Psychiatria Polska 5/2003

Wymiary traumatycznego stresu  771
Traumatic stress span  771
Janusz Heitzman
Summary
Since 1980, a new outlook on stress was applied in connection with the changes in psychiatric concepts and the notion that a traumatic experience may cause specific psychological symptoms varying from the content and source of other psychiatric disorders. The understanding of the trauma, defined by the objective traits of the stressor, separated it from stress as defined by the subjective individual's decision. This was against the current theory of Selye in which the stress reaction is a homogenous entity as a whole, defined by a subjective evaluation of the event, independently of the objective traits. The paper examines new directions in the studies on the meaning of trauma for the person who survived it. According to these studies, the trauma and its consequences cannot be viewed solely in a narrow pathogenic and symptomatic frame. Modern directions of studies on stress led to a model integration of physiological, behavioural and psychological reactions and the trauma itself was to be seen in a cultural and historical context. Today's biopsychocultural model of understanding trauma consists in a complex of common actions from various systems and backgrounds. They comprise the following factors: physical (biological), intrapsychic, interpersonal (familial, social, religious, cultural), educational-professional, economical, political. These systems coexist in a time frame, in common relations and connections. They all affect the capability to evaluate danger, which gives different strategies of coping with oneself. Studies on PTSD give arguments for understanding of the full influence that a trauma can have on a person, and allow for an unlimited outlook on the traumatic situation - its biological, social and existential aspects.

Rola cytokin w depresji  787
The role of cytokines in depression  787
Halina Dubas-Ślemp, Halina Marmurowska-Michałowska, Agnieszka Szuster-Ciesielska, Teresa Kamińska, Martyna Kandefer-Szerszeń
Summary
Clinical and experimental studies on animals indicate that depression is associated with increased plasma cytokine acute phase protein concentrations and hypothalamic-pituitary-adrenal axis (HPA) activation. Additionally it has been detected that immunological activation induces stress-like behavioural and neurochemical changes in organisms of animals and humans. Hypersecretion of cytokines in response to stress or to endogenous trigger factors may induce depressive symptoms. Corticotropin releasing hormone (CRH) overproduction in the brain also may participate in cytokine-induced behavioural and neurochemical changes. Treatment with antidepressants conferred protection against cytokine-induced depressive-like biological and behavioural changes. This is mainly due to alterations of the pro-/anti-inflammatory cytokine balance. There is a substantial body of evidence that the immune system plays a major role in aetiology of depression and that cytokines participate in neurochemical, behavioural and endocrine changes in this illness.

Zaburzenia depresyjne w przebiegu białaczki  799
Depressive disorders in leukemic patients  799
Marcin Jabłoński, Halina Lebiedowicz, Dominika Dudek, Andrzej Zięba, Aleksander B. Skotnicki
Summary
In this paper we review previous research, suggesting a link between depressive symptoms and poor prognosis in cancer patients. The possibility, to identify an association between depressed mood and poorer outcomes and survival in haematological malignancies seems to be very interesting. We shortly describe acute leukemia, actual methods of treatment, and review important factors influencing on mood disturbances and psychosocial difficulties of haematological patients during diagnosis, chemoterapy and after bone marrow transplantation.

