Ewelina Drzał-Fiałkiewcz, Agata Makarewicz, Mateusz Walczak, Aleksandra Walczak, Małgorzta Futyma-Jędrzejewska, Gustaw Kozak, Piotr Frończuk and Hanna Karakuła-Juchnowicz
Introduction: Non-Suicidal Self-Injury (NSSI) is the deliberate injury to one’s own body intended to cause mental or physical harm to oneself. In view of the growing scale of the NSSI, especially among young people without identifying any other psychiatric disorders, the disorder was included in both DSM-5 and ICD10 as independent diagnostic entity. Many etiopathogenetic hypotheses and research tools assessing various aspects of NSSI have been developed.
The aim of the work is to present and discuss the most commonly used scales for NSSI assessment.
Method: A review of available literature was made using the databases Medline / PubMed, using the key words: “self injury”, “self-mutilation”, “non-suicidal,”, “NSSI”, “self-harm” and time descriptors: 2005-2017
Results: Available tools were divided into three groups: I- scale of self-assessment made by the patient, II- assessment made by the clinician, and III- auxiliary scale.
Conclusions: None of the available scales covers the complexity of the NSSI phenomenon. For the overall NSSI assessment, several NSSI assessment tools are suggested, taking into account both self-assessment scales and clinical evaluation.
Michał Hys, Nikodem Skoczeń, Ewelina Soroka and Marcin Olajossy
New achievements within structural and functional imaging of central nervous system offer a basis for better understanding of the mechanisms underlying many mental disorders. In everyday clinical practice, we encounter many difficulties in the therapy of eating disorders. They are caused by a complex psychopathological picture, varied grounds of the problems experienced by patients, often poor motivation for active participation in the treatment process, difficulties in communication between patients and therapeutic staff, and various biological conditions of eating disorders. In this paper, the latest reports on new concepts and methods of diagnosis and treatment of anorexia nervosa have been analyzed. The selection of the analyzed publications was based on the criteria taking into account the time of publication, the size of research cohorts, as well as the experience of research teams in the field of nutritional disorders, confirmed by the number of works and their citations. The work aims to spread current information on anorexia nervosa neurobiology that would allow for determining the brain regions involved in the regulation of food intake, and consequently that may be a potential place where neurobiochemical processes responsible for eating disorders occur. In addition, using modern methods of structural imaging, the authors want to show some of the morphometric variations, particularly within white matter, occurring in patients suffering from anorexia nervosa, as well as those evaluated with magnetoencephalography of processes associated with the neuronal processing of information related to food intake. For example as regards anorexia nervosa, it was possible to localize the areas associated with eating disorders and broaden our knowledge about the changes in these areas that cause and accompany the illness. The described in this paper research studies using diffusion MRI fiber tractography showed the presence of changes in the white matter pathways of the brain, especially in the corpus callosum, which indicate a reduced content of myelin. These changes probably reflect malnutrition, and directly represent the effect of lipid deficiency. This leads to a weakening of the structure, and even cell death. In addition, there are more and more reports that show the normal volume of brain cells in patients with long-term remission of anorexia. It was also shown that in patients in remission stage there are functional changes within the amygdala in response to a task not related symptomatologically with anorexia nervosa. The appearing in the scientific literature data stating that in patients with anorexia nervosa there is a reduced density of GFAP + cells of the hippocampus and increased expression of vimentin and nestin, is also worth noting.
Ewelina Soroka, Inga-Ujma Lesiczka, Magdalena Tracz, Bernarda Bereza and Marcin Olajossy
Refractoriness affects about 25% of patients treated with antipsychotics, and it is a very big challenge for clinicians. The most commonly accepted definition of refractoriness is: lack of satisfactory clinical response to treatment with at least two antipsychotic drugs, from different groups, carried out at therapeutic doses and for a sufficiently long period.
Aim : The aim of the study is to analyze the case of a patient diagnosed with schizophrenia.
Methods: Analysis of medical records, available literature from recent years on treatment-refractory and super-refractory schizophrenia.
Results: A 53-year-old patient, a bachelor, suffering from paranoid schizophrenia with an extremely severe, non-remission course with drug resistance features. The patient's father and sister also suffer from severe paranoid schizophrenia. The patient became ill at the age of 22. Despite the high doses of clozapine, in a sufficiently long period of time, the patient maintained positive and negative symptoms, cognitive deficits and behavioral disorders. The patient was 14 times psychiatrically hospitalized, twice treated with electro-convulsive therapy, which did not bring results despite the combination of electroconvulsive therapywith psycho pharmacotherapy. In addition, the patient was addicted to benzodiazepines, administered during anxiety and anxiety attacks by the mother, during the described hospitalization, gradually discontinued. Patient after several attempts of committing suicide, with a tendency to self-destructive behavior. The illustrated case meets the criteria of super-refractory schizophrenia (SRS).
