39, 2

Adam Bilikiewicz, Jadwiga Gromska
Transseksualizm jako fenomen interdyscyplinarny  227
Transsexualizm as an interdisciplinary phenomenon  227
The authors express their criticism on the currently abiding Polish diagnostic and therapeutic criteria of transsexualism. Relying on their clinical experience and expertise (opinions for the court) as well as current literature, they point to the necessity of a discussion between specialists from various medical fields (psychiatry, sexology, urology, surgery, endocrinology, genetics) and humanistic sciences (psychology, sociology, law, ethics) on this interdisciplinary phenomenon.

Mariusz Ślosarczyk
Czy psychiatria może stać się neuropsychiatrią?  239
Can psychiatry become neuropsychiatry?  239
Today more and more often there are prognoses that in the future psychiatry will have been absorbed by neurology. It would be thanks to the stormy progress of research on the neurophysiological, genetic and molecular foundations of mental disorders. The aim of the article is to assess the possibility as well as the supposed consequences of such an evolution of psychiatry. The considerations concern the peculiarity of the object of interest and the methods used in psychiatry in relation to the neurological object and methodology. This way the appraisal of raison d'etre of one common science: neuropsychiatry becomes possible. The question of fundamental importance for the evaluation of similarities and differences between the psychiatrical and neurological perspectives is the way the psychophysical issue and especially the problem of mind - brain relation are approached. The article presents the manners of solving these problems proposed by the contemporary philosophy of the mind. Together with parting with the full of errors and simplifications heritage of Descartes it appears the necessity to regard the presence of subjective mental states both conscious and unconscious in model of mind - brain relation. The exemple of such a solution is the biological naturalism of John Searle. The psychical life of the man in its subjective dimension remains the peculiar area of interests for psychiatry irrespective of the progress in research on the biological base of mental disorders. The specially valuable cognitive and therapeutic tool in this aspect is psychotherapy constituting the integral part of psychiatry. The present state of knowledge does not indicate that the psychotherapeutic wing of psychiatry can lose its importance and rather somewhat the contrary. The progress of neurobiology does not have to threaten the autonomy of psychiatry by any means and the maintenance of this autonomy depends decisively on the psychiatrists themselves.

Agata Szulc, Beata Galińska, Andrzej Czernikiewicz
Schizofrenia - bliżej do koncepcji neurorozwojowej czy neurodegeneracyjnej?  249
Schizophrenia - neurodevelopmental and neurodegenerative theory revisited.  249
The paper presents a critical review regarding the pathogenesis of schizophrenia. The neurodevelopmental theory which is now mostly recognized, needs some explanations, some elements of neurodegenerative theory are revisited. The developmental factors are confirmed as important in the pathogenesis of schizophrenia, but still it is unclear, how relatively subtle early damage causes so heavy thinking and emotions distortion like schizophrenia. There is also lack of evidence for neurodegeneration. Neuroimaging studies show the evidence for progression of brain abnormalities but at the same time there is no progression in neurocognitive disorders. Most likely late developmental disorders interfere with early brain damage, which leads to neurocognitive disorder and clinical symptoms of schizophrenia.

Andrzej Bembenek
Seasonality of birth in schizophrenia patients. A review of the literature  259
Sezonowość urodzeń pacjentów ze schizofrenią. Przegląd badań  259
Schizophrenia is a major public health problem. The paper presents a review of the literature about seasonality of birth in schizophrenia. Tramer (1929) reported the first study on seasonality of birth in mental disorders. Seasonality of the birth of people who develop schizophrenia refers to a 5-8% excess of births in winter months. However, the peak of research into this phenomenon started in the 1990s. Torrey et al. (1997) reviewed over 250 studies from 29 countries in the Northern Hemisphere and 5 publications by authors from the Southern Hemisphere, concerning the relationship between birth seasonality and the incidence of schizophrenia. The research findings from the Northern Hemisphere were consistent, indicating a 5-8% increase in the risk for mental disorders in individuals born between December and May. Meta-analysis of investigations from the Northern Hemisphere indicates that seasonality of birth increases with geographical width. Results of research from other geographical areas, analysis of stability of this phenomenon during decades and attempts of explanation reasons of seasonality are presented.

