Pacan P. Kantorska-Janiec M. Kiejna A. Katedry i Kliniki Psychiatrii AM we Wroclawiu. [Trichotillomania].[15]Psychiatria Polska. 32(6):799-805, 1998. Trichotillomania is the recurrent pulling out of one's own hair, which results in noticeable hair loss, classified in DSM IV and ICD 10 as an impulse control disorder. Trichotillomania can occur as an isolated symptom or may be associated with affective disorders, schizophrenia, substance abuse, borderline personality, obsessive-compulsive disorder. Its onset is usually in childhood and females are more affected than males. [15]

Borodulin-Nadzieja L. Janocha A. Salomon E. Pilecki W. Sobieszczanska M. Katedry i Zakladu Fizjologii AM we Wroclawiu. [Exercise test in the neurotic patients].Psychiatria Polska. 32(6):789-97, 1998. While testing neurotic patients it was noted that almost all of their complaints concerned physical weakness, easy tiredness, chest pain, heart beating and palpitation. In order to evaluate objectively their physical efficiency, the patients were subjected to exercise test on a treadmill, their ECG, HR and blood pressure being monitored. The exercise test was carried out twice, i.e. before and after 3-month psychotherapy. The average physical efficiency coefficient before treatment was significantly lower than after the treatment, but repolarization disorders were significantly higher before the treatment. ECG analysis proved non-specific repolarization changes induced by excitability of sympathetic system. 8 patients showed changes in ST-T before the treatment and 4 persons after it. Another kind of changes (that appeared in 14 cases before the treatment) were extrasystoles mainly supraventricular. After psychotherapy they were noted only in 1 case. The analysis of HR and blood pressure proved a significantly higher HR and lower blood pressure before the treatment. The obtained results may become an argument supporting the functional character of the changes mentioned.

Landowski J. Lysiak-Szydlowska W. Katedry i I Kliniki Chorob Psychicznych AM w Gdansku. [Low serum dopamine -- beta-hydroxylase activity in patients with panicdisorder].Source Psychiatria Polska. 32(6):781-8, 1998. Serum dopamine-beta-hydroxylase (DBH) activity was determined in the following diagnostic groups of patients (DSM-III-R criteria): panic disorder (n = 16), generalized anxiety disorder (n = 10), hypochondrical disorder (n = 16). Twenty healthy persons constituted the control group. Enzyme activity in the group of panic disorder (9.3 +/- 12.5 IU/l) was statistically significantly lower as compared to the groups: control (20.1 +/- 8.1 IU/l), generalized anxiety disorder (17.6 +/- 13.5 IU/l) and hypochondrical disorder (13.6 +/- 10.6 IU/l). Possible relationship between low serum DBH activity and panic disorder is not clear.

Malyszczak K. Kiejna A. Grzesiak M. Katedry i Kliniki Psychiatrii AM we Wroclawiu. [Factorial structure of Hamilton Anxiety Rating Scale].Psychiatria Polska. 32(6):771-9, 1998. Among subjects suffering from anxiety disorders, mixed anxiety-depression and dysthymia (DSM III R), severity of disease has been assessed in six centres, using the Hamilton Anxiety Rating Scale. Results from two centres have been rejected because of major difference in comparison with the other centres, in which there were no statistically relevant difference. Resting on 90 subjects' rates, the analysis of factorial structure and factor reliability has been conducted with the principal components method and varimax rotation. Four factors have been extracted: somatization, psychic anxiety, somatic anxiety and psychic depression. The rotated factors accounted from 13% to 19% of the total variance (all four--60%). Unlike many previous investigators, we found that psychic factors of depression and anxiety are clearly separated, what must be due to heterogeneity of the group. The factorial structure in case of a homogenic group could be reduced to two factors: somatization and psychic anxiety or depression--depending on cases selection. Results explain the ability of Hamilton Anxiety Rating Scale to assess severity of anxiety as well as depressive state, and point out that the scale is not diagnostic.

Komender J. Popielarska A. Tomaszewicz-Libudzic C. Jagielska G. Brzozowska A. Wolaanczyk T. Kliniki Psychiatrii Wieku Rozwojowego AM w Warszawie. [Follow-up study of adolescents with anorexia nervosa].Psychiatria Polska. 32(6):759-69, 1998. Analysis of the results of treatment of 132 patients hospitalized because of anorexia nervosa is presented. Average time of observation after hospitalization was 7,9/12 years. Mean age when the disease started was 13,7/12 years, when the analysis was performed--22 years. Catamnestic data were received directly from patients--46, from family members--25, from health service--3.18 sent answers by post, 40 neither contacted us nor answered to questionnaire. Analysis was founded on Morgan, Russel criteria, modified by Ratnasuriya. It showed that good results of treatment were received in 76% of all analyzed patients, in 11% they were intermediate, and poor in 12%. Two persons (2%) died. The social functioning of patients was found to be the best. More than half of the examined group had depressive and/or anxiety disorders. These disorders are significant in all the patients who remain chronically ill.

