Archives 1992-2013

2007, volume 16, issue 3

Original article

Psychopathological symptoms associated with eating disorders

Cezary Żechowski
Postępy Psychiatrii i Neurologii 2007; 16 (3): 185-191

Objectives. The main aims of the study were to assess psychopathological symptoms in adolescent patients with eating disorders (restrictors and bulimics) and compare the two groups with healthy controls.
Method. 40 hospitalized female adolescents diagnosed with anorexia nervosa or bulimia nervosa and 46 healthy adolescent girls were examined using the EDI, Hamilton Scale, YBOCS, and STAI. Intergroup comparisons were made between restrictors (the restrictive subtype of anorexia nervosa), bulimics (the bulimic subtype of anorexia nervosa and bulimia nervosa) and healthy controls.
Results. As compared to healthy controls, both groups with eating disorders exhibited statistically significantly higher levels of psychopa-thology (depression, anxiety, and obsessive-compulsive symptoms). The restrictive group had a higher level of depression, and a lower level of anxiety than had bulimics, while the severity of obsessive-compulsive symptoms was similar in the two groups. Correlations were found between some personality traits (EDI) and both state and trait anxiety symptoms (STAI) in restrictive patients. Moreover, personality traits (EDI), state and trait anxiety (STAI) and depressive symptoms were intercorrelated in the bulimic group.
Conclusion. Both groups of patients with eating disorders had higher levels of psychopathological symptoms as compared to healthy controls. Differences were found between bulimic and restrictive patients in personality traits and psychopathological symptoms. Careful examination may improve our understanding and treatment of these patient groups.

Original article

Brain choline level changes in female patients with anorexia nervosa measured by proton MR spectroscopy (1H-MRS)

Piotr Grzelak, Witold Gajewicz, Dominik Strzelecki, Agata Majos, Marek Olszycki, Ludomir Stefańczyk, Jolanta Rabe-Jabłońska
Postępy Psychiatrii i Neurologii 2007; 16 (3): 193-199

Objectives. Proton MR spectroscopy (1H-MRS) allows measurement in vivo of changes in some metabolites level in the brain tissue. The technique may be used to seek relationships between macroscopically and microscopically observed alterations and the underlying metabolic abnormalities. The purpose of the study was to analyze changes in the choline levels measured using the 1H-MRS in anorexia nervosa (AN) patients with acute nutritional deficit on admission, and post-treatment.
Method. Participants in the study were 15 young women diagnosed with AN, examined on their first admission. Nine them were reexamined on treatment completion. The reference group consisted of 10 female volunteers. Single voxel proton magnetic resonance spectroscopy (1H MRS) was conducted using the 1.5TMR scanner Acquisition was made in two sites: the parietal lobes (white matter) and the occipital lobes (gray matter). Spectrum analysis was focused on the choline resonance lines (3.22 p.p.m.).
Results. In AN patients in the acute stage a reduced choline signal was found in both acquisition areas as compared to the controls. Moreover, a tendency to regression of the changes after successful treatment was noted. The reduced choline signal in the white matter in the AN group with no simultaneous changes in the neuronal marker (NAA) signal suggests glial character of the disorder. The observed choline compounds signal reduction in AN patients may result from systemic metabolic disorders affecting sterol compounds. The findings seem to support the view that regulatory disturbances in the cell membrane renewal process affect the functional status of neurons and may be an important factor in thepathomechanism of the disease development. The tendency to choline signal normalization observed in the study after successful treatment indicates that the disorder is transient, at least in an early stage of the disease.
Conclusions. The obtained data suggest a significant choline signal reduction in both the white and gray matter in female patients in an acute stage of AN. In those who underwent successful treatment a tendency to recovery from choline signal disturbances was found.

Original article

The use of Rey-Osterrieth Complex Figure for differential diagnosis of cognitive dysfunctions following damage to the frontal vs. occipital lobes and adjacent cortex

Paweł Przybylski, Urszula Oszwa
Postępy Psychiatrii i Neurologii 2007; 16 (3): 201-209

Objectives. Copying of the Rey-Osterrieth Complex Figure is used for the neuropsychological assessment of visual perception and visual-constructional abilities. However, a poor performance on this test may also result from impaired planning and organization of complex activity. No method has been developed so far that would allow to differentiate accurately between the two causes ofperformance deterioration. The aims of the study were to devise a procedure enabling such a differentiation and to examine its validity.
Method. For the purposes of this study a modification of the original method was devised involving firstly, an appropriate organizational help provision (effective only in cases of planning impairment) and secondly, observation of qualitative changes in the produced copy. Two groups of neurological patients were examined using the new procedure: 1) patients sufferingfrom damage to the occipital lobes and adjacent cortex (whereperceptual and visual-constructional deficits were expected), and 2) those sufferingfrom damage to the frontal lobes (where an impairment of planning and organization was expected).
Results. The new procedure was found to differentiate accurately between the two compared groups, and therefore, between the mechanisms underlying their disorders.
Conclusions. The proposed procedure may be useful for the neuropsychological assessment of a wide range of disorders, especially for the differential diagnosis of various forms of dementia and specific developmental learning disabilities in children.

