38, 6


Artur Pałasz
Zaburzenia czynnościowe podwzgórza u chorych na jadłowstręt psychiczny  1001
Functional disturbances of hypothalamus in patients with anorexia nervosa  1001
Summary
Anorexia nervosa is a complex disease characterized by abnormal feeding behaviour, food aversion and acute disturbances in perception of the body shape. Every eating disorder comes about as a consequence of disturbances in synaptic transmission in particular brain regions (hypothalamus, limbic system, cortical centres). The human and animal feeding physiology is precisely regulated by autonomic nuclei of hypothalamus. The perikarya of arcuate nucleus, lateral hypothalamic nuclei and other areas produce and release both the orexigenic (e.g. NPY) and anorexigenic (e.g. ?-MSH) signalling substances. The novel hypothalamic and peripheral neurohormones: orexins and ghrelin as well as serotonin and dopamine seem to play a significant role in pathogenesis of eating disorders. In anorexia nervosa simultaneous excess of orexigenic and anorexigenic factors may evoke a "mixed signal" leading to failure of hypothalamic regulatory pathways. Experimental results also suggest that women with anorexia nervosa have disturbances of regional cerebral blood flow.


Izabela Łucka, Aleksandra Cebella
Cechy kształtującej się osobowości u dzieci chorujących na jadłowstręt psychiczny  1011
Characteristic of forming personality in children suffering from anorexia nervosa  1011
Summary
Goal: the evaluation of forming personality in 30 children (27 girls and 3 boys) suffering from anorexia nervosa (average age - 13,5). Method: Anamnesis from patients and their panrents, clinical observation, the psychiatric investigation, the psychological investigation with use of following methods: The Thematic Apperception Test, Colourful Pyramids Test, The House - The Tree - The Man Test. Results: After conducted investigation and observation, the characteristics of forming incorrect personality were observed in 80% of examined children. According to DSM IV classification, in 50 % - from the bundle C, and in 30% cases - the bundle B. According to ICD - 10 classification: 26,6 % attributer of dependent personality, 16,6 % - histrionic personality, 13,3 % avoiding personality, 10 % - anancastic personality, 6,7 % borderline personality and 6,7 % dissocial personality. Conclusions: There is predominating opinion in literature, connecting restrictive type of psychical anorexia, with disorders of personality of anxiety type - the bundle C, and the figure bulimic- with personality the bundle B. Those results were confirmed with statistical significance in conducted examinations.


Beata Pawłowska, Maria Chuchra, Marek Masiak
Obraz siebie a obraz innych ludzi w percepcji pacjentek chorych na jadłowstręt psychiczny  1019
The self-image and the image of other people in perception of the patients with anorexia nervosa  1019
Summary
Aim: The aim of this study was to compare the self-image and the image of other people in perception of the female patient with anorexia nervosa. Method: Thirty women with anorexia nervosa were investigated during hospitalisation in the Psychiatric Department of the Medical School of Lublin. The mean age of patients was 20. years. The Adjective Check List (ACL) of Gough and Heilbrunn was used with the instruction: how you are, how would you like to be, how are the other people. Results: The measurement gave us the possibility to obtain the real and ideal self-image and the real image of the other people. The results showed that here are statistically significant differences between self-image and the image of other people in the perception of anorectic females in connection with self-acceptance, self-control, the need of: intraception, nurturance, exhibition, autonomy, aggression, need of abasement, deference, the scale of masculine attributes, the scale of feminine attributes and the scale of the free child. Conclusions: Significant differences occurred also in the scale of based on the results the final conclusions are as follows: 1) Anorectic females show negative self-image and even more negative image of other people. 2) According to anorectic females the people are more aggressive, more self issued, avoiding close contacts, manipulating, tending to gain autonomy and to be in the centre of the group's attention.