Andrzej Bembenek
Czy ekspozycja płodu na infekcje grypy może zwiększać ryzyko zachorowania na schizofrenię w życiu dorosłym?  271
Does the foetus exposition on influenza infection may increase the risk of schizophrenia in adult life?  271
Introduction: Epidemiological studies indicate the existence of various environmental factors, which elevate the risk of schizophrenia in adult life. Influenza infection is a widely discussed causal factor in the relation to schizophrenia. The paper is a review of the studies on the theme of exposition to viral infections in foetal life - in connection with schizophrenia morbidity in adult life. Many of such studies, and yet not all of them show such a relationship. Aim: The aim of our study was to find the effect of influenza exposition in fetal life on the increase in schizophrenia morbidity of the Polish population, by applying the seasonal decomposition method. Method: All persons discharged from hospitals in Poland with a diagnosis of schizophrenia in the years 1997 - 2000 were taken up for the study. The data on the population births in the given months of the period 1964 - 1984 was also used. Monthly indices of the number of births of patients with a diagnosis of schizophrenia per 10,000 live births in the general population of men and women was applied in order to eliminate the seasonal variability due to the unstable number of births in the general population. The number of influenza cases in Poland was divided by the number of inhabitants and multiplied by 10,000 thus forming indices of influenza cases in the subsequent months of the period studied. The seasonal decomposition method - Census I - was used for the basic analyses - this being one of the methods of time interval analyses available in the Statistica programme. Results: The study results show that exposition to influenza infections 2-4 months prior to birth may be a risk factor in schizophrenia development in adult life.

Hanna Karakuła, Katarzyna Szajer, Justyna Pawęzka, Anna Grzywa, Adam Gut, Grzegorz Przywara
Psychofarmakoterapia zaburzeń psychotycznych w okresie ciąży i laktacji  285
Psychopharmacotherapy of psychotic disorder during pregnancy and lactation  285
The aim of our work based on the global literature - review is to present the guidelines of the psychopharmacotherapy during pregnancy and lactation recommended by various experts - groups as followed: 1. American Academy of Pediatrics, American Psychiatric Association, American College of Obstetricians and Gynecologists, The Maudsley Guidelines, Department of Psychiatry, Medical University of Mainz, Institute of Psychiatry and Neurology in Warsaw. In the first part the guidelines concerning to psychopharmacotherapy of psychotic disorders have been presented and actual data about spreading of these illnesses, pre- and perinatal effects of drugs used, the classification of neuroleptic drugs according to FDA and the safety of these medicines for the breast fed newborn.

Jan Aleksander Beszłej, Magdalena Grzesiak
Otwarte badanie skuteczności i tolerancji leczenia kwetiapiną u pacjentów z rozpoznaniem schizofrenii  293
An open study on the efficacy and tolerability of quetiapine treatment of patients with schizophrenia  293
Aim: Assessment of efficacy and tolerability of quetiapine in treatment of schizophrenia. Method: Patients with a diagnosis of schizophrenia (according to ICD-10, DSM-IV) have been included in the 12-weeks open study. Severity of schizophrenia symptoms have been evaluated using the PANSS Scale. Adverse events have been assessed according to The Adverse Events Inventory, The Simpson Angus Extrapyramidal Symptoms Scale, the Akathisia Barnes Scale and the Involuntary Movement Scale. Quetiapine has been used in the increasing doses up to 600 mg/day. Results: Thirty-eight persons were included. The total scores in PANSS before treatment were 84,7 on average. Twenty- eight patients (74%) completed the study. Reduction in severity of schizophrenia according to the PANSS Scale was statistically significant (p<0.01). Reduction of scores in the range 20-29 % was obtained in 18 patients (48.6%), 30-39% in 10 patients (26.3%) and above 40% in 2 patients (5.4%). Adverse events occurred in 71% patients. The most common were: drowsiness (18%), weakness (10.5%), restlessness (10.5%), agitation (10.5%) and increase in severity of delusions and hallucinations (10.5%). Conclusion: In the study Quetiapine caused the reduction in the positive and negative symptoms of schizophrenia. Serious adverse events requiring drop-out of the study, were not observed. The severity of extrapyramidal symptoms with statistical significance decreased during the quetiapine treatment (p<0.05).

