Archives 1992-2013

2008, volume 17, issue 3

Original article

Metabolic syndrome and its components in patients with first-episode schizophrenia before and after a 1-year antipsychotic treatment

Jolanta Rabe-Jabłońska, Anna Dietrich-Muszalska, Grzegorz Nawarski, Tomasz Pawełczyk
Postępy Psychiatrii i Neurologii 2008; 17 (3): 195-200

Objective. The aim of the study was to evaluate the prevalence of metabolic syndrome (MS) and its components in young patients diagnosed with first-episode schizophrenia, before and after a 1-year antipsychotic treatment with the same neuroleptic.
Methods. Participants in the study were 30 patients aged 16-21, with the first episode of schizophrenia and no other mental and somatic disorders (ICD-10), never treated with antipsychotics previously. They were examined before and after a 1-year treatment with a single neuroleptic; during the treatment they received no other psychotropic drugs. At baseline and on the treatment completion their fasting glucose level, total cholesterol, its fractions (HDL-C, LDL-C) and TG levels, waist circumference, body weight, and blood pressure were measured. The results were compared with these obtained in a diagnostically similar Polish population (EUFEST) and in the general population of Poland (NATPOL PLUS).
Results. At baseline none of the patients had MS, and the prevalence of MS components was lower than both in the in EUFEST sample and in the general population. After the 1-year antipsychotic treatment 10% of the patients were diagnosed with MS. The number of patients diagnosed with more than two MS components among those treated with LPIIG increased, indicating a higher risk of developing MS by the young patients. Over 2/3 of the patients gained in body weight, while an >5% increase in the baseline weight was found in " of this group. In about 1/3 of the patients waist circumference was above the norm, and this was usually associated with a pathological lipid profile. This phenomenon was found both in patients treated with typical neuroleptics and in those receiving second-generation antipsychotics, but the most frequent and conspicuous body weight increments followed olanzapine treatment. While none of the patients displayed carbohydrate metabolism impairment before treatment, after treatment this condition was found in a single case only.
Conclusions. The data suggest that risk factors for MS should be assessed prior to pharmacotherapy, appropriate antipsychotic medication should be selected with due caution, patients and their caregivers should be educated about the need for adequate diet and physical activity, and the patients' waist circumference as well as laboratory parameters should be monitored during pharmacological treatment.

Original article

Usefulness of diffusion-weighted magnetic resonance imaging (DWI-MR) with apparent diffusion coefficient (ADC) mapping for detection of fresh foci of demyelination and ADC changes in the cerebral white matter in patients with sclerosis multiplex

Renata Poniatowska, Małgorzata Lusawa, Jarosław Krakiewicz, Wanda Sobczyk, Grzegorz Witkowski
Postępy Psychiatrii i Neurologii 2008; 17 (3): 201-205

Objectives. The purpose of the study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DWI-MR) in patients with multiple sclerosis (MS).
Method. The MR examination including standard MR imaging and diffusion-weighted images (DWIs) was performed in 66 patients diagnosed with MS and in 23 controls.
MS patients were divided into two groups on the grounds of their MRI scans: one consisted of patients showing plaque formation, and the other of those without any demyelination symptoms. Apparent diffusion coefficients (ADCs) were measured in the normal-appearing white matter (NAWM) of frontal, parietal and temporal lobes of both cerebral hemispheres.
Results. Statistically significant differences in white matter ADCs were found between MS patients (M= 117.32; SD = 8.68; SE = 1.069) and the control group (M = 109.21; SD = 10.251; SE = 2.138)), as well as between MS patients with numerous foci of demyelination and those without such foci (M= 119.47; SD = 7.965; SE = 1.105, and M = 111.3; SD = 8.617; SE = 2.303, respectively).
Conclusions. ADC mapping is a simple and repeatable method allowing to assess the degree of white matter damage. The technique may be useful not only for the assessment of MS severity, but also for long-term monitoring of its course and of treatment outcomes.

