Objective. The course of PTSD in people deported in childhood to the Soviet Union is reported in the paper.
Case. In three persons deported in childhood to the SUpost-traumatic stress disorder was diagnosed. In all the three cases a period ofPTSD symptoms latency lasting many years, with a rather good social adjustment, was followed by a very rapid aggravation of both psychopathological and somatic symptoms, as well as an accelerated ageing.
Commentary. In individuals deported in childhood to the SU, PTSD seems to have a specific dynamics, with a long period of latency followed by rapid deterioration.
Objective. A case of PTSD following a particularly traumatic childbirth is reported.
Case. A 22-year-old woman after a childbirth that ended in death of the baby. A specific pathogenic chain is described - from the period ofpregnancy, through childbirth associated with the mother 's acute stress reaction with dissociation features, up to the onset of PTSD symptoms.
Commentary. In addition to the severe psychological trauma, the patient's personality traits, as well as environmental, above all - familial factors played a significant role in the PTSD pathogenesis.
Objective. A case of mental disorders following the treatment of chronic hepatitis C virus is presented.
Case. A female patient aged 52 was treated for chronic hepatitis C virus with interferon alpha and ribavirine. After three months transient motor and speech disorders were noted, with subsequent epileptic fits and dementia. For that reason the patient was diagnosed to differentiate between dissociative disorder and the Creutzfeldt-Jakob disease.
Commentary. Prednisolone treatment turned out to be effective. No clear cause of the patient's condition was found.
Objective. The effect of epilepsy and right-sided amygdalotomy on the patient 's emotional-cognitive performance is presented.
Case. After right-sided amygdalotomy, a female patient with epilepsy was examined using a wide battery of neuropsychological tests.
Commentary. The patient 's emotional-cognitive deficits were found resulting from her cerebral lesions, especially in the frontal and temporal lobes.
Objective. The treatment of depression in Parkinson 's disease involves a risk of not only neurological symptoms aggravation, but also dangerous interactions between anti-Parkinsonian drugs and antidepressants. Nevertheless, it may improve the patient's wellbeing and functioning.
Case. A patient with a depressive episode in the course of advanced Parkinson 's disease, treated with mirtazapine.
Comment. Mirtazapine may be an effective and safe drug in the treatment of depression associated with Parkinson 's diseases in patients receiving concurrent treatment with Levodopa.
Objective. A case is reported of an acute paranoid syndrome in the course of Cushing 's disease caused by hypophysial adenoma.
Case. A female patient aged 24, hospitalisedfor an acute paranoid syndrome after several months of Cushing 's syndrome. She was treated with drugs lowering the cortisol level, and without improvement - with haloperidol andfluphenzine. Subsequent treatment with clozapine was very effective. After resection of the hypophysial adenoma no relapse of the psychotic disorder was noted. In the patient 's family there were cases of not only hypophysial adenoma, but also mental disorders.
Commentary. Clozapine treatment associated with neurosurgical intervention may be effective in patients with an acute paranoid syndrome in the course of Cushing's disease.
Objective. The described patient presented the picture of the supraorbital frontal lobe syndrome.
Case. A 35-year-old male patient presenting with the supraorbital area frontal lobe syndrome had no past history of either mental disorders or somatic disease.
Commentary. No cause of the patient 's disorder was found and the administered treatment turned out to be ineffective.
Objective. A case is reported of obsessive-compulsive disorder after the onset of Sydenham 's chorea.
Case. A female patient at present aged 35, had the onset of Sydenham 's chorea at the age of 19 years, and ever since has suffered from obsessive-compulsive disorder with predominance of compulsive behaviours. Moreover, the patient has had bilateral contraction of the eyelids since the age of 30 years. Focal dystonia (blepharospasmus) was excluded after a neurological consultation and EMG examination. Cognitive impairments and radiological abnormalities within the skull bones were found.
Commentary. In patients with obsessive-compulsive disorder following Sydenham 's chorea partial improvement can be attained after treatment with serotonin reuptake inhibitors.
