Psychiatria Polska

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The present paper discusses the theoretical background and present the practical use of the case management model of psychiatric care. Case management is a model of psychiatric care, in which the therapeutic effort is not restricted to biological and psychological functioning of the patient, but is also directed at reinforcement of the patient's environmental resources and social support. The basic principles of cases management are the community of care and the use of the patient-therapist relationship in the treatment. The patient is managed by one person responsible for all the issues relating to the patient. That person, called case-manager, directs the treatment in consultation with a psychiatrist, helps the patient in contacts with institutions and undertakes interventions in the patient's community. The paper discusses the obstacles in introducing the community care model based on case-management principles in Poland.
 
The World Psychiatric Association (WPA) and World Health Organization (WHO) are currently engaging in the revision of the International Classification of Diseases and Related Health Problems (ICD-10). Polish Psychiatric Association (PPA) is participating in that process and the first step was an international survey of Polish psychiatrists expressing their experiences and concepts about the new ICD-11. The mission is to produce an international classification that is up to the contemporary challenge, is ready for electronic health records, serves as a standard for scientific comparability and facilitates communication in psychiatry. This is the review of works currently underway, including PPA members' tasks and efforts, regarding ICD-10 revision.
 
This work presents results of a retrospective and prospective research of 15 persons with a double diagnosis: body dysmorphic disorder, and delusional disorder, somatic type. It was established that these disorders starting in adolescence, occurred in persons who earlier had traits of avoidant and obsessive-compulsive personality or social phobia. In most subjects with dysmorphophobia there was comorbidity of dysthymia or major depression. An improvement in the state of these patients, most often after implementation of complex therapeutic measures: psychotherapy as well as pharmacotherapy with neuroleptic and SSRI's or clomipramine has to do with withdrawal of delusions, whereas the symptoms of body dysmorphic disorder usually last for years. In some patients delusional disorders had a tendency to reoccur or to be chronic, and lead to a considerable impairment of social functioning.
 
The World Psychiatric Association (WPA) and the World Health Organization (WHO) initiated a series of national surveys regarding the revision of the chapter on Mental and Behavioural Disorders of the ICD-10. They are part of the global and systematic studies providing input into the new classification of mental disorders (ICD-11). In Poland, the survey after translation and implementing was performed electronically in collaboration with the Polish Psychiatric Association (17 Jan - 22 Feb 2011). 206 psychiatrists presented their experiences and ideas regarding international and other classification systems. We present results from our national part of the survey. Psychiatrists called for simplifying the classification system, with less than 100 main categories in ICD-11. That would be beneficial for professionals, their clients and all other participants. Psychiatrists accepted both strict diagnostic criteria and flexible guidance in a classification manual. The independent severity axis should be implemented for all diagnoses. The functional status was considered to be a part of general diagnostic criteria. The dimensional scales were indicated as beneficial for the diagnostic process. Participants did not report any important problems with the cross-cultural applicability of existing classifications. The validity of some categories of ICD-10 was considered poor and their definitions should be reviewed, especially: schizotypal disorder, schizoaffective disorder, borderline personality disorder, dissociative/conversion disorders and some neurotic disorders. The survey, as a part of truly international process, was the occasion to strengthen Polish psychiatrists' contribution regarding developing the new international classification (ICD-11).
 
Results of scarce epidemiological studies on depression in adolescents are diverse and dependent of survey methodology as well as on the theoretical approach of research. Those studies where the methods are comparable show that depression prevalence depends on the macrosocial situation and the adolescence stage. The study aimed to assess changes in depression prevalence in mid-adolescents between 1984 and 2001. A presumption was made that the social situation in Poland had changed in the last 17 years. In 2001 a representative sample of school attending 13 y.o. adolescents was screened with KID-IO "B1". The results were compared with those of a similar survey, using the same method, carried out in 1984. Point prevalence index in 2001 appeared to be lower than in the survey in 1984 (24.6% versus 31.6%). This resulted exclusively from a significant decrease in depression among girls (26.8% versus 42.2%). The obtained data allows for an interpretation of the findings as being a result of macrosocial changes. Other hypotheses e.g. influence of the adolescence timing and course requires a longitudinal prospective study.
 
Results of family studies show the importance of genetic factors in etiopathogenesis of schizophrenia. Susceptibility to the disease is probably due to an interaction of many genes. This association study was conducted to investigate frequencies of alleles and genotypes in a group of patients with schizophrenia and in healthy controls. We examined DRD2 gene promoter polymorphism--insertion or deletion of the cytosine in the position -141 of 5'-flanking region of this gene. No relationship between the polymorphism under study and schizophrenia has been found.
 
