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Biblioteka Psychiatrii Polskiej
Polish Psychiatry
 Editorial Board
Archives of Psychiatry and Psychotherapy
Psychiatry and Psychotherapy



Polish Psychiatry 5/2005

Maria Orwid
The model of action in early schizophrenia      849
Summary I will present the model of thinking of the Cracow society in dealing with first episodes of schizophrenia in adolescents. During adolescence schizophrenia brings about diagnostic difficulties, because it is a period of stormy psychosocial and biological changes in the patient. Also, the responsibility of the therapists seems to be different - perhaps even more so than in their work with an adult. Importance of the environment of the psychiatric ward and group psychotherapy as well as the peer group for the patients, the role of family therapy, especially trans-generational transmission, place of individual psychotherapy and biological therapy in this system, all will be discussed. I will describe the importance of both, pedagogical therapy and the school in the course of the therapeutic process of the adolescent patients. In a closer manner, I will also describe the emotional problems of therapists dealing with adolescents having psychosis.
Beata Galińska, Agata Szulc, Andrzej Czernikiewicz
Duration of untreated psychosis in first-episode schizophrenia: clinical and cognitive correlates      859
Summary Objective: Duration of untreated psychosis (DUP) is associated with poor premorbid functioning and poor outcome in patients with schizophrenia. The authors determined whether duration of untreated psychosis was associated with severity of clinical symptoms and neurocognitive functioning in patients with first-episode schizophrenia. Method: A total of 30 first-episode patients were evaluated by means of WCST, Vocabulary, Arithmetic, Block Design, attention and verbal fluency tests. Results: The mean duration of untreated psychosis was 31.3 weeks. The group was divided on the basis of median duration of untreated psychosis (10 weeks) to short and long DUP group. There were no significant differences between the groups in results of clinical symptoms and neurocognitive functioning. There were no correlations between severity of clinical symptoms and neurocognitive functioning with duration of untreated psychosis. Conclusions: Duration of untreated psychosis is not associated with severity of clinical symptoms and neurocognitive functioning in the group of patients with first-episode schizophrenia.
  Piotr Tomczak
Religiousness of patients with diagnosis of schizophrenia. Introductory studies      869
Summary Aims: (1) The correlations between various aspects of religiousness and age, span of treatment, rate of therapy, anxiety-state, anxiety-trait, locus of control, and self-rating of the state of self-feeling, and the state of feeling of illness, and quality of life in the group of patients with a diagnosis of schizophrenia and in the group of healthy persons, and (2) the comparison of various aspects of religiousness of patients with schizophrenia and healthy persons were studied. Methods: The Individual Religiousness Scale, Scale of Christian Religiousness, Intrinsic, Extrinsic and Quest Religious Orientation Scales, Scale of Fundamentalism, Rotter's questionnaire of locus of control, State-Trait Anxiety Inventory, visual analogy of self-feeling, visual analogy of feeling of illness, questionnaire of quality of life-WHOQOL-BREF-were used in the study. 61 adults of both sexes, 30 patients with a diagnosis of schizophrenia according to ICD-10 and DCR-10 in the diagnostic group and 31 healthy persons were studied. Groups were similar in the terms of age, sex, age of education, abede, social conditions, professional status, civil state and denomination. Results: It was noted, that: (1) intrinsic and extrinsic religiousness correlates with age in both groups and with span of treatment in the diagnostic group, but only intrinsic religiousness correlates with the rate of therapy; locus of control increases with a decrease of orthodox religiousness in the diagnostic group and with ethical aspects of religion in the group of healthy individuals; state of anxiety is correlated backwards with orthodox religiousness in the diagnostic group; (2) patients diagnosed as having schizophrenia have a significantly higher level of extrinsic religiousness and fundamentalism than healthy individuals; (3) there was many results pointed out in bibliography, that had no verification in these studies. Conclusions: The knowledge about the religiousness of schizophrenia patients can be important for the diagnostic and therapeutic process in this disorder, therefore further studies on these characteristics are necessary.
