Małgorzata Futyma-Jędrzejewska, Hanna Karakuła-Juchnowicz and Ewelina Drzał
Pregnancy, childbirth and motherhood are new situations for women and require adjustment. Women suffering from schizophrenia require special attention due to the course of the disease. Physiological changes that occur in the body during pregnancy may be unacceptable for women suffering from schizophrenia. They may delusively deny the existence of the pregnancy, lead an unhealthy lifestyle (stimulants, poor diet, lack of gynaecological check-ups), which in turn causes an increased risk of complications. In the research conducted so far, it has been proven that three kinds of complications are associated with schizophrenia: complications concerning pregnancy itself (bleeding, diabetes, Rh-incompatibility, pre-eclampsia), intrauterine growth restriction (low birth weight, congenital malformations, small head circumference) and complications regarding labour (uterine atony, asphyxia, emergency Caesarean section). The course of the labour itself in this specific group of patients has not yet been sufficiently examined. It has also been proven that perinatal complications are one of the factors determining an increased risk of schizophrenia.
Aleksandra Iwanicka, Joanna Iwanicka and Anna Urbańska
The aim of the article is to point out to the specificity and difficulties an expert psychologist faces while producing a court expertise in family and guardianship cases. Such a diagnosis is prepared at the request of a family court. The questions asked by the court in family and guardianship cases determine the range and aim of diagnosis including the type of examined case. Having considered the court’s questions, a psychologist formulates hypotheses and operationalizes variables. This article will present the main areas of problems which arise while developing opinions in family and guardianship cases. The two main issues will be discussed: the range of an expert psychologist’s competences in the light of the court’s expectations frequently exceeding an expert’s capabilities and the impact of the choice of research methods on the quality of an opinion issued to obtain the final ruling in the court case.
Żaneta Brudkowska, Małgorzata Tomczyk, Katarzyna Jusiak, Hanna Karakuła-Juchnowicz and Ewa Rudnicka-Drożak
Introduction: Beta blockers are mainly used in treating cardiovascular diseases. However, it has been observed that these drugs have also an anxiolytic potential. Over the years, a number of clinical trials have been conducted aimed at determining the effectiveness of beta blockers in treating anxiety disorders.
The aim of the article: The main objective of the article is to present the significance and position of adrenolytic drugs in the pharmacotherapy of anxiety disorders on the basis of available literature. Moreover, the authors also decided to take into account the data from current research results, considering the problem of side effects of using adrenolytic drugs - especially the controversial reports on their effect on the development of affective disorders.
Method: An analysis was conducted of articles from Medline/PubMed database, selected on the basis of the following key words: anxiety disorders, beta blockers, adrenolytic drugs, as well as on the basis of their dates of publication: 1960-2017. In order to conduct a reliable and complete review of literature, the authors decided to include works from quite an extended period of time. The articles included in the review were published in Polish and English.
Results: The review of articles concerning the treatment of anxiety disorders clearly suggests that propranolol is effective in reducing the frequency of panic attacks and the tendency for avoidance behavior in patients with agoraphobia. Other studies report on potential benefits in terms of early interventional prevention and treating posttraumatic stress disorder with propranolol. However, there is lack of randomized clinical trials concerning the therapeutic effect of other adrenolytic drugs in treating anxiety disorders. Early research works reported that (mainly lipophilic) beta blockers may have a depressogenic effect; however, the latest studies have not confirmed it.
The contemporary research on the therapeutic potential of beta blockers in treating anxiety disorders is insufficient. What seems to be most promising, however, are reports concerning the desirable effects of using adrenolytic drugs in treating posttraumatic stress disorder, which implicates the necessity of conducting further research verifying the validity of their application.
In creating his Psychophysiological Theory, Jan Mazurkiewicz transplanted John Hughlings Jackson’s method into the field of psychiatry. Like his precursor, he distinguished four evolutionary levels, but this time with regard to mental activity. According to Mazurkiewicz’s approach, disease is the reverse of evolution. Doing damage to the highest evolutionary level, it allows evolutionarily lower levels to take control of the patient’s psyche. Distorted by the etiological factor, the lower mental levels manifest as mental disease. In his Psychophysiological Theory, Mazurkiewicz distinguishes three types of dissolution: intra-level dissolution (psychoneuroses), slow dissolution or dissociation proper (schizophrenia), and rapid, delirium-like dissolution (impaired consciousness). Kaczyński noted that, based on an in-depth analysis of the phylogenetic and ontogenetic development of the successive evolutionary levels of the nervous system, Mazurkiewicz transposed the principles of the Jacksonian concept of hierarchical evolution – dissolution. Within a dozen or so years from birth to maturity, the process of evolution of mankind is recapitulated, with the speed of lightning, in an individual – from instincts, which are phylogenetically the oldest, to the highest functions of the frontal lobes. The present paper makes mention of research conducted at Lublin’s Department of Psychiatry which expands on Mazurkiewicz’s theory.