Beata Pawłowska, Maria Chuchra
Akceptacja siebie i rodziców przez kobiety z jadłowstrętem psychicznym  1031
The self-acceptance and the acceptance of the parents by patients with anorexia nervosa   1031
Summary
Aim: The aim of this work is to describe the ralationship between self-esteem and characteristics of self image and acceptance of parents and the characteristics of their images in the perception of patients with anorexia nervosa. Method: The test group consisted of 30 patients diagnosed with anorexia nervosa undergoing a treatment in the Department of Psychiatry of the Medical Academy in Lublin. The average age of the examined patients was 20 years. All patients had secondary education. In my work the ACL Gough and Heilbrun Adjectival Test was used which was completed by the examined women three times following the instruction: "I am", "my mother is", "my father is". As a result the actual images of the patients as well as of their mothers and fathers were obtained. The esteem rates were calculated by comparing the number of positive adjectives to the number of negative adjectives used by the patients to evaluate individual persons. The interdependencies between esteem rates and the characteristics of the actual images of these persons were determined based on the r-Pearson correlation. Results and conclusions: The results obtained indicated the existence of crucial statistic dependencies between the variables analysed and constituted the basis for the formulation of the following conclusions: Patients are characterised by a low self-esteem and a low acceptance level of their parents. They accept their fathers in the smallest degree, compared to that their self-esteem is higher and the acceptance of their mothers is the highest. 1. Self-esteem is related in a significant way to the characteristics of self image such as: sense of responsibility, autonomy, ability to accomplish life objectives and establishing close relationships with other people. 2. The acceptance of their mothers is related to the characteristics typical of them such as: protectiveness, ability to establish and maintain positive interpersonal relationships, empathy and understanding the motives of their own behaviour and those of other people. 3. The acceptance of their fathers is related in a significant way to such characteristics discerned in them as: perseverance, ability to work hard, protectiveness, responsibility and ability to cope with tasks and problems and establishing close relationships with other people.


Elżbieta Mikołajczyk, Jerzy Samochowiec, Małgorzata Śmiarowska, Szymon Syrek
Analiza wymiarów temperamentu i charakteru u dorosłych kobiet z zaburzeniami odżywiania się  1043
Temperament and character of Polish women with anorexia and bulimia nervosa  1043
Summary
Aim: One of the factors influencing eating disorders are personality traits. The authors analyse temperament and character of healthy women. Method: The Cloninger Temperament and character Inventory was applied to 52 eating disordered patients (33 with anorexia nervosa and 19 with bulimia nervosa). The patients were divided into subgroups of restrictive type and bulimia types of anorexia, bulimia and bulimia episodes. Results: In all the subgroups of the patients a higher result was obtained on the harm avoidance scale (HA), cooperativeness (C) and the self transcendence ST2 subscale. Lower results were seen in self-directedness (SD) in the SD2, SD3 and SD5 subscales. The subgroups differed in temperament. Bulimia patients noted a higher for NS stimulation and a higher reward dependence (RD). Anorectic patients had higher results in the persistance scale (P), whilst the restrictive anorectic patients had lower results in the NS1 and RD3 subscales. Conclusions: The TCI Inventory is a useful tool, helping for a precise of the difference in temperament of anorectic and bulimia patients as compared to their healthy pears.


Izabela Łucka, Aleksandra Cebella, Monika Fryze, Jadwiga Gromska
Próba oceny stanu zdrowia i funkcjonowania społecznego pacjentek z zaburzeniami jedzenia - badanie katamnestyczne  1055
An attempt to evaluate the health condition and social functioning of anorectic females - a follow-up study  1055
Summary
Goal: An attempt evaluate, on the basis of follow-up data, the health condition and social functioning in patients with anorexia nervosa, four years after hospitalization. Method: Anamnesis from 20 young females (aged 17-24, average 21,7) hospitalized for the treatment of anorexia nervosa in The Department of Developmental, Psychotic and Geriatric Psychiatry, Medical University in Gdańsk. Results and conclusions: 50% of those studied suffer protractedly, with periods of remission or intensifity of symptoms. 80% of woman have achieved normalization of weight (30% of them seemed to be healthy and well functioning; 50% of them is in partial remission), 20% still fulfill DSM IV criteria for anorexia nervosa. Currently 60%menstruate (10% of them without hormonal treatment). In the examined group, 50% appear to have an abnormal manner of nutrition. Abnormal behaviour caused weight loss in 70% of those studied. Most of the females (55%) consider themselves overweight, 75% have weight-gain phobia.


