38, 3


Błędy w opiniowaniu sądowo-psychiatrycznym - analiza zjawiska  385
False forensic expertise - analysis of the phenomenon  385
Janusz Heitzman
Summary
Main problems that await the modern Polish forensic psychiatry are presented. The most common mistakes made in forensic expertise are discussed and their causes are shown. The need for a change in the manner of teaching forensic psychiatry at an academic, as well as post graduate level to medical students/doctors as well as law officials, has been stressed. The criteria for calling on experts, system of control and evaluation of the expertise formulated and rules of payment to the experts - all need changing. The altered criminal structure and possibilities of putting pressure on experts through corruption, threatening or blackmail were noted. The clearly defined status of the forensic psychiatric expert gives him a guarantee of legal defence and through this an unbiased position. Giving forensic expertise is not only part of the diagnostics in forensic psychiatry. An even layout of protection, treatment and rehabilitation of psychiatrically ill criminals has to be present in this system.


Składowa P50 słuchowych potencjałów wywołanych u chorych na schizofrenię i ich krewnych pierwszego stopnia   395
P50 component of auditory evoked potentials in persons with schizophrenia and their first degree relatives  395
Jacek Węgrzyn, Jacek Wciórka
Summary
A pair of auditory stimuli presented in a 0.5 second interval cause a reduction of the P50 auditory evoked potential (P50 AEP) amplitude after the second stimuli in the pair. In some, but not all studies, a clear deficit of such P50 AEP gating was observed in schizophrenic patients. It was present constantly irrespective of the clinical state. This deficit was also found in first degree relatives of schizophrenic patients. However the results of the studies, as well as their interpretation remain controversial. Aim: To differentiate between P50 AEP in groups of schizophrenic patients, their healthy first degree relatives, as well as those in the control group. Method: 50 schizophrenic patients (ICD-10 criteria (DCR)) in early clinical improvement phase, 26 healthy first degree relatives, as well sa 46 healthy individuals with no psychiatric illness in the self-report and family history. All those studied were stimulated with 120 pairs of auditory stimuli (clicks), each of duration 2 msec and a sound intensity of 73dB, with a 500 msec interval between the stimuli in a pair (S1 and S2) every 8 seconds. A high-end filter of 70Hz and low-end filter of 10Hz were applied. Bio potentials were recorded from the head apex, relatively to the mastoid process (A1 + A2). Eyeball-movement artefacts were registered from the Fp1 - A1 and Fp2 - A2 potentials. The registered bio potentials were evened on-line. Results: Relative (i.e. evaluated in relation to the potential after S1) lowering of the P50 potential after S2 was the most significant in the healthy control group (75%), in the other groups usually there was an increase in the S2 potential - higher in the schizophrenic patient group (-45%) and lower in their first degree relatives (-11%). Conclusions: (1) Healthy individuals suppressed the neurophysiologic response to the second pair of auditory stimuli much more than the schizophrenic patients and their healthy families. (2) No difference was seen in the suppression of the response between the schizophrenic patients and their first degree relatives. The results are coherent with the idea of the dysfunction of the P50 gating having endophenotypic traits as far as schizophrenia goes.


