Psychiatria Polska 1/2003

Leki antypsychotyczne drugiej generacji: podobieństwa i różnice  7
Second generation antipsychotics: similarities and differences  7
Marek Jarema, Janusz Rybakowski, Jerzy Landowski
Second generation antipsychotics share some similarities but display also differences in their action. The pharmacological profile as well as the clinical efficacy and tolerability of these drugs currently on the market in Poland have been described. The analysis of their properties reveals distinct differences between the drugs. Those differences underline the value of the medications in the treatment of psychotic disorders. The differences allow tailoring the antipsychotic therapy to the individual needs of each single patient. Such a possibility to use the pharmacological agents according to the needs of the patient makes an important feature of the second generation drugs. At the same time it indicates that obvious differences in action exist inside the group.

Jadłowstręt psychiczny u dorosłych kobiet  29
Anorexia nervosa in adult women  29
Jolanta Rabe-Jabłońska
Summary
Aim and method: The author presents the clinical picture of anorexia nervosa and comorbidity in women with serious symptoms of anorexia nervosa (diagnosed acc. to DSM-IV), which appeared in adulthood, after the age of 25 years. Results: Most of these patients (25-40 years old) had mild symptoms of eating disorders (restricted anorexia nervosa), from adolescence, never diagnosed and treated, had a nondisturbed somatic state and social functioning. The worsening of psychic state and full development of anorexia nervosa symptoms occurred during stressful life event (eg. avoidance by sexual partner). The majority of those patients had present and past (from adolescence) various anxiety and depressive disorders and personality disorders (obsessive - compulsive, borderline). In most of the women older than 40 years, anorexia nervosa comorbided with depressive disorders, less often with mixed, anxiety - depressive, disorders. The symptoms occurred during menopause, after loss of life-partner (separation or death). It was not established, which of these disorders appeared as the first one. The prognosis was better for the second group of those patients.

Czynność tarczycy a metabolizm tłuszczów u osób z jadłowstrętem psychicznym  39
Thyroid function and lipid metabolism in patients with anorexia nervosa  39
Alicja Smorawińska, Eugeniusz Korman, Andrzej Rajewski, Alicja Karlik
Summary
Aim: There are clinical similarities between anorexia nervosa (AN) and hypothyroidism. Previous reports have shown (FT3, (rT3, sporadically (FT4 and normal levels of serum TSH. Method: To assess thyroid function in 36 patients with AN (4 males, 32 females the subjects ages ranged from 12 to 18 yrs) serum levels of FT4, FT3, rT3, TSH were measured. Out of this group, 24 patients have been singled out to examine the lipid metabolism by measuring the level of cholesterol, HDL, LDL, triglicerides. Results: 67% (24) of the examined group resulted in low level of FT4 (0,75-0,97 ng/dcl), but ŻFT3 (=0,67 pg/ml) was only found with 1 patient. The level of rT3 (measured in 94% (34) patients) were normal. The level of TSH were low (0,87-0,97 (IU/ml) in 25% (9) of patients, but 6 of them also manifested (FT4 (0,87-0,97 ng/dcl). At the same time, we found higher level of cholesterol in 63% of patients, (HDL in 71%. It is interesting to notice that in 80% of cases with a lipid metabolism disorder we found (FT4. Conclusions: Thyroid dysfunctions may be one of the essential reasons for lipid metabolism disorder in AN.

Badanie asocjacyjne polimorfizmu genu receptora serotoniny 5-HT2A w jadłowstręcie psychicznym w populacji polskiej  47
Association study of 5-HT2A receptor gene polymorphism in anorexia nervosa in Polish population  47
Filip Rybakowski, Agnieszka Słopień, Monika Dmitrzak-Węglarz, Piotr Czerski, Joanna Hauser, Andrzej Rajewski
Summary
Aim: Anorexia nervosa (AN) is a disorder of complex etiopathogenesis including the genetic factors. The previous studies on the role of -1438 A/G promoter polymorphism in 5-HT2A receptor gene brought conflicting results, and it is possible that the analysed polymorphism increases the risk of AN only in some ethnic groups. The aim of the study was to assess the frequency of -1438 A/G polymorphism in Polish patients with AN and ethnically matched healthy controls. Method: The genotyping of 5-HT2A receptor polymorphism was performed in 67 AN patients and 114 healthy controls. The frequencies of alleles and genotypes were compared with Chi2 test. Results: The deviations from the Hardy-Weinberg equilibrium were not observed in any group. The frequencies of A/A, A/G and G/G genotypes in AN group were respectively: 37.3%, 50.7% and 11.9%; and in the control group: 40.4%; 47.4% and 12.3% (chi2= 0.2; df=2; p=0.91). The prevalence of A and G alleles in the AN group was respectively 62.7% and 37.3%; and in the control group 64.0% and 36.0%; and did not show any statistically significant difference (chi2=0.67; df=1; p=0.79). Conclusions: These results suggest that -1438 A/G polymorphism in the promotor region of the 5-HT2A receptor gene does not increase the risk of AN in the Polish population.