Anna Basińska-Starzycka, Anna Katarzyna Bażyńska, Anita Bryńska, Elżbieta Tomaszewicz-Libudzic, Jadwiga Komender, Irena Namysłowska, Maciej Moskwa, Lar-Haakarz Thorell
Odmienne przetwarzanie informacji wzrokowej u dziewcząt z jadłowstrętem psychicznym - badania potencjałów wywołanych podczas testu uwagi  1063
Altered visual information processing in anorectic girls - the study on potentials related to the test of attention  1063
Summary
Aim of the study: Combined biological and psychological basis of anorexia nervosa, related to increased self-control, low self-esteem and peculiar motivation, makes a synthetic approach still hard to achieve. The presented study assessed cognitive functions in anorectic patients with respect to both neuropsychological (test of attention) and biological (electrophysiology of information processing) approaches, and their reciprocal interrelations as well. Methods: Eleven adolescent anorectic females and 10 control subjects performed the Continuous Attention Test CAT. Parameters of potentials elicited by the visual CAT items were referred to the CAT results. Results: The anorectic girls were more accurate during CAT performance, revealing a lower index of errors, especially of commissions. On the other hand, they revealed a lower amplitude of the P2 component (correlated with index of commissions) and shortened latency of the frontal N2 component (correlated with a lower index of errors). The groups differed in relations between psychometric and biological parameters referring to the earlier stages of information processing. In the control group, high index of detections was correlated to right-sided P1 and P2 components. In the patient group, correlations linked a lowered index of commissions with right-sided N1 and bilateral P2 amplitudes. Conclusions: Increased self-control in anorexia nervosa, reflected by lower frequency of needless reactions, is related to alterations in biological visual information processing yet on its early, preconscious stage.


Krzysztof Sołtys, Leszek Bidzan, Jacek Turczyński, Joanna Łapin
Ocena wpływu niekorzystnych wydarzeń życiowych w dzieciństwie na obraz kliniczny depresji u osób w wieku lat 50 i powyżej  1075
Assessment of early traumatic life events influence on intensity and frequency of symptoms in patients aged 50 years and over  1075
Summary
Aim: Assesment of early traumatic life events influence on psychological symptoms of depressive syndromes. Method: 88 patients with diagnosis of depression were included. The inventory of psychopathological symptoms -AMDP and depression rating scales - MADRS, GDS were applied. Results: Early traumatic life events were associated with general intensity of depression, but also with specific categories of symptoms (thinking disturbances, phobias, obsessions). Conclusions: Traumatic life events in early childhood may in effect lead to changes in the clinical picture of depression in adulthood. The strength of the particular events may vary.


Andrzej Bidziński, Iwona Koszewska, Danuta Turzyńska, Antoni Kalinowski, Łukasz Święcicki, Marek Dąbrowski, Jarosław Torbiński, Elżbieta Burna-Drażkowic, Sławomir Fornal, Dorota Grądzka, Magdalena Namysłowska, Stanisław Pużyński, Adam Płaźnik
Profil aktywności cytochromu CYP 2D6 w grupie chorych na depresję  1085
CYP 2D6 activity profile among patients with depression  1085
Summary
Aim: The aim of this work was to establish the profile of CYP 2D6 activity among patients with depressive disorders, and compare it with the literature data on this activity among healthy volunteers, recruited from Polish population. Method: The debrisoquine test was used to determine CYP 2D6 activity. Debrisoquine metabolic ratio (MR) was determined with the use of high performance liquid chromatography with spectrophotometric detection. Our results were compared with the results obtained with the use of analogous method in the study performed at the Institute of Cardiology in Warsaw on 154 healthy controls. Results: The percentage of "ultra-fast metabolizers" was 1.03% in the group of patients with depression, and 1.3% in the group of healthy volunteers. The percentages of the "slow metabolizers" in both groups were 5.1% and 5.6% respectively. Also, the percentages of persons considered to be at an increased risk of undesirable side effects from drugs metabolized by CYP 2D6, i.e. persons with debrisoquine metabolic ratio values above 4 were nearly identical in both groups (11.3 and 11.6%). Conclusion: The results showed that CYP 2D6 activity profiles were practically identical in both groups. This indicates that there is no relationship between CYP 2D6 gene expression, as measured by the debrisoquine test, and affective disorders morbidity.


Monika Szewczuk-Bogusławska, Magdalena Grzesiak, Jan Aleksander Beszłej, Andrzej Kiejna
Badanie aktywności CYP2D6 jako forma optymalizacji terapii lekami przeciwdepresyjnymi  1093
Assessment of CYP2D6 activity as a form of optimizing antidepressant therapy  1093
Summary
Cytochrome 2D6 catalyzes oxidation processes of many antidepressants (TCAs, SSRIs, maprotyline, mianserine, nefazodon, trazodon, venlafaxine). CYP2D6 is characterized by genetically determined polymorphism which may lead to serious clinical consequences. Based on CYP2D6 activity four phenotypes are distinguished: poor metabolism (PM), intermediate (IM), extensive (normal) EM and ultrarapid (UM). In case of PM and IM increased plasma concentration of a drug and adverse events or toxicity may appear. Decreased plasma level and lack of clinical effect may be connected with ultrarapid phenotype. CYP2D6 activity may be assessed by phenotyping or genotyping . Model drugs such as sparteine, debrisoquine, dextrometorhan and metoprolol are used in the phenotyping method. Based on metabolic ratio of model drug the phenotype status is established. Genotyping consists in an assessment of genotype i.e. an identification of alleles coding the CYP2D6 protein. The environmental factors may modify the CYP2D6 activity and influence on phenotyping but not genotyping results. The knowledge of CYP2D6 phenotype is of special value when drugs characterized by a narrow therapeutic index are used and in polymedicated and older patients.


