Psychiatria Polska 4/2003

Aktualny stan i perspektywy psychiatrii sądowej w Polsce  577
Current state and perspectives of forensic psychiatry in Poland  577
Józef Krzysztof Gierowski
Summary
The paper is an attempt to describe the current state of affaires and perspectives in Polish forensic psychiatry in relation to the EU rules and standards on dealing with psychiatric patients who break the law. Basic dillemas and rules of forensic psychiatry are presented which allow for the formulation of a specific meta-model which in turn will enable further reforms and improvement of Polish forensic psychiatry. The author also analyses new opinion formulation rules in accordance with the criminal justica act of 1997. New legal regulations introduced solutions which improved the earlier legal regulations. This includes the role of the psychologist together with the psychiatrist, when deciding on the person's accountableness. Limiting detention use only in the cases of non-accountable offenders is an unfavourable action which is against European standards and makes it difficult for many psychiatrically ill offenders to obtain therapeutic help or adequate rehabilitation.

Gdzie osoby z zaburzeniami psychicznymi poszukują pomocy?  591
Where do people with mental disorders are looking for help?  591
Tomasz Pawłowski, Andrzej Kiejna
Summary
This article presents and discusses the concept of "pathway to psychiatric care". According to literature review, only few people, who meet criteria for mental disorders, reach psychiatrists. Therefore it is important to identify institutions where people with mental disorders look for help. On the basis of World Health Organization programme "Pathway study" authors present institutions in different countries all over the world, which are involved in helping people with mental disorders. In all European centers taken part in the "Pathway study" most of the people who reached psychiatrists had been consulted in primary healthcare first. Project "Pathway study" has been the first research programme related with this topic. It has initiated similar studies in different centers all over the world. Results of those studies show, where outside psychiatric institutions, it is possible to diagnose and treat mentally ill people.

Schizofrenia w świetle koncepcji ewolucyjnych  601
Schizophrenia in the light of the evolutionary theories  601
Dawid Wiener, Janusz Rybakowski
Summary
The aim of the article was to review the hypotheses of schizophrenia in the light of the evolutionary theory. The authors distinguished adaptationist and non-adaptationist hypotheses concerning the evolutionary underpinnings of schizophrenia. The adaptationist hypotheses are firmly based on notions of adaptation, natural selection and proximate and ultimate causes. The standard hypotheses of this sort proposed by Steven and Price as well as by Pollimeni and Reiss were discussed. Also, the other similar conceptions originated from McGuire and Troisi and proposed by David Horrobin were presented of which the latter is especially promising and worth further investigating. The non-adaptationistic authors criticised many assumptions of the adaptationist program i.e. too broad use of term "adaptation" in the area of human behaviour or the very idea of proximate and ultimate causes. Unlike the adaptationists, they focus their attention on other aspects of the evolutionary processes i.e. the role of the mutation and also they are searching in a much intensive way than their opponents for verification of the hypotheses based on the empirical evidence. The theories developed by Crow and by Yeo were listed among the non-adaptationistic ones and presented.

Zaburzenia procesów kojarzeniowych w schizofrenii  615
Associative processes disorders in schizophrenia  615
Kamila Pers, Andrzej Rajewski
Summary
This paper tries to approach and systematise knowledge about the character of associative process disorders in schizophrenia. In considering schizophrenia as an illness composed of various symptoms which may lead to different clinical progress, the paper is mainly focused on disorganization of thinking and, consequently, speaking and communication disorders. Authors reviewed various concept of pathogenesis and course of associative process disorders in schizophrenic patients. Special attention was paid to a connectionist model of disturbed associations. This model originates from cognitive psychology and assumes that concepts are represented as networks in the mental lexicon. Following from this model, a hypothesis was presented, claiming that disturbed associations in schizophrenia may be related to abnormalities in semantic networks. Results of research, supporting this hypothesis, were referred. Moreover, authors tried to describe the relationship between associative processes disorders in schizophrenia and abnormalities in neurophysiological (event - related potentials) and neuropathological (MRI) examinations. At least hypotheses describing the role of neurotransmission disorders was presented.

