Archives 1992-2013

2011, volume 20, issue 2

Special paper

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

Norman Sartorius, Wolfgang Gaebel, Helen-Rose Cleveland, Heather Stuart, Tsuyoshi Akiyama, Julio Arboleda-Flórez, Anja E. Baumann, Oye Gureje, Miguel R. Jorge, Marianne Kastrup, Yuriko Suzuki, Allan Tasman
Postępy Psychiatrii i Neurologii 2011; 20(2): 89–104

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigmaon a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

Original article

TaqIA polymorphism of DRD2 receptor gene and the risk of developing substance dependence

Joanna Biskupska, Grażyna Adler, Krzysztof Borowiak, Małgorzata Drożdżyńska, Grażyna Zielińska, Barbara Potocka-Banaś, Jarosław Piątek, Andrzej Ciechanowicz
Postępy Psychiatrii i Neurologii 2011; 20(2): 105–109

Background. Psychoactive substance abuse leads to a chronic, recurrent CNS disease, complex in terms of its etiology, molecular mechanisms, clinical course, and treatment. This process is underpinned by interacting genetic, psychological and environmentalfactors. It has been evidenced time and again that not only alcohol, but also other psychoactive substances produce a rewarding effect in the midbrain dopaminergic system. Due to the postulated universal character of this process the dopaminergic transmission pathway constituents became the subject of research into genetic determinants of substance dependence. The aim of this study was to investigate the relationship between TaqIA polymorphism of the DRD2 gene and the risk of developing dependence on psychoactive substances (including amphetamine, THC, and opiates) among patients of an outpatient substance dependence treatment clinic in Szczecin.
Method. Participants in the study were 100 patients (88 men and 12 women aged 18-52 years) of the Outpatient Clinic for Substance Dependence Treatment in Szczecin. The controls were 114 newborns (95 male and 19 female) delivered at the PUM Obstetrics and Gynecology Clinic in the years 2004-2005. Their DNA used in the study was obtained from umbilical cord blood. Results. There were no significant differences between the group of substance dependent patients and the controls as regards the distribution of the genotypes and alleles under study.
Conclusions. In the analyzed material no relationship was found between the DRD2 gene TaqIA polymorphism and an increased risk for developing dependence on the psychoactive substances taken into account in the study.


Observation in a psychiatric facility under the Code of Criminal Procedure Amendment to Article No. 203

Piotr Gałecki, Antoni Florkowski, Kinga Bobińska, Krzysztof Eichstaedt
Postępy Psychiatrii i Neurologii 2011; 20(2): 111–117

Objectives. The aim of the paper is to present an assessment of the current Polish legislation concerning observation in a psychiatric hospital. The issues of the perpetrator's accountability and forensic-psychiatric observation are discussed both from a historical perspective and in the light of the legal regulations currently in force.
Review. Particular attention was paid to a number of issues: the changing-over-the-years approach to observation of the accused (suspect) in a psychiatric care facility, change of the proponent or of the authority competent to decide whether psychiatric observation needs to be implemented, as well as the possible observation period duration and its extension within a specified time limit. The amendment to Article 203 of the Code of Criminal Procedure was discussed in detail from the perspective of the expert forensic psychiatrist and of the proceeding authority for adjudication of placement under psychiatric observation.
Conclusions. The amendment to Article 203 of the Code of Criminal Procedure has brought positive changes concerning observation in a psychiatric hospital, and provided new possibilities for both forensic experts and courts. However, it is still not free of flaws.


The role of changes in regional cerebral hemodynamics in the process of aneurysm development and rupture

Wojciech Świątnicki, Piotr Komuński, Krzysztof Tybor, Mariusz Heleniak, Bartosz Bryszewski, Marek Zawirski
Postępy Psychiatrii i Neurologii 2011; 20(2): 119–125

