38, 2

Czym zaznaczył się rok 2003 w psychiatrii polskiej?  191
What was significant for Polish psychiatry in 2003?  191
Jacek Bomba
The aim of this paper was a reflection on the most significant events in Polish psychiatry in 2003. Reform in health care financing and its realisation in 2003 introduced a risk of inhibiting further development of mental health care. The endangerment is a result of allocation of resources, which is inadequate to real costs and promotes in-patient treatment. An additional risk is seen in a project of privatisation of health care institutions. Increasing orientation towards methodology of molecular biology, which is similar to a general global tendency, influences research in psychiatry. Nevertheless the low number of publications resulting from government sponsored studies is disturbing. The situation in forensic psychiatry calls for involvement and studies. Psychiatria Polska published a report indicating low standard of psychiatric expertise for courts and high probability of corruption. The same was reflected in mass media publications later on. Polish Psychiatric Association Board had appointed a special commission to study this problem.

Stanowisko Zarządu Głównego PTP i konsultanta krajowego w dziedzinie psychiatrii w sprawie sytuacji w orzecznictwie sądowo-psychiatrycznym    198

Częstość występowania zaburzeń afektywnych dwubiegunowych wśród chorych na depresję leczonych przez psychiatrów w warunkach ambulatoryjnych  203
Frequency of bipolar affective disorders among depressive outpatients treated by psychiatrists  203
Janusz Rybakowski, Aleksandra Suwalska, Dorota Łojko, Joanna Rymaszewska, Andrzej Kiejna
Aim: To assess the frequency of bipolar disorders among outpatients with affective illness treated by 96 Polish psychiatrists, representing all regions of Poland. Methods: The study was performed on 880 patients (237 male, 643 female). They were identified, according to the criteria used, into the  following diagnostic categories: 1. Bipolar affective illness, type I (Bipolar I); 2. Bipolar affective illness, type II (Bipolar II); 3. Bipolar spectrum disorder; 4. Unipolar affective illness. Results: Affective disorders having bipolar features were found in 61.2% of the patients studied, bipolar I more frequent in men (27.4% vs 17.6%) and bipolar II more frequent in women (31.7% vs 21.5%). Bipolar spectrum was identified in 12% of the studied patients. Patients with bipolar affective illness compared with unipolar affective illness had a family history of bipolar disorder significantly more frequently, premorbid features of hyper- or cyclothymic personality, early onset of depression (before 25 years), symptoms of atypical depression (hypersomnia and hyperphagia), episodes of psychotic depression, postpartum depression, and treatment-resistant depression. The group of bipolar spectrum had most clinical features similar to classic types of bipolar affective illness and showed significant differences with unipolar affective illness. Conclusions: In outpatients, who had a depressive episode in the past and were treated by psychiatrists in Poland, bipolar disorders may amount to 60% of them. Patients with bipolar affective illness significantly differ from patients with unipolar affective illness as to the numerous clinical features, not connected with manic, hypomanic or mixed states. The results of the study may also indicate a legitimacy to delineate a bipolar spectrum disorder.

Ocena skuteczności terapeutycznej słabych zmiennych pól magnetycznych o niskiej wartości indukcji u chorych z zaburzeniami depresyjnymi  217
Estimation of therapeutical efficacy of weak variable magnetic fields with low value of induction in patients with depression  217
Aleksander Sieroń, Robert T. Hese, Jarosław Sobiś, Grzegorz Cieślar
Aim: Preliminary results of research on the therapeutical efficacy of weak variable magnetic fields with low value of induction used as magnetostimulation in patients with depression not reacting to two consecutive, correctly applied anti-depressant pharmacological treatment are presented in the paper. Method: The examined patients (24 persons aged 18-65 years) treated with antidepressants accessible in Poland were randomly divided into 2 groups. In 1 group (11 persons - 9 women and 2 men) magnetostimulation with the use of a weak variable magnetic field with a low value of induction of 15 mT generated by the VIOFOR JPS device (Poland) lasting 12 minutes daily for 15 days was added to pharmacological therapy. Patients from 2 groups (13 persons - 11 women and 2 men) were exposed to exposure with the same device. The intensity of depression was estimated with Beck's, Montgomery-Asberg's and Hamilton's scales. Results: As a result of a cycle of active magnetostimulation a distinct, statistically significant decrease of intensification of depression, both in the 7th and 15th day exposure was obtained, while in the sham-exposed group only slight, transient decrease of intensification of depression in the 7th day of sham-exposure was observed. Conclusions: It was concluded that adding magnetostimulation to pharmacological therapy results in a progressive, significant reduction of intensification of depression symptoms.

