Archives 1992-2013

2007, volume 16, issue 1

Original article

Mental health research in Poland at the beginning of the 21st century

Grażyna Herczyńska
Postępy Psychiatrii i Neurologii 2007; 16 (1): 9-21

Objectives. For years the WHO has been calling for the current research into mental health to be used not only to identify the needs in this area, but also to improve resources utilization, research policy development, and in consequence, mental health action. Implementing these ideas the WHO launched a project entitled "Mental health research and its infrastructure in low- and middle-income countries ". The project, carried out in 10 countries worldwide including Poland, was aimed to obtain information about mental health related research and its resources in the year 2003.
Method. Two questionnaires developed by the WHO were used in the study: one concerning the country profile, and the other - institutions involved in broadly defined mental health research. Official documents and statistical data served as sources for the first questionnaire. The second one was mailed to 55 mental health research institutions. Data received from 38 centres were processed and statistically extrapolated so as to provide a general picture.
Results. The paper presents research policy changes in Poland in the 15-year period of transformation, as well as goals and priorities in mental health research, its financing, human resources, publications, dissemination of research results, and ethical issues. About 6% of the total number of researchers in medical sciences were involved in mental health research. Approximately 10% of the total funding for research in medical sciences was allotted to the mental health field. 5.5% of medical publications in Polish journals dealt with mental health.
Conclusions. Goals and priorities in mental health research should be clearly formulated. The expenditure on research in this field was definitely insufficient. Despite the difficulties, mental health research dealt with current scientific questions and was relevant to mental health practice demands. A periodical updating of mental health research and its infrastructure evaluation would allow to objectively identify the existing trends.

Original article

The role of DaTSCAN SPET examination in the diagnosis of the extrapyramidal system diseases - original observations

Wanda Lipczyńska-Łojkowska, Tomasz Jędrzejczak, Włodzimierz Kuran, Jerzy Kulczycki, Izabella Kozłowicz-Gudzińska, Halina Sienkiewicz-Jarosz, Anna Bochyńska, Agata Sackiewicz-Słaby, Danuta Ryglewicz
Postępy Psychiatrii i Neurologii 2007; 16 (1): 23-29

Objectives. An attempt was made to find out whether SPET examination using the 123I FP-CIT (DaTSCAN) may contribute to an improvement in the diagnostics of diseases presenting with the extrapyramidal syndrome symptoms.
Method. Participants in the study were 9 patients with symptoms of the extrapyramidal system impairment diagnosed on the neurological examination at the onset of the disease. Six patients were diagnosed with Parkinson's disease, and the remaining three were single cases of: multisystem atrophy (MSA), a sporadic form of the Creutzfeldt-Jakob disease, and the Gerstmann-Straussler-Scheinker disease. In all the patients SPET of the brain was conducted with the use of 123I FP-CIT. SPET scans were evaluated using optical and semi-quantitative methods. In the semi-quantitative method of the DaTSCAN uptake assessment regions of interest (ROI) were identified for the striatum and occipital cortex. The index of DaTSCAN uptake by DAT in the striatum was determined.
Results. In 6 persons with different degrees of Parkinson's disease advancement lowered 123I FP-CIT uptake indexes were found in the striatum. The results correlated with the degree of the disease advancement. In patients with the hemi-parkinsonian syndrome changes in the opposing striatum were found in SPET scans. In the female patient with MSA a lowered radio-marker uptake index was observed bilaterally in the striatum. In the remaining two cases of the Creutzfeldt-Jakob disease the DaTSCAN SPET scans were normal.
Conclusions. SPET examination with the use of 123I is helpful in diagnosing Parkinson's disease and other, so-called "presynaptic", forms of Parkinsonism, as well as in the evaluation of the disease advancement.

