[Evaluation and determinants of pain in patients hospitalized for cancer]

Pain is a symptom that occurs in almost every third person at the time of diagnosis of cancer. Its intensity and frequency increases with the progression of the disease.

AIM

The aim of the studywas to determine of pain conditions in patients treated for cancer during oncological treatment.

MATERIALS AND METHODS

The study included 229 randomly selected patients hospitalized at Fr. B. Markiewicz Specialist Hospital of the Podkarpacki Oncological Center in Brzozów. The method of the diagnostic survey and the technique of the survey were used. The research tools were the author's questionnaire and the numerical rating scale NRS (Numeric Rating Scale). The statistical analysis used the following tests: U Mann Whitney and symmetric measures Phi and V Kramer based on the chi-square test. The statistical significance level p≤0.05 was assumed.

RESULTS

The incidence of pain resulting from neoplastic disease, treatment and the consequences of the disease was declared by 61,6% of patients. The mean severity of pain in patients was 3.38. Middleaged pain was reported by 55.3% of patients. Low level pain occurred in almost every third patient (31.9%) and in severe form in 12.8% of patients. The most frequent places of pain were abdominal cavity, osteoarticular system and head. Painkillers were taken by 59.4% of patients and mainly were drugs from the first stage of analgesic ladder, among them Paracetamol. Morphine - every tenth patient took the drug of the third grade of the analgesic ladder. The pain was not affected by education, age, sex, marital status, place of residence and self-assessment of functioning in everyday life. Patients suffering from pain assessed their health better.

CONCLUSIONS

Most individuals with cancer suffered from pain and painkillers, mainly from the first degree of analgesic ladder. The occurrence of pain was not differentiated as for socio-demographic variables. The treatment method was associated with the sensation of pain, the experience of which influenced the self-assessment of health. Pain is a threat to the quality of life and significantly affects the treatment process. Relief and elimination of pain is a priority in the care and treatment of cancer patients.

[Obesity, overweight as main risk factors of cancer in Sanok's county population]

Weight disorder such as obesity and overweight are an significant risk factor in cancer development.

AIM

The aim of the study was to determine an obesity and overweight in cancer prevention among the population of Sanok's county.

MATERIALS AND METHODS

The research was conducted in 157 residents of Sanok's county in 2015 yrs. A method of diagnostic survey and conventional survey was used. The main research tool was a selfmade survey. In the evaluation of statistical significance we have accepted the level of p<0,05.

RESULTS

Almost half of the respondents of the survey declared doing sport regularly and most of them were young people with higher education. Almost half of the responders had good BMI, one third was overweight and one tenth was obese. The latter weight disorder was mostly common among men and people with vocational and primary education.

CONCLUSIONS

Risk factor of cancer in the study group were: overweight, obesity and low level of physical activity. Age, sex and place of residence conditioned the level of physical activity and up keeping proper body weight. These studies require constant increase of awareness in the area of physical activity and maintaining proper body weight.

[Low level of physical activity as main risk factor of cancer in Sanok's county population]

Physical activity is a key component of a healthy lifestyle. The data of WHO conclude that little physical activity is the fourth key risk factor of premature death. Weight disorder such as obesity and overweight are an significant risk factor in cancer development.

AIM

The aim of the study was to determine physical activity in cancer prevention among the population of Sanok's county.

MATERIALS AND METHODS

The study covered a group 157 residents of Sanok's county in 2015. A method of diagnostic survey and conventional survey was used. The main research tool was a selfmade survey. The p values p<0.05 were considered statistically significant.

RESULTS

Almost half of the respondents of the survey declared doing sport regularly and most of them were young people with higher education. The preferred form of physical activity among the survey group was jogging. Only one third of surveyed people declared regular physical activity. The responders usually evaluated their level of physical activity as medium. The main reasons for physical activity were: achieving better wellbeing and maintaining good physical condition, whereas laziness and lack of time were the main reasons of the lack of physical activity. Responders most often spend from 30-90 minutes on working out on their workout days.

CONCLUSIONS

Risk factor of cancer in the study group were physical activity. Age, sex and place of residence conditioned the level of physical activity and up keeping proper body weight. These studies require constant increase of awareness in the area of physical activity.

Development and validation of polish version of matrics consensus cognitive battery

Introduction

Neurocognitive deficits account for most of the long-term poor functional outcomes of patients with schizophrenia. Effective treatment of cognitive impairment is the most important challenge in the treatment of this disorder.