Antkowiak R. Rajewski A. Kliniki Psychiatrii Dzieci i Mlodziezy AM w Poznaniu. [Administration of moclobemide++ in children with attention deficithyperactivity disorder].Psychiatria Polska. 32(6):751-7, 1998. ADHD is a frequent disorder that occurs among approximately 5-10% of school children. Treating this syndrome, pharmacotherapy with different forms of psychotherapy are applied. In many European countries and in the USA the primary medicines are the psychostymulative ones; in Poland, however, they are not registered in the Pharmacopeia. Thus, what seems to be important is seeking other drugs that can be useful in ADHD treatment. In the Child and Adolescent Psychiatry Clinic in Poznan, a group of 15 children (13 boys, 2 girls) at the age of 6-13 were recognised to have ADHD; they were administered moclobemid (Aurorix) in dose of 75-225 mg/d throughout the period of 8 weeks. The medicine efficacy was being estimated with psychometric, questionnaire, and experimental methods. After 4 weeks, the drug ceased to be administered to two children due to complete lack of improvement or deterioration in functioning. It was observed that in the rest of the children their attention and hyperactivity functioning improved significantly. It is essential that the medicine was well tolerated and undesirable symptoms occurred rarely.

Jackowska E. Katedry Psychologii Uniwersytetu Szczecinskiego. [Sources of resistance and its overcoming in group therapy of adolescentswith conduct disorder].Psychiatria Polska. 32(6):739-49, 1998. The author presents her experience on recognition of sources of resistance in group therapy of adolescents with conduct disorder and effective ways of its overcoming. Three categories of resistance factors have been distinguished: factors connected with a therapist/his way of understanding patients/,factors connected with psychological features associated with CD and factors connected with structure of therapy group. In accordance with the foregoing categories the author describes effective ways of reducing the resistance. In relation to factors connected with a therapist the author shows how it is possible to reinforce the patient's consciousness and motivation to therapy. The role of direct and parallel communication is emphasised. In relation to factors connected with features associated with CD, correspondence between intellectual abilities of young patients and organisation of a therapeutic session is discussed.

Brynska A. Wolanczyk T. Kliniki Psychiatrii Wieku Rozwojowego AM w Warszawie. [Psychotherapeutic methods in the treatment of obsessive-compulsive disorder(OCD) in children and adolescents].[54]Psychiatria Polska. 32(6):723-38, 1998. The psychiatric and psychological literature was systematically reviewed for studies applying psychotherapeutic principles to young persons with obsessive-compulsive disorder. Abundant clinical and empirical evidence suggest that cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, is an effective treatment for OCD in children and adolescents. Thirty-two investigations, most of them single case reports, showed some benefit for such kind of interventions. Graded exposure and response prevention form the core of treatment; anxiety management training and specific family interventions may play an adjunctive role. [54]

Kucharska-Pietura K. Grzywa A. Debowska G. Katedra i Klinika Psychiatrii AM w Lublinie. [Attitudes of Polish and British high school students towards the mentallyill and their beliefs in the causes of mental illness].Psychiatria Polska. 32(6):711-22, 1998. The aim of this work was to examine the attitudes of Polish and British adolescents towards the mentally ill and their beliefs about the causes of mental illness. Using a questionnaire constructed for the purpose of this work, 130 seventeen year old high school students were examined: 66 from Lublin, Poland and 64 from Wallesy, Great Britain. Analysis of the data from the first part of the questionnaire shows a similarity between the attitudes of the examined youth towards the mentally ill--the majority of respondents showed positive attitudes. Besides this, the students' beliefs on the causes of mental illness were examined. Among the students from Great Britain, the largest percentage thought that the most important causes of mental illness were brain dysfunction (28.1%), head trauma (23.4%) and vulnerability to mental illness (14.1%), where the Polish group felt that the most important are vulnerability to mental illness (22.7%), dysfunction of the brain (18.2%) and stress at work or school (12.1%).

Rzewuska M. Samodzielnej Pracowni Farmakoterapii IPiN w Warszawie. [Sulpiride: the best known atypical, safe neuroleptic drug. Review ofliterature].[46]Psychiatria Polska. 32(5):655-66, 1998. This is a review of literature data on a neuroleptic drug--sulpiride. Sulpiride, a benzamide derivative displays selective affinity for mesolimbic and mesocortical dopamine receptors. For this reason it is classified as an atypical antipsychotic drug. In clinical use, it causes undesirable side effects (particularly extrapyramidal, cholinolytical) less often than classical neuroleptics, does not cause sedation, and has activating and antidepressive properties. These characteristics caused that it is considered a drug of first choice in delusional psychoses with inhibition, depression, lowered activity, intensified negative or deterioration symptoms. The most serious drawback of the drug is the risk of symptoms caused by increased prolactine excretion, and increase in body weight. [46]

Piekarska A. I Oddzialu Psychiatrycznego ZOZ w Lipnie. [Reactive manic syndromes].Psychiatria Polska. 32(5):643-53, 1998. The paper is an attempt at discussion of reactive manias--one of the least studied issues in psychiatry. The author present its clinical picture, the course of the two distinguished forms of the disorder, factors conductive to its onset (the rple of life stress events). The differences between "true" and situationally conditioned manic episodes are indicated. The paper discusses views of supporters and opponents of pathogenesis of manic psychosis. In modern classifications of mental disorders the pathology described by the author is not recognized as a separate disease. In the literature of the subject, the problem of reactive manias does not receive much attention, hence an attempt at their description for psychiatric theory and practice.

