Archives 1992-2013

2002, volume 11, issue 1

Original articles

Does substance dependence result from an impairment of the mechani s m o f drive satisfaction (

Fostępy Psychiatrii i Neurologii, 2002, l, 9-22

Substance dependence is a complex brain disorder, characterised by the lass oj eontroi over drug seeking and drug taking behavior and by the risk oj relapse, even aftera prolonged period oj abstinence. This disorder may have its source in a disturbed balance oj drive-related behaviors that eontroi appetitive reactions aimed at seeking eontael with an addictive substance. The act oj consumption hecomes more and more attractive, and the behavior takes on compulsive character. According to the the01y proposed by Koob and LeMoal [2001], addiction is a disorder involving an allostatic mechanism defilzed as the process maintaining reward function mechanism with a permanent deviation oj the rewCll·d set point. We suppose that drug addiction may involve a change in the mechanism oj drive satisfaction and in the stale oj satiety as well. To understand how the motivational processes are changed with the development oj dependence one mus t consider the mechanism oj drive satisfaction and satiation states that occur in reiarion with the eonsumatory rejlex. When a given drive is satisfied t he state oj fulfilment e!lSlles. This state may be a re suit oj t he so-called .. antidrive" mechanism [Konarski 1967]. While the drive activity is characterised by generał activation and tension, the stale oj drive satisfaction (.,antidrive") is characterised by relaxation and relief When a partieu/ ar drive is satisfied the operatżon oj other drives hecomes possible. Therefore, we postulale that dysfunction oj drive satisfaction leads to the sustained activation related to the current drugrelated drive, which blocks the operatżon oj other drives. In effect, uncontrolled compulsive appetitive behavior (drug seeking) is released, and the operatżon oj other drives is restrained thus Jareing t he lO Wojciech Kostowski organism to focus on drug-related drive. The reason for the "antidrive" dysfunction may be related to adaptive changes that develop during a prolonged contact with an addictive substance.

Review papers

Neuroleptic malignant syndrome

Postępy Psychiatrii i Neurologii, 2002, II, 23-30

Since the initial description ofneuroleptic malignant syndrome (NMS) 40 years ago, a wealth of clinical data has accumulated on the
manifestations, course, treatment and pathogenesis of this uncommon but serious and potentially Zethal drug reaction. Nevertheless vigilance must be maintained, as this disorder remains obscure to many practising physicians. Herc we review the clinical features of NMS to enhance patient safety and reduce physician liability whenever antipsychotic drugs are administered.

Review papers

PANDAS: Pediatric Autoimmune Neuropsychiatrie Disorder s Associated with Streptococcal infection

Fostępy Psychiatrii i Neurologii, 2002, i i, 3i-35

in recent years a number of obsessive compulsive disorders and tics Jollawing streptococcal infection have been distinguished on the grounds of clinical observations. in these cases various psychopathological symptoms develop follawing interaction of autoantibodies with new·ons of basal ganglia in the brain. The artżele presents new data concerning etiopathogenesis, clinical symptoms, and treatment of these disorders.

Review papers

Risk factors for osteoporosis in schizophrenic patients - indications to osteoporosis prevention and treatment

Postępy Psychiatrii i Neurologii, 2002, 11, 37-43

The etiopathogenesis, clinical symptoms and indiealians to the prevention and treatment of osteoporosis in patients with schizophrenia,
as well as a literature review on risk factors for osteoporosis in schizophrenics are presented in the paper. Decreased bane mass density (BMD) is
caused in these patients mostly by a long-term neuroleptic treatment (with the ensuing hyperprolactinemia and hypoestrogenism), insufficient ca++ intake, law physical activity and limited exposure to UV rays. Other important risk factors are: alcohol and tobacco abuse, treatment with other ( e.g. antiepileptic) drugs, polydipsia. Clinical symptoms of osteoporosis (most often vertebral, stemal andlor costal fractures) can be seen not earlier than ten or more years s ince t he onset o f t he disease. In patients with schizophrenia osteoporosis is diagnosed and treated too seldom. Reduction of risk factors, prevention and early treatment oJ osteopenia seem to the most important strategies in the prevention oJ osteoporosis in schizophrenic patients.

Original papers

The subjective experience of illness in male and female patients with endogenous depression

Postępy Psychiatrii i Neurologii, 2002, l l, 45-53

The experience of mental illness has many important consequences in various spheres of human life. Depression disturbs the patient's functioning in various dimensions - cognitive, affective, behavioural and social. Research conducted in depressive patients indicates that the clinical patters of depression is not homogeneous and that gender is an important differentiating jactor in this respect. In the study an attempt was made to check whether małe andjemale patients differ in their self-rating oj subjectively experienced symptoms. Participants in the study were 68 patients (32 males and 36 females) hospitalised for endogenous depression. The Adjective Checklist (ACL) by H.G.Gough and A.B. Heilbrun was used to assess the patients' past and present self-image, in order to find out in which areas of personał functioning there were genderrelated changes reflecring the extent and degree of the subjective experience of illness. Moreover, a structured clinical interview "My Experience of Illness" (MEJ) { /2] with items concerning the subjective experience and self-rating of depression was carried oąt. Obtained results suggest that in the group ofpatients with endogenous depression males significantly differed jrom females in their subjective experience and self rating of depression. The differences affect the patients' cognitive, emotional, behavioural and social fu.nctioning. These genderrelated differences should be taken into account in therapeutic interventions.

Original papers

Psychological well-being of female patients after mastectomy. Research report

Postępy Psychiatrii i Neurologii, 2002, li, 55-70

Despite the progress in methods of breast cancer treatment, bot h early diagnosis of the disease, and the provisżon of medical and psychological
care to the patient re main a crucial issue. In the Polish health care system psychological care to patients with oncological diseases is sadly neglected. The a im of the study was to establish not only t he severity and direction of impact of t he disease (as a criticallife event) on psychological wellbeing of Jemale patients undergoing mastectomy, but also to describe t he sources of their social support during the disease and its treatment.

Original papers

Coping with stress in caregivers to patients with Alzheimer' s disease

Postępy Psychiatrii i Neurologii, 2002, l l, 71-80

Caregivers to patients suffering from Alzheimer 's disease are exposed to chronic stress of intensity higher than that in the generał population.
Research findings show that emotion-oriented coping strategies are preferred to task-oriented coping. The crucial resource in coping with illness of a close relative is a strong social support, first and Jaremost from family me m bers, but also from medical staff and self-help discussion groups. Anther important factor is the provisżon of caregivers firstly, with education about the nature of Alzheimer 's disease, and secondly, with therapy helping them to cope with emotions evoked by the crisis.