Rozpowszechnienie zaburzeń depresyjnych wśród kobiet w wieku okołomenopauzalnym zgłaszających się do lekarzy ginekologów  811
Prevalence of depressive disorders in perimenopausal women in gynecological practice  811
Marcin Wojnar, Wiktor Dróżdż, Aleksander Araszkiewicz, Wiesław Szymański, Dorota Nawacka-Pawlaczyk, Roman Urbański
Summary
Aim: The aim of the study was to evaluate the prevalence of depressive disorders in perimenopausal women reporting to gynecologists and to assess a possibility of screening and diagnosing depression in gynecological practice. Method: The study entailed 2262 female patients of the age of 45-55 attending 120 gynecologists in Poland. Patients were first asked to fill in the Beck's Depression Inventory and next examined by their gynecologists to verify the presence of the basic symptoms of depressive episode according to ICD-10 diagnostic criteria. Patients who obtained 12 points or more in BDI total score were referred for a psychiatric consultation, including the MINI questionnaire. The study was monitored by 'Servier Polska'. Results: 32.5% of women aged 45-55 years visiting gynecologists scored 12 points or more on the BDI scale. Patients with high BDI scores reported long-lasting somatic and emotional symptoms associated with menopause more frequently than patients with low BDI scores. Women with high BDI scores also more frequently experienced gynecological surgery in the past, more frequently attended gynecological clinics, and reported more peri- and postnatal mood disorders. 57% of patients did not visit psychiatrists. Depressive disorders were diagnosed in 76% of patients who came for the psychiatric evaluation. Conclusions: The study suggests that more than 19% of perimenopausal women attending their gynecologists suffer from depressive disorders. Gynecologists in Poland can diagnose depression accurately and start pharmacological treatment of the disorder in half of the patients.

Monitorowana terapia trójpierścieniowymi lekami przeciwdepresyjnymi  825
Therapeutic monitoring of tricyclic antidepressant drugs  825
Magdalena Grzesiak, Jan Aleksander Beszłej, Monika Szewczuk-Bogusławska
Summary
Therapeutic drug monitoring (TDM) is used to optimise therapy by an assessment of the drug's plasma concentration. The indications for TDM according to Preskorn are: 1. well defined relationships between plasma concentration of a drug and its therapeutic efficacy, and between plasma level and adverse events and/or toxicity, 2. narrow therapeutic index of a drug, 3. significant  interindividual variability of the dose - plasma concentration relationship, 4. delayed onset of action, 5. difficulty in early diagnosis of toxic events. Tricyclic antidepressants (TCA's ) fulfill many criteria for TDM. Interethnic and interindividual differences in pharmacokinetics of TCA's lead to pronounced differences of plasma level. Interindividual variability of plasma concentration of TCA's is connected with age, concomitant diseases, genetically determined  polimorphism of cytochrome P-450 enzymes (e.g. CYP2D6) and co-medications (the drug may change pharmacokinetic properties of TCA's). There is no clear relationship between plasma concentration of TCA's and therapeutic efficacy of a drug. Contrary there is clear correlation between plasma level and adverse events (especially cardiotoxic and neurotoxic AE). Therapeutic ranges of plasma concentration for TCA's are well established. In the case of SSRI's or newer antidepressants the clear relationship between plasma level and their therapeutic effect, that is  their efficacy and  tolerability has not been determined  yet. The relationships between plasma concentrations and efficacy and tolerability of TCA's, as well as  therapeutic ranges of TCA's and other antidepressants are presented in this paper.

Skuteczność citalopramu w dawce przekraczającej zalecaną maksymalną w leczeniu depresji opornej na leki. Opis kazuistyczny  939
Efficacy of citalopram in more than maximal dose in drug-resistant depression. Case report  939
Summary
A case report of a 30 year old white man with chronic, drug-resistant depression, was presented. The condition resolved during treatment with citalopram, 100 mg/day (against medical advise). There was no side effects. Results of the debryzochine test show activity of CYP2D6 to be in normal range.

Epizod maniakalny jako reakcja na wiadomość o zachorowaniu na nowotwór u chorej z zaburzeniami afektywnymi dwubiegunowymi  845
Manic episode as a result of information about breast cancer in a patient suffering from bipolar affective disorder  845
Hubert Wichowicz
Summary
The paper describes a patient who suffered from bipolar affective disorder for 22 years and the following manic episode appeared after getting information about a diagnosis of breast cancer. During mania the patient presented delusions of being healthy which caused a marked delay in introducing the necessary treatment of the tumor. Besides, we discuss different authors' views about the possibility of evoking manic episodes by psychological factors. Same authors agree, that such an event may happen but others do not. This matter requires further studies, but any doctor who takes care of a patient with bipolar affective illness should always remember about the possibility of being evoked manic episode by harmful stress events.