MMP-9 is a candidate gene related to the neurodevelopment hypothesis of schizophrenia. The aim of this research was TDT analysis of polymorphism -1562C>T MMP-9 gene in schizophrenia. Research was carried out on 147 trios (patient and his/hers both healthy parents). Genetic material was isolated from leukocytes using the salting out method. Polymorphism was studied with PCR-RFLP, statistic analysis was made using transmission disquilibrium test by Haploview 4.2. There was no significant association between analyzed polymorphism of MMP-9 (-1562 C>T) and schizophrenia. Insignificant association doesn't exclude the possible contribution of MMP-9 to pathogenesis of schizophrenia. Further research is needed to be carried out on bigger groups and other populations.
 
Plasma cortisol level was measured 7 times between 3 and 5 pm in 34 inpatients with major depression and 25 controls. 1 mg of dexamethasone per os was administrated the day before a 11 pm. The maximum, minimum, mean and range of cortisol concentration were calculated. All these parameters were statistically significantly higher in the depressed group.
 
Article 169 of the penal code imposes a ban on sexual contacts with a person, who is fully or to a significant degree deprived of the ability to recognize the meaning of his/her actions or to control his/her behaviour. A partner of a mentally retarded or mentally ill person, who engages fully in biologically and culturally appropriate sexual activity, can become criminally liable, receiving up to 10 years of freedom loss. The freedom of the insane and persons with strongly diminished mental ability is supposed to be a protected "good". The Polish Psychiatric Society tabled a motion in favour of abolishing this regulation, but the penal code reform committee did not accept this postulate. It is worth noting that sexual partnership constitutes both for men and women an irreplaceable human right. Nature itself does not exclude the mentally ill from the mystery of life which is unpredictable in its destiny. It should be added that some of the mentally ill identify hope for further living with the hope of keeping an intimate partnership.
 
The aim of the present study is a characterisation of the personality dimensions of patients with anxiety disorder. Personality of 103 patients with different mixed ICD-10 diagnosis of anxiety disorders (79 females, 24 males, mean age: 38 +/- 12 years) were studied and compared to 183 healthy controls (117 females, 66 males, mean age: 35 +/- 14) using the 16 PF Cattell's Questionnaire and Cloninger's TCI. Spielberger's State and Trait Anxiety Inventory and Self-evaluation of the Beck's Depression Scale were also applies. Levels of anxiety and depression were significantly higher in patients. It was found that patients with anxiety disorders scored higher in Cattell's following factors: O, Q4 and lower in: C, E, F, H, Q3 when compared to standard population norms. Following TCI scales differentiated the personality of patients when compared to the controls: A significant increase of all HA subscales, decrease of NS in females and NS1 in both female and male patients, increase in RD1 and decrease in RD3 in patients, decrease of P, SD, C (except C4 and C5 subscales) were observed. Both TCI and 16 PF describe similar traits in the personality of patients with anxiety disorders, and are helpful in the diagnosis and prognosis of therapy.
 
Aim of the study To determine whether the following symptoms: depressive symptoms, eating disorder symptoms among adolescents in Cracow secondary schools are associated with an increased risk of psychoactive substance use. Subject or material and methods A representative sample of the population of Krakow secondary school pupils was tested. A two-stage draw method identified a group of 2034 2nd form pupils of all types of secondary schools: grammar schools, technical schools and vocational schools (17-year olds). They were tested using the following screening questionnaires: Beck Depression Scale, EAT-26 eating disorders scale and author’s drug questionnaire. Results The prevalence of depressive symptoms among boys and girls is associated with an increased alcohol use, cigarette smoking and drug use. All of the relationships are statistically significant in both sexes. 41.7% of depressive boys admit to smoking, versus. only 32.6% in the non-depressive group. The relationships are statistically significant in both sexes. The prevalence of eating disorder symptoms among boys and girls is associated with a higher alcohol use, cigarette smoking, and drug use. Compared with a group of young people without eating disorder symptoms, the relationships are of statistical significance. Discussion Comorbidity of the following symptoms was found: depressive symptoms, eating disorder symptoms and symptoms of psychoactive substance use. Conclusions The presence of depressive symptoms increases the risk of the use of psychoactive substances, especially alcohol and tobacco, to a lesser extent – drugs, both in the boys and in the girls. The presence of eating disorder symptoms increases the risk of smoking and drug use among both boys and girls.
 
Results of scarce epidemiological studies on depression in adolescents are diverse and dependent of survey methodology as well as on the theoretical approach of researchers. Those studies where the methods are comparable show that depression prevalence depends on the macrosocial situation and the adolescence stage. The study aimed to assess changes in depression prevalence in mid-adolescents between 1984 and 2001. A presumption was made that the social situation in Poland had changed in the last 17 years. In 2001 a representative sample of school attending 17 y.o. adolescents was screened with KID-IO"C1". The results were compared with those of a similar survey, using the same method, carried out in 1984. Point prevalence indexes appeared to be similar as well as higher for girls in comparison with boys. However, dependence of depression prevalence and the type of the senior school has changed. In 1984 it was higher in senior schools preparing for university studies, while in 2001--in those which train in a skill. Earlier conceptualisations of adolescent depression as connected with social conditions making ways to adulthood difficult (e.g. unemployment) as well as high indexes of depression prevalence in adolescents living in regions with higher unemployment rates than in Kraków, allow for an interpretation of the findings as result of macrosocial changes. Other hypotheses e.g. influence of the adolescence timing and course require a longitudinal prospective study.
 