Depresyjny przebieg dorastania jako czynnik ryzyka powstawania zaburzeń psychicznych - piętnastoletnie badania prospektywne  57
Adolescent depression as a risk factor for the development of mental disorders - 15 years prospective follow up  57
Jacek Bomba, Renata Modrzejewska, Maciej Pilecki
Summary
Aim: Assessment of impact of adolescent depression on the development of mental disorders, substance dependency and social pathology in adulthood, and difference of the risk between depression in early and middle adolescence. Method: In 1984 prevalence of depression was assessed in a representative sample of adolescent urban population. Kraków Depression Inventory (KID) was used as a screening tool. In 2000 all participants of the earlier phase of the study were informed by mail about the tasks of the project and asked to answer attached the questionnaire. Information on care was collected from district psychiatric hospitals and local intoxication centres. 985 letters were sent (introductory data about 50 persons were not complete). 50 letters were returned without an answer. 256 persons (168 women and 87 men) responded. Results: A statistically significant relation was observed between adolescent depression and worse general health condition and cigarette smoking. Mid-adolescent depression in men was related with a lack of significant partnership, while in women with motherhood and disrupted marriage. Early adolescent depression in women was related with less extended extra-familiar social relations. Women depressive in mid-adolescence, on the contrary, declared more relations of this kind. Conclusions: Adolescent depression screened by KID seems to influence a general health status and social relations, especially in women. The character of this impact is not clear. Gender is of a more important role in comparison with the stage of adolescence in which depression appeared.

Czynnik środowiskowy a obawy i lęki adolescentów  71
The environmental factor and adolescent fears and anxiety  71
Jan Fenczyn
Summary
Aim: The following article aims to show the significant part that the environmental factor plays in developing fears and anxiety in adolescence. Both literature and psychological practice underestimate the role of that factor, emphasising at the same time the influence of sex, age or various types of stimulants causing negative emotional states. Method: In order to verify the suggested hypotheses, 540 adolescents in 18 groups of 30 people divided according to sex (270 girls and 270 boys), age (90 individuals of both sex in the following age groups: 12.0-13.0, 15.0-16.0 and 18.0-19.0) originating from three different environments: big city, town and village (180 individuals from each place) were examined. The following instruments of research have been used: MPi-64 of H.J. Eysenck, STAI of C.D. Spielberger and original Questionnaire of Anxiety. Results: The results of the examination have confirmed the authenticity of the suggested hypothesis which stated that intensity of fears and anxiety depends on the types of stimulants, sex, age and particularly - on the kind of environment the individuals under examination have originated from. The second hypothesis was partially confirmed. In the group of boys the level of courage corresponded with the level of fear; in the group of girls in general the level of fear exceeded the level of courage. Conclusion: Socially-educational environment has a decisive influence on developing fears and anxiety, particularly on the intensification of those disorders. The village environment is the most conducive to developing strong fears, when the environment of a big city - the least. Other variables (sex, age, type of stimulant) have indirect influence on the substance and level of fears experienced by adolescents.

Występowanie lęku społecznego wśród reprezentatywnej grupy młodzieży z Łodzi  87
The prevalence of social phobia in a representative group of adolescents from Łódź  87
Jolanta Rabe-Jabłońska, Anna Dietrich-Muszalska, Agnieszka Gmitrowicz
Summary
Aim: Recent epidemiological studies have produced a remarkable variation in the estimated life-time prevalence of social phobia, ranking from 0.5% to 22.6%. About 95% of social phobia occurs prior to the age of 20, approximately 40% prior to the age of 10. Studies of mainly patient samples report a mean age of onset of 14.6 to 20 years. Method: In cooperation with GUS, the year 2000 we assessed with a specially prepared questionnaire including DSM-IV criteria for social phobia and CIDI, the prevalence of specific and generalised type of social phobia in a representative group of adolescent population from Łódź. Subjects of the study (n=1929) were chosen from 36450 adolescents. Results: We found, that generalised social phobia was present in 7% of subjects, specific subtype in 17% of subjects, more frequently in women than in men (p<0.05), with the same prevalence in adolescents from various type of schools. 15% of adolescents with social phobia were alcohol or psychoactive drug abusers, 5% attempted suicide. Conclusion: Only 1/4th of adolescents with social phobia was in psychological or psychiatric therapy. Subjects with social phobia have a high risk of other comorbid psychiatric disorders and significant worsening of social functioning.