Escitalopram - druga generacja inhibitorów transportera serotoniny?  227
Escitalopram - second generation of serotonin transporter inhibitors?  227
Janusz Rybakowski, Alina Borkowska
Escitalopram is the first antidepressant introduced according to chirality rules, it is an S-enantiomer of citalopram, the drug which has been used for many years. Experimental studies showed that the property of serotonin transporter inhibition - one of the main mechanisms of antidepressive action is connected with the S-enantiomer of citalopram, and that escitalopram is the most selective inhibitor of this transporter. The results of most clinical studies in patients with depression show significant superiority of escitalopram, 10-20 mg/day, over placebo, as early as within the first week of treatment, and a faster onset of action and higher therapeutic efficacy of escitalopram, compared to citalopram, 20-40 mg/day. A similar efficacy of escitalopram, 10mg/day, and sertraline 50-200 mg/day, as well as escitalopram, 20 mg/day, and venlafaxine, 225 mg/day was demonstrated. It has also been shown that escitalopram, 10-20 mg/day, exerts therapeutic efficacy in general anxiety disorder, panic disorder and social phobia. Escitalopram may meet many criteria for the optimal antidepressant. The drug is efficacious in depressions of various intensity, has a rapid onset of action and, in long-term treatment, prevents the relapses of the illness. It exerts therapeutic activity in anxiety disorders. The dosing is convenient, and the drug is safe and well tolerated due to a mild profile of side-effects and favorable pharmacokinetic properties. Further studies are needed, aiming e.g. at the comparison of the therapeutic efficacy of escitalopram with other antidepressant drugs in different patients and the assessment of the effect of the drug on cognitive functions. The results of such studies may provide a convincing answer to the question whether escitalopram can be regarded as an antidepressant drug belonging to the second generation of serotonin transporter inhibitors.

Poziom kortyzolu w godzinach popołudniowych u chorych z depresją w przebiegu choroby afektywnej  241
Afternoon plasma cortisol level in patients with depression in the course of affective disorder  241
Hubert Wichowicz
Aim: The aim of paper was to assess parameters characterising fluctuation of afternoon cortisol level in a group of patients with major depression compared to matched healthy controls. Method: 34 inpatients (21 women and 13 men) with major depression and 28 matched healthy controls (18 men and 10 men) were included in this study. 25 patients fulfilled the criteria for melancholic type. The mean age of the depressive group (43.4±10.4) was similar to the controls (40.8±10.9). The intensity of depression measured by 17 - items HDRS varied from 20 to 26 (mean: 24). The duration of depression lasted: from 6 to 37 weeks (mean: 13). Plasma cortisol level was measured in 7 samples of blood collected between 300 and 500 p.m. The following parameters characterising fluctuation of hormone level were specified: maximum, minimum and mean plasma cortisol level and its range (maximum-minimum). Results: There were no statistical differences between the depressed group and healthy controls in all four parameters. There were also no statistical differences between healthy controls and the separated groups of patients: with melancholic features, single episode, recurrent depressions and bipolar affective disorder. Conclusions: Results showed that the afternoon drop in cortisol level took place in both groups: depressed patients and matched healthy controls. In the group of depressive patients diurnal patterns of cortisol secretion was maintained between 3 p.m. and 5 p.m.

