Archives 1992-2013

2006, volume 15, issue 3


Therapeutic contact with a person suffering from schizophrenia

Irena Namysłowska
Postępy Psychiatrii i Neurologii 2006; 15 (3): 137-141

The author presents her reflections on contact with those suffering from schizophrenia. Characteristics of this contact as outlined by Kępiński and other authors are referred to in a broader context of the philosophy of dialogue. The principles of the so-called pre-treatment are discussed. An analysis is presented of transference and counter-transference that develop in the course of contacts with a person with schizophrenia, including their importance for the personal growth of those working with the patients.

Original article

Comorbidity of eating disorders and bipolar spectrum disorders

Postępy Psychiatrii i Neurologii 2006; 15 (3): 143-146

Objectives. Prevalence of two types of symptoms was assessed in the study: firstly, of bipolar spectrum disorders among female patients hospitalized for eating disorders, and secondly, of eating disorders in female patients with bipolar affective disorders.

Methods. Participants in the study were 98patients diagnosed with eating disorders, 48 with bipolar affective disorders, and 113 healthy women as controls. The Mood Disorder Questionnaire and Eating Attitude Test (EAT-26) were used for the assessment of bipolar spectrum and eating disorders symptoms, respectively.

Results. The prevalence of bipolar spectrum symptoms was significantly higher in patients with eating disorders than in the healthy controls. In patients with bulimia and the bulimic type of anorexia nervosa bipolar spectrum symptoms were significantly more frequent than in those with the restrictive type anorexia. In patients with bipolar affective disorders symptoms of eating disorders were found more often than in the healthy controls.

Conclusions. Eating disorders with binge episodes show a high comorbidity with the bipolar spectrum disorders. This may suggest a common pathogenic and temperamental background of both the disorders.

Original article

Preliminary evaluation of Mini International Neuropsychiatrie Interview for children and adolescents (MINI-Kid) validity in Polish adaptation

JOANNA MAZUREK, Krzysztof Małyszczak
Postępy Psychiatrii i Neurologii 2006; 15 (3): 150-146

Objectives. The aim of the study was to assess validity of a Polish version of the MINI-Kid questionnaire (Mini-International Neuropsychiatric Interview for Kids).

Methods. Examined were 34 adolescents (12 boys and 22 girls aged 11 to 17 years), patients of a Day Psychiatric Centre for Children and Adolescents or of an Outpatient Mental Health Clinic in Wrocław. Diagnoses obtained by means of the MINI-Kid questionnaire were compared with those proposed by the doctors responsible for a given patient. Diagnoses made by psychiatrists were considered as the reference point. In the analysis the 6 coefficient of concordance was used.

Results. Both for anxiety disorders jointly and for maladjustment the same 6 coefficient of 0.65 was obtained, while for attention deficit/hyperactivity disorder (ADHD) it was 0.71, and for behaviour disorders 0.38.

Conclusions. The Polish adaptation of the MINI-Kid questionnaire turned out to have a moderate, and as regards behaviour disorders - rather low validity However, validity of other diagnostic instruments used in psychiatry is similar. The MINI-Kid is a tool useful especially in screening or epidemiological research. The examiner should seek information also from other sources, including interview with the child's caregivers, with an emphasis on behavioural abnormalities. Moreover, an organic underpinning of the disorder should be excluded, since it may be an important etiopathogenic factor in children.

Original article

Relationship between dementia etiology and aggressive behaviours in nursing home residents

Postępy Psychiatrii i Neurologii 2006; 15 (3): 154-146

Objectives. Verbal and physical aggression is a common problem in people with dementia. The aim of the study was to find out whether there is a relationship between dementing process etiology on the one hand, and the intensity of aggression (physical and verbal) and agitation on the other.

Methods. Participants in the study were 39 nursing home residents diagnosed with Alzheimer 's dementia (n = 24) or vascular dementia (n = 15) by the ICD-10 criteria. They were assessed for aggressive and impulsive behaviours using The Cohen-Mansfield Agitation Inventory (CMAI).

Results. The two groups (Alzheimer's disease and vascular dementia) differed in their aggressive behaviour intensity. Moreover, the association of age and cognitive impairment with aggression was confirmed.

Conclusion. The findings may have important implications for caregivers of demented nursing home residents.

Review article

Unreal visual perceptions: a review of the literature

Stefan Krzymiński, STANLEY N. CAROFF, Grzegorz Rossa
Postępy Psychiatrii i Neurologii 2006; 15 (3): 155-164

Objectives. A review of the literature on unreal visual perceptions (visual hallucinations and parahallucinations - VHP).

