Archives 1992-2013

2012, volume 21, issue 2

Special article

WPA Forum: Broadening the diagnosis of bipolar disorder: benefi ts vs. risks

Stephen M. Strakowski, David E. Fleck, Mario Maj
Postępy Psychiatrii i Neurologii 2012; 21(2): 79-103

There is considerable debate over whether bipolar and related disorders that share common signs and symptoms, but are currently defined as distinct clinical entities in DSM-IV and ICD-10, may be better characterized as falling within a more broadly defined "bipolar spectrum". With a spectrum view in mind, the possibility of broadening the diagnosis of bipolar disorder has been proposed. This paper discusses some of the rationale for an expanded diagnostic scheme from both clinical and research perspectives in light of potential drawbacks. The ultimate goal of broadening the diagnosis of bipolar disorder is to help identify a common etiopathogenesis for these conditions to better guide treatment. To help achieve this goal, bipolar researchers have increasingly expanded their patient populations to identify objective biological or endophenotypic markers that transcend phenomenological observation. Although this approach has and will likely continue to produce beneficial results, the upcoming DSM-IV and ICD-10 revisions will place increasing scrutiny on psychiatry's diagnostic classification systems and pressure to re-evaluate our conceptions of bipolar disorder. However, until research findings can provide consistent and converging evidence as to the validity of a broader diagnostic conception, clinical expansion to a dimensional bipolar spectrum should be considered with caution.

Special article

Walking in the minefield – comments on the use of medicines at variance with medical product specifications

Tomasz Szafrański, Anita Szafrańska
Postępy Psychiatrii i Neurologii 2012; 21(2): 107–115

The paper presents a critical commentary on current stipulations, doubts and controversies concerning the use of pharmaceuticals beyond the registered recommendations included in the "medical product specifications" – in the context of regulations on the medical profession performance and the principles on drug reimbursement (Eds.).

Original article

Metabolic syndrome and dementia

Hanna Wehr, Małgorzata Bednarska-Makaruk, Wanda Lipczyńska-Łojkowska, Ałła Graban, Anna Bochyńska, Maria Rodo, Danuta Ryglewicz
Postępy Psychiatrii i Neurologii 2012; 21(2): 117–122

Objectives. Co-occurrence of metabolic syndrome features and dementia was studied.
Methods. In 151 demented patients and 64 control individuals the presence of metabolic syndrome was diagnosed according to the modified Grundy et al. criteria (hypertension, obesity, high triglyceride and low high density lipopoprotein (HDL) cholesterol serum levels, as well as hyperglycemia). The serum insulin level was determined and the HOMA-IR index of insulin resistance was calculated. Polymorphic forms of a gene candidating for a role in the insulin signaling pathway – the glycogen-associated regulatory subunit 3 of protein phosphatase 1 (PP1R3), and of the apolipoprotein E gene - ε2, ε 3 and ε 4 alleles – which are well-known strong genetic risk factors for Alzheimer's disease - were identifi ed.
Results. Metabolic syndrome was found more often in the group with vascular dementia (VaD) than in the controls. In the former group a tendency for higher HOMA-IR index values was observed. The most frequent characteristic of glucose metabolism differing all the patients from the controls was an increased 2-hour postload glucose level, which is a feature of prediabetes. No differences between the patients and controls were found in the frequency of particular polymorphic forms of the PPP1R3 gene. Low HDL cholesterol levels and glucose intolerance – two important metabolic syndrome features - were signifi cantly more frequent only in the ε4 allele noncarriers, but not in the carriers of this allele.
Conclusions. Metabolic syndrome features were observed most often in patients with dementia of vascular origin. Frequency of these characteristics was higher only in noncarriers of the apolipoprotein E ε4 allele.

