Aim. The aim of the present study was to assess and explain the reasons for the regionally dependent disparity in hospitalization of patients with affective disorders.
Methods. The hospitalization prevalence (i.e. the percentage of a population that was hospitalized in different Polish provinces in 1999 and 2001) was analyzed. The following independent variables, which may influence the hospitalization prevalence, were taken into account: three demographic traits (i.e. gender, age, permanent residence in the country or in town), ten health and social variables (the percentage of people living lonely not-married, below the social minimum or eke out an existence, the unemployment rate, the suicidal rate, alcohol abuse, the prevalence of affective disorders and related mental disabilities in the mental health outpatient clinics), two measures of the mental health care accessibility and four measures of the mental health care performance (an average length of hospitalization, a hospital admission index for mental illness, affective disorders, anxiety disorders and schizophrenia). Correlation coefficients between the hospitalization prevalence and independent variables were calculated using the Spearman's non-parametric coefficient.
Results. According to the region, a hospital admission index varies significantly with the highest in the Wielkopolska, Ziemia Kujawsko-Pomorska and Podlasie Province and the lowest (a twofold decrease) in the Śląsk, Ziemia Świętokrzyska and Pomorze Zachodnie Province. The following independent variables influenced the hospitalization prevalence: age between 20 and 44, the fact of being female and the permanent residence in town. The regionally dependent disparity does not depend on the Province demographic traits and analyzed health and social variables. There was a week correlation between the hospitalization prevalence and the period of stay in a hospital: the more patients admitted the shorter length of hospitalization. In two Provinces (Podlasie and Pomorze Zachodnie) high hospitalization prevalence probably resulted from the higher availability of hospital beds. A considerable increase in the number of hospitalization in the Province of Wielkopolska was due to the diagnostic preferences for affective disorders.
Aim. Stroke should be regarded as the extraordinary adaptation challenge for a patient due to its specific course, i.e. acute onset with neurological deficits progressing over seconds to hours, life activity limitations and the necessity of hospitalization followed by rehabilitation. The sense of coherence is one of the main factors that influence the way of coping with the illness and the patients' involvement in the treatment and rehabilitation process. The aim of the present paper was to find out if there is any relationship between the sense of coherence and the knowledge of the illness, its aetiology, symptoms, treatment and prognosis.
Methods. 31 patients hospitalized in the department of neurology or rehabilitation were examined 2-2,5 months after an acute incident of stroke. Questionnaire methods were used, including the Life Orientation Questionnaire (SOC-29) about the sense of coherence and experimentally prepared by the authors the Picture of My Illness Questionnaire about the disease knowledge.
Results. There was a significant link between the sense of coherence and the knowledge of illness treatment and rehabilitation. No other correlations were found. The present results may reflect the patients' ability to discriminate subjectively important areas of knowledge from the unimportant ones which are marginalized and recognized as not useful for further development. Since the stronger sense of coherence corresponds well with the better knowledge of illness treatment and rehabilitation, it is possible to assume that both factors are inextricably linked and may contribute to the more effective way of coping with the illness.
Conclusions. For each stroke patient, it is important to evaluate his subjective sense of the illness knowledge. With regard to the medical and psychological practice, providing patients with information about undertaken and scheduled treatment options is of great significance.
Aim. A potential relationship between the quality of life and emotional experience of patients with a duodenal and/or gastric ulcer was analyzed in the present paper.
Methods. 60 professional soldiers hospitalized at the WAM University Hospital in Łódź in 2000-2001 were the subject of this study. The following diagnostic scales were employed: the Brzeziński Emotional Control Questionnaire and the SF-36 Living Standard Scale.
Results. The standard of living significantly correlated with the emotional excitability and control over situation and emotional expression.
Conclusions. Compared with healthy controls, the living standard of soldiers with a duodenal and/or gastric ulcer was significantly lower and was related to the patients' emotional experience
Aim. A functional polymorphism (5-HTTLPR: 5-hydroxytlyptamine transporter linked polymorphic region) in the promoter region of the serotonin transporter gene (SLC6A4) has been associated with a number of psychiatric disturbances. To our knowledge, the involvement of this polymorphism in the pathogenesis of schizophrenia has not been reported. The aim of the present study was to investigate the possibility that the 5-HTTLPR polymorphism might be associated with the psychopathology of schizophrenia.
