38, 4

Małgorzata Dąbkowska
Fobia społeczna u dzieci i młodzieży  589
Social phobia in children and adolescents  589
Epidemiological data indicate that anxiety disorders are the most common childhood disorders. 1% of children and adolescents suffer from social phobia and it may influence further adult life. The aim of the article is to show differences of child and adolescent social phobia and its diagnostic criteria. Contrast and distinction of childhood social phobia symptoms are also shown, such as risk factors of appearance of childhood social phobia. The article presents main therapeutic methods - psychotherapy and pharmacotherapy applied to children with phobia and difficulties with estimating efficacy of the particular therapy in this group of patients. Phobic children percept surroundings more negatively. They have reduced estimations of their own competency to cope with danger. They also show cognitive impairments of ambiguous situations. As much as 60% children with social phobia suffer from a second, concurrent disorder. Widening of information about symptoms and therapeutic methods may reduce the intensity of the disorder during adulthood.

Krzysztof Małyszczak, Marcin Szechiński
Współwystępowanie różnych postaci zaburzeń lękowych i depresji  603
Comorbidity of different forms of anxiety disorders and depression  603
Aim: Comorbidity of some anxiety disorders and depression were examined in order to compare their statistical closeness. Method: Patients treated in an out-patient care center for psychiatric disorders and/or family medicine were recruited. Persons that have anxiety and depressive symptoms as a consequence of somatic illnesses or consequence of other psychiatric disorders were excluded. Disorders were diagnosed a with diagnostic questionnaire based on Schedule for Assessment in Neuropsychiatry (SCAN), version 2.0, according to ICD-10 criteria. Analyses include selected disorders: generalized anxiety disorder, panic disorder, agoraphobia, specific phobias, social phobia and depression. Results: 104 patients were included. 35 of them (33,7%) had anxiety disorders, 13 persons (12,5%) have depression. Analyses show that in patients with generalized anxiety disorder, depression occurred at least twice as often as in the remaining patients (odds ratio = 7.1), while in patients with agoraphobia the occurrence of panic disorder increased at least by 2.88 times (odds ratio = 11.9). In other disorders the odds ratios was greater than 1, but the differences were not statistically significant Conclusion: Depression/generalized anxiety disorder and agoraphobia/panic disorder were shown to be statistically closer than other disorders.

Monika Guszkowska
Wpływ ćwiczeń fizycznych na poziom lęku i depresji oraz stany nastroju  611
The effects of exercise on anxiety, depression and mood states  611
This article reviews the studies on the effects of physical activity on the emotional states - anxiety, depression and mood. The meta-analyses of correlational and experimental studies reveal positive effects of exercise, in healthy people and in clinical populations (also in patients with emotional disorders) regardless of gender and age. The benefits are significant especially in subjects with an elevated level of anxiety and depression because of more room for possible change. The most improvements are caused by rhythmic, aerobic exercises, using of large muscle groups (jogging, swimming, cycling, walking), of moderate and low intensity. They should be conducted for 15 to 30 minutes and performed a minimum of three times a week in programs of 10-weeks or longer. The results confirm the acute effect of exercise i.e. the reductions in anxiety and depression after single sessions of exercise. The changes in anxiety, depression and mood states after exercise are explained most frequently by the endorphin and monoamine hypotheses. Exercise may also increase body temperature, blood circulation in the brain and impact on hypothalamic-pituary-adrenal axis and physiological reactivity to stress. The possible psychological mechanisms include improvement of self-efficacy, distraction and cognitive dissonance.

Izabela Łucka
Zaburzenia depresyjne współwystępujące z jadłowstrętem psychicznym  621
Depression syndromes in patients suffering from anorexia nervosa  621
Aim: The purpose of the study was the estimation of comorbidity of depressive syndromes and anorexia nervosa (based on criteria of ICD-10 and DSM-IV). A group of 30 children (average age - 13.5), 27 girls and 3 boys suffering from a first episode of anorexia nervosa was considered. Method: Anamnesis from patients and their parents, clinical observation, the psychiatric investigation with use of The Depression Rating Scale for Children (Elva o. Poznański and comp.) and the Hamilton Depression Rating Scale. Results: The comorbidity of depressive syndromes and anorexia nervosa was frequently observed. 73.3% children suffered from depressive syndromes in the course of anorexia nervosa. As for intensity - in 33% it was moderate, in 20% - severe, and in 20% - mild depression. In the investigated group of children depressive syndromes appeared in the bulimic subtype of anorexia nervosa in 88.8% cases and in the restricting subtype in 72.2%. Statistically, in the considered group, the depression was significantly frequent in the first and the second degree relatives. Conclusions: In the examined group, the number of biological as well as psychological events which could predispose to depression was found. However, the children were not suffering from depression until they were sick from anorexia nervosa and their bodies were not cachectic.