Paulina Wróbel-Knybel, Michał Flis, Rafał Dubiel and Hanna Karakuła-Juchnowicz
Introduction: Sleep paralysis (SP) is a condition that widely occurs among people all over the world. It has been known for thousands of years and is rooted in the culture of many countries. It arouses strong emotions, though still little is known about it. The clinical picture of the disorder can be very diverse. It is often accompanied by hypnopompic and hypnagogic hallucinations, somatic complaints and the feeling of intense anxiety. A feeling of paralysis in the body with inhibited consciousness is always observed with the experience. SP pathophysiology is not fully understood, however, most theories explaining this phenomenon are based on the assumption that it results from dysfunctional overlap of REM sleep and wakefulness. It is experienced by healthy people, but it is more often associated with somatic and mental disorders, which is why it is becoming an object of interest for researchers.
Aim: The aim of this work is to present the most important information about the disorder known as sleep paralysis - its history, cultural context, pathophysiology, prevalence, symptomatology, coexistence with other somatic and mental disorders as well as diagnostics and available forms of prevention and treatment.
Materials and methodology: The available literature was reviewed using the Google Scholar bibliographic databases searching the following keywords: sleep paralysis, REM sleep parasomnias, sleep disorder, night terrors and time descriptors: 1980-2018.
Results 1. Sleep paralysis has already been described in antiquity, and interpretations related to its occurrence are largely dependent on culture and beliefs.
2. Symptomatology of the disorder is very diverse: both mental and somatic symptoms are present.
3. The pathophysiology of the disorder has not been fully explained. The basis of most theories regarding sleep paralysis is the assumption that it results from the dysfunctional overlap of REM sleep and wakefulness.
4. The prevalence of SP at least once in a lifetime is 7.6% in the general population, although it is estimated that it is much more frequent in people with various mental and somatic disorders.
5. Treatment of SP is associated with a change in lifestyle and the use of pharmacotherapy and psychotherapy.
The article presents a study on delusory changes in perceiving one’s own body in a patient with mental illness. The story of Daniel Paul Schreber is an example of strongly experienced delusions, which, in the described form are contemporarily attributed to schizophrenia. This story, coming from over one hundred years ago, is still vivid, and actualizes the image of mental illness and suffering connected with it in the thoughts of the reader. The author presents these characteristics focusing mainly on the symptoms of dysmorphognosia or dysmorphophobia, which became an important element of delusional constructs. He describes the nature of the experienced symptoms in detail, documenting them with extensive quotations from „Diary of a mental patient” written by such patient. The study of mental illness presented in the paper reveals the meanders of distorted psyche and some changes that are happening in it under the influence of delusions. It is a study undertaking the issue of describing and understanding the symptoms of mental disorders.
People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental procedures to reduce the risk of bleeding. Informal discussions with patients suggested that many do not complete the prescribed course of treatment. A literature review indicated that TXA was prescribed inappropriately for procedures with a low bleeding risk, and that there are inconsistencies in the recommended dose, mode of administration and duration of TXA for this patient group. A new protocol was implemented in the haemophilia centre at St George’s University Hospital NHS Foundation Trust, London, to rationalise the prescribing of TXA in dental procedures. A study was conducted to explore patients’ experience of this new guideline in the form of a service evaluation. Structured telephone interviews were completed following 39 dental procedures to collect data on concerns about bleeding; whether TXA was taken as prescribed and reasons for non-adherence; and any unplanned post-operative treatment. The financial impact of the new guideline was also explored. Patients were supportive of the new regimen, although almost half (46%) did not complete the prescribed course of TXA. The majority (37/39) were prescribed tablets rather than mouthwash. No patients required additional unplanned haemostasis support to control haemorrhage. Cost savings were made by replacing a five- to seven-day course of TXA mouthwash with a three-day course of TXA tablets. Although the data collected from patient interviews supports the new guideline, patients appear to be making decisions about taking TXA based on their own experience rather than following the prescribed regimen. Prescribers should support patients to make informed decisions about their medicines and incorporate patient experience into individualised regimens. Given the lack of bleeding complications experienced in this cohort of patients, it is possible that TXA is being overprescribed. Further work exploring how patients with IBDs make decisions about taking medicines is needed.