Cechy osobowości a związki małżeńskie osób chorych na schizofrenię  409
Personality and marriages of schizophrenic patients  409
Katarzyna Uznańska, Jan Czesław Czabała
Summary
Aim: The aim of this research is to compare some personality factors like self-perception and perception of an ideal partner in two groups of schizophrenic patients. The first group is people ill with schizophrenia who have been married for at least a year and the other group is unmarried people ill with schizophrenia who were not previously married or in a relationship for longer than a year. Method: In this study, using The Adjective Check List - ACL by H.G. Gough and A.B. Heilbrun (Polish translation by M. Matkowski), has been used as an instrument for evaluation self-perception and perception of an ideal partner. Results: Results of the research corroborate differences between chosen personal dimensions in compared groups of people ill with schizophrenia. There were statistically substantial differences in some scales of ACL between the married and unmarried schizophrenic patients. The married patients were characterized by a larger number of positive adjectives chosen, higher results in the scales of: FAV - Favourite, NUR - Nursing, HET - Heterosexuality, CHA - Change, CPS - Creative personality, UGD - Amicability; and lower results in the scales of: CRS - Care support. Perception of an ideal partner differentianted the groups in a lower degree. Two scales proved to be statistically substantial: NUR - Nursing, CHA - Change. The married patients were substantially weaker in displaying such needs towards their ideal partners. Conclusions: What differs the group of married people ill with schizophrenia from unmarried people ill with schizophrenia is mainly personality features connected with the need to initiate and keep up interpersonal contacts. The married patients want such relationships, are more prone to compromise and do something for others and are less afraid of changes. They also have lower expectations of their ideal partners as to the care of others. They do not expect their ideal partners to be ready to change as much as unmarried patients.


Różne podejścia do koncepcji brzemienia rodzin osób z rozpoznaniem schizofrenii  421
Different approaches to the concept of family burden in schizophrenia  421
Szymon Chrząstowski
Summary
This paper explores selected theoretical and experimental issues related to the notion of burden. The burden is a phenomenon which appears not only inside families with diagnosed schizophrenia but also in families of people presenting a different kind of psychic disorder or those being mentally handicapped. Using the term "family burden" is not usually followed by such operationalisation of the notion, that would unable its investigation in the family system. Research does not say which sociodemographic and psychosocial factors have a decisive impact on the level of the noticeable burden. It seems, however, that a minor role should be attributed now to sociodemographic factors, while methods of overcoming the problems are the most significant. Findings let us think that objective factors composing the burden are individually judged by care givers who work with people with psychic disorders. This evaluation decides how important a specific factor is. This situation makes us reconsider the traditional division of the objective and subjective burden. The symptoms that might be noticed with the patients are not the only predictors of the burden. The source of care givers' burden is not directly connected with the psychopathological symptoms but rather with a deficit in a patient's sphere of functioning. While analysing the burden inside families of patients with psychic disorders it should be remembered that the reason can be not only problems related directly to the illness but also a number of unspecific factors saddling the family like unemployment, poor living conditions, difficulties at work, at school etc. Findings presented in this article disclose a poor precision of existing burden definitions resulting from a lack of a consistent conception of this phenomenon. The author attracts our attention to socio-cultural conditioning of the burden and shows how people with mental disorders positively contribute to family life. Nowadays the classical concept of the burden is more often replaced by stress management models. In the conclusion the author points out that the research on burden conducted so far is rather insufficient.


Ocena efektywności psychoedukacji w grupach pacjentów psychotycznych i depresyjnych - badanie pilotażowe  433
The effectiveness of psychoeducation in schizophrenic and depressive patients - preliminary report
Regina Popławska, Andrzej Czernikiewicz, Agata Szulc, Beata Galińska, Beata Konarzewska, Inessa Rudnik-Szałaj  433
Summary
Earlier studies suggest that psychoeducation as a form of psychosocial care is of value in improving the patient's attitude towards mental illness as well as in reducing and delaying the relapse rates of both - psychotic and depressive disorders. Aim: The aim of this study was the evaluation of influence of psychoeducation on clinical symptoms, quality of life and drug attitude in schizophrenic and depressive patients. Method: 52 patients, aged 18-50 years, hospitalized in the Department of Psychiatry of Medical Academy in Białystok, were involved in the study. They were randomly assigned into 2 groups: on medication without psychoeducation (12 schizophrenics, 12 depressive patients) and on medication and psychoeducation (16 schizophrenics and 12 depressive patients). The patients were assessed by means of BPRS, BNS, IMHC 2000, Raskin/Covi Scale, DAI-10. The assessment was performed twice - shortly after admission and before discharge from the hospital.
Results: The patients in both groups showed improvement in symptoms and in quality of life. Patients on psychoeducation changed their drug attitude positively significantly more often. Conclusion: Knowledge about the positive influence of medication on psychiatric symptoms helps to improve compliance and improves the course of disease.


