Archives 1992-2013

2005, volume 14, issue 1

Original article

Mental health problems in the population of high school students in Warsaw

Postępy Psychiatrii i Neurologii 2005; 14 (1): 1-9

Objectives. In various studies symptoms and behaviours suggesting mental health problems in adolescents have been reported. Anxiety, depressive symptoms, alcohol abuse and experimenting with drugs are mostfrequently listed. This study was aimed at mental health assessment in early adolescence (i.e. in first grade students of high school).

Methods. Participants were Warsaw high school students (N=1128) from randomly selected 40 first grades of state secondary schools and 7 first grades of private high schools in the City area. A Canadian questionnaire developed in the Toronto Centre for Addiction and Mental Health to monitor adolescents' mental health was adapted by the authors and used in the study.

Results. About 43% of the participants reported some symptoms of mental health problems. A majority of them manifested an increased level of distress as assessed by the GHQ-12 scale. Adolescents with an increased distress level (GHQ-12) who at the same time rated their mental health as poorfor at least 14 days in the past month (about 9% ofsubjects) can be regarded as a group at a very high riskfor mental disorders. Mental health in about 11-13% of the high school students in our research is at a serious risk. Especially numerous group of the high school students reported experiencing depressive symptoms: sadness, loneliness, depressed mood, suicidal thoughts. Methods of mental health promotion and prevention of mental health disorders as well as psychological counselling may become important instruments for alleviating psychological distress and reducing its negative consequences to mental health and development of children and adolescents.

Conclusions. About 43% of high school first graders in the City of Warsaw experience various symptoms ofpsychological malaise that constitute a riskfor their mental health. The group at a particular high riskfor mental disorders was as numerous as about 11-13% of the population studied.

Original article

Chronic cerebellar syndromes

Postępy Psychiatrii i Neurologii 2005; 14 (1): 11-18

Objectives. An attempt was made in the study to evaluate etiology of disorders in patients with features of a chronic cerebellar syndrome, referred to the 1st Neurology Department in the years 1998-2002.

Methods. Epidemiological and clinical features, as well as results of investigations including genetic examination, MRI brain scan, and EMG were analysed in 45 patients with a cerebellar syndrome predominating in the clinical picture as recognised by the referring physician. In the DNA analysis (at the Genetics Department) unstable trinucleotide repeats as well as features indicating the spinocerebellar ataxia (SCA) presence were looked for. Although only SCA1 and SCA2, as well as SCA8 and SCA17 (in a single family) have been diagnosed to date in Poland, in cases of familial SCA the examination covered as a rule the complete set of mutations. Most patients were analysed looking for SCA1, 2, 3, 6, 7, 8, 12, 17 and dentato-rubro-pallido-luysi atrophy (DRPLA).

Results. The patients under study were divided into 4 groups: (I) with confirmed SCA (1 and 2), (II) with symptoms of cerebellar atrophy in the MRI scan (and no SCA features detected), (III) with generalised cerebral lesions manifesting in the form of cerebellar-pyramidal-extrapyramidal syndromes (with no features of cerebellar atrophy and no confirmed SCA), and (IV) with secondary cerebellar symptoms in the course of other diagnosed CNS disorders. The main objective of the study was not quite attained, as in some patients etiology of the disorders remained unclear.

Conclusions. The major problem in differential diagnosis of chronic cerebellar syndromes seems to consist in establishing whether it is the case of (1) a primary (often genetically determined) damage to the cerebellum, (2) a generalized degenerative process affecting the brain, or (3) secondary cerebellar symptoms occurring in the course of other conditions in the CNS and predominating in later stages of the disease. Such differentiation should be based, above all, on an analysis of the presenting symptoms, their sequence and severity over time. Genetic and neurophysiological examinations as well as MRI of the brain seem to contribute most to the differential diagnosis. Moreover, obtaining a detailed genetic case history of the patient is of utmost importance.

Original article

Correlation between motor disability and MRI brain scans in patients with sclerosis multiplex

Renata Poniatowska, Jerzy Kulczycki, Wanda Sobczyk, RENATA KRAWCZYK, ROMANA BOGUSŁAWSKA
Postępy Psychiatrii i Neurologii 2005; 14 (1): 19-24

Objectives. The Magnetic Resonance Imaging (MRI) examination shows white matter abnormalities, and allows assessing the localisation, number, and volume of lesions. The aim of the study was to find correlation between clinical symptomatology ofpatients with multiple sclerosis (MS) and demyelinisation lesions in their MRI brain scans.

Methods. In 31 MS patients disability was assessed using the Kurtzke EDSS. The number, volume and localisation of demyelinisation lesions in MRI were assessed in the standard planes, using SE and FSE sequences. Relationship was analysed between the white matter demyelinisation lesions and various MS phenotypes, the disease duration, and EDSS scores.

