Archives 1992-2013

2007, volume 16, issue 2

Original article

Psychometric properties of the Problematic Marijuana Use (PUM) test for adolescents

Katarzyna Okulicz-Kozaryn
Postępy Psychiatrii i Neurologii 2007; 16 (2): 105-111

Objective. To examine psychometric properties of the PUM test for the assessment ofproblematic cannabis use among adolescents.

Method. The criterion standard for the test validity was a clinical diagnostic interview conducted by specialists trained in drug prevention and therapy. Respondents were reached in 58 randomly chosen Polish local communities by snowball sampling. A total of 1277 adolescents (36% female) aged 13 to 18 years, who used cannabis at least once in the past 12 months, participated in the study. The majority (89%) had no contacts with any drug-therapy facilities. Among respondents 49% were diagnosed as occasional users and 51% - as problematic users or addicts. A 24-item self-report questionnaire concerning drug use in the past 12 months was administered. Moreover, a diagnostic interview to assess the phase of cannabis use was conducted according to precise guidelines by trained therapists and prevention workers.

Results. Logistic regression analysis showed that 8 out of the basic set of 24 test items were most powerful in differentiating occasional and problematic users. A test score of 3 or higher was optimal for identifying problematic cannabis use (sensitivity - 0.81, specificity - 0.88 in the whole group of cannabis users, and sensitivity - 0.80, specificity - 0.94 in the sub-group of adolescents for whom cannabis was the first choice drug). Validity was not affected by age or sex.

Conclusions. The prognostic validity of the PUM test was examined in a large community sample. Satisfactory psychometric properties of the test allow to recommend it for use in different settings (e.g. outpatient and primary-care centres, schools) by youth specialists. However, evaluation of the test functioning in the process of intervention toward drug using adolescents is needed.

Original article

The stigma of mental illness: anticipation and experiencing

Andrzej Cechnicki, Anna Bielańska, Joanna Franczyk
Postępy Psychiatrii i Neurologii 2007; 16 (2): 113-121

Objectives. To describe the „ anticipated " and „ subjectively experienced " stigma and discrimination, as well as to analyze relationships between demographic data, clinical and social variables, and experienced discrimination.

Method. Participants in the study were 202 patients from the Małopolska region, diagnosed with schizophrenia or schizophreni form syndromes (according to the ICD-10 criteria). Their mean age was 40 years, and the average number of past hospitalizations amounted to 6. The Angermeyer questionnaire was used. The patients shared their opinions (anticipation) and reported their own experiences of discrimination.

Results. An analysis of the patients' opinions (anticipated discrimination) shows that: 66%o of the respondents believe that the mentally ill are treated in an unfriendly way; 76%o - that employers have no employment for persons with mental disorders; 65% are convinced that a majority ofpeople regard the mentally ill as unpredictable, 52% - as dangerous, while 41% of the general public think that their treatment is ineffective; 36% have noticed that the mentally ill are presented in mass media as a criminals; 64% have noticed discrimination in court; according to 47% of the respondents there are not enough facilities providing treatment to the mentally ill. The patients' own experiences indicate that as many as 87% of them have experienced rejection by others, 50% have experienced breaking up of a relationship because of mental illness; 60% have met with understanding and willingness to help, receiving care most often from their family andfriends (39%); 70% of the patients attempted to get an employment, and 31% of them failed to get a job because of their mental illness; 62%o have read a newspaper article and watched a TV program presenting the mentally ill in a good light; 54% have seen a film with a mentally ill person shown as a positive character; 13% have had negative experiences in judicial proceedings.

Conclusions. Both in the patients' opinions and in their own experience two spheres are most affected by discrimination of the mentally ill: relations with others and employment.

Original article

Territorial differentiation of hospital admissions of patients with schizophrenia in Poland in the years 1999 and 2003

Elżbieta Słupczyńska-Kossobudzka, Ludmiła Boguszewska, Walentyna Szirkowiec
Postępy Psychiatrii i Neurologii 2007; 16 (2): 123-132

Objective. The main aim is to investigate stability of territorial differentiation of hospitalization and attempt at explaining the causes of this phenomenon.

Method. The hospital-registered prevalence (HRP) indicators in various provinces of Poland in the years 1999 and 2003 were analyzed (the number of patients treated, patient days, and long-term inpatients). A number of independent variables potentially affecting HRP were taken into account: the economic situation indicators, accessibility of inpatient care and of nursing homes, as well as post-treatment care accessibility. The Spearman rank correlation coefficient was used in the statistical analysis.

