[Social functioning of schizophrenic patients after 15 years from the first hospitalization (Part I -- evaluation of social functioning)]. / Funkcjonowanie spoleczne chorych na schizofrenie po 15 latach od pierwszej hospitalizacji (cz. I--ocena funkcjonowania).

Catamnestic data concerning 109 patients, inhabitants of Warsaw-Praga, hospitalized for the first time in the years 1978-79 with schizophrenia (92 persons) or paranoid psychosis-ICD IX number 297.9 (17 persons), were collected in 1993-94. Smaller number and shorter duration of hospitalisations has been observed during 15 years, in comparison with other Polish data. Twenty persons died during the period of observation. In the group of 85 investigated persons-69% were not working at all-15% were fully and 18% partially unable to meet their basic needs on their own-29% were temporarily or permanently unable to function adequately in their marital and/or parental roles, 31% were single and childless. Taking into account the mortality among 109 observed persons (18.7% during 15 years); good prognosis according to social functioning has been found in 48.6% of the group observed at first hospitalisation.

[Social functioning of schizophrenic patients after 15 years from the first hospitalization (Part II -- the evaluation of needs for community care)]. / Funkcjonowanie spoleczne chorych na schizofrenie po 15 latach od pierwszej hospitalizacji (Cz. II--ocena zapotrzebowania na opieke srodowiskowa).

The description of the studied group was given in the first part of the paper. Some of the factors having been present at the first hospitalization were found to be important for the patients' functioning 15 years later. On the basis of the collected regarding data 85 patients, significant coincidence has been found between more intensive use of extramural services, more frequent and longer hospitalizations, and worse social functioning during 15 years' period in individual cases. The conclusion has been assumed that there exists obvious need for more intensive community care for such patients. On the basis of 0.15% morbidity index the number of schizophrenics needing social support, sheltered accommodation and sheltered working conditions were estimated. According to the Mental Health Care Act of 1994 such services have to be organized within social care system.

[Methods of measurement of social adjustment in schizophrenia]. / Metody oceny funkcjonowania spolecznego chorych na schizofrenie.

Social functioning as well as reduction of psychopathological symptoms constitute basic criteria for evaluation of effectiveness of psychiatric treatment and rehabilitation. Social functioning is often estimated by measuring fulfillment of social roles as well as concurrent difficulties and behaviour of patients who can be troublesome to others-RASP, and SRPS scales (9, 20). KAS and SAS Scales (11, 21) focused on measuring social "adjustment" itself are being criticized. The LSP, SFS, ILLS (4, 15, 24) can be recognized as scales that are easy to use and adopted to the specific functioning of schizophrenics. These scales measure basic abilities needed for independent life outside mental hospital. They are being used for planning social rehabilitation and community care.

[Agranulocytosis in the course of clozapine treatment]. / Agranulocytoza w trakcie stosowania klozapiny.

Clozapine is highly effective for drug resistant schizophrenia, it does not cause any extrapiramidal side effects, but involves a high risk of agranulocytosis with fatal outcome. The pathogenesis of agranulocytosis is not clear but genetic factors, as well as immunological and toxic mechanism may play an important role. Since the introduction of the monitoring system of leucocytosis for every patient an increasing number of agranulocytosis cases are being registered. Owing to the monitoring system, an immediate discontinuation of the drug, and the initiation of appropriate treatment the number of cases with fatal outcome is not growing in spite of the increasing number of patients treated with clozapine. In the described patient with chronic schizophrenia and ulcerative disease, agranulocytosis disappeared within 7 days after discontinuation of the drug. Three months later the patient died because of perforation of a duodenal ulcer. A negative influence of closapine on ulcerative disease should by considered, but the authors have not found any information on this topic in the literature.

[Heart rhythm reactivity in patients with endogenous depression. I. Respiratory tests]. / Reaktywnosc rytmu serca na bodzce u osób z endogennym zespolem depresyjnym. I. Próby oddechowe.

The aim of the study was the evaluation of central autonomic regulation in endogenous depression. It was based on estimation of heart rhythm reactivity to physiologic stimuli with regards to the dependence between the severity of anxiety and the reactivity. In thirty healthy subjects, fourteen neurotics and thirty patients with endogenous depression intensity of anxiety and depression symptoms was measured. The measurements included: heart beat rate and respiratory rate in rest, amplitude of heart rhythm changes during normal breathing and both during hyperventilation and Valsalva test, the time of duration of heart rhythm acceleration in Valsalva test, and the index of termination of heart beat rate in hyperventilation test. It was proved the domination of excitability and reactivity to weak and short stimuli, and the functional dominance of sympathetic system in endogenous depression. No dependence was found between autonomic system reactivity in depression and the intensity of anxiety. The results may indicate that one part of vegetative disturbances in endogenous depression is not connected with anxiety but results from other pathogenetic mechanisms of depressive syndrome.

Urinary MHPG is not a good predictor of antidepressive drug response.

The final results of treatment with 4 antidepressants (amitriptyline, imipramine, chlorimipramine and mianserine) in 80 patients with endogenous depression were analyzed with respect to their pre-treatment levels of urinary MHPG. The analysis revealed that MHPG measurements were of no practical value in predicting individual response to antidepressants.

Failure to correlate urinary MHPG with clinical response to amitriptyline.

On the basis of studies carried out in a group of 44 patients with endogenous depressive illness, the authors conclude that MHPG in urine is not a good predictor of response to amitriptyline treatment. There are no correlations between MHPG level and clinical improvement after 2 weeks' treatment and with final results of the therapy.

Studies on biogenic amine metabolizing enzymes (DBH, COMT, MAO) and pathogenesis of affective illness. III. Platelet monoamine oxidase activity in endogenous depression.

Platelet MAO activity was determined in blood from 31 healthy persons and 43 persons with endogenous depressive syndrome. It was found that the enzyme activity is significantly higher in women than in men, both in healthy controls and in affective illness groups. Statistically significant lowering of the enzyme activity was found in the group of women with affective illness as compared with healthy women controls (P less than 0.05). Although the latter phenomenon is true of all three diagnostic subgroups of affective disorder (bipolar, unipolar, undifferentiated), it is most pronounced, and statistically significant only in the group of women with an undifferentiated course of disease. A small rise in the enzyme activity was noticed in some patients during remission, as compared with a period of depression, but this was not statistically significant. Analysis of the possible links between MAO activity and the clinical picture, or the severity of depression, revealed no significant correlations. No correlation was found between the level of MAO activity and a family history of psychiatric disturbances in general, and affective disorders in particular--in either women or in men.

Studies on biogenic amine metabolizing enzymes (DBH, COMT, MAO) and pathogenesis of affective illness. I. Plasma dopamine-beta-hydroxylase activity in endogenous depression.

On the basis of studies carried out with a group of 47 patients with endogenous depressive illness, lower plasma activity of dopamine-beta-hydroxylase (DBH) was found as compared with a control group (31 healthy persons). Lower DBH activity particularly characterized bipolar patients. Lowest DBH activity was found in patients with a family history of psychiatric disorders, in particular, affective illness (in comparison with the control group the difference was statistically significant, P less than 0.05). It was noticed, that in a period of remission or significant improvement the enzymatic activity increases, although in some cases the level of activity is still lower than in the control group. There was a correlation between activity of the enzyme and clinical course of the illness and susceptibility to antidepressive drugs. Most of the observed phenomena are related to male patients. On the basis of these studies and data supplied by corresponding literature, concerning in particular the effects of DBH inhibitors (fusaric acid, disulfiram), the authors consider that changes in DBH activity may play a role in the pathogenesis of depression and that DBH deserves further studies, also of genetic nature.