Original article

The incidence of prolonged disturbances of consciousness in patients aged over 60

Danuta Ryglewicz, Halina Sienkiewicz-Jarosz, Wanda Lipczyńska-Łojkowska, Anna Bochyńska, Beata Sawicka, Włodzimierz Kuran, Krystyna Niedzielska, Aleksandra Wierzbicka-Wichniak
Postępy Psychiatrii i Neurologii 2007; 16 (1): 31-35

Objectives. The aim of the present study was to investigate the causes of prolonged (lasting over 12 hrs) disturbances of consciousness in patients aged 60 and above, and to develop optimal diagnostic and therapeutic procedures to be used in such cases.
Method. Analyzed were data obtained from patients with prolonged (over 12 hours) disturbances of consciousness, hospitalized in the 1st Neurological Department of the Institute of Psychiatry and Neurology between 01.11.2003 and 30.10.2005. The case series included 130 patients, mean age 75.7±8.8 years, 82 (63.1%) women and 48 men.
Results. In 28 patients prolonged disturbances of consciousness were due to a haemorrhagic stroke, mostly (in 90% of the cases) penetrating into the ventricular system, while in 27 patients previously diagnosed with epilepsy of non-vascular origin they were usually preceded by a convulsive seizure. The most numerous group in our study were 40patients with cerebrovascular lesions. In this group 7 cases (17.5%) had been diagnosed earlier with post-stroke epilepsy. In the remaining patients disturbances of consciousness were caused by infectious diseases, cerebral tumours, acute ischemic stroke, and blood flow insufficiency in posterior regions of the brain.
Conclusions. In the cases of prolonged disturbances of consciousness in persons aged over 60, a possibility of epilepsy should be taken into account in the differential diagnosis, especially in patients with a history of brain damage of vascular origin.

Original article

Pain perception threshold in depressive disorder

Marcin Szechiński, Sławomir Sidorowicz
Postępy Psychiatrii i Neurologii 2007; 16 (1): 37-41

Objectives. Clinical practice and recent literature indicate that pain is experienced not infrequently in depression. Origins of such pains are unknown, and in particular it is not known whether the pain perception threshold (PPT) may be of importance in this respect. The aims of the study were: (1) to assess PPT values during a depressive episode and on amelioration in the study group and to compare their PPTs with these in the control group, (2) to analyze the relationship between pain perception in depression and pain perception threshold.
Method. The SG consisted of 60 hospitalized patients with the diagnosis of a depressive episode in the course of either recurrent depressive disorder or bipolar affective disorder. The CG included 30 healthy volunteers. In the clinical study PPTs were measured twice using a mechanical algometer (on admission and when an amelioration was attained). Other instruments included: the Hamilton Depression Scale, the Pain Questionnaire by Melzack, and a verbal rating scale for pain assessment.
Results. Pains varying in character, location and duration were reported by 75% of the study group. The mean PPTs were: 4.85 kg in the group under study and 4.78 in the controls (difference not significant); 4.81 kg in the subgroup with pain (75% of the SG) and 4.96 kg in the pain-free subgroup (25% of the SG) (difference not significant). In the subgroup of patients with depressive episode amelioration or remission the mean PPT was 4.06 - the difference was significant as compared to their PPT on admission or to that in the CG (p<0.001).
Conclusions. In the sample studied the mean pain perception threshold was slightly higher, but not significantly different, in the study group than in the controls. The PPT decreased significantly on amelioration of the patients' mental state (their PPT was even lower than that in the CG). No relationship was found between PPT value and the type of depressive episodes - in the course of recurrent depressive or bipolar affective disease.

Original article

A subscale of the Bermond-Vorst Alexithymia Questionnaire related to the diagnosis of essential hypertension

Krzysztof Małyszczak, Angelika Pyszel, Andrzej Szuba
Postępy Psychiatrii i Neurologii 2007; 16 (1): 43-47

Objectives. The paper presents a Bermond-Vorst Alexithymia Questionnaire (BVAQ) subscale made up of items most markedly related to essential hypertension. A preliminary analysis of the subscale reliability and validity is also presented.
Method. The study was conducted in Boguszyce, a little town near Wrocław, as a part of local residents ' screening for cardiovascular diseases. Among 99 participants of the screening (71% women, 29% men, aged 19 to 73, median age 53 years), 42 persons (42%) were diagnosed with essential hypertension. The BVAQ items significantly differentiating between hypertensive and non-hypertensive respondents were identified and included in a separate subscale.
Results. No statistically significant differences were found between the two groups as regards the global BVAQ mean score and mean scores for particular dimensions of the questionnaire, except for verbalization. The following items were included in the hypertension-related subscale: 8, 11, 14, 23, 24, 25, 29, 30, 35, 36 and 39. The hypertension group scored on the subscale significantly lower than did nonhypertensive respondents (mean scores 24.68 and 34.72, respectively, p<0.000001). The intergroup difference remained statistically significant when age and education level were controlled for. The Cronbach a coefficient of the subscale internal consistency was 0.68. In factor analysis 4 factors were distinguished in the subscale: emotional reactivity, emotional identification, ability to verbalize, and to recognize emotions.
Conclusions. Mean scores on the Bermond-Vorst Alexithymia Questionnaire subscale developed by the authors significantly differentiated between the hypertensive group and non-hypertensive controls. The subscale items indicate that persons with hypertension have a more pronounced emotional reactivity. Moreover, they are less skilled in recognizing and verbalizing their own emotions.

