Bogdan de Barbaro
Między rozpoznaniem psychiatrycznym a "rozpoznaniem rodzinnym" 771
Between a psychiatric diagnosis and a familial diagnosis 771
If the idea of a biopsychosocial model is not going to be merely a phrase, then every clinical diagnosis and therapeutic vision need to consider the familial issues. Taking the family issues into consideration has evident gains; it allows for a better understanding of the patient and allows for actions which reduce the risk of a relapse of illness. The fact that such issues are not part of the therapeutic armament, despite the effectiveness of psychoeducation, is bewildering: on one hand the families are not always invited to co-operate, on the other hand - they often give up this co-operation. In such a situation, the relation between the patient's family and the personnel needs analysis, especially common, often unconscious emotions and prejudices. They can form a dysfunctional 'knot', which does not allow for a therapeutic alliance to be formed. How to come out from such an impasse and make a common positive alliance? Paradoxically, the therapeutic possibilities are bigger when - especially in the initial phase of treatment - the psychiatrist "is able to not know" and is capable of listening into the patient's family perspective, and has an interest in the 'family story'. It is only after the knowledge on the family is gained and the family perspective is accepted, that the deconstruction of that part of the family's story that forms the problem and a common search for "positive changes" are possible. Although it may not appear to be so, such an ordeal can be very difficult for the psychiatrist who is used to controlling the situation through psychiatric theory and diagnosis, psychiatric language and the psychiatric institution. The issue presented appears to be part of a universal dilemma: what is the range of "the language power" of the psychiatrist and when is the sharing of this power with the patient and the family beneficial for the therapy.
Schizotaksja - konstrukt czysto teoretyczny czy też pomocne narzędzie do badań klinicznych? 783
Schizotaxia - theoretical construct or a tool for clinical research? 783
From Kretschmer's trials binding personality traits with risk of psychoses have been described in literature.Still there is lack of one theory linking genetic factors with schizophrenia. In 1962 Meehl, introducing the term "schizotaxia", had been trying to find an answer to such a question. He described schizotaxia as subtle neuronal integration deficit caused by a single genetic factor, which depending on conditions, can give schizotypy or schizophrenia. Actually,this theory has only historical meaning. Recently Tsuang and Faraone reformulated the concept of schizotaxia used in clinical studies. Preliminary results lead to a conclusion that presence of schizotaxia has a detrimental influence on social functioning, which is improving after neuroleptic therapy. Studies confirmed that the risk of schizophrenia in persons with schizotaxia was higher as compared to persons without such characteristics. It is supposed, that paying attention to traits of schizotaxia will improve the possibility of early diagnosis of schizophrenia.
Marek Masiak, Bartosz Łoza
Podstawowe wymiary zaburzeń schizofrenicznych w oparciu o pomiar skalami PANSS i SAPS/SANS. Zróżnicowanie i porównanie trafności pomiarowej PANSS i SAPS/SANS 795
Core factors of schizophrenia structure based on PANSS and SAPS/SANS results. Discerning and head-to-head comparing of PANSS and SASPS/SANS validity 795
Objective: A lot of inconsistencies across dimensional studies of schizophrenia(s) are being unveiled. These problems are strongly related to the methodological aspects of collecting data and specific statistical analyses. Psychiatrists have developed lots of psychopathological models derived from analytic studies based on SAPS/SANS (the Scale for the Assessment of Positive Symptoms/the Scale for the Assessment of Negative Symptoms) and PANSS (The Positive and Negative Syndrome Scale). The unique validation of parallel two independent factor models was performed - ascribed to the same illness and based on different diagnostic scales - to investigate indirect methodological causes of clinical discrepancies. Methods: 100 newly admitted patients (mean age - 33.5, 18-45, males - 64, females - 36, hospitalized on average 5.15 times) with paranoid schizophrenia (according to ICD-10) were scored and analysed using PANSS and SAPS/SANS during psychotic exacerbation. All patients were treated with neuroleptics of various kinds with 410mg equivalents of chlorpromazine (atypicals:typicals -> 41:59). Factor analyses were applied to basic results (with principal component analysis, normalized varimax rotation). Investing the cross-model validity, canonical analysis was applied. Results: Models of schizophrenia varied from 3 to 5 factors. PANSS model included: positive, negative, disorganisation, cognitive and depressive components and SAPS/SANS model was dominated by positive, negative and disorganisation factors. The SAPS/SANS accounted for merely 48% of the PANSS common variances. The SAPS/SANS combined measurement preferentially (67% of canonical variance) targeted positive-negative dichotomy. Respectively, PANSS shared positive-negative phenomenology in 35% of its own variance. The general concept of five-dimensionality in paranoid schizophrenia looks clinically more heuristic and statistically more stabilised.
