Archives 1992-2013

2010, volume 19, issue 4

World Psychiatry Forum

Problematic Internet use: an overview

Elias Aboujaoude
Postępy Psychiatrii i Neurologii 2010; 19(4): 247–261

There is wide agreement that the Internet can serve as a tool that enhances well-being. It is more difficult, however, to find consensus around the issue of problematic Internet use. That may be in part because scientific investigation has lagged far behind technological advances and media attention. The diagnostic schemas that have been proposed since 1996, and the screening tools that have been developed, stress similarities with substance use, impulse control disorders, and obsessive-compulsive disorder. Prevalence figures vary as a function of the diagnostic definition used, the age group studied, and whether the surveys were conducted online. Studies suggest high comorbidity rates with mood disorders and, among younger individuals, attention-deficit/hyperactivity disorder. Treatment should address any comorbid conditions present, as those may be causing, or exacerbating, problematic Internet use. Interventions that may specifically target problematic Internet use include cognitive behavioral therapy and selective serotonin reuptake inhibitors, but detailed guidelines must await further studies. For a medium that has so radically changed how we conduct our lives, the Internet's effects on our psychology remain understudied. More research is needed into the pathophysiology, epidemiology, natural course, and treatment of problematic Internet use. In addition, the more subtle psychological changes, such as disinhibition, that seem to characterize people's online behavior also deserve attention, even if they cannot be seen as necessarily pathological.

Original article

Vitamin B12 deficiency and cognitive performance in geriatric patients with dementia

Marzena Zboch, Jarosław Serafin, Paweł Tyfel, Krzysztof Śmigórski
Postępy Psychiatrii i Neurologii 2010; 19(4): 263–267

Objectives. The aim of the study was to investigate the relationship between vitamin B12 serum levels and cognitive performance in different types of dementia: Alzheimer's Disease, Vascular Dementia and Mixed Dementia. Considering the more and more often emphasized need for taking into account both the cultural background and genetic differences in the research on physiology of cyanocobalamine, participants in the study (222 patients with dementia) represented the Polish population.
Method. In this cross-sectional study utilizing the ex-post facto paradigm the main independent variable was the vitamin B12 blood serum level, laboratory measured in pg/l. The dependent variable was the patients' cognitive performance (measured using the MMSE) and their nosological diagnosis. Gender was adjusted for as an extraneous variable.
Results. In the statistical analyses no significant relationships were found between the vitamin B12 serum level, cognitive performance and dementing diseases including Alzheimer's Disease, Vascular Dementia and Mixed Dementia. An interesting finding was that gender differentiated the relationship between the cyanocobalamine serum level and the type of dementing disease. The results show that male patients with Vascular Dementia as compared to those with Alzheimer's Disease had not only significantly lower vitamin B12 serum levels, but also significantly better cognitive performance.
Conclusions. No relationship between vitamin B12 deficiency, cognitive performance and type of dementia was found in patients with Alzheimer's Disease, Vascular Dementia and Mixed Dementia. In the research on relation between cyanocobalamine serum levels and the progression of the dementing process the effect of gender should be taken into account. The research method needs improvement, especially as regards the sample selection and cognitive performance assessment. The obtained findings require replication.

Original article

Frequency of stigmatization experiences among patients with schizophrenia as compared to those with other health problems

Piotr Świtaj, Jacek Wciórka, Paweł Grygiel, Julita Smolarska-Świtaj, Marta Anczewska, Anna Chrostek
Postępy Psychiatrii i Neurologii 2010; 19(4): 269–274

Aim. The purpose of this study was to compare the frequency of social stigma experiences reported by patients with schizophrenia and by people with other health problems.
Method. The stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ) was administered to patients with schizophrenia (n=153), recurrent depression (n=31), drug dependence (n=30), alcohol dependence (n=39), hematological malignancies (n=31), or cardiovascular disorders (n=33).
Results. Multiple regression analysis showed that schizophrenia patients experienced stigmatization significantly more often than did respondents diagnosed with hematological malignancies or cardiovascular disorders. Moreover, patients with schizophrenia were found to experience stigma at a level similar to that in patients with depression or alcohol dependence, but lower than that experienced by drug addicts.
Conclusions. The study findings confirm that the stigma of schizophrenia is stronger than that associated with physical illnesses. However, people with schizophrenia were not found to experience stigmatization more often than people with other severe mental disorders.

