Archives 1992-2013

2006, volume 15, issue 1

Original article

Neuropsychological evaluation of prefrontal cortex function in patients aged over 50, with depression or mild cognitive impairment

Alina Borkowska, Agnieszka Kałwa, Marzena Ziółkowska-Kochan, Janusz Rybakowski
Postępy Psychiatrii i Neurologii 2006; 15 (1): 1-6

Objectives. The aim of the study was to compare the performance on neuropsychological tests that assess "frontal "functions, in matched groups of patients aged over 50 years, with the diagnosis of either recurrent depression or mild cognitive impairment (MCI).

Methods. Participants in the study were 30 patients with depression in the course of unipolar affective disorder (21 female, 9 male, mean age 55.4 ±4.7 years) and 30 MCI subjects (21 female, 9 male, mean age 61.9 ±5.6 years). The control group were 30 healthy persons (20 female, 10 male, mean age 59.7 ±7.7 years). Depression was assessed using the 17-item Hamilton depression scale, while the Mini Mental State Examination (MMSE) served to estimate global cognitive impairment. Neuropsychological evaluation entailed the following "frontal" tests: the Trail Making Test (TMT), the Stroop test, the Wisconsin Card Sorting Test (WCST) and the N-back test.

Results. Mean depression scores were 23.9 ±3.7 and 4.5 ± 1.4 points in the depressed group and in MCI subjects, respectively, while the MMSE mean scores were 29.1 ±1.3 in depression and 25.3 ±0.9 in MCI subjects. Both depressive and MCI patients' performance on all the neuropsychological tests was significantly inferior to that of healthy controls. The performance on the WCST and N-back test assessing working memory and executive functions was much poorer in the MCI group than in depressive patients.

Conclusions. Using the WCST and the N-back test we demonstrated that depressed patients aged over 50 years had moderate disturbances of frontal functions during the acute episode. On the other hand, MCI patients with no depressive symptoms had severe disturbances offrontal functions measured by these tests, and their impairment was several times more severe than that in depressive patients.

Original article

Gender-related differences in risk factors distribution in ischaemic stroke in various age groups

Małgorzata Wiszniewska, Adam Kobayashi, Danuta Milewska, Zbigniew Szych, Anna Członkowska
Postępy Psychiatrii i Neurologii 2006; 15 (1): 7-10

Background. Stroke is the third most common cause of death in Western Europe and the United States, and the fourth in Poland. The incidence of stroke is higher in males, increasing with age irrespective of gender.

Method. The aim of the study was to assess possible gender differences in the nature and frequency of risk factors as well as ischaemic stroke etiology in various age groups. Analysed data on 12 396 stroke patients treated in 60 neurological departments in Poland between January 1st and December 31st 2000 were obtained from the National Stroke Register database.

Results. Hypertension was the most frequent risk factor regardless ofgender and occurred in ca. 50% of the patients. Smoking was more often noted in males regardless of age (53.3% vs. 22.5% in the age group under 56years, and 15.8% vs. 1.3% in that over 80years;p<0.001). Atrial fibrillation was more frequent in women (30.7% vs. 20.2% in the age range 66-80 years, p<0.001) and its prevalence increased with age in both men and women. Cardioembolic stroke was more frequently diagnosed in women, while carotid stenosis over 70% - in men (differences statistically significant).

Conclusions. Our results indicate that hypertension was a much more pronounced risk factor for ischaemic stroke regardless of gender and age. Smoking and alcohol intake were more frequent risk factors in males, especially in younger age groups, while atrial fibrillation occurred more often in females and in older age groups. Gender differences in the prevalence of stroke risk factors should be taken into account in stroke prevention.

Original article

Are there gender- and age-dependent differences in stroke course and outcome?

Małgorzata Wiszniewska, Adam Kobayashi, Danuta Milewska, Zbigniew Szych, Anna Członkowska
Postępy Psychiatrii i Neurologii 2006; 15 (1): 11-15

Objectives. In recent years cardiovascular mortality has increased so much that it surpassed cancer mortality. There are discrepancies in data on gender-related differences in stroke. The aim of the study was to assess gender and age-dependent differences in the stroke course and outcome.

Methods. Data on 12 396patients with ischaemic stroke treated in 60 neurological departments in Poland in the year 2000 were obtained from the National Stroke Register database. The register included data on the type of stroke (according to the OCSP classification), level of consciousness at admission, and stroke course. Outcome and prevalence of dementia adjusted for age and sex were assessed at one-year follow-up.

Results. Women, especially those aged over 65 years, had severe stroke (TACS) more frequently than men (in the age group 66 to 80 years 29.4%o vs. 21.3%, respectively; p<0.001). Disturbances of consciousness occurred more frequently in women aged over 55, but this relationship was statistically significant only in the age group 66-80 years (37.6% vs. 34.6%; p < 0.01). During inpatient treatment men had more often respiratory tract infections, while women more frequently suffered from urinary tract infections and depression (depressive symptoms: 38.1% vs. 29.2% in the age group over 80 years; p<0.001). At the one-year follow-up after stroke dementia was reported by carers more frequently in women than in men.

