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Aktualne problemy psychiatrycznej opieki zdrowotnej w Polsce (2003)  7
Current problems in psychiatric health care in Poland (2003)  7
Stanisław Pużyński
The paper is a presentation of the most important and actual psychiatric health care problems in Poland: the financial situation of hospitals, the risks faced by the out-patient psychiatric care, maintaining the legal issues of the psychiatric patients, the situation of forensic psychiatry and legal-psychiatric expertise, post-graduate training, availability of psychotropic drugs. Attention is paid to the importance of giving the programme of psychiatric health protection a status of evident value and that this programme should become a national programme.

Porównanie rozpowszechnienia depresji wśród 17-letniej młodzieży krakowskich szkół średnich w latach 1984 i 2001  13
Point prevalence of depression in the Kraków population of 17 year old students in 1984 and 2001  13
Renata Modrzejewska, Jacek Bomba
Results of scarce epidemiological studies on depression in adolescents are diverse and dependent of survey methodology as well as on the theoretical approach of researchers. Those studies where the methods are comparable show that depression prevalence depends on the macrosocial situation and the adolescence stage. Aim: The study aimed to assess changes in depression prevalence in mid-adolescents between 1984 and 2001. A presumption was made that the social situation in Poland had changed in the last 17 years. Method: In 2001 a representative sample of school attending 17 y.o. adolescents was screened with KID-IO"C1". The results were compared with those of a similar survey, using the same method, carried out  in 1984. Results: Point prevalence indexes appeared to be similar as well as higher for girls in comparison with boys. However, dependence of depression prevalence and the type of the senior school has changed. In 1984 it was higher in senior schools preparing for university studies, while in 2001 - in those which train in a skill. Conclusions: Earlier conceptualisations of adolescent depression as connected with social conditions making ways to adulthood difficult (e.g. unemployment) as well as high indexes of depression prevalence in adolescents living in regions with higher unemployment rates than in Kraków, allow for an interpretation of the findings as result of macrosocial changes. Other hypotheses e.g. influence of the adolescence timing and course require a longitudinal prospective study.

Krzywdzenie dzieci jako czynnik ryzyka zachowań samobójczych - przegląd literatury  29
Child maltreatment as a risk factor for suicidal behaviour - a literature reviev  29
Agata Brzozowska
Based on a review of studies done in the last 20 years the author presents recent knowledge on the possible relationship between child maltreatment and suicidal behaviour in childhood, adolescence and adulthood.

Depresyjność młodzieży z upośledzeniem umysłowym stopnia lekkiego w świetle badań empirycznych  37
Depressiveness in adolescents with mild retardation. A report of the research done  37
Ewa Jackowska, Kamilla Dęga-Rudewicz
The clinicians agree to a point that mental retardation is a risk factor for the development of a mental disorder and that all kinds mental disorders are present in this population. Aim: The aim of this research was to find answers to two questions: 1. Was the intensity of depressiveness higher in adolescents with mild mind retardation in comparison to adolescents with normal IQ? 2. Were variables like gender, family situation and a religious attitude associated with the rate of depressiveness? Method: The subjects were 160 adolescents (80 with mild mind retardation and 80 with normal IQ). The Children's Depression Inventory by M. Kovacs was used. Results: The results pointed out that an intensity of depressiveness was significantly higher in adolescents with mental retardation. In the whole population girls had a higher rate of depressiveness in comparison to boys and in the whole population the family situation influenced the results in CDI. In adolescents with mental retardation a religious attitude was not significantly associated with depressiveness. In adolescents with normal IQ this dependence was found.

Program profilaktyki zaburzeń odżywiania się - badania pilotażowe  51
Eating disorders prevention programme - pilot study  51
Cezary Żechowski, Irena Namysłowska, Andrzej Korolczuk, Anna Siewierska, Antoni Jakubczyk, Anna Bażyńska, Zofia Bronowska
Aim: Recent research has suggested that school-based programmes of prevention of eating disorders obtained ambiguons results. The aim of our work was to establish the efficacy of the eating disorders prevention programme for schoolgirls of secondary schools. Method: Subjects in the experimental groups received 8 sessions of practice with various tasks, while the control group did not participate in sessions of psychoeducation. Overall, we examined 109 adolescents participating in sessions and 117 adolescents in the control group. Participants were examined at the beginning of the programme, after the operation and 6 months later. Assessment was made with EDI, EAT-26. Results: Assessment before and after the study phase showed that participants in the experimental groups had not made significantly more improvement than the control group. It was also shown that in the two subgroups (girls form technical college and girls form college) there were significant differences in the pre-test, post-test and follow-up results. Conclusions: Similarities that were obtained through the research suggest the necessity of examining other possible relationships between chosen variables. Analysis of participants' feedback information emphasises that the changes the programme brought appeared feasibly in the social functioning area (with peers, parents relations). It is not excluded that it is too late for eating disorder prophylactics in the phase of personal development, as some researchers argue. Differences in results between schoolgirls from college and from technical college suggest some differences in risk and protective factors. It seems important to verify this.

