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Hiponatremia in the practice of a psychiatrist. Part 2: psychogenic polydipsia

Abstract

Objective. The study is the second part of the literature review on hyponatremia in patients with diagnosed mental disorders. This article focuses on psychogenic polydipsia as, along with the SIADH, one of the two most common causes of hyponatremia in the mentioned group of patients.

Method: The literature review was based on searching the Medline, the Google Scholar and the Ebsco databases in Polish and English by entering the following phrases: psychogenic polydipsia, the psychosis – intermittent hyponatremia – polydipsia syndrome, water intoxication.

Discussion: Psychogenic polydipsia occurs in up to 25% of patients treated for mental disorders. It most frequently concerns patients with schizophrenia. 30% of patients with psychogenic polydipsia suffer from hyponatremia with or without symptoms of water intoxication. In the etiology of psychogenic polydipsia, the influence of dopaminergic and noradrenergic neurotransmission has been considered, as well as angiotensin, which is claimed to have dipsogenic properties. In order to reduce the severity of the disorder, attempts have been made to administer the following groups of medications: β-blockers, opioid receptor antagonists, angiotensin convertase inhibitors and angiotensin receptor antagonists. Other methods include replacing classic antipsychotic drugs with clozapine. There are also reports of a reduced severity of polydipsia with hyponatremia after introducing risperidone and olanzapine. Preventing episodes of water intoxication in patients with psychogenic polydipsia requires the monitoring of their body weight and a suitable reduction of fluid intake by them.

Results: Mentally ill patients, especially those with chronic schizophrenia, should be monitored for psychogenic polydipsia and the concomitant hyponatremia.

Open access
Phantom limb phenomenon as an example of body image distortion

Abstract

Introduction: The perception of one’s own body, its mental representation, and emotional attitude to it are the components of so-called “body image” [1]. The aim of the research was to analyse phantom pain and non-painful phantom sensations as results of limb loss and to explain them in terms of body image distortion.

Material and method: Three methods were used in the study of 22 amputees (7 women and 15 men, between 43 and 76 years old, M = 61, SD = 11.3): (1) a clinical interview; (2) The Questionnaire of Body Experiencing after Limb Amputation; (3) modified version of The Pain Questionnaire based on The McGill Pain Questionnaire.

Results: The prevalence of phantom limb pain was 59%. Some various non-painful phantom sensations after amputation were experienced by 77% of respondents. There was a statistically significant relationship between phantom pain and non-painful phantom sensations in a group of participants experiencing phantom limb phenomenon at the moment of the research.

Conclusions: Deformation of body image in the form of phantom pain and non-painful phantom sensations is a frequent experience after limb loss. We suggest that phantom limb is a form of out-of-date or inadequate body image as an effect of the brain activity trying to keep a kind of status quo. A co-occurrence of non-painful phantom sensations and phantom pain suggests that these both forms of post-amputation sensations may share neural mechanisms. Results indicate, that there exists somatosensory memory which may be manifested in similarities between pre- and post-amputation sensations.

Open access
Psychological Support for Families During Crises (as exemplified by families members of Ukrainian war veterans)

Abstract

The goal of the article is to describe the theoretical and empirical research of characteristics of families under non-normative crises, having as an example the families of combatants participated in the anti-terrorist operation in Ukraine. The following family crises are discussed: normative crises, as period of transition from one stage of the family life cycle to another and non-normative crises caused by traumatic life events.

Research methodology. In order to differentiate more clearly the families of war veterans (those who returned from the anti-terrorist operation zone were examined) and their reactions to the crisis, a sample consisted of chosen nuclear families and the attention was focused on the marital subsystem as a family basis. At the end, survey and psychological testing of war veterans’ wives were conducted; the following diagnostic techniques were used: the author’s questionnaire, FACES-3 method (D.Olson), the questionnaire of family anxiety (E.Eydemiller); the methods of mathematical statistics were used to estimate the data.

Research results. The data of the empirical study of the 36 families of war veterans who participated in the military operations in the ATO zone (Ukraine) show that such non-normative family crisis is characterized by family system imbalance and its correction requires adaptation of the family as a whole system to the new reality. Most war veterans’ families undergo series of transformations associated with changes in family structure, communication, significant emotional stress.