Conclusions. Both gender- and age-related differences in the stroke course were observed. Severe stroke, disturbances of consciousness and depression were more frequently experienced by elderly women. At the one-year follow-up women than men were found to suffer from dementia.

Review article

Structural and functional neuroimaging abnormalities in patients with anorexia nervosa

ANNA ŚMIECH, Jolanta Rabe-Jabłońska
Postępy Psychiatrii i Neurologii 2006; 15 (1): 45-21

Objectives. The paper presents a review of current knowledge based on neuroimaging findings concerning the brain structure and functioning in anorexia nervosa.

Review. It is commonly known that anorexia nervosa is associated with a variety of somatic complications resulting from chronic undernourishment. Although the central nervous system has mechanisms protecting from consequences of nutritional and energetic deficiency, a vast amount of data have been collected evidencing impairments of the brain structure andfunction in the course of the disorder in question. Most of the detected abnormalities correlated with the degree of the patients' cachexia and duration of the disorder There are findings suggesting that some of the abnormalities ameliorate when remission is attained. However, even though there is no certain evidence, some authors continue to claim that neuropathology is a premorbid feature triggering the onset of anorexia nervosa.

Conclusions. The future research should be aimed at seeking possible causes of neuropathology concurrent with anorexia nervosa, and possibilities ofpreventing these abnormalities development or supporting the CNS regeneration in the process of recovery.

Review article

Management of hyperprolactinaemia due to antipsychotic medication

Postępy Psychiatrii i Neurologii 2006; 15 (1): 45-23

Objectives. The aim of the paper was to review management methods in hyperprolactinemia resulting from antipsychotic medication.

Review. The onset ofclinical symptoms suggesting prolactinemia in a patient receiving antipsychotic medication requires a detailed diagnostic procedure in order to either confirm or exclude a relationship between these symptoms and antipsychotic treatment. The next step involves a reduction antipsychotic medication dose, introduction of corrective treatment with dopamine agonists, or the antipsychotic drug replacement with another one that would not affectprolactine secretion significantly. Doubts associated with each of these methods are discussed.

Conclusions. Hyperprolactinemia is an often neglected side effect of antipsychotic treatment. It may lead to a severe health impairment as well as to a withdrawal of the patient's co-operation. Some findings indicate that in cases in which the treatment modification involves a risk of aggravation of the patient's condition, an attempt at administration of dopamine agonists may lead to normalization ofprolactine concentrations without any aggravation of psychotic symptoms.

Review article

Saliva secretion disorders as a side-effect of pharmacological treatment of mental disorders - a review of the literature

Postępy Psychiatrii i Neurologii 2006; 15 (1): 45-34

Objectives. Presentation of current views on the pathogenesis and therapeutic management of saliva secretion disorders (xerostomia and sialorrhea) due to psychotropic medication.

Review. Psychotropic drugs while affecting receptors of the autonomous system at the same time disturb saliva secretion. Xerostomia is a troublesome side-effect occurring most often in the course of treatment with tricyclic antidepressants. A recommended but not quite effective procedure is some kind of stimulation of saliva secretion - either mechanic (e.g. gum chewing), chemical (administration of citric acid on the mucous membrane of the tongue), or pharmacological (e.g. pilocarpine). Sialorrhea is most frequently caused by Clozapine. No standard recommended management ofsialorrhea has been developed, and relevant publications are usually case reports. Effective attempts have been reported of sialorrhea treatment with benzatropine, terazosine, atropine, clonidine, pirenzepine, scopolamine, biperiden, and botuline.

Conclusions. Appropriate management ofsaliva secretion disorders may significantly influence the course of treatment of mental disorders.

Review article

Second generation antypsychotics and QT interval prolongation syndrome

Tadeusz Pietras, Piotr Gałecki
Postępy Psychiatrii i Neurologii 2006; 15 (1): 45-39

Objectives. The aim of this study is to discuss the relationship between treatment with second generation neuroleptics and the QT interval duration.

Review. Neuroleptics have long been associated with sudden death due to the torsade de pointes ventricular tachycardia, and were reported to cause QT prolongation both in therapeutic doses and in overdose. Among the first generation neuroleptics, thioridazine turned out to be the most dangerous one causing QT prolongation and arrhythmia. All atypical antipsychotics are also known to prolong the QT interval by inhibiting rapid delayed rectifier current in the heart tissue, but only ziprasidone (and sertindole) produce a clinically significant QTc interval prolongation.

Conclusion. The treatment with second generation neuroleptics is one of risk factors for QTc prolongation and polymorphic ventricular tachycardia of the torsade de pointes type.