Objectives. The aims of this report were to present different hemodynamic consequences of the circle of Willis variations and to estimate their significance in the development and rupture of cerebral aneurysms.
Review. Cerebral aneurysms are pathologic dilations of the arterial wall that most frequently occur near arterial bifurcations in the circle of Willis. It is generally accepted that unique structural features of cerebral vasculature contribute to development and subsequent rupture of aneurysms. Among the risk factors of aneurysm growth and rupture, certain hemodynamic aspects of cerebral blood flow as well as intra-aneurysmal flow patterns may be considered as significant. In addition, aneurysm hemodynamics was proved to be contingent not only on the aneurysm geometry (i.e. its size and shape), but also on its relation to the parent vessel (i.e. nutrient vessels configuration and diameter). Moreover, the work on Computed Fluid Dynamics demonstrated a correlation between cerebral arterial circle morphology and certain hemodynamic flow patterns which directly affect the vascular wall biology, weakening the vessels.
Conclusions. The risk of aneurysm rupture depends on many factors including genetic aspects, certain structural features of the cerebral vessels, and the aneurysm geometry. With the increasing use of noninvasive intracranial imaging, a vast number of clinically silent aneurysms are discovered incidentally prior to their rupture or exerting pressure on adjacent structures. Since the prognosis after subarachnoid hemorrhage is still poor, a possibility of early treatment in patients with high risk for aneurismal bleeding would be most desirable. The authors believe that the cerebral hemodynamics aspects outlined in the review may be helpful in estimating the risk of rupture among the patients suffering from this vascular pathology, and in assessing potential benefits and risks associated with the planned treatment.

Case report

Combined intravenous and intra-arterial thrombolytic therapy in patients with acute ischemic stroke – four case reports

Piotr Sobolewski, Jarosław Wójcik, Irena Łabudzka, Tomasz Adamczyk, Monika Śledzińska, Marcin Grzesik, Wiktor Szczuchniak
Postępy Psychiatrii i Neurologii 2011, 20(2): 127–134

Background. Intra-arterial (IA) thrombolysis is an emerging treatment method for acute ischemic stroke. In IA thrombolysis, the cervicocephalic arterial tree is traversed with an endovascular microcatheters delivery system, the tip of a catheter is positioned directly in the middle of the clot or next to it, and fibrinolytic agents are infused directly into the clot.
Material and methods. We present 4 patients treated in our Department with this method in the year 2009. All the patients received IV t-PA treatment which was ineffective, or IV thrombolytic therapy followed by a rapid recurrence of signs of stroke.
Conclusion. Combined IV and IA thrombolysis is a promising treatment strategy for acute ischemic stroke.

Case report

Can spinal tuberculosis be an interdisciplinary problem? Two case reports

Małgorzata Wiszniewska, Marcin Rogoziewicz, Ewa Ptaszyńska, Tomasz Przysiecki, Wojciech Kozubski
Postępy Psychiatrii i Neurologii 2011, 20(2): 135–140

Background. Tuberculosis is a systemic disease most often affecting the respiratory system. However, 1-3% of patients present with lesions of the osseous system, usually in the spinal column. Tuberculous lesions are located in the anterior part of two adjacent vertebral bodies with the intervertebral disk. The initial symptoms are nonspecific. The patients' complaints include osseous pain, limited mobility and local tenderness, weight loss, hyperhidrosis and subfebrile body temperature. Classic X-ray examination and imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), are most useful in the diagnostic procedure. Antituberculotic therapy should be implemented immediately on diagnosing the condition, and the treatment period of 9-12 months is recommended.
Case reports. The authors present two patients with back pain, diagnosed with spinal tuberculosis at the neurology department on the grounds of their medical history, neurological examination, and imaging techniques. Specific antituberculotic therapy supplemented with multidirectional treatment was rapidly implemented and continued over many months. The treatment was effective – the symptoms disappeared, and the patients' motor ability improved attaining the premorbid level.
Commentary. In patients with inexplicable back pains a possibility of skeletal tuberculosis should be taken into account, especially if systemic symptoms are present. The use of imaging techniques is most important in the diagnostic procedure. Early diagnosis and proper treatment of vertebral tuberculosis can lead to full recovery. Interdisciplinary cooperation among different medical specialists as in the reported cases, seems crucial in the process of diagnosis and comprehensive treatment.

Case report

Between the Scylla of hospitalization and Charybdis of untreated psychosis – dilemmas of the patient and his psychiatrist. A case report

Janusz Chojnowski
Postępy Psychiatrii i Neurologii 2011, 20(2): 141–148

Objective. The paper presents the dilemmas faced and decisions made by the psychiatrist in his clinical practice.
Case report. A female patient treated for schizophrenia prior to her hospitalization had asked her doctor to disregard her request for discharge from the hospital should such a request be made during her hospital stay. She subsequently did request discharge during her hospitalization and was involuntarily detained on the grounds of the Mental Health Act. This allowed to achieve a beneficial treatment outcome and to form a therapeutic alliance with the patient.
Commentary. From the legal viewpoint these are banal phenomena, but from that of the patient-psychiatrist relationship they are of pivotal importance, being most significant for the therapeutic alliance. In the author's opinion the matter is deserves reflection.