Biologiczne podstawy psychiatrii 911
Biological principles of psychiatry 911
Psychiatry had retained the status of art rather than science for longer than other branches of medicine. However, the views that psychiatric disorders have material basis, existing since antiquity, had eventually been accepted by modern medicine, in spite of troubles connected with the rise of analytical psychiatry. Presently, there are no doubts that structural and functional integration of the brain is a prerequisite of psychical health. The psychical processes are presently regarded as neurobiological phenomena, and the technical progress, particularly brain imaging techniques, allow to investigate, with objective methods, even phenomena such as consciousness, that for long remained in the domain of philosophy. The applied success of biological psychiatry is the introduction of effective psychotropic drugs. It cannot be forgotten, however, that psychotherapeutic methods (which also have neurobiological roots), are as indispensable as psychopharmacotherapy in a modern psychiatric clinic.
Poczucie koherencji a odległe następstwa stresu pourazowego u osób represjonowanych w Polsce z przyczyn politycznych w latach 1944–56 921
Sense of coherence and delayed consequences of post-traumatic stress in persons persecuted for political reasons in Poland in the years 1944–56 921
The paper presents the results of research of 100 persons persecuted for political reasons in Poland in the years 1944–56. The research aims to study the relations between the level of Sense of Coherence and delayed effects of post-traumatic stress disorder in personal functioning (which is manifested by anxiety, depression, lack of meaning of life, and low well-being), and in interpersonal functioning. Introduction of this article presents the problems connected with delayed effects of post-traumatic stress disorder, and the general principle of Antonovsky’s salutogenic concept also characterizes the sense of coherence category (SOC). SOC is a generalized, long-lasting feeling of confidence that the world is comprehensible (internal and external environments are structured, predictable, and explicable). People with a high level of SOC see their life as having some purpose and that their life is worthy of personal investments, and see themselves as having the personal resources to cope with the difficulties.
The data was collected with using: The Sense of Coherence Questionnaire, PTSD-Interview, Beck Depression Inventory, State-Trait Anxiety Inventory, Purpose in Life Test, The Psychological General Well-Being (PGWB) Index, and The Scale of Interpersonal Relationships. The results indicate that the strength of the sense of coherence is negatively correlated with level of anxiety, depression, enmity syndrome, and positive with meaning of life, psychological well-being, and pro-social relationships. The research confirmed the important role of a sense of coherence (SOC) in modifying experience of delayed consequences of post-traumatic stress in victims of political persecution.
Objawy schizofrenii paranoidalnej a lęk – analiza dynamiczna 937
Symptoms of paranoid schizophrenia and anxiety – a dynamic analysis 937
Bożena Śpila, Hanna Karakuła, Anna Grzywa
The paper analyses the connection between anxiety and different symptoms of paranoid schizophrenia. In the study 66 patients admitted to hospital with an episode of paranoid schizophrenia were examined by a set of tests. Exacerbation of anxiety was measured by State-Trait Anxiety Inventory (STAI), whilst symptoms of schizophrenia- by the Brief Psychiatric Rating Scale (BPRS) and Scale for Assesment of Positive and negative Symptoms( SANS< SAPS). Statistically important correlations between anxiety and the majority of positive symptoms were observed. On the other hand, correlations between negative symptoms and anxiety experienced by the sick appeared variously.
Różnice w czynnikach rokowniczych między mężczyznami i kobietami hospitalizowanymi po raz pierwszy z rozpoznaniem schizofrenii 951
Gender related prognostic factors in the first admission of DSM-III schizophrenic patients 951
Aneta Kalisz, Andrzej Cechnicki
In the group of the 80 – DSM- III – first schizophrenic out patients we evaluated differences between men and women in predictive factors. First symptoms of illness were manifested later in women than in man. What’s more women achieved better results in social functioning as well in global assessment, as in partial criteria. Work was the only domain in which there wasn’t any differences in favour of women. Women hed a lower rate of personality disorders. There were no differences in psychiatric symptoms severity.
Zaburzenia kontroli emocji w schizofrenii i w jednostronnych uszkodzeniach mózgu 965
Disorders of emotional control in schizophrenia and unilateral brain damage 965
Katarzyna Kucharska-Pietura, Grzegorz Kopacz
Although, emotions play a crucial role in schizophrenia, the changes in emotional dimension still remain controversial. The aim of our work was: 1) to compare the disorders of emotional control between the examined groups: S – non-chronic schizophrenic patients (n=50), CS – chronic schizophrenic patients (n=50), N – healthy controls (n=50), R – right brain-damaged patients (n=30), and L - left brain-damaged patients (n=30), 2) to assess a level of impairment of emotional control, its relation to lateralised hemisphere damage and chronicity of schizophrenic process. All psychiatric subjects were diagnosed as paranoid schizophrenics according to DSM-IV criteria and were scored on the PANSS scale after four weeks of neuroleptic treatment. Brain-damaged patients were included if they experienced single-episode cerebrovascular accidents causing right or left hemisphere damage (confirmed in CT scan reports). The neurological patients were examined at least 3 weeks after the onset of cerebrovascular episode. Emotional control was assessed using Brzeziński Questionnaire of Emotional Control aimed at the evaluation of: 1) control in perception and interpretation of emotive situation, 2) emotional arousal, 3) emotional-rational motivation, and 4) acting caused by emotions. Our results revealed significantly greater impairment of emotional control in schizophrenics (chronic schizophrenics, in particular) compared to healthy volunteers. Chronicity of the schizophrenic process seemed to intensify emotional control impairment. Interestingly, no significant qualitative and quantitative differences in emotional control mechanism between unilateral brain-damaged patients and the control group were found.