Objective. The clinical picture and course of psychotic disorders after heart transplantation are presented.
Case. A patient with delusional syndrome following heart transplantation. The disorder was atypical due to the presence of a "pure " delusional syndrome, with no impairment of consciousness, thus resembling the picture of "cardiac psychosis " described in the 1960s in patients after cardiac surgery.
Commentary. Disorders of this type are reported very rarely after heart transplantation.
Objective. A rare psychopathological syndrome is presented, known as shared paranoid disorder, or folie a deux.
Case. In the reported case grandiose and religious delusions of the son were shared by his father
Commentary. The diagnosis of folie a deux allows to implement an effective treatment strategy resulting in a fast abatement of symptoms after the inducing patient is separated from the healthy partner.
Objective. Neurological symptoms are among the most frequent complications of infectious endocarditis (IE), and quite often are its first manifestation. The proper diagnosis of the underlying primary disease may be difficult.
Case. In a 22-year-old patient with massive neuropsychiatric disorders difficult to describe precisely IE was recognised as the primary cause not earlier than after a few weeks.
Commentary. Difficulties in the differential diagnosis of severe thinking and speech disorders were pointed out, and the pivotal role of careful questioning for obtaining case histories in the diagnostic process was emphasized.
Objective. Pancreatic insulinoma is often erroneously recognised at first in cases of epilepsy. Diagnostic difficulties are presented in a patient with consciousness disturbances in the course of insulinoma of the pancreas.
Case. A 30-year-old patient with an aortic valve grafted a year earlier, sufferedfrom fits of quantitative and qualitative consciousness disturbances. During his psychiatric hospitalisation insulinoma was hypothesized to be the cause of his disorders. The hypothesis was confirmed by subsequent diagnostic procedures including endoscopy performed at an internal diseases department.
Commentary. In order to reduce the time between the onset of the first symptom and the appropriate diagnosis of the disease it is important to early and carefully differentiate between hypoglycaemia symptoms, including neuroglycopenia.
Objective. Assessment of the role of developmental CNS abnormalities in the onset and course of a schizophreniform psychotic disorder.
Case. A 21-year-old male patient treated since the age of 18 years, initially because of conduct disorders, and later for depressive and paranoid symptoms. In neuroimaging examination non-communicating hydrocephalus, cereballar cyst, and agenesis of corpus callosum were found.
Commentary. The case can be referred to the neurodevelopmental conception of schizophrenia. In non-progressing encephalopathy the psychotic process may develop for a long time symptom-free, with intellectual abilities unaffected. "Soft" neurological symptoms may be the first prodromal signs of the existing abnormalities.
Objective. A case is presented of anxiety disorder effectively treated with citalopram, in the course of the Charcot-Marie-Tooth disease.
Case. In a patient with the Charcot-Marie-Tooth disease and family history of mental disorders the onset of anxiety disorder was noted as fear of urinary incontinence, associated with agoraphobia.
Commentary. Citalopram treatment supplemented with psychoeducation turned out to be efficient and well-tolerated.
Objective. A case of hyperprolactinemia during paroxetine treatment of depression is presented.
Case. A female patient with the past medical history of hormonal disorders was treated for depression with paroxetine. When hyperprolactinemia was recognised, bromocriptine was added.
Commentary. Concurrent treatment of both disorders had positive results. It is difficult to establish which of the disorders was primary. The patient 's hormonal state has probably increased the risk of hyperprolactinemia after paroxetine treatment.
Objective. It is difficult to appropriately recognise bipolar affective disorder in children and adolescents due to a different picture of affective disorders in that developmental stage, especially if they are concurrent with deafness. The latter not only makes communicating difficult, but also results in an impaired development of abstract thinking.
Case. A 16-year-old patient with pre-language deafness and bipolar affective disorder is described.
Commentary. Due to the specificity of psychopathological symptoms, as well as difficulty in their naming and classification, mood disorders in deafpatients, and particularly bipolar affective disorder, are diagnosed too seldom or erroneously.