Rokowanie w łagodnych zaburzeniach poznawczych  251
Rates of progression in mild cognitive impairment  251
Leszek Bidzan, Mariola Bidzan
Aim: The aim of the study which was based on a five year prospective scheme was the evaluation of progressive changes in persons with a diagnosed mild cognitive impairment (MCI). Method: A result of 3 in the Global Deterioration Scale (Reisberg's criteria), allowed for mild cognitive impairment diagnosis. The CGI scale result in the 5th year of observation was the bases to divide the studied population into a group with a stable MCI course and a group with progressive symptoms. Result: 41 persons finished the five years of observation, out of a total 46 chosen for the study. After 5 years, 26 persons had no changes in the CGI result, whilst 15 persons showed a worsening in their clinical picture. At the initial qualification to the study the two groups of patients did not differ in their psychiatric state. However differences in the ADAS-kog could be seen in the second measurement done after the first year of the observation. Amongst those persons who had a worsening above 1.68 in the first year of the observation, Alzheimer's disease could be diagnosed definitely more frequently in the further stages of the observation. Conclusions: Evaluation of cognitive function impairment progression seems to be one of the most important diagnostic elements and should be included in the diagnostic criteria of MCI.

Uczenie się wzrokowo-przestrzenne w otępieniu i depresji  263
Visuospatial learning in dementia and depression  263
Wioletta Radziwiłłowicz
Aim: The aim of the study was an analysis of the efficacy, the progress and the structure of disturbances of the visuospatial learning process in patients with dementia, depression and aging. 96 people were examined altogether. Each of the tested groups was of the same size - 32 patients with dementia, depression and aging. Method: The following tools were applied: Global Deterioration Scale, Beck Depression Inventory, Hamilton Depression Scale, Diagnostics of Cerebral Injuries (Weidlich, Lamberti), MMSE  - subscales: Information, Vocabulary, Comprehension of the Wechsler Intelligence Scale. Results: Their retrieval process was most disturbed in patients with dementia. Tendency to forget turned out to be the greatest in patients with dementia. In the course of the learning process in patients with dementia, the recency effect dominated. In patients with aging and depression one did not observe relative superiorities of the primary effect or of the recency effect. Patients with depression and aging did not differ in the general number of errors and the number of each kind of errors. Confabulations, perseverations, reversals in the recall trials and confabulations in the delayed recognition trial turned out to be characteristic for patients with dementia. Conclusions: Patients with dementia and patients with depression were characterized by different efficacy, progress and structure of disturbances of the learning process. In all the examined groups there were characteristic interdependencies between efficacy, progress and structure of disturbances of the learning process.

Choroba Creutzfeldta-Jakoba i inne pasażowalne encefalopatie gąbczaste człowieka. Część I  283
Creutzfeldt-Jakob disease and other human transmissible spongiform encephalopathies. Part I  283
Adam Zaborowski
In the first part of this work the main problems of prion diseases - also called transmissible cerebral amyloidoses (TCA) or subacute (transmissible) encephalopathies (SSE, TSE) - and clinical symptoms of Creutzfeldt-Jakob disease are presented. Some problems of neuropathology of Creutzfeldt-Jakob disease and basic informations about other human prion diseases will be presented in the second part. The growth of the interest in prion diseases during last years is caused by the problem of bovine spongiform encephalopathy (BSE or  "mad cow disease") and its transmission into a human. The new variant of Creutzfeldt-Jakob disease (nvCJD) has appeared. Prion diseases: Gerstmann-Sträussler-Scheinker syndrome (GSS), kuru, fatal familial insomnia (FFI) and particulary the most frequent of them - Creutzfeldt-Jakob disease (CJD) - have nonspecific, sometimes variable clinical (psychopathological and neurological) symptoms. The imaging, EEG, cerebrospinal fluid tests and other laboratory tests are not specific either and their diagnostic value is limited. Neuropathological studies are needed but their interpretation is often difficult. The only certain diagnostic marker for TSE is the presence of PrP(Sc), the prion protein, which is presently believed to be a direct cause for all transmissible cerebral amyloidoses (TCA).

