Psychiatria Polska 3/2003

Rok 2002 w psychiatrii w Polsce  409
The year 2002 in Polish psychiatry  409
Jacek Bomba
Summary
The aim of this paper is a reflection upon the most important issues in Polish psychiatry in 2002. In the mental health care development, an unfavorable legal regulation on the profession of the psychologist was passed and another change in health care financing in Poland. The role of Polish psychiatrists in international actions inspired by the World Psychiatric Association could be noted, especially in the de-stigmatising "Open the doors", as well as the stance towards 2nd generation antipsychotics. A positive growing interest and tendency in post-graduate psychiatric training was noticed, especially constant training. The publication of a new, large clinical textbook on psychiatry was noted, leading the probable direction of post-graduate training and development of scientific research. Special attention was drawn to the return of neuro-surgical interventions in treatment resistant obsessive-compulsive disorders, namely the nonstandard position of stereotactic operations on the limbic system in these disorders. Such a position is the result of insufficient scientific documentation on the effectiveness of such procedures and weakly documented theoretical bases.

Obraz i leczenie kolejnych epizodów depresji (wyniki polskiego badania wieloośrodkowego)  419
Clinical picture and treatment of subsequent depressive episodes - results of Polish multicenter study  419
Janusz Rybakowski, Andrzej Kiejna, Dorota Nawacka-Pawlaczyk, Marcin Kargul
Summary
Aim. A comparison of the clinical picture and treatment results of the first depressive episode with the second and the third and further depressive recurrence. Methods. The study was designed as a one-year, prospective, naturalistic observation of the clinical course of depression. One hundred and sixty-six psychiatrists participated in the study, performed in the years 1999-2000. Data of 179 patients with the first depressive episode, 170 patients with the second episode and 183 patients with third or further episode were included in the analysis. Results. At the beginning of the observation, the groups of patients did not differ as to age, proportion of gender and intensity of depression, both global and particular symptoms. Patients with the first depressive episode were included into the study after longer duration of symptom occurrence and were more often treated with new generation antidepressants. Comparison of the course of disease revealed higher intensity of depressive symptoms, both global and particular clusters after 6 months and 12 months of treatment, and lower percentage of remission in patients with multiple episodes compared to the first episode group. The type of antidepressant was not significantly related to the efficacy of treatment. Ten patients (2%) had suicidal attempts, one (0,2%) with fatal outcome: in first episode group they were made during initial period of treatment, in multiple episodes - later in the course. Conclusions. The results obtained indicate that the course and the treatment outcome of subsequent depressive episodes are less favourable compared to the first depressive episode. Treatment recommendations for depression may be varified based on the results of the study.

Retrospektywna ocena tolerancji leczenia lekami przeciwdepresyjnymi u pacjentów z rozpoznaniem depresji, z różnym genotypem CYP2D6  433
Retrospective assessment of the antidepressants tolerance in the group of patients with diagnosis of depression and different CYP2D6 genotype  433
Magdalena Grzesiak, Aleksander Beszłej, Arleta Lebioda, Anna Jonkisz, Tadeusz Dobosz, Andrzej Kiejna
Summary
Aim: The majority of antidepressants undergo the oxidative biotransformation catalised by cytochrome P-450, particularly by izoenzyme CYP2D6, whose activity is genetically determined. In many cases poor tolerance of antidepressants depends on CYP2D6 activity. The aim of the study was the evaluation of the relationship between the CYP2Dg genotype and the occurrence of side effects during antidepressive pharmacotherapy. Method: Eighty nine patients were included into study. During the last episode of depression all included patients were treated with antidepressants, whose metabolism is catalised mainly by CYP2D6. Based on medical records and patient interview the occurrence of side effects was evaluated. The genetic material was isolated from the patients' saliva. Genotyping of CYP2D6 was performed using the PCR techniques. The most frequent inactive alleles in the Caucasian population, *3 and *4 were identified. Alleles that were not identified as *3 or *4 were stated as active allels *1. Results: Based on retrospective analysis among patients treated with antidepressants during the last episode of depression 42 patients (47,2%) reported severe side effects. Comparing to the group of patients with wide type genotype ( *1/ *1), in the group with the genotype including at least one inactive allel, side effects occurred significantly more frequently. Conclusion: In this group, comparing to the group of patients with wide type genotype, severe side effects that required discontinuation of antidepressants also occurred significantly more frequently.