Objective. Diagnostic difficulties in the case ofpatients with symptoms typical of schizophrenia are presented.
Case. In three young female patients with schizophrenic symptoms described in the paper an almost complete remission was attained after various periods of time.
Commentary. In persons with schizophrenic symptoms it may be difficult to establish a definite diagnosis.
Objective. A case is reported of symptom substitution in a patient with a long-term history of mental disorders.
Case. The patient was diagnosed with schizophrenia 16 years earlier At present his medical records were analysed, with an emphasis on the diagnoses, symptoms, and treatment efficacy. An alteration in his symptomatology was noted. The patient's psychosocial functioning was assessed using clinical methods and psychological tests. Finally, bipolar affective disorder was recognised in this case.
Commentary. In patients with many years' past history of mental disorders a change ofsymptomatology is possible. An attempt was made to explain this phenomenon.
Objective. An example of the effect of marrying on the course of schizophrenia is presented.
Case. A women with a history of five episodes of inpatient psychiatric treatment for schizophrenia married and went abroad, remaining in contact with her psychiatrist. She has been in remission for many years now.
Commentary. Marriage can have a beneficial effect on the course of schizophrenia.
Objective. A case is presented requiring either exclusion or confirmation of the presence of schizotypal disorders - a new diagnostic category introduced in the ICD-10 classification.
Case. A 22-year-old male patient, never treated psychiatrically, with a positive family history, admitted due to altered behaviour and an evidently decreased life activity (suicidal thoughts, a breakdown of his career and personal life). He produced extraordinary opinions, and his reasoning had the features of magical thinking. CT of the head and EEG were carried out, as well as psychological assessment of personality and organic deficits. Moreover, a computerised expert system SABA to support the process of diagnosing and treating schizophrenic disorders was used.
Commentary. The problem of differentiation between schizotypal and neurotic disorders in young patients admitted for the first time was outlined. The usefulness of the expert SABA system in the diagnostic process was confirmed.
Objective. The role of non-verbal communication in interaction with patients suffering from schizophrenia is discussed.
Case. A female patient aged 23, suffering from schizophrenia for the past four years, got interested in art therapy sessions during her treatment in a day hospital. During her 4-week treatment she produced over 20 works of art expressing her feelings andfears. Her works were discussed with the therapist, which allowed to learn about her traumatic experiences she was unable to communicate otherwise. That way the contact with the patient became deeper and her therapy could be more intense.
Commentary. Patients' works of art as a means of expression may become a starting point for their psychoeducation and improved co-operation with the therapist.
Objective. A case is presented of exacerbated schizophrenic symptoms and extreme difficulties in social functioning concurrence with sensitivity and poetic talent.
Case. The case of a 20-year-oldfemale patient suffering from schizophrenia with a complex psychopathological picture is reported from the clinical-descriptive and psychological perspective using the psychodynamic and systemic paradigms. Examples of the patient 's poetry and paintings are enclosed.
Commentary. Schizophrenia should be considered multidimensionally, with individual features of the patient taken into account. A marked severity of schizophrenic symptoms does not have to impair, and may even enhance the patients' ability to express their experiences in poetry.
Objective. Diagnostic difficulties are discussed in a patient initially treatedfor suspected schizophrenia, but finally diagnosed with PTSD.
Case. A male patient aged 29, after a car crash, treated in the past few years on the outpatient basis for suspected schizophrenia. During his hospitalisation PTSD was eventually recognised and his treatment was altered accordingly.
Commentary. Pre-morbidfactors superimposed on circumstances of the symptoms onset, the course of the disorder, and response to treatment may sometimes make the differential diagnosis of schizophrenia and PTSD difficult.
Objective. A case is reported of compulsive-obsessive disorder in the course of schizophrenia treated with clomipramine.
