On the cover
Gustaw Neusser 1840-1904
Grażyna Herczyńska
The authors present the most recent information on the structure of the central cholinergic system, the physiological basis of its functioning, the role of muscarine and nicotine receptors in the CNS and the substances which affect these receptors.
The authors present the most recent information on the role of cholinergic mechanisms in physiological processes and in the pathomechanism of diseases of the CNS. They also indicate several theoretical premisses for the study of possible applications of substances modifying cholinergic transmission in the therapy of neurodegenerative diseases, Parkinson's disease, schizophrenia, nicotine dependence etc.
Three cases in which the diagnosis of the Charles Bonnet syndrome (CBS) was considered and visual hallucinosis was finally diagnosed are presented. Difficulties in CBS diagnostics are discussed vis a vis a review of the literature.
A case study is presented of an elderly woman with auditory hallucinosis and the predominance of musical hallucinations in the clinical picture. Fleeting visual hallucinations reminiscent of the Charles Bonnet syndrome also appeared.
A questionnaire for the screening of visual hallucinations in amblyopic patients [Teunisse et al., 1995] is presented.
Studies of behaviour disorders and psychotic symptoms in patients with Alzheimer's disease have shown that the most frequently observed disorders and symptoms are: delusions, hallucinations, activity disorders and aggressive behaviour. Presence of these different symptoms have been found to correlate with each other. Their manifestations and dynamics suggest that delirium is more frequent in Alzheimer's disease than clinical diagnoses suggest. Problems inherent in the diagnosis of dementia delirium are discussed. New diagnostic criteria for severely and very severely dementia patients, developed on the basis of the author's own research and analysis of the literature, are suggested.
The clinical symptoms of Alzheimer's disease include disturbed cognitive functioning on the one hand and objective and subjective disturbances of perception, thought content, mood and behaviour on the other hand. These symptoms seriously affect the progress of the disease and interfere with patient care. This work focusses on the analysis of behaviour disorders and psychopathological symptoms in Alzheimer's disease, other than cognitive disturbances, in the different phases of development of dementia. These symptoms were found in the majority of the studied patients. They occurred most frequently in moderately severe and severe cases. Their frequency diminished in very severe dementia. The manifestations of behaviour disorders changed as the disease progressed: inadequate activity became increasingly more bizarre. The frequency of depressive disorders decreased whereas the frequency of delusions and activity disorders increased. The manifestations and dynamics of the observed symptoms suggest that disturbances of consciousness are more frequent in Alzheimer's disease than clinical practice would indicate.
This work analyzes the relationships between behaviour disorders and psychotic symptoms in different degrees of dementia in Alzheimer's disease. In all three phases of Alzheimer's disease (moderate, moderately severe and severe dementia) in the studied group of patients a significant correlation was found between presence of hallucinations and presence of delusions. In moderately severe dementia a significant correlation was found between presence of delusions and aggression. In severe dementia significant correlations were found between hallucinations and anxiety and between anxiety and insomnia. The manifestations of these disorders, their dynamics and mutability suggest that some behaviour disorders and psychotic states in patients with Alzheimer's disease may be caused by disturbed consciousness but they are difficult to diagnose because it is not possible to assess orientation in severely dementive patients. Some of the disturbances presented by the observed patients only resemble typical psychoses but are in fact responses to other symptoms such as memory loss, disturbed orientation, visual hallucinations, disturbed recognition of places, people, their behaviour and mimicry.
It is currently believed that reactive forms of oxygen, produced by the mitochondrial electron transportation chain, play an important part in the process of senescence of the central nervous system and in the pathogeny of Alzheimer-type dementia. Recent studies have shown that mutations in mitochondrial genes for cytochrome-C-oxidase for two subunits are a risk factor for the development of Alzheimer's disease in the elderly. Damage to this enzyme increases the mitochondria's production of reactive forms of oxygen which play an important part in the process of accumulation of beta-amyloid deposits in the CNS. Administration of antioxidants (alpha-tokopherol and/or selegiline) cheeks the progression of Alzheimer's disease in moderately-advanced stages. This confirms the crucial role of reactive forms of oxygen in the pathogeny of dementive syndromes.
Selected socio-demographic factors were studied in a follow-up of 142 schizophrenic patients who had been hospitalized for the first time during adolescence (at the age of 13-18 years). The follow-up was conducted 23 years after that juvenile hospitalization. Four variables were analyzed: sex, age, education and marital status. The study revealed earlier age of onset in boys and a positive relationship between male sex and unmarried status at follow-up. No changes were found in education at follow-up in patients with early-onset schizophrenia.
The relationships between early-onset of schizophrenia and later (23-years) occupational activity were studied in a follow-up of 142 schizophrenic patients who had been hospitalized for the first time during adolescence (at the age of 13-18 years). A significant correlation was found between early onset of the illness on the one hand and later poor occupational functioning and frequent disability on the other hand. At follow-up men were on disability pension more often than women but also did paid work more often than women. Women, more often than men, had no disability pension or were unemployed.
The authors share their several-years-long clinical experience in the introduction of horse-assisted therapy to patients of the Adolescent Department, Second Psychiatric Clinic, Łódź Medical Academy. They present their own model of medical documentation of therapeutic progress. Despite its many positives, horse-assisted therapy, a form of hippotherapy, is still a very unpopular form of therapeutic intervention and therefore there is a great need to develop a realistic program for this form of therapy in Poland.
One of the methods of treatment of ischaemic heart disease is revascularizing heart surgery. Several forms of protection of the internal organs are applied during surgery. However, these interventions may have several adverse clinical consequences for the patient's cognitive functioning and neurological and mental condition. The authors review the literature, pointing out the possible risks of complications, the various risk factors and the mechanisms of the complications.