The impact of lifetime substance use on psychiatric comorbidities and treatment seeking in patients with alcohol use disorders.

It is well-recognized that individuals with alcohol-related disorders often use other psychoactive substances; however, systematic research on this topic remains limited. The primary objective was to determine the prevalence of lifetime psychoactive substance use and describe the dependence between concurrent use of alcohol and other drugs on psychiatric comorbidities in the analyzed group. The secondary aim was to try to assess the frequency of seeking psychiatric treatment between individuals declaring the concurrent use of alcohol with other drugs and those declaring the use only alcohol. The study was designed as a retrospective cross-sectional analysis based on discharge reports from psychiatric patients admitted to the Regional Psychiatric Hospital in Olsztyn, Poland. 1015 cases were included and analyzed in the study. Data for the study were collected in specially designed monitoring cards from discharge reports including data from psychiatric examinations, especially anamnesis. The percentage of people declaring lifetime use of psychoactive substances was 17.6%. 2.8% of them were diagnosed with substance-related disorders (F11-19 according to ICD-10). The most frequently declared use was cannabis, followed by amphetamine-type substances, benzodiazepines and new psychoactive substances. In the group of people declaring the lifetime use of psychoactive substances, 13.4% were additionally diagnosed with mental disorders. It was, consequently, 8% in the group of people denying the lifetime use of psychoactive substances. People declaring lifetime use of psychoactive substances were significantly more likely to seek psychiatric treatment, i.e. they were admitted significantly more often on an emergency admission than on an elective one, these people were significantly more likely to have undergone psychiatric treatment in the past and were more often hospitalized in our center during the research period. People who concurrently use alcohol with other drugs significantly more often have psychiatric comorbidity than people who deny the use of other drugs. That group also visibly more often seeks psychiatric treatment than patients who deny taking psychoactive substances.

Life time use of illicit substances among adolescents and young people hospitalized in psychiatric hospital.

Adolescents are known to be particularly vulnerable, compared to children and adults, to initiation of substance use and progression to problematic use. This study aimed to examine the prevalence and type of illicit drug use in a population of adolescents and young adults who were hospitalized in a psychiatric hospital. The purpose of the study was also to find the link between age, sex, type of admission and particular mental disorders and using psychoactive substances at least once in a lifetime. A 12-month retrospective cross-sectional analysis of medical records compiled for adolescent and youth psychiatric patients who had been admitted to the Regional Psychiatric Hospital in Olsztyn, Poland, between October 1, 2018, and September 30, 2019, was conducted. After analyzing the available medical records, 506 cases were included and analyzed. Data for the study were collected in an Excel spreadsheet from discharge reports, including data from psychiatric examinations, especially anamnesis. Subsequently, statistical calculations were performed. Lifetime prevalence of any illicit substance use (34.0%) was common. The most frequently used drug was Cannabis (29.2%), the next New Psychoactive Substance-NPS (14.2%) and Amphetamine (13.0%). The higher number of people declaring to take illicit substances was proportional to the increasing age. Except for the group 10-15 years, the subject group was dominated by males. The highest, statistically significant percentage of patients who declared taking illicit substances in general, was found in people with diagnoses F20-F29 (schizophrenia, schizotypal and delusional disorders) (55%), additionally, we found a statistically significant association between NPS use and these diagnoses. Only in the group of patients diagnosed with eating disorders no one declared taking psychoactive substances. However, the correlation between taking illicit drugs and the subgroups with diagnosed psychiatric diseases should be treated with caution because of the small sample size in some cases. Our findings have shown the significant prevalence of the phenomenon in this population. These data highlight the need to explore this population at high risk carefully.

The case of an abused child exposed to the direct danger of serious damage to health in the form of a permanent mental illness. / Przypadek dziecka maltretowanego jako narazenie na bezposrednie niebezpieczenstwo wystapienia ciezkiego uszczerbku na zdrowiu w postaci trwalej choroby psychicznej.