Elektrowstrząsy w leczeniu depresji w wieku podeszłym  445
Electroconvulsive therapy in the treatment of depression in the elderly  445
Ewa Hordyńska, Danuta Palińska, Tomasz Sobów
Summary
Introduction: The use of a electroconvulsive therapy (ECT) in the elderly suffering from depression is still controversial in Poland. Not only psychiatrists but also specialists who qualify the patients for ECT - internal medicine specialists, neurologists and anaesthesiologists - treat the advanced age of a patient as a contraindication to ECT. It is also believed that ECT has adverse influence on the mental state of patients with the so-called psychoorganic syndrome. In most centres in Poland ECT is reserved for patients with drug-resistant depression and those in whom pharmacotherapy is contraindicated for any reason, such as pregnancy. Nevertheless the patients are carefully selected with respect to their physical condition. In many countries however the older the patient, the more likely he/she is to receive ECT as a method of choice. The effectiveness of this method in elderly patients is considered to be higher than in younger groups. ECT seems to be particularly effective in depression with psychotic symptoms and psychomotor retardation. The adverse effect of ECT on cognitive functions (learning and memory) which is a great concern of both doctors and patients, is actually noted in a small group of patients and usually transient. Moreover, the frequency of occurrence of this effect in elderly is not greater than in younger patients. Aim: We have been encouraged to write this paper by very promising results achieved in patients treated with ECT in the Psychogeriatric Ward of the Ist Department of Psychiatry, Medical University of Łódź. Method: All 7 patients were diagnosed with severe depressive episode (in 4 cases with psychotic symptoms) in the course of either recurrent depression (6 cases) or bipolar disorder (1 case). Results: In all patients at least partial improvement was noted. It seems that ECT, assuming careful patient qualification, is an effective and safe method of therapy in elderly patients.

Zaburzenia depresyjne u pacjentów w podeszłym wieku objętych stacjonarną długoterminową opieką  457
Depression disorders in aged patients in stationary long-term care conditions  457
Artur Ostrzyżek, Józef Kocur
Summary
Aim: The prevalence of depression-type disorders in patients of over 65 years staying in a long-term care department was evaluated. Method: The 15 item Geriatric Depression Scale was used in this evaluation. Results: In the examination carried out almost 68% of the patients showed sub-depression symptoms, and in more than 25% cases depression was diagnosed. No crucial connection between the age of the examined and the depression symptom intensification and also between the living efficiency evaluation and the GDS-15 was diagnosed. There was no significant correlation between the cognitive functions evaluation and the GDS-15 one either. Conclusions: In order to improve the quality of life of depressive patients in stationary long-term care it seems necessary to give them psychogeriatric help along with early diagnosis and treatment of depression

Zespół anankastyczno-depresyjny u chorego z torbielą przegrody przezroczystej. Psychiatryczne i psychologiczne studium przypadku  463
Obsessive-compulsive disorder in a patient with septum pellucidum cyst. Psychiatric and psychologic case study  463
Piotr Radziwiłłowicz, Wioletta Radziwiłłowicz, Anita Krystoforska, Wiesław Jerzy Cubała
Summary: The aim of this paper is to introduce the bases of neurobiology, embryology and pathology of one of the important structures of the limbic system - septum pellucidum. The presented patient was diagnosed with a septum pellucidum cyst, OCD and depression. The following diagnostic methods have been applied: Beck Depression Inventory, Ways of Life, Rorschach test, Subscales: Similarities, Comprehension, Digit Span of the Wechsler Intelligence Scale, Long-term Memory Subscale of the Choynowski's Memory Scale, verbal fluence test, Rey Complex Figure, Diagnosis of Brain Damages (Weidlich, Lamberti). The patient presented global impairment of the examined cognitive functions. Within the personality domain the following features were found: symptoms of obsessive-compulsive disorders (discrepancy of necessity of self-control and with impulsiveness, perfectionism), depression (dependence from other, mood disturbances, psychasthenia), epileptoidal personality (shallowing of mental life, egocentrism, aggressiveness, affect occurrence).

Kiła ośrodkowego układu nerwowego i jej psychopatologiczne następstwa. Przegląd piśmiennictwa  477
Neurosyphilis with its psychopathological implications. Literature review  477
Andrzej Rozwens, Piotr Radziwiłłowicz, Katarzyna Jakuszkowiak, Wiesław Jerzy Cubała
Summary: The aim of this paper is to present the up to date literature review on neurosyphilis and its psychopathological implications. The authors briefly describe the history of lues, its aetiology with pathomechanisms, epidemiology, clinical aspects with the emphasis on the CNS, coincidence with HIV infection, groups of risk, diagnostic aspects of lues and the therapy. The authors' intention is to stress the importance of lues in clinical differentiation in today's psychiatric practice since it happens to be omitted in the course of the diagnostic process.