Conclusions: 1. The category of refractory schizophrenia encountered in the literature is not a separate diagnostic category - it does not exist in classification systems, therefore we consider the phenomenon / symptom of drug resistance - variously defined. 2. Social relations have a big impact on the functioning of the patient as well as the course of the disease and prognosis (the role of the family). 3. There are numerous methods for the potentiating of clozapine treatment, of which combining clozapine with EC therapy is effective and safe. The strategy for combining clozapine with EC is effective, but not in all patients.
This article explores the phenomenologically informed, theoretical and empirical research direction on self-disorders in the schizophrenia spectrum conditions. First, we describe the concept of ‘self’ that is operative in the concept of ‘self-disorders’ and we discuss how this self may be disordered or fragile in the schizophrenia spectrum. Second, we offer a detailed psychopathological presentation and discussion of 3 patients with schizophrenia. The vignettes provide paradigmatic examples of self-disorders in schizophrenia. Third, we summarize the main findings in the current empirical research on self-disorders. These findings consistently indicate that self-disorders constitute a crucial, trait phenotype of the schizophrenia spectrum.
Hanna Karakuła-Juchnowicz and Justyna Morylowska-Topolska
A defined and formed identity is the foundation of human mental functioning. The sense of one’s own existence as an individual, together with the conscious image of oneself, plays a fundamental role in regulating behaviors. The ability to see the limits of one’s own body is a significant milestone in human development, because it allows the development of a global sense of self, and that is the basis for the process of identifying one’s own identity.
The paper presents the contribution of Polish researchers (psychiatrists and psychologists) to understanding the phenomenon of the sense of self, identity, and their disorders with particular emphasis on schizophrenia.
Method: A review of the available literature by Polish authors on the subject was undertaken by searching the following data-bases: Polish Bibliography of Medicine, CEJS, NUKAT and National Library Database, using the keywords: identity, self, personality, schizophrenia, ego, within time frame: 1970–June 2017. The article includes only those works which made the original contribution of Polish authors to research on the issue of self and the sense of identity, with particular emphasis on their disorders in schizophrenia.
Results: The works of three Polish authors: J. Reykowski, J. Kozielecki and Z. Zaborowski deserve particular attention in the context of the definition of self and the sense of identity.
The works of A. Kępiński, in turn, have contributed to understanding the problem of disorders of self in schizophrenia. Kępiński’s psychopathological concept was based on the analysis and description of the pathology of self, the pathology of the boundary self–the world, disorders of time-space order and the hierarchy of values. In these terms, he considered the structure of the psychotic world, especially in schizophrenia and melancholy. In his opinion, schizophrenic psychosis manifests itself primarily in the form of the blurring of the boundary self–the world and the pathology of self.
The paper also presents the contribution of J. Zadęcki, M. Rzewuska, J. Wciórka, S. Steuden, M. Huflejt-Łukasik to understanding the disorders of the sense of self in schizophrenia.
Conclusions: The views of Polish authors presented in the paper are an interesting contribution to world literature on research into disorders of self in schizophrenia.
Josef Parnas, Paul Møller, Tilo Kircher, Jørgen Thalbitzer, Lennart Jansson, Peter Handest, Dan Zahavi, Hanna Karakuła-Juchnowicz, Justyna Morylowska-Topolska and Dariusz Juchnowicz
Skala EASE jest listą objawów do częściowo ustrukturalizowanego fenomenologicznego badania subiektywnych lub empirycznych nieprawidłowości (anomalii), które można uznać za zaburzenia podstawowej, „minimalnej” samoświadomości. EASE opracowana została na podstawie samoopisów otrzymanych od pacjentów chorujących na zaburzenia ze spektrum schizofrenii. Skala ma duże znaczenie dla opisu, diagnozy oraz diagnozy różnicowej zaburzeń ze spektrum schizofrenii. Prezentowana wersja zawiera istotne szczegółowe kwestie dotyczące zbierania wywiadu oraz opisy objawów psychopatologicznych (Podręcznik), arkusz wyników (Aneks A), listę pozostałych pozycji Skali stosowanych w czasie wywiadu (Aneks B) oraz porównawczą listę pozycji EASE/BSABS (Bonner Skala für die Beurteilung von Basissymptomen, Bońska Skala do Oceny Objawów Podstawowych) (Aneks C).
Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to disruption of the sense of ownership of experience and agency of action and is associated with a variety of anomalous subjective experiences. Little is known about the neurocognitive correlates of basic self-disturbance. In this paper, we review recent phenomenological and neurocognitive research and point to a convergence of these approaches around the concept of self-disturbance. Specifically, we propose that subjective anomalies associated with basic self-disturbance may be associated with: 1. source monitoring deficits, which may contribute particularly to disturbances of “ownership” and “mineness” (the phenomenological notion of presence) and 2. aberrant salience, and associated disturbances of memory, prediction, and attention processes, which may contribute to hyper-reflexivity, disturbed “grip” or “hold” on the perceptual and conceptual field, and disturbances of intuitive social understanding (“common sense”). These two streams of research are reviewed in turn before considering ways forward in integrative models, particularly regarding the role of early neurodevelopmental disturbances, primary versus secondary disturbances, and the state versus trait nature of such pathology. Empirical studies are required in a variety of populations in order to test the proposed associations between phenomenological and neurocognitive aspects of self-disturbance in schizophrenia. An integration of findings across the phenomenological and neurocognitive domains would represent a significant advance in the understanding of schizophrenia and possibly enhance early identification and intervention strategies.