Original article

Assessment of neurotic tendencies in patients with functional dyspepsia - methodological aspects

Joanna Grzyb
Postępy Psychiatrii i Neurologii 2007; 16 (3): 211-214

Objectives. The aim of the study was to assess the severity of neuroticism (NEU) and neurotism (N) in patients with functional dyspepsia (FD), using two different methods.
Methods. Two groups of FD patients were examined: one consisted of 30 (19 M, 21 F; mean age 39.2 years) and the other of 34 individuals (16 M, 18 F; mean age 37.9). Our assumptions were verified by means of two independent methods, based on the same theory: the NEO-FFI questionnaire measuring NEU intensity, and the 16-Factor Personality Questionnaire (PF-16) by R.B. Cattell evaluatning the tendency to N.
Results. The patients examined with the NEO-FFI questionnaire did not differ significantly from the general population in the NEU level. Those assessed with the PF-16 showed a significantly stronger tendency to N.
Conclusions. The intensity of neurotic tendencies in patients with functional dyspepsia turned out to depend on the assessment method used.

Original article

Apoliprotein E genotype and its relation to behavioral and psychological symptoms in Alzheimer's disease

Tomasz Sobów, Iwona Kłoszewska, Marcin Flirski, Ewa Golańska, Paweł P. Liberski
Postępy Psychiatrii i Neurologii 2007; 16 (3): 215-220

Objectives. Inconclusive results have been obtained so far in the research into the apolipoprotein E (APOE) genotype association with either behavioral and psychological symptoms of dementia (BPSD) or psychotic symptoms in Alzheimer 's disease (AD). However, many studies suggest a possible relationship between psychotic symptoms, especially delusions, and the presence of at least one e4 allele. The aim of the study was to assess the prevalence and severity of BPSD in relation to the APOE genotype.
Method. A cohort of 54 highly selected AD patients was included in the study The patients were evaluated using the Clinical Dementia Rating scale (CDR; for dementia severity), two psychometric scales (ADAS-cog and MMSE; for the cognitive dysfunction profile), and the Neuropsychiatric Inventory (NPI; for the presence and severity of BPSD). APOE genotyping was performed using the standardized protocol.
Results. APOE e4 allele carriers were at a substantially higher risk of exhibitng psychotic symptoms (particularly delusions, but not hallucinations analyzed separately), as well as agitation/aggression. This association was more pronounced in moderately than in mildly demented subjects. No association between the APOE genotype and other behavioral or psychological symptoms was noted.
Conclusions. The risk of developing delusions or hallucinations might be differentially modulated by the presence of APOE e4 allele. Further research is needed to evaluate the significance of other genetic polymorphisms for the risk of BPSD.

Original article

Alexithymia - a risk factor or a consequence of PTSD in female victims of domestic violence

Małgorzata Dąbkowska
Postępy Psychiatrii i Neurologii 2007; 16 (3): 221-227

Objectives. The aims of the study were, firstly, to assess the prevalence and severity of alexithymia and posttraumatic stress disorder (PTSD) symptoms in female victims of domestic violence, and secondly, to examine correlation between alexithymia and PTSD severity in this group.
Method. Participants in the study were 30 women aged 17 to 55 years (mean age 37 years), living in hostels for domestic violence victims. They had experienced both physical violence and psychological abuse. The presence and severity of alexithymia were assessed using the 20-item self-rating Toronto Alexithymia Scale. For the PTSD diagnosis and severity evaluation the PTSD Interview (PTSD-I) by C.G. Watson et al. (1991) was used.
Results. In this group of domestic violence victims 53% had alexithymia or subclinical alexithymia, and 97% were found to suffer from PTSD symptoms. In as many as 70% of the victims PTSD severity was profound, very profound, or extreme. Higher scores on the alexithymia scale were correlated with higher PTSD severity.
Conclusions. The prevalence of alexithymia among domestic violence victims was higher than that in the general population. The intensity of alexithymia was correlated with PTSD symptoms severity.