Results. On the basis of their MRI brain scans the patients were divided into 2 subgroups: with either distinctive multiple foci or diffuse lesions (N = 12 and 19, respectively). In the multiple foci group 10 patients were diagnosed with the relapsing-remitting MS, and 2 with the primary-progressive MS, which was recognised also in 9 cases in the diffuse lesions group. The volume of lesions turned out to be 7.5 times smaller in patients with multiplefoci than in those with diffuse lesions. The disease duration was almost twice as long in the latter patients, who demonstrated also a more marked disability.

Conclusions. The lesion volume was found to correlate positively both with EDSS scores and the disease duration. The patients from the diffuse lesions group were more disabled than those with multiple foci. The total volume of lesions was larger in patients with the secondary-progressive MSphenotype than in those with relapsing-remitting MS. Diagnostic difficulties in some cases of primary progressive MS were due to an atypical onset of the disease presenting as mental disorders.

Original article

EEG and MRI abnormalities and the clinical course of subacute sclerosing panencephalitis (SSPE)

ANNA RUDNICKA, Wanda Sobczyk, Jerzy Kulczycki, TERESA JAKUBOWSKA, ROMANA BOGUSŁAWSKA, Renata Poniatowska, Waldemar Lechowicz, Krystyna Niedzielska
Postępy Psychiatrii i Neurologii 2005; 14 (1): 19-24

Objectives. Subacute sclerosing panencephalitis (SSPE) is a rare inflammatory and degenerative disorder of the CNS, following a systemic infection with a mutant measles paramyxovirus. The purpose of this study was to establish relationship between SSPE patients' clinical status and their EEG and MRI abnormalities.

Methods. Participants in the study were 30 SSPE patients in stage II of the disease, hospitalized in 1st Neurology Department in the years 1990-1996. All the patients received immunomodulatory treatment. In 21 patients EEG and MRI examinations were repeated at similar intervals over a 2-year period. The evaluation of their neurological status included the ability of verbal communication, orientation, as well as motor impairment and gait disturbance severity. In the neuropsychological assessment dementia severity was evaluated, as well as the degree of visuo-spatial functions impairment, constructional apraxia, visual agnosia and acalculia. T2-weighted MRI scans were analysed for the presence of elevated signal in the paraventricular white matter, and in cortex ofparticular lobes, as well as for the Evans index values and the volume of cortical atrophy. In the analysis of basic EEG activity of the brain an emphasis was laid on the occurrence of localized and ictal changes registered between typical Rademecker discharges.

Results. Over the two-year observation period no correlation was found between the degree of the SSPE patients' motor impairment and localization of their MRI abnormalities. The localization of inflammatory-degenerative lesions in MRI scans was found to be consistent with EEG abnormalities in 17 out of the 30 SSPE patients (i.e. in 56% of cases).

Conclusions. No clear-cut correlation was found between neurological symptomatology of patients with SSPE in stage II and localization of abnormalities in their EEG recordings and MRI scans.

Original article

Superoxide anion generation by granulocytes in bipolar affective disorder

Tadeusz Pietras, Piotr Gałecki
Postępy Psychiatrii i Neurologii 2005; 14 (1): 19-24

Objectives. Bipolar affective disorder is associated with neurotransmission changes, genetic factors, and brain anatomy abnormalities. The aim of the study was to compare superoxide anion generation (NADPH oxidase) by whole blood neutrophilic granulocytes in patients with bipolar affective disorder and in healthy controls.

Methods. Participants in the study were 42 patients with bipolar affective disorder (21 in the course of a depressive episode and 21 during a manic episode), and 21 healthy volunteers. All the patients were enrolled in the study on the basis of their medical history and psychiatric examination. NADPH oxidase activity was examined in granulocytes harvested from peripheral blood. Superoxide anion generation was evaluated using the Bellanite et al. method.

Results. Superoxide anion generation by whole blood granulocytes was significantly higher in bipolar affective patients than in healthy controls (13,9 ±4,4 in the depressive subgroup and 13,07 ±4,59 in manic patients vs. 9,79 ±2,05 in the controls, p<0.01). There were no differences between the depressive and manic subgroups.

Conclusion. Increased NADPH oxidase activity in blood neutrophilic granulocytes was found in bipolar affective disorder.

Original article

Predictors of treatment completion in alcohol dependent males an females

Postępy Psychiatrii i Neurologii 2005; 14 (1): 19-24

Objectives. Despite reports indicating gender differences in numerous variables related to the development of alcohol problems and to treatment motivation, a majority of studies on alcohol dependence are focused on men. The aim of this study was to identify factors prognostic for treatment completion by alcohol dependent men and women.