Original article

Neuroticism in patients with essential hypertension

Krzysztof Małyszczak, Angelika Pyszel, Andrzej Szuba
Postępy Psychiatrii i Neurologii 2007; 16 (1): 49-52

Objectives. The aims of the paper were to compare persons with essential hypertension with those with no hypertension for mean neuroticism level, and to identify the neuroticism scale items most markedly associated with the presence of arterial hypertension.
Method. The study was conducted in Boguszyce, a little town near Wrocław, as a part of local residents ' screening for cardiovascular diseases. Among 99 participants of the screening (71% women, 29% men, aged 19 to 73, median age 53 years) 42 persons (42%) were diagnosed with essential hypertension. All the screening participants were examined using the neuroticism scale of the Eysenck Personality Questionnaire (EPQ-R). The items most markedly associated with the presence of arterial hypertension were identified and included in a separate subscale.
Results. The mean neuroticism score was significantly higher in the hypertension group than in the non-hypertensive respondents (14.8 and 12.2, respectively, p = 0.02). However, significance of the difference disappeared when age was controlled for (p = 0.074). The developed subscale consisted of 7 items from the neuroticism scale. The essential hypertension group scored on this subscale significantly higher than did non-hypertensive respondents (mean scores 4.73 and 3.24, respectively, p<0.000068).The Cronbach a coefficient of internal consistency was 0.67. The difference between mean scores of the two groups was statistically significant also when age and education level were controlled for (p = 0.0015).
Conclusions. The subscale developed from the EPQ-R neuroticism scale items differentiated statistically significantly between respondents with hypertension and non-hypertensive controls, irrespective of their age and education.

Original article

Polymorphism of the 5-HT2A serotonin receptor gene promoter (-1438 G/A) in patients with seasonal affective disorder, non-seasonal affective disorder, and healthy controls (a preliminary communication)

Łukasz Święcicki, Małgorzata Bednarska-Makaruk
Postępy Psychiatrii i Neurologii 2007; 16 (1): 53-56

Objective. To assess polymorphism of the 5-HT2A serotonin receptor gene promoter (-1438 G/A) in patients with seasonal affective disorder (winter depression).
Method. The rates of the 5-HT2A promoter (-1438 G/A) polymorphism in a group of 29 patients with seasonal affective disorder (SAD), 32 depressive inpatients with non-seasonal affective disorder, and 198 controls with hypercholesterolemia and no mental disorders were estimated.
Results. The A/G genotype and A allele were more frequently present in the group of SAD patients as compared to non-SAD depressive inpatients and the controls, but the differences were not significant (p2 test; p = 0.174 and 0.503, respectively). Further investigations are planned.
Conclusions. The findings are not conclusive, but promising, so continuation of research in this direction seems justified.

Review article

Prevalence of depressive symptoms in patients with end-stage renal disease (ESRD) - a review

Marta Makara-Studzińska, Piotr Książek, Wojciech Załuska, Renata Kaim, Andrzej Książek, Justyna Morylowska
Postępy Psychiatrii i Neurologii 2007; 16 (1): 57-61

Aim. An attempt was made in the paper to review the literature on the prevalence of depressive disorders in patients with end-stage renal disease (ESRD).
Review. Depression is a severe problem markedly impairing ESRD patients' quality of life. The depressive syndrome prevalence in ESRD patients is unknown, but it ranges probably from 5 to10%. The most recent data confirm that the presence of depressive symptomatology is associated with morbidity, as well as with subjectively perceived quality of life perception and mortality in dialysed ESRD patients. An important and unresolved question is a lack of a specific diagnostic instrument for an early diagnosis of depression in ESRD that would enable these patients to receive an appropriate treatment possibly soon.
Conclusions. Dialysis patients should be screened for depression. All medical staff members should cooperate to identify problems related to dialysed patients' quality of life. A correct and early diagnosis followed by an appropriate anidepressive and anxiolytic treatment may considerably reduce the risk of interrupting dialysis therapy.

