[Emotional regulations among benzodiazepines dependent patients--preliminary results]. / Regulacja stanów emocjonalnych u pacjentów uzaleznionych od benzodiazepin--doniesienia wstepne.

BACKGROUND: The aim was to examine emotional states among benzodiazepine dependent patients who have been recently successfully detoxified and their coping strategies. METHOD: 32 patients dependent from benzodiazepines had been chosen to participate in the study and they were examined with State-Trait Anxiety Inventory (STAI), The Coping Inventory for Stressful Situations (CISS), The UWIST Mood Adjective Checklist (UMACL). RESULTS: Detoxified benzodiazepine-dependent patients experience symptoms such as: high levels of anxiety (both state and trait), tense arousal, unpleasant mood and low body energy level. CONCLUSIONS: In the examined group, the most common coping strategy has been the emotions oriented style which does not affect sources of emotional problems. Presented results point towards necessity of psychological therapy, based around strengthening of coping resources and anxiety removal (relaxation) techniques.

[Emotional identification and management disorders among benzodiazepine dependent patients as a factor leading towards interpersonal relations problems]. / Zaburzenia rozpoznawania i rozumienia emocji u osób uzaleznionych od benzodiazepin jako czynnik prowadzacy do trudnosci w relacjach interpersonalnych.

BACKGROUND: The aim was to examine an ability to identify and manage the emotions defined as Emotional Intelligence Quotient (EQ) among benzodiazepine-dependent patients. METHOD: 32 benzodiazepine-dependent patients had been chosen to participate in the study. They were examined by the following EQ measurement surveys: INTE, SIE-T. Personality traits and anxiety levels have been studied using NEO-FFI and State-Trait Anxiety Inventory (STAI). RESULTS: Research points toward EQ decrease among benzodiazepine dependent patients, particularly in face expression recognition ability. Most characteristic results are the neurotic trait (high results), extrovert and scrupulous. CONCLUSIONS: Improving abilities enabling proper use of emotional intelligence in problem-solving and effective social functioning is apparently an important component of therapeutic programmes for benzodiazepine dependent patients.

[Evaluation of cardiovascular autonomic nervous system in ethanol withdrawal]. / Ocena ukladu autonomicznego sercowo-naczyniowego w zespole odstawiennym u chorych przewlekle uzaleznionych od alkoholu.

UNLABELLED: The aim of the study was to assess the risk factors and state of cardiovascular autonomic nervous system injury in ethanol dependent patients. The group examined consisted of 85 alcoholics (17 females and 68 males) aged from 27 to 68 y (45.7 +/- 8.82) hospitalized at the Ward of Toxicology and Environmental Diseases because of alcohol withdrawal. Ethanol dependence was diagnosed according to ICD -10 criteria, withdrawal syndrome was scored according to CIWA - A scale. A blood ethanol concentration, creatinine, urine, coagulation parameters and liver enzymes activity were measured on admission. Cardiovascular autonomic nervous system was evaluated by standard Ewing battery tests using VariaCardio TF5 system. The parasympathetic system was assessed by the heart rate response to forced breathing, the heart rate response to standing up, and to heart response to the Valsalva maneuver. The sympathetic system was evaluated by the blood pressure response to standing up. The original Ewing normal values were used. RESULTS: The mean duration of ethanol dependence was 13.7 +/- 8.2 y. In 92% of examined patients heavy and in 8% moderate ethanol withdrawal syndrome was diagnosed. The mean blood ethanol concentration was 1.07 +/- 1.21g/l. Liver injury was diagnosed in 43.5% of the examined group. No changes in autonomic battery tests were found only in 28.2% of the examined subjects. Early parasympathetic damage was stated in 23.5%, definite parasympa-thetic damage in 44.7%, combined para-sympathetic and sympathetic damage was diagnosed in 3.5% of patients examined. The relative risk for parasympathetic and sympathetic system injury rose together with CIWA - scoring, blood ethanol concentration on admission (OR = 1,4 95% CI: 0,81 +/- 2,4), and when GTP activity was three times greater than normal (OR = 1.2 95% CI: 0.92 +/- 1.7).

[Tobacco smoking by alcohol addicted patients--preliminary report]. / Palenie tytoniu przez pacjentów leczonych z powodu uzaleznienia od alkoholu--doniesienie wstepne.