Aktywność N-acetylo-b-heksozoaminidazy i g-glutamylotransferazy w surowicy osób uzależnionych od alkoholu hospitalizowanych po okresie przewlekłego picia  495
The activity of N-acetyl-b-hexosaminidase and g-glutamyltransferase in the serum of alcohol dependent people hospitalised after a long-lasting drinking period  495
Tomasz Markowski, Mirosława Ferens-Sieczkowska, Krzysztof Zwierz, Aleksandra Wojtulewska
Summary
Aim: The aim of the study was to compare the activity of N-acetyl-b-hexosaminidase (HEX) and g-glutamyltransferase (GGT) in the serum of alcohol dependent people hospitalised after a long-lasting drinking period. Method: The studied group consisted of 30 alcohol dependent men hospitalised after a long-lasting drinking period. The control group consisted of 30 healthy men - social drinkers. The activity of HEX was determined with colorimetric method Chatteriee (modified by Zwierz). The activity of GGT was determined by kinetic method. Results: The medium activity of HEX in the serum in the studied group on the 1st day of abstinence was 2.3 times higher than the control group (p<0.05). The activity of HEX decreased during abstinence. Starting from the 10th day of abstinence the activity of HEX was similar to the control group. The medium activity of GGT in the serum of the studied group on the 1st day of abstinence was 7 times higher than in the control group (p<0.05). The activity of GGT decreased during abstinence. On the 30th day of abstinence the activity of GGT in the studied group was 2.7 times higher as compared to the control group (p<0.05). Conclusions: The activity of HEX and GGT in the serum significantly increases during long-lasting drinking period in alcohol dependent people. Increased HEX activity in the serum can be a more sensitive marker of long-lasting drinking period than GGT activity. The normalisation of HEX activity in the serum during abstinence in alcohol dependent people takes place significantly faster than the normalisation of GGT activity.

Chronobiologiczne aspekty działania alkoholu etylowego  503
Aspects of chronobiological effects of ethanol  503
Tomasz Czarnecki, Elżbieta Czarnecka
Summary: Circadian rhytms regulate various life processes in plants, animals and in humans. These rhytms are generated by an endogenous mechanism called the biological clock. It has been known that there is circadian variability of receptors susceptibility to drugs and circadian changes of drugs kinetics. Biological effects of ethanol raise interest of many researchers due to consequences of its use. Effects of ethanol on various ion channels and receptors suggest that its action may also depend on circadian rhythms and may modulate action of the biological clock. Experimental studies on animals and humans have shown that circadian variability influcences hypnotic and hypothermic effects of ethanol, cortisol levels, ethanol pharmacokinetics and ethanol intake. Chronic ethanol administration influence thyroid and sex hormones excretion, stimulate the HPA axis and changes various circadian rhythms (of sleep, motor activity and food intake). Changes in circadian ethanol effects may have significance for toxicity and interaction with drugs. Disturbances of circadian rhythmis in alcohol-dependent patiens may case therapeutic problems.

Zagrożenie narkomanią w wojsku  511
Threat of drug addiction in the army  511
Marian Jędrzejczak, Józef Kocur
Summary
Drug addiction belongs to those phenomena of social pathology with complex canses, mechanisms and conditionings. Drug addiction mainly concerns young people, also those from the military environment despite the fact that recruitment boards consider detected drug addicts-conscripts to be completely or temporarily unfit for service. Aim: The aim of this study is to assess the scale of drug addiction among soldiers taking into account the reasons and range of the phenomenon. Method: Using the method of the auditorial questionnaire, the tests were carried out on the amount trial among servicemen using anonymous questionnaires. The tests were performed in 1996 and the trial consisted of 552 soldiers and then they were repeated using the same questionnaire among 682 soldiers in 2001. Results: It was found that in the years 1996-2001 the number of soldiers using psychoactive agents increased threefold. Marijuana and amphetamine were the most frequently used drugs. Nearly half of the soldiers tested think that in the army there are no problems with the supply with drugs, and over half of those who take drugs are of the opinion that drugs do not disturb their ability to service. The results of the tests point to the following conclusions: in 2001 16,6% of the tested soldiers confessed to having contact with drugs, in 1996 this result was 5,1%. Conclusion: Marijuana and amphetamine still are the most popular among active soldiers. Although majority of servicemen consider taking drugs as a negative phenomenon, every tenth tested soldier pointed to positive effects of their taking. First contacts with drugs the tested soldiers had as early as in secondary school (58,3%), whereas as many as 25% of the tested subjects reported that they had the first contact with drugs in the army.