Review article

Treatment of postherpetic neuralgia

Postępy Psychiatrii i Neurologii 2006; 15 (1): 45-41

Objectives. The aim of this paper is to discuss therapeutic interventions for the management of neuralgia following herpes zoster

Review. Pain syndrome is a common complication following herpes zoster infection, especially in the elderly, as the virus causes damage to both peripheral and central sensory axons. Attempts at the prevention of this type of neuralgia do not give the expected results. Hence, on the basis of the literature on this subject and their clinical experience, the authors present different therapeutic interventions covering pharmacological treatment and other clinical procedures, supported by behaviour therapy. In discussing the various options, they examine the efficacy of different treatments, their availability and the occurrence of undesirable side-effects. The authors consider anti-depressant and anti-epileptic medication, local and general anaesthetics and the use of opioids.

Conclusion. They conclude that only a systematic and multi-faceted approach to treatment is likely to be successful in managing pain following herpes zoster infections.

Case report

Problems with estimation of a high probability of recurrence of acts of high social harmfulness

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2006; 15 (1): 45-49

Objectives. To present problems inherent in the assessment of a high probability of recurrence of an act of a high harmfulness to the community by individuals demonstrating symptoms of paranoid syndromes.

Review. On the grounds of examples from the author 's own practice as a forensic psychiatric expert two occasions are indicated on which such difficulties are encountered: 1) in the evaluation of indications to the necessary application offorensic detention as a preventive measure, and 2) in the evaluation of a change in the individual 's psychiatric condition, due to which his/her further forensic detention is no longer necessary (i.e. the probability of recurrence of an act of high social harmfulness is not high).

Conclusions. The author proposes that in case of a motion forforensic detention application as a preventive measure forensic psychiatric experts should prove that criteria listed in Art. 94 par. 1, or in Art. 93 of the penal code are fulfilled. As regards persons releasedfrom further forensic detention, they should be under control and in care of their local psychiatric outpatient clinic and of a professional probation officer. These institutions should be obligated to inform the relevant criminal court about the discharged person's treatment outcome and his/her functioning in the community.

Case report

Forensic psychiatric expertise concerning parents who administered corporeal punishment as a child-rearing method - case report

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2006; 15 (1): 51-56

Objectives. In view of increasing family violence, reflected also in forensic psychiatric opinions, a case is presented of physical punishment used by parents as a child-rearing method, with dramatic consequences.

Case. A young unmarried couple were accused of maltreating for over two years their son aged six and a half. Moreover, the concubine was accused of battering the boy to death, while his father was accused that he had not stopped the beating, but consented to it, left the flat abandoning his son in a situation involving a direct threat to the boy 's life, and had not provided medical assistance to the boy in appropriate time. It seems that personality traits of both the parents played a crucial role: the father was submissive to his obviously dominating concubine, who regarded corporeal punishment as an effective child-rearing method, even for petty offences. The father 's personality was assessed as not quite mature, he was egocentric and lacking self-confidence, had difficulties in decision-making, and was sensitive to other people's opinions (including that of his concubine). According to psychological assessment, the concubine manifested features of abnormality in her personality development. Forensic experts did not take under consideration a possibility of an organic personality disorder in her case. In both parents a high level of intellectual competence was found, and no symptoms of mental disorders or other disturbances in their mental functioning were diagnosed, hence there were no grounds to doubt their accountability for the deeds they had been accused of.

Commentary. The reported example indicates that family violence can be used by persons free of mental illness and mental retardation symptoms, with no substance dependence, and functioning in responsible social and professional roles. In this specific case the parents' personality traits played the crucial role.

Case report

Thoracic outlet syndrome - a case report

Postępy Psychiatrii i Neurologii 2006; 15 (1): 57-59

Objectives. The paper presents the thoracic outlet syndrome (TOS), a rare disorder affecting the lower trunk of the brachial plexus and subclavian vessels between the neck and axilla. Several types of TOS are distinguished: vascular (venous or arterial) and neurogenic (true or non-specific).

Case report. A case of TOS is presented: a 21-year-old woman complaining of pain in the right upper extremity, with weakness and atrophy of the intrinsic hand muscles, as well as paresthesia of the 4'h and 5th fingers. The clinical examination (including vascular tests) and EMG confirmed a lesion of the lower trunk of the brachial plexus. In this case angiography showed a blood flow decrease in the right subclavian artery with hands up, so the neurogenic and vascular type of TOS was recognized. The patient underwent a partial resection of the 1st rib, which prevented progression of the condition. After the surgery an improvement was noted in vascularization of the right hand, but the neural structures of the brachial plexus were found to be damaged permanently.

Commentary. The diagnosis of TOS is extremely difficult, requires not only the clinical examination (including vascular tests), but also a wide range of additional investigations (electroneurophysiological tests, angiography, classical radiology, MRI and USG-D).