Archives 1992-2013

2005, volume 14, issue 4

Original article

The picture of posttraumatic stress disorder in flood victims depends on the range of sustained loss

Agnieszka Stępień, Krzysztof Małyszczak, Andrzej Kiejna
Postępy Psychiatrii i Neurologii 2005; 14 (4): 277-284

Objectives. The aim of the study was to describe the prevalence and picture ofPTSD among eye witnesses of flood, who had neither received any psychiatric treatment previously, nor experienced any other concurrent stressful life events that might have been an independent cause of the PTSD onset.

Methods. Flood victims were interviewed between the 60th and 63rd month after theflood by the same psychiatrist using the Composite International Diagnostic Interview (CIDI), section A (concerning demographic data) and section N (referring to PTSD) They were visited at home, by previous appointment over the phone. The course of PTSD was analyzed in two groups (of 47 and 50 respondents) distinguished on the grounds of the scope offlood-related material loss.

Results. The presence of PTSD was more frequent among those who had sustained severe loss due to the natural disaster (N = 30) than among persons who had experienced no significant loss (N = 30), with the PTSD ratios of 23.7% vs.7.2%, respectively. An analysis of symptom severity on the three main axes indicated a significantly higher prevalence of such symptoms on each axis in the group of victims who had experienced a permanent loss. In a vast majority of cases PTSD symptoms persevered for over a year, irrespective of the amount of loss.

Conclusions. The higher severity of symptoms in persons who had sustained a permanent loss evidences a relationship between PTSD and prolonged stressful situation due to permanentflood-related loss. The duration ofsymptoms similar in both compared groups indicates a strong effect of the major stressor as well as a negative effect of absence ofpsychological support for the victims.

Original article

Problem behaviors as a dimension of mental health assessment in adolescents

Postępy Psychiatrii i Neurologii 2005; 14 (4): 277-284

Objectives. An assessment of health status in adolescence includes, among other variables, also problem behaviours that may involve either direct or potential mental health risk. In the study two categories were introduced in the mental health assessment, defined as externalization (problem behaviours) and internalization (emotional disturbances) indicators. Thefirst aim of the study was to estimate problem behaviours prevalence among students beginning secondary school, while the second objective was to analyze relationships between internalization and externalization indicators.

Methods. Participants in the study were first grade students (N= 1123) of secondary schools in the City of Warsaw area. They responded to a Polish adaptation of a self-report Canadian questionnaire monitoring adolescents ' mental health. Thefollowing indicators of problem behaviours were used: getting drunk, problems due to alcohol drinking, drug use, problems caused by drug use, violence, law-breaking. The following internalization indicators were analyzed: depressive symptoms (as measured by the CES-D scale), psychological distress (the GHQ-12 questionnaire by Goldberg), self-rated poor mental health, suicidal thoughts.

Results. The presence of at least one of the problem behaviors was reported by a half of the sample (52%), more often by boys (59.9%). A high percent of those manifesting problem behaviours were characterized by a higher intensity of experienced psychological stress, more severe depressive symptoms and lower self-rated psychological wellbeing. Those who reported symptoms ofpoor mental health together with two or more problem behaviours constituted 14.9% of the sample.

Conclusions. The group at risk for mental health constituted about a third of the sample studied, irrespective of gender.

Original article

Quality of inpatient psychiatric services as rated by patients of selected psychiatric wards

Joanna Raduj, Anna Indulska, Marta Anczewska, Waldemar Lechowicz, Maciej Pałyska, Katarzyna Prot
Postępy Psychiatrii i Neurologii 2005; 14 (4): 277-284

Objectives. Patient satisfaction with treatment together with staff competence, are prerequisites ofa good therapy outcome. The aim of the study was to obtain information about the patients ' opinion on the quality of medical services provided to them at the Institute of Psychiatry and Neurology (IPiN).

Methods. Participants in the study were 102 inpatients of 6 IPiN psychiatric wards providing diagnostics and treatment. They responded to a patient satisfaction questionnaire developed by the authors.

