Archives 1992-2013

2004, volume 13, issue 3

Original article

The Burning Mouth Syndrome (BMS) alleviation after treatment with citalopram in BMS patients with associated anxiety or depressive disorders or without mental health problems

Postępy Psychiatrii i Neurologii, 2004, 13 (3), 201-214

Background. The Burning Mouth Syndrome (BMS) is defined as a burning sensation in the mucous membrane of the mouth in patients with no clinically observable mucous membrane changes. Anxiety and depressive disorders associated with the BMS were often reported. The treatment of BMS is difficult, but preliminary results of rather scarce studies on the effects of the BMS treatment with antidepressants in the dosage used in the therapy of depression seem promising. The aims of this study were: to assess citalopram effectiveness in the treatment of pain and anxiety-depressive disorders in the course of BMS; to examine correlations between mental health improvement and pain relief; to compare efficacy of BMS treatment with citalopram in BMS patients without mental disorders and in those with associated anxiety-depressive disorders; and finally, to find out factors (such as sociodemographic variables or BMS pattern characteristics) that might predispose BMS patients to alleviation of mental disorders or pain.

Method. The study sample consisted of 66 BMS patients. All the patients underwent a pre-treatment psychiatric examination and were diagnosed by the ICD-10 criteria, with an emphasis on anxiety and depression symptoms (assessed using the Hamilton Depression Scale, the Beck Depression Inventory, and the Hamilton Anxiety Scale) as well as pain severity (evaluated on a 6-point rating scale). Effectiveness of citalopram administered in a daily dose of 20 major 6 weeks was assessed using the same scales on the 14th and 42nd day of the treatment.

Results. In a third of the patients an improvement was found as regards pain severity alter 6 weeks of citalopram treatment. The medication was significantly more effective in BMS patients with associated depressive or anxiety disorclers than in those without such disorders. The citalopram treatment reduced anxiety and depression levels in BMS patients with these concurrent disorders. The patients' mental health improvement was correlated with pain alleviation. No significant differences regarding the clinical pattern and duration of BMS, or demographic characteristics were found between patients with alleviation of mental disorders and/or pain severity and those with no improvement of mental health and/or pain severity alter the citalopram treatment.

Conclusion. Citalopram treatment may be an effective method of BMS management, especially in patients with associated anxiety-depressive disorders.

Original article

Temperamental traits assessed by PTS (Pavlovian Temperamental Survey) and TCI (Temperament and Character Inventory) as predictors of pharmacotherapy effectiveness

Iwona Koszewska, EWA PRAGŁOWSKA, STANISŁAW PUŻYŃSKI, ELŻBIETA BURNA-DRASKOVIC, Marek Dąbrowski, SŁAWOMIR FORNAL, Antoni Kalinowski, Łukasz Święcicki, Jarosław Torbiński
Postępy Psychiatrii i Neurologii, 2004, 13 (3), 215-224

Background. The goal of the study was to investigate temperamental traits as predictors of response to antidepressant treatment in major depression, in relationship with some clinical factors.

Method. 42 patients (24 women and 18 men) diagnosed with major depression were examined using the PTS and TCI temperament inventories.

Results. Patients with depression in the course of affective disorder who had a history of drug resistance and did not respond to the antidepressant treatment differed significantly from those with no drug resistance in the past and a positive response to the present treatment. The differences pertained to: harm avoidance, cooperativeness, persistence, and self-directedness on the TCI, as well as reactivity, repressiveness and mobility of the nervous system on the PTS.

Original article

Cognitive functioning and state-trait anxiety in patients with seasonal affective disorder (SAD) assessed before and after phototherapy, and during remission (in the summer)

Łukasz Święcicki, EWA PRAGŁOWSKA, SŁAWOMIR FORNAL, Antoni Kalinowski, Jarosław Torbiński, Barbara Remberk, DOROTA GRĄDZKA, Dorota Bzinkowska
Postępy Psychiatrii i Neurologii, 2004, 13 (3), 225-233

Background. The paper presents results of a three-year prospective study of patients with seasonal affective disorder (SAD, diagnosed by the DSM-IV criteria) completely remitting in the summa

Method. Out of 33 patients who participated in the study 13 dropped out (refused or did not turn up for a subsequent assessment), therefore in final analysis included were 20 patients who had at least two assessments (before and after phototherapy).