Discussion. Psychological assistance to war veterans’ families should include psychological learning, prevention and resolving of marital relationship problems, including construction of a new family image, joint life prospects, discussion and transformation of family rules and regulations, development of family cohesion and communication.

Open access
The society’s perception of suicide

Abstract

Introduction: On account of its radical character, suicide is differently perceived by the society. The consequence of this phenomenon is the issue of moral evaluation by the society in the practical aspects of daily life, such as religious, psychological and social ones. Regarding society’s complexity, it is understandable that the knowledge and the evaluation of this act amongst people are different.

Materials and methods: In the study a method of the diagnostic survey was applied. The questionnaire was conducted amongst 168 individuals ranging from 18 to 49 years of age. The study involved 69 women and 99 men. The arranged personal data questionnaire served as the evaluation of perceiving the suicidal act and people’s knowledge about this occurrence.

Results: Respondents claim that suicidal behaviours affect 72.5% of young people, and 22.7% of adult men. Large group of the study participants had personal experience with individuals after a suicide attempt (41.92%). As many as 49.7% of individuals are fierce opponents of suicidal acts while 46.1% are of an opinion that ‘the one who commits suicide should not be condemned or judged’.

Conclusions: Respondents present vast knowledge about the universality of suicide phenomenon and its most frequent causes. They are against such behaviour, but do not condemn individuals who committed this act. The study participants show understanding of ways to prevent suicide.

Open access
Original paper. Assessment of the need for information about planned gynecologic surgery

Abstract

The objective of the study was to assess the level of patients' need for information about the planned gynecologic surgery.

Material and Methods. The number of 173 patients preparing to undergo planned gynecological procedure were qualified for the study. The participation in the survey was entirely voluntary. Each patient was asked to fulfill the survey conducted using the Amsterdam Preoperative Anxiety and Information Scale- APAIS that enables the estimation of the patient’s need for surgery-related information. Furthermore patients’ clinical and demographic data was collected. Results were analyzed using appropriate statistical tools: the Shapiro-Wilk W-test (for distribution of the studied parameters) and the Mann-Whitney U-test (for comparing two independent groups). P value less than 0.05 was considered statistically significant.

Results. It was shown that premenopausal women have a greater need for information about the planned surgery than postmenopausal patients (p<0.05). Patients, who have never been operated, displayed a significantly greater need (p=0.04) for information about their planned surgery in relation to women who have already undergone surgery. The patient’s age, the phase of the menstrual cycle, the education level, the marital status, as well as the preoperative diagnosis and the type of the planned surgery did not affect the level of the preoperative information requirement (p>0.05).

Conclusions. The high level of the need for information about the planned surgery characterizes premenopausal patients and those operated for the first time.

Open access
Review paper. Chemobrain in patients suffering from cancer based on the example of multiple myeloma

Abstract

Introduction: The incidence rate of cancers emphasizes the necessity to investigate not only patients’ somatic ailments but also their psychosocial functioning as well as the need to raise the quality standards of cancer patients. The improvement of the quality of life is one of the major challenges of psycho-oncology, which is the science created in the interface of two disciplines: psychology and medicine.

One of the important aspects of psycho-oncologists’ activity is the minimization of negative side-effects related to treatment, such as changes in patients’ cognitive functioning resulting from anti-cancer treatment.

Objective: The aim of this work is to provide the reader with the knowledge concerning the phenomenon of chemobrain in a very special group of patients with hemato-oncologic tumour. Few researches related to this topic have confirmed the occurrence of cognitive deficits resulting from the cancer process, taken cytotoxic drugs, other forms of anti-cancer therapy and the activeness of biochemical compounds in patients with multiple myeloma.

Methods: The author has done a literary review concerning the topic under study using the Google Scholar and EBSCO databases. The main part of this work consists of references to Polish and English research literature published after 2000. The review includes also classic works from the eighties and nineties of the 20th century.

Results: The present work has been divided into several sections. The part devoted to explanation of the term chemobrain describes the evolution of its definition over the years. The second section - ‘Heterogeneity of the phenomenon - causes’ - underlines the influence of biochemical etiological factors, such as the impact of the activity of proinflammatory cytokines on the cognitive state of the patients suffering from tumour. Next part - ‘Chemobrain and multiple myeloma’ is devoted to the clinical characteristics of this cancer and to the descriptions of the selected methods of chemotherapy. The review of researches concerning the deteriorated cognitive functioning of patients with multiple myeloma in relation to the probable aetiology of this disease has been also presented.