Objectives

Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Project produced a battery of 10 tests called the MATRICS Consensus Cognitive Battery (MCCB), designed to asses cognitive treatment effects in clinical trials of patients with schizophrenia.

Methods

In this validation study of Polish version of MCCB, 120 patients with schizophrenia will be investigated. 60 of them will be randomly chosen and examined again after 4 week. Altogether MCCB is going to be applied 180 times on 120 patients. The results will be compared with the results of American standardization study of MCCB (MATRICS-PASS).

Results

Until now 19 patients (12 males, 7 females, mean age 25.63 ± 5.14) have been investigated. Following MCCB T-scores in seven cognitive domains were obtained: attention/vigilance (38.33 ± 9.03), working memory (40.95 ± 14.35), verbal learning (38.11 ± 8.37), visual learning (41.37 ± 10.48), reasoning/problem solving (36.95 ± 10.14), social cognition (35.79 ± 10.67), composite T-score (30.22 ± 12.93).

Conclusions

These preliminary results show that MCCB could be successfully adopted into Polish. After the end of validation process MCCB will be an important research tool in studies aiming at improvement of cognitive functioning in Polish patients with schizophrenia.

Daytime sleepiness, executive functions and working memory in schizophrenia patients treated with sertindole and olanzapine

Objectives

Sedation is a frequent side effect of antipsychotic drugs with a high impact on patients’ functioning. We investigated whether patients who were switched from sedative antipsychotics to sertindole, an antipsychotic drug without sedative effect, showed better results in measures of sleepiness, executive functions and working memory than patients with a good tolerance to sedative effect of olanzapine.

Methods

18 patients with schizophrenia treated with sertindole (9 females, mean age 27.9 ± 4,1, mean dose 15.6 ± 3.0 mg/d) and 18 sex and age matched patients treated with olanzapine (15.3 ± 6.5 mg/d) underwent EEG recording, Wisconsin Card Sorting Test (WCST), psychomotor vigilance task, filled out Epworth Sleepiness Scale (ESS) and Athens insomnia scale (AIS). PANSS, UKU, BARS scales and DAI-30 were used to rate mental state, medication side effects and subjective attitude to treatment.

Results

At time of the assessment PANSS scores were similar in sertindole (43.6 ± 7.1) and olanzapine (42.3 ± 12.2) groups. Increased slow wave activity (SWA) was found in EEG in 3 patients treated with sertindole and in 10 with olanzapine (p < 0.05). Treatment with sertindole was also related to lower ratings on BARS scale (p < 0.05) and item “prolongation of sleep” in the UKU scale (p < 0.05). However, no superiority of sertindole was found in other used measures.

Conclusions

Although sertindole does not induce SWA in EEG and prolong sleep, patients who were switched to sertindole did not have improved executive functions, vigilance and working memory as compared to patients treated with olanzapine.

Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation

OBJECTIVE

To review the current status of psychiatry in selected countries of Central and Eastern Europe: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Russia, Slovakia, and Slovenia.

METHOD

A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages.

RESULTS

There is a shift from traditional in-patient facilities towards out-patient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West.

CONCLUSION

The major changes in the period of transition documented in the review pose new challenges for psychiatry.

Healthcare resource utilization during 1-year treatment with long-acting, injectable risperidone

BACKGROUND

Schizophrenia is associated with disproportionately high costs, mainly due to hospitalization rates. This study assessed healthcare resource use in patients with schizophrenia and schizoaffective disorder during treatment with long-acting risperidone.

METHODS

Patients (n = 397 [inpatients, 24%; outpatients, 76%]) receiving stable doses of an antipsychotic for >or=4 weeks were eligible to enter this 1-year, open-label study. Following a 2-week run-in period (oral risperidone 1-6 mg/day), patients received intramuscular long-acting risperidone (25 or 50 mg modal dose) every 2 weeks. Healthcare resource use in the previous 12 weeks was assessed at baseline and 12-weekly intervals.