The problem of alcohol and nicotine addiction is both social and medical. The substances are often used together and give complex addiction. The knowledge about mechanisms of complex addiction would be useful for creating effective ways of treatment the abused patients. The aim of the paper was to describe the complex ethanol and nicotine addiction phenomenon. The research was made using data from 30 ethanol and nicotine addicted patients treated in Clinic of Toxicology Jagiellonian University Collegium Medicum in Krakow. 90% of them were nicotine addicted. Tobacco was the first abused substance in the group of patients. The mean period of addiction was 29.0 years for tobacco and 22.2 years for alcohol. The majority of the patients (51.9%) smoked more than 20 cigarettes per day; 29.6% smoked 11-20 cigarettes per day. Single patients were narcotics and drugs addicted. Continuation of the research and toxicological determination of the substances and their metabolites concentrations would be useful for the complex addiction problem explanation and description.

[Evaluation of regional cerebral blood flow using 99mTc-ECD SPECT in ethanol dependent patients: pilot study]. / Ocena zaburzen regionalnego przeplywu mózgowego metoda tomografii emisyjnej Pojedynczego Fotonu z uiyciem 99mtc-ECD u pacjentów uzaleinionych od alkoholu: doniesienie wstepne.

UNLABELLED: The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics. MATERIAL AND METHODS: Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y). RESULTS: The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

[Evaluation of pituitary-gonadal axis in alcohol dependent males]. / Ocena osi przysadkowo-gonadalnej u mezczyzn uzaleinionych od alkoholu.

UNLABELLED: Chronic alcoholism leads to organic damages of nervous system, the liver and the endocrine system. The aim of the study is to evaluate pituitary-gonadal axis in males chronically dependent with alcohol. MATERIAL AND METHODS: The study group consisted of 50 alcohol dependent men aged 27 to 53 years (40.7 +/- 6.6) treated at the Ward of Toxicology and Environmental Diseases (Detoxification Unit). Al-cohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. In all the patients anthropometrical measurements and abdominal ultrasonography were performed as well as blood pressure was measured. Levels of gonadotropin, total testosteron, PRL were determined, thyroid and adrenal gland function were assessed and oral glucose tolerance test (OGTT) was performed in all patients. Activity of the liver enzymes, urea and creatine concentration were determined. Erectile dysfunction was assessed using IIEF. 5 questionnaire: in those patients who received < or =21 points an incidence of diabetes mellitus, thyroid gland and cardiovascular diseases was assessed using standardized questionnaire. RESULTS: Alcohol dependency longer than 15 years was stated in 25, longer than 10 years in 9, and longer than 5 years in 16 of examined patients. The moderate withdrawal syndrome was diagnosed in 22, severe withdrawal syndrome in 26 and very severe withdrawal syndrome in 2 of the patients. BMI ranged from 15.8 to 33.8 kg/m2 (mediane 24.67; +/- 0.54 kg/m2). In 24 men erectile dysfunction was diagnosed using IIEF5 questionnaire. No significant difference was noted between level of total testosterone and PRL in the group with or without erectile dysfunction (testosterone: 5.07 +/- 2.41 vs. 4.54 +/- 2.74; PRL: 330.2 +/- 214.2 vs. 307.4 +/- 258.2). Gonadropine level in the group of men with erectile dysfunction was significantly higher than that without erectile dysfunction (LH: 7.4 +/- 5.2 vs. 4.38 +/- 2.23, p < 0.01; FSH: 13.3 +/- 29.3 vs. 4.59 +/- 19.92, p < 0.05). CONCLUSION: The results obtained confirm that secondary stimulation of pituitary-gonadal axis in alcoholic men depends on liver function and ethanol toxic effect on gonads.

[Carbohydrate metabolism in acute poisoning with xenobiotics]. / Zaburzenia gospodarki weglowodanowej w ostrych zatruciach ksenobiotykami.

