36, 2

Stanisław Pużyński, Wanda Langiewicz, Bożena Pietrzykowska
Reforma psychiatrycznej opieki zdrowotnej w Polsce - 2001  181
The reform of psychiatric care in Poland - 2001  181
Both positive and negative effects of the reform of the health care financing system are noted.
Low prices offered by Sickness Funds for particular services (a bed-day, a visit) should be regarded as a negative effect of the reform. Particularly insufficient were the prices of services in some specialised psychiatric wards and in outpatient clinics. Prices in many community-based psychiatric facilities were also considerably underestimated.
Undoubtedly, the reform has led to positive changes in the organization of inpatient care. These changes include: further reduction of beds in large hospitals organizational structure as well as a marked increase in the number of psychiatric wards at general hospitals, which should be the key units of psychiatric inpatient care. Increase in the number of day hospitals is another positive effect of the reform.
The programme of psychiatric care transformation is presented mostly in the Mental Health Programme. The main goal of this programme is to ensure appropriate care for the mentally disordered people, namely comprehensive and accessible health care as well as other forms of help and support necessary for living in family and in society. This goal will be accomplished by health care and other forms of help mentioned in the Mental Health Act and in the Social Help Act. Community-based model of psychiatric care is the key element of this system.
Also, the Programme states desired accessibility rates for staff, number of beds and number of particular forms of psychiatric and alcohol treatment care. Separate rates for adult and children/youth population have been elaborated.

Stanisław Dąbrowski
Przymus bezpośredni stosowany w niektórych czynnościach leczniczych  193
Physical restraint as a therapeutic procedure  193
A study of 959 notices on physical restraint (Ph.R.) sent to the head of a mental hospital during 6 months showed that: imminent danger to the patient's own life or health or the life or health of others, violent destroying of ward equipment, grave psychomotor excitement prevail among the reasons for Ph.R. Therapeutic reasons are much less common. Every sixth (17%) episode of Ph.R. was used exclusively to perform therapeutic procedures, mainly intravenous drip. The Ph.R. was a therapeutic procedure is relatively seldom used without sufficient justification. As a rule a physician accepts nurses decision on Ph.R. with no further consideration. The same is true for director's acceptance of a physician's decision.

Józef Zając, Andrzej Kiejna, Joanna Rymaszewska
Reforma służby zdrowia a zmiany niektórych wskaźników ruchu chorych w szpitalach psychiatrycznych  201
Reform of medical services and changes of some patients' movement coefficients in psychiatric hospitals  201
Selected empirical data relating psychiatric hospital morbidity from Lower-Silesian province in the years 1998-2000 was analysed. Official statistics became the main source of information about occurrences and epidemiological processes, because of lack of population studies from the psychiatric domain. Three main limitations of assessing disruption of such processes were pointed: - inter-regional moving of patients; - imperfection of procedures connected with accumulation of empirical material; - influence of various administrative factors. These last exert essential influence on changes of patients" movement coefficients in hospitals during implementation of the Health Care reform in Poland. Number of admitted patients in general and for the first time increased, simultaneously time of stay in the hospital grew shorter. No reasons have been found, for which these observed changes would be able to have reference in real epidemiological processes, quality of treatment. These changes are rather caused by the realization of the reform, and precisely adaptive mechanisms of the subjects to Health Insurances requirements.

Ryszard Kamiński, Agata Lisiecka
Nasilenie objawów chorobowych oraz wybrane dane demograficzne jako predyktory oceny efektywności terapii pacjentów ze schizofrenią w warunkach oddziału dziennego  211
Intensity of psychotic symptoms and selected demographic data as predictors of effectiveness of psychotherapy of schizophrenic patients in a day-hospital treatment  211
The aim of the study was to assess the effectiveness of psychotherapy in patients with a diagnosis of schizophrenia in a day hospital. The presented model is based on the combination of group psychotherapy, individual psychotherapy and pharmacotherapy with respect to the individual needs of a patient. Psychotherapy was more effective in patients with a lower educational level and those married. We found that the effectiveness of psychotherapy depended on a psychopathological status of a patient.

