Archives 1992-2013

2008, volume 17, issue 2

Original article

A study of prevalence of the metabolic syndrome in patients with schizophrenia

Katarzyna Olszewska, Janusz Rybakowski
Postępy Psychiatrii i Neurologii 2008; 17 (2): 117-121

Objectives. The purpose of the study was to assess the prevalence of metabolic syndrome in patients with diagnosed schizophrenia, hospitalized at the Psychiatric Hospital in Gniezno.
Methods. Eighty patients were studied - 27 women and 53 men admitted to the hospital between 01.12.2005 and 01.11.2006. Schizophrenia was diagnosed according to ICD-10 criteria. Metabolic syndrome was diagnosed according to the criteria of the International Diabetes Federation (IDF). The following criteria were measured: glucose, lipid profile, body weight, blood pressure, and waist circumference.
Results. Metabolic syndrome was diagnosed in 32.5% of the patients. No statistically significant difference was found between male and female patients. The most frequent elements of the metabolic syndrome were low HDL cholesterol and excessive waist circumference. The metabolic syndrome was more prevalent in patients over 40 years of age (47%) than in patients aged 20-30 (24%). No relationship was found between duration of illness and the probability of metabolic syndrome. The metabolic syndrome was more prevalent in patients treated with perazine, olanzapine and clozapine than in patients receiving other neuroleptics.
Conclusions. Metabolic syndrome and its components are a frequent phenomenon in patients with schizophrenia.

Original article

Polish adaptation of the Illness Perception Questionnaire for Schizophrenia: Patients ’ and Relatives ’ versions. Step I - language adaptation

Agnieszka Dyduch, Anna Zaborska, Tomasz Kucmin, Katarzyna Tomkiewicz, Radosław Leśniak, Anna Grzywa
Postępy Psychiatrii i Neurologii 2008; 17 (2): 123-126

Objective. The purpose of this study was to conduct a linguistic validation of the Polish translation of the original English version of the Illness Perception Questionnaire for Schizophrenia: Patient's and Relatives' versions.
Method. The validation process is presented. The validation proceeded according to international standards.
Results and conclusions. There were some problems with the translation of phrases describing symptoms. Subtle differences in meaning made it very difficult to find Polish equivalents which would be comprehensible for the Polish respondent. Due to lack of Polish equivalents, some phrases are not translated literally and are substituted by alternatives instead. The psychometric validation of the questionnaire will be undertaken and the results will be published so that the cultural adaptation can be completed.

Original article

Involuntary hospitalisation and direct constraint on psychiatric wards in 2006 compared with previous years

Wanda Langiewicz, Monika Pasiorowska
Postępy Psychiatrii i Neurologii 2008; 17 (2): 127-133

Objective. The need to monitor the implementation of the mental health act motivated the present attempt to verify the material concerning the admission procedures and application of direct constraint in psychiatric wards and hospitals. The main purpose of this study was to analyse the data concerning involuntary hospitalisation in 2006 taking into account the type and size of admitting institution. Additionally, the study sought to identify the sites of proceedings of the custodial court in art. 23, 24 and 28 cases and to determine the frequency of application of direct constraint on psychiatric wards.
Method. The study is based on data from 117 institutions that were monitored in 2006, including 46 psychiatric hospitals and 71 general hospitals.
Results. In 2006, 15 628 individuals were admitted involuntarily to psychiatric wards on the basis of one of four (23, 24, 28, and 29) articles of the mental health act, that is 8.7% of all admittances. Art. 23 dominates in the structure of involuntary hospitalisations, i.e., 75% of all these admissions. In 55.6% of the monitored institutions the proportion of involuntary hospitalisations did not exceed 5%o of all admissions. The level of direct constraint in both psychiatric and general hospitals was the highest since 1996. The differences in the level of involuntary hospitalisations in psychiatric hospitals and general hospitals may be due to the practices of the emergency service which prefers to transport patients to psychiatric hospitals. Another reason may be social opinion and differences in patient attitudes: patients may demonstrate more resistance during admission to a psychiatric hospital than during admission to a general hospital.
Conclusions. Psychiatric hospitals accept nearly twice as many involuntary patients as psychiatric wards in general hospitals. Dominant in this group are admissions based on art. 23 but an increasing number of admissions based on art. 24, permitting involuntary observation, can also be observed in current „admission" practice. As far as general hospitals are concerned, there is a clear relation between the size of the institution and the proportion of involuntary admissions. Whatever the institution, the custodial court case usually takes place at the hospital to which the patient was admitted.