Results. A significant improvement in the Hamilton Depression Scale (HAMD21) scores was found after therapy. Further improvement was observed during the summer. State anxiety after phototherapy as compared to that before treatment was also significantly reduced. Moreover, phototherapy was associated with significant positive changes in some reaction time constituents, and with an improved performance on the nonverbal learning test (NVLT).

Conclusion. The findings suggest that phototherapy may primarily act on psychomotor drive rather than on mood.

Review article

The hypothalamic-pituitary-adrenal axis regulation in stress responses

Postępy Psychiatrii i Neurologii, 2004, 13 (3), 235-246

Objective: The paper outlines not only physiological and stress-related activity of the hypothalamic-pituitary-adrenal (HPA) axis, but also interactions between the HPA axis and other neurotransmitters.

Review: The hypothalamic-pituitary-adrenal axis plays an important role in adaptation of the organism to stressful situations, as it controls and co-ordinates stress-induced increases in the secretion of glucocorticoids. Abnormalities in the HPA axis activity are associated with various mental disorders, e.g. depression or posttraumatic stress disorder (PTSD). The HPA axis activity is modulated by many neurotransmitter systems (including glutamatergic, GABA-ergic, and serotoninergic) and by neurosteroids.

Conclusions: Chronic stress induces abnormalities in the HPA activity and leads to an excessive glucocorticoid secretion. Explanation of the mechanism regulating the HPA axis activity is most important for understanding response of the organism to aversive stimuli. The presented findings indicate that CRF subtype 1 receptor antagonists may represent a novel group of drugs for the pharmacotherapy of depression and/or anxiety disorders.

Review article

Historical background of research into anorexia nervosa

Cezary Żechowski
Postępy Psychiatrii i Neurologii, 2004, 13 (3), 247-253

Objective: The aim of article is to present the changing views on anorexia nervosa, especially in 20th century.

Views: Anorexia nervosa is a mental disorder widespread in the Western culture from ancient times at least. However, it has not always been regarded as a mental disorder. A considerable progress in the diagnosis of anorexia dates back to the 17th century. In the 20th century detailed diagnostic criteria and effective therapies were developed.

Conclusions: The development of knowledge and treatment methods is associated with many changes in the understanding and treatment of anorexia nervosa. The changes pertain to: the importance of collaboration between patients, doctors and therapists; increased awareness of the patient: subjective and objective problems; multimodal interventions; helping the whole family; better understanding of eating disorders by general practitioners, paediatricians and psychiatrists.

Review article

Aggression in patients with mental disorders – selected theories, mechanisms, and instruments for the assessment of aggressive behaviour

Postępy Psychiatrii i Neurologii, 2004, 13 (3), 255-261

Objectives. The authors intended to present selected theories dealing with the phenomenon of aggression, discuss aggressive behaviours in people with mental disorders, and outline basic instruments for the assessment of aggression risk and evaluation of aggression level.

Views. Theories of aggression are based on both psychological and biochemical mechanisms of the individual's functioning. Attempts are made also to establish a relationship between aggression and heredity processes. Among concepts originating from psychological sciences, the following seem to be most important: the theory of instincts, drive theory, and the theory of social learning. Biochemical concepts assume that aggression may result from endocrinopathy, lipometabolism disorders, and abnormalities in neurotransmitter metabolism. Research findings suggest that as regards aggressive behaviours incidence in mental disorders, aggression occurs most frequently in schizophrenic patients and in individuals with symptoms of brain damage.

Conclusions. Many years of research into the phenomenon of aggression and its underlying mechanisms show the problem complexity. Novel theories of aggression that appear with the development of science and diagnostic techniques are based on psychological knowledge as well as on analysis of biochemical phenomena. Some theories demonstrate a relationship between aggression and organic lesions within the CNS.