Grażyna Adamiak, Ewa Świątnicka, Lucyna Wołodźko-Makarska, Małgorzata Julita Świtalska
Ocena jakości życia studentów medycyny w zależności od liczby i nasilenia stwierdzonych objawów depresyjnych  631
Assessment of quality of life in students of medicine in relation to the number and intensity of depressive symptoms  631
Aim: To assess the number and intensity of depressive symptoms in medical students of the Łódź Medical University as well as students of other faculties and to find the correlation between the intensity of depression and factors determining the quality of life. Method: Beck's Depression Inventory was applied to evaluate the depression intensity and the F. Baker and J. Intagliate Quality of Life Scale was used to find out about the life-quality. 177 2nd year and 86 4th year medical students and 109 students form other faculties in Łódź, took part in the study. Results: 28.8% of the 2nd year students and 14% of the 4th year medical students were diagnosed with depressive symptoms. A negative correlation between the depressive symptom intensity and a feeling of satisfaction with life was shown. Amongst the students of architecture and pedagogy, the depressive symptoms were above average for the general population. No statistically significant differences were noted amongst the groups of medical students and others in relation to the life perspectives, possibility of professional and personal development. Conclusions: To find the other causes of depression in the academic society, further research is necessary. This has a vital role for the protection of mental health of this specific professional group of people.

Katarzyna Prochwicz, Anna Starowicz
Trichotillomania. Przebieg i następstwa psychospołeczne  639
Trichotillomania. Its course and psychosocial consequences  639
The article contains the definition and characteristics of trichotillomania, its prevalence, main syndromes and factors which intensify the pressure of uncontrolled hair pulling. It also raises the problem of the role of tension in maintaining these behaviours what is connected with some controversy around the definition of trichotillomania. In addition this article includes its relationship with other mental disorders. Special attention was given to the subjective experiences of chronic hair-pulling, and to social and psychological consequences of trichotillomania.

Bogusław Borys, Mikołaj Majkowicz
Radzenie sobie ze stresem przez osoby, które doświadczyły urazu psychicznego  651
Coping with stress in those who experienced a traumatic situation  651
Aim: Does the traumatic experience influence the choice of a particular coping style? If yes, which style is preferred by those who experienced trauma? Answering these two essential questions is the aim of this paper. The authors have accepted the assumption (Holman, Silver, 1998), that the individuals who experienced trauma prefer past temporal orientation and they present a higher level of distress. Method: The authors investigated two groups. The experimental group consisted of 46 victims of the Gdańsk Shipyard concert hall fire. The control group comprised the 41 individuals who never experienced any trauma. Two psychological methods were used. CISS - Endler and Parker, which measures coping styles. STAI - Spielberger and al., was the second method used for measuring the level of anxiety as an essential distress indicator. Results and conclusions: The results show, that individuals who experienced trauma, presented a significantly higher level of anxiety and that the victims of trauma prefer the emotional coping style. The difference is statistically significant. There is also an indirect conclusion (based on these results), which confirms the above mentioned assumption.

Bogusław Borys, Mikołaj Majkowicz
Zmiany psychiczne u ofiar pożaru hali widowiskowej Stoczni Gdańskiej obserwowane w latach 1995-1999  661
The psychological changes in the victims of the Gdańsk Shipyard Hall fire in the period of 1995-1999  661
Aim: The aim of this paper was to answer two questions. First - has a particular traumatic event (the Gdańsk Shipyard concert-hall fire) caused any psychopathological changes in the victims? Secondly - if yes, how do the dynamics of these changes manifest themselves? Method: The authors used two psychological methods. Adjective Check List, which measures the structure of psychological needs, and in some way, the picture of oneself (before and after the fire) and HADS-M, which measures the intensity of negative emotions (anxiety, depressiveness and aggression). The first investigation in 1995 included two groups: 46 victims of the fire and a control group (47 youngsters, who did not participate in this particular concert). The investigation of the victims group was then repeated twice, in 1996 (35 persons) and in 1999 (39 persons). Results: The series of investigations lead to the conclusion that the traumatic event (Gdańsk Shipyard hall fire) caused statistically significant, psychopathological changes in the victims (the first investigation). The changes concerned the worsening of the picture of oneself and an increase in the intensity of negative emotions (anxiety, depressiveness, aggression). All these changes still exist, despite the time which passed since the traumatic event (the repeated investigations).