Prolonged exposure to violence in any form takes a toll on children's health. It may increase the risk of multiple mental disorders appearing in adult life. Such disorders may be of severe intensity, and in extreme cases, they can even disable normal functioning both individually and socially. The present case concerns an eight-year-old girl subjected to all forms of abuse (sexual, physical, psychological and negligence) in her biological family. The foster parents made a notification of a suspected criminal offence based on their multiple observations of behavioral disorders of the child. After analyzing the evidence, including observations of behavior in the foster family and a comprehensive medical-psychological examination of the subject, all forms of child abuse according to ICD-10 have been diagnosed, as well as a negative impact of violence on the child's psychological well-being. A thorough analysis of the whole available data led to a conclusion that the girl, functioning in her biological family, was exposed to a direct danger of severe health impairment in the form of a permanent mental illness within the meaning of art. 160 of the Polish Penal Code.

Analytically confirmed presence of psychoactive substances, especially new psychoactive substances in a group of patients hospitalized with mental and behavioural disorders due to the use of psychoactive substances diagnosis.

OBJECTIVES: The study assessed the presence of new psychoactive substances (NPS) in comparison to "classic" drugs in the group of newly admitted patients with mental and behavioral disorders due to the use of psychoactive substances diagnosis (section F11-19 according to ICD-10). MATERIAL AND METHODS: Data from anamnesis and the blood and urine samples were collected from 116 patients diagnosed with mental and behavioral disorders due to psychoactive substance use. All of them expressed written informed consent. Analytical confirmation was obtained by highperformance liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS). Liquid-liquid extraction was used for sample preparation. RESULTS: In the sample, 108 (93%) of 116 were positive for psychoactive substances (including 96 cases where >1 substance was found), 69% of individuals were tested positive for opioids and 67% for benzodiazepines. Eleven (9%) of 116 patient samples were positive for NPS. We detected 7 different substances. Six of them were synthetic cannabinoids: PB-22, MDMB-CHMICA, MMB-CHMICA, AB-CHMINACA, MMB-FUBINACA, THJ-2201 and one synthetic cathinone 3-CMC. CONCLUSIONS: The prevalence and NPS profile (the predominance of synthetic cannabinoids) are similar in the group of people with addiction to psychoactive substances as in populations of people taking recreational drugs and the overdose patients admitted to the hospital. Int J Occup Med Environ Health. 2022;35(4):485-95.

Characteristics of psychiatric inpatients diagnosed with mental and behavioral disorders caused by psychoactive substances (F11-19 block), with a focus on NPS and psychiatric co-morbidities.

OBJECTIVES: This study analyzed the prevalence of new psychoactive substance (NPS) use in the analyzed group and compared demographic features and psychoactive substance profiles between the 2 subgroups (NPS users, non-NPS users). The secondary measure was used to determine the prevalence of psychiatric comorbidities in study group and to compare demographic features and psychoactive substance profiles between 2 subgroups (the F11-19 only diagnosed group and the F11-19 group with psychiatric comorbidities according to ICD-10). MATERIAL AND METHODS: A 12-month retrospective cross-sectional analysis of medical records compiled for adult psychiatric patients who had been admitted to the Regional Psychiatric Hospital in Olsztyn, Poland, in October 1, 2016 - September 30, 2017 was conducted. After analyzing the available medical records, 157 cases were included and analyzed. Data for the study were collected in a specially designed monitoring card from discharge reports, including data from psychiatric examinations, especially anamnesis. RESULTS: The most commonly declared psychoactive substances were amphetamine (AMF) - 54% and cannabinoids - 46%. The prevalence of NPS use in the study group was 34%. Inpatients taking NPS, as compared with non-NPS users, were younger and more often admitted to hospital through the Emergency Department. It was also found that NPS users more often took AMF or cannabinoids, and less frequently benzodiazepines (BDZ) or opioids. However, the taking of AMF, cannabinoids and BDZ was also age-dependent. CONCLUSIONS: The prevalence of psychiatric comorbidities in the study group was 9%. Inpatients with psychiatric comorbidities were older and took BDZ significantly more often than AMF. In addition, NPS use affects different groups, including a specific group as the analyzed sample, which shows a similar NPS use profile as different groups described in the literature. Int J Occup Med Environ Health. 2020;33(2):125-36.