Radziwillowicz P. Radziwillowicz W. Katedry i I Kliniki Chorob Psychicznych AM w Gdansku. [Selected psychopathological and psychological questions in an inpatientafter a suicide attempt].Psychiatria Polska. 32(5):629-41, 1998. Authors have analysed 120 inpatients who committed suicidal attempt. Diagnoses in 83 women and 37 men aged between 14 and 73 years according to DSM-V classification were analysed. Patients aged between 14 and 27 constituted 60%, while those more than 28 years old 40% of suicidal attempts. In the outcome of diagnoses the analysis showed that because of psychotic and nonpsychotic mental disturbances among them, patients after suicidal attempt needed scrutinised psychiatric and psychological evaluation. In consulted patients the clinical diagnoses distinguished: conversive reaction (54%), endogenous depression, dysthymic depression, personality disturbances characteropathic type and adolescent crises. Endogenous and dysthymic depression were predominantly found in persons above 28th, they constituted 26% of all diagnosed patients. In particular age groups no characteristic psychopathological diagnoses were found. The diagnosis of characteropathic type of personality disturbances was distributed most regularly.

Zieba A. Dudek D. Jawor M. Krzysiek J. Kliniki Psychiatrii Doroslych CM UJ. [Sexual dysfunctions in depressed patients].[38]Psychiatria Polska. 32(5):621-8, 1998. Sexual dysfunction in depressed patients is an important clinical problem. Its complex etiology involves depressive symptoms, comorbid medical disorders, medication, difficulties in interpersonal relationships with partner, level of sexual functioning prior to the onset of illness. Also, mechanisms of action of psychotropic medication on sexual function are complex. Sexual dysfunction is a source of additional suffering for depressed patients and may contribute to poor compliance with treatment. It is an important challenge for the therapy of depression. [38]

Honory A. Kliniki Psychiatrii Doroslych CM UJ w Krakowie. [Winter depression and light therapy].[74]Psychiatria Polska. 32(5):605-19, 1998. This paper is a review of the literature on winter depression--a from of seasonal affective disorder encountered most often. Winter depression was diagnosed first in the early eighties in the USA and since then it has been the subject of extensive research. The results of many studies confirmed the efficacy of light in the treatment of winter depression and at present phototherapy is considered the treatment of choice of this disorder. However, mechanisms underlying the pathophysiology of winter depression and therapeutic response to light evoke great controversy and hypotheses are still evolving. [74]

Jarzebska E. Katedry Neurologii AM we Wroclawiu. [The picture of psycho-organic syndrome in multiple sclerosis].Psychiatria Polska. 32(5):597-604, 1998. The aim of this study is the analysis of the picture of psychoorganic syndrome in multiple sclerosis patients, taking into account the medical and psycho-social variables. Multiple sclerosis patients (N = 40) were examined with the Organic Brain Damage Rating Scale, used to the diagnosis of psychoorganic syndrome. The variables related to the course of illness, work, attitude to own illness and attitude of the family to the patients were also considered. The obtained picture of psychoorganic syndrome and the relations of the investigated variables were compared to the data concerning this issue, reported in the literature of the subject.

Bidzan L. II Kliniki Chorob Psychicznych AM w Gdansku. [The psychopathological pictures of the early stages of dementia syndromes(vasogenic and of Alzheimer's type)].[23]Psychiatria Polska. 32(5):583-95, 1998. The goal of the research is to determine the early symptoms predicting dementia syndromes both Vasogenic and Alzheimer type. The investigations covered: 36 people without any psychopathological syndrome, 32 people with dementia of Alzheimer type and 36 people with vasogenic dementia. DSM IV criteria were accepted as a basis for recognition of dementia syndromes. The qualified patients underwent basic examination consisting of the following elements: AMDP scale (the estimation of psychic and somatic condition), Global Scale of Dementia, Hachinski scale, Blessed scale, Folsteins scale (MMS), Instrumental Activities of Daily Living, Physical self Maintenance Scale and two methods of the authors: Current Events Card and Prodromal Symptoms Card. On the basis of examinations the following conclusions can be stated:--persons in early stages of dementia differ from those without any symptoms of it by the occurrence of many psychopathological symptoms--not only connected with the cognitive sphere;--in the period preceding the development of dementia the frequency of occurrence of some symptoms is different according to etiology of the process (Alzheimer or vasogenic);--the applied clinical scales differ significantly in their value for the diagnosis and the estimation of intensification of dementia processes. [23]

Soltys K. II Kliniki Chorob Psychicznych AM w Gdansku. [Pathomorphology and pathogenesis of changes in Alzheimer's disease]. [20]Psychiatria Polska. 32(5):573-82, 1998. In this paper the actual issues of pathomorphology and pathogenesis of Alzheimer's disease are discussed. The importance of beta-amyloid is recognized. The linkage between late-onset form of Alzheimer's disease and the mutations of gene encoding the amyloid precursor protein (on chromosome 21) was found. Phosphorylation of paired helical filament (which are composed of tau protein) plays the important role. There is evidence for a strong association between apolipoprotein E genotype (on chromosome 19) and late-onset dementia of Alzheimer's type. Two more genes were recently identified: PS-1 and PS-2. Their mutations occur in 70-80% cases of early-onset form of the disease. There is much information about the role of head injury, cholinergic deficiency, estrogen, nerve growth factor and the decline in brain glucose metabolism. Our current knowledge can lead to development of prevention strategies and early recognition of Alzheimer's disease. [20]