Katarzyna Kucharska-Pietura, Marek Masiak
Miejsce deficytów komunikacji emocji w modelach wymiarowych schizofrenii 809
The location of the deficits of emotional communication in dimensional models of schizophrenia 809
Disordered communication of emotions belongs to the primary schizophrenia symptoms. The aim of this study was our attempt of the localisation of the deficits in emotional communication (its decoding and expression) in dimensional models of schizophrenia. The evaluation of emotionality in schizophrenia might be performed indirectly via negative dimension (for instance: apathy, diminished verbal fluency, flat or inappropriate emotional reactions), via excitement (elevated mood) and depression (decreased mood) or via cognitive dimension. Interpretation of emotional phenomena within cognitive dimension remains an oversimplification. Brain emotional and cognitive systems act independently although they also reveal mutual interactions enabling the control of emotional behaviour via social learning of emotions. To conclude, to date emotional dimension in schizophrenia has not yet received satisfactory explanation which is in line with the complex nature of emotions. Thus the question regarding the location of emotions in dimensional models of schizophrenia still remains open.
Własności struktury "ja" a zaburzenia monitorowania źródła informacji u osób chorych na schizofrenię 819
Features of self-structure and source monitoring disorders in people with schizophrenia 819
Purpose: The aim of this study was to explore relationships between self-structure and source monitoring in people with schizophrenia. Material and method: Forty-one outpatients with an ICD-10 diagnosis of schizophrenic disorders participated in the study. Subjects were asked to select personality trait words from a check-list that described themselves, themselves as they were five years ago, and what most people are like. They also performed a source monitoring task and were assessed on current psychiatric symptoms. Results: Patients who lacked a sense of continuity over time tended to attribute self-generated items to an external source. Subjects who had a less clearly defined self-structure and whose self-representation was less differentiated from others-representation tended to falsely attribute items to themselves. Conclusion: The basic features of self-structure were significantly related to some problems in discrimination of self-generated stimuli in the source monitoring task.
Zaburzenia bramkowania składowej P50 słuchowych potencjałów wywołanych - neurobiologia filtrów informacyjnych i ich dysfunkcja w schizofrenii 833
Disordered sensory gating of the P50 component of the auditory evoked potentials (AEP) 833
The paper presents a review of recent data on research and clinical significance of gating of the P50 component of the auditory evoked potentials (AEP). Information filters are a necessary element for the proper functioning of the brain. It appears as though they have an important role in the information-transfer mechanisms. Neurophysiologically, they appear hypothetically in the sensory gating of the P50 component of the AEP. Schizophrenic patients and their first degree relatives do not have proper sensory gating of the P50 AEP. This suggests that there is a common biological base for these disorders. Some clinical aspects of the schizophrenic psychoses can be linked to this disordered gating. There are also notes which show the contrary. Currently we do not know whether the improper sensory gating of the P50 AEP is a trait endophenotypically linked to schizophrenia, or only something that partially explains the pathophysiology of the illness - especially since the described phenomena may be evoked in healthy persons.