Profilaktyka zaburzeń odżywiania się u dzieci i młodzieży. Część I. Założenia ogólne i czynniki ryzyka  65
Prevention of eating disorders in children and adolescents. Part I. General considerations and risk factors  65
Cezary Żechowski, Irena Namysłowska, Andrzej Korolczuk, Anna Siewierska, Antoni Jakubczyk, Anna Bażyńska, Zofia Bronowska
The paper presents general considerartions concerned with using prevention programmes mental disorders in children and adolescents. In this context the authors try to describe current views on creating prevention programmes of eating disorders. These programmes require clearly defined, potentially modificable risk factors and protective factors.

Profilaktyka zaburzeń odżywiania się u dzieci i młodzieży. Część II. Programy profilaktyczne i ich efektywność  75
Prevention of eating disorders in children and adolescents. Part II. Prevention programmes and their effectiveness  75
Cezary Żechowski, Irena Namysłowska, Andrzej Korolczuk, Anna Siewierska, Antoni Jakubczyk, Katarzyna Bażyńska, Zofia Bronowska
This paper presents various models of child and adolescent prevention programmes of eating disorders with the emphasis on the efficiency of these models. On the ground of the available literature, the authors present the results of these methods. It seems that in every prevention programme risk and protective factors, which are connected with the given intervention should be precisely defined. Therefore it is absolutely necessary that the programmes should be clear with better inner coherence which will consequently result in better efficiency.

Ocena temperamentu i charakteru w bulimii  85
Evaluation of temperament and personality in bulimia nervosa  85
Agnieszka Słopień, Filip Rybakowski, Andrzej Rajewski
Previous studies revealed the possibility of abnormal personality development role in the etiology of eating disorders. It was found that a diagnosis of personality disorders, mostly borderline personality and/or histrionic personality can be made in about 44-46% of bulimic patients. The inconsistencies in identifying personality types using categorical assessment approaches have encouraged a conceptualization of the personality from a dimensional perspective. It was revealed that the Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventory (TCI) are useful in studying patients with eating disorders. Aim: The aim of the study was personality dimensions and depression symptoms assessment in bulimic patients. Method: We studied 36 women with purging type bulimia according to DSM-IV and ICD 10 criteria. The mean age of the studied women was 19,7 years. The control group were 44 healthy women: university and last year high school students (mean age 20,4). We assessed body height, body mass and Body Mass Index (BMI). Severity of depression symptoms was assessed with the use of Beck Depression Index (BDI), and personality dimensions with the use of (TCI). Conclusions: Women from the study group had higher harm avoidance (HA) scores, which shows that bulimic patients are shy, fearful, doubtful, tend to be inhibited in most social situations. Mood disorders present in the studied women influenced HA scores. The results of the study revealed lower possibilities of self-directness in bulimic patients in comparison with the control group. Negative correlation between BDI and SD scores, shows that a decrease of depression severity may lead to an increase of self-esteem, independence and effectiveness of bulimic patients.