Kloszewska I. Sobow TM. II Kliniki Psychiatrycznej AM w Lodzi. [Modern views on etiopathogenesis of Alzheimer's disease].[80]Psychiatria Polska. 32(5):557-72, 1998. The aetiology of Alzheimer's disease (AD) remains, despite vast progress, not fully understood. Four genes involved in the development of the disease have been identified. Three fully penetrant ones (the amyloid beta-protein precursor on chromosome 21, presenilin 1 on chromosome 14, and presenilin 2 on chromosome 1) lead to the development of relatively rare familial form of AD. Together, they account for about half of this early-onset form of the disease. One genetic risk factor--polipoprotein E-4--is associated with late-onset Alzheimer's disease while at least two others are proposed. None of these genes can be by now adopted for use as a diagnostic or predictive test for Alzheimer's disease. Apart from the above, some environmental factors are also implicated in pathogenesis of the disease with the amyloid cascade hypothesis being the most commonly accepted as central. In the presented paper we have critically reviewed a literature on etiopatogenesis of Alzheimer's disease and discussed some practical consequences of the progress in understanding the mechanism of the disease. [80]

Bilikiewicz A. II Kliniki Chorob Psychicznych AM w Gdansku. [Psychiatry at the turn of the 20th and 21st centuries].Psychiatria Polska. 32(5):547-55, 1998. The author makes an attempt at considering the most important achievements in psychiatry which have taken place in the global scale during the passing century, and the direction taken up by the development of global psychiatry in the coming century. The 20th century was characterised not only by the impressive development of science, thanks to which completely new possibilities opened up for global psychiatry, but also by the presence of extreme events that took place as a result of false ideologies such as fascism and communism. In the 20th century concepts like homicide, holocaust, the extermination of the mentally ill, experiments on people that are prohibited by the ethics of medicine and the elementary rules of humanity, etc. The paper includes the achievements of diagnosis and therapy of psychiatric disorders and the latest organisational solutions as well as the perspectives for further development of psychiatry. The author also implies the aims that psychiatry has to take up due to the numerous threats from our civilization: the technical-technological development, pollution of the natural environment, the negative changes in human values, the rising brutality in interhuman relations due to racial, national and religious conflicts and terrorism, the disappearing feeling of being safe in society, vision of hunger and poverty in many countries on a few continents, the danger of an epidemic outbreak of new unknown diseases caused by viral mutations, or genetics--the possible negative effects of genetic engineering (cloning of humans), etc. The author tries to define the role of psychiatry in preventing the threats of civilization.

Kiejna A. Grzesiak M. Kantorska-Janiec M. Katedry i Kliniki Psychiatrii AM we Wroclawiu. [The Composite International Diagnostic Interview: possibilities ofutilization for economic studies in psychiatry].Psychiatria Polska. 32(4):463-79, 1998. The analysis of treatment costs includes two basic elements--direct and indirect costs. Two major models of analysis are distinguished; the first is based on prevalence of disorders in population, the second--on incidence of disorder. Independently of chosen method, detailed epidemiological data are the starting point of each analysis. The diagnostic instrument that can be useful in these studies seems to be the CIDI--the Composite International Diagnostic Interview. It gives possibility not only to evaluate the prevalence of mental disorders in general population but also to analyse the comorbidity of disorders in examined persons during their lifetime. Apart from that, it allows to assess the individual functioning in different aspects of life. The CIDI is a highly structured instrument for assessment of mental disorders according to diagnostic criteria ICD 10 and DSM IV. It was designed by WHO to serve cross-epidemiologic studies of psychopathology in general population. It can be employed by non-clinicians lay interviewers after proper training. The core version of CIDI consists of 16 modules (diagnostic categories) that can be used independently. Great deal of studies on its reliability and validity have confirmed its high quality, and nowadays it is used widely in several countries in epidemiological studies.

Dabrowski S. Brodniak W. Gierlacki J. Welbel S. Instytutu Psychiatrii i Neurologii w Warszawie. [Community self-help houses as a form of community social support].Psychiatria Polska. 32(4):453-61, 1998. Two forms of community-based social support were introduced by the Polish Mental Health Act--community specialist social help services and community self-help houses--for seriously mentally ill and severely mentally retarded persons. According to the art. 8 community social support should be organized by social help agencies in consultation with psychiatric facilities. Data obtained from the Ministry of Labour and Social Policy indicated that from 21th of January 1995.  (when the Mental Health Act was put in force) until 30th of June 1997.  social help agencies and non-governmental organizations sponsored by social help agencies have set up 134 community self-help houses with 4103 places. In the middle of last year nearly 3500 persons were using these houses. Most of the houses were located in the following districts: Gdansk (20), Gorzow (16), Plock (12), Warszawa (8 for 164 persons). Vast majority of them served as day rehabilitation houses, while only a few provided sheltered housing as well. Tentative evaluation of functioning of these houses shows that: operational definition of community self-help house given in the target network of nursing homes and community self-help houses should be modified to include statutory purposes of community social support provided in art.8, selection of the persons using community self-help houses should follow the legal requirement of the Mental Health Act (art. 8), separated rehabilitation programs for mentally ill (psychotic) and mentally retarded persons need to be provided, participation of psychiatric facilities in the organization of the community self-help houses should be increased, functioning of the community self-help houses ought to be supervised by specialists, staff of the community self-help houses need to be systematically trained.

