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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
Can factitious disorder reach delusional level? A case study

Abstract

The paper describes a patient, who has been consulted and hospitalized multiple times, due to dermatological lesions on his face. We will present his medical history and describe circumstances leading to the final diagnosis of factitious disorder. In the theoretical part we will try to answer the question, whether the extreme severity of the factitious disorders can, at some point, reach the level of delusions.

Open access
Cognitive decline affects diabetic women

Abstract

Introduction: DM provokes peripheral complications and changes in central nervous system. Central changes in the course of diabetes mellitus (DM) include changes in brain tissue structure, electrophysiological abnormalities but also disturbances in neurotransmission leading to cognitive decline.

Aim of the study: The aim of our study was to asses cognitive functioning of patients suffering from DM1 for at least 5 years but without any diagnosed complications.

Materials and methods: Cognitive functions were assessed in 59 patients (35 men) with Trail Making Test A (TMT A) and B (TMT B), Maze Test (MT), Stroop Test (SCWT) and Rey Auditory Verbal Learning Test (RAVLT). Mental disorders were excluded with Beck’s Depression Inventory (BT), Mini Mental State Examination (MMSE) and psychiatric examination.

Results: We stated that women, compared with men, presented worsening of executive functions, speed and motor control. Cognitive decline depended on number of episodes of at least moderate hypoglycemia and duration of disease. HbA1c below 8% resulted in better memory, speed and motor control. Cognitive decline was more escalated in the patients with atherogenic lipid profile.

Conclusions: It seems that even apparent lack of complications is not unambiguous with lack of cognitive decline and women seem to be more susceptible. DM1 affects young individuals, whose cognitive functions are in the course of the development, so it is important to find the underlying mechanisms and the areas of disturbed cognitive functioning and further investigations are needed.

Open access
Coping strategies in individuals at risk and not at risk of mobile phone addiction

Abstract

The aim of the present study was to provide an answer to the question of whether, and what, differences in stress coping strategies could be found between university students at risk and those not at risk of mobile phone addiction. The study included 408 students aged 19 to 28 years. The following instruments were used: a sociodemographic questionnaire, the Mobile Phone Addiction Assessment Questionnaire (in Polish, Kwestionariusz do Badania Uzależnienia od Telefonu Komórkowego, KBUTK) by Pawłowska and Potembska, and the Coping with Stress Questionnaire (SVF) by Janke, Erdmann, and Boucsein, translated into Polish by Januszewska. The results of the study showed that individuals at risk of mobile phone addiction were more likely to cope with stress by seeking substitute gratification, reacting with resignation, passivity, dejection and hopelessness, blaming themselves, pitying themselves and looking for support. They also tended to ruminate over their suffering, withdraw from social interactions, react with aggression and/or take to drinking.

Open access
Delirium in the course of dependence upon gamma-butyrolactone (GBL) - a case report

Abstract

Gamma-butyrolactone (GBL) is an organic chemical compound of the lactones group, undergoing biotransformation into gamma-hydroxybutyrate after the intake (GHB). Because of the easy access, low price and fast psychotropic effect, GBL is becoming increasingly popular substance having intoxicating effect. Taking of GBL causes dose-dependent euphoric, sedative, hypnotic effects. Its use can quickly lead to physical dependence with severe course of withdrawal syndromes. Withdrawal symptoms resemble those occurring in the course of addiction to alcohol or benzodiazepines. In some patients, delirium develops during substance withdrawal. There are described severe, life-threatening complications in the course of delirium in GBL-dependent patients. The management of withdrawal syndromes and delirium mainly involves administration of benzodiazepines. In this paper, we present a case of delirium in 24-year-old man addicted to GBL hospitalized in a psychiatric ward. Delirium in this patient went without complications and was successfully managed with diazepam and lorazepam.

Open access
Dental anxiety – causes, characteristics and occurrence in the Polish population

Abstract

The present paper discusses the problem of dental anxiety. Based on the scientific review of Polish literature of the past 10 years, there are discussed causes of dental anxiety in different age groups and the methods of assessing the level of anxiety – physiological, behavioral, projection and psychological. Dental anxiety affects the patients’ attitude towards their own health, confidence in dentist, the frequency of reporting to the dental prophylaxis and treatment, which translates into oral health. It is also a major impediment to everyday clinical practice of a dentist.

