Biologia w oczach psychiatry, czyli czego psychiatra spodziewa się po biologii 527
Psychiatrists looking at biology. What are they expecting? 527
Psychiatry defines itself as a medical discipline using achievements of biology and other sciences concerned with human kind. Its methodology is borrowed from them. Biological methodology seems to be more attractive taking onto account contemporary standards of science. But, answers to questions formulated by psychiatry appear to be not satisfactory due to reduction both biological and humanistic methodology requires. Nevertheless new achievements in both approaches open new horizons for research. The main difficulty for this direction is a solid wall erected between them in a course of psychiatry development.
Andrzej Kiejna, Joanna Rymaszewska, Monika Kantorska-Janiec, Wojciech Tokarski
Epidemiologia zaburzeń obsesyjno-kompulsywnych 539
Epidemiology of obsessive-compulsive disorder 539
In the article the problems of prevalence of obsessive-compulsive disorder (OCD), comorbidity with other mental disorders and the most commonly used diagnostic instruments were presented. Epidemiological data indicate OCD as the fourth most common mental disorder, which appears as frequent as asthma or diabetes. In an international study from 1994 the year's prevalence of OCD was from 1,1% to 1,8%. In each country obsessions and compulsions appear with different intensity, what can testify for certain cultural conditionings of disorder. Men suffer from OCD equally often as women, however both first symptoms and full symptom disorder appear several years earlier in men than in women. The prevalence of OCD among children is from 2% to 4%. At least half of the patients suffer from OCD also in maturity. OCD should be differentiated from generalized anxiety disorderce, panic disorder, phobias, anancastic personality and hypochondria.
Zbigniew Srebro, Bogdan Wiliński, Konrad Dziobek
Histopatologia podwzgórza i tylnego płata przysadki w przypadku śmierci samobójczej 549
Histopathology of the hypothalamus and the neural lobe of hypophysis in suicide victims 549
Histologic studies of the hypothalamus and neurohypophysis revealed that in young (17-35 y. o.) suicide victims, there are degenetative changes in the supraoptic and paraventricular nuclei and partial destruction by inflammation of the neurohypophysis. Simultaneously foci of micromalaic and the gatuering of azurophilic material in neuronal perikarya around the cerebral blood ressel and the laptomeninges. The degenerated neurones contain great vaculoes, often filled with lipofuscin. The probable pathogenic mechanism of the observed changes is discussed with its influence on mood-lowering leading to suicide.
Paweł Holas, Maria Radziwoń, Mariusz Wójtowicz
Niepłodność a zaburzenia psychiczne 557
Infertility and mental disorders 557
Infertility is recognised as an important clinical and social issue, because of the common occurrence and therapeutical difficulties. It is suggested by some researchers that psychopathological factors might play an important pathogenic role in its development, some others claim that psychopathology is rather secondary to the infertility. Although a growing number of articles related to this issue are observed, we are far from the simple and commonly accepted model of relationship between psychoemotional factors and infertility. In this article, basing on the literature, a multidimensional problem of relationship between infertility and psychopathological factors is discussed; both pathogenic (psychogenic model) and secondary to the illness model are presented.
Paweł Potocki, Kamil Hozyasz
Niektóre zaburzenia psychiczne współistniejące z chorobą trzewną 567
Psychiatric symptoms and coeliac disease 567
Psychiatric symptoms and psychological behavioral pathologies are common in patients with untreated coeliac disease. There are several case reports of coexistance of coeliac sprue and depression, schizophrenia and anxiety. Views on association between coeliac disease and psychiatric disturbances and results of the most important studies are discussed. Biological background is referred. Malabsorption and deficiency of aminoacids and vitamins implicate reduction of synthesis of neurotransmitters in the central nervous system. Psychiatric symptoms could also be linked to immunological disregulation in coeliac patients. Psychological pathologies do appear in treated and untreated coeliacs, the need of psychological support is stressed. Coeliac disease should be taken into consideration in patients with psychiatric disorders, particularly if they are not responsive to psychopharmacological therapy, because withdrawal of gluten from the diet usually results in disappearance of symptoms. In recent years, an increased incidence of subclinical/silent coeliac disease has been reported. Psychiatric symptoms and psychological behavioral pathologies could be the only clinical manifestation of coeliac disease, but the epidemiological aspects need further investigation.
