Archives 1992-2013

2007, volume 16, issue 4

Original article

SSRI and SNRI antidepressants in the treatment of old age depression: a systematic literature review and meta-analysis of randomized controlled trials

Tomasz Sobów
Postępy Psychiatrii i Neurologii 2007; 16 (4): 281-290

Aim. To assess efficacy and tolerability of modern antidepressants (SSRI and SNRI) in the treatment of depression in the elderly.

Methods. A systematic literature review with the use of electronic databases (Medline {Pubmed}, Cochrane, Embase and PsychInfo) was carried out. A meta-analysis of available studies have been conducted using Mantel-Haenszel method utilizing fixed model. We have compared two efficacy parameters (proportions of subjects achieving a 50% reduction of symptoms {response} or remission) and a basic parameter of safety, being a number of adverse effect leading to drug discontinuation.

Results. Thirteen randomized, controlled (with placebo or active control use) trials (RCT) evaluating the efficacy and tolerability of either SSRI or SNRI in the treatment of old age depression have been identified. Due to limited number of studies only two meta-analytic comparisons (SSRI versus placebo, and SSRI versus tricyclics) were possible to conduct. SSRI drugs as a group tended to be more efficacious though significantly less well tolerated than placebo. No advantage of one SSRI over another have been detected. The results of treatment with SSI are better in more severely depressed subjects. Venlafaxine (no data available with other SNRIs, milnacipran or duloxetine) have no advantage in efficacy over sertraline or citalopram being less well tolerated than the two SSRIs. Tricyclic antidepressants (TCA) are similarly efficacious and significantly less well tolerated than SSRIs in the treatment of old age depression.

Conclusions. Extrapolation of the results of trials conducted in younger populations to the elderly depressed may be seriously misleading. Contrary to younger populations analyzed, SNRIs and TCAs are not more efficacious than SSRIs in the treatment of old age depression. Moreover, large placebo effect observed in the treated elderly subjects leads to severe interpretation difficulties.

Original article

Hospitalization of patients with schizophrenia in the years 1999 and 2003

Ludmiła Boguszewska, Elżbieta Słupczyńska-Kossobudzka, Walentyna Szirkowiec
Postępy Psychiatrii i Neurologii 2007; 16 (4): 291-296

Objectives. The study was aimed at investigating, firstly, the socio-demographic factors that determine hospitalization of patients with schizophrenia, and secondly, the model of various inpatient facilities utilization in the years 1999 and 2003.

Method. The hospital-registered prevalence and incidence in sociodemographic subgroups (defined by gender, age, place of residence), as well as the structure of hospitalization in various inpatient psychiatric facilities were analyzed.

Results. The hospitalization prevalence among previously treated patients did not change between the years 1999 and 2003, while the registered incidence increased by 14%. The mean duration of inpatient treatment decreased by 7%. In both these years the diagnosis ofparanoid schizophrenia predominated (62 and 70%, respectively). The highest rates of hospitalization prevalence were found in the age group 36-50years (150per 100.000population). First admissions were most frequent in the 20-35 age range, being earlier in males. Men are more often hospitalized than women, and the difference was even more marked after the five years. The duration of inpatient treatment was longer in men than in women, and in the year 2003 this difference was smaller than 5 years earlier. Urban area residents were hospitalized more often than those from rural areas, and the inpatient treatment duration was shorter in the former group. These differences were more pronounced at the 5-year follow-up.

Conclusions. The analyses suggest that rural area residents are admitted to psychiatric facilities later, when their condition is more severe, and so they need longer treatment. These findings should be taken under consideration by psychiatric care managers. The model of psychiatric care utilization in the year 2003 differed from that noted 5 years earlier. From the viewpoint of the health policy postulated by the Mental Health Programme, the changes are twofold: some are beneficial (e.g. less patients are treated in general wards of mental hospitals, and more receive treatment in psychiatric wards at general hospitals), while other changes are disadvantageous. Namely, according to the Programme more patients should be treated in specialist psychiatric facilities. However, the utilization of such units as those providing psychiatric rehabilitation, or care for long-term patients, has decreased. The only exception was the use of one type of specialist unit, i.e. nursing-treatment residential facility, which was found to be increased. Moreover, no hostels came into existence.

Original article

Personality of individuals with homosexual orientation

Iwona Janicka, Marcin Kwiatkowski
Postępy Psychiatrii i Neurologii 2007; 16 (4): 297–-302

Objectives. The study was aimed at outlining homo- and heterosexual individuals ' personality profiles, as well as differences concerning their psychological gender.

