[Gender identity disorders or andromimetic behaviour in a victim of incest--a case study]

Nowadays, it is becoming increasingly difficult to clearly classify the issues associated with the phenomenon of gender dysphoria due to the fact that one identifies oneself in the context of increasingly fluid categories of gender identity-- an intrinsic sense of being a woman or a man. The authors present a woman whose internal problems connected with her sexuality and incomplete identification with the role attributed to her gender originate from her family history. Long-lasting, traumatic experiences of incestuous abuse and violence on the part of close relatives disturbed her development in many areas of personality and functioning. The aim of the study was to verify the hypothesis of the existence of gender identity disorder accompanied by depressive disorders. In addition to the medical history, the study of patient's problems included the following diagnostic tools: the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach Inkblot Test in a CSR Exner system (TPA). The study revealed that as for sexual identification, the patient unambiguously identifies herself as a woman. Her behaviour to become like a man does not deny her sex, or even involve a temporary need of belonging to the opposite sex. It should be interpreted in the broader context of her traumatic experiences, not just sexual, but also concerning different aspects of a female gender role.

Therapeutic efficacy assessment of weak variable magnetic fields with low value of induction in patients with drug-resistant depression

BACKGROUND

The aim of this prospective study was to verify whether magnetostimulation with weak variable magnetic fields with low value of induction could enhance the effects of pharmacological therapy in drug-resistant depression.

MATERIALS AND METHODS

Thirty patients, 26 women and 4 men, with drug-resistant depression were enrolled in the study. The subjects from Group No. I (14 patients) were given fluvoxamine and treated with weak variable magnetic field using the VIOFOR JPS device; the subjects from Group No. II (16 patients) were also given fluvoxamine but they were treated with the VIOFOR JPS device in placebo mode. Changes in depressive symptoms were estimated with the 21-point Hamilton Depression Scale (HDRS), Montgomery-Asberg Depression Scale (MADRS) and Beck Depression Inventory (BDI) questionnaire.

RESULTS

After 15 days of treatment highly significant differences were revealed between the patients treated with magnetic field and the patients treated with placebo: the final HDRS score was 53% of the initial value for the group receiving combined treatment, and 86% in the placebo group (p<0.001); for MADRS score the values were 51% and 88% (p<0.001), respectively, and for BDI 60% and 87% (p<0.001). Thus, the average effect of placebo applied with fluvoxamine was a ca. 15% reduction of symptoms, while the concurrent application of magnetic field and SSRI treatment resulted in a 40-50% improvement.

CONCLUSION

Our study indicates that adding a two-week low-induction variable magnetic field stimulation to a classical pharmacologic therapy reduces the intensity of symptoms in patients with drug-resistant depressive disorders.

[A case of ketamine dependence]

Ketamine is a rapid-acting anaesthetic agent which has been used for over 40 years. It is an antagonist of N-methyl-D-aspartate (NMDA) receptors and agonist of mu and sigma opiate receptors. Ketamine acts through inhibition of sensory parts in the brain and stimulation of the limbic system and optic thalamus. The most common psychiatric disorders observed after the use of ketamine are: psychomotor agitation, hallucinations, status of stupor, consciousness disorders. There are observed cases of non-medical use of ketamine since the sixties of the 20th century. The authors describe the case of a 52 year old man who has been addicted to ketamine for 15 years. The patient was admitted to hospital to observe and treat the withdrawal syndrome as an effect of abrupt discontinuation of a chronically abused substance. On the ground of medical examinations, standard tests, anamnesis and hospital observation, ketamine dependence syndrome of a person with personality disorders was recognized. There was no somatic symptoms of withdrawal syndrome observed. The patient complained of sleep disorders and anxiety. Diazepam, carbamazepine and vitamins was used during treatment. The patient was motivated to stop using ketamine. This case and the described symptoms were compared with others articles.

[The association of quality of life with mental status and sociodemographic data in patients after total hip replacement]

AIM

The aim of this study was to assess the mental status and sociodemographic data and their influence on the quality of life in patients after total hip replacement.

METHODS

SF-36, Soc-29, HADS, MPI, sociodemographic questionnaire were given to a cohort of 48 subjects who participated in this study (28 female, 20 male), with age range of 54-70 (mean 56). Questionnaires were administered to subjects two weeks before surgery and three months after surgery.

