Archives 1992-2013

2010, volume 19, issue 3

Special article: personal experiences

My way to recovery

Anna Kubiak
Postępy Psychiatrii i Neurologii 2010; 19(3): 183–184

On the grounds of her personal experiences the author presents her own vision and interpretation of the recovery process seen as a way from the chaos of psychosis through a period of isolation and adjustment (mindfulness, observation, analysing) to mental balance (Ed.).

Original article

Second-generation antipsychotics in the treatment of delirium

Tomasz Sobów
Postępy Psychiatrii i Neurologii 2010; 19(3): 191–196

Aim. The aim of the study was to review the existing clinical trial evidence about the effectiveness and safety of second-generation antipsychotics (APIIG) in symptomatic treatment of delirium, excluding alcohol-related delirium or that following substance abuse.
Method. The database search results obtained using selected keywords (delirium, management, treatment) were limited to original research studies and sorted by APIIG international drug name.
Results. Four randomized controlled clinical trials, 17 prospective open trials and 4 retrospective case record reviews were identified, with the total number of 1113 patients. Risperidone, olanzapine and quetiapine, as well as amisulpride, aripiprazole and perospirone were all found to be potentially effective in symptomatic treatment of delirium. None of the APIIG drugs has been proven to be more efficacious than the standard comparator (haloperidol). However, APIIG were generally better tolerated than haloperidol, namely, their risk of adverse side effects (e.g. parkinsonism, oversedation) was lower.
Conclusions. As the supportive clinical findings are insufficient so far, it seems premature to recommend a routine use of second generation antipsychotics instead of haloperidol in the treatment of delirium. Risperidone, olanzapine and quetiapine, i.e. the APIIG drugs with the largest patient samples investigated, might be proposed as an alternative to haloperidol, especially in patients with respiratory deficiency, at risk for blood pressure changes, and in those with baseline extrapyramidal symptoms. Moreover, secondgeneration antipsychotics should be preferred in the treatment of delirium in patients with a history of poor haloperidol tolerance, involving particularly oversedation and parkinsonism.

Original article

Physical attractiveness and self-evaluation in relation to motives underlying the decision about cosmetic breast surgery and to expected consequences of the surgery

Maciej Pastucha, Teresa Rzepa, Andrzej Modrzejewski, Wilhelm Grzesiak
Postępy Psychiatrii i Neurologii 2010, 19(3): 197–204

Objectives. To explore the relationship of self-rated own physical attractiveness and personality traits to: (1) motives underlying the decision to undergo cosmetic breast surgery, and (2) expected consequences of the surgery.
Method. Participants in the study conducted in the years 2006‑2008 were 113 women who anonymously and individually responded to a questionnaire developed for the research purposes.
Results. The decision to improve their appearance is usually made by single women aged about 30, who assess their looks as rather attractive or average, and their personality traits as positive or very positive. Their self-rating of own physical attractiveness is consistent with that of their personality traits, and both these variables are related to inner-directedness of their decision-making concerning the surgery. However, neither of these variables is related to the participants' generally positive expectations of the cosmetic breast surgery consequences.
Conclusions. A combination of the patient's external motivation with overly positive expectations about post-surgery changes in her appearance and interpersonal relationships (especially these with her partner) involves the greatest risk to her mental health. Therefore, special attention and care are required from the medical team.

Original article

Assessment of the Mini-Mental State Examination usefulness in the diagnostics of post-surgery cognitive impairments in patients after general anesthesia in the prone position

Tamara Trafidło, Katarzyna Nowakowska, Tomasz Gaszyński, Wojciech Gaszyński, Irena Kovger
Postępy Psychiatrii i Neurologii 2010, 19(3): 205–209

Objective. To analyze the Mini-Mental State Examination (MMSE) usefulness in the assessment of post-operative cognitive impairments in patients who received general anesthesia in the prone positioning.
Method. The study sample consisted of 43 patients in the 28‑87 age range who had underwent surgery for lumbar spondylosis. The patients were assessed with a battery of neuropsychological tests before, 7 days after, and 30 days after the surgery. A performance level on the post-surgery tests lower by at least 20% than that at the baseline assessment was defined as cognitive impairment. The Mann- Whitney test and Fisher's exact test were used in the statistical analysis of the demographic factors that promote the postoperative cognitive dysfunctions. The Wilcoxon test served the assessment of MMSE results.
Results. No post-operative impairment was found using the MMSE. The remaining neurocognitive tests revealed a post-operative cognitive deterioration to varying degrees. The patients with post-operative cognitive impairments were significantly (p<0.005) characterized by older age, lower education level, longer time of anaesthesia, cardiovascular diseases and depressed mood diagnosed using the Beck Depression Inventory.
Conclusions. The MMSE lacks sufficient sensitivity to assess post-operative cognitive impairments. The other neurocognitive tests show minor deterioration of executive functions in a varied range.

