[Others physical methods in psychiatric treatment based on electromagnetic stimulation]. / Inne fizykalne metody leczenia w psychiatrii oparte o stymulacje elektromagnetyczna.

In the last decades a few new physical methods based on the electromagnetic head stimulation were subjected to the clinical research. To them belong:--vagus nerve stimulation (VNS),--magnetic seizure therapy/magnetoconvulsive therapy (MST/MCT),--deep stimulation of the brain (DBS) and--transcranial direct current stimulation (tDCS). The paper presents a description of mentioned techniques (nature, advantages, defects, restrictions), which were compared to the applied electroconvulsive treatment ECT, earlier described transcranial magnetic stimulation TMS and the pharmacotherapy (the basis of the psychiatric treatment).

Cognitive impairment after sudden cardiac arrest.

AIM: To evaluate the incidence and severity of the impairment of selected cognitive functions in patients after sudden cardiac arrest (SCA) in comparison to patients after myocardial infarction without SCA and healthy subjects and to analyze the influence of sociodemographic and clinical parameters and the duration of cardiac arrest on the presence and severity of the described disorders. MATERIAL AND METHODS: The study group comprised 30 cardiac arrest survivors, the reference group comprised 31 survivors of myocardial infarction without cardiac arrest, and the control group comprised 30 healthy subjects. The Mini-Mental State Examination (MMSE), the Digit Span test from the Wechsler Adult Intelligence Scale, Lauretta Bender's Visual-Motor Gestalt Test, and the Benton Visual Retention Test (BVRT) were used to assess the presence of cognitive impairment. An original questionnaire developed by the author was used for overall mental state assessment. RESULTS: The Bender test demonstrated a significant difference in the presence and severity of visual-motor skills between the study group and the control group, while BVRT and MMSE revealed increased incidence of cognitive impairment in the study group. The Bender and BVRT (D/D)/SS (version D, method D, scaled score) scales indicated cognitive impairment in 53.3% of these patients, while the BVRT (C/A)/SS test indicated cognitive impairment in 40%. For the reference group, the values were 32.3% and 12.9%, respectively. No correlation was found between the severity of cognitive impairment and the duration of cardiac arrest. CONCLUSIONS: Impairment of visual-motor skills, short-term visual memory, concentration, and visual-motor coordination occurs much more frequently and is more severe in individuals after SCA than in healthy individuals. Impairment of memory trace storage and recall after delay occurs more frequently in patients after SCA than in patients after myocardial infarction without cardiac arrest and in healthy individuals. SCA duration did not have any influence on the severity of the described disorders.

Analysis of psychiatric consultations in a multidisciplinary hospital patients.

UNLABELLED: AIM : The aim of the research is the analysis of psychiatric consultations conducted in the multi-disciplinary hospital, establishing the cause of the consultations according to ICD-10 and the analysis of psychiatric consultations regarding their number on particular wards. METHODS: Retrospective analysis of medical documentation concerning given consultations in the multidisciplinary hospital in Tarnowskie Góry in the years 2002-2010 has been conducted. In the statistics studies Shapiro-Wilk test, Kruskal-Wallis test, Mann-Whitney U test, Chi-square test of independence and the others have been used. RESULTS: In the analyzed years, 3,672 consultations have been done, the mean age of the consulted patients has been 46.9 years. Taking into consideration the sex of the consulted patients, 41.99% of them were female and 58.01% were male. The main diagnoses of all consultations present as follows: F00-F09: 18.82%, F10-F19: 29.58%, F20-F29: 17.70%, F30-F39: 10.29%, F40-F48: 13.83%, F50-F59: 0.16%, F60-F69: 3.21%, F70-F79: 1.77%, F80-F89: 0%, F90-F98: 1.01%, other: 3.62%. The consultations most often have taken place on the following wards: Hospital Admitting Department (13.21%), Hospital Emergency Service (6.97%), Surgery Department (8.42%), Internal Medicine Department (6.51%), Neurology Department (4.82%). CONCLUSIONS: The most frequent causes of consultation were addictions, the next were organic and psychotic disorders, neurotic and affective disorders. Consultations most often have taken place at the Hospital Admitting Department/Hospital Emergency Service, Surgery Department, Internal Medicine Department and Neurology Department.