RESULTS

Patients after total hip replacement showed significant improvement in health-related quality of life in the summary scale of PCS and MCS and HADS-D and HADS-A. There were no significant differences in SOC and MPI. The postoperative values of the PCS and the MCS for the whole group of patients correlated positively with the SOC values. Neuroticism (MPI) was also associated with the postoperative functioning in the mental and physical dimensions. Older patients had more likely to have worse score in MCS and PCS before and after surgery.

CONCLUSIONS

Total hip replacement significantly improves patient health and well-being at three months after surgery. Sense of coherence, neurotism and old age influence quality of life.

[The influence of some sociodemographic and clinical factors on depression in women undergoing coronary arteriography]

AIM

The aim of this study was to evaluate the influence of sociodemographic and clinical factors on symptoms of depression in 90 female patients awaiting coronarography.

METHOD

The factor dividing the patients into two groups: those without significant atheromatosis - 48 women and those with coronary atheromatosis - 42 women, was the result of invasive diagnostics of coronary heart disease. BDI (Beck Depression Inventory), HAM-D (Hamilton Depression Rating Scale) and sociodemographic and clinical data questionnaire were used in the study.

RESULTS

It was proved that there was a connection between the appearance of increased parameters of depression and more frequent number of annual visits in the Primary Care or Cardiologic Clinic, higher level of depressiveness and anxiety, fear of obtaining information applying to the necessity of coronarography, lack of hormonal replacement therapy and of support from other people. Additionally, it was noticed that the intensity of symptoms were higher for those less educated, those waiting shorter for coronarography and those with hypertension. There were no statistically significant differences in the estimation of depressive states in both groups, neither in prevalence, nor in the intensity.

CONCLUSION

Patients with increased parameters of depression need special therapies and multidisciplinary care.

Anxiety and depression and their influence on the quality of life after total hip replacement: preliminary report

Objective. The study investigated health-related quality of life in relation to mental status (anxiety and depression) and demographic factors in patients before and after total hip replacement due to osteoarthrosis. Methods. The SF-36, HADS, socio-demographic data questionnaire was delivered to a group of 184 subjects (108 females, 76 males) at the mean age at the time of surgery of 59 years. Questionnaires were delivered to the subjects 2 weeks before the surgery and 6 months after the operation (by mail). Results. Patients after hip replacement showed significant improvement in health-related quality of life in most domains of SF-36 score and summary scale of PCS (Physical Component Summary Scale) and MCS (Mental Component Summary Scale). They also showed improvement in mental status. Elderly patients were more likely to show worse score in MCS and PCS before and after surgery. BMI (body mass index) was correlated only with preoperative PCS. Mental status was associated with postoperative PCS and MCS. Patients who were satisfied with the results of the surgery showed higher PCS and MCS score. Conclusion. Hip replacement surgery brings significant improvement to the quality of life. Age and mental status of those patients influence markedly their postoperative performance.

Sense of coherence in patients after limb amputation and in patients after spine surgery

Objective. To assess the score of SOC (sense of coherence), BDI (Beck Depression Scale), STAI ( State and Trait Anxiety Inventory) in three examined groups and correlation of SOC score with sociodemographic data, anxiety and depression. Methods. The SOC, BDI, STAI questionnaires were given to 51 patients after limb amputation, 65 patients after vertebral surgery because of chronic back pain and 40 persons in the control group. Results. Patients after limb amputation achieved the same level of SOC score as the control group. Patients who had higher results on the SOC score rarely suffered from phantom pain. Patients after spine surgery had a lower level on the SOC score than the control group. A lower score of SOC was observed in older, unemployed, poorer educated, subjects taking medicine, who did not report improvement after operation. Patients after limb amputation and patients after spinal surgery were more depressed and anxious than healthy people. Conclusion. Patients with higher SOC results, in both examined groups, were less depressed and anxious.

[Personality types in patients after vertebral surgery]

AIM

To compare personality types in patients after vertebral surgery.

METHOD

74 patients after vertebral surgery were examined with the MPI. 22 patients were operated because of injury. 52 patients were operated because of chronic pain back. The control group consisted of 20 healthy people. Maudsley Personality Inventory created by Eysenck, was used to study personality types.