Review article

Mental disorders and disturbances in cognitive, social and family functioning in offspring of parents with bipolar disorder – a literature review

Anna Braniecka, Dorota Bzinkowska, Iwona Koszewska
Postępy Psychiatrii i Neurologii 2010; 19(4): 275–281

Objective. The paper presents an overview of 65 articles concerning children of bipolar parents.
Conclusions. Findings from reviewed studies are critically discussed with respect to the prevalence of mental disorders, as well as cognitive, social, and family functioning of bipolar parents' offspring. The findings suggest that these children suffer from mental disorders in childhood more often than do those of healthy parents, but no specific pattern of their disturbances was found. Increased rates of mood and anxiety disorders in this group were also reported. Although findings concerning their cognitive functioning are not univocal, they suggest more frequent deficits among bipolar parents' offspring – especially in attention, memory, language competencies, and executive functions. Their cognitive deficits are similar to those typical of people with bipolar disorders and may be predictive of the incidence of affective disorders in the future.

Review article

The trigeminal nerve – structure and function

Ewa Bałkowiec-Iskra
Postępy Psychiatrii i Neurologii 2010; 19(4): 283–286

Objectives. To present the role of the trigeminal nerve in sensory information (including pain sensation) transmission from the meninges of the brain and spinal cord, the temporomandibular joint, and teeth.
Review. The molecular mechanisms of sensory transmission in the trigeminal system have not been fully identified so far. Apart from the neuronal activity also the calcitonin gene-related peptide (CGRP) and brain-derived neurotrophic factor (BDNF) are hypothesized to play a significant role in this respect.
Conclusion. Research into the role of the latter factors in modulation of the trigeminal nerve function may contribute to the development of new treatment paradigms for trigeminal neuralgia, among other conditions.

Review article

Genetic background of behavioural and psychological symptoms of dementia in Alzheimer’s disease

Marcin Flirski, Tomasz Sobów, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2010, 19(4): 287–297

Objectives. To update knowledge about the genetic background of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD).
Review. BPSD emerge in the course of the disease progression in almost all AD patients. Both biological and environmental factors play a significant role in BPSD etiology. As regards the former, accruing data suggest a putative influence of genetic background on the clinical picture of dementing disorders and their treatment efficacy.
Conclusions. Multiple genes coding for proteins involved in the process of neurotransmission and potentially in AD neurobiology have been evaluated so far. In this paper we present and discuss results of studies that show significance of genetic variance in a number of genes, namely apolipoprotein E, serotonin and dopamine receptors, serotonin transporter, and catechol-O-methyltranferase, as a risk for behavioral disturbances in AD. The influence of genetic factors in BPSD etiology seems beyond controversy. However, a precise estimation of the importance of a single polymorphism is hardly possible due to prominent discrepancies in research findings. Potential sources of this variation, comprehensively reviewed and discussed, include differences in study methodology, selection and definition of target symptoms, selection errors, inadequate statistical power, and inherent limitations of genetic studies on complex traits.

Case report

Serotonin syndrome – a case report with reference to cases described in the literature

Stefan Krzymiński, Ewelina Piotrowska, Małgorzata Czekaj
Postępy Psychiatrii i Neurologii 2010; 19(4): 299–303

Objective. A case of serotonin syndrome (SS) development in the course treatment with trazodone was presented and compared to these described in the literature.
Case report. A 75-year-old male patient admitted for dementia with behavioral symptoms was initially treated with typical antipsychotics. In the course of further treatment, when trazodone was introduced, the patient developed SS. His case is discussed in the context of 18 other SS cases reported in the literature. An analysis of all the 19 cases revealed that monotherapy was used in a single case treated with citalopram only. The remaining patients received polytherapy with a combination of several drugs that have either direct or indirect serotoninergic action. In six cases (32%) trazodone was one of these drugs.
Commentary. Serotonin syndrome is an adverse drug reaction usually following concomitant administration of two or more serotoninergic agents. Such drugs, if necessary, should be used in monotherapy. In the treatment with trazodone caution is advised due to possible drug interactions.