Beata Hintze, Anna Bembenek, Aleksandra Kühn-Dymecka, Anna Wrońska, Jacek Wciórka
Dysfunkcja pamięci operacyjnej u osób chorujących na schizofrenię i ich krewnych pierwszego stopnia 847
Working memory dysfunction in patients suffering from schizophrenia and their first-degree relatives 847
Working memory deficits are considered to play an important role affecting not only the pathogenesis but also the course of schizophrenia. Numerous studies of schizophrenic patients and their first-degree relatives suggest that this impairment may be an indicator of susceptibility to developing schizophrenia. Aim. A comparison of selected working memory indicators in patients with schizophrenia, their first-degree relatives, and healthy controls. Subjects. Participants in the study were 99 patients with the diagnosis of schizophrenia (according to the ICD-10-DCR criteria) in an early period of remission, their healthy first-degree relatives (N = 42), relatives with a history of psychiatric disorder (N = 14), and a control group of participants (N = 54) unrelated to the subjects and with no psychiatric history. Methods. Selected tests from the computer-aided Vienna Test Battery were used, measuring: reaction time (RT) in a task that required choosing among complex stimuli of two modalities, a tendency to perseveration (PERSEV), and immediate visuospatial memory span (CORSI). Results. Schizophrenic patients' performance was found to be significantly inferior to that of controls on all the cognitive tests related to working memory: they had a longer reaction time in forced choice tasks, elevated perseverative tendencies and reduced immediate visuospatial memory span. Moreover, healthy relatives of schizophrenic patients performed significantly poorer than did the controls both as regards perseverative tendencies and visuospatial memory scan. Schizophrenic patients did not differ significantly from their close relatives in the degree of visuospatial memory span impairment. Conclusions. The findings indicate that working memory deficits as assessed by the tests used in the study may be related to familial susceptibility to schizophrenia. Therefore, the dysfunction may be taken into account in the capacity of endophenotype of such susceptibility.
Beata Hintze, Aleksandra Kühn-Dymecka, Anna Bembenek, Anna Wrońska, Jacek Wciórka
Dysfunkcja uwagi u osób chorujących na schizofrenię i ich krewnych pierwszego stopnia 861
Attention impairment in patients suffering from schizophrenia and their relatives of first-degree 861
Attention dysfunction as assessed by standardized tests has often been reported in schizophrenic patients. Since many cognitive dysfunctions noted in these patients occur also in their close relatives, a supposition arises that they may be indicators not so much of transient states, but rather of a stable feature of cognitive functioning. This feature perhaps is transmitted from generation to generation and might contribute to the onset of the disease. Aims. A comparison of selected attention indicators in schizophrenic patients and their first-degree relatives with these in healthy controls without family history of schizophrenia. Subjects. Participants in the study were 99 patients diagnosed with schizophrenia (according to the ICD-10-DCR criteria) in an early period of remission, their first-degree relatives (N = 56), out of whom 42 were healthy and 14 had a history of psychiatric disorders, and a control group of participants (N = 42) unrelated to the subjects and with no psychiatric history. Method. Several tests of the computer-aided Vienna Test Battery were used, and namely: the RT test measuring reaction time to simple visual or auditory stimuli, and LVT test measuring the accuracy and performance time in a task that consisted in visual tracking of lines, and required concentration of visual perception. Results. As compared to the controls, the patient group was found to manifest attention deficits in the form of longer reaction time to simple stimuli as well as increased performance time and decreased correctness of visual line tracking. The patients had also somewhat longer reaction time to visual (but not auditory) stimuli, and their line tracking was inferior as compared to that of their healthy relatives. As regards the reaction time to simple stimuli, the latter did not differ significantly from the controls, but in the line tracking test which required more attention, their performance was significantly inferior to that of the control group.
Bogusław Helon, Anna Adamczyk-Helon, Roman Mikuła
Zespół paranoidalny w przebiegu guza mózgu - opis przypadku 875
The paranoid syndrom a in the course of a brain tumor - case study 875
An inpatient case of The Mental Hospital in Żurawica, in which an appearance of a brain tumor was preceded by a paranoid syndrome, was described in this article. One of the numerous clinical situations, when an appearance of a somatic disease was preceded by manifestation of psychic disturbances, was demonstrated in this article.
