Archives 1992-2013

2011, volume 20, issue 1

World Psychiatry Forum

Pathophysiology of depression: do we have any solid evidence of interest to clinicians?

Gregor Hasler
Postępy Psychiatrii i Neurologii 2011; 20(1): 5–22

Due to the clinical and etiological heterogeneity of major depressive disorder, it has been difficult to elucidate its pathophysiology. Current neurobiological theories with the most valid empirical foundation and the highest clinical relevance are reviewed with respect to their strengths and weaknesses. The selected theories are based on studies investigating psychosocial stress and stress hormones, neurotransmitters such as serotonin, norepinephrine, dopamine, glutamate and gamma-aminobutyric acid (GABA), neurocircuitry, neurotrophic factors, and circadian rhythms. Because all theories of depression apply to only some types of depressed patients but not others, and because depressive pathophysiology may vary considerably across the course of illness, the current extant knowledge argues against a unified hypothesis of depression. As a consequence, antidepressant treatments, including psychological and biological approaches, should be tailored for individual patients and disease states. Individual depression hypotheses based on neurobiological knowledge are discussed in terms of their interest to both clinicians in daily practice and clinical researchers developing novel therapies.

Review article

The role of neuropsychologists in the assessment and treatment of Huntington’s disease

Emilia J. Sitek, Witold Sołtan, Emilia J. Sitek
Postępy Psychiatrii i Neurologii 2011; 20(1): 23–31

Objectives. The paper presents the role of the neuropsychologist in care of patients with Huntington's disease (HD), the profile of cognitive dysfunction in HD, as well as suggestions for neuropsychological assessment planning, interpretation of test results, and for psychoeducational interventions.
Review. The major tasks of the neuropsychologist working with HD patients include the neuropsychological assessment of the patient (both in the clinical and preclinical stages) and psychoeducational interventions for his/her caregivers. The dementing process, traditionally considered to be subcortical, is inevitable in HD. Executive dysfunction and working memory impairment predominate in the clinical picture. Neuropsychological assessment in HD requires knowledge about the symptom specificity, cooperation with the doctor in charge of the patient (a neurologist and/or psychiatrist) as well as taking into account in the interpretation of test results all factors that may affect the patient's performance.
Conclusions. Neuropsychologists, besides neurologists and psychiatrists, are essential members of the HD care team. The neuropsychological assessment, if properly conducted, belongs among the most important diagnostic procedures (complementary to the neurological, psychiatric, genetic and neuroimaging examinations) allowing to evaluate the disease severity, progression rate and treatment efficacy. The neuropsychological assessment may also provide grounds for psychoeducational intervention planning.

Review article

Stroke in patients with chronic kidney disease

Piotr Sobolewski
Postępy Psychiatrii i Neurologii 2011; 20(1): 33–44

Objectives. The aim of the study was to report and discuss intercorrelations between stroke risk factors and chronic kidney disease (CKD), cardiovascular complications in dialyzed patients, and the problem of post-contrast nephropathy.
Review. The following risk factors common for ischemic stroke and CKD were reported: the patients' advanced age, Afro-American race, male sex, hypertension, diabetes, atrial fibrillation, and smoking, while the common risk factors for hemorrhagic stroke and CKD included: advanced age, Afro-American race, hypertension, diabetes, amyloid angiopathy, and smoking.
Conclusion. A thorough analysis of all factors and problems associated with cerebrovascular diseases and CKD allows to choose appropriate diagnostic methods and treatment approaches in this group of patients.

Review article

Evaluation of phototherapy effectiveness in the treatment of non-seasonal affective disorders

Magdalena Chojnacka, Łukasz Święcicki
Postępy Psychiatrii i Neurologii 2011; 20(1): 45–51

Objectives. The paper reviews studies on effectiveness and tolerability of phototherapy in non-seasonal affective disorders.
Review. Efficacy of phototherapy (involving exposure to bright, white light) was confirmed in the treatment of seasonal affective disorders. This non-pharmacological treatment method is well-tolerated, relatively safe and simple to use. Its side effects are rare. The method provides a viable alternative for patients who cannot accept or tolerate medication, or in whom pharmacotherapy may be contraindicated.
Conclusions. More and more reports are published on the use of phototherapy also in non-seasonal depression, either as monotherapy or as an adjuvant to conventional antidepressants. The results are inconclusive. Further research is needed to explain the doubts.

Case report

Anxiety disorder and depression in the course of adrenal pheochromocytoma – a case report

Bertrand Janota, Lucyna Papierska, Maria Załuska, Katarzyna Janota, Andrzej Cichocki, Elżbieta Piaseczyńska
Postępy Psychiatrii i Neurologii 2011, 20(1): 53–58

Background. The aim of the paper was to outline anxiety and depression symptoms and well as other somatic ailments in the course of pheochromocytoma of adrenal glands. This type of tumor is relatively rare, mostly benign, and hormonally active. Secreting excessive amounts of catecholamines the tumor may manifest itself in elevated blood pressure, tachycardia, nonspecific abdominal complaints, and sometimes symptoms of anxiety and depression. Early diagnosis and surgical removal of pheochromocytoma lead to full recovery in a majority of cases.
Case report. A female patient, not stressed and with no hypertension, had been unsuccessfully pharmacologically treated for anxiety and depression on the outpatient basis. Following an episode of acute abdominal pain and nausea her USG examination revealed a tumor in the right adrenal gland. Elevated urinary metoxycatecholamines suggested the diagnosis of pheochromocytoma, confirmed histopathologically. After surgical removal of the tumor and discontinuation of pharmacotherapy the patient's depressive and anxiety symptoms completely abated. No recurrence of the tumor was found within a 2-year follow-up period.
Commentary. Pheochromocytoma should always be taken into account in the differential diagnosis of anxiety and depression causes, since this condition if not recognized in time and left untreated may be fatal due to vascular complications and metastases. The reported case highlights the necessity of including pheochromocytoma in the differential diagnosis of anxiety and depressive disorders in the absence of hypertension, particularly if pharmacotherapy is ineffective and there are no significant stress factors. It should be remembered that signs and symptoms of pheochromocytoma include not only tachycardia, elevated blood pressure and headaches, but also abdominal complaints (pain, nausea, dyspepsia). The latter, interpreted as anxiety symptoms, may be actually manifestations of pheochromocytoma, and therefore require relevant screening procedures.