Stanisław Pużyński, Iwona Koszewska, Ewa Habrat, Sławomir Fornal, Dorota Bzinkowska, Dorota Grądzka, Antoni Kalinowski, Łukasz Święcicki, Jarosław Torbiński
Ocena przydatności wybranych metod klinicznych i baterii testów do pomiaru procesów poznawczych jako wskaźników skuteczności działania leków przeciwdepresyjnych (doniesienie wstępne)  225
Evaluation of clinical and psychological methods in estimating efficacy antidepressants in depression (prelimary report)  225
The aim of the study was to evaluate the onset of action of antidepressants using CGI i CGI Improvement, MADRS, Self Analouge Scale and Wiener Battery Test System. Onset of action of antidepressants was evaluated in a group of 18 patients with major depression. Evaluation was assessed at 4, 8, 10, 14, 28 days of treatment. Significant reduction of symptoms in MADRS at day 8 was the predictor of effect at day 28. Reduction of symptoms in MADRS was not correlated with improvement in cognitive functions. Most of the psychological tests showed to be not sensitive enough to estimate a change in cognitive processes under pharmacotherapy.

Małgorzata Rzewuska
Kwas walproinowy w leczeniu zaburzeń afektywnych dwubiegunowych  239
Valproate in the treatment of bipolar disorder  239
The paper presents the views on the use of valproate and its' derivatives in the treatment of mania and in the prophylactics of recurring bipolar affective disorder. The anti manic use of valproate has been confirmed in about half of those treated. Monotherapy of manic states with valproate brings about good results less frequently than with the use of lithium or neuroleptics. However in the treatment of mania, valproate is suggested equally frequent as lithium and carbamazepine, especially in the USA. This particularly concerns those ill in nonacute mania, mixed manic-depressive states, rapid cycling of manic as well as depressive phases - in these cases the results of treatment with valproate are best. Also in those where treatment with lithium proved ineffective, the addition of valproate can be of benefit. Valproate is also useful in the combined treatment with a neuroleptic. In the prevention of recurrence of bipolar affective disorder, the use of valproate seem to be not only equally effective as lithium, but also beneficial due to its' better tolerance. For the final outcome of the effectiveness of valproate in inhibiting recurrence, a study which would last longer than one year, would appear necessary. Further studies are also necessary in order to confirm the effectiveness of valproate in schizoaffective psychoses, manic patients addicted to medications or alcohol, organic disorders of the CNS, or the elderly patients. The more precise description of doses and the therapeutic concentration of the drug in the bloodstream in correlation with its' anti-manic and anti-recurrence action, seems to be necessary.

Tadeusz Nasierowski
Klemens Maleszewski - pionier terapii elektrowstrząsowej w psychiatrii polskiej  259
Klemens Maleszewski - the pioneer of electroshock therapy in polish psychiatry  259
On the grounds of Lithuanian and Russian archival materials unpublished so far, the paper presents the professional activity and psychiatric views of Klemens Maleszewski (1798-1873), who was the head of Vilnius's Asylum in 1837-1864. The time of 50s and 60s of the 19th century was a period of increasing attention about metallotherapy and electrotherapy. Above all, these methods were used in the treatment of cholera. Maleszewski conducted researches on the use of galvanic current and metallotherapy not only in cholera treatment, but also in the treatment of psychiatric disorders. He implemented successful electroshock therapy in a 35-year-old catatonic patient in 1861.

Aleksandra Suwalska, Dorota Łojko, Janusz Rybakowski
Zaburzenia psychiczne podczas leczenia glikokortykoidami  271
Psychiatric complications of glucocorticoid treatment  271
In the article, clinical symptoms of psychiatric complications occurring during treatment with glucocorticoids were described, and therapeutic guidelines were suggested. Psychiatric symptoms are observed in approximately 25% of patients receiving glucocorticoid therapy. Depression, mania and mixed states are the most frequent, psychotic symptoms and cognitive impairments (including delirium) are but less frequent. Associations between clinical factors (i.e. age, sex, past psychiatric story, medical condition, the dose of glucocorticoids) and the frequency and the severity of psychiatric complications were discussed. When psychiatric disturbances occur, the reduction or discontinuation of glucocorticoids should be taken into account. Treatment of psychiatric symptoms is needed when psychiatric disorder is severe or the patient is suicidal or agitated. In such cases the use of neuroleptics, antidepressants, normothymic and other drugs, as well as electroconvulsive therapy was discussed. The outcome is generally good, the majority of patients make a good recovery, over 90% of patients restored to health within 6 weeks of the onset of treatment.

