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Open access

Agata Makarewicz, Hanna Karakuła-Juchnowicz and Łukasz Łobejko

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

Łukasz Łobejko, Piotr Machała, Agata Makarewicz and Hanna Karakuła Juchnowicz

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

Olga Nowacka, Henryk Welcz and Hanna Karakuła-Juchnowicz

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

Joanna Róg and Hanna Karakuła-Juchnowicz

Abstract

Despite the increasing offer of antipsychotic drugs, the effectiveness of pharmacotherapy in schizophrenia is still unsatisfactory. Drug resistance, lack of complete remission and the increasing risk of metabolic complications are the reasons why the new forms of therapy in schizophrenia among which unsaturated essential fatty acids omega 3 (EFAs ω-3) affecting the proper functioning of nervous system, are mentioned, are being looked for.

Fatty acids represent 50-60% of the dry weight of the brain and diet is one of the factors that influence the value of each of the fat fractions in the neuron membranes. Patients with schizophrenia tend to have irregular nutritional status concerning essential fatty acids ω-3, which might result from metabolic disorders or irregular consumption of fatty acids.

Apart from being a review of the literature on this subject, this very paper characterizes essential fatty acids ω-3, their metabolism, the most important sources in the diet and the opinions of experts in the field about the recommended intake. It pays attention to the role of essential fatty acids in both the structure and functioning of the central nervous system is, as well as their role in the pathophysiology of schizophrenia, with particular emphasis on the membrane concept by David Horrobin. The assessment of the errors in consumption and metabolism of essential fatty acids are described as well.

The evidence was found both in epidemiological and modeling studies. It supports the participation of EFAs in etiopathogenesis and pathophysiology of schizophrenia. Further research is needed, both observational and interventional, as to the role of essential fatty acids ω-3 in the functioning of the CNS as well as the development and course of schizophrenia.

Open access

Hanna Karakuła-Juchnowicz and Justyna Morylowska-Topolska

Abstract

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.

Open access

Joanna Gałaszkiewicz, Krzysztof Rębisz, Justyna Morylowska-Topolska, Hanna Karakuła-Juchnowicz and Gustaw Kozak

Abstract

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.

Open access

Bernarda Bereza, Justyna Morylowska-Topolska, Anna Urbańska, Diana Szymczuk and Hanna Karakuła-Juchnowicz

Abstract

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).

Open access

Klemens Hłodzik, Ewelina Dziwota, Hanna Karakuła-Juchnowicz and Marcin Olajossy

Abstract

From the ancient times up till now hysteria has been a mysterious and intriguing issue. The authors of this article using mainly the work of Etienne Trillat of the same title, present the most important facts from the history of hysteria. Our work shows how notions of hysteria known initially as uterine dyspnoea, which was the term used by Hippocrates in the seventh tome of his “Collected Works” evolved step by step. At the end of 1st century AD a newcomer to Rome, Soranus of Ephesus, as an experienced anatomist in his “Treatise on midwifery and the diseases of women” moved away from the old ideas of Plato and Hippocrates equating uterus to an animal. How did views on hysteria develop throughout Middle Ages, Renaissance or World Wars period? In this article the authors are trying to determine the nature of hysteria as well as what remained from hysteria in the contemporary times, depicting hysteria’s elusiveness as a disease, many difficulties with its definition and connection with many shocking events in history of mankind. From the ancient sages, through Kramer, Sprenger, Wier, Harvey, Willis, Sydenham, Blackmore up until Mesmer, Freud and many others. From hysteric witches, beings suffering from vapors, through sensitive, fragile and musing women up until mythomaniacs, nymphomaniacs and what we define today as histrionic personality disorder. In the words of French neurologist and a creator of psychiatry – Charcot – hysteria existed forever, everywhere and all-time. Why did it vanish though? Authors of this article will address this problem in the final part, trying to determine the cause.

Open access

Kamil Jonak, Paweł Krukow and Hanna Karakuła-Juchnowicz

Abstract

Background: According to current knowledge, gamma frequency is closely related to the functioning of neural networks underlying the basic activity of the brain and mind. Disorders in mechanisms synchronizing brain activity observed in patients diagnosed with schizophrenia are at the roots of neurocognitive disorders and psychopathological symptoms of the disease. Synchronization mechanisms are also related to the structure and functional effectiveness of the white matter. So far, not many analysis has been conducted concerning changes in the image of high frequency in patients with comorbid schizophrenia and white matter damage. The aim of this research was to present specific features of gamma waves in subjects with different psychiatric diagnoses and condition of brain structure.

Methods: Quantitative analysis of an EEG record registered from a patient diagnosed with schizophrenia and comorbid white matter hyperintensities (SCH+WM), a patient with an identical diagnosis but without structural brain changes present in the MRI (SCH-WM) of a healthy control (HC). The range of gamma waves has been obtained by using analogue filters. In order to obtain precise analysis, gamma frequencies have been divided into three bands: 30-50Hz, 50-70Hz, 70-100Hz. Matching Pursuit algorithm has been used for signal analysis enabling assessing the changes in signal energy. Synchronization effectiveness of particular areas of the brain was measured with the aid of coherence value for selected pairs of electrodes.

Results: The electrophysiological signals recorded for the SCH+WM patient showed the highest signal energy level identified for all the analyzed bands compared to the results obtained for the same pairs of electrodes of the other subjects. Coherence results revealed hipercompensation for the SCH+WM patient and her level differed substantially compared to the results of the other subjects.

Conclusions: The coexistence of schizophrenia with white matter damage can significantly disturb parameters of neural activity with high frequencies. The paper discusses possible explanations for the obtained results.

Open access

Małgorzata Futyma-Jędrzejewska, Ewelina Drzał and Hanna Karakuła-Juchnowicz

Summary

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.