Method. The total of 152 respondents participated in the study. The homosexual orientation group consisted of 59 men and 31 women, while the control group representing heterosexual orientation included 31 men and 31 women. The Costa and McCrae NEO-FFI and the Psychological Gender Questionnaire by Kuczyńska were used.

Results. In both genders personality profiles were found to differ depending on the respondent 's sexual orientation. Homosexual women as compared to heterosexual females were characterized by higher neuroticism and conscientiousness (p = 0.001). The level of conscientiousness was also significantly higher in homosexual men than in their heterosexual counterparts (p = 0.018). Homosexual individuals more often represent the androgynic type of psychological gender, associated with their self-image including characteristics socially attributed both to males and females.

Conclusions. Some personality dimensions were found to differentiate between individuals with homo- or heterosexual orientation. The findings require verification in further study on a more numerous sample.

Original article

Polish adaptation of the Postpartum Depression Screening Scale (PDSS)

Karolina Kossakowska-Petrycka
Postępy Psychiatrii i Neurologii 2007; 16 (4): 303–-308

Objectives. To develop a Polish adaptation of the Postpartum Depression Screening Scale (PDSS) for the assessment of riskfor postpartum depression, and to evaluate its psychometric properties.

Method. Soon after giving birth to a child 194 young mothers were examined using the PDSS in the Polish adaptation. Their mean age was 27.9 (SD=4.01). The majority of the participants were married (87.6%) and had a university education (69.9%). In most cases it was their first pregnancy (75.3%), with a spontaneous labor (69.1%). The mean time from childbirth was 4.97 weeks (SD=1.76).

Results. The Cronbach alpha coefficient of reliability was 0.97 for the whole scale, and 0.81 for the brief version. The brief form of the PDSS was significantly correlated with the global scale (r = 0.90, p<0.01). The patients' scores both on the global and abbreviated PDSS versions were significantly correlated with their BDI scores (r = 0.761, p<0.01; r = 0.646, p<0.001, respectively), as well as with their EPDS performance (r = 0.801, p < 0.01; r = 0.741, p < 0.01, respectively).

Conclusions. Psychometric properties of the Polish adaptation of the PDSS do not differ from these of the original version of the scale. The reliability parameters obtained in the study were high. The Polish adaptation of the PDSS can well be used for the assessment of riskfor depression.

Original article

The effect of sociodemographic variables on the evaluation of medical care quality by psychiatric

Maciej Pałyska, Marta Anczewska, Joanna Raduj, Anna Indulska, Katarzyna Prot
Postępy Psychiatrii i Neurologii 2007; 16 (4): 309-314

Objectives. To establish whether patients' demographic characteristics, including the education level and gender, affect their opinions on the provided health care quality (i.e. the conditions and ways of medical services provision).

Method. The study on evaluation of psychiatric services quality was carried out in inpatient settings in a Warsaw public mental hospital in 2006. All the admitted inpatients (N = 2.937) were asked to fill out a 51-item questionnaire on their discharge from the hospital. Participation in the study was entirely anonymous. Due to missing data, only 808 questionnaires (out of the 1.045 received) were included in the analysis.

Results. The respondents' education level differentiated their opinions about the quality of services provided. Those with a university education were most disapproving in their assessment. As regards gender - women were more critical than men. Significant differences of opinion were noted in respect of the staff availability and information provided.

Conclusions. In order to improve the quality of mental health services consideration should be given first andforemost to opinions of the most critical patient groups. In further research the respondents' demographic characteristics should be taken into account. From both the methodological and practical point of view it is necessary to constantly bear in mind the differentiation of patients' opinions related to their education level.

Review article

Dementia with Lewy bodies - clinical diagnostication

Stefan Krzymiński, Grzegorz Rossa, Sebastian Stoszek
Postępy Psychiatrii i Neurologii 2007; 16 (4): 315-324

Objectives. To review the literature on the clinical diagnostication of dementia with Lewy bodies (DLB).

Review. DLB is regarded as the second most frequent type ofprimary degenerative dementia, next to Alzheimer's disease (AD). In the clinical diagnostics of DLB particular attention is given to the specific neuropsychological profile of dementia, with a predomination of visuospatial and attention disorders over memory impairment in the early stage of the disease. As regards axial symptoms of DLB, considerable importance is ascribed to the fluctuation of cognitive processes and of the state of consciousness. Special scales for the evaluation of the latter have been developed. At present a major diagnostic significance is attributed to symptoms suggesting hypersensitivity to neuroleptics, REM sleep disorders, and a decreased nigrostriatal transport ofdopamine in functional neuroimaging. The presence ofoccipital hypoperfusion / hypometabolism in SPECT/PET investigations is also regarded as important for diagnosing DLB. This condition should be diagnosed, above all, for therapeutic reasons - in DLB there is an increased risk associated with the administration of neuroleptics. At the same time, DLB patients are respond better to the treatment with cholinesterase inhibitors.