RESULTS

Patients needing hospitalization decreased significantly and continuously from 38% during the 12 weeks before study entry to 12% during the last 12 weeks. Mean hospitalization length during the study was 30.5 days (outpatients, 4.9 days; inpatients, 110 days). This included 28 patients (7%) who remained in hospital throughout the study. During treatment, 71% of those hospitalized at baseline were discharged. Partial hospitalization decreased significantly from 7% of patients during the 12 weeks before treatment to 3% during the last 12 weeks. Outpatient consultations also decreased significantly from 70% of patients to 30% in the first 12 weeks of treatment and remained stable thereafter. Only 9% of patients required an emergency room visit; mostly for non-psychiatric conditions.

CONCLUSION

Healthcare resource use is significantly reduced in patients with stable schizophrenia or schizoaffective disorder receiving long-acting risperidone. It is highly likely that these reductions will decrease healthcare costs in patients receiving long-acting risperidone.

[Subjective and objective evaluation of treating schizophrenia with classic or atypical drugs]

Subjective and objective evaluation of pharmacological treatment was made in 105 schizophrenic in-patients. PANSS and Calgary scale as well as Van Putten scale were used. Fifty-four percent of subjects received classic neuroleptics and 46%--new atypical drugs for an average period of 8 weeks. The severity of schizophrenic symptoms during treatment as well as subjective evaluation of first effects of the drug did not differ among subjects treated with classic or atypical drugs. Depressive symptoms decreased significantly during treatment with atypicals but not with classic drugs. Also a significant decrease of depression was found under olanzapine treatment. The severity of neuroleptic-induced side-effects did not differ in both groups. Neurological side effects were more prominent in subjects after 4 weeks of therapy with risperidone, in comparison to patients receiving olanzapine. Forty-seven per-cent of patients showed a dysphoric reaction to the first dose of medication. After treatment with atypical drugs, better subjective evaluation of pharmacotherapy correlated with less severe general and depressive schizophrenia symptoms. Patients' better evaluation of olanzapine treatment correlated with less severe schizophrenic general symptomatology. The subjective evaluation of treatment was better in patients with less severe neurological side-effects of atypical drugs (including olanzapine but not risperidone) and less severe autonomic side-effects of classic drugs. The evaluation of pharmacotherapy made by patients' family members did not correlate with subjects' opinions after distribution of the first dose of the drugs, but correlated significantly with patients' opinion after 8-weeks of treatment. The treatment received by the patients was judged better by the family members if less severe neurological side-effects were present.

[Practical aspects of drug resistance in schizophrenia]

About 30-60% of patients with schizophrenia show resistance to neuroleptic treatment. In about 5-20% of them the resistance to antipsychotic treatment appears during the first therapy (primary resistance), however in the rest of patients, treatment resistance develops during 5 to 10 years of the illness (secondary resistance). In addition, another group of 5 to 20% of schizophrenics shows intolerance of therapeutic dosages of neuroleptic drugs. Before the diagnose of treatment resistance has been made, there is the need to reconfirm the diagnosis of schizophrenia, exclusion of other psychiatric disorders, assessment of patients' compliance, drug dosing, as well as pharmacokinetic and pharmacodynamic factors which have an impact on the therapeutic effect of antipsychotic treatment. Clozapine seems to be a "gold standard" for treatment of drug-resistant schizophrenic patients, however new atypical antipsychotics should be considered as a new therapeutic strategy, even before clozapine. The use of adjunctive treatment with carbamazepine, lithium, valproic acid, benzodiazepines and others, is a reasonable strategy, however dangerous drug interaction has to be taken into account.

[Quality of life in schizophrenic patients treated with classic and "old" atypical neuroleptics]

Subjective health-related quality of life was evaluated in 100 patients from day-hospital, treated for schizophrenia with classical (perazine, perphenazine, zuclopenthixol) or "old" atypical (klozapine, sulpiride) neuroleptics. No correlation was found between the clinical improvement (PANSS scale) and the quality of life (SF-36). After the treatment the improvement of the quality of life was significantly better in female than in male patients. In women more correlations were found between clinical improvement after treatment and the of quality of life domains. The general subjective health-related quality of life after treatment with classical and "old" atypical drugs did not differ. After the treatment those patients who received classical neuroleptics reported more physical complains but better improvement in the domain "role-emotional" than the subjects treated with "old" atypical drugs. Significant clinical improvement was found in patients treated with perazine, perphenazine and zuclopenthixol but not with clozapine or sulpiride. The presence and intensity of neuroleptic side-effects did not correlate with the quality of life. In patients who had more pronounced neuroleptic side-effects less favorable improvement was found in regard to those quality of life domains which included physical status as well as the evaluation of patients' mental health.

