Archives 1992-2013

2005, volume 14, issue 3

Original article

A Retrospective Appraisal of Seasonal Affective Disorder - 5-Year Follow-up

Łukasz Święcicki
Postępy Psychiatrii i Neurologii 2005; 14 (3): 175-181

Objective. To conduct a retrospective appraisal of winter depression in out-patients treatedfor at least 5 years at the Phototherapy Unit, Department of Psychiatry II, Institute of Psychiatry and Neurology.

Method. Analysis of the medical files of 53 patients with preliminary diagnosis of seasonal affective disorder (winter depression) according to DSM-IV criteria.

Results. After the five-year follow-up, pure seasonal affective disorder was still found in 24 patients (47%) whereas 15 patients (27%) had shown no sign of affective disorder for at least two years and 9 patients (17%) still had affective disorders, usually more intense, but no longer seasonal and 5 patients (9%) were diagnosed with personality disorders.

Conclusions. Five years after the initial diagnosis the seasonal pattern of affective disorders, meeting DSM-IV criteria, persisted in 47% ofpatients whereas 27"%o ofpatients demonstrated relatively stable remission. As far as basic demographic variables are concerned, the patients with a persistent seasonal pattern did not differ significantly from patients in whom a change ofpattern had been observed.

Original article

Hospitalisation dynamics in patients with eating disorders, 1997-2002

Ludmiła Boguszewska, Elżbieta Słupczyńska-Kossobudzka, Walentyna Szirkowiec
Postępy Psychiatrii i Neurologii 2005; 14 (3): 183-188

Objective. To study hospitalisation dynamics and territorial diversity and its determinants.

Method. Hospitalisation dynamics (prevalence and incidence) in 1997-2002 were analysed in subgroups distinguished according to sex, age and place of residence and in diagnostic subgroups. Two groups of independent variables were considered when analysing the determinants of territorial diversity: bed availability and the demographic structure of the population.

Results. Male hospitalisation is marginal (27 a year), as is hospitalisation of women over 30, and hence the more detailed analysis was conducted on the population of women aged 11-29. Within the 6 studied years prevalence of hospitalisation in this group increased by 152% with the largest increase in 25-29-year-olds (by 575%). Urban dwellers were hospitalised morefrequently than rural dwellers - 2.6 times more frequently at the onset of the observation period and 1.8 times more frequently at the end of the observation period. Hospitalisation peaks at age 17-19, both in anorectic patients and bulimic patients. Within the 6 years under study hospitalisation of anorectic patients increased by 65% and hospitalisation of bulimic patients increased by 371%. The rate of hospitalisation differs greatly with respect to territory -from 7 to 20 per 100 thousand in 2002. The demographics structure of the provinces (voivodeships) does not significantly affect the frequency of hospitalisations.

Conclusions. The typical female bias of patients treated for eating disorders is particularly high in Poland. Although urban women are hospitalised more frequently than rural women, the dynamics of increased hospitalisation are higher in the population of village women. This pattern has been observed in many countries in Europe and the USA. The present model of hospital treatment seems to be relatively ineffectivefor many patients (about one quarter of the patients were treated in general psychiatric wards and about 40% were in treatment for less than a month). Frequency of hospitalisation differs greatly from province to province (from 7.1 to 20.4 per 100 thousand in 2002). The territorial differences in rate of hospitalisation are largely determined by the availability of beds for children and adolescents and neurotic patients.

Original article

Forensic-psychiatric expert reviews on substance dependent offenders or offenders acting under the influence of psychoactive substances: (!) reviews issued by experts from the Institute of Psychiatry and Neurology

ZENON KULKA, ELŻBIETA BOGDANOWICZ, Krystyna Tarczyńska, Alfreda Ruzikowska
Postępy Psychiatrii i Neurologii 2005; 14 (3): 189-193

Objective. To analyse the forensic-psychiatric reviews issued following observation and out-patient examinations of offenders abusing, dependent on, or acting under the influence of psychoactive substances.