Methods. We studied the functional polymorphism in the 5'flanking regulatory (promoter) region of the gene (SLC6A4) coding for the serotonin transporter protein in 242 patients with schizophrenia (according to the DSM-IV and ICD-10 criteria) and 192 control subjects. Patients were evaluated for psychotic symptomatology using the PANSS scale and typed for 5-HTTLPR variants using PCR techniques.
Results. 5-HTTLPR allele frequencies were not significantly different between controls and schizophrenics; genotype analysis also did not show any association. However in homozygotic patients the s allele of the 5-HTTLPR was associated with a decreased intensity of psychopathological symptoms measured by the PANSS scale. Similarly, in homozygotic schizophrenic women the s allele of the 5-HTTLPR contributed to the benignity of the disease.
Conclusions. A functional polymorphism in the promoter region of the serotonin transporter is not a risk factor for the development of schizophrenia. The s allele of 5-HTTLPR in homozygotic schizophrenic women is associated with a reduced psychotic symptomatology.
Aim. Electroconvulsive therapy (ECT) is an established treatment used in modern psychiatry. The technical aspects of ECT have been modernized in order to obtain two therapeutic objectives: high clinical efficacy and good tolerance. In this paper we present some methods to determine the electric energy dose needed for ECT.
Review. As measured by the EEG, the traditional criteria for the ECT efficacy are generalized tonic-clonic seizures lasting at least 25 seconds. Good tolerance to ECT requires the minimal risk of cognitive and consciousness impairments after the treatment. To achieve this goal, it is necessary to adjust the electrical dose to the individual seizure threshold measured prior to the treatment. The optimal electrical dose exceeds in small degree the level of the seizure threshold. Both small and high electrical dose usage results in shortening seizures and increasing the risk of cognitive impairments. Problems with determining electrical doses are due to the changes in the ECT individual seizure threshold, accompanying pharmacotherapy and the patient's personality trait. Recently, the criterion for the ECT efficacy is based on analyzing the EEG record during the seizure-like activity.
Conclusions. The new ECT method makes possible to determine the individual seizure threshold during the treatment and adjust the most effective electric energy dose for each patient. This technique is being applied in the modern ECT equipment.
Aim. This article reviews current opinions on epidemiology, pathogenesis, diagnosis and treatment of tardive dyskinesia.
Review. The incidence of tardive dyskinesia is expected to decline with increasing use of atypical antipsychotic drugs, the risk in susceptible patients, the continued use of older conventional antipsychotics, and the legacy of thousands of patients who previously acquired dyskinesias, underscore the relevance of this potentially irreversible adverse drug reaction. Considerable evidence has accumulated concerning the epidemiology, clinical presentation, pathogenesis and management of tardive dyskinesia.
Conclusions. Belter understanding of the condition is important not only for clinical practice, but also in elucidating the interaction between antipsychotic drugs and dyskinetic vulnerability associated with schizophrenia and ageing.
Aim. This review article deals with the current opinions on the role of prolactin and its secretion mechanism.
Review. We discuss the pathogenesis, clinical findings and long-term consequences of hyperprolactinemia and emphasize the mechanism of antipsychotics action. Both typical and some new atypical antipsychotics may influence the secretion of prolactin.
Conclusions. Using antipsychotics, it is necessary to recognize their influence on the prolactin secretion and hormones produced by the hypothalamus-pituitary-gonads axis.
Aim. This review article deals with the osteoporosis in patients with schizophrenia.
Review. Decreased density of bones leads to the osteopenia and osteoporosis. We discuss the pathogenesis, risk factors and a potential influence of the antipsychotic therapy on osteoporosis. It is generally recognized that patient with schizophrenia suffer from other somatic illness.
Conclusions. Better understanding or the osteoporosis pathogenesis in patients with schizophrenia may help with making diagnosis, introducing the appropriate treatment and developing individual prophylaxis.
Aim. This review article presents basic forms, features and kinds of the forensic psychiatrist opinion.
