Archives 1992-2013

2006, volume 15, issue 2

Original article

Depressive symptoms in patients with chronic Hepatitis C virus (HCV) infection

Postępy Psychiatrii i Neurologii 2006; 15 (2): 67-70

Objectives. The aims of this study were, firstly, to assess depression prevalence and severity of depressive symptoms in patients with chronic hepatitis C before interferon treatment, and secondly, to describe the relationships between depressive symptoms and selected clinical and viral parameters.

Methods. 79 patients with chronic HCV infection treated in the Department of Infectious Diseases at the Wrocław Medical University were examined. Psychiatric examination included the Beck Depression Inventory (BDI), the Hamilton Depressive Rating Scale (HAMD), the Montgomery-Asberg Depression Rating Scale (MADRS), and Eysenck's questionnaire of neuroticism. Diagnoses of depression were based on the Present State Examination (PSE) questionnaire from the Schedules of Clinical Assessment in Neuropsychiatry.

Results. Depressive disorders were diagnosed in 8 (10%) subjects. Severity of depressive symptoms was independent of the HCV infection duration, biochemical parameters, liver fibrosis and steatosis level. Significant correlations werefound between HCV viral load, liver inflammation and depressive symptoms severity. Moreover, there were highly significant correlations between neuroticism level on the one hand and depression severity and viral load on the other.

Conclusions. The observed correlations indicate a biological influence of HCV on the prevalence of depressive symptoms in the population studied. A hypothetical mechanism underlying this effect may involve an increase of susceptibility to stress-related depression.

Original article

Assessment of the role of selected psychobiological factors in the onset and course of irritable bowel syndrome

Magdalena Agnieszka Wrzesińska, DARIUSZ SZCZĘSNY, Józef Kocur
Postępy Psychiatrii i Neurologii 2006; 15 (2): 76-70

Objectives. The aim of the study was to investigate the relationship of selected personality traits and ways of coping with the irritable bowel syndrome (IBS) onset and its clinical course.

Methods. Participants in the study were 25 patients diagnosed with the irritable bowel syndrome (8 males and 17 females aged 20 to 70years, mean age 43.7). A number of personality traits and dispositions were measured using the Neo-Five Factor Inventory of personality by Costa and McCrae, such as neuroticism, extraversion, openness to new experiences, agreeableness, and conscientiousness. Moreover, the intensity of aggressive behaviours constituting the "aggression syndrome", as well as the most frequent patterns of coping styles among the IBS patients were assessed by means of an Aggression Syndrome Psychological Inventory (Inwentarz Psychologiczny Syndromu Agresji, IPSA) and the Coping Inventory for Stressful Situations (CISS, by Endler and Parker).

Results. Task-oriented coping was the style most frequently employed by the IBS patients, followed by emotion-oriented coping, while the avoidance-oriented coping style was used the least often. Aggressive behaviour intensity was found to be related to the IBS presence. Aggression intensity turned out to be the highest for physical aggression, followed by verbal and mixed aggression, while affective self-aggression, self-aggressiveness index and latent aggression indicator ranked as the lowest.

Conclusions. The main findings: (1) neuroticism severity (as measured by the NEO-FFI) was low, (2) both the presence and intensity of certain aggressive behaviours were related to the irritable bowel syndrome diagnosis, (3) task-oriented coping was the style most frequently reported by the IBS patients, (4) there were significant gender-related differences in the agreeableness and conscientiousness scores, as well as in the global level and extent of aggressive behaviours.

Original article

Analysis of depressive symptoms in patients with lumbar discopathy receiving conservative therapy or surgical treatment

Postępy Psychiatrii i Neurologii 2006; 15 (2): 81-70

Objectives. A relationship between pain and depression is commonly recognized. Patients with lumbar discopathy suffer from chronic spinal pain that may lead to depressive states. An assessment of depression severity not only enables to optimize the therapeutic process, but also may serve as an indirect measure of treatment efficacy. The aim of the study was to analyze depressive symptoms in patients with lumbar discopathy receiving either conservative therapy only or surgical treatment.

Methods. The sample studied consisted of 665 patients aged 16 to 76 years, suffering from lumbar discopathy at the L4-L5 and L5-S1 levels. Conservative therapy only was provided to 348patients, while 317 underwent surgical treatment. The patients were examined during their hospitalization and at an over 10-year follow-up. Three age groups were analyzed: of young (under the age of 30 years), middle-aged (31-50 years) and elderly (over the age of 50 years) patients. Depression severity was assessed using a self-report rating scale of depressive symptoms frequency.