Review. Unreal visual perceptions are qualified as hallucinations irrespective of the amount of accompanying insight. Many states are reported in the course of which hallucinations may occur. First of all, there is a variety of brain diseases, in particular vascular and degenerative conditions, besides, eye diseases, psychiatric disorders, and adverse side effects of medicaments. Much attention is still paid to the Charles Bonnet syndrome. It is difficult to estimate the real prevalence of VHP, because patients are reluctant to reveal such experiences. Impaired vision and old age are considered to be the main risk factors for VHP. Content of VHP is not specific to any definite disorder. Treatment of VHP is regarded as difficult.

Conclusion. The span of VHP prevalence indices is considerable. No single riskfactor is either necessary or sufficient for the VHP onset. There are no qualitative differences in the VHP clinical picture related to the type of concurrent disorders. If VHP are correctly diagnosed, the treatment outcome is good. An analysis of collected VHP cases will be presented in the second part of this paper.

Review article

The Smith-Magenis syndrome - neurological and neuropsychiatrie abnormalities

Postępy Psychiatrii i Neurologii 2006; 15 (3): 155-165

Objective. Major findings concerning the phenotype and psychoneurological symptoms of the Smith-Magenis syndrome (SMS) are presented.

Review. The Smith-Magenis syndrome (SMS) is a complex neurobehavioral, contiguous gene syndrome ascribed to interstitial microdeletion of chromosome 17, band p11.2, or - rarely - to mutations of RAI1 gene located in this region. The estimated frequency of SMS is 1 in 25000, but this may be an underestimate. The syndrome is characterized by distinctive facial features, hoarse, nasal voice, short hands and feet with brachydactyly, developmental retardation, cognitive impairment, behavioural and neurological abnormalities (including, among others, inattention, hyperactivity, impulsivity, aggression). Hearing loss, ocular problems, congenital heart and urinary tract defects are also reported. Self-injurious behaviours, including inserting foreign objects into body orifices (polyemoilokomania) and yanking finger nails and/ or toenails (onchyotillomania), as well as two stereotypic behaviours, self-hugging and the so-called,, lick and flip " behaviour, (i.e. hand licking and page flipping with no attention to the text) are thought to be specific to SMS. Patients with SMS also suffer from long-term sleep disturbances associated with inverted circadian melatonin rhythm (with high hormone levels during the day and low at night). Diagnosis of SMS is difficult and often delayed until the characteristic physical and behavioural phenotypes become evident. The Smith-Magenis syndrome may be misdiagnosed with other contiguous gene syndromes (Down 's syndrome, DiGeorge syndrome, Williams syndrome, Prader-Willi syndrome, fragile X chromosome syndrome), autism, or attention deficit/hyperactivity disorder (ADHD).

Review article

Biological rhythm disturbances in depression: in search of new therapeutic strategies

Postępy Psychiatrii i Neurologii 2006; 15 (3): 155-178

Objective. To present the mechanisms underlying depression and outline the hitherto known chronobiological treatment strategies.

Review. Circadian rhythms and sleep disturbances are important clinical features of depression. Circadian abnormalities are found in the daily profile of various hormones (e.g. prolactin, corticotropin, cortisol, growth hormone, thyrotropin and melatonin), body temperature, excretion of various metabolites in the urine, as well as in sleep timing and structure. The frequent presence of circadian dys function in depression suggests that the human circadian system holds possible important clues regarding the etiology and treatment of affective disorders. At present more and more patients suffer from depression and receive some kind of available treatment, but various antidepressant therapies are still associated with many severe problems, like adverse side effects and interactions with commonly used drugs. Another significant issue is drug resistance: over 20% of depressive patients do not respond to pharmacotherapy. This means that new approaches to drug and non-pharmacological forms of treatment for depression are needed. Circadian methods include sleep deprivation or light therapy, but chronobiological approaches to drug discovery have been, until recently, nearly entirely neglected by the pharmaceutical in dustry. Lately, agomelatine, a chemical compound with a novel pharmacological profile (melatonin agonist and serotonin antagonist, endowed with chronobiotic properties), has been proposed as a candidate for antidepressant therapy.

Conclusions. Non-pharmacological methods of antidepressant treatment based on chronobiology include light therapy, sleep deprivation or shifting the sleep-vigilance cycle. Among pharmacological therapies the most promising seem to be melatonin agonists, with agomelatine first and foremost.