Symptoms of depression and anxiety after cardiac arrest.

OBJECTIVES: The aim of the study was to assess the incidence of depression and anxiety symptoms in patients after cardiac arrest (SCA) in relation to patients with a history of myocardial infarction without SCA and in healthy individuals. The analysis of the impact of selected socio-demographic and clinical parameters and duration of SCA on the presence and severity of depression and anxiety symptoms in different groups was also performed. METHODS: The study involved 30 patients after SCA and 31 patients with a history of myocardial infarction without SCA. The control group consisted of 30 healthy subjects. To assess the mental state, a specially developed questionnaire was used, while the presence and severity of the symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Statistically, a significantly higher average level of depression and a higher incidence of anxiety was demonstrated in patients after a sudden cardiac arrest (study group) and after myocardial infarction (reference group) compared with the control group. There were no statistically significant differences in the incidence of anxiety between the study and reference groups. No impact of the duration of cardiac arrest on the incidence of depression and anxiety symptoms in the study group was observed. CONCLUSIONS: In the group of people with a history of cardiac arrest, the most common mental disorder is depression. Anxiety and depression are significantly more frequent in patients with a history of SCA than in healthy individuals. There were no differences in the incidence and severity of depression symptoms in patients after SCA compared to patients after myocardial infarction without SCA. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety in the investigated groups.

[Contemporary place of the electroconvulsive therapy. Part 2. Clinical aspect]. / Obecne miejsce terapil elektrowstrzasowej Czesc 2. Aspekt kliniczny.

Electroconvulsive therapy (ECT) is an important method of biological treatment in serious psychic disturbances. Similarly to drug therapy it is marked by a determined schematics of applying including the list of indications, contraindications, procedures of the performance, as well as the list of adverse invents. Applying defined schemas allows for minimizing the risk and influences the final effectiveness of therapy.

[Transcranial magnetic stimulation in psychiatric therapy]. / Przezczaszkowa stymulacja magnetyczna w terapii psychiatrycznej.

Transcranial magnetic stimulation (TMS) is one of new techniques of the physical treatment in psychiatry. Its advantage is painlessness, so as lack of invasiveness and evoking a convulsive effect. The technique of TMS was introduced into the clinical practice in 1985--originally as a diagnostic method in neurology. Later TMS became a valuable tool in the basic research in neurophysiology and neuropsychology, so as in clinical examinations. In 1994 the first papers on TMS application in therapy of depression and schizophrenia were published. The research on the therapeutic TMS effectiveness encounters certain problems and restrictions: difficulties in determining a place of the stimulation, lack of the possibility of the selection of optimal parameters for the stimulation, problem in guarantying optimal conditions for the double-blind study, etc. During the last two decades TMS was applied in therapy of mood disorders and psychoses more on the principle of consuetude, than confirmations of the evident effectiveness. However recently a group of European experts presented the study, in which they regarded TMS as the effective method in therapy of depression and schizophrenia--presenting conditions to the optimal stimulation.

[Contemporary place of the electroconvulsive therapy Part 1. The historical context arnd the biological basis]. / Obecne miejsce terapii elektrowstrzasowej Czesc 1. Kontekst historyczny i podstawy biologiczne.

Electroconvulsive therapy (ECT) is a former physical therapy method in psychiatry which is applicable up till today in relation to its high effectiveness and the safety. Centuries of applying nonconvulsive methods of the electric stimulation preceded introducing this method into the clinical practice. ECT is arousing a lot of controversies; populous myths are connected with its applying--that demands explanations. Numerous biological mechanisms explaining the clinical efficacy of ECT action are well-known.

[Deep brain stimulation--the newest physical method of treatment of depression]. / Gleboka stymulacja mózgu--najnowsza fizykalna metoda leczenia depresji.