UNLABELLED: The aim of the study was to evaluate carbohydrate metabolism in patients hospitalised because of acute intoxication with xenobiotics. MATERIAL AND METHODS: An analysis of 3628 patients (1553 females and 2075 males; age: 40.6 +/- 15.9 y) hospitalized at the Ward of Toxicology and Environmental Diseases because of acute poisoning in 2004-2006 was done. The patients with diabetes mellitus diagnosed prior to hospitalisation were excluded from the analysis. The blood ethanol concentration was measured, medication drugs and/or psychoactive substance screening test were performed in all patients on admission. Fasting glucose level on admission and control level on second or third day of hospitalisation were determined. Risk ratio of hyperglycaemia according to toxic agent was assessed using multiple regression model considering age, gender, and the patient education. RESULTS: In 18.2% (398 males and 254 females) of the patients the blood glucose level on admission was > or = 7.8 mmol/l; in u 3.6% (78 males and 50 females) > or = 11.1 mmol/l. In 24 (0.6%) of the patients glycaemia on admission was < or = 3.5 mmol/l. Control fasting glucose level of > or = 7.0 mmol/l was determined in 115 males and 76 female patients. 42% elevation in risk of hyperglycaemia was noted in acute carbon monoxide poisoning (OR = 1.42; 95% PU: 1.11-1.82). In ethanol intoxicated patients 12% drop in risk of hyperglycaemia was noted (OR = 0.88; 95% PU: 0.72-1.07). Benzodiazepine poisoning diminished risk of hyperglycaemia in 36% (OR=0.64; 95%PU: 0.48-0.84). Risk of hyperglycaemia in poisoning by medicines co-ingested with ethanol was always lower compared to poisoning with the single agent. CONCLUSION: A higher risk of hyperglycaemia was related to acute carbon monoxide poisoning whereas lower risk of hyperglycaemia was attributed to benzodiazepines and alcohol. A frequency of hypoglycaemia in the group of poisoned patients was much more lower compared to hyperglycaemia.

[Assessment of socio-demographic factors in alcohol-addicted patients recurrently treated in a detoxification unit]. / Ocena czynników socjodemograficznych u osób uzaleznionych od alkoholu wielokrotnie leczonych w oddziale detoksykacji.

The aim of the presented study was the assessment some socio-demographic factors of alcohol dependent patients more times hospitalized in Department of Toxicology in Kraków in the years 1999-2004. The repeatedly hospitalization of 334 patients (298 men and 36 women), aged from 17 to 71 years (mean 45.1 years) due the alcohol problem on the basis of clinic documentation were established. The following socio-demographics traits were taken in analysis: age, sex, marital status, place of living, education, kind of jobs, employment and others sources of money. The patients were admitted from 2 or more 29 times during 6 years. Medical history of addiction of mentioned patients was from 1 to 40 years, mean 25 years. 43.7% persons live single and 53.6% was married. The most patients live in Kraków (80%) and others near the town. The education of them: 15.0% ended high school, 28.7% "medium", 30.5% "low professional" and elementary school--13.8% of them. This factor was similar like regional data. Amount mentioned persons 25.8% worked for salary, 11.7% had own business, and 25.4% was retired, and 29.0% was unemployed. This last factor was worse liked similar from mentioned region. The kind of jobs of persons on the aspect of "social safety" was described. Among the mentioned chronic alcohol addicted persons about 18.8% of them with machines in traffic was worked (bus drivers i.e.) and 7.5% described persons in special jobs was worked (policemen, physician i.e.). The authors were suggested that mentioned factors due health services cost in Poland and propose integration of treatment of alcohol-addicted patients.

Cytogenetic aspects of buprenorphine maintenance treatment program--preliminary report.

The study was aimed at a preliminary evaluation of the effect of buprenorphine, a synthetic opioid used as a substitute in the therapy of dependence on psychoactive substances, on the structure of the genetic material of patients receiving such treatment. The material for the study were lymphocyte cultures from peripheral blood, analysed by a cytogenetic micronuclear test. The obtained results were compared with the literature data on the mutagenic action of methadone.

[Committed suicide in the background of the history of previous suicide attempts--a 5-year prospective study of suicide attempts]. / Samobójstwa dokonane na tle historii wystqpujqcych uprzednio prób samobójczych--5-letnie badania prospektywne.