Results. The circumstances of admission to the mental hospital and ward, as well as the situation of hospitalization were assessed positively by a majority ofpatients, as only 10% of the respondents were dissatisfied with their admission and hospital stay, while 5% - with their relations with the staff. Less positive were the patients ' ratings concerning the quality of hospital equipment, noise at night, support received from particular staff members, and too scarce information concerning patient rights and duties, mental illness and its treatment - only every third patient confirmed having received information about the illness, and every fifth - about treatment. About a half of the sample did not confirm their being acquainted with their rights and the ward regulations. Accessibility of doctors was assessed as good by 93% of the patients, and of nurses - by almost all. Accessibility of therapists, as well the amount ofpsychological support from therapists and nurses were reported as unsatisfactory. The patients often complained of troublesome behaviors of their co-patients, of noise and inadequate ward equipment.

Conclusions. Improvement is needed in the following areas of provided medical services: therapists (i.e. psychologists and occupational therapists) should be more active, medical and formal information more available, and living conditions related to the ward infractructure - more user-friendly.

Original article

Patient satisfaction with community-based psychiatric care

Katarzyna Prot, Maciej Pałyska, Marta Anczewska, Anna Indulska, Joanna Raduj
Postępy Psychiatrii i Neurologii 2005; 14 (4): 299-304

Objectives. Patient satisfaction is an important variable in patients' assessment of psychiatric care quality. Constant monitoring and taking into account patient opinions in the process of changing the type or manner of care provision is a prerequisite of such assessment. The aim of the study was to evaluate quality of community psychiatric care provision to patients, as well as usefulness of the Verona scale (VSSS-4) for the purpose.

Methods. Participants in the study were 55 patients diagnosed with schizophrenia, receiving psychiatric care in a day hospital, outpatient clinic, or from a mobile community team. The patients were asked by their doctor or therapist to anonymously fill out the 54-item VSSS-54 questionnaire and then insert it into a sealed box.

Results. The patients were more satisfied with the services received than with the amount of time devoted to them. Among the assessed categories skills and behaviors of the staff were allotted the highest mean ratings. Information concerning the patient 's health status (diagnosis and prognosis) was more frequently positively evaluated than that about the offer and programs available at the facility. Treatment expenditure was less often positively assessed than was attractiveness of therapeutic settings. Activities targeted on the patient received the most positive ratings, while these aimed at an improvement of interpersonal relations were evaluated less positively. The main organizational shortcomings consisted in an incomplete continuity of care, especially during holidays, weekends, and at night. The patients were dissatisfied with collaboration with their families in the treatment process. Some therapeutic interventions were assessed most positively, but a considerable number of interventions were not eligible for evaluation, being never encountered by the patients.

Conclusions. The Verona scale is a good instrument for the measurement of patient satisfaction with community care. There is a need for an enlargement of the range of community care by inclusion of interventions provided at the patient's home, collaboration with the family, and co-operation with social welfare centers. For practical purposes it would be important to replicate the study on a larger sample ofpatients in care of the same psychiatric facility.

Original article

An opinion poll - are Poles anxious about their mental health?

BOGNA WCIÓRKA, Jacek Wciórka
Postępy Psychiatrii i Neurologii 2005; 14 (4): 305-317

Objectives. Mental health has become a focus of interest for societies and international health care organisations in recent years. Since in Poland it is difficult to attract to this issue a similar attention of authorities and circles influencing the public opinion, a question arises whether this situation meets or rather signifies disregard for expectations of the society In the study an attempt was made to learn about the Polish society's apprehensions concerning mental health.

Methods. The opinion poll was conducted on a representative random sample of adult inhabitants of Poland (N= 1037) by the Opinion Poll Centre network in June 2005, as a monthly poll on "Current problems and events".

