Dominika Janeczko, Magdalena Hołowczuk, Anna Orzeł, Barbara Klatka, Małgorzata Neścior-Piech and Michał Dzikowski
Introduction: Schizoaffective disorder is described as a combination of symptoms of schizophrenia and mood disorder components. It is estimated that in 2009 in Poland over 30 thousands women were treated in outpatient care because of schizotypical disorders, also in 2009, over 5,5 thousands Polish women, were hospitalised because of the same reason.
Material and method: We searched through whole medical documentation of the patient, which were available at the Department of Psychiatry and Gynaecology. We mainly focused on the last hospitalization of the woman. We found research connected to our subject on Science Direct website.
Discussion: A 34-year-old woman was admitted to Department of Psychiatry, patient was 14 weeks pregnant. Family described her behaviour as verbally and physically aggressive and dysphoric which forced her parents to take woman to the hospital. It was her third hospitalization. Pharmacotherapy was insufficient to improve the mental state of the woman. Doctors decided to carry out a series of electroconvulsive treatments (10 procedures). When woman was 36 weeks pregnant, there was a leak of green amniotic fluid and it was necessary to perform a caesarean section. A newborn required mechanical ventilation, had decreased muscle tone and facial dysmorphic features, also defect of the atrial septum was found.
Conclusions: Pregnant women with psychiatric disorders should be all considered high risk. It means that they need multidisciplinary care – psychiatrist, gynaecologist, neonatologist or other specialists, in order to stay in a good condition mentally and physically during pregnancy.
Rafał Mazur, Sebastian Masternak, Michał Pająk, Nikodem Skoczeń, Ewelina Soroka and Marcin Olajossy
Introduction: Smoking is a huge medical and social problem in Poland, with as many as about 24% of Poles being addicted to nicotine. Approximately 6 million people worldwide die every year from conditions that are closely related to tobacco addiction, such as cancer and cardiovascular, metabolic or lung diseases. The difficulty in combatting nicotine dependence is largely due to the complex mechanism of this addiction. The motivation of a patient to quit smoking is of great importance in the difficult withdrawal process. Strengthening this motivation is one of the most important tasks of physicians and addiction therapists.
Overview of literature: Nicotine replacement therapy (NRT) has been the most widely known way to break away from smoking addiction for many years now. It involves delivering nicotine to the body in ways that are less harmful than through tobacco smoke. As a consequence, the cravings for nicotine are reduced, making it easier for the patient to break with the addiction. Clinical trials have shown that the use of NRT is associated with a 50-70% increased chance of maintaining abstinence from smoking compared to placebo. There are many NRT products, including nicotine chewing gum, nicotine patches, lozenges, dissolvable nicotine sticks, or inhalers. Bupropion is a selective dopamine–noradrenaline reuptake inhibitor. This drug is one of the most commonly used in the pharmacotherapy of depression in the United States. At the same time, it has been found to have a positive effect on people trying to break up with the habit of smoking cigarettes. The mechanism of action remains unknown in this case, but studies clearly indicate the efficacy of bupropion, which is comparable to the efficacy of NRT. Varenicline is a partial agonist selective for α4β2 nicotinic acetylcholine receptors. It has a higher affinity for these receptors than nicotine. By stimulating them, it causes an increase in dopamine secretion (but to a lesser extent than cigarette smoking), helping in this way ease withdrawal symptoms.
Conclusions: Varenicline has higher efficacy than bupropion and NRTs. Simultaneous use of two NRT forms increases the effectiveness of this method to a level comparable to varenicline. Contrary to previous reports, it seems that varenicline does not increase self-aggressive behaviour and the risk of suicide. The effectiveness of antinicotinic drugs depends on the sex of the patient. For both sexes, the most effective drug is varenicline. It is slightly more effective in women than in men. By contrast, NRT and bupropion show greater therapeutic potential in men.
Joanna Niedziałek, Marta Pachla, Aleksandra Kordyga, Łukasz Proć, Ewelina Soroka and Marcin Olajossy
Introduction: Irritable bowel syndrome is a chronic gastrointestinal disease classified as a functional gastrointestinal disorder. It has been diagnosed on the basis of the so-called Rome IV criteria since 2016. The prevalence of IBS in the general population is about 10–20%, with most patients being women. The etiology of the syndrome is multifactorial and is associated with visceral sensory dysfunction, abnormalities of motor and secretory bowel function, a history of infectious diarrhea and abnormalities in gut microbiota, dysregulation of the brain–gut axis (the influence of the hypothalamic-pituitary-adrenal axis and sex hormones), genetic, psychosocial, and environmental factors, and the patient's personality traits. IBS patients may show differences in the structure and function of the brain when compared to healthy control individuals. Treatment of IBS involves the use of non-pharmacological interventions (psychotherapy, education, hypnotherapy, dietary modifications, regular physical activity) and pharmacotherapy (cholinolytic drugs, opioid receptor antagonists, tricyclic antidepressants, serotonin 5-HT3 receptor antagonists and 5-HT4 agonists).