Original article

A Polish adaptation and psychometric evaluation of the Postpartum Depression Screening Scale (PDSS) for diagnosing symptoms and signs of postnatal depression

Karolina Kossakowska
Postępy Psychiatrii i Neurologii 2012; 21(2): 123–129

Objective. To evaluate psychometric properties of the Postpartum Depression Screening Scale (PDSS) in the Polish adaptation.
Methods. Participants in the study were 586 women after childbirth, at the average age of 27.9 years (SD = 4.01). They were asked to complete the Postpartum Depression Screening Scale (PDSS) translated into Polish, as well as the Beck Depression Inventory (BDI) and the Edinburgh Postpartum Depression Scale (EPDS). The two latter scales were used to assess validity of the Polish adaptation of the PDSS.
Results. The Cronbach α coeffi cients of reliability were 0,97 for the full scale, and 0.81 for the brief version, ranging from 0.73 to 0.92 for the seven PDSS subscales. The brief PDSS was signifi cantly correlated with the full scale of the tool (r = 0.90). PDSS global scores both in the full and brief versions signifi cantly correlated with the BDI (r = 0.63 and 0.56, respectively), and EPDS global scores (r = 0.67 and 0.61, respectively).
Conclusions. The reliability coeffi cients of the Polish adaptation of PDSS do not differ from these reported by the author of this scale in her original study. The Polish adaptation of the questionnaire fulfi lls basic psychometric criteria, therefore the tool can be used for the assessment of the risk for postpartum depression.

Case report

Electroconvulsive therapy in the elderly: three case reports

Stefan Krzymiński, Ewelina Piotrowska, Małgorzata Czekaj, Stanisław Marcinkowski
Postępy Psychiatrii i Neurologii 2012, 21(2): 131–138

Objective. We present three cases of elderly women with comorbid severe mental disorders and somatic illnesses, successfully treated with electroconvulsive therapy (ECT).
Case reports. The following cases are discussed: (1) A 78-year-old woman with catatonia and comorbid diabetes, arterial hypertension, atrial fibrillation, endometrial hyperplasia with bleeding, experiencing a state after brain stroke; (2) A 67-year-old woman with catatonia developed after discontinuation of clozapine treatment, refractory to various neuroleptics. Her comorbid somatic conditions included enormous obesity, telescopic fracture of two thoracic vertebraes and chronic urinary tract infection; (3) A 69-year-old woman with profound mental retardation and long-term behaviour disorders involving aggression and self-injuries, refractory to various psychotropic medications. Her comorbid somatic disease was diabetes. In all these cases a good response was obtained to ECT treatment, without any serious adverse events.
Commentary. Comorbidity of psychiatric and somatic diseases in these patients resulted in life-threatening conditions that required ECT. The treatment was effective and with no adverse side effects.

Case report

POEMS syndrome in a 45-year-old man referred to a rehabilitation program – a case report

Marek Tradecki, Andrzej Pozowski, Małgorzata Paprocka-Borowicz, Jadwiga Kuciel-Lewandowska
Postępy Psychiatrii i Neurologii 2012, 21(2): 139–142

Objective. We present a case of 45-year-old man with POEMS syndrome (the name is an acronym deriving from the main features of the syndrome: polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins, and skin disorders). The patient was admitted to a rehabilitation ward in September 2011.
Case report. The final diagnosis was established in May 2011, while his initial symptoms had emerged in 2007. In the course of the diagnostic process the patient developed sensorimotor polyneuropathy in the upper and lower limbs, as well as other characteristic symptoms. In June 2011 he had chemotherapy supported by autologous stem cell transplantation.
Commentary. After the five-week rehabilitation program the patient was discharged with improved muscle strength in his lower limbs.

Practical reflections

Costs of forensic opinions and experts’ fees for rendering a forensic-psychiatric opinion

Krzysztof Eichstaedt, Kinga Bobińska, Piotr Gałecki
Postępy Psychiatrii i Neurologii 2012, 21(2): 143–148

Objectives. An attempt was made in the paper to objectively and reliably assess the legislation on and practice of estimating the costs of forensic opinions and experts' fees for rendering such opinions.
Observations. The agency conducting the trial is obligated to bear the costs of forensic expert opinions – the costs include not only the experts' fees, but possibly also these of performing additional diagnostic examinations or forensic-psychiatric observation. Forensic experts' fees are estimated on the grounds of offi cial regulations specifying the price for services of forensic experts representing particular professions and specialties. If an expert's fee cannot be established by a normative flat rate, an hourly rate is used in pricing of their work. Services of the expert psychiatrist commissioned by the court or prosecution to render a forensic psychiatric opinion do not directly serve prevention, maintenance, rescue, restoration and improvement of health, therefore such services are not exempt from VAT.
Conclusions. Controversies and discrepancies between the legislation, practice, and contemporary expectations are numerous. Undoubtedly, there is a definite discrepancy between the VAT regulations and the pricing practice, which suggests that the legislation should be adjusted to contemporary reality.