Archives 1992-2013

An outline of trends in contemporary neuropsychological research is presented in the paper. Particular attention was paid to cognitive neuropsychology. Theoretical assumptions underlying this area of research are discussed: the concept of modular vs. generalized representation of mental functions in the brain, postulated goals of neuropsychological research, as well as the recommended methodology using the double dissociation method and case studies. A critical discussion of the theoretical rationale of cognitive neuropsychology and of its research findings is presented as well.

In contradistinction to the traditional approach focusing on functional interhemispheric differences, in the paper attention was paid to the phenomena of functional equipotentiality of and co-operation between the cerebral hemispheres. The phenomena in question were exemplified by studies on junctions of the hemisphere non-dominant for speech. Research findings reported in the paper indicate that for an efficient performance of these junctions collaboration of both differently specialized cerebral hemispheres is often necessary.

The paper presents an evolution of views on interhemispheric differences in language functions, with special emphasis on research and theoretical concepts dealing with the role of the non-dominant cerebral hemisphere in language processes. Manifestations of the co-operation between the two hemispheres of the brain, as well as the dynamic and relative character of hemispheric asymmetry in respect of language were described.

Neuropsychological research indicates no absolute dominance of the left cerebral hemisphere for language communication in right-handed persons. Since the right hemisphere of the brain is involved in many important aspects of communication, lesions in this hemisphere may be the cause of various language disorders. Experiments discussed in the paper evidence that the right cerebral hemisphere is co-responsible for the lexical-semantic processing, discourse comprehension and production, as well as for linguistic and emotional prosody. It is relatively less important for the representation of the phonetic and syntactic language systems.

In alcohol dependent persons lateralization of motor and some cognitive functions is different from that in other populations. Relationship between the reversed handedness and tendency, to alcohol abuse is not clear. Anxiety states and cognitive deficits – more frequent in left-handers – may have an effect there. There is no evidence of asymmetric morphological changes due to alcohol abuse. However, alcohol-related changes are noted at the neurophysiological level. Neuropsychological studies show a more marked dysfunction of the right cerebral hemisphere in alcohol dependents. Two hypotheses are posed to explain the causes of this phenomenon: (1) the right hemisphere is particularly susceptible to the toxic effect of alcohol, (2) the findings are an artifact resulting from a methodological flaw, i.e. more "difficult" tests are used for the right hemisphere, which yields interhemispheric differences in test performance although the extent of alcohol-related damage is similar in both hemispheres of the brain.

The paper presents the contribution of psycholinguistic methods of discourse analysis to the development of neuropsychological therapy of speech disorders, mostly aphasia, resulting from brain damage. The contribution was most noteworthy in the so-called pragmatic therapy aimed mainly at an improvement of the patient's communication (message reception and production), irrespectively of linguistic correctness of his utterances. The author outlined the rationale and examples of clinical work in two approaches of pragmatic therapy, directed at (1) development of the patient's abilities regarding discourse structures, and (2) improvement of his communication skills.

The paper deals with disorders of higher mental processes which may be expected by the clinician in cerebral stroke patients. Symptoms of neuropsychological deficits are presented in relation to the locus of lesion in the brain, in the areas supplied by the main cerebral arteries. Aphasic syndromes are discussed in more detail, due to high prevalence rates of these disorders and their disabling sequelae. The complex problems of neuropsychological diagnosis and diagnostic difficulties are briefly outlined. The role of the neuropsychologist in the clinic of cerebrovascular diseases is signalized.

The ability of learning new information was studied in the aged, in relation to the type of material and mode of its presentation. Obtained results indicate that memory deficits are not present in all the elderly subjects. Learning deficits found in the study are probably due to the CNS dysfunctions. Particular difficulties noted in simultaneous learning of verbal material suggest an impairment of cooperation between the two cerebral hemispheres in the process of aging.

The aim of the reported study was to assess the MMSE and some other neuropsychological tests scores in the diagnosis of cognitive deficits in patients with either psychotic disorders or confirmed brain damage without clinically manifested dementia. Subjects in the study were 44 patients with mental disorders in remission and 37 patients with the CNS lesions. No significant differences between the two groups were found on the MMSE, although performance of patients with bipolar affective disorder was better than that of patients with encephalopathy. Schizophrenic patients had considerable difficulties with learning new material. Administration of a battery of neuropsychological tests may contribute to a more precise differential diagnosis in some specific cases only, but the tests may be useful in the assessment of adjustment ability in patients with psychotic disorders.