Conclusions: The review of Polish and English literature concerning the functioning of memory and attention processes in the patients suffering from multiple myeloma can serve as an inspiration for a search for objective biochemical factors conditioning the deterioration of cognitive processes of the patients undergoing anti-cancer treatment.

Open access
Review paper. Does genius border on insanity? Part I: A relationship between creativity and the presence of psychopathological symptoms in bipolar disorder

Abstract

The theory linking the development of mental disorders with the processes of human evolution assumes that these disorders may be the result of a side effect of natural and sexual selection processes. Creativity is one of the adaptive features associated with the increased incidence of psychopathological symptoms (as compared to the general population).

In this review paper, the definition of creativity has been characterized, and contemporary existing theories on its background, have been presented. Also, the paper describes the relationship between creativity and the presence of psychopathological symptoms. Special attention has been paid to the relationship between creativity and bipolar disorder.

The research results prove the existence of a correlation between a high level of creativity and a higher prevalence of psychopathological symptoms, particularly concerning the symptoms of bipolar disorder spectrum.

Open access
Review paper. Gluten-related disorders and schizophrenia - potential linking mechanisms, diagnostic and therapeutic challenge

Abstract

More and more evidence confirms the theory that the intake of cereal products containing gluten may play an important role in the pathogenesis of many diseases. There are also premises indicating the relationship between the so-called gluten-related diseases and the development and course of mental disorders, including schizophrenia.

The aim of this article is to review the literature on the potential relationship between the consumption of gluten and schizophrenia, considering the etiopathogenesis and the role of gluten-free diet in the treatment of schizophrenia.

Methods: There were analysed available research papers in PubMed and Google Scholar with the key words: schizophrenia, gluten- related disorders, allergy to grain products, celiac disease, microbiota, immune system, exorphins and time span: 1960-2016 .

Conclusions: Existing research results indicate a possible relationship between diet rich in grain products with high gluten content and the occurrence or exacerbation of schizophrenia symptoms. However, further studies are necessary to: 1) identify groups of patients for whom the consumption of cereal products (gluten) is associated with a particular risk of schizophrenia exacerbation, 2) determine the mechanisms relating the consumption of gluten with the mental state of schizophrenic patients, 3) get the possible benefits of implementing gluten-free diet in patients with schizophrenia.

Open access
Review paper. Neuropsychological dimension of schizophrenia - evaluation possibilities and therapeutic implications

Abstract

Introduction: In the last decades, researchers' attention has been focused on cognitive dysfunction in schizophrenia. Numerous studies indicate the existence of neurodegenerative deficits in schizophrenia including, but not limited to, motor functions, learning and memory, executive functions, attention, language, spatial skills and general intelligence.

Method: A review of available literature on the topic of the past two decades, available in the Pubmed, EBSCO, SCOPUS databases has been made using the keywords: schizophrenia, cognition, early intervention.

Results: Cognitive dysfunction is an important feature of the prodromal phase and the first episode of schizophrenia. Researchers have thus proposed to initiate early therapeutic interventions for people with so-called risky mental conditions. The article includes the reference to research on neurocognitive disorders essence in schizophrenia, the definition and review of methods used to identify specific cognitive deficits and issues related to risk of developing psychosis and early therapeutic intervention in high-risk states.

Conclusions: Researchers report the importance of detecting cognitive disorders in the early stages of schizophrenia. This broadens the range of therapeutic interventions and enables early intervention in the increased risk of psychosis.

Open access
Review paper. Terminal lucidity

Abstract

Terminal lucidity is a term used in the medical literature to determine the improvement of mental functioning shortly before death, even among patients with serious and long-term disorders. In 19th century, cases of mind clarity recovery shortly before death, were often recognized by doctors and interpreted as a sign of an impending death. In 20th century, the interest in this phenomenon decreased and then, virtually disappear. In recent years, on the wave of publications concerning near death experiences and related events such as the end of life experiences, papers about the improvement of mental functioning shortly before death, exponentially grew and got a new name, terminal lucidity. In this paper, an overview of the available literature is presented to outline the historical, phenomenological and clinical picture of this phenomenon and its possible implications for medical care and future studies.

Open access