Review article

Some aspects of quality of life in persons with epilepsy

Krzysztof Owczarek, Hanna Rozenek, Lidia Michalak
Postępy Psychiatrii i Neurologii 2007; 16 (1): 63-68

Objectives. The article presents criteria by which patients assess their quality of life, as well as medical professionals' approach to this variable. Moreover, main sources of discomfort in epileptic patients important for their treatment progress and outcome are discussed.
Review. Although medical professionals for years have focused their interests and hopes on the continually increasing offer of the pharmaceutical industry, they pay now more and more attention to issues related to their patients' psychological condition and to psychological forms of helping them to cope with daily life hassles. As regards epilepsy, a chronic condition with a very heterogeneous etiology, the concepts of quality of life and QoL-related psychosocial functioning are gaining particular importance. In medical diagnosis of the degree of discomfort resulting from epilepsy the focus is usually on the frequency and dynamics of epileptic seizures. Doctors ' efforts are aimed at pharmacotherapy optimisation so as to achieve a complete control over the patient's seizures or, if that is impossible, to reduce their frequency and intensity. On the other hand, epileptic patients hold their own views on their condition limitations and have their own criteria for their quality of life evaluation. Assessing their quality of life epileptic patients take into account not only their physical health, but also their social status, a sense of being useful and self-sufficient, as well as a range of aspects of their daily functioning.
Conclusions. Discomfort experienced by epileptic patients results from a discrepancy between their plans and expectations on the one hand and their daily life failures on the other. Coping with epilepsy involves an ability to make use of one's own potential in overcoming illness-related limitations and difficulties in daily life.

Review article

Amyloid beta peptide toxicity and oxidative stress in the pathogenesis of Alzheimer’s disease

Tadeusz Pietras
Postępy Psychiatrii i Neurologii 2007; 16 (1): 69-73

Objectives. Alzheimer 's disease is characterized by the formation of plaques and neurofibrillary tangles around nerve cells. Amyloid beta peptide is the major component of these plaques. This review is aimed at weighing up the evidence that supports both the trophic and toxic properties of amyloid beta peptide.
Review. Amyloid beta protein is the pivotal factor in the pathogenesis of Alzheimer's dementia. In low concentrations the amyloid beta peptide can bind Cu, Zn, and Fe cations, and protect against oxidative stress by inhibiting Fenton's reaction. In high (micromolar) concentrations the amyloid beta peptide undergoes nucleation process and acts as a catalyst participating in the formation of toxic reactive oxygen species such hydrogen peroxide and hydroxyl radical. Moreover, amyloid beta peptide in high concentrations was found to display prooxidative activities of cholesterol oxidase and peroxidase with heme as the prosthetic group. Molecules of amyloid beta peptide activate also strongly prooxidative NADPH oxidase enzyme in granulocytes and microglial cells in the brain via interaction with the neurokinine receptor, Rac protein, and intracellular kinases.
Conclusion. Our conclusion is that amyloid beta peptide under physiological conditions is an important factor of the brain antioxidant system, but when overproduced in Alzheimer's disease it has prooxidative properties, being the source of neuron-damaging reactive oxygen species.