Evaluation of survival time and acting capability after fatal injuries based on the type and extent of injuries

One of the tasks of the forensic specialist is to attempt to determine the interval between fatal injuries and death, and to assess whether the victim could be physically active before death and, if so, to what extent. There is ongoing research aimed at the application of additional tests (histological, immunohistochemical and others) to answer these questions. Unfortunately, currently used methods have numerous limitations and require further improvements. Moreover, they are not commonly employed in medicolegal practice in Poland. The greatest difficulty in assessing the time of survival and activity occurs when the period is relatively short (seconds-minutes-hours). Therefore, in practice, injury examination is often the only tool to assess the interval between fatal injuries and death, and the possibility of physical activity during that time. The aim of the paper is review the literature on this topic with a focus on biological methods and attempt to find a correlation between the nature of injuries and survival time, and between the nature of injuries and the capability to be physically active. An analysis of available cases has shown that unfortunately, on account of numerous limitations, the approach with the exception of specific situations, allows determining at most an approximate time interval during which the victim could be alive and active.

Methods for the initial (non-laboratory) assessment of unfitness for driving caused by psychoactive substances

The psychophysical impairment of drivers caused by psychoactive substances is still a common and important factor in road accidents. While in the case of ethyl alcohol the initial detection of drivers who have consumed alcohol is not a problem due to the widespread use of breathalyzers, other psychoactive substances are a problem. These substances are a group of numerous, variously acting and regularly growing compounds. In this publication, the authors have reviewed the methods used worldwide for the initial detection of psychoactive substances, i.e. saliva testers and elements of the medical examination grouped into test kits, which can be used as part of routine police control, and have also assessed their usefulness. New methods of detection based on the evaluation of pupils and eyeball mobility, which are still in the process of improvement, were also discussed.

Role of Stem Cells in Pathophysiology and Therapy of Spondyloarthropathies-New Therapeutic Possibilities?

Considerable progress has been made recently in understanding the complex pathogenesis and treatment of spondyloarthropathies (SpA). Currently, along with traditional disease modifying anti-rheumatic drugs (DMARDs), TNF-α, IL-12/23 and IL-17 are available for treatment of such diseases as ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Although they adequately control inflammatory symptoms, they do not affect the abnormal bone formation processes associated with SpA. However, the traditional therapeutic approach does not cover the regenerative treatment of damaged tissues. In this regards, stem cells may offer a promising, safe and effective therapeutic option. The aim of this paper is to present the role of mesenchymal stromal cells (MSC) in pathogenesis of SpA and to highlight the opportunities for using stem cells in regenerative processes and in the treatment of inflammatory changes in articular structures.

[Evaluating the applicability of medical examinations constituting "the protocol of obtaining a blood sample" in measuring the degree of intoxication]. / Przydatnosc badan lekarskich wymienionych w "protokole pobrania krwi" dla oceny stopnia upojenia alkoholem.

Breathalysing and blood analysis is the basic instrument of measuring the level of intoxication. Prior to collecting a blood sample, an individual suspected of being under the influence of alcohol is examined by a physician, who fills out the "protocol of obtaining a blood sample". This work aims at evaluating the applicability of the described examination in measuring the level of intoxication. In order to do so, our team analyzed 352 "protocols of obtaining blood sample" referred to the Forensic Laboratory KWP in Bydgoszcz, Poland, and compared them with the results of blood analysis. The results of the above analysis point to the fact that the elements of medical examination constituting "the protocol of obtaining a blood sample" are of a minor usefulness in determining the degree of intoxication with ethyl alcohol. The smell from the mouth and the conclusions formulated the examining physician prove to be the most useful. The summary usage of deviations from the norm does not seem to increase the usefulness of methods used within "the protocol of obtaining a blood sample" in evaluating the degree of intoxication.

[Bacterial nosocomial infections in the material of the Chair of Forensic Medicine, Collegium Medicum, Medical University in Bydgoszcz in the years 2000-2006]. / Bakteryjne zakazenia szpitalne w latach 2000-2006 w materialach wlasnych Katedry Medycyny Sadowej CM UMK w Bydgoszczy.