Wanda Foltyn, Ewa Nowakowska-Zajdel, Aleksander Danikiewicz, Andrzej Brodziak
Oś podwzgórze-przysadka-tarczyca w depresji  281
Hypothalamic-pituitary-thyroid axis in depression  281
Depressed patients, although viewed as chemically euthyroid, have alterations in the function of hypothalamic-pituitary-thyroid axis including slight elevation of the serum thyroxine (T4), loss of the nocturnal TSH rise, blunted thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) stimulation and predisposition to autoimmune thyroiditis. Both hypothyroid and depressed patients share a number of clinical features in common. This is the reason that some research workers use the "brain hypothyroidism" hypothesis to explain the pathogenesis of depression. They suggest that depression is a state of local hypothyroidism in brain with normal peripheral thyroid hormone concentrations as a result of brain type II deiodinase inhibition and impaired transport T4 across the blood brain barrier. This theory seems to be compatible with the serotonin deficiency hypothesis of depression. Some studies confirm the existence of classical feedback between serotoninergic and hypothalamus-pituitary-thyroid systems. TRH remains under a constant inhibition by serotonin and reduced intracerebral serotonin concentration seen in depression will lead to increased TRH concentration in brain tissue. This mechanism is probably responsible for blunted TSH response to TRH stimulation. Triiodothyronine stimulates the serotoninergic system to serotonin secretion in the central nervous system, so local brain hypothyreosis decreases the serotonin level and enhances depression. There is little known about the association between thyroid hormones and central noradrenergic system in depression. Some animal studies have shown that triiodothyronine may play a neuromodulatory or neurotransmitter role in the adrenergic nervous system, facilitate nerve conduction in it and enhance the function of beta adrenergic receptors. Although, there is a considerable progress in neuroendocrinolgy, the association between thyroid hormones and depression remains still unclear and needs further investigations.

Ewa Kopczyńska, Magdalena Lampka, Lech Torliński, Marcin Ziółkowski
Stężenie 8-izo-prostaglandyny F2a oraz 4-hydroksynonenalu i dialdehydu malonowego u osób uzależnionych od alkoholu w trakcie kompleksowej terapii odwykowej  293
The level of 8-iso-prostaglandin F2a, 4-hydroxynonenal and malondialdehyde in alcohol dependent men during combined therapy  293
The aim of the study was the estimation of intensity of lipid peroxidation in alcohol dependent male patients after three months of therapy with naltrexone or tianeptine and the next three months follow-up. 61 males with clinical diagnosis of alcohol dependence (ICD-10) have been examined. The investigated parameters have been determined in blood serum, the 8-iso-prostaglandin F2a by means of immunoenzymatic assay (ELISA) and malondialdehyde with 4-hydroxynonenal by means of colorimetric method. In alcohol dependent men before pharmacotherapy the mean concentration of 8-iso-PGF2a and [MDA+4-HNE] was higher than the reference interval. Both, after three months of applied drugs and the next three months follow-up, the concentration of studied parameters decreased considerably. The above results show intensification of lipid peroxidation in alcohol abusers and adventageous influence of abstinence from alcohol and treatment of naltrexone or tianeptine on free-radical changes of lipids as well.

Jerzy Samochowiec, Jolanta Kucharska-Mazur, Jan Horodnicki, Klaus Peter Lesch, Hans Rommelspacher, Lutz Gerhard Schmidt
Polimorfizm genu promotora PAX-6 i inne czynniki związane z atrofią mózgowia u osób uzależnionych od alkoholu  303
PAX-6 gene promoter polymorphism and other factors involved in brain atrophy in alcohol dependent patients  303
PAX-6 gene promoter polymorphism, alcohol dependence history and CT were determined in the group of 68 alcoholics. We found negative correlation between numbers of PAX-6 gene promoter B (AC)m (AG)n repeats and atrophy of the brain and the cerebellum. Occurrence of these lesions was correlated with a decrease of alcohol tolerance, withdrawal symptoms - especially delirium tremens.


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