To determine the extent to which mental disorders (depressive disorders, anxiety disorders, eating disorders) and psychoactive substance use are prevalent among Krakow secondary school adolescents in the late adolescent phase. A representative sample of the population of Krakow secondary school pupils was tested. Two-stage draw method identified a group of 1933 2nd form pupils of all types of secondary schools: grammar schools, technical schools and vocational schools (17-year-olds). They were tested using the following screening questionnaires: Beck Depression Scale, EAT-26 eating disorders scale, Obsessive-compulsive disorder (Leyton) scale and the author's drug questionnaire. Girls declared symptoms of mental disorders twice as often as boys (41.2% vs. 22.7%). Among girls, the most common disorders were: depressive symptoms (33.6%), eating disorder symptoms (18.7%) and obsessive-compulsive disorders (5.4%). And in the boys group: depressive symptoms (22.7%), eating disorder (7.3%) and obsessive-compulsive symptoms (3.4%). Findings were obtained concerning the prevalence of substance use in the boys and girls group (73% vs. 68%), mainly alcohol, as well as alcohol and cigarettes and alcohol, cigarettes and drugs. The prevalence of mental disorders in the population of 17-year-olds is significant; it concerns especially depressive symptoms and eating disorder symptoms. A significant prevalence of psychoactive substance use was found in this age group, mainly alcohol and mixed type substance use: alcohol and cigarettes and alcohol, cigarettes and drugs.
 
The authors investigated the daily urinary excretion of 17 ketosteroids (17 KS) in 29 patients with endogenous depressive syndromes (9 men, 20 women). In the group of women 17 KS excretion was found to be lower in patients with unipolar depression as compared with those with depression in the course of manic depressive psychosis. 17 ketosteroid excretion was found related neither to the pattern of the depressive syndrome (syndromes with inhibition, syndromes with inhibition and anxiety) nor to the treatment method (thymoleptics, neuroleptics, lithium). Analysis of 17 KS excretion in relation to the intensity of depression revealed greatest excretion in the group with deep depression. The authors discuss the significance of that phenomenon and its interrelation with the pathogenetic mechanisms underlying affective disorders.
 
The primary objective of the study was to evaluate the severity of extrapyramidal symptoms during treatment with olanzapine (10-20 mg) versus perphenazine (8-40 mg) using the Simpson Angus Scale (SAS). The secondary objective was to assess the safety profile and clinical efficacy of the investigated drugs. A total of 95 patients with schizophrenia who met the criteria for DSM-IV were randomized to a double-blind, 18 week prospective comparative trail conducted in Poland. The tolerance of treatment was assessed with the use of scales: BAS, SAS and UKU. The efficacy of treatment was evaluated with BPRS, PANSS and CGOI scales. For olanzapine patients, the severity of extrapyramidal symptoms improved after 3 first weeks of treatment, and significantly decreased from the baseline to endpoint. Perphenazine patients showed an increase of extrapyramidal symptoms. The difference of the SAS scores change was statistically significant between olanzapine and perphenazine groups. Akathisia symptoms decreased significantly in the olanzapine group during the treatment period, whereas symptoms of akathisia increased in the perphenazine group. Statistically significant differences of mean change of BAS total score from baseline to endpoint were noted between treatment groups Treatment--emergent adverse events occurred more frequently in patients receiving perphenazine (46%), than in patients receiving olanzapine (17%). The proportion of patients complying with improvement criteria for CGI scale score was statistically greater in the olanzapine group (72.7%) than in the perphenazine group (47.9%). Results of this study showed that the tolerance profile in patients taking olanzapine is superior to perphenazine. Olanzapine was better tolerated than perphenazine. After olanzapine treatment more subjects fulfilled the criterion of improvement and schizophrenic symptoms were less severe than in patients treated with perphenazine.
 
We introduce a case of an 18 years old man suspected of murder attempt of his colleague. We made a diagnosis of immature personality with schizoid features; we also want to remind Edward Brzezicki's thoughts on paragnomen.
 
Top-cited authors
Janusz Rybakowski
  • Poznan University of Medical Sciences
Dominika Dudek
  • Jagiellonian University
Andrzej Kiejna
  • Dolnośląska Szkoła Wyższa
Marcin Siwek
  • Jagiellonian University
Marta Podhorecka
  • Nicolaus Copernicus University