The ever increasing number of legal claims and lawsuits associated with nosocomial infections has become a serious problem. The present authors analyzed the medicolegal opinions regarding nosocomial bacterial infections issued by the faculty of the Bydgoszcz Department of Forensic Medicine in the years 2000-2006. Within the evaluated period, the investigators observed an increase in the number of court cases concerning hospital-acquired infections. The most frequent pathogen was Staphylococcus aureus.

[A case of homicide by ergotamine poisoning]. / Przypadek zabójstwa przez zatrucie ergotamina.

The report presents a rare case of homicide. A mummified body of a man was found bricked up in the kitchen. Toxicological examination revealed high concentration levels of ergotamine in the internal organs and blood.

[Bullet embolism]. / Przemieszczanie sie pocisków w swietle naczyn.

Bullet embolism is an uncommon consequence of penetrating firearm injuries, rarely observed in everyday forensic practice. The present report presents two cases of gunshot bullet embolism. The first examined case is a contact gunshot wound with the entry wound situated at the back of the victim. The wound channel terminated in the thoracic aorta, where from, in keeping with the blood flow, the bullet was transported into the left common iliac artery. The second case pertains to a gunshot in the head, with the bullet shot from a point blank range. The wound channel had a downward course and terminated in the superior vena cava at the level of the pericardium, where from the bullet was transported down the inferior vena cava to the right femoral vein.

[Gunshot wounds in the material of Forensic Medicine Institute, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz]. / Obrazenia postrzalowe w materialach Katedry i Zakladu Medycyny Sadowej CM UMK w Bydgoszczy z lat 1995-2005.

The Medical Forensic Institute, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz annually conducts approximately 600 autopsies. Gunshot wounds constitute only a small percentage of that number. The authors of this work have conducted an analysis of autopsy protocols prepared at the Institute in the years 1995-2005. During this period, 48 people were found dead as a result of gunshot wounds. This number constitutes 0.66% of all autopsies conducted within that time-frame. The objective of this study was an attempt at assessing the character of this phenomenon with due consideration given to the following parameters: age, sex, sobriety, circumstances and locality of the event, as well as season of the year, at comparing the results with data found in the literature on the subject.

[Myocardial infarction as an occupational injury as represented in the materials collected at the Department of Forensic Medicine in Bydgoszcz in the years between 2000 and 2004]. / Zawal serca jako wypadek przy pracy w materiatlach katedry i Zakladu Medycyny Sadowej w Bydgoszczy w latach 2000-2004.

Myocardial infarction is defined as coagulational necrosis of the cardiac muscle caused by ischaemia. In the majority of cases, myocardial infarction is a consequence of atherosclerosis of the coronary arteries. Excessive physical or mental effort can lead to a sudden increase in the required supply of oxygen necessary for the proper functioning of the cardiac muscle and in consequence to cardiac muscle necrosis. The objective of the present study was to analyze cases of myocardial infarctions occurring at work opinionated at the Medico-Legal Institute in the years 2000-2004. The analysis included 12 civil court cases where the plaintiffs demanded compensation for falling victim to myocardial infarction in a work setting. In the majority of cases (11), it was concluded that professional tasks performed during work-time did not meet the criteria of an occupational accident and the most prominent factor that caused cardiac muscle necrosis was internal rather than external in character. In one case, where the plaintiff's professional duties were not only associated with mental stress and a prolonged lack of rest, but were also performed in adverse weather conditions and required sustained and considerable physical effort, it was established that working conditions exerted a significant effect on the occurrence of a myocardial infarction. Opinionating in the above presented cases posed a significant problem due to the lack of legal criteria that would define the term of an "occupational accident".

[Opinionating in cases of assessing the subject's ability to undergo imprisonment in materials collected by the Department of Forensic Medicine in Bydgoszcz in the years 1998-2003]. / Opiniowanie w sprawach dotyczacych oceny zdolnosci do przebywania w warunkach pozbawienia wolnosci w materialach Katedry i Zakladu Medycyny Sadowej w Bydgoszczy w latach 1998-2003.

