Archives 1992-2013

2000, volume 9, issue 2

Original article

Psychiatric-legal opinions following hospital observation of individuals with non-psychotic disorders. Part I: types of punishable acts

Postępy Psychiatrii i Neurologii, 2000, 9, 111-126

Out of the total of 936 psychiatric expert opinions issued after a period of inpatient observation by 19 psychiatric wards and mental hospitals in Poland, 428 were analysed. The opinions concerned offenders with diagnosed non-psychotic disorders, including: personality disorders (190), mental retardation (41), and organic mental disorders (197). They committed a total of 618 punishable acts. In all diagnostic categories offences against property were committed most frequently. As regards offenders with personality disorders, there was a high percentage of offences against life and health (including homicide), against the family, and against freedom (including sexual offences). In the group of the mentally handicapped the most frequent offences were those against life and health (including homicide ), and against freedom (including sexual offences) – frequency of the latter category was the highest in the sample studied, and twice as high as in the 1960s. Offences committed by those with organic mental disorders were against freedom (including sexual offences), against the family (the highest percent in the sample studied), and against life and health (including homicide). Homicide victims were usually distant relatives of perpetrators, their acquaintances, or strangers, while motivation included long-standing conflicts, strong affect, and alcohol intoxication. A comparison of these findings with results reported by Uszkiewiczowa (1960) indicates that the type and percentage of offences committed by perpetrators with such diagnoses remains similar, especially as regards acts against property, life and health, homicides, and sexual crimes (except for the mentally handicapped, among whom frequency of the latter offences has increased). As compared to the earlier study, we noted a somewhat higher percentage of arsons, as well as numerous offences against the family (maltreatment), that had not been committed previously.

Original article

Psychiatric-legal opinions following hospital observation of individuals with non-psychotic disorders. Part II: assessment of accountability and grave danger to legal order

Postępy Psychiatrii i Neurologii, 2000, 9, 127-136

Among 428 individuals submitted to hospital observation and diagnosed with non-psychotic mental disorders (personality disorders, mental deficiency or organic mental disorders), in 157 (37%) accountability was questioned by court experts. Non-accountability was decided in 16 cases (4%): in 2 cases due to moderate mental retardation, in 6 individuals with organic personality disorders, and in 8 – with dementia. In 6 cases ex pert psychiatrists brought forward a motion for security measures according to regulations of Article 99 of the penal code. Greatly diminished accountability was recognized in 141 cases (33%). In that number there were 6 cases of personality disorders, 16 with mental retardation, and 119 with organic mental disorders. A motion for security measures was filed in 10 cases (i.e. in 7% of those with diminished accountability). In comparison to findings reported by Uszkiewiczowa (1960), in all the diagnostic categories in question percentages of non-accountability diagnoses have decreased. The frequency of diminished accountability evaluations has decreased markedly in personality disorders, remained the same in the case of the mentally deficient, and has evidently increased in those with organic mental disorders. Percentage of those diagnosed with organic mental disorders referred to detention has remained similar over the years. On the other hand, there was a considerably smaller proportion of individuals with personality disorders or mental retardation for whom a motion for this security measure was lodged by court experts.

Original article

Subjective evaluation of pharmacotherapy and quality of life in schizophrenia

Marek Jarema, Sławomir Murawiec, Tomasz Szafrański, AGNIESZKA SZANIAWSKA, ZUZANNA KONIECZYŃSKA
Postępy Psychiatrii i Neurologii, 2000, 9, 137-147

