This work basing on a study of medical records is a story of a young patient, repeatedly hospitalized with various diagnoses, in whom the psychiatric symptoms significantly decreased after waking from coma, resulting from an unfortunate accident.
There are presented subsequent stages of treatment and hospitalizations and the analysis of the problem if the restart is possible in terms of mental state, in a patient who for years had experienced omental-delusive experiences of high severity and anxiety, leading to several suicidal attempts with serious consequences.
The discussion also describes the issue of double diagnosis and the criteria for amphetamine-induced psychosis.
Can schizophrenia be cured and its symptoms reset ?
Children growing up in families with alcohol problems experience many emotions and events that are inadequate to their age. All these experiences are related to their subsequent functioning. Having a mother or a father suffering from alcohol dependence has a big impact on who one becomes in the future and how he/she perceives the world and other people.
The purpose of this study was to determine the relationship between the level of self-esteem, satisfaction with life as well as basic hope in the so-called Adult Children of Alcoholics (ACoA), and the attitudes of their parents.
The study involved 49 persons, aged from 18 to 70. To obtain the necessary data we used the Questionnaire Survey for Adult Children of Alcoholics, Rosenberg Self-Esteem Scale (SES), Satisfaction with Life Scale (SWLS), Basic Hope Inventory (BHI-R) and Re-trospective Assessment of Parental Attitudes Questionnaire (KPR-Roc).
The results show a positive correlation between the level of self-esteem and life satisfaction, and the attitudes of autonomy and acceptance in the mothers of our subjects. Also, life satisfaction, self-esteem and basic hope proved to be interrelated, i.e. an increase within one coincided with an increase in the other two. In addition, our results show that experiencing violence in the families of persons with the ACoA syndrome significantly correlates with the retrospective assessment of their parents' attitudes. Fathers in the so-called violent families are perceived as excessively demanding, yet inconsistent, while mothers as more rejecting and less protecting.
Joanna Gałaszkiewicz, Krzysztof Rębisz, Justyna Morylowska-Topolska, Hanna Karakuła-Juchnowicz and Gustaw Kozak
Clozapine is the drug of choice for drug-resistant schizophrenia, but despite its use, 30-40% patients fail to achieve satisfactory therapeutic effects. In such situations, augmentation attempts are made by both pharmacological and non-pharmacological methods. To date, most of the work has been devoted to pharmacological strategies, much less to augemantation of clozapine with electroconvulsive therapy (C+ECT), transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS).
Aim: The aim of the work is to present biological, non-pharmacological augmentation treatment methods with clozapine.
Material and methods: A review of the literature on non-pharmacological augmentation treatment methods with clozapine was made. PubMed database was searched using key words: drug-resistant schizophrenia, clozapine, ECT, transcranial magnetic stimulation, transcranial electrical stimulation and time descriptors: 1980-2017.
Results: Most studies on the possibility of increasing the efficacy of clozapine was devoted to combination therapy with clozapine + electric treatments. They have shown improved efficacy when using these two methods simultaneously from 37.5 to 100%. The only randomized trial so far has also confirmed the effectiveness of this procedure. Despite the described side effects of tachycardia or prolonged seizures, most studies indicate the safety and efficacy of combined use of clozapine and electroconvulsive therapy. Transcranial magnetic stimulation also appears to be a safe method in patients treated with clozapine. However, further research is needed before ECT can be included in standard TRS treatment algorithms. The data for combining transcranial electrical stimulation with clozapine, come only from descriptions of cases and need to be confirmed in controlled studies.
Conclusions: The results of studies on the possibility of increasing the effectiveness of clozapine using biological non-pharmacological treatment methods indicate a potentially beneficial effect of this type of methods in breaking the super-resistance in schizophrenia. Combination of clozapine and ECT can be considered as the most recommended strategy among these treatment methods.
Introduction: As the global number of diabetes and the burden of depression together with other mental disorders increases, there is a need for better understanding of the connection between these diseases. In patients with diabetes, mental disorders are more common than in the general population, especially anxiety disorders and depression, which are often difficult to detect by health professionals.
Material and methods: Using the keywords searched in the international bibliographic databases: Embase, Medline, Science Direct, Web of Science. We analyzed clinical trials published in English and international journals
Results: Patients with diabetes are exposed to serious physical and mental complications. The occurence of depression and psychiatric disorders among people with diabetes was twice as frequent as in the general population. There are also studies showing a higher risk of suicide among people with diabetes. In addition, patients with both diseases, diabetes and depression, had an increased risk of cardiovascular complications and increased mortality and higher costs of health care. Diabetic patients have increased incidence of anxiety disorders in relation to non-diabetic patients by 20%.