Jacek Radzik, Bartosz Grotthus, Jerzy Leszek
Zaburzenia funkcji wątroby w przebiegu długotrwałego leczenia risperidonem u chorego na schizofrenię - opis przypadku  309
Liver in schizophrenic patient after long-term risperidone treatment - case report  309
We present a 51-year old man with a 18 year history of chronic paranoid schizophrenia. The last four years he was treated only with risperidone at the dose 3 mg per day. He was admitted to hospital due to a psychotic decompensation. Jaundice and skin pruritus were also observed at admission. Laboratory tests revealed elevated liver enzymes. Cholestatic and viral hepatitis were excluded. Risperidone was changed to other antipsychotic drugs. After 7 weeks of treatment the patient was discharged with significant improvement of his mental condition. The liver function test results returned to normal values except for the slightly increased total bilirubin level. Regular liver monitoring was suggested. In this case liver dysfunction was possibly collerated with long-term risperidone therapy.

Sławomir Murawiec
Kliniczna ilustracja leczenia psychozy w kontekście jej koncepcji jako stanu zaburzonego uwydatniana znaczeń  315
Clinical example of recovery from psychosis in the context of the psychosis as a state of aberrant salience theory  315
According to the theory proposed by S. Kapur psychosis is a state of aberrant salience. Dopamine and mesolimbic system play the key role in the occurrence of psychosis. According to Kapur dopamine mediates the conversion of neural representations of an external stimulus from a neutral into attractive or aversive. In the psychosis this physiological role of the dopamine is changed. Dopamine starts to create a process of salience acquisition, instead of mediate it as it is in normal circumstances. According to Kapur delusions are cognitive explanations that the individual imposes on the experience of aberrant salience. Pharmacological agents share the psychological effect - dampening salience. But antipsychotics only provide the state of attenuated salience and symptomatic improvement needs further psychological and cognitive resolution. Thw case of a patient with paranoid psychosis during treatment with risperidone was analyzed in the context of Kapur's theory. Reports of experiences given by patients can support the theory and make it valuable in the conceptualization of the process of step-by-step recovery from psychosis.

Maria Chuchra, Beata Pawłowska
Współzależności między lękiem a przedchorobowym i aktualnym obrazem siebie u chorych na schizofrenię paranoidalną  327
Interdependencies between anxiety versus premorbid and present self image in patients with paranoid schizophrenia  327
The aim: The aim of this work was to determine the relationship between anxiety versus premorbid and present self-image in patients with paranoid schizophrenia hospitalized for the first time as well as many a times. Tested Group/Material: The test group consisted of 120 patients, hospitalized for the first time, aged 19-20 years diagnosed according to ICD-10 with paranoid schizophrenia, who had suffered from this illness for a period not longer than 2 years. The other group consisted of patients aged 25 - 46, who had suffered from this disease for 5 - 15 years and who had been hospitalized many a times (3 ( 10). Methods: In the tests' the H.G. Gough and A.B. Heilbrunn ACL Adjective test and R.Cattell's Ipat Anxiety Scale were used. The ACL test was done by the patients following the instruction "I am", "before the illness I was". The average, general anxiety level was correlated with the scales of the ACL test of the premorbid image and the present image in both groups. Conclusions: 1. The anxiety in patients with paranoid schizophrenia is connected both to the premorbid and the present self-image. 2. There is a more frequent and stronger relationship between anxiety and present self-images. 3. There are more interdependencies between anxiety and premorbid self-image in patients hospitalized for the first time. 4. There are more interdependencies between anxiety and present self-image in patients with chronic schizophrenia. 5. After the treatment there is no change of the direction of interdependencies but the strength of the relationship is getting deeper, the above tendency being manifested more often and stronger within the chronic group. 6. The higher the anxiety level, the more negative the self-esteem and the greater the need for support, whereas the need for self-accomplishment is lower.