Review. The court of justice takes forensic expert opinion or the scientific and research institute opinion whenever it needs some special information. Unlike a private expert opinion presented by the defence, the forensic expert opinion requested by the court is considered to be evidence at the trial. The court makes the final decision about the opinion form (i.e. written or verbal, joint or separate in case there are two or more experts) and as to who should be an expert. The joint opinion of experts from different areas is called a complex opinion. Very often this type of opinion is the one prepared by the group of experts at the scientific and research institute and must be in written form. By law, forensic opinion should be complete, clear and without any contradiction. The expert opinion given under oath must be objective and should be prepared with conscientiousness and impartiality. The court expects a categorical statement from the expert, but (this is impossible each opinion should be presented in the probable form with indicating how likely something is. Occasionally only alternative opinion can be offered.
Aim. This article reviews the legal regulations on the appointment of a forensic psychiatrist in a trial.
Review. The court or prosecution appoints each forensic expert. This written appointment should include the experts name and his area of interest, indicate the subject of expertise and set a deadline for preparing requested opinion. It is the expert's job to explain presented facts and relate them to the subject of the case with emphasizing the cause-and-effect relationship. The penal and civil code regulate expert's rights and obligations. Existing differences result from the peculiarity of both codes.
Aim. The association between the Internet and mental health problems has been presented.
Review. Websites devoted to the mental health problems are prepared for both professional and mentally ill patients. Up to now, there is no data supporting the internet impact on psychological functioning. However; same results may suggest that the Internet is a useful tool for developing an acquaintance and overcoming feelings of isolation.
Conclusions. Due to its communicative and ill formative potential, the internet can be a useful tool for rehabilitation of mentally ill persons
Aim. The paper presents assumptions, activities offered and some outcomes of functioning of the Internet portal "Knowing and understanding schizophrenia" (www.schizofrenia.info).
Review. The portal is a new, and in a sense experimental form of therapy – an Internet aid available to its participants. Patients, their friends and family members may get involved in various ways – through discussions on the web, co-editing a newsletter, writing a blog, sharing their accomplishments, both literary and in the fine arts. One asset of the portal is its constant accessibility both in time and in space. Another asset emphasized by the participants is its anonymity, as their need for "hiding the face" may originate from various reasons. There is one more invaluable feature – on the discussion forum experiences can be shared with those who have also suffered from psychosis, so it is possible to learn how others have coped with similar problems. Numerous opinions of the participants on this point are quoted.
Conclusions. The portal serves not only as a website that offers information about the illness. First and foremost it serves as a website self-support group, filling up the gap in the system of care provided to the patients, and constituting a supplementary form of schizophrenia treatment. It is also an evidence of the exceptional activity and creativity of people suffering from schizophrenia.
Aim. Sporadic CJD is diagnosed four times more often in western countries than in Poland. A typical clinical presentation consists of three symptoms: dementia, myoclonus and specific EEG picture. Some patients present psychiatric prodromal signs such as depressive disorders, personality changes, and emotional lability. Cases of sCJD, which begin with psychotic signs, are thought to be rare.
Case. A 68 year old man, who presented psychotic symptoms as onset of sCJD.
Comment. Intravital diagnosis of sCJD can be given in a non-typical case, only if the patient is thoroughly examined and we take into consideration psychiatric and cognitive disturbances other than those which are typical for elderly patients. sCJD should always be considered when dementia signs worsen rapidly alongside with neurological and psychotic symptoms.
Aim. Numbers of lonely and abandoned elderly patients suffering from psychotic disturbances are on the subject of community psychiatry. The literature on the treatment and rehabilitation options in these patients is relatively poor suggesting that this subject is of no interest. The aim of the present study was to discuss a treatment dilemma in elderly and lonely patients.
Case report. A 70 year old woman with delusions illustrates a typical situation of elderly and lonely people dealing with everyday problems related to mental illness and the treatment options of this disease. Both somatic and mental state of the presented woman was good enough to get in touch with her in the place of residence. There were no reasons to act against her will.
Comment. Both psychiatric and psychological aid to the elderly ought to cover as many variables as possible. Environmental, social, cultural and related to the age factors should be taken into account. Thus, the effective pharmacological treatment of some psychopathological symptoms is not the only therapeutic option that can be offered to the elderly.