Review article

Cognitive impairment in systemic lupus erythematosus

Postępy Psychiatrii i Neurologii 2006; 15 (3): 155-183

Objective. The article presents the first part of a review of major research findings concerning cognitive function impairment in patients with systemic lupus erythematosus (SLE).

Review. SLE is an inflammatory disease of autoimmunological origin, characterized by periods of exacerbation and remission. A variety of symptoms can be seen in the course of SLA, including these of both peripheral and central nervous system dysfunction. Due to the diversity of neurological and psychiatric symptoms in SLA patients attempts have been made to group these symptoms together, and eventually a classification was developed. It was published by the American College of Rheumatology (ACR) in 1999. The classification includes cognitive impairment symptoms, at present regarded as one of the most frequent manifestations of SLA, seen in 80% of these patients. Results of studies on the prevalence of cognitive deficits in SLA had been discrepant (with estimates ranging from 21 to 71 %) until the ACR classification was published. The discrepancies resulted probably from a lack of uniform diagnostic criteria for cognitive impairment, and from using different methods for the assessment of cognitive functions. Rather few prospective studies conducted so far did not bring any clear-cut conclusions, since although in most cases cognitive deficits show some stability, nevertheless both a significant improvement and exacerbation of SLA patients' cognitive functioning have been reported.

Conclusions. Cognitive impairment belongs to the most common symptoms of the nervous system dysfunction in SLA patients. Since no conclusive findings have been obtained from prospective studies, further research into cognitive functions in SLA is needed. Psychological assessment is regarded as an indispensable element of the diagnostic process in SLA patients.

Review article

Neurobiological characteristics of selected homicidal behaviour types - clinical and criminal aspects

Postępy Psychiatrii i Neurologii 2006; 15 (3): 155-185

Objectives. Three selected homicidal behaviours are characterised in the paper. An attempt was made to show a possible application of neuropsychiatric knowledge to understanding such a specific behaviour as homicide. Moreover, formal aspects of the relationship between brain functioning and crime are indicated, which in the future may provide a scientific basis for criminological neuroprofiling.

Review. The authors outline specific neurobiological mechanisms underlying Syndrome E, i.e. a set of features of perpetrators who commit crime against an innocent victim because of their obsessive identification with some ideology. In a similar way the so-called abandonment homicide is described. The latter is a homicide committed during a transient disorganization of the brain stress resistance system. The third homicidal behaviour is the limbic psychotic trigger reaction - an atypical form of epileptic seizure evoked by a remembrance of a specific event. The authors propose that characteristics of perpetrators' neurobiological processes can be linked with crimino-logical analysis of circumstances of the committed crime.

Conclusions. Although the described mechanisms are hypothetical, it seems that the current knowledge about the CNS functioning may enable us to understand better some types of homicidal behaviour. An empirical verification of the above-mentioned hypothetical relationship between brain functioning and crime may contribute to an improvement of strategies of construing such forensic activities as interrogation of the perpetrator, reconstruction of his/her motives, as well as to issuing forensic opinion about the homicide perpetrator 's accountability .

Review article

Issues dealt with in psychological publications in the times difficult not only to Polish psychology

Teresa Rzepa
Postępy Psychiatrii i Neurologii 2006; 15 (3): 193-201

Objective. The author presents and analyses characteristic events and attitudes of representatives of Polish psychology in the period of Stalinism.

Review. The article presents: (1) two key events in the post-war history of Polish psychology (the conventions held in Krynica and Wrocław); (2) reflections on the reasons why Polish psychologists assumed attitudes typical of the period ofStalinism; (3) exemplification of these attitudes in the form of a brief analysis ofpsychological articles published in the paper "Nowa Szkoła" ("Modern School") in the years 1950-1956.

Conclusions. The historical reflection leads to considerations concerning the determinants and consequences of fanatical attitudes in science.


Public health problems in the context of ageing of the population of Poland. Report

Postępy Psychiatrii i Neurologii 2006; 15 (3): 203-211

A number of factors contribute to the population ageing: an improvement of living conditions, advances in medicine and, above all, a drop in the birth-rate. Ageing of the population is a common phenomenon observed all over the world, especially in developed countries. In Poland, even though the situation is not dramatic yet, people aged over 60 years constitute about 13% of the total population and this percentage will undoubtedly rise in the future. In the report a demographic prognosis for Poland, major health problems related to ageing, andforms of care provided to the elderly are presented. Moreover, essential factors negatively affecting their quality of life are identified. The authors suggest what procedures and activities should be undertaken to improve the situation of the elderly in the Polish health care system.