Review article

Dosing psychiatric drugs in patients with chronic kidney disease

Maciej Banasiak, Tadeusz Pietras, Magdalena Szklarek-Kubicka, Michał Nowicki
Postępy Psychiatrii i Neurologii 2008; 17 (2): 135-140

Objective. This study is about the dosing of psychiatric drugs in psychiatric patients with chronic kidney disease (CKD). It gives a detailed account of drugs whose dosage must be reduced.
Review. Psychiatric disorders often coexist with renal insufficiency. On the other hand, a number of psychiatric patients are at risk for renal impairment. It is also known that renal dysfunction can alter the metabolism of certain drugs. Inappropriate dosing in patients with chronic kidney disease may lead to intoxication or ineffective therapy. The question therefore arises: which medications can safely be prescribed and which must be administered in reduced doses to psychiatric patients with chronic kidney disease?
Conclusion. Not many studies describe the pharmacokinetics of psychotropic agents in patients with CKD at different stages of renal function impairment because most clinical trials exclude patients with advanced renal insufficiency. The pharmacokinetic properties of a selection of drugs often used in clinical practice are reviewed. The review of the literature suggests that most psychotropic medications are well tolerated in the treatment of patients with renal insufficiency although more clinical trials are needed. This is because most of the drugs are fat soluble and mainly metabolised by the liver and subsequently secreted with the bile.

Review article

Neurocognitive aspects of children’s bronchial asthma - research perspectives

Joanna Fryt
Postępy Psychiatrii i Neurologii 2008; 17 (2): 141-144

Objective. This article presents the current status of neurocognitive aspects of children 's bronchial asthma.
Review. It describes the latest trends in diagnosis of cognitive and emotional difficulties observed among children with asthma, focusing especially on attention and memory processes as well as emotion regulation.
Conclusions. Possible explanations of the observed deficits, their clinical significance and future research perspectives are discussed.

Review article

Flurbiprophene and its derivatives in the treatment of dementia in the course of Alzheimer’s disease

Tadeusz Pietras, Maciej Banasiak, Wojciech Musiał
Postępy Psychiatrii i Neurologii 2008; 17 (2): 145-148

Objectives. The aim of this study is to present the state-of-the art research on flurbiprophene and its derivatives in Alzheimer's disease (AD) treatment.
Review. A number of epidemiological studies have suggested that long-term use of some nonsteroidal antiinfammatory drugs may reduce the risk of developing AD and slow down the progress of dementia in the course of this condition. Several studies show that specific agents, including sulindac, indomethacine, flurbiprophene, and ibuprophene, reduce amyloid beta levels in cultured cells of peripheral, glial and neuronal origin. Tarenflurbil, the single R-enantiomer of flurbiprophene, has been shown to lower brain levels of beta-amyloid in animal models of Alzheimer s disease. Preliminary clinical trials suggest that tarenflurbil may protect human brain against amyloid beta aggregation, thus inhibiting cognitive deterioration in AD patients. Flurbiprophene and its derivatives probably modulate gamma secretase activity via selective allosteric inhibition of enzymatic activity.
Conclusions. Flurbiprophene derivatives as allosteric gamma secretase inhibitors may constitute a new class of substances in the pharmacological treatment of Alzheimer's disease.

Review article

The role of Disrupted-In-Schizophrenia genes (DISC1 and DISC2) in schizophrenia - state of the art

Adam Wysokiński, Wojciech Gruszczyński
Postępy Psychiatrii i Neurologii 2008; 17 (2): 149-155

Objective. The role of DISC1 and DISC2 genes in the etiopathogenesis of schizophrenia has been examined in many recent studies.
Review. Although the results are ambiguous, they suggest a possible role of these genes in the development of schizophrenia and other mental disorders, e.g. bipolar affective disorder. The mechanisms through which the DISC1 and DISC2 genes operate are not entirely recognized but their proven participation in the process of neurogenesis and the occurrence of the mutations of DISC1 and DISC2 genes support the view that a disrupted neurodevelopment process plays an important role in the etiopathogenesis of schizophrenia.
Conclusions. Despite numerous evidences attesting to the association of these genes with the occurrence of schizophrenia, the clinical importance of these genes has not been established.

Practical hints

A critical look at the alternative appointment of a “forensic psychiatrist or neurologist”