Clinical observations

Obsessive-compulsive disorders and schizophrenia: differential diagnosis, co-morbidity, and management

Postępy Psychiatrii i Neurologii, 2004, 13 (3), 263-276

Objectives. An attempt was made in the paper to consider relationships between schizophrenia and obsessive-compulsive disorders in terms of possible dimensions (if any) to which these relationships might be reduced. At the same time the authors strived to assess the treatment methods proposed so far in cases of both these conditions concurrence.

Review. The authors draw attention to relatively frequent errors committed in differential diagnosis of severe anancastic disorders and schizophrenia, despite the fact that the two conditions are essentially different, from or even opposite to each other. Therefore, a comparison of their symptomatology is followed in the paper by an outline of differences in etiopathology and by a discussion of their mutual relationships. Having assumed that it is not possible to give a clear-cut definition of the possible role of obsessions in the course of schizophrenia, the authors propose that it is a complex, ambiguous process, individually specific and thus escaping standardization. The authors' main idea was to analyse the phenomenon of obsessive-compulsive disorders and schizophrenia co-morbidity from a wider perspective, as this would enable a more flexible approach to the diagnosis and treatment of individual patients.

Conclusions. The problems of OCD and schizophrenia co-morbidity are the source of considerable difficulty in the etiopathogenic, syndromological, and, above all, therapeutic dimensions. The lack of standards regarding parallel treatment of both these conditions is an incentive to further research in this area. It is definitely advisable to diagnose obsessions in the course of schizophrenia. This requires a closer co-operation with the patient, which in turn contributes not only to the search for more effective treatment methods, but also to the development of the patient's more trustful attitude and better mutual communication. All these factors may alleviate the patient's suffering, so considerable in schizophrenia associated with the OCD.

Clinical observations

Diagnostic accuracy of the transcranial Doppler ultrasound in casus of the middle cerebral artery vasospasm

Postępy Psychiatrii i Neurologii, 2004, 13 (3), 277-282

Objectives. The transcranial Doppler ultrasound development for use in the diagnosis of the middle cerebral artery vasospasm in patients with subarachnoid hemorrhage is described.

Review. Limitations of a conventional ultrasound, the precursor of the transcranial color Doppler ultrasound used for estimation of blood flow velocity are discussed. Transcranial Doppler ultrasound (TUD) accuracy is evaluated by analysis of the receiver-operating characteristic (ROC). The velocity threshold for recognition of the middle cerebral artery vasospasm is also established. Standardization taking into account patients' age and gender, as well as the Lindegaard score (VMCA/VICA) make the method more precise, especially in the diagnosis of small intensity vasospasms.

Conclusion. The results show that newer methods of transcranial Doppler ultrasound, using colour blood flow estimation are becoming an essential tool in the hands of the neuroradiologist.

Case report

Schizophrenia diagnosed in a female patient with organic personality disorders – case report

Postępy Psychiatrii i Neurologii, 2004, 13 (3), 283-287

Background. Organic personality disorders are characterized by considerable changes in established premorbid behavior patterns, especially as regards the expression of emotions, needs and drives. Such clinical picture may sometimes suggest the diagnosis of schizophrenia.

Case report. In this case of a young woman (aged 28, married, with secondary vocational education) childbirth was followed by the onset of disorders. Initially the patient was diagnosed with paranoid schizophrenia and Risperidone treatment was started. However, the patient's condition did not improve and her pharmacotherapy was associated with a number of increasing side effects. A detailed diagnostic analysis revealed organic personality disorders, i.e. features of the temporal lobe syndrome with elements of the supraorbital frontal lobe syndrome of unknown origin. Discontinuation of the antipsychotic medication and administration of symptomatic treatment resulted in an improvement of her condition.

Comment. The reported case indicates that: psychological assessment should be included in the diagnostic process, schizophrenia should be diagnosed with caution, and the process of diagnostic reasoning should be multifaceted in the case of patients with organic lesions, presenting drug resistance, and with side effects inadequate to the dosage of neuroleptic administered.