Archives 1992-2013

2013, volume 22, issue 3

Special article

On structural social exclusion from a different perspective. A case study of the Social Enterprise “Zielony Dół”

Andrzej Cechnicki, Barbara Banaś
Postępy Psychiatrii i Neurologii 2013; 22(3): 171-176

The case of closing down the „Zielony Dół” centre in Kraków, which has until recently effectively implemented an innovative health, social and professional recovery programme for sufferers of a serious mental crisis has shocked the public opinion in the Małopolska Province and in Poland. It has particularly cast a new light on the significance of the prejudice against the people who have suffered mental crisis; the prejudice which is especially manifested in uncooperative responses of individuals, groups and communities, and which results in distancing attitudes, unequal treatment or even exclusion. It is also embedded in legal regulations and persistent habits of public institutions which, in principle, should be free of any discriminating practice and actively counteract any form of prejudice. These notes on the events surrounding the “Zielony Dół” situation may become a starting point for the analysis, discussions and further conclusions about the process of structural stigmatization of the mentally ill. We are publishing them with a strong conviction that public discussion about this issue is vital to the reality of mental health protection in Poland, and eventually, to our own professionalism and humanity.

Original article

Illness perceptions and psychosocial benefits found among HIV positive and AIDS patients

Marlena Maria Kossakowska, Paweł Zielazny
Postępy Psychiatrii i Neurologii 2013; 22(3): 177-185

Objectives. The aim of this study was to examine subjective illness perceptions, coping strategies and psychosocial benefi ts from illness found in patients with HIV and AIDS.
Methods. The research sample consisted of 60 patients with HIV/AIDS (30 with HIV and 30 with AIDS). The following questionnaires were used in the study: the Brief Illness Perception Questionnaire (BIPQ), the Coping Orientations to Problems Experienced (COPE) and the Silver Lining Questionnaire (SL-24). Patients were asked to provide demographic information such as sex, age and education.
Results. The study showed signifi cant differences in subjective illness perceptions and implementation of coping strategies between HIV-infected individuals and those suffering from AIDS. AIDS patients had less favorable illness perceptions, compared to the patients infected with HIV. Furthermore, individuals with AIDS were more likely to seek emotional support from other people compared to those with HIV. The former group was also found to be more focused on their emotional states. The study also revealed the tendency to recognize the value of interpersonal relationships and personal strengths among all the participants. These are the most important psychosocial benefits from chronic illness for them.
Conclusions. Individuals infected with HIV appear to have more positive illness perceptions and coping strategies than those living with AIDS. However, both research groups declare psychosocial benefi ts from their illness at the same level.

Review article

Vortioxetine – a new option in the treatment of depression and general anxiety disorder

Adam Wysokiński, Iwona Kłoszewska
Postępy Psychiatrii i Neurologii 2013; 22(3): 187-192

Objectives. The aim of this publication is to present data available on vortioxetine - a new multimodal antidepressant.

Review. Vortioxetine is a new antidepressant of multimodal mechanism of action: inhibitor of serotonin reuptake, agonist of 5-HT1A and 5-HT1B receptors and antagonist of 5-HT3A and 5-HT7 receptors. Results of clinical trials confirm its antidepressant activity while its safety profile is supposed to be better than duloxetine or venlafaxine. Results of trials on its efficacy in the treatment of general anxiety disorder are inconclusive. Vortioxetine safety profile is similar to typical for other SSRI antidepressants.

Conclusions. Available clinical data does not indicate that the drug is more effective than currently available antidepressants. In two studies (in which doses 2.5 and 5 mg were used) no differences versus placebo were found. Moreover, vortioxetine was not evaluated in studies of more than 20 weeks in duration, thus there is no strong evidence that confirms its efficacy and safety in long-term treatment.

Review article

Cognitive training as a new form of treatment in schizophrenia

Marek Krzystanek, Paweł Krzywda, Adam Klasik, Irena Krupka-Matuszczyk
Postępy Psychiatrii i Neurologii 2013; 22(3): 193-199

Objectives. Cognitive training is a new form of therapy of cognitive impairment in schizophrenia and other neurological diseases. The influence of pharmacotherapy on cognitive functioning of patients who suffer from schizophrenia is not satisfactory. This is the main reason why researchers have begun to look for alternative methods which can bring improvement in thatfield.

Review. This article combines a review of current reliable reports on cognitive training and points to its possible benefits.

Conclusions. Authors suggests, that neurocognitive training may be an effective addition to pharmacotherapy of illnesses which cause cognitive impairment e.g. schizophrenia, mild cognitive impairment and multiple sclerosis. Further research is needed to evaluate the guidelines regarding the frequency, length and construction of tests which should be included in cognitive training.

Review article

Depression and abnormal personality in a psychodynamic perspective

Katarzyna Poniatowska-Leszczyńska, Krzysztof Małyszczak
Postępy Psychiatrii i Neurologii 2013; 22(3): 201-209

Objective. This article shows the interrelation between the level of abnormality in personality and severity of depressive disorders. It correlates depressive symptoms with the quality of psychological structure and processes that determine our understanding of the dynamic of depression and its treatment.

View. Psychodynamic view on depressive disorder is based on the structural personality diagnosis. According to the evaluation of basic psychological qualities such as: identity, defense mechanisms, reality testing, character of object relations, moral functioning allows us to determine level ofpersonality organization. All of our patients' symptoms, along with the decisions about pharmacotherapy, other helping interventions, psychotherapy must be considered based on the structural diagnosis. This article presents the interrelation between Kernberg 's abnormal personality model and the diagnostic criteria of DSM-IV.

Conclusion. Depression is understood as the reaction to object loss. The lower the level of abnormality in personality, the more the depressive states are connected to the genuine loss, and depressive symptoms have more references to the reality. Although in symptomatic perspective, the depressive disorder in people with different personality disorders may seem alike, the symptoms are the result of different psychological processes.

Case report

Hit-and-run: shock reaction or purposeful behavior – a case report

Anna Pilszyk, Alfreda Ruzikowska
Postępy Psychiatrii i Neurologii 2013; 22(3): 211-216

Objectives. Based on the available literature and forensic practice, the article gives a psychopathological description of a man involved in a hit-and-run accident. Legal regulations in force concerning that matter are also presented.

Case report. The article describes a man who was charged with purposeful hit-and-run.

Conclusions. On the basis of the analysis of the case in question it is very difficult to determine whether the hit-and-run accident may have been a proof of a specific psychopathological condition, resulting from the stress suffered and the previous experiences of the offender, or it was in fact intentional.

Case report

Dissection of the internal carotid artery followed by intracranial occlusion not complicated by a stroke

Adam Wiśniewski, Barbara Książkiewicz
Postępy Psychiatrii i Neurologii 2013; 22(3): 217-221

Objectives. The dissection of internal carotid artery is an important risk factor of stroke or transient ischemic attack in middle aged people. The aim of this study is to describe the case ofthis rare condition in which good effects of treatment have been achieved after administering anticoagulant.

Case report. We report on the case of a 57-year-old woman with a headache, neck pain and the Horner syndrome, without symptoms of a stroke. We diagnosed the dissection of the common carotid artery bifurcation, followed by intracranial occlusion.

Conclusions. This case is an example of carotid artery dissection, with good results of anticoagulant therapy, not complicated by a stroke.