Conclusion: Further researches and integration of medical and psychological treatment are needed. Cooperation between psychiatrists and diabetologists can reduce mental and physical harm in patients with diabetes.
Bernarda Bereza, Justyna Morylowska-Topolska, Anna Urbańska, Diana Szymczuk and Hanna Karakuła-Juchnowicz
Aim. The aim of the study was looking for correlations between experiencing of various forms of harming in childhood and severity of personal trait of anxiety in victims of domestic violence.
Material and methods. The number of 112 people (49 women and 63 men) who were attending the mental health clinics in the area of Mazovian district were investigated. The sociodemographic questionnaire and Polish adaptation of the State-Trait Anxiety Inventory (by C.D. Spielberger) were used.
Results. High severity of anxiety as a trait, more often than low severity correlates with experiencing of violence (physical and mental) during childhood. Most often it is mental violence with father as perpetrator (p<0.01). People with the high level of anxiety as a trait have more often still been experiencing violence, living with their perpetrator and using violence towards other people (p<0.05).
Conclusions. Awareness of psychological consequences of using violence towards the youngest permit to hope for optimization of actions preventing spreading of such pathology (for example therapeutic work with learned helplessness and copying of destructive family patterns).
This article reminisces about the life and career of Jan Mazurkiewicz, one of the most outstanding Polish psychiatrists – the author of Psychophysiological Theory, an original conception of mental disease based on the theory of evolution and dissolution of the nervous system developed by the Englishneurologist John Hughlings Jackson. Professor Jan Mazurkiewicz was an active organizer of psychiatric care. He was co-founder and director of hospitals in Kochanówka and Kobierzyn. He held the rank of Associate Professor at the John Casimir University in Lviv and the position of Professor at the Jagiellonian University in Cracow. From 1919 until his death in 1947, Professor Jan Mazurkiewicz was the head of the Department of Psychiatry at the University of Warsaw. For twenty three years, starting from 1924, he was the president of the Polish Psychiatric Association. The Mazurkiewicz's Psychopathological Theory provides a natural model of development of the highest psychic functions. Damage to a higher evolutionary level of the nervous system leads to the activation of the previously suppressed lower levels, transformed by the pathogen into psychopathological symptoms. Mazurkiewicz's scientific thought was adopted and developed by his student andthen, collaborator, Professor Mieczysław Kaczyński, who was later to become the head of the Department of Psychiatry in Lublin. This work discusses the research conducted at Lublin's Department of Psychiatry which expands on Mazurkiewicz's theory
Ewelina Soroka, Kamila Dziwota, Justyna Pawęzka and Marcin Olajossy
Does better insight associated with the process of recovery mean a stronger sense of mental illness stigma? This article presents the relationship between a multidimensional construct, which is the insight and the phenomena of stigma and self-stigma of patients diagnosed with schizophrenia. It is well known that the term insight contains: a sense of illness, the patient's attitude to its symptoms, explanation of the causes of the illness, attitude to the rationale of treatment and awareness of the risk of relapse. On the other hand, self-stigma occurs when the patient internalizes and refers to himself/herselfnegative and stigmatizing social attitudes, conditioned by the presence of conventionalbeliefs, strengthened by the media, and this weakens the process of recovery.
How much does good insight strengthen the patient on the way to fuller social functioning, and how much does it imprint stigma of mental illness and weaken its positionin society? The authors of the paper are discussing the subject of insight and stigma from the patient's perspective, over the patient’s attitude towards the diagnosis of schizophrenia, the process of recovery and the aspect of hope - important in recovery. These study of construct insight shows that the relationship insight-recovery-stigma is a multi-dimensional plane, dependent on various factors, that needs constant deepening and complementing with further research.
Aleksandra Siek, Agata Makarewicz, Łukasz Łobejko, Anna Gralewska, Joanna Tomaka, Justyna Szymańska-Piekarczyk, Jakub Siembida and Hanna Karakuła Juchnowicz
Introduction: Trichotillomania is a mental disorder characterized by a repetitive and compulsive hair pulling, classified in ICD-10 to a group of habit and impulse disorders, and in the DSM-5 to the group of obsessive-compulsive disorders.