RESULTS

There were no differences in personality types between patients suffering from chronic back pain and patients operated because of injury. Statistically, a significantly higher score in the N scale was noticed in the group with chronic back pain in comparison to patients operated because of injury and in comparison to the control group.

CONCLUSIONS

A higher score in the N scale observed in patients suffering from chronic back pain, may suggest a specific personality type of those patients. Higher level of neuroticism may create some difficulties in the acceptation of the illness and adaptation process. It is necessary to take special psychological care of those patients.

[Sociodemographic factors and their influence on anxiety and depression in patients after limb amputation]

AIM

The aim of this study was to assess the score of HADS and the correlation with sociodemographic factors and personality traits in patients after limb amputation.

METHOD

45 patients after limb amputation due to atherosclerosis and 30 persons from a control group participated in the study. HADS Scale and the Maudsley Personality Inventory created by Eysenck were used in the study. Socidemographic data were collected by means of the Sociodemographic data questionnaire.

RESULTS

In comparison to the control group, patients after limb amputation achieved a higher score in HADS-A and HADS-D and in the N scale of the Maudsley Personality Inventory. Higher levels of anxiety and depression were noticed in patients suffering from phantom limb pain and in patients with neurotic personality traits.

CONCLUSION

Patients after limb amputation need multidisciplinary care because of higher levels of anxiety and depression (especially patients with phantom limb pain and those with neurotic personality traits).

[Symptoms of anxiety and depression in atopic eczema/dermatitis syndrome]

The presence of chronic disease is a risk factor for the development of mood disturbances and panic disorders. They can influence the course of disease and effectiveness of therapy. Depression may be the cause of making light doctor's advice. Anxious patients often aggravate symptoms of the disease.

AIM

To study symptoms of anxiety and depression in patients suffering from atopic eczema/dermatitis syndrome (ZAZS). Material. We studied 38 patients suffering from adequately controlled moderate ZAZS and 62 volunteers in the control group.

METHODS

Mental status of subjects was assessed by means of State and Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) questionnaires.

RESULTS

ZAZS patients demonstrated higher intensity of anxiety (as a trait and as a state) than healthy subjects. Intensity and prevalence of depression in the atopic eczema/ dermatitis syndrome group was higher than in the control group.

CONCLUSIONS

Patients suffering from atopic/eczema dermatitis syndrome are pre-disposed to anxiety and depression manifestation. Even adequately controlled symptoms of atopic/eczema dermatitis syndrome may be the cause of those disturbances' occurrence.

[Sociodemographic data and their influence on anxiety and depression in patients after spine surgery]

AIM

The aim of this study was to assess the score of HADS and the correlation with sociodemographic data in patients after spine surgery.

MATERIAL

40 patients after spine surgery because of low back pain and 20 persons of control group participated in the study.

METHODS

HADS was used in the study. Socidemographic data were collected by means of Socio-demographic data questionnaire.

RESULTS

Patients after spine surgery had worse results in HADS-A and HADS-D in comparison to control group. Men, older, worse-educated, unemployed, reporting more concomitant disease and medicine taking patients were more depressed. Anxiety correlated with age, education, tacking medicine and improvement after surgery.

CONCLUSION

Patients after spine surgery need multidisciplinary care because of higher level of anxiety and depression.

[Anxiety and depression in bronchial asthma]

The aim of the study was to establish the frequency and follow the clinical course of depression and anxiety in patients with bronchial asthma. 57 patients (37 atopic and 20 nonatopic) with mild and moderate bronchial asthma and 53 subjects matched for age and sex as control groups were included in the study. The following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate anxiety and mood state. The level and prevalence of anxiety and depression were significantly higher in both groups of asthmatics in comparison to healthy subjects. Symptoms were mild and moderate. Nonatopic patients were more depressed and anxious than atopics.

[Estimation of a sense of coherence in patients with alcoholic dependence syndrome--introductory report]

The aim of this study was an estimation of the sense of coherence in the group of patients suffering from alcohol dependence syndrom. The examined group consisted of 21 patients at the age from 21 to 53 years, treated in The II Department of Psychiatry in Tarnowskie Góry. The control group contained 24 healthy persons at the age from 21 to 44 years. The SOC-29 scale by Antonowsky was used in order to estimate the sense of coherence. SOC level was significantly lower in the group of patients drinking alcohol in comparison with healthy people but only in the group of men.