Original article

Quality of life in patients with epilepsy

Włodzimierz Kuran, Ałła Graban, Wanda Lipczyńska-Łojkowska, Beata Sawicka, Maria Rakowicz, Ewa Ślusarska, Danuta Ryglewicz
Postępy Psychiatrii i Neurologii 2007; 16 (3): 229-232

Objectives. The purpose of the study was to assess quality of life (QoL) among patients with epilepsy and to analyze the effect and significance of selected clinical and social factors on their QoL level. QoL became an important measure of patients' health status, even though it is not always concordant with clinical criteria of health status evaluation. QoL assessment can be regarded as pertaining to a dynamic process, and not to a stable outcome.
Method. QoL was assessed using the international questionnaire QOLIE-31. Participants in the study were 66 epileptic patients (35-M, 31-F) aged 20 to 70 years, suffering from epilepsy for at least 3 years. Besides the QOLIE-31 questionnaire they filled out also the Beck Depression Inventory (BDI). A physician evaluated their cognitive processes using the MMSE, and filled out a special questionnaire concerning the patient's socio-demographic status and medical history.
Results. The mean QOLIE-31 score in the group under study was 61.0, closely approximating that obtained in the American standariza-tion procedure (62.87). However, our patients' scores were much higher than these in a group of 106 Polish patients in Gdańsk (44.73). Neither gender, nor clinical (age, disease duration, frequency of seizures) and social (marital status) factors had a significant effect on the patients' QoL. However, considerable differences in QoL were found between patient groups with different severity of depressive symptoms measured using the BDI. The higher the BDI score, the poorer was the patients' quality of life assessed with QOLIE-3. The relationship was statistically significant.

Review article

Classification of psychiatric disorders in children and adolescents - aid or obstacle?

Cezary Żechowski, Katarzyna Bażyńska, Irena Namysłowska
Postępy Psychiatrii i Neurologii 2007; 16 (3): 233-240

Objectives. The main purpose of the paper was to discuss dilemmas concerning the use of contemporary classifications of mental disorders in children and adolescents. The ICD-10 and DSM-IV classification systems are aimed at unification of diagnoses and diagnostic criteria. While the systems have many scientific, practical and teaching merits, their weak points include their over-embedding in current socio-cultural contexts, difficulty in diagnosing multiple disorders, and a low stability of diagnoses in children and adolescents. Another purpose of the paper was to outline the history of classifying and diagnosing mental disorders in children and adolescents in Poland.
Review. The authors analysed the literature concerning classification systems, the history of classification of mental disorders in children and adolescents, and the effect of environmental, social and cultural factors on diagnosing developmental mental disorders. The analysis of developmental mental disorders classification in Poland from the historical perspective was based on major textbooks of psychiatry and chapters published in Poland since the early 1900s. The classification of child and adolescent mental disorders underwent many changes and transformation in many aspects over the past century. While initially classifications of developmental mental disorders were very similar to those in adults, an increasing awareness of the specificity of mental disorders in children and adolescents, as well as gradual differentiation of diagnostic criteria can be seen with years. Early classifications were usually based on therapeutic pedagogy experiences and on theoretical approaches such as psychoanalysis. The number of diagnoses was gradually increasing, theoretical models were abandoned in favour of phenomenological descriptions on which diagnoses were based, the significance of the context of mental disorders was more and more widely appreciated, and it was more and more often taken into account in classifications. Increasingly clearer diagnostic criteria were specified. On the other hand, stability of diagnoses, especially in younger children, is still low. Besides, a very high prevalence of co-morbid conditions is reported in the research literature. A careful interview with the child and his/her parents/caregivers, as well as family diagnosis taking into account the achievements of family therapy seem to be essential for good diagnostic practice.
Conclusions. Classification and diagnoses of mental disorders in children and adolescents changed significantly in the 20th century. This transformation of views on developmentalpsychopathology was strongly influenced by social and cultural factors. Changes in the classification of mental disorders in children and adolescents in Poland reflect these in Western Europe and the US.

Review article

Posttraumatic stress disorder as a result of natural disasters

Agnieszka Stępień, Krzysztof Małyszczak
Postępy Psychiatrii i Neurologii 2007; 16 (3): 241-245

Objectives. Psychological consequences of natural disasters are outlined in the paper, and a variety offactors affecting the development and persistence of the posttraumatic stress disorder (PTSD) are discussed.
Review. The prevalence of PTSD resulting from cataclysms varies depending on the time interval between traumatic experiences and the diagnosis, as well as on the extent and duration of damage. Significant factors increasing the risk for PTSD include: intensity and suddenness of the disaster, loss or irreversible damage to the flat/house, and death of relatives due to the disaster.
Conclusions. PTSD symptoms persist longer in individuals who received neither economic nor psychological support.