Results and conclusions. A considerable territorial differentiation of HRP was found - the highest prevalence of hospitalization was twice as high as the lowest one, while the prevalence of long-term hospitalization was between ten and twenty times higher than the lowest values. In the five-year period under study a relatively high HRP was noted in four provinces (Lubuskie, Opolskie, Pomeranian and Western Pomeranian), while comparatively low - in other five regions (Kujawsko-pomorskie, Łódzkie, Mazovian, Małopolskie and Podkarpackie). Territorial differentiation of HRP is associated with the economic situation, accessibility of psychiatric beds and nursing homes, accessibility of psychiatric outpatient clinics and of community self-help facilities. No relationship was found between HRP and accessibility of either day treatment units or mobile community teams - most probably because accessibility of the latter two forms of care is a few times lower than the desired minimum.

Original article

Predictors of amnesic mild cognitive impairment to dementia progression: a two-year prospective study

Tomasz Sobów, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2007; 16 (2): 133-138

Objective. To assess selected demographic characteristics (age, gender, education level), clinical variables (cognitive deficit severity, co-morbid cardiovascular disorders) and biochemical parameters (Aβ peptides plasma levels) as potential predictors of amnesic mild cognitive impairment (aMCI) to dementia progression.

Method. An initial cohort of 93 non-demented patients with memory disorders referred to an Outpatient Clinic for Persons with Alzheimer's Disease were examined, and 54 patients with either current somatic disorders or past history that might explain their apparent cognitive deficit were excluded from further study. The remaining 39 patients with aMCI participated in a two-year prospective study: their clinical observation was supplemented with periodic psychometric evaluations using the ADAS-cog, MMSE and CDR. Their plasma levels of Aβ1-40 and Aβ1-42 were measured using the commercially available colorimetric „sandwich" ELISA method.

Results. The aMCI patients who progressed to dementia over the two years, as compared to their clinically stable counterparts, were significantly older (78.5±3.1 vs. 73.0±2.8, respectively, p<0.001); their cognitive dysfunction severity at baseline as measured by the ADAS-cog was more marked (14±2.4 vs. 10.6±1.8, respectively; p<0.01); besides, their ADAS-cog performance was more deteriorated at the 1-year follow-up (4.7 ±1.2 vs. 1.4±2.1, respectively; p<0.01). Additionally, progressors were characterized by lower Aβ1-42 peptide plasma levels (44.7±4.8 vs. 59.2±8.4; p<0.001), and by a lower body mass index (BMI: 26.7±0.5 vs. 27.4±1.0, respectively; p = 0.01). There were no significant differences between the clinically stable and progressing groups with respect to demographic variables such as gender or education level, or the presence of well-controlled cardiovascular disorders.

Conclusions. Older age and higher severity of cognitive dysfunction at baseline (as measured by appropriate psychometric instruments) may be useful predictors of aMCI progression to dementia within two years. Additional factors allowing to assess the risk ofprogression to dementia are lower plasma levels of the Aβ1-42 peptide and lower BMI. However, usefulness of these parameters requires confirmation in larger cohorts. An optimal general medical care, especially in patients with cardiovascular disorders, may be crucial for reducing the risk of dementia development.

Original article

Quality of life and acceptance of illness in patients with myasthenia gravis

Małgorzata M. Bilińska, Emilia J. Sitek
Postępy Psychiatrii i Neurologii 2007; 16 (2): 139-143

Objectives. The poor quality of life in myasthenia gravis (MG) has been explained so far by reduced physical disability. The aim of the study was to assess the impact of psychological factors, such as mood, optimism, state and trait anxiety, on MG patients' quality of life and their adjustment to the disease.

Method. The disease severity was rated by a neurologist according to the Osserman and Oosterhuis criteria. In the psychological assessment the following instruments were used: the Quality of Life Questionnaire, Acceptance of Illness Scale, Life Orientation Test (LOT-R), the Beck Depression Inventory (BDI), State- and Trait-Anxiety Inventory (STAI), and the MG Disability Scale.

Results. Almost all of the quality of life components were diminished in MG. The quality of life in MG is associated with the patient 's daily functioning level and state anxiety intensity. A low state anxiety, positive mood and satisfactory functional status are propitious for the acceptance of illness in MG, comparable to that observed in other chronic disorders.

Conclusions. The quality of life and acceptance of illness in MG are associated not only with the patients' clinical status, but also with psychological factors. A comparison of the obtained data with earlier research findings suggests that participation in support groups may positively influence MG patients ' adjustment to the disease. The diagnosis of depression in MG cannot be based solely on somatic symptoms.

