turned out to be the only characteristic affecting some treatment outcomes.
Conclusions. The problem of severity of functioning deficits as a criterion for the patient's referral to mobile community team s care is still controversial in the literature. Our findings suggest that not only patients with the most difficult symptoms should be treated, but also those with less pronounced symptomatology. The results corroborate also the recently predominating view that hospitalisation should not be avoided at all costs. The patients functioning prior to their enrolment in the mobile community team care is a predictor of the community care efficacy.
Aim. The article presents current concepts on the role of temperament in bipolar affective disorder:
Review. Results of recent studies confirm accuracy of the observation made by Emil Kraepelin, the author of the concept of manic-depressive illness, that temperament - understood as an inborn, mostly biologically determined behavior style based on the function of the central nervous system-may be a significant predictor of affective disorders. Current research on temperament is focused on four issues – the role of temperament as a factor predisposing to bipolar disorder; the importance of temperamental traits for problem behaviours in adolescence preceding the onset of bipolar disorder; the significance of temperament as an indicator of the so-called bipolar spectrum disorders and finally the effect of temperament on the clinical picture of affective disorders.
Conclusions. Research on temperament may contribute to our better understanding of the etiology and nosological associations of bipolar disorder, as well as to improve clinical management of the condition.
Aims. Advances in the molecular genetics of schizophrenia are outlined with reference to the neurodevelopmental theory of schizophrenia. Two approaches are used in the research: the linkage analysis (whole genome screening) and the candidate gene method. The paper presents .findings of studies using the latter method which consists in selecting a priori the genes theoretically associated with the etiology of a given disorder.
Review. Research findings are presented concerning associative polymorphisms of the trophic factor genes (NT-3 – neurotrophin-3, BDNF – brain-derived neurotrophic factor, CNTF – ciliary neurotrophic factor, GDNF – glial-derived neurotrophic factor and NRG1 – neuregulin 1) that have been chosen on the grounds of the neurodevelopmental theory of schizophrenia.
Conclusions. The reported research findings indicate a significant role of brain-derived neurotrophic factor- and neuregulin l-encoding genes in the pathogenesis of schizophrenia.
Aim. This article reviews several independent lines of evidence that suggest an involvement of mitochondrial dysfunction in the pathogenesis, course and treatment of schizophrenia.
Review. Some studies indicate a dysfunction of the oxidative phosphorylation system and altered mitochondrial-related gene expression. In addition, the interaction between mitochondrial respiration and dopamine, a predominant etiological factor in positive symptoms of schizophrenia, is considered as a possible mechanism underlying the hyper- and hypoactivity cycling in schizophrenia. Antipsychotic drugs inhibit the activity of complex I which is probably implicated in the onset of post-neuroleptic extrapyramidal symptoms.
Conclusions. Understanding the role of mitochondria in schizophrenia may encourage novel treatment approaches, the identification of candidate genes, and new insights into the pathophysiology and etiology of the disorder.
Aim. Epidemiological and clinical data on suicide in the elderly are presented in the paper.
Review. The problem of suicide in the elderly is marginalized in the psychiatric literature and almost totally absent in the Polish-language publications. Epidemiological data indicate a disproportionately high prevalence of committed suicides among the elderly (especially males) who had expressed suicidal ideas. The most significant risk factor in the elderly consists in affective disorders, above all-chronic depression. Efficient therapeutic interventions (including appropriate medication and psychotherapy) are possible, as well as prevention programs, which seem to be even more important.
Conclusions. Considering the necessity of transformation of the current ineffective system of health care in Poland it seems worthwhile to develop long-term national prevention programs. Due to the importance of the problem and enormous costs of negligence, the prevention programs should include mental health protection, especially in the aspect of depression and suicide, as well as dementia.
Aim. To present current views on the risk for suicide attempted by patients with schizophrenia.
Review. The prevalence of suicide attempts among patients with schizophrenia is much higher than that in the general population. It is estimated that about 20-40% of these patients attempt suicide, and 10-13% – commit suicide. Since this phenomenon is so widespread, the following risk factors specific for this group of patients could be distinguished: male sex, the first ten years of the illness, the period immediately following a psychotic episode and within the first six months of hospitalisation, earlier suicide attempts, and severe depressive symptoms. Moreover, specific modes of committing suicide most frequently chosen by the patients can be also distinguished. Apart from identification or the risk factors, protective action of new generation antipsychotic drugs may contribute to suicide prevention
Aim. In order to identify; side effects, questions should be asked precisely and even slight abnormalities in the patient s somatic state should be carefully noted and registered. Standardized scales help to recognize and describe side effects, as well as to determine both their severity and dynamics. The paper presents the UKU scale serving to assess the severity of side effects during treatment with psychotropic drugs.
Review. The scale was developed by the Committee for Clinical Research (Udvalg for Kliniske Undersogelser) of the Scandinavian Psychopharmacological Society. Results of studies carried out in the years 1980-1982 confirmed usefulness of this scale for the assessment of side effects of both antipsychotic and antidepressant drugs. Is English version was presented in 1986. Results of studies evaluating the UKU usefulness in clinical research and its applicability in daily practice are discussed. Principles of the scale administration and its Polish adaptation together with instructions are presented.
Aim. The course of mental disorders is often considerably affected by the circumstances of the patients' treatment and by their experiences in this process. Review. A case history is reported of a patient in whom diagnostic errors uncorrected for a long time, the therapists' anxiety-laden and unfriendly attitude, and a very schematic treatment resulted in a most unfavourable course of his mental disorders, the patient's hospitalisation for several years, and a severe impairment of his social functioning. An altered perspective and management have allowed to reverse the unfavourable course of events in this case.
Comments. The reported case exemplifies negative consequences of cognitive stereotypes and stigmatization in the process of psychiatric diagnosis and treatment. The necessity of avoiding such stereotypes and prejudices is emphasized by the authors.