Conclusion. The clinical picture ofDLB has no unique features. Similar symptoms are seen in Alzheimer's disease, Parkinson's disease with dementia, vascular dementia, and in other cerebral diseases. In each of these disorders a special caution is required concerning drug administration, in particular neuroleptics. Therefore, the clinical diagnostication of DLB is at present of theoretical rather than practical character.

Review article

The Borna disease virus (BDV) infections in the pathogenesis of schizophrenia

Tadeusz Pietras
Postępy Psychiatrii i Neurologii 2007; 16 (4): 325-329

Objectives. An attempt was made in the study to discuss a probable relationship between neonatal infection with the Borna disease virus (BDV) and the onset of schizophrenia in later life.

Review. The BDV is a non-segmented, single-stranded, highly neurotropic RNA virus of negative-polarity with non-cytolytic replication in the central nervous system. The virus is the cause of neurological complications primarily in horses and sheep. An association between the history of BDV infection on the one hand and psychiatric disorders or behavioral disturbances on the other has been suggested by numerous serologic and molecular studies. Some publications indicate a relationship between infection with the BDV and clinical symptoms of not only schizophrenia, but also bipolar affective disorder. The damage produced in the rat brain by neonatal BD V infection is similar to that seen in humans in the course of some neurodevelopmental disorders, e.g. autism or schizophrenia.

Conclusion. The perinatal BDV infection is a probable risk factor for schizophrenia and bipolar affective disorder.

Review article

Interleukin-6 - its functions and the effect on mood disorders and other disease processes

Anna Ryś, Anna Miodek, Paweł Szemraj, Janusz Szemraj, Józef Kocur
Postępy Psychiatrii i Neurologii 2007; 16 (4): 331-334

Objectives. To present the main functions of interleukin-6 (IL-6) - its role in the immunological response, inflammatory reaction, mood disturbances, and other disease processes.

Review. The advancement in psychoimmunology and psychoendocrinology in the late 20th century fostered a new understanding of IL-6 as one of the key cytokines regulating defense mechanisms. Numerous studies evidenced the important role of IL-6 in the pathophysiology of many disease processes and mood disorders.

Conclusions. Since IL-6 is involved in activation of the mechanisms that control the inflammatory reaction and immunological response, it constitutes an important link in their development. The IL-6 enhances the synthesis of specific antibodies by B lymphocytes, induces differentiation of cells towards cytotoxic lymphocytes, and suppresses proliferation of some neoplastic cells. An even hundredfold increment in the IL-6 level can be seen in inflammatory states and tumors. The IL-6 level is increased also in depressive disorders due to the enhanced activity of the hypothalamic-pituitary-adrenal axis. In consequence there is a rise in the concentration of glucocorticosteroids, leading to an exacerbation of symptoms typical of depressive disorders.

Review article

Immunological and endocrine aspects of pathogenesis of depression

Anna Ryś, Anna Miodek, Paweł Szemraj, Janusz Szemraj, Józef Kocur
Postępy Psychiatrii i Neurologii 2007; 16 (4): 335-337

Objectives. To analyze the relationship between depression and the immune system disorders that mediate an increased activity of the hypothalamic-pituitary-adrenal axis (HPA).

Review. In the 1980s the relation between depression and cell-mediated response impairment (i.e. a reduced absolute number of TandB lymphocytes, and diminished number and hypoactivity of NK cells) was described in many studies. In the 1990s reports were published concerning the effect of HPA axis disturbances on the pathogenesis of depression, as well as the association of depressive disorders with an increased level of proinflammatory cytokines in patients in whom the concurrence of depression and an inflammatory process had been excluded.

Conclusion. In the 20th century a significant progress was made in the understanding of mechanisms underlying the immune and endocrine system dysfunctions in the pathogenesis of recurrent depressive disorders. A number of stressful stimuli can lead to an increase in the levels of proinflammatory cytokines such as IL-1, IL-6 or TNF- a produced in the peripheral and central nervous system. The increased cytokine concentration in the c.n.s. results in an increased activity of the HPA axis and in consequence, in an increased concentration of corticoliberin and glucocorticosteroids. The latter can evoke and exacerbate the symptoms characteristic of depressive disorders.

