Archives 1992-2013

2011, volume 20, issue 3

World Psychiatry Forum

Pathophysiology of schizophrenia: do we have any solid evidence of interest to clinicians?

Stephen M. Lawrie, Bayanne Olabi, Jeremy Hall, Andrew M. McIntosh
Postępy Psychiatrii i Neurologii 2011; 20(3): 159–174

A diagnosis of schizophrenia, as in most of psychiatric practice, is made largely by eliciting symptoms with reference to subjective, albeit operationalized, criteria. This diagnosis then provides some rationale for management. Objective diagnostic and therapeutic tests are much more desirable, provided they are reliably measured and inter preted. Defi nite advances have been made in our understanding of schizophrenia in recent decades, but there has been little consideration of how this information could be used in clinical practice. We review here the potential utility of the strongest and best replicated risk factors for and manifestations of schizophrenia within clinical, epidemiological, cognitive, blood biomarker and neuroimaging domains. We place particular emphasis on the sensitivity, specifi city and predictive power of pathophysiological indices for making a diagnosis, establishing an early diagnosis or predicting treatment response in schizophrenia. We conclude that a number of measures currently available have the potential to increase the rigour of clinical assessments in schizophrenia. We propose that the time has come to more fully evaluate these and other well replicated abnormalities as objective potential diagnostic and prognostic guides, and to steer future clinical, therapeutic and nosological research in this direction.

Original paper

Non-specific psychopathological symptoms, motivational factors and sense of coherence in patients with anorexia and bulimia nervosa

Paweł Sala, Witold Simon
Postępy Psychiatrii i Neurologii 2011; 20(3): 185–191

Objectives. The aim of the study was to compare patients with either anorexia or bulimia nervosa for differences in severity of nonspecific psychopathological symptoms, motivational factors and sense of coherence levels, and to establish mutual relationships between these variables.
Methods. Two groups of 35 patients each, diagnosed with either anorexia nervosa or bulimia nervosa by the ICD-10 criteria, and a comparative group of 35 patients with neurotic disorders were examined using a number of questionnaires: the HSCL in a Polish adaptation for symptom assessment, a Motivation Questionnaire (KM), and the Orientation to Life (SOC-29) scale to measure sense of coherence. The participants were examined twice, at the time of qualification for inpatient treatment (T1), and on admission (T2).
Results. At T1 (qualification for treatment) patients with anorexia as compared to those with bulimia revealed more severe non-specific psychopathological symptoms and higher motivation to treatment. On admission (T2) the differences were no longer significant. In both groups sense of coherence was lower.
Conclusions. In patients with anorexia nervosa non-specific psychopathological symptoms may be associated with higher motivation to treatment. The level of sense of coherence did not differentiate between the two types of eating disorders.

Original paper

Interdisciplinary team – a new quality in community mental health care

Paweł Bronowski, Maryla Sawicka
Postępy Psychiatrii i Neurologii 2011; 20(3): 193-199

Background and objectives. The interdisciplinary team is the core of any efficiently functioning community support system. Activities of the team usually include social activation, training in new skills, and providing support in daily life. Community-based systems of rehabilitation and support for the mentally ill rely on non-medical staff, nowadays quite numerous throughout the country. Although these facilities have been functioning in Poland for a long time, little is known about their staff. The aim of this study was to characterize the staff of community care facilities in two residential districts of Warsaw (Targówek and Białołęka), with the emphasis on major difficulties encountered by staff members in their work and their need for support.
Method. Participants in the study were 30 staff members employed in community social support services. The main research tool, i.e. a questionnaire developed for the purposes of the study, allowed to collect data on the respondents' therapeutic specialty, their place of employment and length of employment, job description, job satisfaction, and reported occupational problems.
Results. A majority of our respondents were university graduates of pedagogy, while the least numerous group were occupational therapists by training. Their basic responsibilities included social activation, occupational therapy, and providing support in self-dependent daily life. Occupational activation, job seeking and contacts with employers were the least often indicated tasks in the job description. Aggressive behaviors of the charges and difficulties in co-operation with the mental health care system were regarded as the most important occupational problems.
Conclusions. Community care to people with mental disorders is presently provided in Poland to a large extent by non-medical teams not linked directly to the psychiatric care system, but rather to that of social welfare and to non-governmental organizations. Such teams will probably develop, growing in numbers and importance. It seems worthwhile considering how to support them and how to develop effective lines of communication with the mental health care system. At present the two milieus work to a large degree separately. Moreover, there is an obvious need for a nationwide training program aimed at improvement of professional skills required in work with the mentally ill in the community.