Aim: The aim of the authors of this work is to draw attention to certain psychiatric aspects of the irritable bowel syndrome. It meets the criteria for a somatization disorder. Somatization is an important psychological factor directly related to the severity of IBS. It is estimated that the prevalence of psychiatric disorders among IBS patients ranges from 40% to 90% and is higher than in the general population. Affective disorders and anxiety disorders are the most commonly diagnosed.
Method: The article reviews the research and works available in the Google Scholar and PubMed databases combining the issue of IBS with psychiatric aspects, i.e. common for IBS and psychiatric disorders, etiopathogenesis, the concept of somatization in the context of IBS, and the coexistence of diseases and mental disorders with the irritable bowel syndrome.
Conclusion: Further research is needed to determine the causes of comorbidity of IBS and mental disorders.
Introduction: The specific character of Rorschach test responses of parents who had a child with schizophrenia has been reported many times. The analysis presented in this paper is focused on responses commenting on movement seen in the inkblots. According to Zygmunt Piotrowski, these responses reflect the prototypal role – self-concepts and a certain pattern of responding that can be understood as phenomena related to the concept of self.
Material and method: I used the Rorschach test to examine 32 couples of parents who had a child suffering from paranoid schizophrenia (as defined in DSM-IV) and 21 couples of parents who had only healthy children.
Results: Parents of schizophrenic children gave significantly fewer human movement responses than parents of healthy children, and some features of these responses give them a specific character. The groups of fathers differed from each other to a greater degree than the groups of mothers. The analysis of relationships between movement responses and shading (chiaroscuro) responses, which are regarded as a measure of anxiety, revealed significant associations in the case of some movement qualities. The exception was that movement quality which is referred to as blocked movement and blocked-posture movement in Piotrowski’s interpretive scheme. All movement qualities globally considered were significantly correlated with anxiety, the exceptions being the group of parents of healthy children and the group of all fathers.
Discussion: The smaller number of human movement responses found in the group of parents of schizophrenic children may attest to these people’s lower psychological maturity, which is associated with a less distinctly formed prototypal role. Moreover, certain specific features of these responses can be interpreted as a sign of difficulties in expressing this role. The cooccurrence of movement responses with shading responses, which are treated as a sign of anxiety, was not always consistent with expectations; this should be considered a reason to reflect on the psychological meaning of these responses and on the possible return to Rorschach’s original views.
Conclusions: The results of the study suggest lower maturity in the case of parents of schizophrenic children, manifesting itself in a less strongly developed prototypal role and certain difficulties in expressing this role. Based on the analysis of the cooccurrence of movement responses and responses commenting on the shading present in the inkblots, it is possible to conclude that there is a need for a new psychological interpretation of these responses.
Introduction: The theoretical basis for the present article is Zygmunt Piotrowski’s concept of prototypal role. This role is understood as a self-concept and as a mechanism guiding and stabilizing relations with the environment. The concept of prototypal role can be regarded as similar to the concept of self.
It is possible to assess the prototypal role by analyzing the movement responses obtained during an examination using the Rorschach test. Empirical data suggest that patients with schizophrenia have an insufficiently developed or peculiarly formed prototypal role and experience certain difficulties in expressing this role.
Material and method: The number of 32 individuals with schizophrenia and 21 healthy individuals were examined using the Rorschach test. Apart from the analysis of movement and posture responses; responses interpreting the shading (chiaroscuro) visible in the inkblots were taken into consideration. Responses of the latter kind are considered to be a measure of anxiety.
Results: There found no differences in the most significant variables, the number of human movement responses was not lower in the group of subjects with schizophrenia, and the number of human movement responses not adequately reflecting the form of the inkblots was not higher in schizophrenic individuals. Some of the movement qualities distinguished by Piotrowski were significantly correlated with anxiety, but these associations were not always consistent with the predictions.
Discussion: Data analysis revealed no specificity in the development of prototypal role in schizophrenic individuals; difficulties in the expression of this role were not frequent and occurred mainly in schizophrenic women as compared to healthy ones. More differences occurred between schizophrenic women and schizophrenic men, what may attest to the influence of gender on the experience of adaptation to disease.
Conclusions: The analysis of movement responses and shading responses provides the basis not so much for differentiating health and disease as for better insight into the very psychological significance of movement and shading responses.
Introduction: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease with undetermined etiology. Due to diverse symptomatology, it requires a thorough differential diagnosis, with consideration of conversion disorders. The presented thesis describes a case of a young man hospitalized in the Department of Psychiatry in order to verify the possible psychogenic basis of his symptoms, which previously were considered to be a manifestation of neurological disease with an unfavorable prognosis.
Aim: The aim of the thesis is to raise the issue of a multidisciplinary approach to diagnostic process in medicine, as well as taking into account the legitimacy of including psychiatrists, psychologists, and psychotherapists in diagnostic teams.