Review article

Matrix metalloproteinases in gliomas

Anna Łapka, Jagoda Drąg, Anna Goździalska, Jerzy Jaśkiewicz
Postępy Psychiatrii i Neurologii 2008; 17 (3): 207-211

Objectives. Gliomas, tumors derived from glial cells, represent about 50% of all cerebral tumors. The aim of this review is to outline the role of matrix metalloproteinases in the pathological mechanism underlying the development of gliomas.
Review. Matrix metalloproteinases (MMPs) are a group of proteolytic enzymes that modify the tissue structure andfunction under various physiological and pathological conditions. MMPs activity in the nervous tissue was observed to increase in the process of cancerogenesis. In this type of tissue extracellular matrix (ECM) is produced mainly by glial cell secretion. Pathological ECM changes usually result from glial cells' function impairment due to the carcinogenic process, leading eventually to glioma development. Substrate specificity of MMPs in the CNS was demonstrated, as well as a positive correlation between MMPs activity and cancer progression. MMP-2, MMP-9 and MMP-14 were evidenced to be the main proteolytic enzymes in the brain tissue ECM under pathological conditions. Moreover, collagen proteins type I, II, III, IV, V, laminin, fibronectin, aggrecan, perlecan and tenascin were found to be the main substrates for those enzymes.
Conclusions. Understanding the MMPs function in glioma progression will allow to enlarge the present body of knowledge about this cancer group. In the future MMPs may also serve as a potential prognostic marker.

Review article

Endophenotypes in schizophrenia

Aneta Tylec, Katarzyna Kucharska-Pietura, Marta Stryjecka-Zimmer
Postępy Psychiatrii i Neurologii 2008; 17 (3): 213-217

Objective. The paper presents the concept of endophenotype in psychiatry as exemplified by schizophrenia.
Review. In genetic research on mental disorders a concept of endophenotypes or "indirect phenotypes " has been introduced. This "indirect" diagnostic approach can be used in cases not fulfilling all the clinical diagnostic criteria for a specific mental disorder. Such persons might be carriers of a relevant gene manifested in the form of an endophenotype. In the concept of endophenotypes foundations of a biological classification of mental disorders are taken into account. In molecular and genetic studies on schizophrenia the following endophenotypes are analyzed: neurophysiologic, neurocognitive, neuropsychological, neuroanatomical, biochemical, and behavioral. The most popular among researchers are neurophysiologic and neuropsychological parameters known as phenotypic markers of schizophrenia.
Conclusions. Research findings obtained so far corroborate the usefulness of endophenotypes in further genetic research. Identification of more homogeneous phenotypes of mental illness will allow to develop new etiological models of schizophrenia contributing to our better understanding of molecular underpinnings of mental disorders. Furthermore, implementation of endophenotype research findings in clinical practice might help to reduce variability of patient subgroups on the grounds of similarities in their pathophysiological features, symptoms and functional deficits. This might facilitate further research into novel, more effective treatment approaches.

Review article

Neurobiological determinants of impulsive and suicidal tendencies: the role of the endocannabinoid system

Piotr Wierzbiński, Piotr Gałecki, Maciej Kuśmierek, Sławomir Szubert, Kinga Bobińska, Stanisław Teleśnicki, Antoni Florkowski
Postępy Psychiatrii i Neurologii 2008; 17 (3): 219-223

Objectives. The etiology of impulsivity and aggressive behavior is explained in terms of many factors, including social, environmental, and socioeconomic characteristics. Moreover, neurobiological factors seem to be of the utmost importance. The concurrence of affective disorders with the individual's enhanced impulsivity significantly increases his/her suicide risk.
Review. The findings of recent years have shown the endocannabinoid system involvement in a number of processes occurring in the central nervous system. Interaction between the endocannabinoid system, neurotransmitters and the neuroendocrine system suggests a considerable influence of endocannabinoids on psychological well-being.
Conclusions. Endocannabinoid receptor antagonists reduce aggression, impulsivity and may lead to mood improvement, thus potentially contributing to a decrease in suicide rates.