Review article

Cholinesterase inhibitors as “vasoactive ” medications

Tomasz Sobów, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2007; 16 (1): 75-79

Objectives. Data presented in the review indicate a key role of the cholinergic system control in the cerebral blood flow regulation. Moreover, they suggest therapeutic implications of the phenomenon, including a wider spectrum of cholinesterase inhibitors (ChEIs) application in clinical practice - in addition to the central cholinergic deficit amelioration, also a vasoactive mode of their action.
Review. Despite a growing body of evidence for the presence of a central cholinergic deficit in various conditions leading to dementia, cholinesterase inhibitors are at present registered only for the treatment of mild to moderate dementia in Alzheimer's disease. The cholinergic-only hypothesis does not fully explain either the global nature of the clinical effects of ChEIs, their effects in other dementias (dementia with Lewy bodies, Parkinson's disease dementia, vascular dementia), or the strong and unpredictable interindividual variation in response to treatment. The cholinergic system disruption as well as its interaction with both amyloid $ metabolism and neurovascular regulation may shed a new light on the ChEIs impact on the cerebral blood flow regulation.
Conclusions. The common occurrence of a central cholinergic deficit in various dementias, as well as not only metabolic, but also vasoactive properties of cholinesterase inhibitors may justify their use in other than AD disorders leading to dementia.

Review article

A review of neuropsychological methods for the assessment of mild cognitive impairment

Magdalena Gugała, Emilia Łojek, Wanda Lipczyńska-Łojkowska, Anna Bochyńska, Beata Sawicka, Halina Sienkiewicz-Jarosz
Postępy Psychiatrii i Neurologii 2007; 16 (1): 81-85

Objectives. Neuropsychological assessment of cognitive functions in persons with suspected mild cognitive impairment is an important part of diagnosis.
Review. Mild cognitive impairment (MCI) is a transition stage between cognitive changes seen in normal aging and those in dementia. The presence of MCI is associated with a higher risk of dementia in the future. Neuropsychological diagnostic methods are used to assess cognitive functioning. Screening methods, such as the Mini Mental State Examination (MMSE) and The Clock Drawing Test, examine the general cognitive abilities. In a more detailed assessment of verbal functions the following instruments are used: The Naming Test, The Controlled Oral Word Association Test (COWAT), Digit Span from the Wechsler Adult Intelligence Scale, The Rey Auditory Verbal Learning Test (RAVLT), The California Verbal Learning Test (CVLT), The Test of Associated Learning and The Verbal Concept Attainment Test (VCAT). Visuospatial abilities are examined using The Trail Making Test, The Benton Visual Retention Test (BVRT), The Rey-Osterrieth Complex Figure Test (ROCF) and The Ruff Figural Fluency Test (RFFT). The Wisconsin Card Sorting Test (WCST) and many subscales of the above-listed tests assess executive functions.
Conclusions. Neuropsychological diagnostic methods allow to objectively assess cognitive functions in persons with mild cognitive impairment.

Review article

Ultrasound evaluation of intima-media thickness-IMT as a risk factor for cerebrovascular diseases

Maciej Wawrzyńczyk, Krystyna Pierzchała
Postępy Psychiatrii i Neurologii 2007; 16 (1): 87-91

Background. Cerebrovascular diseases are still a common cause of mortality and disability. New and more effective prevention and treatment methods are continually sought.
Review and conclusions. One of the risk factors is carotid intima-media thickness (IMT), measured using the Duplex ultrasound. This article reviews ultrasound techniques of IMT assessment as well as their role in the estimation of risk of cerebrovascular events and in the treatment outcome evaluation.

Case report

Blepharoptosis as a diagnostic and therapeutic problem in a patient with coexistent myasthenia gravis and dystonia - case report

Agnieszka Machowska-Majchrzak, Krystyna Pierzchała, Klaudiusz Kumor, Róża Ślusarczyk, Wojciech Bartman, Jolanta Biernawska
Postępy Psychiatrii i Neurologii 2007; 16 (1): 93-96

Objective. Blepharoptosis is a rather common but nonspecific symptom of various neurological conditions. Diagnostic difficulties related to coexistence of two disorders with the symptom of drooping eyelids are discussed in the paper.
Case report. A case is presented of a 64-year-old man admitted to our department with a two-year history of periodic bilateral ptosis. On the grounds of the clinical picture and diagnostic procedures the patient was diagnosed with myasthenia gravis and concomitant blepharospasm. The asymmetry of palpebral fissures subsided after pyridostygmine therapy. While botuline toxin injections resulted in an improvement of blepharospasm, no evidence of the myasthenic symptoms deterioration was found.
Commentary. In the proper planning of diagnostic procedures and treatment the possibility of coexistence of different disorders characterized by drooping eyelids should be taken into account.