Results. Almost every third respondent categorized mental illness among the most feared conditions, while almost a half (45%) admitted to being sometimes anxious about their own mental health. Slightly over a half (53%) have had personally met someone with mental disorders; as few as every fifth (18%) have done so by means of mass media only, while about a third of the respondents (29%) have never had such an experience. No more than a third of the society (27%) consider themselves to be sufficiently informed about mental health and mental illness, while almost a half (44%) would like to know more about this issue. As regards living conditions perceived as a mental health risk, the following were most often indicated: joblessness (77%), family crisis (47%), poverty (41%), alcohol and drug abuse (39%), and insecurity of the near future (25%). A vast majority of Poles under study (85%) believe that living conditions in Poland are harmful to mental health and that a national mental health program should be developed so as to prevent mental health risks and to modernize psychiatric services.

Conclusions. The opinion poll findings seem to indicate that a large proportion of the society are anxious about their own mental health. Poles consider current living conditions in Poland to be detrimental to mental health and expect that a program of systematic mental disorder prevention should be implemented.

Original article

Situational determinants of aggressive acts committed by schizophrenic patients

Postępy Psychiatrii i Neurologii 2005; 14 (4): 277-284

Objectives. The paper presents circumstances under which aggressive acts were committed by patients with schizophrenia, as well as the relationship between the criminogenic situation and type of their aggression, in cases referred by courts to the Psychiatric Committee for Security Measures in the years 1998-2004.

Methods. Psychiatric court opinions and court records were analysed in 33 cases of homicide perpetrators, 24 perpetrators of battery, and 14 perpetrators ofpunishable threats.

Results. In the period preceding the critical event aggressive confrontation was the most often noted type of relation between the mentally ill and their environment, occurring with a similar frequency in all the cases. In terms of victimology the future victims' behavior towards the perpetrator can be regarded as some form of "provocation " or "carelessness ". The perpetrators' behavior at the time of the aggressive act was characterized by drasticality and determination. The victims of homicide were most often the perpetrators ' relatives. Perpetrators of punishable threats usually demonstrated their aggressive behaviors towards a larger number of persons they had known earlier. In the group of battery perpetrators, who manifested aggression of middling intensity, victims were rather random and in various relations with the perpetrator. The proportion of men and women was equal only in the group of battery victims, while in the remaining two groups of victims males predominated. Sobriety at the time of aggressive act turned out to be an insignificant variable that did not differentiate between the three groups. The mostfrequent responses to the perpetrator 's aggressive behavior were the victim 's active resistance or passivity, similar across the three groups. Immediately after the prohibited act the battery perpetrators usually passively waited to be arrested, perpetrators of punishable threats escaped from the locus delicti, while homicide perpetrators were the only ones who obliterated the traces of crime.

Conclusions. Thefindings confirm that both the psychological state ofperpetrators suffering from schizophrenia, and their victims' behavior contributed to the criminogenic situation. The perpetrators' behavior at the time of the act was characterized by a considerable intensity of aggression. The type and direction of schizophrenic perpetrators' aggressive behavior were dependent on their relations with the victim.

Original article

Influence of apolipoprotein E, low-density lipoprotein (LDL) receptor related protein (LRP) and interleukin 1 ß polymorphisms and of plasma lipids level on dementia treatment

Hanna Wehr, Wanda Łojkowska, Małgorzata Bednarska-Makaruk, Anna Bochyńska, Ałła Graban, DOROTA HOFMANN-ZACHARSKA, Maria Rodo, Danuta Ryglewicz
Postępy Psychiatrii i Neurologii 2005; 14 (4): 325-329

Aim. The aim of the work was to study a possible influence of several genes polymorphism and of lipids on the effectiveness of one year dementia treatment with cholinesterase inhibitors.

Methods. The group consisted of 68 patients - 48 with Alzheimer's disease and 20 with mixed dementia. Apolipoprotein E alleles, two polymorphisms of LRP and two of interleukin 1ß genes were identified by DNA analysis. Lipid levels were determined in plasma using enzymatic methods.

Results. No one apolipoprotein E carrier was in the group of bad responders to treatment. A higher frequency of e4 allele carriers showed bad response to treatment as compared with e2 allele carriers. A higher frequency of carriers of the longer 92 allele of [TTTC]n LRP polymorphism and of carriers of T allele of the C766T LRP polymorphism and ofpersons with plasma LDL cholesterol level >135 mg/dl was observed in the group of bad responders comparing with their frequency in the good responders group. The more of those disadvantageous factors had an individual the significantly worse were his treatment results. It was concluded that APOE and LRP polymorphism as well as LDL cholesterol levels could have an influence on the effectiveness of treatment with acetylcholinesterase inhibitors in patients with dementia. The effect was stronger in Alzheimer's disease patients than in patients with mixed dementia.