Znaczenie wsparcia społecznego dla jakości życia chorych na schizofrenię  443
The role of social support on the quality of life of patients with schizophrenia  443
Krystyna Górna, Krystyna Jaracz, Janusz Rybakowski
Summary
The importance of social support for mentally ill people has been increasingly emphasized in recent years. This has resulted from studies showing that family and professional support plays an important role in preventing rehospitalisations and in improving quality of life of patients with schizophrenia.
This article presents and analyses the findings of current research concerning the effectiveness of social support in rehabilitation programs as well as highlights the problem of matching the type and quantity of social support provided to the patients' needs and to the phase of the disease.


Ocena skuteczności i tolerancji amisulpridu u pacjentów ze schizofrenią: wyniki 6-miesięcznego otwartego badania klinicznego  453
Efficacy and tolerability of amisulpride in patients with schizophrenia: results of a 6-month open study  453
Małgorzata Rzewuska, Wojciech Kuczyński, Małgorzata Luks
Summary
Aim: 6-month multicentre, observational, open study evaluated the efficacy and tolerability of the new generation antipsychotic drug amisulpride in patients with acute schizophrenia. Method: 99 patients were included in the study, 72 (72%) completed the 6-month observation. Results: Marked improvement in CGI after 6 months of treatment was observed in 56 (56%) patients. Therapy with amisulpride reduced both positive (20% reduction of positive symptoms in the PANSS positive subscale in 78%) and negative symptoms (20% reduction of negative symptoms in the PANSS negative subscale in 77%). Conclusion: Amisulpride was well tolerated, adverse events responsible for premature withdrawal from the study were observed only in 6% patients.


Prospektywne badanie oparte na obserwacji chorych na schizofrenię w Polsce - wstępne wyniki dotyczące skuteczności i tolerancji leczenia po 6 miesiącach  469
Prospective observational study of outpatients with schizophrenia in Poland: preliminary 6 month efficacy and tolerability results  469
Joanna Meder, Grażyna Dębowska, Joanna Lis, Aleksander Araszkiewicz, Katarzyna Sierosławska, Andrea Kolesaric, Tamas Treuer
Summary
Aim: To compare the effectiveness and tolerability of olanzapine and other antipsychotic treatments (6 months after enrollment) in Polish patients with schizophrenia participating in the IC-SOHO (the Intercontinental Schizophrenia Outpatient Health Outcomes) study. Method: IC-SOHO is a 3-year, global, prospective, observational study examining health outcomes in outpatients with schizophrenia undergoing treatment with antipsychotics. Patients were offered enrollment by a psychiatrist if they initiated or changed antipsychotic medication for the treatment of schizophrenia. The study was designed to provide two patient cohorts of approximately equal size: patients who initiated or switched to olanzapine, and patients who initiated or switched to non-olanzapine antipsychotic therapy. Mean changes in positive, negative, cognitive, depressive and overall symptoms from baseline to 6 months, as measured using the CGI scale, were assessed. The incidence of extrapyramidal symptoms and sexual dysfunctions and weight changes were compared. Results: Out of 7648 patients participating in the IC-SOHO study, 626 patients were enrolled in Poland. After 3 and 6 months of treatment, significantly greater improvement in overall symptoms measured using the CGI scale was observed in patients with olanzapine than in those with other antipsychotics. Response rate at 6 months was significantly higher in the olanzapine group than in the non-olanzapine group. Incidence of extrapyramidal symptoms and sexual dysfunctions was lower in olanzapine group. Conclusions: After 6 months, olanzapine-treated patients showed greater improvement of clinical status compared with other antipsychotic treatment. Olanzapine treatment was more beneficial for patients; comparing to other antipsychotic treatment less extrapyramidal symptoms and sexual dysfunctions were observed.