Review article

The role of trauma in the onset of some mental disorders

Kinga Bobińska, Antoni Florkowski, Maciej Kuśmierek, Piotr Wierzbiński, Sławomir Szubert
Postępy Psychiatrii i Neurologii 2007; 16 (4): 339-344

Objectives. An attempt was made in the paper to draw attention to the role of childhood trauma in the development of some mental disorders. Another aim was to outline the role of particular neurotransmitters and the stress axis hormones through which traumatic experiences may lead to the development of affective disorders and psychoses.

Review. Childhood exposure to traumatic experiences results in a long-term hyperactivity of the corticotropin-releasing factor (CRF) system, and in numerous changes in the other pathways of neurotransmission. This leads to an enhanced stress responsiveness of the organism.

Conclusions. Research findings accumulated so far seem to confirm the importance of trauma for the development of affective and psychotic disorders, through the individual's increased vulnerability to stress.

Review article

Conceptions of sexual education in the years 1904-1914 as presented in the Warsaw Society of Hygiene press publications

Bartosz Nowożycki
Postępy Psychiatrii i Neurologii 2007; 16 (4): 345-350

Objectives. The modern hygiene movement started in Poland in the early 20th century. The process was associated with the establishment of the Warsaw Society of Hygiene. In the press publications by the Society the problems of hygiene were discussed in the context of a wideranging social program, strongly influenced by the ideas of eugenics. The dramatic state of hygiene in the country and Polish hygienists' striving for good physical and mental health of the citizens demanded that a program of sexual education should be developed. The conceptualization of the sexual education program is outlined in this paper.

Review. The analysis of views on sexual education shared by the Warsaw Society ofHygiene was based on four articles by Drs Konstanty Stróżewski, Zygmunt Srebrny, Leon Wernic and Mieczysław Michałowicz, published in the journal "Zdrowie". The articles can be regarded as presenting the ideological program of Warsaw hygienists. Sexual education of youth was expected to be a rational process controlled by parents and teachers. Adolescents should be provided with information concerning the hygiene of sex life and prepared to parenthood. The process of sexual education was divided into age-adjusted stages. This model of education was characterized by openness to the needs and problems of the youth.

Conclusions. The conceptions of sexual education proposed by Warsaw hygienists in the early 20th century were implemented in the education process in the years 1918-1939, in the independent Poland. They were reflected in the applied methods and in the care taken of adolescents' psychophysical development.

Case report

Sources of discrepancies in forensic psychological opinions

Anna Pilszyk, Ewa Waszkiewicz, Teresa Gordon
Postępy Psychiatrii i Neurologii 2007; 16 (4): 351-355

Objectives. Discrepancies in forensic psychological opinions concerning the same case are relatively frequent. Such differences of opinion make the judiciary authorities distrustful of expert psychologists' professional competence and result in appointing new experts.

Case reports. Several relevant cases are described in the paper and the reasons of differences in forensic psychological opinions are discussed. The discrepancies resulted either from formal errors, an inappropriate choice of diagnostic methods, or from erroneous interpretation.

Commentary. These causes of discrepancies in psychological opinions could be avoided or at least minimized if standards for expert reports were developed and propagated. Such standards would serve expert psychologists as a model to be followed in their preparation of clear, coherent and comparable opinions, comprehensible and easily assessable by courts. The development of such a standard is being discussed.

Clinical hints

STOPP - an Australian program of cognitive-behavioral therapy for patients after the first episode of psychosis

Aleksandra Waluk, Marzenna Falkowska-Śleszyńska, Andrzej Czernikiewicz
Postępy Psychiatrii i Neurologii 2007; 16 (4): 357-360

Objective. To present a psychotherapeutic program designed for patients after the first episode ofpsychosis.

Review. Early intervention in psychotic disorders is an important predictor of recovery. In the study the context of the first episode psychosis was described. The STOPP Program (Systematic Treatment of Persistent Psychosis) - a proposition of cognitive-behavioural therapy in the first episode psychosis was outlined and discussed. The theoretical model and basic assumptions of cognitive-behavioural therapy were presented. The following phases of the STOPP program were discussed in detail: (I) developing a collaborative working relationship; (II) exploring and coping with psychosis; (III) strengthening the capacity to relate to others; and (IV) finishing and moving on. Therapeutic interventions during each phase were characterized.

Conclusions. The treatment of psychoses includes pharmacotherapy and psychosocial interventions (i.e. psycho- and sociotherapy). The provision of only one, isolated form of treatment turns out to be insufficient to attain the patient's complete recovery, therefore inclusion of psychotherapeutic interventions is advisable. The paper draws attention, firstly, to the cognitive-behavioural therapy efficacy in reducing psychotic symptoms, and secondly, to early intervention benefits.