Percepcja chimer twarzowych w schizofrenii a dysfunkcja prawej półkuli mózgu 379
Perception of chimeric faces in schizophrenia and right hemisphere dysfunction 379
The aim of this study was the assessment of cerebral specialisation in perception of emotional chimeric drawings in 50 non-chronic schizophrenics (S),50 chronic schizophrenics (CS),30 right brain-damaged inpatients (P), and 50 normal controls. All were marked right handers. The assessment was performed after a four- week treatment. Structure and intensity of schizophrenia symptomatology were scored on the PANSS scale. Happy-sad chimeric face drawings (David 1989) were viewed twice in free vision. A perceiver bias towards left hemiface of chimeric drawings (LHF bias) and sad bias were scored in all subjects. Subjects rated their mood at the time of testing on a visual analogue scale. The schizophrenics and right brain-damaged inpatients showed significantly weaker LHF bias compared with healthy subjects, which may suggest right cerebral hemisphere dysfunction in perception of emotional chimeric drawings. Moreover, chronic schizophrenic patients revealed significantly weaker LHF bias and sad bias compared to non-chronic subjects. There was no correlation of left perceptual bias with clinical ratings: PANSS scale, MMSE, number of hospitalisations, neuroleptic dose, and current mood, which suggests stable properties of the perceptual deficit.
Możliwość modyfikowania deficytów poznawczych obserwowanych w obszarze funkcjonowania społecznego u osób przewlekle chorych na schizofrenię 991
Capacity of modifying cognitiv deficits in the area of social functioning in chronic schizophrenic patients 991
The paper concerns the effectiveness of rehabilitation of chronically ill schizophrenic patients who participate in social skills training. The assumption was that the participation in a four-month training programme (as authored by R. P. Liberman) will improve emotional problem solving, ability to keep in norms and conflict solving as well as the ability of cause-effect thinking. 100 schizophrenic patients and their families participated in the study. Half of those studied participated in the social skills training programme and the half who did not, were the control group.
The subjects were examined twice in the four months. The following tools were used: “Means Ends Problem Solving” by Platt and Spivack, “PANSS” by Kay and Fiszbein, “Social-demographic questionnaire”. Before the study period the groups did not vary much in the aspect of interpersonal social skills solving. After the training, the participants benefited significantly in the effectiveness of their problem solving and other criteria improved as well.
It was concluded that the study of a group of 100 chronic schizophrenic patients who participated in a four month social skills training programme has a significant effect on social skills problem solving. The improvement of those skills consisted of: interpersonal and emotional problem solving, prediction of the consequences of one’s actions, cause-effect thinking and alternative thinking.
Zaburzenia lipidów błon komórkowych w etiopatogenezie schizofrenii i chorób afektywnych 1005
Lipid disturbances of cell membranes in the etiopathogenesis of schizophrenia and affective illnesses 1005
Piotr Lewandowski, Janusz Rybakowski
The authors present information on the key role of lipid disturbances (mainly phospholipids) of neural membranes in the etiopathogenesis of schizophrenia and affective disorders. Current theories on membrane phospholipid disturbances in the etiopathogenesis of schizophrenia and affective disorders are connected to the idea that the primary metabolic disorder in both these disorders is due to the altered activity of phospholipase AZ, which in turn brings about disturbances in other lipid elements.
Especially the functional insufficiency of some nescessary fatty acids, as well as disturbed prostaglandin secretion has been shown in these disorders.
In the recent years evidence has been collected on the action of pharmacologic substances used in these disorders on the lipid enzyme metabolism.
Objawy psychopatologiczne fazy przedklinicznej choroby Alzheimera 1019
The psychopathological symptoms of the preclinical stages of Alzheimer disease 1019
The aim of the undertaken studies based on many years’ observation of the group of elderly people was to describe psychopoathological pictures typical of preclinical phase of Alzheimer disease (AD) as well as the changes in social functioning. The obtained data were to serve to work out the criteria making initial recognition of preclinical phase of AD possible. Estimation of direct degree - in the perspective of next few years - of the danger of dementia of Alzheimer type should simplify making a decision about including therapeutic activities.
204 persons have completed the five-year-observation (70% of the qualified). During the observation AD has developed at 19 persons, five of the examined at the beginning of the observation were described as „no disturbances of cognitive functions”- I according to the GDS scale and 14 were qualified as „slight impairment of cognitive functions”- GDS II. The basis for further conclusions was the comparison of the results obtained in the groups of people at whom, during the five-year-observation, in the examination with the GDS scale, no changes regarding cognitive functions have been observed, with those examined in whom dementia has been recognised. Statistic analysis has been done mostly for the results obtained before the appearance of the dementia.