Original paper

Psychoeducation for patients with schizophrenia – a preliminary analysis of psychoeducational sessions methodology

Małgorzata Chądzyńska, Joanna Meder, Katarzyna Charzyńska, Anna Drożdżyńska
Postępy Psychiatrii i Neurologii 2011; 20(3): 201-206

Objectives. The aim of the study was to analyze methodology and topics of psychoeducational sessions for patients with schizophrenia.
Method. In this cross-sectional study 16 therapists responded to a questionnaire concerning the settings and methods they used in psychoeducational sessions.
Results. No significant differences between therapists were found regarding the techniques and contents of psychoeducational sessions. The most frequently reported topics included: providing information about the illness and its pharmacological treatment, as well as training in social skills and coping with stress. The problems encountered in family psychoeducation concerned the family members' sense of guilt and inability to accept the illness, their avoiding talking about the illness, as well as the therapists' difficulty in communicating with families.
Conclusions. Psychoeducation should not only provide information about the illness, but also include therapeutic techniques aimed at minimization of consequences of the illness in everyday life. Careful qualification to particular groups it is necessary, taking into account the patient's clinical status and his/her attitude to the illness. In family psychoeducation family members' individual ways of coping with the burden of the patient's illness should be considered.

Case report

Decompressive hemicraniectomy for massive infarction in the middle cerebral artery area in patients treated with rt-PA – a report of two cases

Małgorzata Wiszniewska, Piotr Winkler, Wojciech Beuth, Grzegorz Waliszek, Bartosz Woźniak
Postępy Psychiatrii i Neurologii 2011, 20(3): 207–211

Background. Roughly 10‒15 percent of ischemic strokes in the area of the middle cerebral artery (MCA) are classified as malignant due to the development of malignant cerebral oedema. In patients with this syndrome receiving only pharmacological treatment the death rate amounts to 80%. The results of randomized controlled trials show clear benefits from decompressive hemicraniectomy, i.e. improved survival rates and better functional outcomes as compared to these attained in conservative medical treatment.
Case reports. The authors present two male patients aged 46 and 53, with malignant MCA infarct managed with rt-PA. Decompressive hemicraniectomy was performed with a favourable early 30-day outcome in both patients. The beneficial outcome of hemicraniectomy was observed at a 3-month follow-up in one patient (his health status was satisfactory, score 3 on the mRs scale). The other patient died suddenly 40 days from stroke, for reasons unrelated to hemicraniectomy.
Commentary. The paper presents a review of the research literature on usefulness of hemicraniectomy in the treatment of malignant cerebral edema in the course of MCA infarction. The authors wanted to share their modest experience, suggesting that hemicraniectomy can be performed in a non-academic center as well, provided that good cooperation with a neurosurgeon is established.

Case report

Impact of the family system on the diagnostic process in a patient with bipolar affective disorder

Krzysztof Krysta, Bartłomiej Janas, Ewa Grudzińska, Agnieszka Skrzypulec, Seweryn Segiet, Jacek Przybyło
Postępy Psychiatrii i Neurologii 2011, 20(3): 213–216

Objective. An analysis of the family system influence on the diagnosis and therapy of a female patient with bipolar affective disorder.
Case report. The 32-year-old woman suffering from bipolar affective disorder, with a history of five previous psychiatric hospitalizations, receives pharmacotherapy and participates in group and individual psychotherapy sessions. Remaining under the influence of her family system based on co-dependence she has developed the dependent personality traits. There is a strong association between the family system influence and relapses of her bipolar disorder with atypical course and occurrence of mixed states. In the management of the patient a combination of pharmacological treatment with psychotherapy tailored to meet her exceptional needs turned out to be most effective.
Commentary. The reported case confirms the importance of individually tailored therapeutic approach and the need for developing flexible diagnostic guidelines that would provide for intermediate conditions.

Case report

Chronic anxiety disorders after acute non-allergic reaction to penicillin

Krzysztof Krysta, Anna Paliga, Joanna Leszczyńska, Izabela Oberda
Postępy Psychiatrii i Neurologii 2011, 20(3): 217–219

Objective. A case of acute non-allergic reaction following penicillin administration is described.
Case report. The major symptoms included dyspnoea, chest constriction, palpitations, and strong fear of death. The symptoms developed within less than 20 seconds from the injection and disappeared after about 15 minutes. The incident initiated a long-term anxiety disorder accompanied by somatic symptoms resembling the primary reaction to penicillin.
Commentary. A possibility of long-term sequelae of an acute reaction to medication should always be taken into account. Such side effects may severely impair the patient's psychosomatic condition and affect his/her quality of life.