Rola oreksyn w regulacji łaknienia  95
The role of orexines in appetite regulation  95
Małgorzata Janas-Kozik, Irena Krupka-Matuszczyk
Anorexia nervosa (AN) belongs to the group of eating disorders. Many different factors are taken into consideration as far as the origin of this disorder is concerned, among them: individual factors (genetic, biological), personality factors, sociocultural factors, family factors. Among the biological factors, the role of neuropeptides is considered. Last few years (1998) have resulted in the discovery of two neuropeptides - orexines OXA and OXB which - apart from being regarded as appetite stimulants - are also supposed to be responsible for the energy metabolism of an organism. Orexines, a.k.a. hypocretins, arise from the disintegration of their common precursor - the polypeptide: preorexine. Their name derives from the Greek word for appetite: orexis. The orexine A (OXA) is a 33 amino acid peptide consisting of 2 chains connected by the Cys 6 - Cys 12 and Cys 7 - Cys 14 bridges. It is a potential food intake and gastric juice secretion stimulant. The connecting bridges in OXA play a crucial role in the receptor OXA-1 activation. The orexine B (OXB) is a 28 amino acid peptide with no connecting bridges between the chains. It mainly plays a role in the energy metabolism of an organism and does not influence the secretion of gastric juice. The OXR-1 receptor is a selective receptor for OXA, while the OXR-2 receptor is not privileged for any of the two orexines - both of them can connect to it. Orexines are produced by a small number of hypothalamus neurons, mainly in the lateral hypothalamus (LHA), but also the posterior hypothalamus - the so-called "eating center". Orexines control: the wakefulness-sleep state, food intake (OXA over 100 times stronger than OXB) and the neuroendocrine system. Their discovery may help in understanding the mechanism of anorexia nervosa.

Popaciorkowcowe autoimmunologiczne zaburzenia neuropsychiatryczne u dzieci (PANDAS). Opis 2 przypadków  105
Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). A report of 2 cases  105
Anita Bryńska, Tomasz Wolańczyk
Aim: To critically review the past years of research on paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections in children and adolescents. Method: Literature on PANDAS published from 1995 onward was systematically reviewed. The review focuses on definition and diagnostic consideration aetiological and therapeutical issues. To illustrate the clinical characteristic of PANDAS authors present two cases of children with a severe course of obsessive-compulsive disorder and Tourette's syndrome. Results: Post-streptococcal autoimmunity has been postulated as an aetiologic factor in the development of childhood-onset obsessive-compulsive disorder, tic disorders including Tourette's disorder. This hypothesis arose from a series of clinical observations including the documentation of obsessive-compulsive symptoms of children affected by Sydenham's chorea, a variant of rheumatic fever characterised by neurological dysfunction and also by concomitant investigations of childhood-onset OCD and Tourette's syndrome. Conclusion: Results of these studies led to the identification of children whose clinical course is characterised by abrupt and dramatic symptom exacerbations which are temporally related to group A beta-hemolytic streptococcal infections. The indentification of such a subgroup will allow for testing of the model of pathogenesis as well as development of novel treatment and prevention strategies. Future research are needed to explore the nature of PANDAS and their relationship with diffrerent psychiatric disorders in children and adolescents.

Kompleksowe leczenie uzależnienia od nikotyny u osób z chorobami układu krążenia - doświadczenia własne  125
Comprehensive treatment of nicotine dependence in patients with cardiovascular diseases - personal experience  125
Barbara Bętkowska-Korpała, Piotr Jankowski, Kalina Kawecka-Jaszcz
Aim: To evaluate psychological factors influencing the effectiveness of smoking cessation using bupropion and psychological intervention in patients with cardiovascular diseases. Method: A group of 59 patients (26M, 33F; mean age 44.2±10.2 years) identified among smokers admitted to the 1st Cardiac Department between 2000 and 2001 with hypertension (n=46) and coronary artery disease (n=13). Entry criteria to participate in a 7-week programme included nicotine dependence and no contraindications to bupropion. Pharmacotherapy was used in parallel with psychological interventions based upon cognitive and behavioural methods. The type and degree of nicotine dependence was measured using Fragerstrom tolerance questionnaire whereas motivation was scored according to the Schneider questionnaire. The severity of depression symptoms was measured by the Beck Depression Inventory. Results: At 2 months and at one year after discontinuation of treatment 74.6% and 40% of the patients respectively maintained abstinence from smoking. Among patients with good therapeutic effects the level of motivation to quit smoking was higher (p<0.001 vs. p<0.007). The level of motivation was correlated with the severity of depression symptoms (p<0.005) but not with nicotine dependence, age and sex. Motivation to stop smoking is related to the depression symptoms (beta= -0.32; p=-.01). Conclusion: Patients with initially higher motivation benefit more from treatment of nicotine dependence. The level of motivation is adversely affected by the depressive mode of functioning (negative cognitive patterns, learned helplessness). It appears necessary to take into account the assessment of depressive disorders when planning treatment of nicotine dependence in patients with cardiovascular diseases.


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