Dabrowski S. Instytutu Psychiatrii i Neurologii w Warszawie. [Specialist community social services as a form of community social support].Psychiatria Polska. 32(4):443-51, 1998. Art. 9 of the Polish Mental Health Act provides two forms of community-based social support--specialist social help services and community self-help houses for persons who, due a to serious mental illness or severe mental retardation, face considerable difficulties in their daily life, especially with respect to interpersonal relations, employment and welfare matters. The first form could only be implemented after coming into force of the suitable regulation of the Ministry of Labour and Social Policy of December 18, 1996.  (Dz. U. z 1997.  r., nr. 2, poz. 12). Hence, it may be understood that information on these services is exceptionally scarce. The author presents: a draft of legal evolution of the specialist services, from the vague idea of "community care" provided by psychiatric care facilities to the present regulation of community specialist social help services run by social help agencies in consultation with psychiatric facilities, main guidelines for staff to be observed in performing community specialist social help services (training in maintenance and development of basic skills necessary to independent living and others), the first promising experiences of a team rendering community specialist social help services in one of the communes in Warsaw.

Axer A. Beckett R. Hugo Hills Secure Residential Treatment Facility, Grants Pass, Oregon, USA. [Training in preventing assaultive behaviors for psychiatric professionals].Psychiatria Polska. 32(4):433-41, 1998. Dangerous behaviors in psychiatric institutions constitute major clinical and administrative problems. Staff competency in dealing with assaultive patients is an important factor in reducing institutional violence. One of the training programs for mental health staff working with dangerous patients is called Professional Assault Response Training (PART). PART is a product of several years of experience accumulated by the group of California authors in their efforts at designing a safe and effective approach in responding to various dangerous behaviors. PART principles guide staff in 1) de-escalating dangerous incidents through verbal crisis interventions; 2) avoiding or minimizing the risk of minor physical injury through evasion; 3) preventing serious bodily harm through the use of manual restraint. The importance of maintaining self-control by staff is reinforced throughout the entire course as a crucial professional skill. Other PART principles include identifying realistic treatment expectations for assaultive patients, proper physical mobility and emotional balance of staff, recognizing warning signals of impeding danger, using reasonable force to match response to the level of dangerousness. The PART training explores various theoretical explanations of violence (legal model, stress model, environmental model, communication model, developmental model, basic needs model and common-sense model). Verbal interventions which are a cornerstone of the PART approach are matching specific motives of threatening behavior--fear, frustration, manipulation and intimidation. Physical interventions taught in the course (evasion and manual restraint) include only techniques which can be used safely and which are not pain inducing. Finally, the PART training also assists staff in properly documenting assaultive incidents.

Kloszewska I. Scheffel A. II Kliniki Psychiatrycznej Akademii Medycznej w Lodzi. [Aggressive behavior of psychiatric patients among geriatric population].Psychiatria Polska. 32(4):423-31, 1998. Medical documentation of 674 elderly patients of gerontopsychiatric department was studied in order to estimate the frequency of physical aggression in relation to sex, diagnosis of dementia and other psychiatric disorders. This form of aggression was found significantly more often in men (52%) than in women (32%). The prevalence of aggression in men was even more evident in the dementia group (67% men and 39% women). Aggressive acts, with the use of objects as weapons, were aimed mainly against other patients when carried out by women, while male patients more often used the objects to attack the staff. None of the 118 aggressive women injured the attacked person, but 7% of the 160 aggressive men did. The aggression of sexual nature was observed in men (5%) only.

Mazurczyk Z. Oddzialu Nerwic Wojskowego Szpitala Klinicznego we Wroclawiu. [Psychiatric-psychological aspects of the delinquency in the army].Psychiatria Polska. 32(4):415-21, 1998. Military delinquency is conditioned mainly by two groups of factors: the influence of the environment, and the perpetrator's personality traits. Incorrect interpersonal relationships within a squad are particularly conducive to committing typical military crimes, such as lawless walk away or desertion. Such crimes are committed mainly by soldiers suffering from personality disturbance or minor intellect defects. It has been found that in the summertime these kinds of crimes are committed more often.

Pobocha J. Katedry i Kliniki Psychiatrii PAM w Szczecinie. [The status of psychiatric expert: a controversy].Psychiatria Polska. 32(4):405-13, 1998. In this work the expert's status from the point of view of law, psychiatry, psychology, as well as his social, economical and financial position was discussed. The need of improvement of the expert's part in the lawsuit, and legal protection of his person were shown. The dissimilarity of the relation: the physician--the patient and the expert--the person under examination was discussed. The range of code idea "special knowledge" which, in the author's opinion, includes knowledge and clinical trial of psychiatrist, the know-how of the specificity of prison subculture, the possession of methods and conditions for investigation and competence to pronounce forensic and psychiatric opinion, were analysed. Conditioning of the expert's social position in Poland in comparison with experts from other countries and up-to-date state as well as the needs in the range of getting adequate salary for his work were described. In the author's opinion, the conditioning of the expert's status in Poland shown in this work, may influence the essential level of the expert's opinion. Therefore, the author suggests the following traits to be used in evaluation of experts and their work: competent-incompetent; complementary to knowledge-uncomplementary; critical towards opinion-of little criticism; diagnostically thoughtful-of little thoughtfulness; unemotional in his opinion (the person under examination)-emotional ("the opinions of the heart") and so on. The proposed rating scale may be used among other things for instruction of forensic experts.