Results. Patients with lumbar discopathy manifested severe depressive symptoms, particularly sleep disturbances, and impairment of concentration and decision-making ability. Depression severity was correlated with spinal pain ratings and with evaluation of the patients' "quality of life ". Their depressive symptoms severity increased with the duration of lumbar discopathy. More severe symptoms were found in younger and middle-aged patients than in the elderly, and in patients receiving conservative therapy as compared to those after surgery.

Conclusions. A relatively high level of depression severity in patients treated for lumbar discopathy was correlated with their self-rated spinal pain and quality of life. Moreover, depression severity was related to the patient 's age, duration of the condition, and type of treatment used.

Review article

Genetics of suicidal behavior

Postępy Psychiatrii i Neurologii 2006; 15 (2): 105-83

Objectives. The paper presents an overview of population and molecular genetic studies dealing with etiology of suicidal behaviour

Background. Molecular studies are concerned first and foremost with the relationship between suicide and serotonin system genes. It is suggested that other genes, such as mono-amino transferase Type A gene, neurogenesis-related genes, and the cholecystokinine encoding gene, also have an important role. A predisposition to suicidal behaviour is hypothesized to be closely associated and co-hereditary with certain temperamental traits.

Conclusions. In the light of findings reported in the literature susceptibility to suicidal behaviour can be regarded as dependent on interaction of many factors, both of genetic and environmental nature. A tendency to attempt suicide can be genetically determined and hereditary, irrespective of any predisposition to various mental disorders.

Review article

Development of the concept of mixed state in affective disorders - a historical perspective

Iwona Koszewska
Postępy Psychiatrii i Neurologii 2006; 15 (2): 105-93

Objective. To outline the historical development of the concept of mixed states in affective disorder, from antiquity to the present.

Background. The ICD-10 and DSM-IV diagnostic criteria for mixed states in bipolar disorder have been criticized in recent years. Since the times of Kraepelin mutual relations between depression and mania have been questionable. Mixed states, neglected for many years, become again an object of scientific investigation in recent years. One of the reasons for this rekindled interest is a probability that these states may be induced by antipsychotics.

Conclusions. The diagnostics of mixed states in the course of bipolar affective disorder is important in view of the need for their appropriate therapeutic management.

Review article

Social functioning and social disability - definitions, instruments, and clinical implications for psychiatry

Postępy Psychiatrii i Neurologii 2006; 15 (2): 105-104

Objectives. Terms referring to social functioning, together with concepts and definitions of social disability are discussed in the paper

Background. In the contemporary definition of health not only physical and mental health, but also social wellbeing of the individual are included. Thus, a need arises for an assessment of this sphere of life. Besides, interventions that would improve the patient's functioning in the community should be introduced in the therapeutic process. Attention is drawn to discrepancies between medical and legal definitions of disability and to the necessity of disability assessment criteria unification. Instruments for the measurement of social functioning disorders (useful in clinical, not only psychiatric practice) are briefly outlined.

Conclusions. Importance of the problem of social disability in people with mental disorders is emphasized, as well as the necessity of including social skills training in medical treatment standards.

Review article

Contemporary models of memory in the neurobiological and clinical aspect

Postępy Psychiatrii i Neurologii 2006; 15 (2): 105-110

Objectives. The aim of the article is to present current models of memory and their neurobiological and clinical aspects. The function of particular types of memory, their neuroantomical relations, as well as memory impairments in various neurological and psychiatric conditions are discussed.

Background. Memory was regarded as a uniform phenomenon in the past. At present numerous memory processes are recognized that depend on a variety of systems and neuroanatomical structures in the brain. Different types of memory, i.e. working, declarative (episodic and semantic) and non-declarative (procedural) memory can be distinguished. They are to a various extent susceptible to pathological factors and may be impaired in many neurological and psychiatric conditions.

Conclusions. Understanding the way of particular memory type functioning may help clinicians in the diagnostics and treatment of patients with memory disorders. Molecular-genetic, neuropsychological and neuroimaging research may bring the pathogenesis of memory disorders in different diseases to light.

Review article

Cognitive function impairment in anorexia nervosa

ANNA ŚMIECH, Jolanta Rabe-Jabłońska
Postępy Psychiatrii i Neurologii 2006; 15 (2): 105-115

Objectives. An attempt was made to systematize neuropsychological research findings concerning patients with anorexia nervosa.