Case. A male patient with paranoid schizophrenia preceded by pseudo-neurotic and depressive symptoms occurring for many months. Despite neuroleptic treatment and abatement of psychotic experiences, symptoms regarded as obsessive thoughts and compulsive behaviours persisted in the clinical picture. Clomipramine was added to the antipsychotic treatment, which has evidently improved the patient 's functioning.
Commentary. Addition of clomipramine to antipsychotics may be beneficial in patients with obsessive-compulsive disorder in the course of schizophrenia.
Objective. A case is reported of electroconvulsive therapy (ECT) in acute lethal catatonia.
Case. A male patient with acute lethal catatonia was re-hospitalised after an over a year 's remission with discontinuation of medication. In the differential diagnosis a CNS infection, acute poisoning with psychoactive substances, malignant neuroleptic syndrome, and malignant hyperthermia were taken into account. In view of the diagnostic doubts and the risk of severe complications following inappropriate treatment, it was decided to use ECT. ECT with bi-temporal localization of electrodes was performed in the operating room, and under the EEG and EKG control. After nine ECTs clozapine maintenance treatment, and preventive quetiapine administration, a two-year remission was attained. Quetiapine was substitutedfor clozapine due to a marked eosinophilia in the patient with a past history of allergy.
Commentary. ECT associated with succesive quetiapine treatment may be effective in acute lethal catatonia.
Objective. A case of dual diagnosis is presented - of schizophrenia concurrent with drug dependence. The problem of diagnostic and therapeutic difficulties is discussed.
Case. A male patient aged 35 years, with schizophrenia and drug dependence.
Commentary. Substance abuse in persons suffering from schizophrenia accelerates the onset of psychosis, and is responsible for a more severe course of the disorder, lack of compliance in the treatment, and frequently also for the patient 's drug resistance.
Objective. An attempt was made to establish firstly, the relationship between antisocial behaviours and schizophrenia, and secondly, the reasons for antisocial behaviour abatement in the course of the disease. Moreover, the problem was discussed of compulsory judgment of the patient 's non-accountability in chronic psychotic disorders.
Case. The diagnostic process was reported concerning a person who had manifested antisocial behaviours, sometimes of a considerable social noxiousness, since early adolescence. Although as early as in the school age there had been justification for diagnosing him with schizophrenia, the illness was diagnosed over a decade later, after the onset of exacerbated productive symptoms, especially auditory imperative hallucinations increasing the risk of aggressive and self-aggressive behaviours.
Commentary. Diagnostic doubts were due mostly to the apprehension that the diagnosis of a chronic mental disorder would be equipotent with the judicial decision about the patient 's non-accountability, in consequence of which he could not be deemed guilty and his activity could not be restrained.
Objective. Another variation of a non-psychotic body experience disorder - in addition to anorexia and dysmorphophobia - is presented. The variation seen in young men committed to body building consists in a belief that neither the strength nor size cf their muscles are sufficient.
Case. A men aged 28, engaged in body building for years, supported his efforts with anabolics. Discontinuation of anabolics resulted in a body mass reduction. Although his body build was still average, the patient was worrying about its being meagre, felt his muscles were atrophied, and was convinced he ate too little. In consequence of treatment he accepted his appearance and gave up body building exercises.
Commentary. The patient's symptoms resemble anorexia nervosa, but are an opposite of this disorder The reported disorder is described in the literature as muscle dysmorphia. Since massive musculature is a fad among young men, it may lead to a rise in the incidence of this disorder.
Objective. Definitions and descriptions of focal dystonias and conversion symptoms place these disorders on the borderline between psychiatry and neurology. Various possible interpretations and therapeutic suggestions as exemplified by the musicians ' cramp are proposed.
Case. A case of a man aged over 40 is reported - after a number of diagnostic and therapeutic attempts (from surgical interventions to psychotherapy) that have proved unsuccessful.
Commentary. Conversion and muscle dystonias may serve as a good illustration of the dilemmas associated with choosing the paradigm of thinking in psychiatry. The authors are for a multidimensional approach.