The aim of the study was to compare subjective and objective evaluation (using the Van Putten and Naber scales, respectively) of pharmacological treatment effectiveness and quality of life in patients treated for schizophrenia. 105 patients with the diagnosis of schizophrenia participated in the study. On the grounds of the patients' subjective evaluation of first effects of medication they were divided into two groups: with either dysphoric (D) or positive (P) attitude towards pharmacotherapy (47% and 53% of patients, respectively). There were no intergroup differences in schizophrenia symptoms intensity prior to treatment. On treatment completion in group D positive symptoms of schizophrenia were found to be more pronounced. Quality of life was evaluated similarly in both groups. The quality of life ratings were positively correlated with evaluation of pharmacotherapy on the Naber scale. No significant differences in clinical improvement were noted between groups D and P post-treatment, but clinical improvement was correlated with a better evaluation of pharmacotherapy on the Van Putten scale. The two groups did not differ either in pre- or in post-treatment intensity of side effects of neuroleptics. However, after treatment a correlation was found between side effects intensity and attitude towards pharmacotherapy assessed using the Van Putten scale. In the opinion of family members, patients assessed pharmacotherapy outcome better on treatment completion than they did after the first week of treatment. Their assessment was not related to schizophrenic symptoms intensity, but was' correlated with the patients' subjective evaluation of pharmacotherapy after treatment.

Original article

Lack of association between polymorphisms of DRD2 and DRD3 genes and schizophrenia

Postępy Psychiatrii i Neurologii, 2000, 9, 149-157

Contribution of genetic factors toetiopathogenesis of schizophrenia is well documented.Susceptibility to the disease is probably due toan epistatic interaction ofmany genes. This associationstudy was conducted to investigatefrequenciesof alleles and genotypes of the so-called candidategenes in a group of patients with schizophrenia(n=129), and in healthy controls (n=111). Thepaper presents results of association studies on polymorphisms of candidate genes: DRD2 (T/G substitutionin intron 6, at the position -72 from the 5' endof exon 7, and C/T substitution in codon 313 in exon7) and DRD3 (Ball polymorphism in codon 9 of thefirst exon) in schizophrenia. No relationship betweenthe polymorphisms under study and schizophreniahas been confirmed.

Original article

The immunological and endocrine system evaluation in adolescents after suicidal poisoning

Agnieszka Gmitrowicz
Postępy Psychiatrii i Neurologii, 2000, 9, 159-167

A group of84 adolescents after suicidalpoisoning (SP) with no history of psychiatric treatment was compared to that of 30 adolescents after accidental poisoning (AP). The aimof the study was to seek for a relationship betweenpsychiatric and biological determinants of suicidal behaviours in adolescents. In each subjectcortisol concentration was estimated prior to andafter dexamethasone (DST) administration. Hyperactivationwas expected of the subthalamical-hypophyseal-suprarenal axis, as well as of interleukin-2 (Il-2) , its solvable receptor (sIl-2R),alpha-1-acid glycoprotein, and factor 3 of the complementsystem –all these could confirm the immunologicalsystem hyperactivity. The research findings indicate that female gender and depressivedisorders, mostly adaptive, may be regarded asrisk factors for suicide in adolescents. No significantrelationship was found between the distinguisheddiagnostic subcategories and increasedlevels of the parameters under study –only higherlevels ofIl-2 were somewhat more frequent amongadolescents with marked depression (p<0.1).However, increased I1-2 levels and lack of cortisolinhibition in DST turned out to be significantlyrelated to persistent suicidal thoughts andtendencies, i.e. to an increased risk of re-attemptedsuicide.

Original article

Psychopathological sequels of cardiopulmonary bypass graft surgery – a preliminary report

Postępy Psychiatrii i Neurologii, 2000, 9, 169-176

The aim of the study was to assessmental status of patients submitted to surgical treatmentof the ischaemic heart disease. Coronaryarteriesrevascularization with bypass grafts was carriedout using extracorporeal circulation with normothermiaor hypothermia. Apart from psychiatric examination,the following instruments were used: theBeck Depression Inventory (BDI), the Spielbergeranxiety scale (STAI) and a structured questionnaire,developed for the purposes of this study, includingtwo five-item self-rating scales to assess thepatient's physical and mental health. Among 40 patientsexamined so far, 32% were diagnosed withdepressive syndrome, usually of mild to moderateseverity, both prior to and after the surgery. 21% of patients had a high level of anxiety in both measurements.Female gender and older age were associatedwith lower self-esteem and more frequent anxietyand mood disorders. Surgical factors, except fora positive influence of normothermia on the anxietylevel, had no effect on the patients' psychopathologicalstatus after surgery.

