Psychiatria Polska 6/2002

Marek Jarema
Współczesne koncepcje farmakologicznego leczenia schizofrenii  857
Modern concepts of pharmacological treatment in schizophrenia  857
Summary
The modern concepts of pharmacotherapy of schizophrenia, with the special emphasis put on new antipsychotic drugs were presented. The attention was put on the need for careful evaluation of the patient's state: the diagnosis, treatment which the patient receives and compliance with the treatment. It was stated that modern concepts of treatment of schizophrenia do not solely rely on the use of modern drugs, but include the multidirectional therapeutic actions with an active participation of the patient and his/her relatives.

Magdalena Grzesiak, Aleksander Beszłej
Znaczenie genetycznie uwarunkowanego polimorfizmu CYP2D6 w psychofarmakoterapii; zależność między genotypem CYP2D6 a fenotypem  869
The relevance of genetically determined polymorphism CYP2D6 in psychopharmacology; the relationship between genotype and phenotype  869
Summary
Based on literature review the paper presents some clinical aspects of the genetically determined polymorphism of the CYP2D6. One of the main biotransformation processes of psychotropic drugs is oxidation catalysed by enzymes of cytochrome P-450. CYP2D6 is an izoenzyme of cytochrome P-450. Its activity is determined genetically and is characterised by interindvidual variability. Genetically determined polymorphism of CYP2D6 is related to mutated alleles that code enzymatic proteins with different activity. Based on individual ability to oxidise drugs by CYP2D6 in population there are four phenotypically different groups: extensive (EM), ultra-rapid (UM), intermediate (IM) and poor metabolizers (PM). Each phenotype is determined by a given genotype. About 6- 10% of the Caucasian population is known as PM phenotype. Drugs used in standard doses in this group may reach a markedly higher level in blood, even a toxic level. Compered to the group with EM phenotype persons with PM or IM phenotype are more likely to suffer from side effects that are related to impaired metabolic pathways that are catalized by CYP2D6. In the group with UM phenotype (1-7% of population) metabolism is very rapid, thus they need higher doses of psychotropic drugs to reach therapeutic blood level of drug.

Andrzej Kokoszka
Perspektywy dalszego rozwoju koncepcji metabolizmu informacyjnego w psychoterapii  885
Perspectives of the development of concept of metabolism of information in psychotherapy  885
Summary
Modified Kępiński's concept of information metabolism constitutes a basis for the integrating model of psychotherapeutic diagnosis. It includes estimation of: boundaries, self-control, assimilation of new information ability, accommodation of existing schemata to new information, ability for elimination of unnecessary information, energetic resources. Outlines of concepts of psychopathology and psychotherapy there are in his publications. They have potential of general theory of psychotherapy which may constitute a background of integration of variety contemporary psychotherapeutic approaches.

Marek Drwięga
W sprawie kontrowersji związanych z kompleksem Edypa  895
On controversies around the Oedipus Complex  895
Summary
In the article the author would like to draw the readers' attention to one of the central issues of psychoanalysis, i.e. Oedipus complex. In the development of the psychoanalysis the classical conception of Oedipus complex presented by Freud gave rise to a severe criticism both on the part of some psychoanalysts, especially women such as e.g. Melanie Klein, and on the part of ethnographers such as B. Malinowski. In the paper the author presents the main controversies concerning this interesting discussion. The fact of the matter is that the Oedipus complex is a hotly debated subject, not only from the cultural point of view but also within the psychoanalytical movement.

Marek Gajowy, Witold Simon
Przemoc, zaniedbanie w dzieciństwie oraz straty ciąży - ich wzajemne powiązania oraz psychologiczne konsekwencje tych powiązań  911
Child abuse, neglect and pregnancy losses - combination and its psychological sequel  911
Summary
The authors surveyed the literature focused on childhood mistreatment and pregnancy loss. They present definitions and classifications of child abuse (emotional, verbal, physical, sexual), child neglect (physical, emotional-intellectual) and pregnancy losses (especially miscarriage and abortion). In the second part of the paper a correlation between abuse and pregnancy loss is displayed as well as a correlation between child abuse and neglect. The different kinds of pregnancy losses are viewed as similar in aspect of psychological sequel, though their intensity and particular character depends on the mother's contribution to the loss of her child. In the last part, the consequences of the above correlation are discussed. The clinical observations suggest, that abuse and neglect experienced in childhood increases the probability of pregnancy loss in adulthood. On the other hand, the loss of on unborn child is one of the factors causing child abuse and neglect.

Witold Simon, Marek Gajowy
Terapia grupowa IIPLCARR dla osób doświadczających następstw przemocy, zaniedbania i straty ciąży  929
Group therapy for people damaged by child abuse, neglect and pregnancy loss combination  929
Summary
The authors reviewed the literature focused on groups for people damaged by childhood mistreatment and pregnancy loss. They also presented IIPLCARR therapy designed for those who suffer from a sequel of abuse, neglect and pregnancy loss combination. Time limited group therapy for people damaged by abuse, neglect and pregnancy loss was designed at the Institute of Pregnancy Loss Child Abuse Research and Recovery, Victoria, Canada. The phases of the program include e.g.: realising mistreatment and damage; realising excuses, denial and resistance; training of assertion; resisting manipulation; accepting partial responsibility; facing guilt, mourning the loss of childhood; passing through despair; dead babies rehumanization and mourning; reconciliation with victims, observers and perpetrators; negotiation of realistic expectations; attenuations of unnecessary pair bonding; learning to love; celebration; good good-byes. The study of IIPLCARR therapy effectiveness is displayed as well.