Aim: The aim of the study is to present on the basis of case study:1). the importance of traumatic family experiences in releasing as well as maintaining the symptoms of Trichotillomania, 2). comprehensive medical care, the application of which has resulted in a beneficial therapeutic effect.
Results: In the described case of 16-year-old patient, Trichotillomania was triggered by traumatic events related to lack of support and family stabilization resulting from parental disputes and grandfather’s death, when she was 11 years old. The subsequent years of her life, in spite of the divorce of her parents and their separate residence, abounded in periods of turbulent quarrels between the parents in which she was involved. Each time this type of incident was associated with the recurrence of behavior associated with Trichotil-lomania, the course of which was more severe with the occurrence of self-harm and suicidal thoughts.
Conclusions: 1. In the described case, traumatic events and pathological relations of the immediate family members were not only thetriggering factor, but also maintaining the Trichotillomania symptoms. 2. In accordance with the guidelines of Trichotillomania Learning Center-Scientific Advisory Board (2008), the use of a comprehensive treatment including both the patient - individual psycho-therapy (especially cognitive-behavioral therapy) and pharmacotherapy, as well as her family (family psychotherapy, family mediation, workshops for parents), brought about positive therapeutic effects.
Introduction: The purpose of this study was to examine whether the combination of atypical and typical antipsychotic medications is related with metabolism and cognitive functions in the same manner and degree as taking medications of one kind only, i.e. atypical or typical.
Material and methods: The participants of the study comprised of 91 adults with diagnosed mental illness (F-20-F69). The participants were divided into groups on the basis of the kind of administered medications: T+A (typical and atypical medications), A (atypical medications), T (typical medications), P (antidepressants, sedatives, normothymic/antiepileptic drugs). In the study, Short Test of Mental Status (STMS), Verbal Fluency Test (VFT), Rey Auditory Verbal Learning Test (RAVLT) were used for the purpose of examining cognitive functions.
Results: The kind of antipsychotic medications taken by the patients did not differentiate the group in relation to BMI (p<0.13), nor in relation to the level of general cognitive function (p<0.72) or verbal fluency (p<0.34). Both atypical antipsychotic medications and the combination of atypical and typical medications were related to the occurrence of abdominal obesity (p<0.01). An increase in waist circumference decreased an ability of abstract reasoning (p<0.005). When it comes to the body mass index, waist circumference negatively correlated with the delayed memory (p< 0.03, p<0.004).
Discussion: Both the combination of atypical and typical antipsychotic medications and atypical medications are associated with the occurrence of abdominal obesity. The deposition of fat tissue in the abdomen negatively correlated with an ability to learn.
Conclusions: The future studies might explain the interactions between antipsychotic medications, obesity and cognitive function.
Katarzyna Jusiak, Żaneta Brudkowska, Maria Gołębiowska, Justyna Morylowska-Topolska, Beata Gołębiowska, Michał Próchnicki, Agnieszka Próchnicka and Hanna Karakuła-Juchnowicz
Introduction: Until recently, oxytocin was mainly associated with the pathophysiology of childbirth and sexual functions, but lately this hormone has become the object of interest to psychiatry and psychology due to the significant influence of oxytocin on human behavior in the field of social and emotional functioning. Current scientific research focuses on the participation of oxytocin in the pathogenesis and therapy of mental disorders.
Aim: The aim of the paper is to present, on the basis of available literature, the significance of oxytocin for various psychological functions, with particular emphasis on the influence of oxytocin on the course and clinical picture of schizophrenia.
Method: Available articles from the Medline / PubMed database were analyzed, which were searched using keywords: oxytocin, schizophrenia, therapeutic use of oxytocin, social cognition, positive symptoms, negative symptoms and time descriptors: 2013-2017. There are included articles published in Polish and English.
Results:The research results carried out so far suggest that oxytocin plays a significant role in modulating complex socio-emotional behaviors in schizophrenic patients. The existing research results also indicate a relationship between the dysregulation of the oxytocinergic system and the pathophysiology of schizophrenia. Many of the studies prove that there is a relationship between the level of oxytocin in the patients' blood plasma and the severity of the disease symptoms. Recent genetic studies indicate a possible relationship between polymorphism of oxytocin genesand polymorphism of oxytocin receptor genes and the risk of developing schizophrenia.
Conclusions: Contemporary research on the therapeutic potential of oxytocin and its influence on the functioning of schizophrenia patients seem to be very promising and may contribute to increasing the effectiveness of treatment of schizophrenia and possibly other mental disorders, which in turn will improve the quality of life of patients in cognitive, social and emotional functioning.