Małgorzata Śmiarowska, Barbara Krzyżanowska-Świniarska, Agata Lisiecka, Magdalena Letkiewicz, Krystyna Pilarska, Jan Horodnicki
Maska endokrynna rozwoju procesu schizofrenicznego - studium przypadku 883
The endocrine mask of a developing process of schizophrenia - study case 883
In this research psychic and somatic symptoms related to disturbances of hypothalamus - hypophysis - peripheral regulation which may occur in the schizophrenic process were analysed. Authors discussed the problem of relations between hypothalamus neuroregulation and pathogenesis of endocrine disturbances which suggest the organic cause of obesity, hirsutism and secondary amenorrhea among women diagnosed with paranoid schizophrenia. Actual antipsychotic pharmacological treatment, including some side- effects: the metabolic (obesity) and the endocrine (hyperprolactinemia) ones were considered. The authors conclude that endocrine disorders which are connected with hypothalamus dysfunction (sleeping, eating and reproductive functions) may forereach the psychotic symptoms and treating them influences at the same time some endocrine changes. The estimation of PRL release in a test of stimulation with metoclopramide can be a sensitive (though not specific) test of dopaminergic activity in tuberous - infundibulum pathway and may be used to control the treatment.
Marek Jarema, Sławomir Murawiec, Tomasz Tafliński
Porównanie subiektywnej i obiektywnej oceny leczenia olanzapiną chorych na schizofrenię 895
Subjective and objective evaluation of olanzapine treatment in schizophrenia 895
The aim: The study was to evaluate objectively (by a physician) and subjectively (by the patients) the efficacy of 12-months olanzapine treatment of schizophrenic out-patients. Methods: Olanzapine treatment was either initiated or patients were switched from other antipsychotics to olanzapine. Patients'subjective evaluation with the use of SWN and DAI scales was compared with physicians' objective evaluation with the use of PANSS, CDS and CGI scales. Results: The treatemnt with olanzapine caused significant improvement of schizophrenia positive, negative and affective symptoms. The use of the DAI questionnaire revealed also subjective improvement after olanzapine treatment. The decrease of schizophrenic symptoms correlated with the improvement of patients' subjective feeling of self-control, psychic functioning and somatic health. No serious adverse events were seen during the treatment. The severity of adverse events decreased during the olanzapine treatment. Conclusions: Olanzapine treatment of patients suffering from schizophrenia proved to be efficacious in both objective and subjective evaluation.
Maria Załuska, Dorota Suchecka, Zofia Traczewska, Jolanta Paszko
Znaczenie środowiskowych placówek wsparcia społecznego dla kosztów leczenia osób przewlekle chorych psychicznie 911
The influence of community support services on the costs of treatment of chronically mentally ill patients 911
The aim: To determine changes in costs of treatment for chronically mentally ill patients after their admitting to new social help units; Vocational Rehabilitation Center, Community Center of Mutual Help and Specialized Social Help Services at Client's Home. Methods: In the group of 73 chronically mentally ill persons, for two years before and after their admission to social help units, the global amount of care (months x persons) and all the costs (PLN) in both social help and mental health systems were compared. Results: For two years after the admission to the mentioned services all the costs in mental health system were significantly decreasing (71,9%), but new costs in social welfare system emerged. The overall costs of care were higher than before, but the elevation (35,4 %) of all the costs was not so high as the increase (99,3%) of the care. The structure of care was improved (more day-, and less stationary care). The "out of pocket" expenses for patients increased. Conclusions The implementation of social help services for chronic mentally ill patients is reducing the amount of stationary and day treatment, but increasing active community treatment. Money in health system is saved, but all the expenses on community care are increased. Coordination of care and finances between the mental health and social welfare is needed. Common financing for both systems is questionable because of impending over medicalization. The allocation of saved money to early rehabilitation in schizophrenia would be profitable in the future.