Methods. Participants in the study were alcohol dependent patients (194 men and 94 women) starting an outpatient alcohol treatment programme. The following variables were analysed as possibly related to treatment completion: experienced stress severity, coping strategies, the patient 's beliefs and expectations (self efficacy, values, dispositional optimism, perceiving alcohol dependence as a disease, life satisfaction, valuation of own health), as well as variables related to experienced emotions (emotional control over anxiety, anger, depression; state and trait anxiety). Stepwise discriminatory analysis based on the Wilks 8 minimisation was used.

Results. Nine factors prognostic for treatment completion by men and women were found. In both groups treatment completion was related to the use of two coping strategies: refraining from activity (seldom), and positive reframing (often). Moreover, it was related to low levels of both anxiety and this emotion manifesting. In the female group the role of dispositional optimism, life satisfaction and self-efficacy was confirmed, while in men - the importance of self-esteem and severity of experienced stress.

Conclusions. There are significant gender differences regarding a number of factors that predict treatment completion. Accumulation of negative prognostic factors in a patient should indicate that a thorough diagnosis and comprehensive psychological help are needed in such a case.

Review article

Diffusion-weighted magnetic resonance imaging - physical foundations and clinical application of the method

RENATA KRAWCZYK, Jarosław Ryterski, Renata Poniatowska, ROMANA BOGUSŁAWSKA, Wanda Sobczyk
Postępy Psychiatrii i Neurologii 2005; 14 (1): 47-56

Objectives. Diffusion-weighted MRI is widely used in CNS imaging, especially in diagnosing acute ischemic stroke in an early phase, white matter structural abnormalities in various conditions -from trauma to schizophrenia or dyslexia, and in the differential diagnosis of infectious lesions and neoplasms.

Review. Due to the growing role of DWI in MR diagnostics this technique is presently available not only on high-tesla 1,5-3 T units, but also on low-tesla magnetic resonance systems 0,2-0,3 T. DWI together with the ADC map is very sensitive (>95%) and specific in diagnosing early stages of the acute ischemic stroke. Only the acute stroke shows hyperintensive signal on DWI, while chronic post-stroke lesions show hypointensive signal. Neoplasms, mostly gliomas and metastases with the accompanying edema, show attenuated signal on DWI, and a slightly elevated or normal signal on the ADC map. Epidermoid and arachnoid cysts look alike in conventional MRI scans, but DWI differentiates these pathologies: the epidermoid cyst has a hyperintensive signal, while the arachnoid cyst-hypointensive. The ADC map is very useful in differentiating between vasogenic and cytotoxic edema, as the former is associated with an unchanged or slightly elevated signal, while the latter - with hypointensive one. Infectious inflammatory diseases appear hyperintensive on DWI and hypointensive on the ADC map. DWI is helpful also in differentiation between acute and chronic demyelinisation lesions in multiple sclerosis. D WI allows detecting pathologicalfeatures in the brain tissue earlier than do any other neuroimaging techniques. Moreover, DWI can reveal abnormalities invisible in routine CT and MR studies.

Review article

CNS neurotransmission disorders in infantile autism

Piotr Wierzbiński, Tadeusz Pietras, Piotr Gałecki, ANNA SZYMAŃSKA, AGNIESZKA KWIATKOWSKA, Antoni Florkowski
Postępy Psychiatrii i Neurologii 2005; 14 (1): 57-63

Objectives. Infantile autism is a severe developmental disorder characterized by marked social deficits, language impairment, and a restricted range of stereotyped repetitive behaviours.

Review. Autism is a consequence of disturbances in the anatomical development of the brain, associated with CNS neurotransmission disorders and neuropsychological deficits. Disorders have been found in autism not only as regards the CNS serotoninergic transmission, but also peripheral serotonin metabolism and serotonin receptors affinity to agonists and antagonists. A series of studies have shown elevated serotonin concentrations in the brain, in blood, and urine. In support of this, decreased 5-HT-2 binding has been reported. An association study was performed to elucidate the role of the serotonin transporter gene as a susceptibility factor for autism. Besides, in autistic children the CNS cholinergic transmission is abnormal, as evidenced both by post mortem brain studies and by changed levels of dopamine, acetylcholine and its metabolites in urine samples. The altered CNS metabolism of opioids is associated with aggression and autoaggression - both reduced after admininstration of naltrexone, an opioid agonist. Moreover, some neuropeptides (including VIP, oxitocine, and secretine) are involved in the pathogenesis of autism.

Conclusions. In view of the complex pathogenesis of infantile autism new treatment methods must be sought. It can be hoped that research into neurochemical abnormalities in the CNS will not only will increase our understanding of action of the already existing drugs used in the treatment of autism, but perhaps also contribute to discovering new methods ofpharmacotherapy of this condition.