The aim of the study was to estimate the risk factors for eventual suicide in the case of individuals hospitalised for a suicide attempts (or attempted suicide). The group examined comprised 238 patients, who, in the years 2000-2001, were hospitalised in the Department of Clinical Toxicology CM UJ in Kraków for suicidal self-intoxication with medical drugs. The group consisted of 63 males and 175 females ranging in age from 17 to 79 years (the mean age was 36 years). The instruments applied in the examination included a structured interview and a set of psychological tests; complementary information was obtained from the patients' case histories. In the year 2005, on the basis of the data from the Institute of Forensic Medicine in Kraków, it was established that 10 of the patients under consideration--6 females, and 4 males--had eventually committed suicide within the period concerned. The retrospective analysis of the case of each of these 10 individuals revealed that the majority of them had been treated psychiatrically for depression or alcoholic addiction, had experienced parental or marital bereavement, or had experienced serious financial difficulties. The subjects' case histories informed also about the cases of suicidal death in the families of several subjects. As should be pointed out, the results of psychological tests obtained earlier by the 10 subjects concerned did not unequivocally indicated high endangerment by the risk of eventually committing suicide. Finally, it is necessary to observe that alcoholism and depression were the most frequently diagnosed mental disorders in the case of the male suicides. In the case of the female suicides, the results of the analysis reveal a variety of psychological, psychiatric and socio-demographic factors that, eventually, could lead to suicide.

Simultaneous determination of buprenorphine and norbuprenorphine in serum by high-performance liquid chromatography-electrospray ionization-mass spectrometry.

Buprenorphine is a strong narcotic analgesic. It is also used in the substitution therapy for opium alkaloid addicts. The aim of this paper was to develop and validate a highly sensitive high-performance liquid chromatography-electrospray ionization-mass spectrometry method for simultaneous determination of buprenorphine and norbuprenorphine in human serum. The developed methodology was then applied to real clinical cases in a clinical toxicology setting. Extraction of analytes has been done using solid-phase extraction. Chromatographic separation was achieved on a LiChroCART column with a Purospher RP-18e cartridge, and for detection an LCQ mass spectrometer with an ion trap analyzer was used. Quantitation of buprenorphine and norbuprenorphine was performed in a single ion monitoring mode (m/z 468 buprenorphine, m/z 414 for norbuprenorphine) in order to increase the sensitivity of the method. The standard curves for both compounds were linear over the range of 0.2-10 ng/mL (r2 > 0.995). The quantitation limit was 0.2 ng/mL for both analytes. The method was used for quantitation of both buprenorphine and norbuprenorphine in the serum of 15 patients undergoing the buprenorphine substitution therapy. Serum concentrations ranged between 0.36 and 4.60 ng/mL for buprenorphine and 0.21 and 2.50 ng/mL for norbuprenorphine, with buprenorphine single dosages from 0.8 to 6.0 mg.

[Difficulties in diagnosis of hepatic encephalopathy in ethanol dependent patients]. / Trudnosci w rozpoznaniu encefalopatii watrobowej u osób uzaleznionych od alkoholu.

As a somatic evaluation by outpatient psychotherapy service for alcoholics is being done very rarely the patients are not informed about health harm related to alcohol having the "false feeling of safety". The aim of the study was to evaluate a functional and morphological liver state of patients served by such a service for minimum 5 years who were sent do the Department of Clinical Toxicology via intervention medicine. The changes in the central nervous system were also considered. The West Haven criteria of altered mental state in hepatic encephalopathy were applied. The Number Connection Test, part A and B, and "100-7" test were used to psychometric evaluation. A significantly higher serum ammonia concentration (p<0.02), AST, ALT and GTP enzymes activity, bilirubin (p<0.02), iron (p=0.005) concentration and significantly lower prothrombin index and albumin concentration were found in the group of ethanol dependent patients as compared to the reference group. A significantly lower RBC and platelets number, lower Ht and significantly elevated MCV compared to the control group were also found. The relationship between West Haven criteria and results of laboratory testing was shown: a worse West Haven criteria a worse metabolic disorders. The pathologic changes in the liver ultrasonography and scintigraphy were significantly higher in the group of ethanol dependent patients. The presented observations indicate on necessity of close co-operation between psychologists, therapeutics and clinical toxicologists in early diagnosing and treatment the organ injury in alcohol addicted patients.