Original article

Cardiovascular risk factors in patients with sporadic Alzheimer 's disease

Anita Małgorzata Geppert, Elżbieta Maria Przedpelska-Ober
Postępy Psychiatrii i Neurologii 2007; 16 (2): 145-148

Objective. To estimate the prevalence of arterial hypertension (AH), hypercholesterolemia (HCh), type 2 diabetes (DM) and cardiac dysrhythmia (CD) in patients with the early- or late onset form of Sporadic Alzheimer 's Disease (AD).

Method. Participants in the study were 95 patients with the sporadic form of AD, (in that number 66 patients with late onset AD and 29 with early onset AD), as well as a control group of 73 patients. All AD patients were compared with the controls for the prevalence of AH, HCh, DM and CD. Moreover, the two subgroups of AD patients with early and late onset forms of the disease were compared.

Results. Both AH and HCh were found significantly more often in AD patients than in the controls. AH was the only factor differentiating between the late onset and early onset AD. No significant differences were found between the two AD subgroups as regards HCh, which turned out to be a stable disorder with the same prevalence in both these forms of AD.

Discussion. AD is a heterogeneous, primarily degenerative condition being the most frequent cause of dementia among adults. However, studies on the prevalence of risk factors for AD shed a new light on cardiovascular disorders showing their direct relationship to AD. Epidemiological research findings indicate that AH, HCh, DM, or atrial fibrillation may significantly influence the development of AD, affecting the risk of AD onset and accelerating the progression ofAD symptoms.

Conclusions. The results of our study suggest a particular role of hypercholesterolemia in the etiopathogenesis of AD.

Review article

The role of genetic factors in the etiology of posttraumatic stress disorder

Małgorzata Dąbrowska
Postępy Psychiatrii i Neurologii 2007; 16 (2): 149-153

Objective. To present the state-of-the-art research into hereditary factors in the development ofposttraumatic stress disorder (PTSD).

Review. The research on the role ofgenetic factors in PTSD onset was initiated by an observation that children ofparents with PTSD run a higher risk of developing this disorder. Research into PTSD inheritability included familial and twin studies, as well as candidate gene studies. An analysis of PTSD co-morbidity with other genetically determined mental disorders contributes to the explanation of the risk for developing PTSD. Liability for PTSD is associated with a particularly low tolerance to stress and an increased risk of exposure to traumatic events, determined by many factors.

Conclusions. The findings obtained so far in studies on genetic factors underlying PTSD development evidence the need for further research in this area.

Review article

Contrast Enhanced Magnetic Resonance Angiography of carotid arteries

Jarosław Ryterski
Postępy Psychiatrii i Neurologii 2007; 16 (2): 155-160

Objectives. To review basic principles of Contrast Enhanced Magnetic Resonance Angiography and to present its clinical values in comparison to these other non-invasive vascular imaging techniques.

Review. Contrast Enhanced Magnetic Resonance Angiography is one of the most advanced and accurate non-invasive modalities in the assessment of vascular structures. Due to its high contrast and spatial resolution, a large field of view and a very short acquisition time, the method is very useful in the examination of carotid arteries, being complementary to the Doppler imaging.

Conclusions. In comparison with Computerized Tomography Angiography there is no risk of potential hazardous effects of ionizing radiation or severe side effects of iodinated contrast media.

Case report

Effectiveness of low-dose maintenance therapy in two cases of affective disorders

Magdalena Garbacz, Robert Pudlo, Robert Teodor Hese
Postępy Psychiatrii i Neurologii 2007; 16 (2): 161-163

Objective. An analysis is presented of long-term remission and therapy in 2 persons with affective disorders.

Cases. Two patients with affective disorders who remained in long remission on low-dose maintenance therapy are described. Maintenance therapy discontinuation was followed by a relapse within a few months from the treatment termination.

Commentary. In both cases remission could be induced either by the pharmacological effect of medication or by placebo effect.

Case report

Orolingual Quincke's angioedema during thrombolysis in acute ischemic stroke - case report

Małgorzata Wiszniewska, Hanna Szmaglińska
Postępy Psychiatrii i Neurologii 2007; 16 (2): 165-167

Background. Orolingual Quincke's angioedema is an infrequent complication that can occur during thrombolysis with alteplase in ischemic stroke patients. In most patients, orolingual angioedema is mild and transitory, and only seldom its course is severe and potentially life-threatening. Alteplase-associated angioedema occurs most often in stroke patients previously treated with angiotensin-conv erting-enzyme inhibitors (ACEi).

Case report. The authors describe a patient with acute ischemic stroke treated with alteplase and ACEi simultaneously, who developed orolingual angioedema immediately following the infusion. His oedema disappeared after treatment with hydrocortisone and an antihistaminic drug.

Commentary. Quincke's oedema is a complication that requires treatment in every case, since its either spontaneous abatement or aggravation can never be predicted.