Review article

The role of GAD1 (glutamate decarboxylase 1) gene and its epigenetic regulation in etiopathogenesis of schizophrenia

Adam Wysokiński, Wojciech Gruszczyński
Postępy Psychiatrii i Neurologii 2008; 17 (3): 225-228

Objective. The following databases: ProQuest, ScienceDirect, PubMed and EBSCOhost were analyzed using two key words - "GAD1" and "schizophrenia", with preference for papers published since the year 2000. The article presents paradigms and findings of most recent studies on H3 histone hypermethylation at GAD1 gene promoter, methylation of GAD1 gene promoter and assumed implication of these phenomena in the etiopathogenesis of schizophrenia.
Review. The epigenetic (extragenetic) inheritance is defined as involving mechanisms that participate in the emergence of filial cell characteristics unrelated to genetic mutations ofparent cells. One of the epigenetic mechanisms is histone hypermethylation, or direct DNA methylation and subsequent inhibition of gene expression.
Conclusions. Methylation plays an important role in the regulation of genes in GABAergic neurons, and thus in the neurobiology of schizophrenia. The results obtained so far provide a starting point for future theoretical studies and experimental research.

Practical hints

How to measure community-based treatment efficacy?

Katarzyna Prot-Klinger, Małgorzata Pawłowska
Postępy Psychiatrii i Neurologii 2008; 17 (3): 229-232

Objective. The paper presents various methods of evaluating the effectiveness of community-based psychiatric care provision.
Review. Community psychiatry is a recommended by the WHO form of treatment for people with severe mental disorders, including schizophrenia, bipolar affective illness, major depression, and dementia. The introduction of community psychiatry principles is associated with the process of deinstitutionalization, which despite its commendable striving to transfer mental health care provision from large mental hospitals to the community, may be also associated with increased rates of psychiatric patients' homelessness and poverty. In the light of these changes, evaluation of community-based treatment effectiveness becomes increasingly important. In the measurement of community-based treatment efficacy the health recovery model can be used, as well as the conception of therapeutic relationship . Other approaches include registration of the number of hospital admissions and hospitalization length, as well as the assessment of the patients' social functioning, their subjective quality of life, and family burden.
Conclusions. Community-based treatment efficacy is a complex phenomenon and should be conceptualized multidimensionally rather than limited to symptom relief only. An efficient performance of the community psychiatry sector depends on coordinated action of multidisciplinary teams, including among others the functioning of mental health centers and social assistance services.

Case report

Diagnostic difficulties in a case of dysmorphophobia - a case report

Aldona Augustyniuk, Beata Trędzbor, Krzysztof Kucia, Tomasz Mędrala, Robert Kowalczyk
Postępy Psychiatrii i Neurologii 2008; 17 (3): 233-235

Objective. A case is presented of body dysmorphic disorder, and a possibility is highlighted of a faulty diagnosis leading to therapeutic failure.
Case. In the course of clinical observation of a 28-year-old patient referred with a tentative diagnosis of paranoid schizophrenia, psychotic process was excluded and attention was drawn to the dysmorphic nature of his disorder. Since the age of 24 he had withdrawn from social relations, quit his job and used to spend time pondering on his appearance. He developed thinking disorders of delusional type. No symptom amelioration has been attained in pharmacotherapy provided so far.
Commentary. The onset of body dysmorphic disorder, even in a delusional form, should alert clinicians. Clinical evidence and research findings suggest that in cases of body dysmorphic disorder (BDD) selective serotonin reuptake inhibitors (SSRI) should be administered as the medication of choice. 1n the treatment of BDD any beneficial effects of neuroleptics remain uncertain.

Case report

Metachromatic leucodystrophy as a cause of dementia and organic delusional syndrome in young adults - a case report

Ilona Baleja-Stawicka, Ewa Kwiecińska, Iwona Kłoszewska, Agnieszka Ługowska
Postępy Psychiatrii i Neurologii 2008; 17 (3): 237-241

Objective. The aim of the article is to discuss diagnostic problems in some psychiatric syndromes seen in young adults that may be an initial manifestation of demyelinating disorders.
Case. In the reported case of late-onset metachromatic leucodystrophy in a young man the initial presenting symptoms were these of dementia and organic delusional syndrome, with no features suggesting focal damage in the CNS.
Conclusions. Late-onset metachromatic leucodystrophy should be taken into consideration in the differential diagnosis of dementia and organic delusional syndrome of unclear etiology in young adults.