Metody epidemiologiczne w badaniach rozpowszechnienia zespołu Tourette'a  97
Epidemiological methods used in studies of Tourette syndrome prevalence  97
Paweł Stefanoff, Jacek Mazurek
Tourette syndrome (TS) prevalence was studied since the early 80-ies. Its clinical course is characterised by co-occurrence of motor and vocal tics. Results of previous epidemiological studies were surprisingly divergent: the prevalence varied from 0,5 to 115 cases per 10 000 population. The disease previously recognised as extremely rare and severe is now considered as quite common, with often moderate course. Selected methods used in studies of TS prevalence and analysis of their possible impact on study results are presented. The studies were divided into 3 groups: studies of the hospitalised population, large-scale screenings and studies involving school population, basing on characteristic and size of population, methods of selection of subjects, diagnostic and screening methods used. Studies of the hospitalised population involved patients with most severe symptoms, in different age groups, different methods of final diagnosis confirmation were used. TS prevalence varied from 0,5 up to 15 cases per 10 000 population. Procedures used in large-scale screening studies made possible the elimination of potential selection bias. Large populations were studied using transparent and repetitive confirmation of diagnoses. Their validity was additionally checked in parallel validity studies. TS prevalence was in the range 4,3 to 10 cases per 10 000 population. The highest TS prevalence was obtained in studies involving schoolchildren. Data were gathered from multiple sources: from parents, teachers and children, as well as from classroom observation. Diagnoses were made by experienced clinicians. TS prevalence obtained in school population studies was between 36,2 up to 115 per 10 000 population.

Kontakt studentów medycyny z pacjentami w czasie zajęć z psychiatrii - oczekiwania i wzajemne interakcje  109
The relation between medical students and patients during the course of psychiatry - the expectations and fears  109
Piotr Pankiewicz, Jowita Dejewska, Aleksander Romanowski, Mikołaj Majkowicz, Anna Nitka
Summary
Aim: The aim of this study was to discover methods of preparing medical students for contacts with mentally ill people and to create educational procedures considering the exceptionality of the course of psychiatry. Method: The examined group consisted of IVth, Vth, VIth - year students of the Medical University in Gdańsk. We have analysed a group of 121 students. To perform our study we have created a questionnaire with 22 questions (enclosed). Conclusions: We have founds as follows: 1. Most of the students were at first interested in the subject; 2. Almost all of the students have actively participated in conversation with the patients; 3. Many of the students were afraid of relations with the patients; 4. The most difficult cases for the students were schizophrenic psychoses and affective diseases; 5. In the students' opinion there should be less than 4-6 students in a group; 6. In the students' opinion the time spent on conversation with one patient was too short.

Skale samooceny stanu psychicznego w schizofrenii: ocena rzetelności "Skali nastawień i nastroju" (PD-S), "Frankfurckiej skali samopoczucia" (FBS) oraz dwóch skal analogii wzrokowej  121
Self-rating scales in schizophrenia: assessment of the reliability of the Paranoid-Depressivity Scale (PD-S), Frankfurt Self-feeling Scale (FBS), and two visual analogy scales  121
Ewa Schaeffer, Jacek Wciórka
Summary
Aim: To assess the reliability of the Paranoid-Depressivity Scale (PD-S, Paranoid-Depresivitäts-Skala), the Frankfurt Self-feeling Scale (FBS, Frankfurter Befindlichkeitsskala), and of two visual analogy scales of a sense of illness (WAC) and of self-feeling (WAS). Material: 210 patients with schizophrenia of various clinical courses. Method: All patients in the study group were required to complete each scale twice (test-retest) at 48hr intervals, in order to assess each method's reproducibility. In addition, the two complex questionnaire scales were analysed for internal coherence. Results: Spearman's rho correlation coefficient for reproducibility was found to be very high for all the scales. Also, the Cronbach's alpha coefficient for internal coherence was found to be acceptably high for both complex questionnaire scales, with reference to the scales as a whole, as well as to their dimensions (paranoid and depression dimensions of the PD-S). Conclusion: patients suffering from schizophrenia can reliably use the above-mentioned scales.

Klasyfikacja Wernickego na tle innych koncepcji klasyfikowania zaburzeń psychicznych  135
Wernicke's classification and others concepts of classifying mental disorders  135
Tomasz Pawłowski, Andrzej Kiejna
The authors of this article on the basis "Uber die Klassifikation der Psychosen" analysis present the method of mental disorders' classification proposed by Carl Wernicke in 1899. Wernicke's classification was an alternative for other classification concepts existing in the 19th century. Carl Wernicke as one of the first noticed the impossibility of creating a classification based on etiology. Basing his classification concept on mental disorders localisation, he created an alternative opposed to classifications based on two main approaches: descriptive and etiological.