Current views on the issues of neurotic disorders diagnostics and treatment are briefly outlined on the background of ongoing discussions concerning conceptions and classifications of these disorders. (Ed.)
The paper presents an overview of theoretical approaches to psychopathology of anxiety disorders, anxiety characteristics, and their major psychological and neurophysiological underlying mechanisms. Selected anxiety syndromes are discussed in terms of the ICD-10, with the emphasis on clinical symptoms, differential diagnosis and treatment specificity in accordance with the theory and practice applied in the Department of Neurotic Disorders.
On the grounds of a meta-analysis of community psychiatry studies published in major psychiatric journals and entered in the "Data Bank of Evaluative Studies on Community-Based Psychiatry" operated by the Institute of Psychiatry and Neurology, the current status of research in this field is discussed. (Ed.)
The issue of a presumable relationship between adolescents' suicidal behaviors and various biochemical abnormalities is discussed in the light of an overview of the literature. The least controversial seem to be the serotoninergic system changes (mostly reduced serotonin and its metabolite serum levels). Same studies confirm moreover a relationship between suicidal behaviors and changes in both the dopaminergic and noradrenergic neurotransmission, disturbances in the secretion of cortisol, growth hormone, prolactin and thyroid hormones, as well as a reduced cholesterol level. Reported research findings are frequently controversial, and even contradictory.
An overview of the literature is followed by a presentation of the author's view on relations between suicidal behaviors in adolescents and sleep. No specific sleep patterns have been found so far in patients with specific mental disorders and in those after attempted suicide. The only exception are patients suffering from affective disorder s, since changes reported in their case affect almost all parameters of sleep pattern, differing significantly from that in healthy subjects. In children with depression no changes typical of this disorder were found in polysomnography. The changed sleep pattern in schizophrenic patients after attempted suicide should be regarded as related, above all, to changes in the serotoninergic system.
Two groups of adolescents were assessed and compared in terms of diagnoses structure, family and school situation, as well as motives accompanying the attempted suicide (AS). The first group consisted of adolescents in psychiatric treatment for multiple attempted suicides (MAS group, n=24), and the other – of those referred for a psychiatric consultation due to their first (serious) attempted suicide (FAS group, n=20). While in the MAS group the diagnosis of schizophrenia predominated, in the FAS group depressive disorder s prevailed. Family conflicts were the most frequent motive associated with AS in both groups. Besides, in the MAS group also other significant motives were reported, such as e.g. feelings of hopelessness, non-acceptance of the illness, and commanding voices. Parental alcohol dependence was twice as frequent in the FAS group, while serious difficulties at school predominated in the MAS group.
Acute psychotic disorders do not yield to any attempts of systematic classification. In the paper a comparison is made between various diagnostic conceptions proposed in cases of such disorders, with particular emphasis on the French nosographic conception of bouffée délirante and on research findings suggesting that it constitutes a separate clinical entity. The paper is illustrated by a case of an acute polymorphic psychotic episode with a schizophrenia-like clinical pattern of 6 days' duration in its essential part, ended with a spontaneous regression of symptoms.
Health-related quality of life was assessed using two questionnaires in 60 patients treated for schizophrenia. Scores obtained using the two tools turned out to be correlated. Moreover, some associations were found between the level of quality of life and mental state improvement, related to the type of scale, nature of symptoms, and time of measurement (prior to or after treatment). ( Ed.)
The following four tools for the measurement of psychiatric patients' dangerous behaviors are presented in the paper: the "Overt Aggression Scale", developed in the USA, two Scandinavian tools (the "Staff Observation Aggression Scale" and the "Social Dysfunction and Aggression Scale"), as well as the "Dangerous Behaviors Questionnaire" designed at the Forensic Psychiatry Department of the Institute of Psychiatry and Neurology. These tools were compared, above all, for the type of behaviors assessed and techniques of measurement. Possible areas of these tools applicability were considered, including their usefulness for therapy outcome evaluation in specialized units of forensic psychiatry.
Dr. Halina Jankowska belongs to the generation of Polish psychiatrists that survived the World War I, witnessed the rebirth of independent Poland, and were active during difficult years of reconstruction between the two World Wars. She died during the Warsaw Uprising in the ruins of the St. John of God Mental Hospital, staying to the end with the patients in her charge. From the outset she joined her clinical psychiatric work with scientific research, including experimental animal studies. The main subject of her study was the problem of emotions. Dr. Jankowska – as one of the first authors – considered emotions to be related to biochemical changes, which is concordant with contemporary views on the neurophysiology of emotional processes. Chi/d psychology (eidetism) was a major area of her research. Her works on extramural care organization are also of considerable importance.