Maciej Zygo, Emilia Potembska, Karol Zygo, Andrzej Stanisławek, Łukasz Karaś and Beata Pawłowska
The aim of this paper was to determine differences and similarities between city dwelling teenagers aged 13–17 years who consumed/did not consume alcohol and their rural counterparts in regard to the severity of Internet addiction symptoms.
Participants and methods: The examined group consisted of 1,191 people (890 girls and 301 boys) aged 13–17 years. The following instruments were used in the study: a sociodemographic questionnaire designed by the present authors, the Internet Addiction Questionnaire designed by Potembska, and the Internet Addiction Questionnaire (KBUI) designed by Pawłowska and Potembska.
Results: The results show that adolescents who consume alcohol, both those living in urban and rural areas, are characterized by statistically significantly more severe Internet addiction symptoms measured by KBUI as compared to their non-drinking peers.
Adolescents who consume alcohol, both urban and rural residents, are characterised by statistically significantly more severe symptoms of Internet addiction compared to their peers who do not consume alcohol.
Adolescents who live in a city and who consume alcohol are significantly more likely to use Internet pornography than their non-drinking peers.
Adolescents who live in urban areas are significantly more likely to use Internet pornography, play violent computer games and search for acceptance and understanding only in online interactions as compared to adolescents who do not consume alcohol.
Underage city-dwellers who consume alcohol are significantly more likely to use electronic mail, instant messaging and web pages compared to their rural peers.
Introduction: In the 21st century there is an increased prevalence of depression in the world. So far the mechanism of developing depression has not been exactly known. Risk factors of depression occurrence are complex and nowadays it has been emphasized that air pollution can affect the intensity of depressive symptoms.
Objective: The analysis of the scientific works investigating the correlations between air pollution and depression.
Material and method: The material consisted of the studies published between 2007 and 2017. A systematic review of Medline database (using PubMed search engine) was conducted by typing the English phrase (air pollution) and (depression), and 154 results were obtained. Those results which concerned nicotine addiction or dementia diseases were rejected. The inclusion criterion was the number of people tested, n>500 in case of adults, and n>200 in case of children (a small number of publications). All in all, 9 research in the population of adults and 1 research in the group of children were included to the final analysis. In the discussion part of this work some research carried out on animals and related to the subject matter of own analyses were also investigated.
Results: As many as 8 out of 10 analyzed research demonstrated statistically significant correlation between long-term exposure to air pollution (mainly to fine particulate matter, PM) and depression. This correlation mainly concerned intensification of depressive symptoms during long exposure to air pollution. The exposure also resulted in changes in the neuro-transfer of serotonin and as well in neurodegenerative changes in children exposed to long-term pollution with polycyclic aromatic hydrocarbons (PAH) in prenatal life. Testing on animals indicates that air pollution affects the activation of proinflammatory processes in hippocampus, what may incidentally contribute to the formation of depressive and cognitive symptoms.
Conclusions: In view of the increase of depression incidence and constantly sustained air pollution in the world, there is a need for further research on the correlation between air pollution and depression, taking into account the genetic, social and psychological factors.
Ewa Stelmach, Olga Hołownia, Maciej Słotwiński, Aneta Gerhant and Marcin Olajossy
Introduction. Hyponatremia is an important part of psychiatric practice. In order to analyze its causes and symptoms, the literature on hyponatremia in psychiatric patients has been reviewed. The work has been divided into two separate manuscripts. In the first one the authors discuss the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia occurring with the use of psychotropic drugs (antidepressants, antipsychotics, normotimics), while the second paper discusses research on psychogenic polydipsia. The causes of hyponatremia in patients treated in psychiatric wards include: water intoxication associated with polydipsia, somatic comorbidities, side effect of internal medicine and psychiatric drugs. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin (SIADH). The SIADH syndrome is a group of symptoms, first described in 1967 by Schwartz and Bartter in The American Journal of Medicine, which results from the hypersecretion of antidiuretic hormone, also called vasopressin, which causes patients to develop normovolemic hyponatremia. The phenomenon of drug-induced hyponatremia in psychiatric practice is generally observed with the use of antidepressants, antipsychotics and anti-epileptic drugs (used in psychiatry as normotimic drugs).
Aim and method. The first manuscript includes a review of literature on the syndrome of inappropriate secretion of vasopressin (SIADH) and hyponatremia occurring after the use of psychotropic drugs, and is divided into two subsections: 1. The syndrome of inappropriate secretion of vasopressin (SIADH), 2. Hyponatremia and psychotropic drugs (antidepressants, antipsychotics, normotimics).
Conclusion. In the view of the reviewed literature it is extremely important to control the natremia level during pharmacotherapy using the above mentioned drugs, especially in the initial period of therapy.