Neurorozwojowe koncepcje schizofrenii - badania przedkliniczne  627
Neurodevelopmental theories of schizophrenia - preclinical studies  627
Małgorzata Lehner, Ewa Taracha, Aleksandra Wisłowska, Małgorzata Zienowicz, Piotr Maciejak, Anna Skórzewska, Adam Płaźnik
Summary
Schizophrenia is a complex disorder of unknown origin, characterised by abnormalities in the realms of perception, thinking and the experience of emotions that onset is restricted to young adulthood. Many techniques that range from neuropathology to neuroimaging identyfied subtle brain abnormalities particulary in frontal, temporal cortex, hippocampus, basal ganglia and cerebellum. Neurodevelopmental models of schizophrenia test hypotheses that this disease is caused by a defect in cerebral development which results in altered neural connectivity, brain neurochemistry and aberrant behaviour observed in adult life. Recent evidence indicates that neonatal hippocampal damage may affect prefrontal neuronal integrity. The developmental lesion model appears to have predictive validity because treatment with antipsychotic drugs normalises some abnormal behaviour changes. Therefore it will be a useful paradigm in the work on new therapies and in providing new insights about pathophysiology and etiology of schizophrenia.

Bezpieczeństwo i skuteczność leczenia olanzapiną- w porównaniu z perfenazyną - chorych na schizofrenię, Wyniki 18-tygodniowego badania wieloośrodkowego w warunkach podwójnie ślepej próby  641
Safety and efficacy of olanzapine versus perphenazine in patients with schizophrenia: results of a multicenter, 18-week, double-blind clinical trial  641
Marek Jarema, Marcin Olajossy, Włodzimierz Chrzanowski, Aleksander Araszkiewicz, Jerzy Landowski, Janusz Rybakowski, Adam Bilikiewicz, Jacek Bomba, Grażyna Dębowska
Summary
Aim: The primary objective of the study was to evaluate the severity of extrapyramidal symptoms during treatment with olanzapine (10-20 mg) versus perphenazine (8-40 mg) using the Simpson Angus Scale (SAS). The secondary objective was to assess the safety profile and clinical efficacy of the investigated drugs. Material and method: A total of 95 patients with schizophrenia who met the criteria for DSM-IV were randomized to a double-blind, 18 week prospective comparative trail conducted in Poland. The tolerance of treatment was assessed with the use of scales: BAS, SAS and UKU. The efficacy of treatment was evaluated with BPRS, PANSS and CGOI scales. Results: For olanzapine patients, the severity of extrapyramidal symptoms improved after 3 first weeks of treatment, and significantly decreased from the baseline to endpoint. Perphenazine patients showed an increase of extrapyramidal symptoms. The difference of the SAS scores change was statistically significant between olanzapine and perphenazine groups. Akathisia symptoms decreased significantly in the olanzapine group during the treatment period, whereas symptoms of akathisia increased in the perphenazine group. Statistically significant differences of mean change of BAS total score from baseline to endpoint were noted between treatment groups Treatment - emergent adverse events occurred more frequently in patients receiving perphenazine (46%), than in patients receiving olanzapine (17%). The proportion of patients complying with improvement criteria for CGI scale score was statistically greater in the olanzapine group (72,7%) than in the perphenazine group (47,9%). Results of this study showed that the tolerance profile in patients taking olanzapine is superior to perphenazine. Conclusions: olanzapine was better tolerated than perphenazine. After olanzapine treatment more subjects fulfilled the criterion of improvement and schizophrenic symptoms were less severe than in patients treated with perphenazine.

Subiektywne aspekty farmakoterapii schizofrenii w okresie wprowadzania chlorpromazyny do praktyki psychiatrycznej w Polsce - przegląd piśmiennictwa  657
Subjective aspects of pharmacotherapy in schizophrenia during implemenation of chlorpromazine in Poland - a review  657
Sławomir Murawiec
Summary
Introduction of chlorpromazine was the breakthrough in psychiatric practice. Pharmacotherapy with chlorpromazine started in polish hospitals in the autumn and winter in 1954 and the first papers covering clinical experiences started to be published in 1955. Some of these papers are very informative about subjective aspects of pharmacotherapy, comparison of older and new method of treatment, changes of psychiatric wards atmosphere. They inform also about some social aspects of introduction of this new drug to the practice. In the example families were involved in gaining the drugs for ill family members and doctors sometimes had to win persons' in charge consent to start treatment. In this papers the hope that patients treated with the new drug are more prone to psychotherapy have been expressed. This kind of hope is now expressed in regard to the second generation of antipsychotics. The paper of a Polish author published 1969 that is the pioneering work in the field of research of subjective aspects of pharmacotherapy is presented. Conclusions and methodology of this study are very similar to the later studies that were published in psychiatric literature at the end of 1970's.