Jakub Filuś, Janusz Rybakowski
Neurotrophic factors and their role in the pathogenesis of affective disorders      883
Summary Neurotrophic factors make the group of proteins with similar structure (The regulation of neuronal plasticity and neuron's protection are some of their biological functions). The group of neurotrophic factors consists of: nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT-3) and neurotrophin 4/5 (NT-4/5). BDNF is the most important neurotrophin from the affective disorders point of view. Preclinical and clinical studies of altered BDNF expression during chronic stress and increased BDNF activity during antidepressant treatment, confirm the role of BDNF in the pathogenesis of depression. Studies on animal models point to the antidepressant effect of BDNF, similar to long-term antidepressant treatment. The intracellular mechanisms mediated by this neurotrophic factor are connected with signal transduction pathways in cell mainly mitogen-activated protein kinase cascade and cyclic adenosine 3',5'-monophosphate cascade). The BDNF serum levels studies suggest a correlation between the BDNF expression in central nervous system and its serum levels, what could make BDNF levels specific markers of depression. The molecular genetics studies focus on associations between BDNF gene polymorphisms and bipolar disorder or cognitive functioning disturbances. The novel pathogenetic theories of depression based on neuronal plasticity (Duman et al.) and neurogenesis disturbances (Kempermann and Kronenberg), can be a kind of recapitulation of research on the role of neurotrophins in depression. However many issues related to the role of neurotrophic factors in affective disorders are still unclear and determine areas of the future scientific interests in this field.
  Marcin Siwek, Andrzej Wróbel, Dominika Dudek, Gabriel Nowak, Andrzej Zięba
The role of microelements In the pathogenesis of affective disorders - Pt. I Zinc      899
Summary Zinc is an important modulator of glutaminergic transmission. Recent data indicate that pathology of amino-acidergic neurotransmission may contribute to mood disorders and may be involved in antidepressant-like actions in laboratory models. A growing body of evidence implicates a derangement of zinc homeostasis in mood disorders.The zinc deficiency is related to a variety of psychological symptoms especially depression. There are many reports indicating significant changes in blood levels of zinc during a depressive episode. Moreover zinc exhibits antidepressant-like and anxiolytic-like effects in animal models of depression, in rodents. Recent data revealed that zinc enhances the antidepressant effect in laboratory animals. This article reviews the alterations in central and peripheral zinc homeostasis in relation to pathophysiology and treatment of depression.
Marcin Siwek, Andrzej Wróbel, Dominika Dudek, Gabriel Nowak, Andrzej Zięba
The role of microelements In the pathogenesis of affective disorders - Pt. II Copper and magnesium      911
Summary Magnesium and copper are important modulators of NMDA-receptor activity. Recent data indicate that disturbances of glutamatergic transmission (especially via NMDA-receptor) are involved in pathogenesis of mood disorders. Magnesium deficiency, the same as disturbances in turn over of copper, are related to a variety of psychological symptoms especially depression. There are many reports indicating significant changes in blood levels of magnesium or copper during a depressive episode. Moreover magnesium exhibits antidepressant-like and anxiolytic-like effects in animal models of depression, in rodents. This article reviews the alterations in central and peripheral magnesium and copper homeostasis in relation to pathophysiology and treatment of depression.
  Ewa Obuchowicz, Agnieszka Marcinowska, Zbigniew S. Herman
Antidepressants and cytokines - clinical and experimental studies      921
Summary Clinical and experimental studies indicate that stress and depression are associated with the up-regulation of the immune system, including increased production of pro-inflammatory cytokines. When administered to patients or laboratory animals, some of these cytokines induce typical symptoms of depression. It is known that cytokines modulate brain neurotransmission and the activity of the hypothalamic-pituitary-adrenal axis, both of which are disturbed in depression. This review summarizes in vivo, ex vivo and in vitro clinical and experimental studies of the effect of antidepressants on cytokine production. In vitro culture and animal studies in particular suggest that antidepressants of several classes decrease the production of pro-inflammatory cytokines and shift the pro/anti-inflammatory cytokine balance towards the latter. Some studies suggest that immunological disturbances, including changes in cytokine levels, are not shared by all depressive patients, which means that only in certain groups of patients may the immunomodulatory action of antidepressants play a significant role in producing the therapeutic effect.
