Archives 1992-2013

2008, volume 17, issue 1

Editorial

Why is mental health a factor important for economy?

Friedhelm Hengsbach SJ
Postępy Psychiatrii i Neurologii 2008; 17 (1): 7-13

Objectives. In a polemic with liberal economists the author argues why health as a good is not the same as many other goods.
Review. In his opinion loss of health is a large-scale social risk and for this reason it should be solidarily protected. This implies that market and competitiveness are of secondary importance for the supply of health conceived as a good.
Conclusions. Free market economy as a regulatory mechanism cannot replace the solidarity principle, since the latter proved to be the best, due to the particular nature of the good in the form of health (eds.).

Original article

Strategies of coping with chronic illness in patients with multiple sclerosis

Marlena Kossakowska
Postępy Psychiatrii i Neurologii 2008; 17 (1): 15-21

Objectives. The aims of the study were: (1) to examine coping strategies among multiple sclerosis (MS) patients and healthy individuals, and (2) to assess correlation of coping strategies with socio-demographic factors and clinical parameters in MS patients.
Method. The research sample consisted of 60 patients with multiple sclerosis, while the homogeneous control group - of 60 healthy individuals. Both groups were asked to complete the 'Coping Orientations to Problems Experienced'(COPE) questionnaire by Carver, Scheier & Weintraub, in the Polish adaptation by Wrześniewski [1, 2]. Moreover, in MS patients further socio-demographic variables, such as age, gender, education level, as well as clinical characteristics regarding the duration of illness, age at onset and type of MS, disability level (assessed using the EDSS) were controlled.
Results. Significant differences in coping strategies were found between MS patients and healthy controls. MS patients, especially women suffering from MS, used the strategies of turning to religion and seeking emotional social support more frequently than did the controls. MS patients were also more inclined to accept stressful situations, including their illness. In contrast to the healthy controls, MS patients were not able to apply the problem-solving strategy. Furthermore, in multiple sclerosis some statistically significant correlations of coping strategies were noted, namely with gender (turning to religion and seeking emotional support was more frequent in women) and with clinical data (the patient's disability level, MS type, age at onset, and duration of illness).
Conclusions. The research findings concerning correlation of coping strategies with psychosocial factors may contribute to the development of psychotherapeutic interventions helping MS patients to adapt to their illness.

Original article

Selected methods of autonomie dysfunction evaluation in Parkinson's disease

Beata Łabuz-Roszak, Krystyna Pierzchała
Postępy Psychiatrii i Neurologii 2008; 17 (1): 23-28

Objectives. The aim of the study was to evaluate the prevalence of autonomic dysfunction in patients with Parkinson 's disease (PD) using selected assessment methods and analysing correlations between test performances and clinical features of the disease.
Methods. 21 patients with PD (mean age 68.7 ±8 years) were examined using a self-report questionnaire of autonomic nervous system function, the Ewing battery of functional cardiovascular tests, and a neurophysiological indicator (sympathetic skin response, SSR).
Results. Autonomic function abnormality assessed by means of the questionnaire was present in 71.4% of thepts. Cardiovascular autonomic neuropathy (>2 abnormal cardiovascular tests) was diagnosed in 42.8% cases. Abnormal SSR (prolonged latency or absent SSR in at least 1 limb) was found in 66.7% pts. Scores on all the autonomic tests correlated with the disability status but not with the patient 's age, sex and form of the disease. Duration of the disease affected only the scores on the Ewing battery. SSR correlated both with the Ewing battery performance (p = 0.005) and the questionnaire scores (p = 0.02), while there was no correlation between the latter and the Ewing battery performance.
Conclusions. Symptoms of dysautonomia which occur in a great number of patients with PD increased with the disease progress. While the questionnaire assessment can serve as a preliminary examination, the diagnosis of dysautonomia needs to be confirmed by additional tests. Early diagnosis of autonomic dysfunction, especially that concerning the cardiovascular system, may be helpful in targeting individuals at an increased risk for vascular complications.