Jolanta Paszko
Dzieci z rodzin dotkniętych chorobą psychiczną. Analiza sytuacji trzech rodzin  337
Children from families with mental illnesses. Case study  337
The article reveals the influence of mental illness of one or both parents on the emotional and psychosocial development and possible adjustment disturbances of their children on the example of 3 patients. The patients (all females) were treated in the IV Psychiatric Clinic of the Institute of Psychiatry and Neurology in Warsaw in the all-day clinic, and in the out-patient clinic with community mobile teams and specialised social help services. The analysis of the history of their mental illnesses was done and compared with the analysis of their family situation and accessible data about the emotional and psychosocial development of their children. Each of these patients was at some time a single parent due to different reasons. In each case the adjustment and emotional disturbances of patients' children occurred on the different level of their development (boy and girl of the primary school age, teen-ager and young adult). In all presented cases there is a need of help and support apart from the family, which indicates a need of early diagnosis of situations demanding proper systemic interventions.

Paweł Bronowski, Maria Załuska
Wsparcie społeczne pacjentów przewlekle chorych psychicznie  345
Social support of chronically mentally ill patients  345
Aim: Assessment of the social support system of mentally ill persons covered by a local rehabilitation programme situated in Targówek, Warsaw. Method: The sample consists of 92 participants with serious mental illness. Bizoń's Social Support Inventory and Social Support Map were used. Results: Patients' social networks were small (9 persons in average) but had a broad scope of functions. Therapists from community rehabilitation services consist the biggest group of persons included in the individual network of social support. Lack of emotional support is observed. Results: Participation in a local system of rehabilitation improves the quantity and quality of individual systems of social support.

Magdalena Kolasińska, Jolanta Rabe-Jabłońska
Zaburzenia komunikacji i mowy oraz ich związek z zaburzeniami rozwoju psychicznego i zaburzeniami psychicznymi u dzieci 8-letnich z gminy miejskiej Łódź  357
Communication and speech disorders, and their relationship with psychic development and mental disorders in 8 year old children from Łódź area  357
Aim: The aim of the study was to analyze the occurrence of communication and speech disorders among 8-year-old children in Łódź. The comorbidity of these disorders with mental and somatic disorders was also analysed. We have also studied the correlation between the level of language development and the level of psychic development, and the existence and character of mental disorders. Method: The study comprised 7881 children from Łódź' born in 1991r. The design of the study was two-stage. Stage I consisted of a screening test, using the Questionnaire of Child-Environment Communication Development, which was sent to the parents of all children. On this basis a group of 58 children with communication disorders was identified, which were further evaluated in the stage II of the study. Stage II consisted of a psychiatric examination, Screening Logopedic Test acc.to Tarkowski, Child Developmental Questionnaire acc. to Rabe-Jabłońska and Gmitrowicz, somatic state evaluation and analysis of the available documentation. Results: In 0.81% of the children communication disorders were found. Speech disorders were present in all cases: in 2/3rds expressive language disorders or mixed receptive-expressive language disorders, in the remaining cases phonological disorders. Estimated frequency of occurrence of specific disorders in the studied population was as follows: specific developmental language disorders 2.9/1000, acquired aphasia with epilepsy 4/10000, autistic disorder 6.4/10000. Over one third of children with a verbal communication disorder suffered also from various neurological and developmental disorders; most of the children showed abnormal mental development (f= 0.86) and mental disorders (f=0.66). Conclusions: Poor language development correlated statistically significantly with mental retardation, pervasive developmental disorder and behaviour disorders, caused by brain damage or brain dysfunction. Children with a communication disorder who demonstrated normal language development suffered from social maladaptation or ADHD statistically significantly more frequently.

Magdalena Trzcińska, Alina Borkowska
Dysfunkcje poznawcze i zaburzenia emocjonalne u dzieci z nerwiakowłókniakowatością typu pierwszego (chorobą Recklinghausena). Przegląd piśmiennictwa  371
Cognitive dysfunction and emotional disturbances in children with neurofibramatosis type one (Recklinghausen disease). Review of literature  371
Neurofibromatosis type 1 (NF1) is a genetic disorder associated with a high risk of the neuropsychological, emotional and psychosocial disturbances in children with NF1. In this research the results of the psychological and neuropsychological studies in children with NF1 were presented. According to data of current researches, the most common cognitive deficits are connected with visual - spatial impairment, however verbal, working memory and executive function deficits associated with prefrontal cortex dysfunction are also important. The results indicate that the neuropsychological deficits may increase during the course of the illness.

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Psychiatria Polska
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