Choroba Creutzfeldta-Jakoba i inne pasażowalne encefalopatie gąbczaste człowieka. Część II  297
Creutzfeldt-Jakob disease and other human transmissible spongiform encephalopathies. Part II  297
Adam Zaborowski
The second part of this work presents the neuropathological problems of the Creutzfeldt-Jakob disease and basic informations about other human prion diseases. General problems of prion diseases and clinical symptoms of Creutzfeldt-Jakob disease were presented in the first part. Prion diseases are also known as transmissible cerebral amyloidoses (TCA) or transmissible (subacute) spongiform encephalopathies (TSE, SSE). There are following human TSE's: Creutzfeldt-Jakob disease (CJD) - the most frequent TSE, and its new variant (vCJD) - a result of BSE's transmission into human, sometimes treated as a separate disease; also: Gerstmann-Sträussler-Scheinker syndrome (GSS) that may be a variant of familial CJD, kuru - probably a result of sporadic CJD's transmission by cannibalism, and fatal familial insomnia (FFI). Their clinical symptoms (and especially of the CJD), are nonspecific and sometimes variable. The imaging, EEG and other laboratory tests are not specific either. Neuropathological studies are needed but their interpretation may be equivocal. TSE's are characterised by the neurodegenerative process with characteristic spongiosis. However, vacuolisation - similar as in TSE-spongiosis - may occur in some CNS's disorders and in the case of putrescent brain tissue. In some cases of CJD, particularly those of long duration, the neuronal loss and astrocyte proliferation can mask the presence of spongiform changes, especially when vacuoles are not numerous. The only certain diagnostic marker for TSE is PrP(Sc), prion protein, presently believed to be a direct cause for all TSEs (TCAs). ThePrP(Sc) has a dominant b-sheet amyloid structure which makes its detection by immunohistochemical procedure possible only with special pretreatment, e.c.: hydrolitic autoclaving, hydrated autoclaving, incubations: formic acid (or guanidine thiocyanate) pretreatment, also combined pretreatments. These methods are standard diagnostic procedures for transmissible cerebral amyloidoses.

Zmiany psychiczne u chorego z guzem przysadki mózgowej - opis przypadku  311
Mental changes in course of pituitary gland tumor - a case study  311
Wiesław Jerzy Cubała, Zbigniew Afeltowicz, Piotr Sowiński
The aim of this paper is to present a case of a 59-year old patient diagnosed with a pituitary gland tumour. The psychiatric examination at the day of admission to the clinic suggested the manic episode was based upon the disseminated organic brain lesion. The patient presented mood elevation, carefree joviality, excitement, loss of social inhibition, inability to sustain attention. In course of the clinical observation and diagnostic progress the pituitary gland tumor was revealed and neurosurgical treatment was applied. The psychopathological course of the disorder was not typical for the established location. The psychopathological syndrome that was presented by the patient gave the global clinical impression of frontal and temporal lobes' dysfunction. This case report supports the present neurobiological opinions criticising the direct relation of the location to the function within the central nervous system.

Kliniczne właściwości memantyny  321
The clinical relevance of memantine use  321
Tomasz Sobów
Memantine is an NMDA receptor antagonist with moderate affinity, which results in neuroprotective  potential due to reducing overstimulation caused by glutamate (excitotoxicity) and simultaneous lack of adverse events (especially psychosis) typical for an antagonist with higher affinity like phencyclidine. In randomized, controlled studies it has been shown that memantine is beneficial in the treatment of moderate to severe dementia of Alzheimer's type and it became the very first compound to be registered for this purpose both in Europe (including Poland) and in the United States. Further investigation require usefulness of memantine in less advanced stages of Alzheimer's disease as well as other types of dementia especially vascular; promising results are shown in dual therapy: memantine + cholinesterase inhibitor.


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