Background. In view of neuroimaging research findings that indicate, above all, the presence of cortico-subcortical atrophies and an increased volume offluid spaces in patients with anorexia nervosa, the aim of many subsequent experiments was to describe the state of their cognitive functions. These research results are discrepant, and sometimes contradictory. Some authors reported considerable abnormalities, most often disturbances of attention, working memory, and visuo-spatial abilities, while others eitherfound no significant differences between anorectic patients and the controls as regards the mean level ofparticular cognitive functions, or even reported a superior cognitive performance of the former. In a majority of studies no correlation was found between neuropsychological parameters on the one hand and the degree of the patients' cachexia, duration of the condition, and severity of concurrent mental disorders. However, evidence has been collected indicating that some of the abnormalities observed in the active stage of the disorder disappear during remission. Nevertheless some authors hypothesize that cognitive impairment in anorexia nervosa is premorbid and of pathogenic character.

Conclusions. Anorexia nervosa is associated with an impairment of various cognitive functions of unknown etiology. Further research should be focused on relationships between neuropsychological, neuroimaging and biochemical examination findings.

Review article

Glycine transporters - a potential target ofpharmacological intervention in the treatment of schizophrenia

Dominik Strzelecki, Jolanta Rabe-Jabłońska
Postępy Psychiatrii i Neurologii 2006; 15 (2): 105-117

Objectives. Information is presented concerning glycine transporters (GlyT) and possibilities of modulating their function in order to attain beneficial clinical effects.

Background. Glycine, a co-agonist of the glutamatergic NMDA receptor, was found to have a beneficial effect on negative and cognitive symptoms in patients with schizophrenia. Further substances are presently sought that would have a wider spectrum of action and more pronounced therapeutic effects than glycine. Sarcosine and its derivatives, as well as the so-called second generation GlyT inhibitors with a different chemical structure seem to be at present the most promising drugs.

Clinical hints

Quetiapine - atypical neuroleptic with a moderate effect on carbohydrate and lipid metabolism

Tadeusz Pietras
Postępy Psychiatrii i Neurologii 2006; 15 (2): 121-125

Objectives. Quetiapine, a benzothiazepine derivative, is an atypical antipsychotic with confirmed efficacy in the treatment of schizophrenia and bipolar disorder.

Review. Atypical neuroleptics may be the cause of the metabolic syndrome including obesity, glucose intolerance, hyperinsulinism, and serum lipid disturbances. In contradistinction to olanzapine and clozapine, quetiapine aggravates the metabolic syndrome constituents to a small degree only. Both the clozapine and olanzapine treatment is associated with the highest riskfor the metabolic syndrome incidence and subsequent cardiac disease. Quetiapine generally shows low to moderate levels of mean weight gain, as well as of blood glucose, triglicerides, and cholesterol concentrations.

Conclusions. Quetiapine seems to be an effective neuroleptic in the treatment ofpsychotic disorders in patients at riskfor atherosclerosis and cardiac disease.

Case report

Restless Arms Syndrome

Postępy Psychiatrii i Neurologii 2006; 15 (2): 127-129

Objectives. An extensive literature on the Restless Legs Syndrome (RLS) indicates that this syndrome is too often overlooked or misdiagnosed. On the other hand, concurrent paresthesias and motor restlessness (akathisia) in the upper limbs are very seldom reported. There are extremely few brief reports ofparesthesia and akathisia restricted to the upper limbs. The author recently described 3 patients suffering from motor restlessness associated with painful paresthesias in the upper limbs only, with lower limbs symptom-free.

Case reports. In this paper 5 more cases are presented with paresthesia, disesthesia and motor restlessness occurring in the upper limbs only. Before admission to our clinic the patients had been treated by many other physicians with no effect. Since their complaints had been regarded as due mainly to cervical spondylosis, they had been treated with non-opioid analgesics. Recent reports suggest that analgesics of this type administered regularly or abused are the main risk factor for the RLS development. Considering that, except for its location, the restless arms syndrome (RAS) is analogical to the RLS in terms of the patient's complaints, non-opioid analgesics can be hypothesized to constitute the main risk factor also in the development of the former (RAS).

Commentary. The problem is very important, since there is a systematic increase in the use of non-opioid analgesics (by about 4% annually in Poland). Therefore, it seems necessary to draw not only neurologists' but also other physicians' attention to the danger of inappropriate use of non-opioid analgesics by their patients. It is essential to establish proper diagnostics of both these syndromes, RAS and RLS, in order to undertake their effective treatment.