Zgryzek K. Katedry Prawa Karnego Procesowego Uniwersytetu Slaskiego w Katowicach. [Qualification of persons taking part in psychiatric opinion-giving in apenal trial].Psychiatria Polska. 32(4):397-403, 1998. Introduction of new Penal code by the Parliament brings about the necessity of conducting a detailed analysis of particular legal solutions in the code. The authors present an analysis of selected issues included in the Penal Code, referring to proof from the opinion of psychiatric experts, particularly those regarding professional qualifications of persons appointed by the court in a penal trial to assess mental health state of definite persons (a witness, a victim, the perpetrator). It was accepted that the only persons authorized the conduct psychiatric examination in a penal trial are those with at least first degree specialization in psychiatry.

Gierowski JK. Szymusik A. Katedry Psychiatrii CM UJ. [New penal law from the point of forensic psychiatry and psychology].Psychiatria Polska. 32(4):383-96, 1998. The article discusses selected psychiatric and psychological problems in the new Penal Code in Poland. The authors focussed on the issues like definition of inaccountability and highly limited accountability, the principles of determining and realizing preventive measures, problems regarding competence of experts issuing opinions on mental health state of a perpetrator as well as the necessity of detention. The presented attempt at evaluation of the new penal regulations is a selection performed in a subjective way in accord with the authors' preferences, convictions and views.

Minkowski K. IV Kliniki Psychiatrycznej IPiN w Warszawie. [The study of regional cerebral blood flow in psychiatric disorders]. [11]Psychiatria Polska. 32(3):341-6, 1998. Regional cerebral blood flow is a radiological technique which is safe, non-invasive and relatively cheap. This method allows to assess changes in brain metabolism in patients with psychiatric pathology. The specific changes have been found in regional cerebral blood flow in patients with schizophrenia, affective disorder, obsessive-compulsive disorder as well as alcohol withdrawal and dependence. Advantages and disadvantages of this technique are discussed. [11]

Hunca-Bednarska A. Katedry i Kliniki Psychiatrii AM w Lublinie. [Association meaning of the emotionally aggressive words in a group ofschizophrenic patients and in healthy controls. Semantic analysis].Psychiatria Polska. 32(3):329-40, 1998. Associational responses from 128 schizophrenic people and 120 healthy ones were collected. Four words with aggressive emotional shade were given as the stimuli. Semantic analysis of stimulus words was made, which made it possible to obtain a range of content categories. The collected material was analysed then according to them. Significant differences in five content categories were discovered. Basing on these differences we can infer that associational meaning at schizophrenic people is in some way varied. It was also possible to draw some conclusions concerning emotional life of the examined people.

Prot-Herczynska K. Zespolu Leczenia Domowego IV Kliniki IPiN w Warszawie. [Case management].Psychiatria Polska. 32(3):319-27, 1998. The present paper discusses the theoretical background and present the practical use of the case management model of psychiatric care. Case management is a model of psychiatric care, in which the therapeutic effort is not restricted to biological and psychological functioning of the patient, but is also directed at reinforcement of the patient's environmental resources and social support. The basic principles of cases management are the community of care and the use of the patient-therapist relationship in the treatment. The patient is managed by one person responsible for all the issues relating to the patient. That person, called case-manager, directs the treatment in consultation with a psychiatrist, helps the patient in contacts with institutions and undertakes interventions in the patient's community. The paper discusses the obstacles in introducing the community care model based on case-management principles in Poland.

Prot-Herczynska K. Zespolu Leczenia Domowego IV Kliniki IPiN w Warszawie. [The study of the costs of schizophrenia].Psychiatria Polska. 32(3):307-18, 1998. The present paper considers the problems of measurement of the costs of psychiatric services. Classification of costs' studies includes cost of illness, cost-benefit analysis, cost-effectiveness and cost-utility studies. Costs should be comprehensively measured. Randomised clinical trial is recommended. Information of costs should be integrated with information on patient outcomes. The paper discusses the research which tries to estimate the costs and benefits of community care, using naturalistic or random patient sample methods.

Spiridonow K. Kasperek B. Meder J. Zakladu Rehabilitacji Psychiatrycznej IPiN w Warszawie. [Subjective quality of life in patients with chronic schizophrenia and inhealthy persons].Psychiatria Polska. 32(3):297-306, 1998. The goal of this work was comparison of quality of life in chronic schizophrenic patients with that in healthy persons. As we had expected, the level of QoL in healthy persons was significantly higher than QoL in the examined patients. It also turned out that the level of everyday functioning in the group of healthy persons had certain impact on their subjective QoL. In the group of schizophrenic patients such relation was not detected. The patients' QoL was not influenced by their general level of functioning (measured on the GAS scale) or intensity of psychopathological symptoms either. The healthy persons examined by us expressed satisfaction with their emotional life, sense of freedom and responsibility, life in general and family relations significantly more often than the persons with schizophrenia. The patients admitted also that in everyday life they found it most difficult to exact their rights, make decisions, organize their daily schedule and ask for help.