Jolanta Paszko, Beata Wnęk, Maria Załuska
Specyfika pracy z przewlekle chorym psychicznie w ramach psychiatrycznych specjalistycznych usług opiekuńczych - doświadczenia ze spotkań superwizyjnych 923
Specifics of working with chronic mentally ill patients in Specialized Social Help Services - experiences from training and supervision meetings 923
Information was presented on the development and efficiency of The Specialized Psychiatric Social Help Services for mentally ill in Poland. It took into consideration the specifics of this work and formal requirements for special training of the staff. The experiences of the 3.5 years of work of the specialized services in the Warszawa Targówek district (October 1997 - June 2001) were discussed organization solutions and basic data about clients and staff and establishments and experiences coming from training and supervision meetings were discussed problems and difficulties most often experienced by the staff workers at their work with chronic mentally ill patients were described. Consideration was put from one side on the big rotation of the staff and from the other the need of the extension of the theoretical and practical knowledge as well as of supervision and support was often mentioned in the questionnaire. A need of elaborating the program of training and professional courses for workers of the specialized psychiatric social help services was also pointed out.
Cezary Żechowski, Katarzyna Bażyńska, Irena Namysłowska, Z. Bronowska, A. Siewierska, A. Jakubczyk
Więź z rodzicami i rówieśnikami w ocenie młodzieży hospitalizowanej na oddziale psychiatrycznym - badania pilotażowe 933
Parental and peer attachment of hospitalized adolescent patients - pilot study 933
Aim: In the context of Bowlby's theory of attachment authors made an attempt to assess parental and peer attachment in different clinical subgroups of hospitalized adolescents. Method: 142 patients- 58 with the diagnosis of neurotic disorders, 49 eating disorders and 35 patients with schizophrenic disorders, as well 34 untreated, healthy adolescents were assessed by The Inventory of Parent and Peer Attachment by Armsden and Greenberg. Results: The group of schizophrenic patients was characterized by disturbed attachment with peers and normal attachment with parents. Two other diagnostic subgroups, neurotic and eating disorders were similar as far as nature of attachment was concerned. The attachment was disturbed both with parents and peers, but the level of alienation in relations with peers in the group of eating disorder patients was similar to the level in the group of schizophrenic patients. This conclusion allow us to put the group of eating disorders closer to the group of schizophrenic, than neurotic patients, as far as attachment is concerned. Conclusions: The Inventory of Parent and Peer Attachment, used for the first time in Poland, can be seen as a promising instrument in assessing three dimensions of attachment: communication, trust and alienation in relations with parents and peers.
Ewa Kopczyńska, Marcin Ziółkowski, Ewa Jendryczka-Maćkiewicz, Grażyna Odrowąż-Sypniewska, Krzysztof Opozda, Tomasz Tyrakowski
Stężenia homocysteiny, kwasu foliowego i witaminy B12 u mężczyzn uzależnionych od alkoholu 947
The concentrations of homocysteine, folic acid and vitamin B12 in alcohol dependent male patients 947
Metabolism of homocysteine (sulphur-containing amino acid) is accomplished in the remethylation cycle where vitamin B12 and folic acid are essential coenzymes. Markedly elevated homocysteine concentrations have been observed in patients with nutritional deficiencies of vitamin B12 and folate. Hyperhomocysteinemia in alcohol abusers may result from malnutration and disorder of intestine absorption. The aim of the study was the estimation of homocysteine, folic acid and vitamin B12 concentrations in alcohol dependent male patients. 71 males with a clinical diagnosis of alcohol dependence (ICD-10) have been examined. The investigated parameters have been determined in the blood serum, the homocysteine by means of immunochemical method, vitamin B12 and folic acid by means of immunoenzymatic assay. Serum homocysteine concentration was significantly higher and serum folic acid concentration was lower in alcohol dependent men than in control adolescents. Mean concentrations of folic acid and vitamin B12 were significantly lower in patients with hyperhomocysteinemia than in men with normal homocysteine concentration. The highest correlation was indeed noticed between folate deficiency and the intensity of hyperhomocysteinemia. The development of hyperhomocysteinemia is associated with alcohol dependence that is also a probable cause of folate and vitamin B12 deficiency.