Conclusions. Our results showed that APOE and LRP polymorphism as well as LDL cholesterol levels could modify the effectiveness of treating patients with dementia with acetylcholinesterase inhibitors.

Review article

''Reversible dementia'' - history of the concept, critical review and implications for clinical practice

Tomasz Sobów
Postępy Psychiatrii i Neurologii 2005; 14 (4): 331-336

Objectives. The paper presents a historical background, research on and practical aspects of the so-called "reversible dementia ".

Background. The prevalence ofpotentially reversible causes ofcognitive deficits including full-blown dementias in clinical populations has been investigated in relatively few studies. A review of the literature suggests that since reversible dementias are more common among younger and less impaired subjects, it is in this group of patients that particularly precise diagnostic procedures should be applied. Careful diagnostics revealing potential causes of dementia does not signify an effective treatment; it follows from metaanalysis data that true reversibility (i.e. an effective treatment applied and deficit alleviated) is rare and close to only 1% of all cases with dementia.

Conclusions. Since a majority ofpatients with mild cognitive deficits are seen by family doctors, the latter should have not only an appropriate professional training enabling them to recognize such conditions, but also an access to diagnostic procedures including neuroimaging that facilitate an accurate differential diagnosis.

Review article

Neuropsychiatric symptoms of chronic hepatitis C

Postępy Psychiatrii i Neurologii 2005; 14 (4): 342-336

Objective. In view of a scarcity of information available in the Polish literature on neuropsychiatric symptoms among patients with chronic hepatitis C, the authors decided to review current publications concerning this problem.

Background. In the literature on hepatitis C a considerable number of studies have been devoted to extrahepatic syndromes. The presence of psychological symptoms among patients suffering from chronic hepatitis C is an issue of vital importance to medical doctors, both in the cognitive and practical aspect. The prevalence rate of neuropsychiatric symptoms among HCV-infected patients was found to be higher than that in the general population. Moreover, the proportion of HCV infection cases among patients with mental disorders is higher than that in the general population.

Conclusions. Psychopathological symptoms in patients with chronic hepatitis C are of complex aetiology. Both reactive and biological factors (i.e. a direct effect of HCV on the CNS) seem to contribute to their onset.

Review article

When clozapine is not enough

Postępy Psychiatrii i Neurologii 2005; 14 (4): 352-336

Objectives. An attempt was made in the paper to overview methods most frequently used in cases of a clozapine treatment failure.

Background. The problem of resistance to clozapine treatment is discussed. Since these severely ill patients require treatment and there are neither any algorithms nor clear-cut recommendations available, clinical practitioners are frequently forced to use various therapeutic innovations. First and foremost they try the treatment optimization, and if that fails, attempts are made at the clozapine therapeutic effect augmentation by simultaneous administration of another neuroleptic, a normothymic medication, benzodiazepine, an antidepressant, NMDA receptor agonist, or electroconvulsive therapy.

Conclusions. There is no univocal evidence for any single augmentation strategy superiority over other ones. Thus, data presented in the paper are not a therapeutic prescription, but rather a review ofpossible solutions in this area, of their respective benefits and associated side effects.

Review article

Clinical characteristics of various forms of tremor

Agnieszka Machowska-Majchrzak, Krystyna Pierzchała
Postępy Psychiatrii i Neurologii 2005; 14 (4): 362-336

Objectives. Clinical characteristics of various types of tremor and methods used in their treatment are presented on the grounds of the literature.

Background. Tremor is a common symptom of a variety of neurological disorders as well as of other conditions. Thefollowing types of tremor are outlined: physiological, spontaneous, orthostatic, primary writers', of voice, cerebral, rubral (mesencephalic), palatal, associated with peripheral neuropathy, elicited by some kinds of food and drink, induced by drugs and exposure to neurotoxic substances, and psychogenic.