Original article

Relationship between serum thyrotropin level and selected cognitive functions among patients with schizophrenia

Małgorzata Dąbkowska, Beata Augustyńska, Grażyna Odrowąż-Sypniewska, Aleksander Araszkiewicz
Postępy Psychiatrii i Neurologii 2008; 17 (1): 29-33

Objectives. The aim of the study was to investigate the relationship between serum thyrotropin (TSH) levels and performances on neuro-psychological tests of selected cognitive functions in patients with schizophrenia.
Method. Cognitive functions were assessed using the Trail Making Test (TMT, parts A & B), the Stroop Color-Word Interference Test, and the Verbal Fluency test. The TSH level was measured by means of the Architect TSH (Abbott Laboratories) - chemiluminescent microparticle enzyme immunoassay (CMIA) for the quantitative determination of serum TSH. Serum TSH was determined in 59 patients (26 women) diagnosed with schizophrenia, in most cases undifferentiated or paranoid. Cognitive functions were assessed in 29 patients from this sample (in that number in 17 women).
Results. In the group of 59 schizophrenic patients an elevated TSH level was found in a single case only, while in 11.9% of the participants TSH levels approximated the lower border of the normal range. The serum TSH level was negatively correlated with the performance time on the Stroop Test, part II. A significantly lower mean TSH level was found in the patients who scored on the TMT part B, below or on the border of the normal range, as compared to serum TSH of those whose performance was within the norm. In some of the patients with schizophrenia a tendency to lower TSH levels was noted.
Conclusions. Impairment of some cognitive functions was associated with lower TSH levels.

Original article

Assessment of aggression and specific aggressive behaviors in patients with functional disorders of the digestive system

Magdalena Agnieszka Wrzesińska, Joanna Grzyb, Józef Kocur
Postępy Psychiatrii i Neurologii 2008; 17 (1): 35-38

Objectives. To assess the level of aggressiveness, aggression control and direction, as well as specific aggressive behaviors in patients diagnosed with functional dyspepsia or irritable bowel syndrome.
Method. Participants in the study were 50 patients (19 men and 31 women, mean age 37.7 years) diagnosed with either functional dyspepsia or the irritable bowel syndrome. They were examined using the Psychological Inventory of Aggression Syndrome (IPSA).
Results. In both groups of patients, with functional dyspepsia (FD) and irritable bowel syndrome (IBS), aggressiveness intensity was low. A significant intergroup difference was found as regards aggressive behavior control - high in FD patients and average in those with IBS (U = 198.00; p<0.05). No significant relationship was noted between the intensity of aggressive behaviors studied and the patient's clinical diagnosis. In both groups the levels of self-aggression, latent aggression and outward aggression were low.
Conclusions. Patients with functional disorders of the digestive system are characterized by a low aggression intensity. The level of aggressive behavior control differentiated between patients diagnosed with functional dyspepsia and those with irritable bowel syndrome.

Review article

Acute and transient psychotic disorders - towards nosological disjunction and diagnostic precision

Paweł Potocki, Barbara Remberk
Postępy Psychiatrii i Neurologii 2008; 17 (1): 39-44

Background. In consideration of various diagnostic traditions, as well as the nosological separatedness of and good prognosis in acute short-term psychoses, in the tenth revision of the International Classification of Diseases (ICD-10) acute and transient psychotic disorders (ATPD) were introduced as category F23. The aim of the paper was to overview the available research literature concerning this issue.
Review. In the light of the research conducted so far, ATPDs appear to be infrequent in the population of in-patients, affecting females definitely more often, with an acute or sudden onset, multiform symptomatology, and no typical personality characteristics. Data reported on the ATPD diagnosis stability are rather discrepant in 1-year follow-up studies, and more consistent in those covering longer observation periods. However, as regards susceptibility to stress, familial predispositions, and personality traits, familial and personality studies suggest a clear-cut differentiation between psychotic disorders with and without symptoms of schizophrenia.
Conclusions. There is a growing body of evidence that identification of ATSD as a distinct entity among other psychotic disorders was justified. Nevertheless, the problem requires further study.