[Treatment of catatonic syndrome with fluoxetine. Case report]

The case of catatonic syndrome in 34-years old male patient is described. The patient's initial complaints regarded somatic distress. Previously, because of persistence of somatic complaints and depressed mood, the patient was treated with classic antidepressants with no clinical effect. Consequently, before admission to our clinic, the patient received neuroleptic treatment without any improvement. To our clinic he was referred as drug-resistant schizoaffective psychosis. He was completely inactive, had hipochondriac delusions and blunted affect. Further on, severe psychomotor inhibition and negativism prevailed. Initial treatment with fluphenazine did not bring any clinical effect. Because of presence of depressed mood and lack of activity, fluoxetine was administered concomitantly with fluphenazine. After 8 weeks administration of fluoxetine 20 mg daily showed substantial clinical improvement, especially in regard to the patient's mood and activity. The dose of fluoxetine was increased to 40 mg daily, and the patient was discharged from the clinic. The follow-up revealed that the patient reassumed his professional career. He was still on fluoxetine 20 mg daily and showed substantial clinical improvement. His overall tolerance of fluoxetine 20-40 mg daily was very good.

[The risk of neuroleptic discontinuation in schizophrenia]

The most effective method to maintain clinical improvement in the course of schizophrenia is the continuation of neuroleptic therapy. Sometimes we face the dilemma whether neuroleptic administration could be discontinued. There are some unconditional indications for treatment cessation (signs of intolerance, complications, general medical conditions); all other situations can be considered as relative indications. The risk and benefit of treatment discontinuation should be carefully evaluated. Neuroleptic withdrawal seems to be safer among older patients, with single episode of the psychosis of mild severity, with no family history of schizophrenia. It is necessary to achieve a stable clinical improvement before neuroleptic withdrawal. Worsening of the clinical status creates the most important risk of treatment discontinuation. Other risk factors include unacceptable threatening behavior, increase of family burden. The appearance of withdrawal symptoms such as nausea, vomiting, dyskinesia, insomnia, anxiety, etc. are to be considered. These symptoms are rare, and the risk of relapse is smaller when patients were treated with depot neuroleptics before treatment discontinuation than in the case of treatment with oral neuroleptics. Neuroleptic discontinuation and introduction of placebo cause more risk of relapse than continuation of active treatment.

[Family burden of schizophrenic patients with various forms of psychiatric care]

Caregiver burden was evaluated among family members of 90 schizophrenic patients from hospital psychiatric ward, day hospital or from community psychiatry unit. Psychopathology was evaluated with the use of PANSS while family burden with the use of Tessler's scale which allowed to differentiate between objective and subjective burden regarding assistance to the subject and patient's supervision. Schizophrenic symptoms were more severe in hospitalized patients than among patients from day hospital or patients treated in the community. Family burden, both subjective and objective was more severe among family members of hospitalized patients. There was no difference in the severity of family burden among family members of patients from day-hospital or from community psychiatry unit. The severity of positive and general schizophrenic symptoms (PANSS) correlated positively with the lack of patient's acceptance by a family member as well as with the global subjective family burden and with the necessity of taking control over patient. There was a positive correlation between the severity of schizophrenic negative symptoms and subjective family burden (dimension: assistance to the patient) and the sum of objective family burden.

[Evaluation of depressive syndromes in the course of schizophrenia with the use of Calgary scale in patients from the inpatient hospital care]

Among 98 schizophrenic patients consecutively admitted to day hospital during the period of one year, the presence of depressive syndrome diagnosed with the use of Calgary Depression Scale was established in 39% of patients. The intensity of depression was higher in the patients' than in the investigators' evaluation. After therapy at day hospital, which lasted 3.7 months on average, the repeated clinical evaluation showed significant decrease of all depressive symptoms as well as schizophrenia psychopathology. In 29% of patients there were no symptoms of depression at discharge from the day hospital. In 66%, the depressive symptoms which were most severe at admission, i.e. depressive mood, hopelessness and guilty ideas of reference, showed most distinct diminution after treatment.