Objective. Difficulties in diagnosing anorexia nervosa are reported.
Case. A female patient with eating disorders submitted to psychotherapy - an improvement at the level ofsymptom relief was attained.
Commentary. Diagnostic difficulties in patients with anorexia nervosa result to a large extent from symptomatological heterogeneity of this disorder The role and function of clinical symptoms dynamically developing in the course of therapy have been explained.
Objective. A case is presented ofpathological collecting exacerbated in consequence of a vascular CNS damage.
Case. A male patient aged 73, whose pathological collecting originated from his anakastic personality, developed in the course of obsessive-compulsive disorder, and exacerbated following vascular damage to the frontal lobes.
Commentary. A significant role of psychosocial factors in the case of pathological collecting was emphasized.
Objective. Difficulties related to diagnosing the Münchhausen syndrome are reported.
Case. A patient with an extremely rich and partly inconsistent medical records concerning a variety of complaints. An analysis of the patient 's functioning and a critical review of his medical history and records justified the diagnosis of the Münchhausen syndrome.
Commentary. The diagnosis of the Münchhausen syndrome requires a very careful analysis of both the patient's present condition and his/her previous medical records. The task can be extremely difficult.
Objective. An attempt was made to establish the cause of obsessive-compulsive disorder.
Case. A patient with obsessive-compulsive disorder, probably of an organic origin.
Commentary. Obsessive-compulsive disorders may originate from organic lesions, and their psychopathological picture may be closely related to traumatic experiences from earlier stags of the patient 's life.
Objective. Parasitic paranoia is a psychotic disorder with a single hypochondriac delusional belief. These patients experiencing tactile hallucinations are convinced about the presence of parasites under or in their skin.
Case. A case of parasitic paranoia in a 68-year-old woman and her 71-year-old husband is described.
Commentary. Difficulties in diagnosing parasitic paranoia as an organic hallucinosis or induced (shared) paranoid disorder are discussed.
Objective. Trichotillomania, a rare disorder of impulse control, consists in compulsive pulling out one 's hair which results in a noticeable hair loss.
Case. A 52-year-old woman with symptoms of trichotillomania.
Commentary. In the treatment of trichotillomania mostly selective inhibitors of serotonin reuptake are used. Trichotillomania may be also effectively treated with olanzapine.
Objective. A case of dissociative disorder in a patient with aortic insufficiency is presented.
Case. A female patient diagnosed in childhood with aortic insufficiency was treated at the Department for Neurotic Disorders for her dissociative disorder in the form offaintingfits with convulsions.
Commentary. Mutual relationships among psychological, cardiac and neurologicalfactors, as well as their influence on the mechanisms underlying the occurrence of symptoms, were considered in terms of the holistic approach.
Objective. Biological factors are usually considered as the cause of homosexuality, with social, cultural, and psychological, (also familial) determinants coming next. An analysis of factors determining homosexual tendencies in a young male patient was conducted, with an emphasis on the role of his anxiety symptoms.
Case. A young male patient with anxiety disorder who disclosed his homosexual tendencies after being admitted to therapy.
Commentary. A significant role ofparental attitudes, especially these of the father, in the development of the patient's homosexual tendencies was stressed. His homosexual behaviours were associated with gratification of his needs, not only sexual ones. Anxiety disorder protected him against realization of the homosexual tendencies. The patient's young age and his developmental stage suggest that the process of shaping his sexual orientation has not been completed yet.
Objective. Self-amputation is a drastic type of self-mutilation seldom undertaken by the mentally ill. Efficiency of surgical treatment depends to a large extent on the patient 's mental state.
Case. The paper reports the treatment of a female patient who self-amputated her left hand under the influence of auditory hallucinations.
Commentary. Psychotic symptoms that contributed to her self-mutilation had no significant effect either on the surgical management of this case or on effects of her rehabilitation. Since a long-term treatment ofself-amputees at the surgery department is necessary, is seems that the staff members should have some training in rudiments ofpsychiatry.