Review article

Treatment of fronto-temporal dementia

Marcin Flirski, Tomasz Sobów, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2010; 19(3): 211–217

Aim. To present an update on available options for the frontotemporal dementia (FTD) treatment.
Review. FTD is an umbrella term describing a group of primarily degenerative dementias characterised by a restricted atrophy in the frontal and anterior temporal lobes. The primary feature of FTD is a predominance of severe behavioral and/or language disorders over memory problems typical of Alzheimer's disease (AD). Studies conducted to evaluate the efficacy of various FTD treatment methods are scarce, involve small patient groups, frequently lack methodological rigor, and as a rule evaluate medications that have purely symptomatic action on behavioral disturbances typical of FTD.
Conclusions. The basic option for the treatment of FTD behavioral disorders are serotonergic medications – SSRIs and trazodone. Symptoms that might respond to the serotonergic treatment include disinhibition, impulsivity, dysphoria, depression, anxiety, overeating and stereotypic behaviors. In case of patient behaviors threatening his/her or caregivers' safety, the introduction of atypical antipsychotic medications may be justified, preferably neuroleptics with a low D2 receptor affinity (considering the high risk of extrapyramidal symptoms in FTD patients). Unfortunately, no FTD treatment methods that can enhance cognition or slow disease progression are available yet. Cholinesterase inhibitors and memantine turned out to be ineffective in this regard, which may be due to a different pattern of neurochemical changes in FTD as compared to these in other types of primarily degenerative dementias. Preliminary results of the treatment with dopaminergic medications (moclobemide, selegiline, stimulants) are promising, but the available data are too scant to permit a recommendation of their routine use.

Review article

Structural and physiological changes in the central nervous system, and social functioning of schizophrenic patients and their healthy siblings – a review of literature published in the years 2006–2009

Marta Makara-Studzińska, Rafał Łoś, Ewa Latała-Łoś
Postępy Psychiatrii i Neurologii 2010; 19(3): 219–225

Objective. To analyze research findings published the years 2006–2009 concerning patients with schizophrenia and their relatives.
Review. One of the current approaches in the study of pathogenesis of schizophrenia is to compare schizophrenic patients with their healthy siblings in terms of neuroanatomical and neurophysiological features, as well as social functioning. Research findings reported in recent years provide growing evidence for the presence of cerebral abnormalities, both structural and functional, in healthy siblings. Detection and description of such abnormalities may help to promote understanding of the mechanisms of action of genetic and environmental factors in the development of psychosis.
Conclusions. In recent years a growing body of research compares patients with schizophrenia and their relatives. On the one hand, such studies seek biological risk factors that determine individual susceptibility to developing schizophrenia, and on the other they suggest the range of therapeutic interventions that should be provided to relieve the burden of schizophrenia on caregivers.

Review article

Risk of suicidal behavior during antidepressant treatment: are the warnings justified?

Tomasz Pawełczyk, Agnieszka Pawełczyk, Jolanta Rabe-Jabłońska
Postępy Psychiatrii i Neurologii 2010; 19(3): 227–234

Aims. To summarize the current research findings from randomized, placebo-controlled trials, observational epidemiological studies and meta-analyses concerning the relationship between antidepressant treatment and the risk of suicidal behaviors among children, adolescents and young adults.
Review. On the grounds of an analysis of data reported in clinical studies pharmaceutical inspection agencies issued warnings about increased risk of suicidal behaviors in the child and adolescent, and later also young adult populations treated with antidepressants. These reports started a hot debate in psychiatric circles on the effectiveness of antidepressants in the child and adolescent population and on the alleged increase in their suicidal behavior risk. The latter was surprising to many clinicians, and seemed inconsistent with the fact that many antidepressant medications had been proven to prevent relapse of depressive disorders.
Conclusions. The results of randomized, placebo-controlled trials as well as meta-analyses of observational studies indicate that an increased risk of suicidal behaviors during the first few weeks of antidepressant treatment is possible, particularly among children, adolescents, and young adults. Therefore the decision to introduce antidepressant medication should be made individually, possible therapeutic benefits of such treatment should be carefully considered, and antidepressant treatment should be monitored in these age groups in accordance with the recommendations.

Practical notes

Penal code regulations concerning the rights and duties of persons in mental hospital detention as a security measure

Danuta Hajdukiewicz
Postępy Psychiatrii i Neurologii 2010; 19(3): 235–241

Aims. To draw attention to the executory penal code revisions introduced under the Act of July 24th, 2003, eliminating the discordance between the management of persons detained in a mental hospital and legal regulations of the Constitution of the Republic of Poland.
Legal regulations. The hitherto obligatory principles of the management of persons detained in mental hospital, specified in the Ordnance of the Minister of Health of 26th February 2001, restricted their constitutional rights and freedoms by being discordant with Article 31, paragraph 3 of the Constitution of Poland that provides the possibility to restrict the constitutional rights and freedoms only on the grounds of the Act "and only if it is necessary in the democratic state for its security or public order, or for the environment, public health and morality protection, or for freedom and rights of third parties" and will not infringe the essence of freedom and rights. Under the Act of 24th July 2003 revised were the provisions concerning the types of mental hospitals and alcohol/drug treatment facilities, the principles and mode of referring patients therein, as well as the rights and duties of perpetrators detained in such institutions – thus the discrepancies between legal regulations and the Constitution of Poland were eliminated. An appropriate executive ordnance was issued by the Minister of Heath with annexed rules specifying the rights and duties of persons treated in enhanced security or maximum security psychiatric care facilities.
Commentary. On the grounds of the regulations exemplified in the annex particular facilities should develop their own rules to acquaint the patients and staff with their rights and duties, and to prevent misunderstandings and problems resulting from insufficient information.