Case report

The role of psychological factors in the course of tic syndrome in a 20-year-old male – a case report

Agnieszka Skrzypulec, Seweryn Segiet, Adam Szuścik, Krzysztof Krysta, Irena Krupka-Matuszczyk
Postępy Psychiatrii i Neurologii 2011, 20(1): 59–62

Objectives. A case of a 20-year-old man with tic disorder is presented and the role of psychological factors in the development of his condition is discussed.
Case report. The patient diagnosed with the Tourette syndrome at age 3 was repeatedly hospitalized in child psychiatry and neurology departments. Due to tics exacerbation he was submitted to tiopental-induced coma thrice. Differentiated pharmacotherapy resulted in transient outcomes. No psychotherapy has ever been attempted. The patient was diagnosed with immature personality, manifested anxiety and depressive behaviors and a low self-acceptance level. He had two suicide attempts and was a medication abuser. He responded to stressful situations with aggravation of somatic symptoms.
Commentary. During the patient's most recent hospitalization a significant role of mental disorders in the development and exacerbation of his tic disorder was postulated. Cooperation between various health professionals, particularly psychiatrists, psychotherapists and neurologists is necessary both in the diagnostic process and treatment.

Case report

Does the sentence „I feel I am being watched” always have the same meaning? Clinical significance of erroneous description and attribution of their states by patients treated for schizophrenia – a case report

Maciej Karaszewski, Sławomir Murawiec, Małgorzata Sosnowska
Postępy Psychiatrii i Neurologii 2011, 20(1): 63–67

Objectives. The aim of the paper was to discuss the phenomenon of statements occasionally made by patients treated for schizophrenia – such comments concerning undesirable side effects of medication, or resembling paranoid ideation are related to stressful situations currently experienced by the patient.
Case report. A case is presented of a 35-year old female patient diagnosed with schizophrenia and treated for the past few years, currently in remission. When confronted with difficulties connected with her decision-making about getting a job or in other stressful situations the patient reported brief, transitory episodes of her "eyes skittering away" (which resembles post-neuroleptic acute tardive dyskinesia), or similarly short-lasting feelings of being watched by other people (resembling delusions of reference).
Commentary. If patients in stable remission suddenly report side effects of their medication, or develop short-term psychotic symptoms, psychological background of their complaints should be explored and appropriate help provided to the patient.

Case report

A case of extreme emotional agitation – competence and forensic expertise problems

Anna Pilszyk, Ewa Waszkiewicz
Postępy Psychiatrii i Neurologii 2011, 20(1): 69–73

Objectives. The state of extreme emotional agitation was characterized from the psychological, medical and legal perspectives. The paper presents a detailed outline of legal regulations concerning the use of the notion of „extreme emotional agitation", criteria for diagnosing this state, and diagnostic difficulties of forensic experts.
Case report. A case is reported of a male perpetrator of a double homicide committed under the influence of extreme emotional agitation.
Commentary. On the grounds of the case report a number of doubts concerning „extreme emotional agitation" were presented and an attempt was made to propose possible solutions for their clarification.

Case report

A rare case of bacterial encephalomeningitis as a preliminary symptom of multiple myeloma

Małgorzata Wiszniewska, Marcin Rogoziewicz, Anna Szmydt, Paweł Wiszniewski
Postępy Psychiatrii i Neurologii 2011, 20(1): 75–79

Background. The aim of this article is to present a rare case of bacterial meningitis which turned out to be the first symptom of multiple myeloma. Multiple myeloma is a neoplasm characterised by clonal proliferation of atypic plasmocytes. Anemia, osteolytic lesions, hypercalcemia, renal failure, and osteal pain are the most common symptoms of the disease. Spinal cord lesions, radiculopathy, as well as cranial and peripheral nerve palsy predominate among neurological disorders associated with multiple myeloma. The illness leads to humoral immunity impairment and increases the patients' vulnerability to bacterial infections, including bacterial meningitis. Meningeal and cerebral involvement is very rare as an initial manifestation of myeloma.
Case report. A 69-year-old male was diagnosed with severe acute bacterial meningitis that proved to be the first clinical manifestation of multiple myeloma. Combined antibiotic therapy with a supplementary treatment ameliorated the signs of meningitis. Combined treatment of multiple myeloma with thalidomide and dexamethasone was successful. The patient remains under the care of a hematologist and neurologist.
Commentary. We present this case to emphasize that bacterial meningitis occasionally may be a first manifestation of multiple myeloma. It is very important to make an accurate and rapid diagnosis that allows to initiate complex treatment of both meningitis with antibiotics and subsequently of myealoma with immunosuppressive agents. Such management increases the patient's chance not only of survival, but also of a better quality of life after treatment completion. We would like to emphasize that a good collaboration between neurologists and hematologists is necessary in such cases.