Jan Jaracz, Janusz Rybakowski
Depression and pain: novel clinical, neurobiological and psychopharmacological data      937
Summary Epidemiological studies confirm frequent appearance of pain symptoms in depressive patients and marked prevalence of depression in pain conditions. These observations seem to point at close intertwining between mood regulation and pain perception. In the pathogenesis of both depression and pain symptoms, an important role has been attributed to disturbances of serotonergic and noradrenergic neurotransmission as well as to neuropeptides such as opioids and substance P. In mood regulation as well as in perception and emotional dimension of pain stimuli, such brain structures as amygdala, anterior cingulate cortex and prefrontal cortex are of main significance. The action of antidepressant drugs results in a normalization of the activity of those neurotransmitter systems and brain structures. It was found that dual action antidepressants (i.e. influencing both serotonergic and noradrenergic system) such as tricyclic antidepressants and new generation drugs (venlafaxine, milnacipram, duloxetine, mirtazapine) exert stronger antidepressant effect and possess a broader therapeutic spectrum, including also an effect on pain symptoms. These drugs have been also increasingly used for the treatment of pain symptoms in somatic illnesses (e.g. diabetic neuropathy, fibromyalgia).
  Andrzej Kiejna, Joanna Rymaszewska, Tomasz Hadryś, Aleksandra Suwalska, Dorota Łojko, Janusz K. Rybakowski
Bipolarity among unipolar affective disorder patients - uniDEP-BI national multi-site study      951
Summary The main objective of the study was to evaluate the occurrence of bipolarity among outpatients with recurrent major depressive disorder. Method: The uniDEP-BI study was conducted throughout the Poland by 96 psychiatrists from 16 sites trained in instruments. The sample was selected from the population of outpatients with at least one depressive episode (n=880) consecutively coming to the psychiatrists. Final study group included 246 working aged adults (75,2% of females) treated with recurrent unipolar disorder. The study questionnaire consisted of DSM-IV criteria of major depressive episode, (hipo)manic episode, criteria for bipolar spectrum disorder by Ghaemi et al. Results: Unipolar mood disorder was confirmed in 32,9% cases, bipolar I disorder was found in 19,5%, bipolar II in 35% and bipolar spectrum disorder in 12,6% of assessed patients. Patients with bipolar compared with unipolar mood disorder had significantly more frequently a family history of bipolar disorder, short (hipo)manic episodes after antidepressive treatment, premorbid cyclo-, hyperthymic or impulsive (borderline type) personality, recurrent depressive episodes, atypical depressive symptoms, early onset of depression (< 25 yrs), distracted attention, panic attacks. Subjects with confirmed recurrent depressive disorder were significantly more often working (37,2% vs. 22,7%). Duration of illness was significantly shorter and the number of previous depressive episodes was significantly lower in this group. Conclusions: The findings showed that the bipolarity features are more common among patients with unipolar mood disorders. Its also point at a need of proper and deepen diagnostics of affective disorders and verification of rules and period of antidepressive and normothymic treatment.