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2008; 17 (2): 157-160

Objective. This article informs psychiatrists, neurologists and psychologists about the new legal regulations concerning appointment of forensic experts in legal incapacitation cases and draws the legislators' attention to the fact that alternative appointment of „a forensic psychiatrist or neurologist" is wrong because of the very different competencies of these two specialists.
Review. Earlier legislation obligated courts conducting legal incapacitation cases to refer the examinee for assessment by one or more forensic psychiatrists. This formulation left no doubt that art. 554 § 1 of the civil code (c.c.) meant that the court thought it essential to submit the person to observation at hospital „ on the basis of the opinion of two forensic physicians " and that these physicians were to be forensic psychiatrists. Their duty was (and still is) to assess whether the examinee „was incapable of managing his/her conduct due to mental illness, mental underdevelopment, or other type of mental disorder, and especially alcohol or drug dependence " (art. 13 c.c.) or, for the above reasons, „ needed help to conduct the case" (art. 16 c.c.). All these assessments are within the competencies of the forensic psychiatrist. Now „the person whom the motion to incapacitate concerns, must be examined by a forensic psychiatrist or neurologist, and also a psychologist (art. 553 § 1 c.c.) and § 2 specifies the range of assessments which the forensic opinion must contain. The failure to specify the specialities of the two forensic physicians (on the basis of whose opinions the court shall assess the necessity of observation) is causing doubts as to the specialities of the forensic physicians (the popular opinion among legislators is that only forensic psychiatrists can assess the need for observation).
Conclusions. (1) The chapter entitled „Legal incapacitation " (art. 544-560 c.c.) needs to be amended immediately and the competencies of forensic physicians must be limited to psychiatrists. (2) It would be advisable to return to the former content of art. 553 § 1 c.c. (3) In art. 554 § 1 c.c. it would be advisable to make it clear that the court shall assess the need to submit the examinee to observation in hospital on the basis of the opinions of two forensic psychiatrists.

Case report

Tuberous sclerosis complex (TSC) - a case report

Sylwia Miłońska, Ewa Murak-Kozanecka
Postępy Psychiatrii i Neurologii 2008; 17 (2): 161-164

Objectives. Tuberous sclerosis complex (TSC) is a genetic disease with an autosomal dominant pattern of inheritance varying in gene expression. TDC is characterized by the development of tumours within many organs and systems. TDC is diagnosed by the clinical criteria established in 1998.
Case report. The presented case concerns a woman with TDC and includes the circumstances of her hospital admission, the diagnostic process, and treatment.
Commentary. The patient s medical history shows that TDC is relatively easy to diagnose but its assessment requires the co-operation of various specialists.

Case report

The patient’s conviction about the reality of his experiences during a psychotic episode and long-term prognosis in schizophrenia - a case report

Sławomir Murawiec, Sławomir Pietrak
Postępy Psychiatrii i Neurologii 2008; 17 (2): 165-170

Objectives. The course of treatment after a psychotic episode largely depends on patients' stable beliefs concerning the reality of their experiences at the time. The presented case illustrates selected theoretical concepts accounting for this phenomenon.
Case report. The presented case is a 52-year-old man treated for schizophrenia for 9 years. Even though his productive symptoms have resolved, he has been invariably convinced throughout his treatment that his psychotic experiences were real. The effect of his beliefs on the course of treatment is discussed.
Commentary. Long-term conviction about the reality of psychotic experiences is frequently seen in patients after a psychotic episode. This problem should be taken into consideration during routine psychiatric examination because such faulty beliefs may have an adverse effect on the course of treatment.

Case report

Arachnoid cyst in siblings with diagnosed autism spectrum disorder - a case report

Agnieszka Kapinos-Gorczyca, Piotr Gorczyca, Maciej Kapinos, Robert Teodor Hese
Postępy Psychiatrii i Neurologii 2008; 17 (2): 171-173

Objective. This article presents a case of comorbidity of autistic spectrum disorder and arachnoid cyst in a pair of siblings.
Case report. The authors present two brothers, one 2.5-year-old and one 7-year-old, with diagnosed autistic disorder in whom MRI of the head revealed an anarachnoid cyst in the retrocerebellar area.
Commentary. The relatively minor improvement of speech and persistence of other deficits typical for autistic disorder in the older boy following neurosurgery suggest that the present case study belongs to the line of reports on abnormal brain structure in children with autistic disorder.

Case report

The problems involved in the diagnosing of infanticide - a case report

Dariusz Juszczak
Postępy Psychiatrii i Neurologii 2008; 17 (2): 175-177

Objective. This article discusses the problems involved in the diagnosing of infanticide in forensic-psychiatric assessment.
Case report. The case was a 21-year-old woman suspected of acting with the direct intention of homicide (art. 148 § 1). She given birth to a normally developed daughter, without developmental impairment, weighing 940 grams, capable of surviving in hospital, whom she failed to help, carried to the neighbourhood rubbish dump and abandoned in unfavourable atmospheric conditions on the day of birth. The girl died that same day of lack of nourishment and cold. The court ordered hospital observation during which the diagnostic examinations necessary to formulate the forensic-psychiatric assessment were conducted.
Commentary. On analysis of the case documentation and the hospital observation, the forensic experts came to the conclusion that the patient had an immature personality with hysteroid characteristics and below-average intellectual functioning and that this had seriously limited her sanity.