Case study: We present a case report of a man who has been experiencing progressive feeling and walking problems for the past several years, which originally suggested a neurological or rheumatological disease. Earlier observations and medical tests had led to a diagnosis of amyotrophic lateral sclerosis. After several years, the diagnosis was excluded, and the patient was referred to the Department of Psychiatry to determine the possible psychogenic basis of his symptoms. Diagnostic methods used during the patient’s hospitalization confirmed the conversational nature of his symptoms, and both pharmacological and psychotherapeutic treatment caused reduction of severity of his symptoms and allowed him for a gradual return to independent functioning.
Conclusion: Analysis of the collected data, including patient’s life history and a course of his treatment, indicates the validity of a holistic approach to medical problems, which implies the inclusion of specialists in the field of psychiatry, psychology, as well as psychotherapists in diagnostic teams. Such a multidimensional view of the patient and the source of his symptoms may allow for faster diagnosis and may also contribute to reducing the risk of making mistakes such as an incorrect assessment of factors triggering the disease process.
Karolina Dańko, Piotr Dańko, Ewelina Soroka, Véronique Petit and Marcin Olajossy
The progress of medicine in the recent decades has strongly improved perinatal care, especially its somatic-related aspects. Pregnancy and childbirth have become much safer, but the mental strain and stress have remained the same. The models of motherhood and the number of children in a family have changed, giving rise to significant requirements concerning the quality of life of the offspring. These changes have brought about new psychological challenge for women and a team of psychiatrists and gynaecologists – obstetricians. The aim of this study is to look at the affective disorders affecting women during pregnancy and postpartum: the postpartum depression and so-called baby blues, which were both compiled in the form of a table in the final part of this work to illustrate the differences between these two mental disorders.
Karolina Mielko, Ewelina Soroka, Karolina SprawkaD and Marcin Olajossy
Introduction The authors present an overview of current views on the treatment of obsessive-compulsive disorder refractory to pharmacological and psychological treatment.
Aim: To review the mechanisms of stimulation of deep brain structures and to evaluate the effectiveness of therapy in obsessive-compulsive disorder.
Method: Review and analysis of the Polish and foreign scientific articles from the years 1999-2016.
Conclusions: According to the literature considered, in half of the examined patients there was an improvement of over 35% on the Y-BOCS scale, in some patients even a reduction of symptoms reaching 81-83% was described. Previous studies have been carried out on small groups of patients. Since 2009, the method of invasive treatment with deep brain stimulation of the obsessive-compulsive syndrome is registered in the EU. In spite of the above, additional studies are necessary on a larger group of patients in order to precisely estimate the effectiveness of the procedure and elaborate the criteria for qualifying patients for inclusion in the procedure.
Introduction: Gamma-hydroxybutyric acid (GHB) is commonly known as a recreation drug or the so-called “date rape drug”. It is also used in medicine to treat narcolepsy and alcohol addiction. GHB has an affinity for two types of receptors: GABAB and the relatively recently discovered GHB receptors. GHB receptors were first cloned in 2003 in mice and then in 2007 in humans. So far, evidence has been presented for their impact on dopaminergic transmission, which may imply that they play a role in the pathogenesis of diseases such as schizophrenia. At the same time, it has been demonstrated that benzamide antipsychotic drugs have an affinity for GHB receptors, which is why it is postulated that some of the effects of these drugs may result precisely from this affinity.
Aim: The study presents the current state of knowledge about GHB receptors and their potential role in the pathogenesis of schizophrenia, and discusses drugs which show an affinity for this receptor.
Material and method: The literature review was based on a search of articles indexed between 1965 and 2018 in Medline, Google Scholar, ScienceDirect and Research Gate databases. The following search terms were used: GHB receptor, GHB, sulpiride, and amisulpride.
Result and discussion: 1. It is possible that GHB receptors are involved in the pathogenesis of schizophrenia, although more research is needed in this area. 2. Part of the effects of some benzamide antipsychotic drugs (such as amisulpride) may be due to their affinity for GHB receptors.
Introduction. The basic purpose of this article is to present Jacob Levy Moreno’s psychodrama method as the psychotherapeutic technique useful in work with patients during individual and group psychotherapy.
Material and Method: The author presents the analysis of case studies of patients treated in individual and group psychotherapy. He instances the examples of psychodramatic work on the stage as well as monodramatic and reports their importance in the process of patient psychotherapy. He discusses the effects of these act ivities in the context of changes in the emotional and interpersonal functioning of patients.
Results: The given examples of monodrama and psychodramatic works illustrate the mechanisms of the changes offered by the method, e.g. insight, abreaction, acceptance of internal impulses, confrontation with the feelings of other people, training of alternative behaviors. In the article one can follow each subsequent step of analyzing intrapsychic conflicts of patients, which, thanks to the play on the stage, can be named and experienced by them.
Conclusions: Psychodrama, used in the psychotherapeutic work of the group and in individual work with the patient (in the form of a monodrama), gives great opportunities to broaden the insight of the patient into very complicated internal mechanisms of conflicts and deficits. Psychotherapist - leader encourages patients to be creative and to spontaneous development of their blocked personality elements. The specificity of psychodrama is a relatively quick resolution of many years of ongoing conflict and permanent reparation of traumatic experiences, even from early childhood.