Case report

Persistent depression in the course of Cushing’s syndrome – a case report

Krzysztof Krysta, Eliza Górniak, Karolina Furczyk
Postępy Psychiatrii i Neurologii 2010; 19(4): 305–307

Objective. A case of persistent depression in the course of Cushing's syndrome is reported.
Case. A 55-year-old woman with a 10-year history of depression had been diagnosed with Cushing's syndrome after a year of antidepressant therapy. Surgery brought no improvement in her biochemical parameters. Antidepressant drugs turn out to be ineffective in the presence of persistent hypercortisolemia, and severity of the patient's depressive symptoms remains unchanged.
Commentary. Since a delayed diagnosis of Cushing's syndrome may prolong and complicate treatment, it is important to carefully exclude any somatic causes of depression in the diagnostic process. The emphasis of depression treatment should be on restoration of normocortisolemia, and e.g. steroidogenesis inhibitors may be helpful in this respect.

Case report

Affective disorders in a female patent with Fahr’s syndrome – a case report

Grzegorz Nawara, Anna Nawara
Postępy Psychiatrii i Neurologii 2010; 19(4): 309–313

Objective. A case is reported of atypical depressive disorder in the course of Fahr's syndrome.
Case. In a 63-year-old female patient with atypical depressive syndrome who had been diagnosed with astrocytoma at age 16, Fahr's syndrome was recognized in neuroimaging examination.
Commentary. A precise and careful analysis of depressive syndromes in elderly patients is necessary.

Case report

Difficulties in certification of the defendant’s with mental disorders inability to appear in court in response to summons issued by the authority conducting the proceedings – a case report

Sławomir Krzysztof Sidorowicz, Barbara Świątek, Tomasz Jurek
Postępy Psychiatrii i Neurologii 2010; 19(4): 315–318

Objectives. The paper discusses some causes of difficulties in certification of the defendant's inability to participate in court proceedings. Attention was drawn to differences in the roles of the physician in relation to the patient and the forensic medicine expert in relation to the assessed person.
Case report. Two physicians: a psychiatrist and a forensic medicine expert (non-psychiatrist) were accused of issuing illegal certificates of the defendant's inability to appear in court in response to summons and to participate in court proceedings due to mental disorders. Criteria were presented for the assessment of ability to participate in court proceedings.
Commentary. When assessing the defendant's with mental disorders ability to participate in court proceedings the forensic medicine expert should personally conduct a psychiatric evaluation. It is only on the grounds of the latter evaluation that an appropriate certificate can be issued, where the expert should assess the importance of the defendant's abnormalities to his/her ability to participate in the court proceedings.

Case report

Can celiac disease be the cause of paranoid schizophrenia exacerbation? A case report

Agnieszka Tobiczyk-Teper, Katarzyna Buryan-Marosz, Irena Krupka-Matuszczyk
Postępy Psychiatrii i Neurologii 2010; 19(4): 319–321

Objective. To present a case of a female patient with concurrent exacerbations of both celiac disease and paranoid schizophrenia.
Case report. The patient, 52-year-old woman, was recurrently hospitalized for paranoid schizophrenia. During her recent admission celiac disease was diagnosed. In the course of her treatment intermittent psychotic aggravation, disorganized activity, autistic behavior exacerbation associated with persistent gastrointestinal disturbances including diarrhea, steatorrhea, weight loss, constant hyponatremia, and anemia were seen. The patient's celiac disease was confirmed by small intestine biopsy.
Commentary. A putative relationship between celiac disease and mental disorders was described in the literature. To check this possibility, psychiatric patients with gastrointestinal symptoms should undergo a thorough medical evaluation in consultation with an internist.

Case report

From conversion to Creutzfeldt-Jakob disease – a case report

Agnieszka Tobiczyk-Teper, Katarzyna Konderla, Dorota Maśnica-Machej, Katarzyna Buryan-Marosz, Irena Krupka-Matuszczyk
Postępy Psychiatrii i Neurologii 2010; 19(4): 323–325

Objective. An analysis of psychopathological and neurological symptoms as well as environmental factors in a patient with rapidly progressive dementia.
Case report. A 66-year-old woman previously hospitalized at surgery, neurology and ophthalmology departments for gait and vision disorders was consulted by a psychiatrist due to suspected conversion and anxiety symptoms, and subsequently admitted to a psychiatric department. During her hospitalization there Creutzfeldt-Jakob disease (CJD) was tentatively recognized and the patient was referred back to the neurology ward. The final diagnosis of CJD was based on the clinical picture, EEG examination, the presence of the 14-3-3 protein in the cerebrospinal fluid, and the patient's neuropsychiatric condition.
Commentary. Rapidly progressive dementia associated with neurological and psychiatric symptoms may be a manifestation of the rare disease. A multi-specialist team approach is necessary to arrive at a valid and accurate diagnosis in such cases.