The conducted studies made it possible to verify the stated hypotheses and draw the following conclusions:
– preclinical period of AD is connected with intensification of psychopathological disturbances, especially depression;
– in the period preceding the development of AD usually slight disturbances of cognitive functions appear which are most often revealed during the particular examination of cognitive functions;
– clear decrease in social activity is typical of the preclinical phase of AD;
– people in premorbid period showed various disturbances but no symptom has been observed that would be pathognomic for the preclinical phase of AD;
– it is possible, on the basis of the examination by means of proper clinical scales, to predict the danger of dementia but it is necessary to take into account various elements of psychic state and social functioning.
Risperidon w ambulatoryjnym leczeniu zaburzeń zachowania u chorych z otępieniem typu Alzheimera: analiza retrospektywna 1033
Risperidone for the treatment of behavioural symptoms in demented outpatients with Alzheimer’s disease: a retrospective analysis 1033
Tomasz M. Sobów, Iwona Kłoszewska
Behavioural disturbances are common in the course of dementia in Alzheimer’s disease (AD) and their treatment is usually difficult. Different pharmacological and non-pharmacological options are employed basing mainly on clinical experience, still the number of well-designed, controlled studies in the field is very small. Novel, atypical neuroleptics, including risperidone might potentially be one of these options, taking into account their good safety profile and clinical efficacy in closely related syndromes.
We present the results of a retrospective analysis of 57 outpatients with behavioural symptoms complicating AD treated with risperidone, either alone or in combination with one of the acetylcholinesterase inhibitor (AchEI; donepezil or rivastigmine).
Seventy five percent of patients treated responded to risperidone with the usual effective dose of 0.5-1 mg/day. The influence of risperidone treatment on behavioural symptomatology was irrespective to the use of AchEI and equally well safe in both groups.
The clinical response to the treatment was seen usually within first 2-3 weeks, those who did not respond early tended not to respond later on as well. Additionally, if not responding to low doses of risperidone (0.5-1 mg/day), patients usually did not respond to higher doses or could not tolerate them, mainly due to emerging extrapyramidal symptoms (EPS).
Low doses of risperidone were well tolerated, with the fraction of patients experiencing EPS not achieving 10%. EPS observed, were dose dependent and tended to appear if the dose acceleration was fast. We then recommend low doses of risperidone and its slow titration if needed.
Stany emocjonalne poborowych w dniu ich wcielenia do zasadniczej służby wojskowej 1047
Emotional state of army recruits in the day of their recruitment to the army 1047
Adaptive stress present in army recruits is the result of a permanent and still enhanced by the media stereotype which brings about the experience of deep emotional states. The study, based on empirical representative material of a group of 552 soldiers, presents the type of stress and emotions accomanying it experienced as well as presents the postulates of the soldiers examined on the possibility of stress reduction.
In the conclusion, the author implies on the necessity of the introduction of a programme which would reduce adaptive stress amongst soldiers and would also improve the image of army service in the social viewpoint.
Ocena jakości życia żołnierzy zawodowych z rozpoznanym zespołem zależności alkoholowej 1057
Quality of life estimation of professional soldiers diagnosed as alcohol addicted syndrom 1057
Presented paper is the first estimation probe in Poland of the „quality of life” of alcohol addicted people. The group of 70 professional soldiers that had been undergo treatment in Military Hospital the Section of Psychiatric Clinic in Cracow in years 1996-1998 has been investigated as alcohol addicted syndrome. For the research it has been used: the questionnaire with socjodemographic and epidemiological data,Polish version questionnaire SF-36 for „quality of life” research and Michigan Alcoholism Screening Test (MAST)- the questionnaire for estimation alcohol problems. The main aim of investigation was to recognise the influence of alcohol addicted syndrome that impact on „quality of life” estimation, range changes and their dynamics that depend on alcohol addicted syndrome degree, in age, military degree. The exploration aim was some socjodemographic and epidemiological data analysis. Results confirm the lower „quality of life” within estimated group. All ingredients Q1 have decreased, and the highest differences related such ingredients as: „physical limits in role perform”, „social function”, „emotion limits in role perform” so that „social activity sphere” creation ingredients. The estimation hypothesis related to QL decrease together with addiction degree (numbers of MAST) and decrease of „quality of life” together with age within estimated group have been not confirmed. The analysis of chosen socjodemographic variables has shown the significant variation, relative to QL and: „sexual live”, „alone drinking” and „conflict”. The differences between peoples who are alcohol addicted and non habitual drinking alcohol peoples has been confirmed within range; „frequency of alcohol drinking”, „quantity of single drinking alcohol”, „frequency to be drunk”, „reasons of drinking”, „behaviour after drinking”, „suffering after drinking”, „continuos drinking” or „alcohol tolerance”.