Krupka-Matuszyczk I. I Kliniki Psychiatrii Slaskiej AM w Lublincu. [Cathamnestic long-term study in early schizophrenia. The assessment ofpsychological status and social functioning].Psychiatria Polska. 32(3):287-95, 1998. Mental condition of 142 patents with a diagnosis of schizophrenia (according to ICD X:F 20) first admitted to Psychiatric Hospital at the age of 13-18 was assessed twice. The first assessment took place during their first hospitalization at Psychiatric Hospital, the second one--23 years later. PANSS, BPRS GAS Scale were used at the examination. Mean value of the exacerbation of symptoms and improvement rate were calculated for each group of symptoms: positive, negative and psychopathological. The interpretation of the links between selected factors and rates of improvement as well as the mean value of exacerbation of symptoms were obtained on PANSS Scale. The links between the life assessment index before the first hospitalization and a mean value of points on the PANSS Scale at the discharge from hospital and in the cathamnesis for positive and negative symptoms as well as i cathamnesis for psychopathological symptoms were proved. The obtained data confirm that after the first discharge from hospital more patients function better in life than after cathamnestic examination.

Bury L. Zaborowski B. Konieczynska Z. Jarema M. Cikowska G. Kunicka A. Bartoszewicz J. Muraszkiewicz L. III Kliniki Psychiatrycznej IPiN w Warszawie. [Family burden of schizophrenic patients with various forms of psychiatriccare].Psychiatria Polska. 32(3):275-85, 1998. Caregiver burden was evaluated among family members of 90 schizophrenic patients from hospital psychiatric ward, day hospital or from community psychiatry unit. Psychopathology was evaluated with the use of PANSS while family burden with the use of Tessler's scale which allowed to differentiate between objective and subjective burden regarding assistance to the subject and patient's supervision. Schizophrenic symptoms were more severe in hospitalized patients than among patients from day hospital or patients treated in the community. Family burden, both subjective and objective was more severe among family members of hospitalized patients. There was no difference in the severity of family burden among family members of patients from day-hospital or from community psychiatry unit. The severity of positive and general schizophrenic symptoms (PANSS) correlated positively with the lack of patient's acceptance by a family member as well as with the global subjective family burden and with the necessity of taking control over patient. There was a positive correlation between the severity of schizophrenic negative symptoms and subjective family burden (dimension: assistance to the patient) and the sum of objective family burden.

Brzozowska A. Wolanczyk T. Komender J. Kliniki Psychiatrii Wieku Rozwojowego AM W Warszawie. [Schizophrenia, schizophrenia-like disorders and delusional disorders inpatients with anorexia nervosa: literature review and report of 3 cases].Psychiatria Polska. 32(3):265-74, 1998. The authors present the review of literature concerning schizophrenia, schizophrenia type and delusional disorders in patients with a lifetime diagnosis of anorexia nervosa (AN). The authors describe also 3 patients (2 cases of paranoid schizophrenia and 1 case of catatonic syndrome). The clinical features in all patients are discussed. In 1 patient the catatonic symptoms occurred within the context of AN, (perhaps due to metabolic disturbances) and in 2 other cases the psychotic features occurred after recovery from AN. The authors discuss the occurrence of psychotic features in AN, and the possible function of starvation and metabolic disturbances in their aetiology.

Wciorka J. Anczewska M. Bembenek A. Golebiewska M. Hochlewicz A. Nurowska K. Schaeffer E. Skowronska J. Stanikowska I. Tarczynska K. I Kliniki Psychiatrycznej IPiN w Warszawie. [Psychopathological profile of acute schizophrenic syndromes diagnosedaccording to ICD-10 and DSM-IV criteria].Psychiatria Polska. 32(3):251-64, 1998. Diagnostic and symptomatological profiles of schizophrenic syndromes diagnosed according to ICD-10 and DSM-IV were compared. For this reason a group of patients fulfilling at least one of these sets of criteria was created and then diagnostic and symptomatological profile was compared between those who fulfilled the ICD-10 and those who fulfilled DSM-IV criteria. 105 inpatients hospitalized in acute phase of their first or one of consecutive episodes were included--102 of them had fulfilled ICD-10, and 90 DSM-IV criteria of schizophrenia. Diagnostic concordance between the two systems of criteria was high (83%). Differentiation of diagnostic profile (i.e. difference between frequency of fulfilling the specific requirements of ICD-10 or DSM-IV criteria) of the symptoms in these two groups was not significant, expert of 6-month criterion of duration of illness, which was significantly less frequently valid in ICD-10 syndromes group. A comparison of symptomatological profiles (i.e. frequency and intensity of symptoms) of schizophrenic syndromes diagnosed by ICD-10 or DSM-IV criteria and described by several rating scales (PANSS, SAPS/SANS, KOSS-S) did not show any significant differences. Results suggested that despite of different ways of defining the schizophrenic syndromes in both diagnostic systems, disorders manifested in the groups of patients created by means of them are very similar in psychopathological picture. This seems to be a significant change in comparison to more prominent differences contrasting the previous versions of the diagnostic systems (i.e. ICD-9 and DSM-III-R).