Review article

Antiphospholipid syndrome as the cause of cerebral stroke and of various neurological syndromes

Małgorzata Wiszniewska, Anna Członkowska
Postępy Psychiatrii i Neurologii 2007; 16 (3): 247-250

Objectives. Essential pathogenic and clinical characteristics of the antiphospholipid syndrome (APS) as the cause of various neurological syndrome are outlined.
Review. APS is a systemic autoimmune disease, in which the pivotal factor is the presence of antibodies directed against phospholipids commonly found in cell membranes of human organism. Typical symptoms of APS include: venous thrombotic-embolic disease, arterial thrombosis in the brain, moderate thrombocytopenia, and obstetric complications. Cerebral thrombosis may provide pathophysiological conditions underlying ischemic stroke in young adults. The most common neurological symptom of APS is headache. Since the syndrome can cause disorders both in the central and peripheral nervous systems, its neurological manifestations may be diverse. The treatment for APS is based on antiplatelet and anticoagulation oral drugs administered alone or together.
Conclusions. APS should always be taken into consideration when the patient presents with diverse unexplained symptoms, especially of thrombotic-embolic character In diagnosing the APS a good collaboration with hematologists is of utmost importance, since they can help not only with the hematological diagnosis, but also with treatment.

Review article

Sleep disorders in patients with multiple sclerosis

Piotr Koppa, Jacek Losy, Wojciech Kozubski
Postępy Psychiatrii i Neurologii 2007; 16 (3): 251-255

Objectives. Among patients suffering from multiple sclerosis (MS) various sleep disorders can be seen, often more than one and in different configurations. The disorders can occur at every stage of the disease, and even precede its first symptoms.
Review. The type of sleep disorders depends on the localisation of lesions in the central nervous system, and on the presence of other symptoms and syndromes in the course of MS (e.g. chronic fatigue syndrome, depression syndrome, nycturia).
The most common sleep disorders among MS patients are: insomnia, limb movement disorders during sleep, nocturnal breath disorders, narcolepsy and REM sleep behaviour disorders. Factors that may influence the quality of sleep include pain, nycturia, depression, drug side-effects, location of demyelination lesions and progression of the disease.
Conclusions. An attempt was made in the paper to draw attention to sleep disorders, since they are an important and often underestimatedproblem in SM patients.

Review article

Sleep disorders in children and adolescents

Małgorzata Urban
Postępy Psychiatrii i Neurologii 2007; 16 (3): 257-262

Objectives. An attempt was made in the paper to present the most common sleep disorders in children and adolescents.
Review. Sleep disorders are often seen not only in general medical practice, but also by pediatricians. The disorders include mild, easily corrected abnormalities related e.g. to inappropriate sleep hygiene, but also conditions that may have severe clinical implications. Careful diagnostic examination and establishing the cause of sleep disorders allow to make right therapeutic decisions.
Conclusions. General practitioners' knowledge about sleep disorders is frequently insufficient to recognize sleep disorders in children and adolescents. In some cases it is necessary to refer the patient to a specialist sleep disorders center.

Case report

Extrapyramidal syndrome following metoclopramide treatment

Jerzy Matysiakiewicz, Michał Błachut, Karina Badura-Brzoza, Tomasz Matysiakiewicz
Postępy Psychiatrii i Neurologii 2007; 16 (3): 263-264

Background. Metoclopramide, a drug widely used in common gastro-intestinal disturbances, shows also a dopaminolytic activity.
Case report. A 40-year-old woman treated with mianserine for depression, began receiving metoclopramide prescribed by a general practitioner to relieve dyspepsia. Within a week of the drug administration she developed dystonic-dyskinetic symptoms affecting the tongue and lips.
Commentary. Adverse side effects and complications of popular drugs (used also in self-treatment) are not commonly known. The report also sheds light on the difficulty in communication between physicians treating the same patient for different diseases.

Case report

Drug-resistant schizophrenia with leukopenia in the course of Cytomegalovirus infection - a case report

Michał Błachut, Jerzy Matysiakiewicz, Robert Teodor Hese
Postępy Psychiatrii i Neurologii 2007; 16 (3): 265-267

Objectives. The purpose of the paper is to describe a patient with drug-resistant schizophrenia and leukopenia symptoms who was infected with Cytomegalovirus.
Case report. A 19-year-old man diagnosed with paranoid schizophrenia was admitted with acute psychotic symptoms after a suicidal attempt. Leukopenia was noted during his hospitalization in the course of treatment with several neuroleptics. After additional laboratory tests and consultations asymptomatic Cytomegalovirus (CMV) infection was recognized.
Commentary. The observed low leukocyte levels can be assumed to be due to CMV infection activity.