[Results of the psychological examination of patients--alcohol-addicted drivers, treated in a detoxification unit]. / Wyniki badania psychologicznego pacjentów--kierowców uzaleznionych od alkoholu, leczonych w oddziale detoksykacji.

There are many studies on problems related to alcohol abuse in many aspects from many countries. As a preventive strategy a few years duration programs for numerous populations are being conducted for tightening of social interrelation, to prevent juvenile drinking, to avoid drinking and driving etc. USA study on drinking and driving people indicate on different psychiatric disorders and needs for deeper psychiatric insight. Analysis of different source information on alcohol related traffic collisions is a basis for prevention strategy programs. Our study may contribute in small number of psychology publications related to psychometric testing on motor skills, cognition ability and social condition of people who drive and drink. There were 50 ethanol dependent patients treated at the Department of Clinical Toxicology detoxification unit. All of them had a driving license; majority had access and opportunity to drive a car. A structured interview and psychometric tests were used to evaluate psychology functioning. It can be assumed that deficits revealed in the examination may be detrimental factors to proper and efficient driving ability.

[Somatic and psychiatric disorders in alcohol-addicted patients treated in a detoxification unit]. / Obraz zaburzen somatycznych i psychicznych u osób uzaleznionych od alkoholu leczonych w oddziale detoksykacji.

The aim of the presented study was the assessment of somatic and psychiatric disorders in alcohol addicted patients, treated in the Department of Clinical Toxicology detoxification unit in Kraków in 2002 year. The total number of 443 patients (377 men and 66 women) were considered for the research. More than 50% patients were hospitalized repeatedly (2 or more times) due to alcohol problems. Medical history as well as detail medical examination and diagnostic evaluation revealed the concomitance with alcohol disease different somatic illnesses and psychiatric disorders. In 194 patients (43.8%) the alcoholic liver damage was diagnosed, frequently (in 5.2% patients) with chronic pancreatitis. Only 22 patients (5%) were infected with hepatitis virus type B. Diabetes type 2 and different cardiovascular disorders were present in almost one third of patients. In the past 55 patients (12.4%) have had severe head trauma, and 51 (11.3%) were treated because multiorgan trauma. Psychiatric examination revealed in 102 patients (23%) affective disorders, and in 92 (20.7%) personality disturbances. The presented data should be a ground for discussion about treatment model alcohol dependency in Poland.

[Assessment of disorders after chronic psychoactive drug abuse in patients hospitalized in detoxification units]. / Ocena wystepowania zaburzen po dlugotrwalym przyjmowaniu srodków psychoaktywnych u osób hospitalizowanych w oddziale detoksykacji.

The aim of this study was the assessment of disorders after chronic intake of psychoactive drugs, like marijuana, amphetamine, ecstasy, cocaine and opiates. In 2002 in the Department of Clinical Toxicology detoxification unit were treated 117 chronic drug abusers. The 76 of them use the opiates predominantly, the next 41 persons (35 men, 6 women), were heavy abusers of psychostimulant drugs. In opiate abusers typical withdrawal signs and symptoms were observed. In the group of psychostimulants users, the mean time of marijuana use was 6 years, amphetamine--5 years. The cocaine was used rarely. Among 25 persons (61%) from these group the withdrawal syndrome were established. The excitation of neurovegetative system, depression, or psychomotor effects were observed. We concluded the necessity of estimation of neurobiological changes after using of psychostimulants and that more controlled research might uncover a clinically diagnosable withdrawal syndrome in human psychostimulants users.

[Preliminary research on opioid mutagenicity]. / Wstepne badania nad mutagennym wplywem opioidów.

The aim of the study was a preliminary recognition of genotoxic effect of methadone, using a culture of lymphocytes obtained from the blood of 23 opiate dependent patients from methadone maintenance treatment programme conducted at the Department of Clinical Toxicology of Jagiellonian University Medical College. The micronuclei (MN) occurrence and the number of sister chromatids exchange in methaphasal plate were the examined markers of mutagenesis. Two control groups differently exposed to environmental mutagenic factors were used to verification of results. The increased fraction of cells with the high number of sister chromatids exchange (HFC) indicate on possible genotoxic effect of methadone, however in the populations exposed also to other mutagenic factors the effect is not so evident.