The deep brain stimulation DBS is the newest physical method of the treatment of depressive disorders. When applying of this technique in neurological illnesses (e.g., Parkinson's disease), mood changes were observed. In 2005, Helen Mayberg et al. used DBS in the therapy of the depression for the first time. Stimulating electrodes were placed in Brodmann areas 25. In the period of some past years, only about 30-40 patients with refractory depression have undergone DBS treatment. Numerous problems connected with applying DBS in patients with psychiatric disorders are described in the paper.

Magnetic seizure therapy (MST)--a safer method for evoking seizure activity than current therapy with a confirmed antidepressant efficacy.

Since 1999, attempts have been made in the application of a new technique called magnetic seizure therapy (MST) or magnetic convulsion therapy (MCT) in the treatment of depressive disorder--as an alternative to electroconvulsive treatment. The technique of rapid rate transcranial magnetic stimulation (rTMS) is used to evoke intentional and repeated magnetoconvulsive seizures, though it requires the use of stimulation parameters practically inaccessible in commercially available rTMS magnetic stimulators. Magnetic convulsion therapy has been tested on monkeys as well as humans. A decisive majority of studies carried out both on animals and humans addressed the issue of safety of the MST method and confirmed that the side-effects (mostly of a cognitive nature) which occurred after magnetic seizures were weaker than those observed after electroconvulsive seizures. An analysis of available sources, however, does not confirm any proven antidepressant action of the MST technique. No experimental investigations have been carried out on animal models of depression. Clinical effectiveness had been confirmed in merely a few (perhaps three) patients with depression. The authors submit the results of the hitherto conducted studies on MST to critical analysis, particularly in the aspect of their antidepressant efficacy.

[Computer modelling of electroconvulsive treatment and transcranial magnetic stimulation--an explanation of poor efficacy of the magnetic method]. / Komputerowe modelowanie zabiegów elektrowstrzasowych i przezczaszkowej stymulacji magnetycznej--wyjasnieni slabej skutecznosci metody magnetycznej.

With help of informatics technology it is possible to simulate various physiological processes in virtual models of biological structures. In a created realistic model of the human head we made some comparative investigations over physical phenomena accompanying the electroconvulsive treatment ECT and transcranial magnetic stimulation TMS--two methods with confirmed (ECT) or presumable (TMS) antidepressant efficacy. The present investigations are a continuation of the earlier conducted study in the simple spherical model of the head. Investigations confirmed, that magnetic stimulation TMS generates a considerably weaker current flow in the brain than it is present in electroconvulsive technique. Applying of such weak stimulation in modus,,at haphazard", i.e. on the brain area which does not need to be metabolically disturbed in this patient--cannot cause an antidepressant effect at all. The results of the investigations explain not only the safety of the magnetic method, but the weak effectiveness of this method. The authors propose some methods for improvement of TMS efficacy.

Psychological and psychiatric factors related to health-related quality of life after total hip replacement - preliminary report.

UNLABELLED: Total hip replacement is one of the most successful orthopaedic interventions in improving considerably the patients' performance, nevertheless some patients demonstrate declined functional ability following an operation. Such condition is not a consequence of medical illness or the surgery itself but might rather be associated with mental status. The authors conduct an investigation concerning the relation between some psychological and psychiatric factors and their influence on health-related quality of life in patients after total hip replacement. METHODS: Into the study group we included 102 subjects undergoing total hip replacement (59 female, 43 male). In all subjects we measured depression (Beck Depression Inventory - BDI), anxiety (State and Trait Anxiety Inventory - STAI), sense of coherence (SOC-29), personality traits (Eysenck Personality Inventory - EPI) and health related quality of life (SF-36). RESULTS: The postoperative values of the PCS and the MCS for the whole group of patients correlated negatively with the SOC values (p=0.04 and p=0.03 respectively). Neuroticism (EPI) and anxiety as a trait (STAI) were also associated with postoperative performance, both in mental (p=0.03 and p=0.008 respectively) and physical (p=0.005 and p=0.04 respectively terms). CONCLUSION: Total hip replacement improves significantly the patient's health-related quality of life at 6months after surgery, what is influenced by sense of coherence, neuroticism and anxiety as a trait. Above mentioned factors should be taken into account when rehabilitation and social readaptation processes are planned.