Maria Żerańska, Celina Tomaszewicz-Libudzic, Gabriela Jagielska, Jadwiga Komender
Powikłania chirurgiczne w trakcie szpitalnego leczenia jadłowstrętu psychicznego - przegląd piśmiennictwa i omówienie trzech przypadków 579
The surgical complications occurring during hospitalisation of patients with anorexia nervosa - literature review and discussion of three cases 579
Anorexia nervosa (a.n.) is a mental disorder connected with the high mortality coming up to 18%. The death causes are suicide and somatic complications resulting from cachexy, laxatives and diuretics abuse, which occurs in some patients and from vomiting provocation. The digestive tract complications are considered to be the death causes in a.n, as well. Among the surgical complications, which usually occur in the initial period of the intensive nutrition the most serious and frequent ones are oesophageal rupture in the course of vomiting provocation (Boerhaave's syndrome) and the syndrome of compression of the horizontal part of the duodenum, by the mesentery (superior mesenteric artery syndrome) leading to the gastrectasia and possible gastric necrosis and perforation. In this paper the review of the current literature concerning the digestive tract complications in a.n. has been made. Also, the courses of the diseases and the complications requiring surgical intervention in 3 patients treated between 1998 and 2000 in the Department of Child Psychiatry and the Department of Cardiosurgery of the Medical University of Warsaw have been discussed. The patients developed segmental enteritis, gastrectasia caused by the superior mesenteric artery syndrome and small intestine strangulation. The early surgical intervention in the latter case and the proper maintenance treatment in two other ones allowed to avoid more serious complications. The authors postulate profound analysis of the abdominal complaints from the point if view of surgical complications in anorectic patients in the initial period of their hospital treatment and consideration of the complete parenteral hyperalimentation in the extremely debilitated to avoid life threatening digestive tract complications.
Wiesława Karwowska-Polecka, Dorota Halicka, Piotr Jakubów, Jan J. Braszko
Wpływ enalaprilu i kaptoprilu na procesy emocjonalne u pacjentów z nadciśnieniem tętniczym 591
The effect of enalapril and captopril on emotional processes in hypertensive patients 591
This study was aimed at the estimation of influence of enalapril and captopril on emotional processes in hypertensive patients. Hypertensive subjects evaluated before introducing drug treatment and normotensive persons comprised the control groups. All groups were examined with the psychological methods (BDI, HSC, Raven's Matric test). In BDI, there were no significant differences between the groups in the total score and particular factors as well. In HSC, there were significant differences in the total ratings between untreated hypertensive subjects and the normotensive group (p<0,05). The depression / anxiety profile was the main contributing factor being itself significantly different (p<0,05) in those groups. Enalapril and captopril reversed the negative behavioural changes caused by hypertension only moderately with no statistical significance. There were no alterations in intellectual abilities tested by the Raven's Matric test in any group examined. In conclusion, significant negative emotional effects of high blood pressure are only partly reversed by the antihypertensive doses of enalapril and captopril.
Barbara Starczewska, Katarzyna Mielech, Ewa Kleszczewska
Wybrane metody oznaczania fluoksetyny i fluwoksaminy 603
Some methods of determination of fluoxetine and fluvoxamine 603
Two selective serotonin reuptake inhibitors (SSRIs) have been introduced: fluxetine and fluvoxamine. The literature review shows most methods allow quantitative determination of SSRIs pharmaceutical preparations and plasma, in the lower ng/ml range and that they are, therefore, suitable for therapeutic drug monitoring purposes of this category of drugs. Most procedures are based on investigation of this drugs by spectrophotometric, electrochemical and chromatographic procedures with detection by various detectors.
Jan Jaracz, Janusz Rybakowski
Badania metabolizmu i przepływu mózgowego krwi w depresji za pomocą pozytronowej tomografii emisyjnej (PET) 617
Studies of cerebral blood flow and metabolism in depression using positron emission tomography (PET) 617
Investigations of cerebral blood flow and metabolism provide interesting data concerning specific brain regions involved in depression. The objective of this paper is to present to Polish readers results of studies using PET in patients with depression. Provocation of transient sadness in healthy subjects during clinical experiments was associated with increase of metabolism in limbic and paralimbic regions and decreased metabolism in dorsolateral prefrontal cortex. During depression metabolism of dorsolateral prefrontal cortex (DLPF) was decreased but metabolism of subgenual cingulate was increased. After recovery, normalisation of metabolism, that is increase in DLPF was observed in patients treated with antidepressive drugs as well as psychoterapy. These data point to the role of frontal-thalamic-limbic circuits in regulation of emotions and pathogenesis of depression.