Karol Mausch
Interwencje psychologiczne i ich immunologiczne konsekwencje  945
Psychological interventions and their immune consequences  945
Summary
Psychoneuroimmunology is a new tendency in science which integrates medicine and social sciences. An interdisciplinary point of view on the etiology and treatment of many diseases fortifies the empirically holistic conception which is very old in medicine. The disease is the result of the collapse of the defensive mechanisms in stress. The nervous, hormonal and immune systems are integrated. The social environment and stress influence the individual's personality and cause diseases, frequently cause immunosupression. Psychotherapy can "wake" up the immune system. The results of research in psychoneuroimmunology are particular significance for psychosomatic medicine since they explain in a systemic way the earlier clinical observations and scientific studies concerning the influence of stress on the health condition. Studies of the immune system conditioning and the influence of this the relaxation training on this function are very important in coping with the disease.

Maria Załuska, Jolanta Paszko
Znaczenie środowiskowych placówek rehabilitacji i oparcia społecznego dla ograniczenia hospitalizacji psychiatrycznych   953
The importance of community services for rehabilitation and social support concerning minimalisation of psychiatric hospitalizations  953
Summary
Goal: The evaluation of community services for social support concerning minimalisation of psychiatric hospitalizations. Method: Mean duration, global time and the number of stays in hospital ward, day treatment ward and "home hospitalization"; in two year periods before and after their admission to an Occupational Therapy Workshop (O.T.W.), a Community Home Of Mutual Help (C.H.O.M.H.) or to Community Specialized Social Help Services (C.S.S.H.S.) at home were compared in the group of 73 chronic patients. Results: In two years after the admission to the social support units, the number of all the hospitalizations was decreased (twice or three times). A mean duration of stay in the hospital ward and in the day treatment ward shortened (from 101 days to 48,4 days, from 108 days to 73,3 days), and "home hospitalization" prolonged (from 112 days to 190 days). The global time of stay in the hospital and in the day ward became significantly shorter (by 12,2% and 5,1%), but "home hospitalization" did not change significantly. The most effective was the care of specialised services at home connected with the participation at the same time in one of the day units O.T.W. or the C.H.O.M.H. (16 persons). The minimalisation of the number (3x) and the time of staying in the day treatment ward referred to the participants of the O.T.W. or the C.H.O.M.H. (by 7,2% , 7,9%), but not of the C.S.S.H.S. at home. Conclusions: Introducing of O.T.W., C.H.O.M.H. and C.S.S.H.S. resulted in a significant reduction of hospital stays. The best results come from the combination of the care given by the daily units (O.T.W. or C.H.O.M.H.) with specialized services at home. The care supplied at the O.T.W. or the C.H.O.M.H. reduced the number and time of staying in the day treatment ward.

Piotr Radziwiłłowicz, Wioletta Radziwiłłowicz, Joanna Lis
Wpływ leczenia olanzapiną na funkcje poznawcze u chorych na schizofrenię  967
Effect of olanzapine treatment on cognitive functions in patients with schizophrenia  967
Summary
Aim: The aim of this study was to assess whether olanzapine treatment results in an improvement of cognitive functions that became impaired by the schizophrenic process. Method:  The correlation of the intensity of schizophrenic symptoms and duration of the disease with the level of cognitive functions were also examined. The schizophrenic patients were examined in three steps: before beginning of olanzapine treatment, after 6 weeks of treatment, and after approximately 12 months since the beginning of the olanzapine treatment. 36 patients were examined (9 female, 27 male) aged 20-53 (X = 25.4). The following tests were applied: Positive and Negative Syndromes Scale - PANSS, Squire's Memory Questionnaire, sub-scales: Digit span and Similarities of the Wechsler's Intelligence Scale, Long-term memory sub-test of the Choynowski's Memory Scale, Diagnosis of Brain Damages, Clock Completion Test, Decroly's Box. Results: The olanzapine treatment of schizophrenia was characterized by significant antipsychotic efficacy including both positive and negative symptoms. The positive symptoms were associated with the attention range, the planning process context and the immediate memory with the tendency towards loosing remembrance in the process of non-verbal learning. The negative symptoms were associated with concrete conceptual thinking. Improvement of cognitive functions was noted for almost all of the examined functions. The effect of olanzapine therapy in schizophrenic patients may be regarded as personality integrating.

Wioletta Radziwiłłowicz, Piotr Radziwiłłowicz
Subiektywna i obiektywna ocena funkcji pamięciowych u chorych na schizofrenię leczonych olanzapiną  989
Subjective and objective assessment of memory functions in patients with schizophrenia treated with olanzapine  989
Summary
Schizophrenic patients often complain of intellectual functioning impairment. The aim of this survey was to define the subjective memory loss by means of objective tests. The tests were carried out in three steps: before the admission to the clinic, after 6 weeks of hospitalisation, and after approximately 12 months from the beginning of the olanzapine treatment. 36 patients were examined (9 female, 27 male) aged 20-53 (X=25,4). The following tests were applied: PANSS, Memory Questionnaire (Squire, Zouzounis 1988), subscales: Digit span and Similarities of the Wechsler Intelligence Scale, subtest for Long-term memory of the Choynowski's Memory Scale, Diagnosis of Brain Damages (Weidlich, Lamberti), Clock Completion Test, Decroly Box. The subjective assessment of memory functioning improved during the treatment with olanzapine. Before the hospitalization and after 6 weeks of treatment patients' memory complaints were associated with the visuospatial memory. After 12 month of the olanzapine therapy the memory complaints were associated with auditoverbal memory. Age, level of education and objective intensity of psychopathological symptoms did not influence patients' subjective assessment of memory functioning.