Decline in dehydroepiandrosterone sulfate observed in chronic urticaria is associated with psychological distress.

OBJECTIVE: Dehydroepiandrosterone sulfate (DHEA-S) decline in chronic urticaria (CU) may be involved in etiopathogenesis of the disease or is a secondary phenomenon resulting e.g. from psychological distress. The relation between mental stress and skin diseases is well documented, however not focused on urticaria. We sought to explore the association of mood disturbances and the sense of coherence (SOC), as psychological distress parameters, and DHEA-S decline in patients suffering from CU. METHODS: The patient sample included 54 subjects with active CU. Fifty-nine healthy subjects were enrolled in the control group. In all subjects DHEA-S serum concentration was measured and mental status analyzed using the State and Trait Anxiety Inventory, SOC Questionnaire and Beck Depression Inventory. RESULTS: Urticaria patients showed lower serum concentration of DHEA-S (p = .01) and lower level of the SOC (p = .009), as well as higher level of anxiety as a state (p < .001) and as a trait (p = .001), and higher level of depression (p = .003). DHEA-S concentration correlated negatively with the level of anxiety as a trait (p = .02) and the level of depression (p = .046), and positively with the SOC level (p = .03). CONCLUSIONS: The results of the present study show that CU patients suffer from the psychological distress. We demonstrated for the first time that DHEA-S decline observed in CU patients might be a phenomenon secondary to psychological disturbances.

[Shock therapy in psychiatry--historical feature]. / Terapia wstrzasowa w psychiatrii--rys historyczny.

2008 brings the 70th anniversary of the first electroconvulsive treatment, which was applied in a Psychiatric Clinic of Rome and introduced a new physical therapy to the clinical practice. The electroconvulsive therapy (ECT)--remains as the only method from the earlier therapies practised in the era preceding modem pharmacotherapy. It survived to the present times despite some difficulties. The ECT is a safe and extremely effective method for the treatment of severe affective disorders and psychoses. The paper presents the development of ECT and others convulsive techniques in a historical context.

[Maintenance electroconvulsive therapy--a review of literature]. / Elektrowstrzasowe zabiegi podtrzymujace--przeglad pismiennictwa.

Continuation and maintenance electroconvulsive therapy (ECT) is used to reduce the risk for relapse and recurrence of affective disorders and schizophrenic disorders. Despite the potential value of these ECT schedules, both are relatively neglected in clinical practice. This article reviews the recent research on the subject. Although most of the research are small open studies and case reports, continuation and maintenance ECT does emerge as a safe and effective treatment for relapse and recurrence-prone patients who have responded to the basic course of ECT.

[Electroconvulsive therapy in Poland in 2005--a nationwide questionnaire study performed in Polish psychiatric clinics]. / Leczenie elektrowstrzasowe w Polsce w 2005 roku--wyniki ankiety przeprowadzonej w polskich szpitalach psychiatrycznych.

The aim of this study was to determine the characteristics of ECT practice in Polish Psychiatric Clinics in 2005. A questionnaire was sent to all Polish psychiatric hospitals that performed electroconvulsive therapy in 2005. Altogether 450 patients (0.22% of the general number of psychiatric inpatients in 2005 and 0.72% of the inpatients of hospitals where electroconvulsive therapy was performed) were treated with ECT in Poland in 2005. The rate of ECT use in Poland is the lowest in the Central--East European region.

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.

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.

[The influence of some sociodemographic and clinical factors on depression in women undergoing coronary arteriography]. / Ocena wplywu wybranych parametrów socjodemograficznych i klinicznych na objawy depresji u kobiet poddanych inwazyjnej diagnostyce choroby wiencowej.

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.