Zastosowanie wysokich dawek olanzapiny w leczeniu ostrego nawrotu schizofrenii u pacjenta ze złą tolerancją neuroleptyków klasycznych. Opis przypadku   485
Use of high-dose olanzapine for treatment of acute relapse of schizophrenia in a patient with bad tolerance of typical neuroleptics. Case report  485
Arkadiusz Niedoborek, Anna Wójcicka
Summary
Aim: The purpose of the study was to assess the efficacy of high doses of olanzapine for treatment of the patient suffering from schizophrenia with predominance of positive symptoms. The blood levels of prolactine and glucose were monitored in order to determine the influence of high dose of olanzapine on these levels and to make a comparison between olanzapine and typical neuroleptics in this aspect. Method: The patient suffering from schizophrenia with predominance of positive symptoms, poorly tolerating typical neuroleptics and with no positive result of a standard dose of olanzapine treatment, was treated with high doses of olanzapine. PANSS was used to assess severity of symptoms, to rate side effects. The authors used Webels modification of Simpson and Angus scale. Results: During the high dose olanzapine treatment a marked reduction of PANSS score was achieved. Also the reduction of score in Simpson and Angus scale was observed, high level of this score at the beginning was due to classical neuroleptic treatment. There was no increase in blood prolactine level (in comparison with the high earlier one after typical neuroleptic treatment), whilst glucose level was not elevated. Conclusions: High dose olanzapine seems to be an effective and safe method of treatment of paranoid schizophrenia with predominance of positive symptoms in patients poorly tolerating typical neuroleptics.


Częstość występowania i rodzaj zmian dermatologicznych u pacjentów psychiatrycznych leczonych lekami psychotropowymi  491
Prevalence and type of dermatologic disorders in psychiatric patients treated with psychotropic drugs
Ewa Murak-Kozanecka, Jolanta Rabe-Jabłońska  491
Summary
Aim: The aim of the study was to establish prevalence and type of dermatologic symptoms in patients with mental disorders, treated with psychotropics drugs, and comparison of the frequency and type of dermatologic disorders after typical psychotropics and new psychotropic drugs, and assessment of relationships between diagnosis of mental disorders and type of dermatologic symptoms. Method: In the study 4041 patients hospitalized and treated with psychotropic drugs in a psychiatric hospital took part. Dermatologic consultation was conducted in 340 patients, but only 98 were in monotherapy. This group was assessed with a next procedure: questionnaire regarding demographic dates, early and family dermatologic disorders, treatment with other than psychotropics - drugs, diet, addictions and analysis of medical documentation (psychiatric and dermatologic diagnosis, actual pharmacotherapy). Results and conclusions: 8.4% of the subjects had dermatologic symptoms, which were consulted by dermatologists. 1/2 of this group had their first treatment with psychotropics. Dermatologic symptoms appeared more often in patients treated with more than 2 psychotropics than in patients in monotherapy, usually in the first weeks of pharmacotherapy. Narly 1/3rd of these subjects had allergic disorders. In subjects treated with psychotropics the most frequent dermatologic symptoms (allergic diseases, psoriasis and psoriasislike disorders) were noted after therapy with antipsychotics, next anxiolytics. In 3/4 patients treated with antidepressants had vascular diseases of the skin. In the whole group, dermatologic disorders appeared most frequently after treatment with BZD, phenotiazines and butyrophenones. New psychotropic drugs caused less dermatologic symptoms than typical antipsychotics and antidepressants.


Selektywne inhibitory zwrotnego wychwytu serotoniny - współczesne poglądy  507
Selective serotonine reuptake inhibitors - current knowledge  507
Dominika Dudek, Andrzej Zięba, Marcin Siwek, Andrzej Wróbel
Summary
This article is a review of the current state of knowledge about possibilities of clinical use of selective serotonin reuptake inhibitors in different areas of psychopharmacotherapy. The authors presented information about pharmacodynamic and pharmacokinetic differences between SSRI's, and described emerging clinical consequences. The paper contains data about the most common and typical side effects and possible drug interactions. The reports and information about new therapeutic proposals concerning SSRI's are also discussed.

 

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