Justyna Świerczyńska, Agnieszka Mazur, Izabela Chojnowska-Ćwiąkała and Agnieszka Podosek
This article presents the problem of the functioning of a family with a child suffering from two painful, chronic and incurable diseases - cystic fibrosis and short bowel syndrome. Its aim is to learn about the impact of these diseases on the occurrence and course of mental disorders in a child and on the functioning of the whole family in which such a child is brought up. Like any long-term illness of a child, it has influenced changes in the functioning of the family system. The parents’ functioning and the flexibility of the family system conditioned the acceptance of the diagnosis and determined further participation of the family in the treatment process. This article also discusses the risk of unfavorable attitudes of parents towards the child’s illnesses, which may contribute to the development of mental disorders in the child patient, as well as in his/her parents or siblings. In the process of treatment and rehabilitation, the necessity for cooperation of medical staff, the patient and his/her parents has been emphasised.
Laura Savini, Radoslaw Kaczmarek, Declan Noone, Paul Giangrande, Geoffrey Dusheiko and Brian O’Mahony
In the 1980s and 1990s, thousands of people with bleeding disorders (PWBD) across the world were infected with HIV and hepatitis C virus (HCV) through contaminated treatment products. The extent of the infection, as well as the needs of those still living with HCV, were never properly assessed. The purpose of our survey was to identify how many PWBD were infected with HCV in Europe, as well as their health status and needs. HCV infection was defined as any person with a bleeding disorder who was exposed to the virus and seroconverted to become anti-HCV antibody positive. The survey also looked at testing and treatment availability. Between December 2016 and March 2017, the survey was distributed to 45 national patient organisations in the European Haemophilia Consortium (EHC), who were encouraged to respond with the support of a local hepatologist. The data gathered led us to estimate that some 15,000 people with bleeding disorders were infected with HCV in the 30 countries that responded. Although some countries have detailed records of patients with HCV, most - including some with national haemophilia registries - were unable to provide exact numbers of initial infections, HIV coinfection, survival and SVR rates. Responding countries reported varying degrees of monitoring for disease progression, as well as extremely divergent access to new direct-acting antivirals, with only eight countries prioritising PWBD for treatment. With liver disease and hepatocellular carcinoma being among the main causes of death in an aging bleeding disorders population, this survey identifies a clear gap in care. It is a frustrating paradox that today, in many European countries PWBD, such as haemophilia, may live long and productive lives due to much-improved access to factor replacement therapy, yet die prematurely of a curable disease such as hepatitis C. It has been demonstrated that HCV eradication in PWBD can be achieved through national commitment, especially when the patient population is limited and HCV eradication could be achieved in the short-term. The eradication of HCV in PWBD in Europe is an idea whose time has come.
The aim of this study is to acquaint the readers with some pieces of practical guidance on the therapy of neurotic disorders offered by Professor Mieczysław Kaczyński to his colleagues and students at the Lublin Clinic of Psychiatry. Patients who report so-called neurotic complaints are a group that requires a very thorough clinical analysis. Professor Kaczyński emphasized that it was necessary to make a distinction among patients with a neurotic reaction, a pseudoneurotic syndrome, and ‘neurosis proper’ or psychoneurosis. The first group includes patients who report a psychological trauma as a trigger of their complaints. Therapeutic intervention brings good outcomes leading to resolution of the condition. A group of patients that is very important from the point of view of diagnosis are those in whom neurotic complaints are masking an onset of a somatic or mental illness or an existing illness which is running a mild course. In such cases, a cursory examination leading to a mistaken diagnosis of neurosis can have devastating effects. A misdiagnosis is easy to make, for example, in patients with increased intracranial pressure (“the neurasthenic stage of a brain tumour”) or an onset of a mental illness (the pseudoneurotic syndrome of early schizophrenia). Therefore, often, before the final diagnosis is arrived at, multiple follow-up examinations are needed to monitor the structure and dynamics of the disease. Only when the first two diagnostic options have been excluded, can the physician classify the disorder as a neurosis (psychoneurosis). In such cases, it is necessary to find the etiological agent, which, more often than not, is a situation of conflict or frustration that the patient is unconscious of. A failure to analyze a case in this way may result in the patient’s resignation response, potentially leading to suicide. It appears that Professor Kaczyński’s remarks on the clinical picture of neurotic disorders largely round out the information provided in ICD-10 under F.40–F.48.