Review article

The conditioned fear (freezing) test as a model of emotional disturbances in preclinical psychopharmacology

Janusz Szyndler, Adam Płaźnik
Postępy Psychiatrii i Neurologii, 2000, 9, 177-188

Conditioned fear (freezing) is oneof the most interesting animal models of anxiety.It is designed for analysing mechanisms of emotionalreactions and for testing new anxiolyticdrugs. This paper presents also a brief reviewof animal models of mental disorders, includingconditioned fear. Special attention is paid to brainstructures involved in the acquisition and expressionoffear responses and on methods used fortheir identification. The latter include selectivelesions and electrical or chemical stimulation of brain structures, as well as expression of c-fosprotein. In conclusion, predictive value of this testas a method of determining the action of newanxiolytic drugs is underlined.

Review article

Febrile seizures and their relationship to epilepsy

Postępy Psychiatrii i Neurologii, 2000, 9, 189-197

Interrelations betweenfebrile seizures and epilepsy are among crucial and most controversialissues in the contemporary epileptology. Febrileseizures belong to the most frequent paroxysmaldisorders in children. In the 1990s some elementsof their pathogenesis were explained. Genetic andenvironmental factors are considered to affect theonset of febrile seizures. The locus of the mutationresponsible for febrile seizures was found in recentyears and a few syndromes related to their concurrencewith epilepsy in the family were described.Epilepsy is present in 4 to 7% children with febrileseizures, more often if the latter are complex and oflong duration. The author's research findings indicatethat in the case of simple febrile seizures riskfactors are different than in complex ones. Partialepilepsy is more frequent in children with febrileseizures in history, particularly in those with theconvulsive state and delayed psychomotor development.Among 194 patients studied, partial temporal epilepsy was diagnosed in 8 cases with complexfebrile seizures. In that number in 2 cases hippocampalsclerosis was found. The author presents dataindicating a connection between long-lasting febrileseizures, hippocampal atrophy and temporal epilepsy.In such cases surgical treatment is requiredand datafrom the literature suggest that the prognosisis particularly good.

Case report

Mental disorders in the Fahr syndrome – a review of the literature and two case reports

Jolanta Rabe-Jabłońska, IWONA DOBROWOLSKA, JÓZEF ROJEK, Ewa Kwiecińska, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii, 2000, 9, 199-205

The paper presents an overview ofthe current knowledge about the causes of the Fahrsyndrome, a description of the clinical picture ofneurological and psychological disorders, as well asabnormalities in results of radiological and othersupplementary examinations in patients with thisdiagnosis. Moreover, two cases of female patientsare described, including their mental status, treatment,and treatment outcome. The first sufferedfrom depressive disorders in the course of the Fahrsyndrome related to phosphate-calcium metabolismdisorders, white the other had concurrent schizophreniaand idiopathic basal ganglia calcification.

Case report

Sequence of neurological symptoms in an early stage of acute carbon monoxide poisoning – a case report

Postępy Psychiatrii i Neurologii, 2000, 9, 207-212

In the interval form of the acutecarbon monoxide (CO) poisoning a severe impairment of consciousness occurs directly after the intoxication.This is followed by a symptom-free periodof several weeks to a few months, and thenvarious neurological and/or psychiatric symptomsappear. Brain lesions after CO poisoning areusually localized bilaterally in the white matter,striatum, hippocampus, and cerebral cortex. In thereported case of acute CO poisoning a CT andMRI assessment of the extent and nature of braindamage was performed a few days after the COpoisoning and at a 6 month follow-up. A CT scanrevealed bilateral low density areas in the whitematter. PD and T2 sequences in MRI scansshowed markedly enhanced signal areas within thewhole striatum and in the cerebral cortex, mostlyin the frontallobes. At the 6 month follow-up therewas SPECT evidence of abnormalities in the regionalcerebral blood flow in subcortical nuclei.The MRI and SPECT findings highly correlatewith the clinical picture. MRI as compared toCT seems to be a more useful technique of evaluationand monitoring of brain lesions resultingfrom CO poisoning.