Method. A customised questionnaire was used to analyse 36 expert forensic-psychiatric reviews issued after hospital observation and 14 reviews issued after out-patient examination by forensic psychiatrists from the Institute of Psychiatry and Neurology in 1992-2002. The following variables were analysed: the patients' age, sex, psychiatric diagnosis, type and number of offences committed, type and number of psychoactive substances used, and sanity.

Results. Only one review concerned a woman. The offenders' age rangedfrom 17 to 46 years (M = 26); 26 of them were diagnosed as substance dependent and 24 were diagnosed as substance abusers. Additionally, 13 offenders were also diagnosed as alcohol dependent, 34 had personality disorders and 2 had organic personality disorders. Most of the offenders were intoxicated tempore criminis but in 21 cases theforensic psychiatrists found no grounds for diagnosing insanity according to art. 31 § 1 of the criminal code but resolved to apply art. 31 § 3 cc. With respect to the two offenders with organic personality disorders they resolved to apply art. 31 § 2 cc (seriously reduced sanity). Only in one of the 24 offenders who were not intoxicated tempore criminis did the intensity of the withdrawal syndrome justify resolution to plead seriously reduced sanity. Most offences (60%) were offences against property and 20% were offences against life and health. Most offenders had been taking more than one psychoactive substance, mostly stimulants, less frequently cannabis and hallucinogens. They very seldom took opiates, volatile substances or tranquillisers.

Conclusions. In the majority of the studied cases legally sanctioned offences, mostly against property and against health or life, did notjustify the resolution to plead insanity or reduced sanity. In a few cases, the forensic psychiatrists resolved to apply for application of art. 31 § 3 or plead reduced sanity. Part two of this study will compare this forensic psychiatric practice with the practice in other psychiatric centres.

Review article

Prevalence of mental disorders - a review of major epidemiological research

JOANNA RYMASZEWSKA, TOMASZ ADAMOWSKI, TOMASZ PAWŁOWSKI, Andrzej Kiejna
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-200

Objective. This work reviews the current research on prevalence of various mental disorders.

Review. Once a unified set of diagnostic criteria for the classification of mental conditions and disorders was developed, it became possible to construct precise, structured research instruments based on these criteria. This in turn made it possible to conduct comparable epidemiological research in psychiatry. In Poland no comprehensive study of prevalence of mental disorders in the general population has been conducted so far. Existing studies merely assess the incidence of mental disorders in specific regions or specific populations. Psychiatric facility statistics are also available.

Conclusions. Streamlined epidemiological research helps to plan health care budgets, detect risk factors and support investigations into the etiology of mental disorders. The discrepancies in prevalence indices for mental disorders in various countries, presented in this review, suggest the need for further research and cautious interpretation.

Review article

The countenances of female violence

Marta Makara-Studzińska, Anna Grzywa, RENATA TUREK
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-204

Objective. This article reviews the available data on violence in women and analyses causes, prevalence and offender characteristics.

Review. The frequency of violence towards one 's partner is similar in men and women but the patterns of violent behaviour differ. Violence in intimate relations is found in every social stratum, geographical latitude and culture. The view that men are aggressive and women are helpless is not true. Women usually resort to physical aggression as acts of self-defence or out of revenge for the man 's attack. Most of the violence offemale offenders is directed towards their children as the more accessible and less resistant victims.

Conclusions. Female violence which is mainly directed against men is becoming an increasingly frequent phenomenon although it is less well documented than male violence against women. The preferred mode of female violence against men is psychological violence. Compared with men, women direct their violence against children much more frequently.

Review article

Bifrontal electroconvulsive therapy - comparison of efficacy and tolerance to right unilateral and bitemporal electrode placement

DANUTA PALIŃSKA, Tomasz Sobów, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-207

Objective. Ever since electroconvulsive therapy was introducedfor mental disorders, researchers have been striving to improve the performance of the interventions so as to increase their efficacy and reduce the risk of the electric current harming cognitive functions.