Estimating the subject's ability to undergo imprisonment and determining whether there are any reasons for delaying or interrupting the execution of the penalty has become a serious problem. Currently, the Polish system lacks clear and uniform opinionating criteria, and the available sources provide only general guidelines. The present report outlines the legal criteria in force in such cases and describes the opinionating criteria used in the Department of Forensic Medicine in Bydgoszcz. The authors have also conducted an analysis of 87 opinions issued at the Department in the years 1998-2003 that evaluated the subject's ability to undergo imprisonment. The most frequent reasons for an individual seeking recognition as being unable to undergo imprisonment were as follows: internal diseases (41), neurological diseases (38), mental disorders (28), orthopedic problems (10) and other types of diseases in isolated cases. In nine instances, the subjects' health status was deemed to constitute a contraindication for imprisonment or detention. In 13 cases, in which the subject's files included an opinion previously formulated by a clinician and stating that the given individual was unable to undergo imprisonment, an analysis of the available medical records, as well as a thorough examination of the patient proved that there were no reasons that would contraindicate imprisonment.

[Analysis of deaths caused by rail-vehicles in the materials collected by the Department of Forensic Medicine in Bydgoszcz in the years 1992-2002]. / Analiza zgonów w nastepstwie wypadków z udzialem pojazdów szynowych w materialach Katedry Medycyny Sadowej CM w Bydgoszczy w latach 1992-2002.

The analysis focused on cases of death following accidents involving rail-vehicles, in which autopsies were performed at the Department of Forensic Medicine in Bydgoszcz in the years 1992-2002. Sixty-five individuals died in train accidents (80%), 16 people (20%) were victims of tram accidents (20%). Males constituted 86% of the material, while females accounted for 14%. The highest number of rail-vehicle accidents was observed in 1992. The most common reason of death was multiorgan injury. In the subgroup of tram accidents, the authors noted no injuries of the highest severity, such as limb amputations, amputations or crushing of the head, or fragmentation or rupturing of the trunk. On the other hand, in railroad accidents, the percentage of the above injuries was 26%, 44% and 24.5%, respectively. The most severe injuries were noted in the group of people hit by a train while in prone position.

[Problems associated with medico-legal opinionating in spine injuries--a case report]. / Trudnosci w opiniowaniu w urazach kregoslupa--opis przypadku.

The paper presents a case of a 44-year old male with a compression fracture of the thoracic spine. In view of incomplete medical records and divergent results of medical examinations, the case gave rise to considerable difficulties in medico-legal opinionating.

[Cases of homicide-suicide (post-aggression suicide) in the material of the Chair and Department of Forensic Medicine in Bydgoszcz]. / Przypadki samobójstw poagresyjnych w materiale Katedry i Zakladu Medycyny Sadowej w Bydgoszczy.

Two cases of homicide-suicide (post-aggression suicide) are presented in this report. In the first case, a young man had killed his wife and mother-in-law inflicting numerous stab wounds to the chest and neck of both victims, subsequently strangled his daughter with his bare hands and then committed suicide by cutting his veins. In the second instance, a woman had killed one of her sons and tried to murder another by giving both victims psychostimulants and medicines against worms, as well as stabbing them repeatedly. She then committed suicide by hanging.

[A rare case of suicide by a self-inflicted head injury]. / Rzadki przypadek samobójczego urazu glowy.

The report presents a rare case of suicide committed by the subject by dropping a tree trunk on his head using a suspended pulley system. The corpse of a 60-year old man was found in the cellar, his head encircled by a blood puddle. A razor was placed on the floor near his right hand. A large fragment of a tree trunk and a system of hooks and pulleys fastened to the ceiling and the floor were found at the place of the accident. The autopsy revealed extensive traumatic lesions of the skull and brain.

[Methods of preliminary evaluation of psychophysical skills of drivers]. / Metody wstepnej oceny sprawnosci psychofizycznej kierowców.

Drug and medication use-associated impairment of driving skills is increasingly becoming a serious problem. Detecting such DUI drivers is very difficult due to the diversity of drugs that affect the central nervous system (CNS), or to the possibility of using several drugs simultaneously. In practice there are numerous different simple tests, which do not require special equipment and can be used for preliminary detection of persons, who are suspected of taking drugs causing impairment of driving skills. In order to popularize the knowledge on the subject of testing drivers for drug use, the authors review the most commonly used methods of driving skill impairment evaluation reported in the literature, and present the scope of employing such tests in various countries.