Archives 1992-2013

Neurophysiological mechanisms underlying anxiety formation are presented in a number of approaches (by Papez, Nauta, Gray, Nestoros, and Mogenson). The authors emphasize the role of the limbic structures and outline possibilities of their functions pharmacological modification. Clinical implications of these issues are discussed as well. (Eds.)

Major characteristics of anxiety in its psychophysiological dimension are discussed within the treatment of a clinical approach. Examination methods are presented, as well as an individual character of anxiety response patterns. Intercorrelations between subjectively experienced anxiety, anxious behavior, and accompanying physiological reactions are outlined and a systemic approach to the analysis of this problem is proposed. (Eds.)

The paper presents the second theory of anxiety by Sigmund Freud, as well as anxiety in the developmental perspective, as viewed by Freud, Melanie Klein and Margaret Mahler. According to Freud, in the development of any child there is a characteristic sequence of dangerous situations evolving the child's anxiety and remaining in his/her unconsciousness through the life. The sequence includes: loss of the object, loss of the object's love, castration anxiety in the Oedipal, stage, and the fear of superego. Various forms of anxiety associated with the Oedipal, stage and with superego formation, as described in detail by Freud, are presented in the paper from his viewpoint. On the other hand, the early childhood development with the associated anxieties was discussed from Melanie Klein's point of view (the first year of life) and from that of Margaret Mahler (the first few years).

Anxiety is such a feature of a human beings that must be considered by any theory explaining the functioning of man. Anxiety is regarded by existential theories as the basic feeling accompanying man. Anxiety feelings are experienced most often due to the individual's awareness of his mortality, his responsibility for his own free choice, the awareness of his own existence, and finally, due to his uncertainty as to the purpose of his existence. Conditions of human existence and their accompanying anxiety have a significant effect on mental health.

The paper describes anxiety as viewed from the psychopathological perspective: on the one hand as either a transitory affective state or a stable personality trait and on the other hand as a symptom or constituent of the clinical syndrome. Intercorrelations between physical, psychological, and environmental determinants of anxiety are discussed and its crucial role is emphasized both in the clinical pattern of mental disorders, as well as in the pathogenesis and treatment of some physical diseases.

Incidence of anxiety in neurotic disorders is analysed by the author arguing against the concept of "neurosis" exclusion from some more recent classifications of mental disorders. According to the author, such an exclusion is doubtful and leading to interpretational difficulties. It is emphasized that the state-of-the-art psychiatric, psychological and neurophysiological knowledge allows to support the earlier assumption that negative affects, and especially anxiety, play a crucial role in the pathogenesis of neurotic disorders. Particular subgroups of neurotic disorders differ from each other in respect of the predominating type of anxiety reactions and their intensity, which has some specific therapeutic implications. (Eds.)

Current views on the treatment of anxiety disorders are outlined in the paper the need was emphasized for a comprehensive therapeutic approach, including not only pharmacotherapy, but also – and above all – diverse, adequately chosen psychotherapeutic methods and techniques. (Eds.)

Triazolobenzodiazepines (TBDZs) are anxiolytics of the benzodiazepines (BDZs) group. The triazol ring presence results in some differences in their action as compared to that of traditional BDZs: its relatively short duration, antidepressive properties, and efficacy in panic disorder symptom s amelioration. Owing to TBDZs chemical structure specificity no active metabolites are freed on the drug decomposition. In consequence, the duration of these drugs action is shorter and they do not accumulate. The antidepressive effect is probably due to the fact that not only GABA system is affected by TBDZs. Their beneficial effects in depression include: amelioration of basic depressive symptoms (although their action is less powerful than that of antidepressants), an anxiolytic affect, as well as secondary symptoms relief. Among TBDZs, alprazolam is the only tranquilizer recommended in the treatment of panic disorder. Other drug of this group, i.e. estazolam and triazolam, are hypnotics mostly. Triazolam is seldom administered because of side effects including some mental symptoms and subsequent amnesia.

The aim of the study was to assess anxiety symptoms intensity in patients suffering from a physical disease, and to compare relative share of anxiety and depression in the clinical pattern of selected groups of somatic diseases. Subjects were 93 patients hospitalized for the following groups of physical diseases: psychosomatic (N=32), neoplastic (N=31), and after surgery (N=30). The control group (N=31) consisted of randomly selected healthy persons. The first part of the study consisted of a psychiatric interview and clinical assessment of anxiety and depression level using the Hamilton scale. In the second part the State-Trait Anxiety Inventory was administered. In the stressful situation of illness and hospital treatment women were found to respond with severe anxiety and depression, while men – with an increased intensity of depressive symptoms mostly. Persons with a high trait anxiety level more often indicated a tendency to psychosomatic and neoplastic diseases. Patients with psychosomatic conditions effectively used their defense mechanisms of state anxiety reduction. However, in the case of neoplastic diseases these mechanisms efficacy turned out to be unsatisfactory, probably due to a strong endangerment of these patients health and life. Trait anxiety did not predispose to "surgical" conditions incidence, while stress associated with undergoing a surgery resulted in increased state anxiety level. The patients somatic condition severity had no marked effect on either affective disorders aggravation or heightened subjective experience of illness. The sense of being sick was the stronger the more intense were both the patients depressive symptoms and his anxiety as a personality trait.

The paper presents an overview of American studies of economic effectiveness (cost – gain) of alternative forms of psychiatric care. General methodological problems in studies comparing community care with traditional forms of treatment are outlined, which is followed by three clear examples of community care cost-effectiveness analysis. In the final part of the paper the problem of cost evaluation of various forms of treatment in Poland are discussed.

The paper presents an update of the literature on day hospitals in psychiatric services. Social and historical premises for such facilities establishment, and their distribution both in Poland and in other countries are discussed. Moreover, contemporary views and research findings concerning the tasks assigned to day hospitals and these tasks implementation efficacy are summarized by the author. It was pointed out that day hospitals are most often regarded as an alternative to inpatient treatment. The role of day hospitals in the treatment of the mentally disordered, children and adolescents, alcohol dependent persons and geriatric patients is described. (Eds.)

77 psychologists employed in 39 Mental Health Centers, and 9 experts (medical doctors and psychologists) were asked to assess how much time, take various services rendered by psychologists in a district Mental Health Center. An analysis of their opinions indicates that almost 2/3 of the psychologist's working time is consumed by diagnostic activities, which leaves for therapy less than l/3 of the working time. Individual therapy was assessed as the most time-consuming. In the experts' opinion – in contradistinction to that of psychologists – the latter should devote their working time to diagnosis and therapy in equal proportions (about 40% of time budget for each).

The author presents known an not-sowell-known facts illustrating the biographical figure of the late Professor Jan Mazurkiewicz and his work. (Eds.)