Katarzyna Ciesielczyk, Daria Pracka, Tadeusz Pracki, Małgorzata Tafil-Klawe, Marzena Ziółkowska-Kochan
Zmiany jakości snu i poziomu nastroju pod wpływem fototerapii u pacjentów z chorobą afektywną sezonową ChAS  1105
Changes of sleep quality and mood disorders under influence of phototherapy on patients with seasonal affective disorders SAD  1105
Summary
Major depression, seasonal pattern (seasonal affective disorder SAD) characterize the winter recurrence depressive episodes with remission of symptoms in spring and summer. Patients with winter depression report hypersomnia, fatigue, loss of energy, carbohydrate craving, appetite and weight gain. Aim: The aim of this study was to assess the effect of phototherapy on quality of sleep parameters and subjective estimation of mood disorders in patients with seasonal affective disorders. Method: The investigated group consisted of 17 patients with SAD (15 female, 2 male) aged 18-64 (mean 38±12) years. Phototherapy (bright light therapy) was applied 14 days, everyday morning - 30 minute, between 6.00 to 10.00 - exposition on light about 10 000 lux intensity. Polysomnogram (sleep EEG) was recorded before an after treatment. Results: After phototherapy patients reported a significant mood improvement (57%) measured by the Seasonal Pattern Assessment Questionnaire. Sleep investigation showed: increase sleep efficiency, decrease sleep latency, decrease slow wave sleep latency and increase of sleep spindles in the first hour of sleep. Conclusions: Research confirms that phototherapy is an effective method of treatment of choice for patients with SAD. The result indicates that phototherapy markedly improved of mood and sleep quality.


Antoni Jakubczyk, Sławomir Murawiec, Cezary Żechowski
Niektóre aspekty farmakoterapii w kontekście przeniesienia - przeciwprzeniesienia  1115
Some aspects of pharmacotherapy in the context of transference - countertransference  1115
Summary
The article deals with the psychological background of administration of medication in psychiatry, the meaning of administration of drugs in relation to the doctor-patient relationship. The place of pharmacotherapy among other medical procedures was discussed. The differences in the approach to pharmacotherapy in different therapists was noticed, with the pointing out to two kinds of approach as (symptom oriented and problem oriented). Other than rational motivations for the use of pharmacotherapy was discussed.


Artur Wiśniewski
Zastosowanie aktygrafii w psychiatrii  1127
Application of actigraphy in psychiatry  1127
Summary
Altered motor activity is a frequently observed symptom in many psychiatric disorders. It is an important diagnostic parameter in mania, depression, ADHD and others. The method which allows measuring motor activity precisely and objectively is actometry. An actometer is a small, electronic device measuring body movements. This paper is a review of psychiatric research in which actometry was used: sleep disorders, ADHD, schizophrenia, anorexia nervosa, affective disorders and also in chronobiology and psychopharmacology. Methodology of actometric research and limitations of the method are discussed.


Elżbieta Trypka, Joanna Rymaszewska, Tomasz Adamowski, Tomasz Hadryś, Krzysztof Małyszczak, Andrzej Kiejna.
Przebieg badania EDEN według schematu opisu badań z doborem losowym  1145
Course of the EDEN study by using participants flow  1145
Summary
The development of science allows us to take up new investigative challenges. Interpretations of results can be difficult if there is no adequate and complete information about investigative methods applied, course of trial and statistical analyses. The CONSORT group proposed a standardized diagram facilitating an accurate presentation of the randomised trial. The EDEN study is an example of the application of this method, where the studied groups, number of participants, and all procedures can be presented. It is helpful to prepare reports and find necessary data. The first part of the diagram describes the course of recruitment, the second part presents data necessary to estimate the course of the study and data about numbers of patients in each timepoint whilst the third part shows the assessment of caregivers. Conclusions: The analysis of the course and correctness of the study is legible if the flow diagram is used. It is useful to find the necessary data for statistical analyses at every stage of study. Permanent control of the study allow the to avoid bias upsetting the course of the study and influencing its quality. It introduces comprehensible and straight forward presentation of the results.


 

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