Case report

Concurrence of systemic lupus erythrematosus (SLE) and depressive disorders - a case report

Joanna Kafel, Lena Cichoń, Małgorzata Derejczyk
Postępy Psychiatrii i Neurologii 2008; 17 (3): 243-245

Objective. A case of depression in the course of systemic lupus erythrematosus is reported.
Case. A female patient aged 46, suffering from recurring depressive episodes and diagnosed with systemic lupus erythematosus.
Commentary. The patient's depressive disorders may be a part of SLE symptomatology, a side effect of therapy with glicocorticosteroids, or an independent condition due to traumatic events.

Case report

Difficulties in forensic psychiatric assessment concerning biological effects of a psychological stressor - a case report

Dariusz Juszczak
Postępy Psychiatrii i Neurologii 2008; 17 (3): 247-249

Objectives. To analyze difficulties encountered in the forensic psychiatric assessment of a case involving biological consequences of impact of a psychological stressor.
Case. In the report biological effects of a psychological stressor in the person in a post-stroke state are outlined. Difficulties in formulating the expert opinion are discussed and theoretical assumptions that determined its final shape are justified.
Commentary. A hypothetical cause-effect relationship was proposed to explain the sudden breakdown in the patient's health in the reported case.

Case report

Legal doubts concerning compulsory admission of a patient on maintenance dialysis - case report

Beata Trędzbor, Katarzyna Piekarska-Bugiel, Krzysztof Kucia, Grzegorz Giemza, Radosław Stepańczak
Postępy Psychiatrii i Neurologii 2008; 17 (3): 251-253

Objective. In the paper legal doubts are discussed concerning compulsory admission to a mental hospital of a female patient receiving maintenance dialyses.
Case. The 43-year-old women on maintenance dialysis due to chronic renal insufficiency refused further dialyzing during her hospitalization at a Nephrology Department. Her denial posed a threat to life, and the consulting psychiatrist suspected a psychotic process.
Commentary. Even though the diagnosis of delusional disorder was confirmed, the patient was discharged with immediate effect on the grounds of a court decision. Ethical doubts remained with the authors.

Case report

A case of dissimulation in the course of schizophrenia - a case report

Marek Domański, Maciej Domański, Janusz Perzyński, Aneta Opolska, Anna Kowal
Postępy Psychiatrii i Neurologii 2008; 17 (3): 255-257

Objectives. A differentiation between malingering and dissimulation in a case of schizophrenia is presented.
Case. 30-year-old patient treated on the outpatient basis for paranoid schizophrenia in the past 3 years was receiving a welfare benefit on the grounds of this diagnosis. In 2006 he was admitted to a closed ward for a 6-week forensic psychiatric observation on a charge of punishable threats (he had threatened to kill his neighbor, which was irrelevant to his psychotic disorder). In the course of observation he presented a dissimulating attitude denying his psychotic symptoms. The psychotic symptoms he had reported prior to his hospitalization the patient explained by his strategy of purposeful malingering. He pleaded not guilty to the charge.
Commentary. The diagnosis of schizophrenia was confirmed by an analysis of the overall clinical picture in this case.

Case report

Diagnostic difficulties in forensic psychological assessment concerning malingering mental disorder - two case reports

Ewa Waszkiewicz, Anna Pilszyk
Postępy Psychiatrii i Neurologii 2008; 17 (3): 259-264

Objectives. To demonstrate diagnostic difficulties concerning mental disorders and malingering, which are of importance to expert psychiatrists expected to provide a forensic opinion on the extent of the individual's accountability and ability to take part in judicial proceedings.
Cases. Two cases are described of men submitted to forensic psychiatric assessment on several occasions. The assessments conducted so far had different legal consequences due to difficulties in diagnosing various nosological units.
Commentary. Any perpetrator of a criminal act has a right to defense. However, this right must be taken into account by the expert psychiatrist during forensic psychiatric assessment of a person charged. In the article the examinee's behaviors that may help to differentiate between malingering and genuine mental disorders are outlined.