Bogacki P. Rybakowski J. Kliniki Psychiatrii Doroslych AM w Poznaniu. [Prodromal period of the first episode of schizophrenia].[62]Psychiatria Polska. 32(3):239-50, 1998. The article is a review of the literature on the prodromal period of the first episode of schizophrenia. According to the literature, the first episode of schizophrenia is usually preceded by a few years of prodromal period including non-specific behavioural and affective disturbances as well as psychotic-like and prepsychotic symptoms. The concepts formulated so far concerning a definition of prodromal symptoms were discussed. The data were summarized on clinical characteristics of the prodromal period such as symptomatology, frequency of symptoms, dynamics of changes and the period of occurrence of the prodromal symptoms. Four hypothetical models of transformation of prodromal symptoms into psychotic process were described. Also, the importance of the prodromal symptoms of the first episode of schizophrenia for early diagnosis and therapy of schizophrenia was discussed with regard to currently performed programs of early interventions in schizophrenia. [62]

Kiejna A. Gorna R. Katedry i Kliniki Psychiatrii AM we Wroclawiu. [Alois Alzheimer's traces in Wroclaw].Psychiatria Polska. 32(2):219-23, 1998.

Kiejna A. Gorna R. Chladzinska-Kiejna S. Katedry i Kliniki Psychiatrii AM we Wroclawiu. [Carl Wernicke's school of neuropsychiatry in Wroclaw].Psychiatria Polska. 32(2):209-16, 1998.

Motta E. Miller K. Rosciszewska D. Klosinska E. II Katedry i Kliniki Neurologii w Zabrzu. [Depression in epileptic patients with and without history of suicidalattempts: preliminary report].Psychiatria Polska. 32(2):199-208, 1998. Depression is a significant problem in epilepsy. Suicides occur in epileptic patients five times more often than in general population. Material included 34 epileptics with 76 suicidal attempts and 24 patients with no history of suicide. Psychical state was studied with Beck Depression Inventory and Hamilton Depression Rating Scale. In the group with suicidal attempts 65% of patients had depression (54.5% of them had major depression) and in group without suicide attempts depression was noted in 54% (23% with major depression). Patients with depression were divided into two groups: group I with suicidal attempts and group II without history of suicide. In group I more patients were alcohol abusers (50% vs 31%), more were treated because of epilepsy longer than 10 years (59% vs 46%) and more had tonic-clonic seizures (82% vs 46%). In group I, 54% of patients were on polytherapy (more than half of them with fenobarbital). In group II, 31% of epileptics were on polytherapy (no one with fenobarbital). Major depression was significantly more frequent in epileptics with suicidal attempts. The severity of depression may influence the risk of suicide. Major depression may be associated with late age of onset of epilepsy, longer treatment duration, tonic-clonic seizures, polytherapy (mainly with fenobarbital) and alcohol abuse.

Radziwillowicz W. Radziwillowicz P. Instytutu Psychologii Uniwersytetu Gdanskiego. [Memory processes in endogenous depression].Psychiatria Polska. 32(2):187-97, 1998. The thesis aims to answer the questions about the profile of mental ability in endogenous depression and to decide whether self-estimation of depressive symptoms influences the results achieved by patients in memory tests. Fifty six patients suffering from endogenous depression have been examined. The following methods have been applied: Mini Mental State Examination, Benton Visual Retention Test, Beck Depression Inventory, hold tests: Vocabulary, Information, Comprehension and Digit Span of Wechsler Adult Intelligence Scale (WAIS), Rey-Osterrieth Complex Figure, Auditory Verbal Learning Test, DCS Weidlich. General status of cognitive functions correlates with the profile of specific kinds of memory results, particularly with delayed memory. Self-estimation of depressive symptoms intensity is mostly influenced by memory capacity, visuomotorial factor, functions of perception and lingual factor. High correlation between verbal and non verbal learning shows uniform influence of depression on the process of learning.

Foltyn W. Nowakowska-Zajdel E. Knopik J. Brodziak A. Katedra i Klinika Chorob Wewnetrznych Slaskiej Akademii Medycznej. [The influence of early childhood experiences on depression among medicalstudents. Preliminary study].Psychiatria Polska. 32(2):177-85, 1998. The aim of this study was an attempt to estimate depression prevalence in medical students. Simultaneously we tried to asses the impact of early negative experiences on the level of depression in that population. We examined 92 third year medical students of the Silesian Academy of Medicine (54 women and 38 men) at the age from 20 to 24. Frequency and intensification of depression were assessed by using Beck Depression Inventory. Early experiences including negative and positive ones were estimated with the use of a self prepared repertory test called "biographical path", based on Personal Construct Theory of George Kelly. The obtained results indicated that 25% of examined students had depression symptoms. These students were exposed more frequently to early negative experiences than students without depression. In childhood depressive students were under pressure of their environment to score successes. If they did not realise these expectations they were exposed to discontent and frustration of their parents. Depressive students came less frequently into contact with other people and acquired independence later than non depressive students.