[Comparison of quality of life of schizophrenic patients in different forms of psychiatric care]

Health related quality of life and severity of psychopathological symptoms were evaluated in 90 patients with schizophrenia, hospitalized in a psychiatric ward in a day hospital or followed by the therapist in a community care center. No statistical differences were found in the quality of life evaluation between patients from all three settings. The quality of life did not correlate with the severity of schizophrenic symptoms. Older patients and those more frequently hospitalized were more pessimistic in evaluation of their quality of life. Health status transition, as compared to the situation one year before, correlated inversely with patients' age. Male patients as well as patients from schizophrenic families evaluated their quality of life as worse.

[Cortical atrophy in MRI, mental status and neuroleptic treatment effect in schizophrenia]

MR imaging of the head was performed in forty schizophrenics (DSM-IV). Mental status was evaluated before and during 8-weeks of neuroleptic treatment. Cortical atrophy in frontal and temporal regions was found in 40% of subjects. They were older, had longer history of schizophrenia, were less active professionally and were more frequently hospitalized. Patients with and without cortical atrophy in MRI did not differ in the severity of schizophrenic psychopathology at baseline. During neuroleptic treatment negative schizophrenia symptoms were significantly better diminished in patients without cortical atrophy than in subjects with cortical atrophy in MRI; this regarded specially the severity of emotional blunting. Clinical improvement after 8-weeks of neuroleptic administration was less favorable in patients with cortical atrophy.

[Evaluation of health-related quality of life in hospitalized schizophrenics]

Health related quality of life was evaluated in 40 schizophrenics from day hospital at admission, during the treatment and after 8 weeks. In contrast to the psychopathology which significantly decreased after 4 weeks already, the improvement of quality of life was found to be significant only at the discharge from day hospital. The quality of life did not correlate with the severity of schizophrenic symptoms. The older and more frequently hospitalized patients were, the less favorably they evaluated the quality of life. Patients professionally disabled were also less pleased with their quality of life. All quality of life domains improved after treatment with the exception of physical functioning and reported health transition. Physical functioning, role-physical, general health and mental health correlated inversely with severity of schizophrenia after treatment. There was no correlation between clinical improvement after treatment and quality of life domains. The higher was the patients' educational level the better they evaluated their vitality, social functioning and reported health transition.

[Selected parameters of magnetic resonance imaging of the brain, clinical picture and recovery after treatment in schizophrenia. Preliminary report]

In forty schizophrenic (or schizophreniform disorder) patients diagnosed according to DSM-IV, the magnetic resonance imaging was performed. The T2 relaxation time was measured in selected brain regions from the dorsolateral prefrontal cortex as well as in amygdala. These results were compared with clinical parameters regarding severity of psychopathology and improvement after neuroleptic treatment. The mean T2 values of grey matter of right inferior frontal gyrus were significantly higher in patients with schizophreniform disorders (those patients were clinically diagnosed as suffering from cycloid psychoses) than in other types of schizophrenia. The T2 values of this region correlated inversely with the severity of negative symptoms before treatment. The T2 values of gray matter of left inferior frontal gyrus correlated positively with the severity of schizophrenic symptoms before treatment. Mean T2 values of left amygdala were significantly higher in patients showing less favorable improvement after neuroleptic treatment in comparison to those who improved better. No correlation was found between the presence of brain atrophy and T2 values in brain regions studied. The results allow to suggest that the measurement of T2 relaxation time might reveal interesting relations between clinical picture and neuroradiologic findings in schizophrenia, however clinical significance of such parameters still requires further elaboration.

[Improvement criteria after neuroleptic treatment and clinical and neuroradiological factors in schizophrenic psychoses. Preliminary studies]

In 40 schizophrenic patients, various criteria of clinical improvement after neuroleptic treatment were compared in order to establish correlations between improvement after treatment and some clinical and MRI parameters. Three ways of evaluation of clinical improvement (CGI scale, PANSS index, percentage of improvement) correlated strongly with one another. Only the distribution of numbers of patients with different clinical improvement evaluated by the use of PANSS index was not statistically significant. Clinical improvement, evaluated with all three methods, significantly correlated with basal PANSS score as well as with the severity of positive symptoms and affective blunting, but not with the severity of schizophrenia negative symptoms. Only clinical improvement with the use of CGI demonstrated significantly better improvement in patients who had good previous response to neuroleptics. This particular method of clinical improvement evaluation, in contrast to other two methods, failed to reveal better response to neuroleptics among patients with no cortical atrophy found in MRI. Among patients with different improvement after treatment, evaluated with the use of all three methods, selected MRI parameters did not show significant differences with the exception of CGI improvement which correlated positively with the intensity of signal in T2-weighted image of gray matter in left medial frontal gyrus.