Review. One of the focuses of research is electrode placement. Unilateral placement over the non-dominant hemisphere causes fewer complications in the form of disturbed memory and learning but it is often less effective than bitemporal or bifrontal electrode placement. On the other hand, bitemporal placement involves greater risk ofdamaging the cognitivefunctions. Bifrontal electroconvulsions were first conducted in 1973 and reverted to in the nineteen-nineties. This is when the Canadian researchers, Lawson et al. published their work supporting earlier hypotheses that bifrontal electroconvulsions are just as effective for the treatment of depression as bitemporal electroconvulsions but cause less harm to the cognitive functions.

Conclusions. Bifrontal electrode placement is gaining more and more acclaim world-wide. However, there is still too little research comparing bifrontal placement with other placements to recommend bifrontal placement as the treatment of choice in the managing of mental disorders.

Review article

Will statins be helpful in Alzheimer's disease?

Tomasz Pawełczyk, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-209

Objective. Drawing upon the most recent literature the authors discuss the relations between cholesterol metabolism and dementia and the data suggesting the potential usefulness of statins in the prevention ofAlzheimer 's disease.

Review. The ageing of contemporary societies means that the health problems of old age will be more and more prevalent in the next few decades. It has been estimated that the number of cases of Alzheimer 's disease world-wide will increase fourfold by 2047. If the emergence of symptoms could be delayed by five years, the increase in morbidity rate would be reduced by one half. Drugs currently registered as treatments for Alzheimer 's mainly ensure symptomatic relief and symptom reduction.

Conclusions. Research efforts are currentlyfocused on the search for treatments which will prevent or delay symptom development. Several groups of compounds which may satisfy these expectations have been intensely studied in recent years. These include: non-steroid anti-inflammatory drugs, oestrogens, Vitamin E and lipid concentration reducers.

Review article

Second - generation antipsychotic medications in the treatment of aggression

LESZEK BIDZAN
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-221

Objective. This article reviews the application of second-generation antipsychotic medications in the treatment of aggression and agitation in the course of schizophrenia, mental retardation and senile dementia.

Review. Many medications have been used in the treatment of aggressive disorders and agitation but it is very difficult to appraise their efficacy and safety, mainly because of the paucity of randomised, placebo-controlled studies. Other serious methodological limitations include: lack of unified inclusion criteria, heterogeneous methods of appraisal of therapeutic efficacy, inadequate sample selection due to vaguely-defined concepts of aggression and agitation, and inadequate control groups. Clinical outcomes largely depend on the medical condition in which aggressive states are involved. Agitation has traditionally been treated with neuroleptics and second-generation neuroleptics have been applied more and more frequently in recent years.

Conclusion. Research to date suggests that clozapine is the most effective treatmentfor aggressive behaviour of all second-generation neuroleptic medications.

Review article

The effects of ethanol on cytokine level

DARIUSZ ANDRZEJCZAK, ELŻBIETA CZARNECKA
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-223

Objective. This article reviews the effects of ethanol on cytokine level studied in vivo and in vitro.

Review. The effects of ethanol on the immune system have long been known. Ethanol abuse leads to reduced immunity and increased susceptibility to infections. However, new aspects of the immuno-modulating effects of ethanol are now being discovered in already understood complications due to abuse. Many studies focus on the effects of ethanol on the cytokines. These low-corpuscular proteins may act as mediators of immunological and inflammatory reactions. Thanks to them, competent immunological cells may operate within one system to effectively incapacitate foreign bodies. The role of cytokines in alcoholic liver disease is emphasised. Several studies also suggest that ethanol may affect CNS cytokines.

Conclusions. Ethanol may have a modulating effect on cytokines and this may be reflected in alcoholic liver disease, altered cytokine action in the CNS or body resistance. Further research should help us to gain a better understanding of the effects of alcohol on the immunological system.

Review article

Depressive disorders in the course of treatment of chronic viral hepatitis with interferon a

Dominik Strzelecki, Tomasz Pawełczyk, Jolanta Rabe-Jabłońska
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-229

Objective. This article reviews the epidemiology of chronic type C hepatitis and the neuropsychiatric complications of its treatment with Interferon a and Ribavirin.

