Archives 1992-2013

2003, volume 12, issue 1

Schizophrenia: prevention, early intervention

Primary and secondary prevention of schizophrenia: facts and visions

Postępy Psychiatrii Neurologii, 2003, 12, 3-24

In contrast with the prevention of common physical diseases leading to disability, the primary and secondary prevention of schizophrenia, also a disorder entailing many years of life in disability, are still being neglected. A precondition of preventive intervention in schizophrenia is the detection of aetiological risk factors that can be eliminated or modified. As possible targets pre-, peri- and postnatal complications, urbanicity and early behavioural risk indicators are discussed. As examples of early prevention targeted at risk indicators successful attempts to prevent depression and violence are considered. The most promising approach at present is secondary prevention focused on early illness course. Based on a controlled retrospective assessment of 232 first illness episodes the course of prodromes, impairments and psychotic symptoms prior to the climax of the first episode is shown. Most of the social consequences occur in the early course before the first treatment contact. Tools sufficiently validated are not yet available for early diagnosis and prediction of psychosis onset at the prepsychotic stage. The criteria for inclusion in intervention must be supplemented by traditional high-risk criteria such as family history of schizophrenia and pre- and perinatal complications. However, this procedure excludes large proportions of at-risk persons. Appropriate early intervention at the prepsychotic and the early psychotic stages, as well as relevant ethical considerations are discussed. The frequency of and distress associated with single psychotic symptoms in the general population are potent predictors of a psychosis. The vision of treating this early illness dimension with third-generation, side-effect-free antipsychotics or of preventing its onset by oestrogen-like substances is discussed.

Schizophrenia: prevention, early intervention

When should pharmacological intervention be started in schizophrenia?

Jolanta Rabe-Jabłońska
Postępy Psychiatrii Neurologii, 2003, 12, 25-35

Various meanings of such terms as "early intervention", "risk factors for schizophrenia Development", or "schizophrenia markers" are discussed in the paper. Principles of diagnosing susceptibility to schizophrenia development are outlined. Moreover, the concept of schizotaxia, as well as a review of the recent literature on the scientific and ethical foundations of early intervention in the pre-psychotic stage of schizophrenia are presented. New ideas of such treatment and of psychosis prevention are reviewed as well.

Artykuł orginalny

Discriminatory power of the General Health Questionnaire (GHQ-30)

Krzysztof Małyszczak
Postępy Psychiatrii Neurologii, 2003, 12, 37-44

Objective – The General Health Questionnaire is a self-rating scale, firstly for screening non-psychotic psychiatric disorders, and secondly, to measure general psychological distress. The paper presents discriminatory parameters of the Polish version of the GHQ-30 questionnaire.

Subjects – The study was carried out on a group of 104 patients (39 males and 65 females, mean age 41.4 years) attending either psychiatric outpatient clinics or primary health care outpatient facilities due to anxiety and depression symptoms.

Method – They were diagnosed using a diagnostic questionnaire based on the Schedule for Clinical Assessment in Neuropsychiatry (SCAN 2.0). GHQ scores were calculated using the [0, 0, l, 1] method. The receiver operating curve (ROC) was used to determine theoptimal values of discriminatory parameters.

Results – The best cut-off point was found to be the score 12/13, with sensitivity 82%, and specificity 80%. The positive and negative predictive values were 82% and 88%, respectively for the real prevalence of 64%. Adjusting the results so as to truly reflect the lower case-prevalence rate in the general population (prevalence rate = 10%), the predictive values of 31% and 98% were obtained.

Conclusions – Such discriminatory parameters are quite satisfactory, allowing to use the GHQ-30 as a screening tool to identify people with psychological problems in the general population. Moreover, the GHQ-30 can be a useful measure of general psychological distress.

Artykuł orginalny

Evaluation of the “Return to the community” training program outcome in rehabilitation of schizophrenic patients treated with antipsychotics of I and II generation

Postępy Psychiatrii Neurologii, 2003, 12, 45-53

Objective – In our work with patients we want not only to impart some knowledge to them, but also to teach them certain skills they could use in the future. The following research questions were posed: Will the patients' participation in the behavioural training program "Return to the community" result in an increase in their knowledge and social skills level? Will the participants' treatment with II generation drugs result in their better social functioning (particularly in their increased knowledge and social skills) than that in a group of patients treated with a classical neuroleptics in comparable doses?

Subjects and method – Participants in the study were 60 patients with schizophrenia, 30 of them were treated with olanzapine, and the other 30 – with chlorpromazine.

Results – In the effect of the patients' participation in the "Return to the community" behavioural training program both their knowledge and social skills have increased. Treatment with olanzapine of the "Return to the community" program participants resulted in their significantly better social functioning, including a higher level of their knowledge and social skills.

Artykuł orginalny

Frequency of falls among elderly psychogeriatric inpatients

Postępy Psychiatrii Neurologii, 2003, 12, 55-60

Falls of the elderly constitute a serious health problem due not only to physical injuries, but also to psychological trauma.

Objective – to assess the frequency of their falls, and to establish the relationship between falls and the patient's diagnosis, pharmacotherapy applied, and the workload of the staff on the ward. \

Subjects and method – hospital records of the 909 inpatients of a psychogeriatric ward was analysed.