Conclusions. Treatment efficacy depends on a correct diagnosis. Identification of the type of tremor depends on a carefully obtained case history and clinical examination, as well as tremor registration with subsequent analysis of its parameters, particularly amplitude and frequency. Even though drugs are available for effective treatment of various forms of tremor, some types of tremor are resistant to pharmacological treatment. In such cases surgery is an alternative (including thalamotomy, pallidotomy, or grafting of stimulating systems).

Review article

The Münchhausen Syndrome by proxy

Postępy Psychiatrii i Neurologii 2005; 14 (4): 366-336

Objectives. The paper presents a clinical unit that is rather little known, i.e. the Münchhausen syndrome by proxy, its diagnostics, and treatment difficulties.

Background. In this syndrome carers produce or elicit illness in others so as to obtain medical care. In a majority of cases a parent (almost always mother) is the perpetrator, while the child is a victim. The Münchhausen syndrome by proxy results in the child's severe condition, in some cases even leading to death. Medical staff members frequently are not acquainted with this disorder.

Conclusions. Early diagnosis of the Münchhausen syndrome by proxy might reduce the frequency of complications and deaths in cases with this syndrome.

Case report

Mortality and causes of death in anorexia nervosa - a review and case report

Małgorzata Urban
Postępy Psychiatrii i Neurologii 2005; 14 (4): 367-370

Objectives. Anorexia nervosa belongs among mental disorders with the highest death risk. The aim of the paper was to briefly summarize the current knowledge about mortality and causes of death in the course of anorexia nervosa, and to present a fatal case of a female patient with this diagnosis.

Case report. The reported case was a 19-year-old woman suffering from anorexia nervosa of a bulimic type, who died in consequence of complications of this disorder.

Commentary. Death in patients with anorexia nervosa is most often caused by somatic complications of the disorder or by suicide. In the treatment of anorexia not only compensation of nutritional deficiency, but also psychotherapy is important.

Case report

Unauthorized medical certificates issued by psychiatrists in criminal proceedings

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2005; 14 (4): 367-376

Objectives. Medical certificates issued by psychiatrists on their patients' request that include not only information about the administered treatment, but also a psychiatric diagnosis and psychiatric court opinions are unauthorized, as in such cases the authors act in the capacity of a court expert although they have not been appointed by the authority conducting criminal proceedings. Since such medical certificates are issued with increasing frequency, the problem was presented in the paper so as to draw attention to inappropri-ateness of such practices.

Case reports. Legal grounds for the appointment of court experts in psychiatry in criminal proceedings (Article 202 par. 3 and 4 of the penal code) are referred to in the paper, with an emphasis on the tasks of expert psychiatrists. Two cases are reported where unauthorized opinions (including psychiatric expertise) were issued by psychiatrists not being court experts.

Commentary. The psychiatrist providing treatment has a right to issue on the patient's request a certificate that the patient is in treatment. However, inclusion of psychiatric court opinions in such a certificate is unauthorized: no psychiatrist should act as a court expert in a case of his/her patient, as he/she may be accused ofpartiality.

Case report

Attitudes of psychiatrists - expert and non-expert

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2005; 14 (4): 367-383

Objectives. In recent years increasingly more attempts to influence court decisions have been made by unauthorized persons. The aim of the paper is to draw attention of psychiatrists and lawyers to inappropriate behavior of psychiatrists, in that number court experts, accused by mass media offrequently conscious and purposeful attestation of an untruth.

Cases. Examples are presented of attitudes of psychiatrists acting in various capacities (as court experts, treatment providers, scientific authorities, supervisors ofprofessional liability), as well as situations where competences of court experts in psychiatry were infringed by unauthorized diagnostic and psychiatric court opinions (concerning accountability or a high probability of recurrence of an act of social danger).

Commentary. It seems that if various medical certificates or other documents (irrespective of their author) were more critically assessed by the court, and not put on a par with expertise issued by reliable court experts in psychiatry, it would prevent the intended gains.