Review. Special attention is paid to mood disorders because of their considerable prevalence and clinical significance. Psycho-pathological symptoms are one of the most important and most frequent complications of treatment of hepatitis C and their presence forces the reduction of interferon doses or even withdrawal of antiviral treatment altogether. The currently tested hypotheses explaining the adverse effect of interferon on the CNS and the emergence of affective spectre symptoms are presented.

Conclusions. Therapeutic strategies for the improvement of quality of life in patients and the chances of completion of interferon treatment are suggested.

Review article

Development of the concept of regional forensic psychiatry centers (RFPC)

Stanisław Dąbrowski
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-239

Objective. The stages of development offorensic psychiatry centers are presented.

Review. The following topics are reviewed: (1) development and presentation of the first concept which foresaw, e.g., that "a relatively small group of offenders with court sentences of security measures, particularly dangerous and requiring special supervision ... should be hospitalised in another medical facility which has "a setting and staff' capable of safeguarding against the possibility of escape" (1971); (2) acceptance of the concept of a special facility for the aforementioned persons by the Ministry of Health and Social Welfare as part of the "Report on the Condition of Psychiatry and Directions for Further Development" (1981); (3) the Ministry of Health decides to adapt three large psychiatric wards for the needs of regional forensic psychiatric centers, located in the North, Central and South parts of the country (1993); (4) the Ministry of Health accepts the "Guidelines for the Rationale for the RFPC Adaptation Project (1993); (5) publication of the Ministry of Health instructions of 26 February 2001 and 10 August 2004 on facilities for the execution of security measures, including regional forensic psychiatry centers.

Conclusions. All three centers are now operating.

Review article

The structure of forensic psychiatric expert opinions concerning criminal and civil cases

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-243

Objective. To encourage the psychiatric community to apply a common structure of forensic psychiatric expert opinions in both criminal and civil cases in the hope that this will improve the quality of the opinions (which is unsatisfactory at present) and will help the court to evaluate the opinions. Another goal is to train resident physicians to write forensic psychiatric opinions correctly.

Review. The proposed structure for forensic psychiatric opinions is based on: (a) the norms of the criminal code, art. 200 § 2 and art. 201-203 and the civil code, art 278 § 3 and art. 285 § 1; (b) the opinions of legal commentators of these codes; and (c) Supreme Court sentences.

Conclusions. The structure of most frequently issued opinions has been proposed: in criminal cases - appraisal of the defendant 's mental condition and in civil cases - appraisal of capacity to bequeath.

Review article

Legal regulations concerning excusing absence due to illness following court summons

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2005; 14 (3): 195-251

Objective. To present the legal foundations and method of excusing absence due to illness following court summons.

Review. This article presents the contents of the amended art. 117 § 4 of the criminal code which obligated the Minister of Justice to issue instructions in agreement with the Minister of Health concerning the method and circumstances of excusing absence in court. On 24 June 2003 only the Minister of Justice issued such instructions declaring that the following persons are entitled to issue certificates acknowledging incapacity to answer court summons to attend due to illness: a doctor employed at a public or non-public health care facility in the concerned person 's catchment area, the head of a hospital ward in which such persons are hospitalised or a doctor responsible for issuing medical certificates in treatment and nursing homes, nursing homes, sanatoriums, preventoriums and other round-the-clock or all-day medical services. The fact that the instructions do not say whether the examination and certificate are free of charge and that certificates may be issued by doctors employed in non-public health care facilities raises doubts as to whether this will not encourage the practice of having to pay for the certificate, especially considering that the instructions do not mention any form of remuneration for the "entitled" doctor.

Conclusions. For practical reasons it is important that doctors, including psychiatrists, acquaint themselves with the aforementioned instructions with which most doctors are currently unfamiliar.

Report

Facing the challenges, building solution - European governments focus on mental health

Grażyna Herczyńska, Czesław Czabała, Irena Namysłowska
Postępy Psychiatrii i Neurologii 2005; 14 (3): 259-266

In January 2005, at Ministerial Conference, 52 European member-countries of WHO signed a Declaration and Action Plan on mental health for Europe. This paper discusses the main aspects of these two documents and analyses the challenges in implementing the agreements.