Porównanie subiektywnej i obiektywnej oceny jakości życia w grupie chorych na schizofrenię  669
Comparison of subjective and objective quality of life in schizophrenic patients' group  669
Andrzej Czernikiewicz, Joanna Górecka
Summary
Aim: The aim of this study is a comparison of subjective and objective quality of life in schizophrenic patients. Methods: The research was carried out on 120 in- and out- patients (from 19 to 65 years) who fulfilled ICD-10 and DSM-IV criteria for schizophrenia. The quality of life was assessed by means of two instruments: Quality of Life Scale (QLS, Heinrichs et al. 1984), Self-Report Quality of Life Measure for People with Schizophrenia (SQLS, Wilkinson et al. 2000). The basic statistical methods used were: correlation analysis between measurable variables with Pearson's index (P), t-Student test, analysis of variance, factor analysis. Results: In the investigated group there is no correlation between subjective and objective quality of life. Sex does not influence a correlation between these variables. Subjective and objective quality of life correlate with each other only in out-patients' group (P= -0,386). The factor analysis of SQLS distinguished 7 factors: mood; everyday activities, side effects connected with movement; side effects- others; support; interpersonal contacts; others; this division differs completely from a division on subscales. The factor analysis of QLS distinguished 3 factors: intrapsychic functioning; social functioning; functioning in roles; this division is similar to a division on subscales. Conclusions: It seems that in the schizophrenic patients' group using subjective and objective ways to assess the quality of life determines a difference of the obtained results. Only the subjective measurement fulfills the assumption of quality of life definition, that is why the usefulness of QLS in assessing quality of life is rather restricted.

Znaczenie konsultacji rodzinnej dla diagnozy psychiatrycznej  683
The role of systemic consultation in the psychiatric diagnosis  683
Maria Rostworowska, Małgorzata Opoczyńska, Bogdan de Barbaro, Jolanta Robak
Summary
Basing on the example of one patient and her family, the advantages and disadvantages of a systemic consultation are presented. The patient was hospitalized due to schizophrenia. In the given example the psychiatrist was an observer of the consultation conducted by a therapist from the ward. A systemic consultation allowed a "multiple-picture" to be obtained: the family members and the patient presented their own understanding of the situation, their "stories" This new and multi-perspective description, showing the patient's symptoms functionality caused diagnostic uncertainty in the psychiatrist - how far is the diagnosis of schizophrenia a justifiable one. The possibility to empathize with the existential, psychological and family problems of the patient caused a skepticism in the psychiatrist, towards the stigmatizing diagnosis. The authors stress the danger arising in the systemic consultation , which broadens and deepens the knowledge on the patient's situation. According to the authors, the systemic consultation is necessary to understand the social context of the patient and to formulate a complex treatment plan. At the same time however, the multiple layered perspective (which contains the psychological, social and existential domains of the patient) should not over-shadow the psychopathological domain. For the therapeutic team, the consideration of the given levels of systemic reality description remains a challenge.

Częstość rozpoznań schizofrenii katatonicznej w szpitalach w Lublińcu (1894-1932, 1934-1936, 1970-1999) i Bolesławcu (1958-1999)  695
The frequency of diagnosis of catatonic schizophrenia in hospitals in Lubliniec (1894-1932, 1934-1936, 1970-1999) and Bolesławiec (1958-1999)  695
Agnieszka Wlazło, Jacek Kleszczyński, Aleksander Błaszczyk, Paweł Tyfel, Anna Jakubczyc, Janusz Morasiewicz
Summary
Aim: The analysis of the data from the psychiatric hospitals in Lubliniec (1894-1932, 1934-1936, 1970-1999) and Bolesławiec (1958-1999) proved a decrease in frequency of diagnosis of catatonic schizophrenia, what could testify to a decrease in morbidity with this form of schizophrenia. Method and results: Basing on the facts from scientific literature there was ascertained that the decrease in frequency of diagnosis of catatonic schizophrenia is connected with following causes: firstly, with the changes in nozology, secondly, with the introduction of a new form of therapy and finally, with the fact that here psychological and sociological factors exist which eliminate catatonia as the most expresive form of schizophrenia.

Zaktualizowany model metabolizmu informacyjnego  703
The revised version of the information metabolism model  703
Andrzej Kokoszka, Paweł Holas, Andrzej Bielecki
Summary
The concept of information metabolism was introduced by prof. Kępiński at the end of the 1960-ies of the 20th century. The article presents the synthesis of a series of papers aiming to concrete, update and describe in mathematical terms the concept of metabolism of information. Theoretical basis of the model in the context of the theory of information and the main structures and functions of the metabolism of information are presented. These structures are: control centre (nucleus), boundaries (cell membrane), functional structures (endoplasmic reticulum), energy centres (mitochondria), synthesis centres (ribosoms) and elimination centres (lysosoms). At the end, the publications on the mathematical description of the information metabolism model are presented and discussed.