[Therapeutic effect of zuclopenthixol acetate on positive and negative symptoms in schizophrenia]

Fifty schizophrenic in-patients (DSM-IV) were treated in an open study with zuclopenthixol acetate. Mental status, improvement and side-effects were measured before administration of the drug as well as after the 1st, 2nd and 3rd injection. Positive and negative symptoms were evaluated with the use of PANSS. 60% of patients received three injections. Usually the intervals between injections lasted 48 hours. The improvement after the 3rd injection of zuclopenthixol acetate was found in 80% of patients. All positive symptoms improved after the treatment (p < 0.001), among them excitement (54% reduction vs. baseline), hostility (49%) suspiciousness/persecution (45%). The study revealed that parallel to the decrease of positive symptoms, the severity of negative symptoms also decreased, in particular: difficulty in abstract thinking (28%) and stereotyped thinking (27%) (p < 0.001). Passive/apathetic social withdrawal and lack of spontaneity as well as flow of conversation only slightly improved (p < 0.05). 50% of patients experienced side-effects--usually extrapyramidal reactions.

[The evaluation of well-being of schizophrenic or depressed patients with Bradley's questionnaire: a pilot study]

Well-being of 65 in-patients with the diagnosis of schizophrenia or major depression was evaluated with the use of Bradley's well-being questionnaire. The severity of psychopathology as well as clinical improvement after pharmacotherapy were evaluated by doctors using CGI scale. Patients with the diagnosis of depression estimated their well-being lower in comparison to schizophrenics. The groups did not differ in the subscales of depression and energy. Female patients revealed more anxiety than male ones, regardless diagnosis. Physicians' evaluation of disease severity did not correlate with patients' well-being judgement using Bradley's questionnaire. After pharmacotherapy correlation between clinical improvement and several questions from Bradley's questionnaire was found.

[A test for using meta-analysis to evaluate antidepressive effects of fluoxetine]

The review of clinical antidepressive efficacy of fluoxetine was made on the basis of various authors' reports. The results showed that clinical efficacy of fluoxetine and of classical antidepressive drugs in the treatment of depression was comparable. The meta-analysis revealed effect-size of fluoxetine to be similar to tricyclics. Also the clinical effects of fluoxetine in the treatment of depressive disorders of different severity (mild, moderate, severe) were similar to the effects of classic tricyclic agents. The tolerability of therapeutic doses of fluoxetine in the daily range 20 to 40 mg is comparable while the dosage augmentation to 60 mg per day causes increase in the percentage of patients demonstrating side effects. In comparison with placebo fluoxetine showed significantly better clinical efficacy in the treatment of depression.

[Chronic mental illness: quality of life]

The article summarizes briefly the most important directions of research in the quality of life (QOL) of schizophrenic patients. Results gained by cited authors seem to confirm that the QOL of these patients is lower in comparison with normal population. Researchers look for factors that would be able to rise the subjective QOL of this population. It seems that the most influential factors are: rehabilitation programs, work, active way of spending free time and suitable pharmacological treatment. It is also very important that patients included in community care program and those who live in group houses for patients have the highest QOL. We present also first results of our work that mostly confirm other data and a questionnaire designed for investigation of the quality of life in chronically ill patients.

[The evaluation of radiotherapy in the treatment of epidermoid carcinoma of the oral cavity]

An effect of radiotherapy, in 442 patient presented with epidermoid carcinoma of the oral cavity was studied. No significant prolongation of life-span was observed in patients subjected to radiotherapy both prior and after surgical procedure. Reoccurrence of carcinoma was less likely and appeared later in patients treated with radiotherapy than in patients subjected only to surgery.

[Depression in schizophrenia. Comments on possibilities to use fluoxetine]

Depressive symptoms are frequently diagnosed in patients with schizophrenia. The coexistence of mood disorders and criteria of schizophrenia may result in the diagnosis of schizoaffective disorders. Depressive symptoms can also be recognized after the acute phase of schizophrenia or after neuroleptic treatment which results in the diagnosis of postpsychotic or postneuroleptic depression. Sometimes, depressive symptoms can be misinterpreted; it happens because depressive symptoms can resemble negative symptoms of schizophrenia or neuroleptic side effects. The principles of therapeutic approach to depressive symptoms in schizophrenia have been discussed. Taking into consideration the hypothetical role of the serotoninergic system in the genesis of schizophrenia, special attention has been paid to the drugs selectively acting on this system. The results of the use of fluoxetine as co-treatment with neuroleptics, published by various authors have been presented.