Open access
Genetic and environmental factors in the etiology of schizophrenia - towards mainstreaming

Abstract

The prevalence of schizophrenia in a population is about 1%. Many efforts are constantly made to find the cause of this mental illness. Authors of this article provide groups of factors influencing the development of the disease. Among these factors, genetics seems to be an interesting and reasonable trend of exploration. GWAS research studies allow not only determining the point mutations in the genome, but also try to give an answer to the question about the biological mechanisms of disease. A microRNA MIR137, which is involved in neurogenesis and maturation of neurons may be an example. However, the genetic component may not always be sufficient to trigger symptoms. Definitely, a large group of environmental factors has an important role. Schizophrenia is a complex disease in which many genes interact with the environment. This article is a presentation of genes and the impact of various external environmental factors, leading to the onset of schizophrenia. Interrelationship between polygenic determinant of disease and the impact of both environmental and social factors in future will certainly become the field of interest for research concerning the etiology and course of schizophrenia-spectrum disorders.

Open access
Omega-3 fatty acids in schizophrenia Part II: Clinical applications

Abstract

Ω-3 unsaturated fatty acids are compounds belonging to the group of essential fatty acids (EFAs). The history of the discovery of EFAs dates back to the 1930s of the twentieth century, however, growing interest in ω-3 EFAs in the context of mental health has been observed since the year 2000. In view of their multidirectional action, these compounds are a promising form of adjunctive therapy of many illnesses, including psychiatric disorders. The present article aims to review the literature on the clinical applicability of ω-3 EFAs in treating schizophrenia. We present the results of preclinical studies in this area and the mechanisms of ω-3 EFAs action discussed by the authors. The randomized controlled trials (RCTs) evaluating the possibility of using ω-3 EFAs in schizophrenia are characterized in detail. The results of the tests are not clear, which may result from the methodological diversity of interventions made. Ω-3 EFAs seem to be a promising form of adjunctive therapy of schizophrenia. Further research is needed, which will allow for defining groups of patients in which intervention will bring the expected results.

Open access
The schizo-obsessive disorder: a case report

Abstract

Purpose: A case of schizophrenia with coexisting obsessive-compulsive symptoms is reported.

Case: The frequency of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) occurrence among patients suffering from schizophrenia is considerably higher in comparison to general population. The results of some studies show that schizo-obsessive disorder is characterized by higher intensity of negative and depressive symptoms. Patients with comorbid schizophrenia and obsessive-compulsive disorder show greater level of social dysfunction and they exhibit suicidal behaviours more often than patients diagnosed with schizophrenia. We present a 33-year-old female with obsessive-compulsive symptoms with onset in her early teens with no satisfactory response to treatment, in spite of her good intellect and insight into illness and cooperation.

Comment: There is some evidence suggesting that patients with “schizo-obsessive disorder” have a worse prognosis compared to the group of patients suffering only from schizophrenia, but the effect of OCD on schizophrenia symptom profile is unclear.

Open access
Silent angels the genetic and clinical aspects of Rett syndrome

Abstract

Rett syndrome is a neurodevelopmental genetic disorder and, because of some behavioral characteristics, individuals affected by the disease are known as silent angels. Girls with Rett syndrome perform stereotyped movements, they have learning difficulties, their reaction time is prolonged, and they seem alienated in the environment. These children require constant pediatric, neurological and orthopedic care. In the treatment of Rett syndrome physical therapy, music therapy, hydrotherapy, hippotherapy, behavioral methods, speech therapy and diet, are also used. In turn, psychological therapy of the syndrome is based on the sensory integration method, using two or more senses simultaneously. In 80% of cases, the syndrome is related to mutations of the MECP2 gene, located on chromosome X. The pathogenesis of Rett syndrome is caused by the occurrence of a non-functional MeCP2 protein, which is a transcription factor of many genes, i.e. Bdnf, mef2c, Sgk1, Uqcrc1. Abnormal expression of these genes reveals a characteristic disease phenotype. Clinical symptoms relate mainly to the nervous, respiratory, skeletal and gastrointestinal systems. Currently causal treatment is not possible. However, researchers are developing methods by which, perhaps in the near future, it will be possible to eliminate the mutations in the MECP2 gene, and this will give a chance to the patient for normal functioning.

The paper presents the etiology and pathogenesis of the disease, genetic, clinical, pharmacological aspects and other forms of Rett syndrome treatment.

Open access