An overview of the literature on calcium channel blockers in the treatment of patients with tardive dyskinesia is followed by a presentation of preliminary results of the authors own pilot study on the efficacy of Diltiazem treatment in an open sample of 11 schizophrenic patients with dyskinesic symptoms. Diltiazem was administered in the daily dose of 60 mg for 6 weeks. In the group under study more marked symptom relief was noted in patients with severe dyskinesic disorders of relatively recent onset. Symptom relief was noted, above all, as regards acathisia and involuntary movements of the lower limbs, after a relatively long (continued for 5 to 6 weeks) treatment with Diltiazem. No serious side effects were found. In some patients the subsidence of tardive dyskinesias was associated with an amelioration of their mental state.

The paper presents an overview of the available research literature on the application of calcium channel blockers (CCB) in the treatment of alcohol withdrawal syndromes. Such studies are not numerous and they usually have some methodological flaws. Reported results suggest a rather limited effectiveness of CCBs in the treatment of withdrawal syndromes. At the same time, the treatment involves a rather high risk of undesirable side effects.

Referring to the calcium channel hypothesis in degenerative diseases the author reviews findings reported in the research literature dealing with the effect of calcium channel blockers (CCBs) on specific receptors and with the role of CCBs in cognitive functions impairment in man.

The paper presents the state-of-the-art knowledge about biological determinants of psychoactive substance dependence and of alcohol dependence in particular. Advances in the research on neurotransmitter mechanisms of action of habit-forming substances are discussed, and attempts at pharmacotherapy are outlined on this background. (Eds.)

Results are presented of a pilot study on the response to a homogeneous program (task and psychoeducation-oriented therapeutic groups targeted on acquirement of new skills) in a group of alcohol dependent men (N=28) and women (N=35) treated on the inpatient basis. Obtained results indicate different extent and direction of behavior and personality change after the treatment in persons with different types of alcoholism according to the Cloninger typology. Among assessment tools used the Adjective Checklist (ACL-37) by Gough and Heilbrun turned out to have a particularly high discriminative power.

Vitamin Bl2 and folic acid concentration in blood serum was measured in 116 psychiatric inpatients, 32 healthy controls, and 21 neurotic patients. Vitamin B12 deficiency was found in 46 (39.7%), 5 (15.6%) and 2 (8%) subjects, respectively, while folic acid avitaminosis in 23 (19.8%), 0 (0%) and 1 (4.3%) patients, respectively. The majority of intergroup differences were highly statistically significant (except for the prevalence rate of folic acid avitaminosis in psychotic an neurotic patients). Higher rates of avitaminosis prevalence were correlated with older age, elementary education and Carbamazepine treatment, either jointly with a neuroleptic drug or as the only medication (in the case of vitamin B12). Type of mental disorder (psychotic vs. neurotic) had 110 significant effect either on the frequency of avitaminosis or on the mean level of the vitamins concentration.

Subjects in the study were 22 patients suffering from bipolar affective disorder and receiving prophylactic lithium treatment for 2 to 19 years, with a good effect. 31 episodes of the treatment discontinuation were noted. No "withdrawal symptoms" resulting from discontinuation of medication were noted. The risk of relapse due to the effective lithium treatment discontinuation is rather high, since 48% of the patients relapse during the subsequent month. A two-year remission was found in 25% of the subjects only. In the majority of the relapsed patients normalization of mood was attained by resumption of the lithium treatment. Incidence of lithium resistance due to discontinuation of treatment with this drug requires further study.

An autoimmunological reaction to viral infection in an early stage of the brain development may be considered as a pathogenic factor contributing in some schizophrenic patients to the onset of this disease. This is reflected in microstructural abnormalities in the brain, as well as in changes in the immunological system found in some schizophrenic patients.

The tasks and method of an English language computer bank of information on community psychiatry program s and methods as well as their effectiveness are described. The bank contains summaries of particular published papers, including coded data on a given community-based intervention, methods of its evaluation, and obtained results. The summaries are made using a structured IFEI questionnaire covering about 100 variables. At present the bank contains 130 summaries of papers published in 1993 and 1994. About 110 new entries are to be added to the bank annually. Computerized information from the bank will be available from mid-1995. The bank is run by the Institute of Psychiatry and Neurology in collaboration with the WHO and some European centers.

The autobiographic relation illustrates how mental disorders are experienced and coped with by the patient.

Editor's note
Since such evidence may play an important educative role in the training of mental health professionals, the Editors would like to encourage and invite potential authors to publish their relations in Postępy (the invitation is extended also to those in possession of such materials, naturally, provided that the authors permission is obtained).