[The evaluation of subjective quality of life in patients with schizophrenia or depression]

Subjective evaluation of the quality of life was studied in 53 schizophrenics (hospitalized, from the day-hospital, and from the rehabilitation unit) and in 12 depressed patients before and after pharmacological treatment or rehabilitation. The self-evaluation questionnaire SF-36 was used. The subjective quality of life of depressive patients at baseline was low in comparison to the schizophrenics. The best improvement of subjective quality of life after the treatment was found in hospitalized schizophrenic patients. Evaluation of the quality of life both before and after treatment/rehabilitation did not correlate with doctors' estimation of the severity of their illness. Depressive patients expressed more negative opinion regarding their physical condition and social activity than did the schizophrenics. The positive opinion on patients' health status correlated positively with good evaluation of patients' physical condition and good performance at home or work.

[Debrisoquine hydroxylation test as an example of new possibilities of research in psychopharmacology]

About 5-10% of European white population has a genetically determinant defect of the CYP2D6, one of the enzymes of cytochrome P-450. This defect leads to the impaired metabolism of many drugs including various psychopharmacological agents. The measurement of the hydroxylation of debrisoquine is a laboratory test which allows to identify such an individual. Patients who show an impaired hydroxylation of debrisoquine usually demonstrate severe side effects and poor outcome of psychopharmacotherapy. This depends on whether the administered drug is metabolized the same way as debrisoquine, i.e. in the presence of CYP2D6. The diagnosis of the phenotype of debrisoquine hydroxylation before treatment may allow to select the group of poor metabolizers. This diagnosis can help to identify the appropriate treatment for those patients, i.e. the selection of either a drug which is not metabolized in the presence of CYP2D6 or an alternative form of therapy.

[A case report of cyclic psychosis]

Cycloid psychoses have a special position in psychiatric classification. Usually they are listed among atypical psychoses, located between the group of schizophrenias and affective psychoses. Nevertheless, there are indications for nosological differentiation of cycloid psychoses from other psychotic conditions. The case of cycloid psychosis of a 38 year old woman with two severe psychotic episodes of mixed, paranoid and affective symptomatology is described. Among the characteristic features of psychotic episodes were acute onset, severe but short course of the episodes and the lack of residual/defect symptoms at outcome. On the basis of this case the differential diagnosis of cycloid psychoses is discussed.

The predictive value of psychopathological subclassifications for the neuroleptic treatment outcome in schizophrenia

In the group of 58 schizophrenic patients who fulfilled the DSM-III-R criteria for schizophrenia, various subgroups have been identified according to the DSM-III-R subdivision of schizophrenic types, the DCR classification of systematic, nonsystematic schizophrenia and cycloid psychosis, as well as positive/negative symptoms of schizophrenia. All patients underwent therapy with one neuroleptic from four different neuroleptic groups. Some significant differences between the subgroups in respect to sociodemographic data were found. The DCR subdivision of patients revealed the majority of meaningful data regarding the predictive validity of psychopathology for the outcome of the neuroleptic treatment.

[Advances in the diagnosis of Alzheimer's disease]

Alzheimer's disease is diagnosed ever more frequently and this requires more precise clinical and laboratory diagnostic methods. The authors discuss the diagnostic criteria and principles of diagnosis in this disease. Neuropathological lesions are described which are required for reliable diagnosis of the disease. Much attention is given to neuroradiological methods, including nuclear magnetic resonance and positron emission tomography.

[Neurologic changes in the white matter of the brain in dementia]

Neuroradiologic white-matter lesions (WML) found in CT and NMR were evaluated in 30 demented patients and 12 dementia-free subjects aged over 65 years. NMR revealed more WML signs than CT. All NMR results of demented patients demonstrated abnormalities (brain atrophy and/or WML), while 15.4% patients with dementia had normal CT scan. WML in CT were found more often among male than female demented patients. No dependence between the intensity of dementia symptoms, age of subjects, age of onset of cognitive impairment, risk for vascular diseases, and the presence of WML in CT and NMR was found.