Results – the frequency of falls observed was lower than that reported in the literature. It was slightly higher in women than in men, with the highest frequency of falls in patients with vascular dementia. No relationship was found between the number of patients on the ward and the frequency of falls.


The “pathway to psychiatric care” model by Goldberg & Huxley and prevalence of mental disorders

Postępy Psychiatrii Neurologii, 2003, 12, 61-66

Review – The paper presents the Goldberg and Huxley model of "pathways to psychiatric care", which confirms that only a small proportion of hose with psychiatric disorders in the general population ever receive specialist psychiatric care. This model is based on five levels, each representing a different population. In order to get from one level to the next it is necessary to pass through a filter.

Conclusions – Epidemiological surveys conducted at all the levels simultaneously can determine local needs for mental health care.


Patterns of reactive disorders in offenders as reported in the literature (1950-1970)

Postępy Psychiatrii Neurologii, 2003, 12, 67-77

Review – The authors present various approaches to the etiology and pathogenesis of reactive disorders, and describe the most common patterns of such disorders reported in the years 1950-1970 in prisoners serving their sentence and in those detained in custody for inquiry. Data reported by Uszkiewiczowa (1971) indicate a gradual decline both in the frequency and severity of reactive disorders, e.g. in the late 1960s as compared to 1950s. Similar conclusions can be drawn from research conducted at the Forensic Psychiatry Department concerning individuals submitted to hospital observation with view to forensic psychiatric expertise.

Conclusions – It is the authors' experience that in recent years reactive disorders are seen mostly in the form of neurotic reaction, while psychotic disorders are rare.


The osseous system in eating disorders

Postępy Psychiatrii Neurologii, 2003, 12, 79-87

Review – Osseous mass deficiency of various severity (osteopenia or osteoporosis) is a common phenomenon in anorexia nervosa. In the article data are presented concerning prevalence of this complication. Its underlying mechanisms as well as methods of diagnosis, prevention and treatment are discussed.

Conclusions – Clinical importance of the problem is stressed and same diagnostic and corrective measures are suggested.


Neuroleptics in psychogeriatry

Stefan Krzymiński
Postępy Psychiatrii Neurologii, 2003, 12, 89-99

Review – On the grounds of the literature the paper presents indications to and recommended treatment with neuroleptic drugs in old-age patients.

Conclusions – The author emphasizes the need for taking into account age-related changes in the metabolism of traditional and novel neuroleptics. The changes result in an increased risk of side effects in the elderly.


Analgesic effects of antidepressants

Postępy Psychiatrii Neurologii, 2003, 12, 101-109

Review – Antidepressants are quite often applied in the treatment of chronic pain. Available research findings indicate complexity of the mechanism underlying their analgesic action. The following factors most likely contribute to this effect: noradrenalin or serotonin reuptake blocking, a specific effect on opioid receptors, adenosine reuptake inhibition, blocking of both the NMDA receptor and ion channels. Analgesic action of TLPD was proven, and numerous data confirm also SSRI effectiveness in the treatment of pain. However, this group of pharmaceuticals requires further research. Preliminary reports on the analgesic effect of SNRI seem to be most promising. In patients with chronic pain and no symptoms of depressive disorders an attempt can be made to administer antidepressants due to their analgesic effect.

Conclusions – Antidepressants, particularly those with few side effects involving no risk to patients' health, may be considered as an auxiliary remedy at all levels of the "analgesic ladder".


Biochemical markers of brain damage

Postępy Psychiatrii Neurologii, 2003, 12, 111-116

Review – Brain damage due to head trauma or stroke is nowadays a serious clinical and social problem. The great progress in diagnostic procedures (neuroimaging) has no counterpart either in therapy or in early and accurate prognosis. Biochemical markers are a new strategy in the diagnosis, treatment monitoring, and prognosis estimation in brain damaged patients. At present two specific, brain-originated proteins play a major role: S100B protein and neuron-specific enolase (NSE). S100B is a marker of astrocytes, while NSE has been found in neuronal cytoplasm. These proteins are released into the blood (and also to the cerebrospinal fluid) during brain damage. Several authors investigated usefulness of neurobiochemical markers in the diagnosis and treatment of patients with head trauma, stroke, or after cardiac surgery. Research .findings suggest a good correlation between the release of neurobiochemical markers and the patient s clinical status of' CT image. Particularly important seems a high predictive value of the markers as regards the long-term functional status of patients after head trauma or stroke.

Conclusions – Usefulness of neurobiochemical markers in the treatment monitoring, especially post-stroke, is still unclear. To investigate this problem further studies are needed. It is already known that S100B protein release following brain damage may be involved both in brain repair processes and in secondary damage of neurons. Serum S100B protein and NSE analysis during the first past-stroke days may also help to predict neurobehavioral outcome.

Case report

An isolated cognitive syndrome in a patient with bilateral parietal-occipital lesions following two brain stroke episodes. Case report

Postępy Psychiatrii Neurologii, 2003, 12, 117-122

The authors present a case of a fifty six-year-old man with bilateral brain lesions in parietal and occipital lobes due to two stroke episodes. In consequence of the lesions the patient developed an isolated cognitive syndrome, with predominant apraxia, spatial disorders, finger agnosia and selective language impairment.