Review article

Tobacco smoking as a risk factor for cerebral stroke

Paweł Zatorski, Halina Sienkiewicz-Jarosz, Anna Ścińska, Agnieszka Korkosz, Danuta Ryglewicz
Postępy Psychiatrii i Neurologii 2008; 17 (1): 45-51

Objective. To present an overview of studies on the relationship between tobacco smoking and risk of cerebral stroke.
Review. Cigarette smoking is an independent risk factor for cerebral stroke. The relative risk of stroke increases with the number of cigarettes smoked, depends on the type of stroke, and is not distinctly related to gender. Middle-aged smokers as compared to non-smokers are the highest risk group. On smoking cessation the relative risk for stroke significantly decreases, which indicates a causative relationship between tobacco smoking and cerebral stroke onset. There is growing evidence that passive smoking is also a stroke risk factor.
Conclusions. Nicotine dependence is a life-threatening condition that should be treated by all medical practitioners representing various specialties.

Review article

Mechanism of action of new antiepileptic drugs

Alicja Sobolewska, Janusz Szyndler, Danuta Turzyńska, Adam Płaźnik
Postępy Psychiatrii i Neurologii 2008; 17 (1): 53-60

Objective. The paper describes mechanism of action of new antiepileptic drugs.
Background. Epilepsy is a frequent disorder that affects about 1%% of the general population. At present seizures and epilepsy are assumed to result from an imbalance between excitatory and inhibitory systems in the CNS. A number of systems are involved in the maintenance of homeostasis: the GABA-ergic system, glutamatergic system, monoamines, neurotrophins, neuropeptides. Currently used antiepileptic drugs may cause many side effects and have no therapeutic effects in up to 25% of patients. That is why new antiepileptic drugs - more effective and with a better tolerance profile - are sought for.
Conclusions. Epilepsy treatment is based on pharmacological therapy. Antiepileptic drugs vary in their mechanism of action. Compo.u.n.ds blocking sodium and calcium channels and enhancing GABA-ergic neurotransmission seem to be the most promising candidates.

Practical hints

The Barratt Impulsivity Scale

Magdalena Grzesiak, Jan Aleksander Beszłej, Marcin Szechiński
Postępy Psychiatrii i Neurologii 2008; 17 (1): 61-64

Objective. The Barratt Impulsivity Scale (BIS-11) was discussed in the paper.
Review. Overimpulsiveness occurring in many mental disorders may significantly affect both the course of the disease and therapeutic procedures. Impulsiveness is an important problem in clinical practice. In the assessment of impulsiveness constituting a crucial element of psychopathological analysis various scales are used to measure different aspects of this variable and its intensity. The BIS-11 is often used in the research on the relationship between impulsiveness and biological factors, and in studies on drug efficacy and effectiveness of psycho-therapeutic methods in the treatment of individuals with impulsiveness disturbances. The history of the scale development was briefly outlined, and the Polish adaptation of the BIS-11 is enclosed in the paper.
Conclusions. The BIS-11 is an instrument useful not only in clinical practice, but also for research purposes.

Practical hints

Psychologist as a freelance professional

Monika Talarowska-Bogusz, Antoni Florkowski, Agata Orzechowska, Marta Strombek-Milczarek, Piotr Gałecki, Krzysztof Zboralski
Postępy Psychiatrii i Neurologii 2008; 17 (1): 65-69

Objectives. The paper is aimed at presenting the psychologists' job characteristics that would justify inclusion of this group among the so-called freelance professions.
Discussion. The history of scientific psychology in Poland goes back to over a century. Regulations concerning the psychological profession were not taken under consideration by successive legislative authorities almost throughout the 1900s. The present situation seems interesting for some reasons. Firstly, a new corporation has emerged that is to represent the interests of a quite dynamic professional group. Moreover, the number of „young" psychologists increases every year, while in the Polish society facing the new challenges of transformation there is a growing tendency to seek psychological help.
Conclusions. The Act on the Psychological Profession and Professional Self-Government of Psychologists of June 8th 2001 has been in force since January 1st 2006. It should be remembered though that this implies not only rights but also numerous duties for those pursuing the profession of psychology.