Adela Monieta, Wojciech Anczurowski
Nasilenie objawów zespołu stresu pourazowego (PTSD) u Sybiraków z terenu północno-wschodniej Polski  673
Intensification of Post-Traumatic Stress Disorder of Siberian deportees from the north-east region of Poland   673
Aim: Presentation of Post-Traumatic Stress Disorder based on the approach of various authors concentrating, upon the concept of the American classification: DSM III (1980) and DSM IV (1994). We acknowledged the necessity of displaying empirical results of intensification of PTSD among the Siberian deportees population in the region of North-East part of Poland. Method: In our analysis, we stressed the importance of the distant in time, psychological consequences of dwelling in extremely difficult living conditions that often threatened the life of those who had been deported to Siberia between 1939 and 1956. 40 "Siberian deportees" (20 men and 20 women) were examined. The method of PTSD-Interview (PTSD-I) was used here in order to obtain, in each individual case, the indicatory number indispensable for the statistical analysis. Results and conclusion: An average result of PTSD intensification in the case of women reaches a "very significant" level and in the case of men it is even higher. The disparity between the average results of women and of men are statistically significant (p<0.05). This research has confirmed the assumptions that suffering from trauma in the early stage of development (within the age range of 8-15) leaves a permanent mark in the human psyche. Statistical analysis revealed a high level of intensification of PTSD among the population of the "Siberian deportees" from the North-East region of Poland.

Tomasz Pawłowski, Piotr Baranowski, Krzysztof Małyszczak, Andrzej Kiejna
Metody leczenia proponowane pacjentom na poszczególnych etapach "drogi" do psychiatry 685
Methods of treatment in different stages of the pathway to psychiatric care  685
Aim: The aim of this study was to analyse the treatment methods at the different stages of the pathway to psychiatric care. Method: In a period of two months all patients age 15 and over who applied to the Psychiatric Service in the Ząbkowice catchment area and Psie-Pole catchment area were assessed by psychiatrists for their eligibility to enter the study. Those who had fulfilled the entry criteria were interviewed using a Polish version of WHO's encounter form (EF) by the mental health professionals during their initial interview. Results: A total of 228 patients (105 men and 123 women) were seen. Encounter forms were completed on 200 people. 28 patients refused to answer some of the questions. There were significant differences in treatments offered to patients by hospital doctors and medical specialists, general practitioners (GP's) and psychiatrists. Our data show that sedative/hypnotics are the main psychotropic drugs prescribed by GP's. The small percentage of antidepressant (10 % of all psychotropic drugs) used by GP's and medical specialists was noteworthy. They didn't decide to prescribe neuroleptics to their patients. Conclusions: The study revealed that GP's, hospital doctor & medical specialists prescribed antidepressant and neuroleptics far too rarely and GP's far too often prescribed sedative/hypnotics. This can indicate that they have difficulties in diagnosing of mental disorders as well as poor knowledge concerning indications relating the use of psychotropic drugs.

Elżbieta Krajewska-Kułak, Wojciech Klapa, Jolanta Lewko, Irena Wrońska, Cecylia Łukaszuk, Barbara Jankowiak, Anna Bartoszewicz, Hanna Rolka, Katarzyna Ostapowicz-van Dammae, Marta Leszczyńska, Katarzyna Krajewska, Matylda Sierakowska, Agnieszka Szyszko-Perłowska
Potrzeba edukacji chorego psychicznie i jego rodziny w opinii pielęgniarek  697
The nurses opinion on the necessity of educating the psychiatric patient and his family  697
Aim: To gather information on the need for educating psychiatric patients and their families by the nursing staff. Method: An anonymous questionnaire was especially constructed for this study. 628 nurses who worked in different health institutions (except for psychiatric departments) were asked to answer the questionnaire. Results: Getting the patient ready for functioning in the normal world and showing him ways to cope with the illness were considered as the most important educational themes. It is disturbing to note that 14.01% of the responders did not answer this question at all. According to the nurses, the families should be educated well on how they should deal with their ill member. Most of those questioned declared a readiness to educate the ill, but only 31.8% of them felt only minimally prepared for the task. The best form of learning to be an educator were (according to 79.7% responders) training seminars in the preferable form of talks, lectures or lessons. The medical doctor should be the one who would help in the educational role. Conclusions: The majority of the nurses believe that they are not prepared well enough for this educational function. Only 4.5% of those studied did not show any need for educating patients and their families. Training seminars for nurses should be organized, so that the nurses feel competent to educate patients and their families. Interdisciplinary teams dealing with the issue of educating patients and their families should be formed.

Sławomir Murawiec
Lek jako obiekt relacji - opis przypadku  707
Object relation with drug - case report  707
Psychoanalytic exploration of the action of psychotropic drugs has a long tradition which begins in the pioneer days of contemporary psychopharmacotherapy in 1950-ties. This exploration and publications based on them theorized about influence of neuroleptics on ego defences, id drives and intrapsychichic conflicts and decrease in symptomatology as a result in of action of the medication on all listed above. The paper presented is the case story about psychodynamic meaning of medication with a neuroleptic drug in a new context. The patient after a psychotic episode (paranoidal type) was treated with quetiapine 600 mg per day and in the same time had an individual psychotherapy. During psychotherapy her inability to establish object stability was disclosed. In that particular intrapsychic situation the patient established a relation with an omnipotent and idealized representation of the drug. Medication was an absolutely idealized object for her one that was controllable and stabile and could not abandon her. The quality of relation with the drug was based on a primary defence mechanism like splitting, idealization and omnipotence and denial.


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Psychiatria Polska
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