Tomasz Sobów, Elżbieta Kisiela, Olga Łuczak, Iwona Kłoszewska
Depression in the course of bipolar disorder and recurrent depressive disorder in the elderly: diagnostic difficulties      963
Summary Misdiagnosis of bipolar disorder in depressive subjects is a common clinical problem estimated to be evident in up to 40% of patients. Elderly patients might be especially vulnerable to that sort of diagnostic error. Aim: To estimate the rate of misdiagnosis in the elderly (60yrs+) hospitalized due to depression and to establish clinical correlates that might improve diagnosis. Method: A retrospective analysis of medical records of all the patients hospitalized in the University based Psychogeriatric Ward and suffering form depressive episode due to bipolar disorder or recurrent depressive disorder. Results: The rate of misdiagnosis was 54% in bipolar and 9% in recurrent depressive disorder. Bipolar patients were mainly misdiagnosed as having recurrent depression. Severe episode was more common in bipolar subjects (particularly in women) while recurrent depressive subjects tend to suffer from less severe but more protracted episodes. Somatic symptoms of depression were more prevalent among recurrent depressive subjects while psychotic features, particularly delusions, and, to the lesser extent, hallucinations, were more common in patients suffering from bipolar depression. Conclusions: Bipolar depression is very often misdiagnosed in the hospitalized elderly. There are several features that might help the clinician to distinguish it form the recurrent depression. Long history of the illness, high number of previous episodes, severe episodes and the presence of psychotic symptoms are typical for bipolar elderly while protracted current episode and the presence of somatic symptoms of depression might indicate the diagnosis of recurrent depression.
  Leszek Bidzan
Vascular factors In dementia      977
Summary Cerebrovascular factors are acommon cause of dementia or contribute to cognitive decline in other dementias. Studies showing that cerebrovascular factors are the risk factors for neurodegenerative dementias, especially Alzheimer's disease. Practically all neurodegenerative dementias have a vascular component that reduces cerebral perfusion and has great impact on the clinical picture. Recent data support the view that the neurodegenerative process is caused by cerebrovascular mechanisms. The results showed that patients with vascular cognitive impairment have a typical clinical picture. Various important non-cognitive features are caused by cerebrovascular factors and are associated with a more rapid course of illness. On the other hand the term vascular diseases or cerebrovascular factors include a variety of vascular pathologies.
Leszek Bidzan, Mariola Bidzan
Vascular factors and progression of cognitive decline in elderly people      987
Summary The aim of the study was to assess the impact of vascular factors on the rate of progression of cognitive impairment. The study included 291 subjects without dementia. Cognitive function were assessed with the Alzheimer Disease Assessment Scale - cognitive subscale (ADAS - cog) which were conducted at baseline and at the end of the study. Statistical analysis included 215 persons. During the observation AD developped in 19 subjects and 11 vascular and mix dementia (according to DSM IIIR and DSM IV criteria) Subjects were categorized by the baseline Modified Hachinski Ischemic Score as having vascular factors 0-1 point (n = 140) or vascular factors > 1 point (n = 75). Statistical analyses were based on the patients' Modified Hachinski Ischemic Score dichotomization. The results show that vascular factors were risk factors for Alzheimer type dementia but the study does not prove the impact of vascular factors on progression of cognitive impairment.
  Leslaw Kulmatycki, Jan Łazowski
Programme of promotion of social attachment among Poles in Australia in relation to psychic problems      997
Summary Among the Polish community in Sydney in 1989 there was a significantly higher percentage of men than women. Compared to the Australian population,there was also a high percentage of single people (especially men), a high rate of childlessness and a majority of incomplete families. The data on admission to psychiatric institutions in New South Wales indicate, that Polish-born persons (males) hospitalized with psychiatric disorders were 2.5 times more than the population of Australian-born. Sociologists pointed that because of lesser contacts with other members of their ethnic groups, people find themselves isolated. There were also limited familly members or relatives who could provide support. From the South Western Sydney Area Health Service initiative a 2-year programme "Gazeta seniora". The strategic goal was to reduce number of isolated Polish-born older people through a number of regular initiatives: newspaper supplement, radio programmes, meeting groups, phone line. According to the information obtained from health and social services and from the respondents survey, letters and interviews, there was an increased access to medical services (15 percent), number of ethic meeting groups (40 percent). The programme has encuraged community leaders to provide personal contact and support for isolated people. After two years there were twice as many programme participants "satisfied with life" mainly because of "other peoples and the community's" involment (from 7.0 to 21.4 percent). In the discussion part the authors stressed a holistic and long-term aspect of social and environmental support of any community based health promotion intervention related to psychic health improvement.