Tomografia komputerowa pojedynczego fotonu (SPECT) w diagnostyce i orzecznictwie - opis przypadku ciężkiego zespołu depresyjnego po urazie głowy  851
SPECT in diagnosis and medical certification - the case of depression after head trauma  851
Anna Banaś
Summary
A case of severe organic affective disorder after head trauma with loss of consciousness is presented. While CT in this case was normal, SPECT brain perfusion imaging showed hipoperfusion in the right frontal lobe and the left temporal-parietal region. The psychological tests: Benton, Bender, MMPI confirmed changes in CNS as well. These findings help to explain the severity and chronicity of disorders and medical certification.

Psychoza paranoidalna w przebiegu wirusowego zapalenia mózgu - opis przypadku 857
The paranoid psychosis in the course of a viral encephalitis - a case study  857
Bogusław Helon, Roman Mikuła
Summary
This article describes an inpatient case treated at the Mental Hospital in Żurawica, in which an appearance of a viral (herpetic ?) encephalitis was preceded by a paranoid syndrome. One of many clinical situations, when an appearance of a somatic disease was preceded by manifestation of psychic disturbances, was demonstrated in this article.

Ocena stresujących wydarzeń życiowych i poczucie koherencji u pacjentów z chorobą afektywną jedno- i dwubiegunową  863
Assessment of stressful life events and sense of coherence in patients with unipolar and bipolar disorder  863
Magdalena Sariusz-Skąpska, J. Czesław Czabała, Dominika Dudek, Andrzej Zięba
Summary
Aim: Comparison of stressful life events assessment and level of sense of coherence in patients with unipolar and bipolar affective disorder and healthy subjects. Method: 60 patients with unipolar and bipolar disorder and 30 healthy subjects were examined with the Stressful Life Events Questionnaire R. H. Rahe'a and Sense of Coherence Questionnaire. Results: It has been proved that between examined groups exist sufficient differences in the assessment of stressful life events and level of sense of coherence. Besides that it has been observed that patients with affective disorder do not differ in number of named stressful life events. Conclusions: Knowledge about the individual characteristics concerning cognitive assessment of stressful life events made by the patients with unipolar and bipolar disorder and their level of sense of coherence can play an important role in diagnostic and therapeutic process, so this kind of knowledge ought to be broadened by new research.

Związki między autonomią a zaburzeniami psychicznymi  877
Relations between autonomy and mental disorders  877
Katarzyna Romanowska
Summary
The aim of this article is to present three new cognitive approaches to autonomy and it's importance for pathology. According to Ryan and Deci's self-determination theory autonomy is manifested through intrinsically motivated behaviour. As the individual develops it's autonomous activity is expanded gradually by the integration of regulatory processes. Being autonomous, one can modulate and manage one's emotions and impulses, is aware of emotional states and hence is capable of behaving adequately. Pathology develops when the problems with the integration of external regulatory processes occur. According to Toru Sato, there are two parts of the self - autonomy and relatedness. The first one focuses on control over one's environment and one's bodily functioning. For the other one "being associated" with one or more persons is a goal in itself. For correct functioning the person's autonomy and relatedness needs should be satisfied. Both self-systems are involved in the process, which should result in their integration. Sato claims that too much stress put on one of the systems weakens the other one. The person satisfies only one need and it is crucial for it's mental condition. Pathological mechanisms are culturally conditioned. Beck describes two personality dimensions - autonomy and sociotropy. Autonomy refers to the personal interest in independence, individuality and attaining personal goals. The autonomous individual takes it's sense of well-being from personal achievements and control over her/his own activity and environment. The author claims that both highly autonomous and highly sociotropic individuals are vulnerable to depression.