Practical hints

Contents of certificates issued by the psychiatrist and his professional functions

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2008; 17 (1): 71-75

Objectives. To remind psychiatrists the scope and contents of expert certificates they deliver, depending on the professional function performed, in order to prevent their exceeding their competences.
Review. As a forensic witness in criminal proceedings the psychiatrist in his expert psychiatric opinion formulates the evaluations he is obligated to by Article 202 Par. 4 of the penal code, and namely concerning the perpetrator 's sanity at the time of the alleged deed and competence to stand trial, as well as the necessity of protective measures implementation, if needed. Moreover, the expert wittn ess is obligated to answer additional questions asked by the authority competent to pursuit the penal proceedings, while in civil proceedings his evaluations depend on the type ofproceedings. As a forensic medical expert the psychiatrist is authorized to issue a certificate that a given party is unable to appear in the court in response to the summons (on a certain date, and with the period of this inability specified), or to inform the authority competent to pursuit the proceedings.
Conclusions. The psychiatrist treating a patient on the outpatient basis has the right to issue a certificate about the treatment provided, either on the patient's request, for another physician involved in the patient's treatment (on the physician 's request), or on request of a legally authorized body - on condition that the person to be examined shall be informed about that prior to examination.

Practical hints

Current legislation on medical forensic expert

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2008; 17 (1): 77-84

Objectives. To acquaint physicians with new legal acts appointing physicians to act as forensic experts, the only body authorized to grant a certificate of illness to account for non-appearance at court of a party summoned by the authority competent to pursuit penal or civil proceedings.
Review. Current legislation definitely differs from the regulations issued previously by the Minister of Justice. At present the only physicians qualified to act as forensic experts are those selected from a list of candidates recommended by the Regional Medical Council and contracted by the Chairman of the Regional Court. In the regulations concerning the acquirement and loss of the right act as a forensic medical expert the main emphasis is laid on the candidate's non-punishability, his not being subjected to penal proceedings or charged of gross medical negligence. In case of reasonable doubts concerning reliability of the physician 's professional activity (medical certificates issued), the Chairman of the Regional Court breaks the contract with immediate effect.
Conclusions. The knowledge of the current legislation, even if criticized, but still in force, is crucial for all physicians so that they would not infringe competences of the forensic physician, as well as for the latter so that they could insist on respectful treatment of their honest work.

Case report

Medico-legal context of psychiatrie hospitalization of a Swedish citizen in Poland - a case report

Paweł Kempisty, Aneta Gerhant, Janusz Perzyński, Anna Wójcicka, Jacek Gajewski, Agata Morawska, Madladena Derewianka
Postępy Psychiatrii i Neurologii 2008; 17 (1): 85-87

Objectives. Medico-legal difficulties involved in psychiatric care provision to foreigners in our country.
Case report. A case is reported of a Swedish citizen hospitalized in our Department for paranoid schizophrenia. In the light of legal regulations currently in force there was no possibility of transporting the patient to Sweden against his will.
Commentary. There is a need for the development of appropriate regulations concerning psychiatric care provision to foreign residents in Poland.

Case report

Neuropsychiatrie aspects of Huntington 's disease - case report

Beata Nicewicz, Justyna Pełka-Wysiecka
Postępy Psychiatrii i Neurologii 2008; 17(1): 89-92

Objectives. To characterize the dementing and neuropsychiatric disorders specific to Huntington 's disease (HD), and illustrate them by a case report of a 34-year-old woman with an early onset HD, hospitalized three times in the Psychiatry Department.
Review. Huntington 's disease is a progressive degenerative disease of the CNS associated with motor impairment, dementia and mental disorders. The diagnosis is based on genetic tests, neuroimaging and neuropsychiatric examinations. HD is related to a number of abnormalities: mood and personality disorders, irritability and explosive behaviors, schizophreniform psychotic disorders, suicidal tendencies, and specific cognitive dysfunctions.
Conclusions. Dementia in HD differs from that present in other degenerative diseases of the CNS. Mental disorders may be a first signal of HD onset.