[Contradiction model to prevent addictions in university students from Kraków]. / Krakowski model przeciwdzialania uzaleznieniom wsród studentów.

Students' community is a peculiar environment where the problems of psychoactive substance using has been raised for many years, whereas the real scale and extent of the phenomenon has not been appreciated enough so far. Results of the preliminary research carried on in 2000 and 2004 indicate a considerable degree of the popularity both of alcohol and drugs among students. Therefore both the continuation and widening of the activity of Polish Anti Drug Action "University Free from Abuse" is necessary. In October 2004 the Council of the Rectors of Krakow Universities came to a decision about the necessity of the beginning of an action which aims at the diagnosis and counteraction of the problems in question. In December the outpatient clinic was established with the help of the Clinic of Toxicology. It aims at the prophylaxis, diagnosis and treatment of the addiction. As to prophylaxis, lectures for the first year students have been provided. Their role is to inform about the ethanol, psychoactive substance impact as well as the action of addiction. Lectures have been connected with a public-opinion poll which led to the estimation of the scale of the problem. At the same time the Clinic has rendered both diagnostic and therapeutic service for drug users and alcoholics and their relatives from the above-mentioned environment. There are plants to spread the prophylaxis among more students. Among others the secondary prophylaxis and the creation of consulting points is our aim.

[Suicidal behavior and suicide attempts in adolescents and young adults--epidemiology, risk factors, prevention and treatment]. / Zachowania i próby samobójcze mlodziezy i mlodych doroslych--epidemiologia, czynniki ryzyka, prewencja i leczenie.

According to WHO, every year, suicide is committed by at least 1 mln people in the world. In Europe, suicide is committed by about 43 thousand people a year, most frequently by middle-aged and elderly males, and attempted by 700 thousand people. In Poland, in 2002, 5100 people committed suicide. The number of suicide attempts is probably ten times higher. The aim of the study is to investigate the current state of knowledge concerning suicidal behaviour and attempted suicide in adolescents and young adults. The literature on the subject is analysed, and special attention is paid to the issue of suicide epidemiology, risk factors, prevention and treatment. Definitions of suicidal behaviour and presuicidal syndrome are debated. In the chapter concerning treatment, Bohme's model of crisis intervention in the case of suicidal patients is discussed, and detailed indications for treatment are presented. Suicide attempts are undertaken most frequently by young people, especially by teenage girls and young women. The ratio of suicide in this age group increased significantly in the last few years. Phenomena which are of special importance for the prevention of suicide among adolescents include suicidal thoughts, attempted suicide, and completed suicide. Multicentre study into suicidal behaviour conducted by WHO indicate that the highest average yearly European coefficients of suicide attempts have been detected in young females ranging in age from 15 to 24 years. Polish and foreign literature on the subject is dominated by publications regarding completed suicide. The issue of attempted suicide is treated rather marginally, which may be due to the scantiness of reliable data concerning large populations. The past few years, however, brought a significant advancement of the research into the epidemiology, etiology, and treatment of suicidal behaviour in adolescents. It is difficult to establish linear correspondence between risk factors and suicidal behaviour. The cause is usually a combination of constitutional factors including genetic ones, earlier personal experiences, and precipitating stressful events. Paradoxically, the risk of suicide among adolescents increases in highly developed countries, where the quality of life has undergone a significant improvement. In conclusion, the authors have stressed the importance of an interdisciplinary approach to work with individuals endangered by the risk of suicide. Attention has also been drawn to the importance of personal contact and the necessity to accompany the individual in suicidal crisis from the beginning to the end of the therapy.

[The frequency of suicide attempts depending on gender and the age structure]. / Czestosc prób samobójczych w zaleznosci od plci i struktury wiekowej.

Sex and the age structure have been for decades the crucial factors determining the dimensions of suicide. In the literature of the subject, it is possible to find different interpretations concerning the widely known facts of larger effectiveness of suicide among males. Females, on the other hand, exhibit suicidal behaviour and suicide attempts several times bigger than the number of completed suicides. In comparison with wide literature dealing with the problematic of completed suicide, the number of publications concerning suicide attempts is, both in foreign and in Polish literature rather scarce. That is why the present authors have undertaken the analysis of suicide attempts by subjects hospitalized in the Department of Clinical Toxicology Jagiellonian University College of Medicine in Krakow in the years 2000-2002. On the basis of the medical documentation, 2757 cases of attempted suicide through self-intoxication by subjects undergoing treatment in the toxicological department. In the period concerned, the number of hospitalizations after suicide attempts increased from 856 cases in the year 2000 to 971 cases in 2001, and subsequently slightly decreased to 930 cases in 2002. The highest indicator of suicide attempts through self-intoxication has been observed among adolescents and young adults. In the absolute values, within the span of the years in question, there is a substantial predominance of suicide attempts undertaken by adults ranging in age from 20 and 50. On the contrary, in the oldest age group (over 60), the number of suicide attempts through self-intoxication was in the years concerned the lowest. In contrast with completed suicide, where the proportion of males to females is 4:1, in the group examined, females constituted 50% of subjects after suicide attempts. The number of females after suicide attempts in the consecutive years analysed was higher among adolescents and young women under 30. Despite drawbacks in data gathering, there is convincing testimony indicating that suicide is the result of number of complex risk factors. Sex and the age structure belong to non-modifiable factors, and thus emphasis should be put on the importance of the gathering of relevant data and on further research into the factor of sex and age structure in suicide attempts and completed suicide.

[Fluctuations and seasonality in suicidal attempts]. / Fluktuacje i sezonowosc prób samobójczych.

The aim of the study was to analyze seasonality and temporal fluctuations in suicide attempts by persons living in Krakow and hospitalized in the Department of Clinical Toxicology CMUJ in the years 2000-2002. The research focussed on the frequency of suicide attempts in relation to the time of the day, day of the week, and month of the year. Temporal fluctuations in the frequency of suicide attempts have been assessed on the basis of the data from medical documentation concerning 2757 suicide attempts by individuals ranging in age from 14 to 90 years. The group consisted of 1607 females and 1150 males. According to the results of the research, seasonality and temporal fluctuations in the frequency of suicide attempts is different for males and females. In the case of the males examined, no dependence between the frequency of suicide attempts and a particular month or season has been observed. In the case of females, on the contrary, the data indicate the existence of a seasonal pattern with the peak in the spring (or early part of the summer), and in the autumn--in October and November. In males, the peak day for attempted suicide was Monday, whereas in females--Sunday and Monday. As regards the time of the day, both the results of the present research and data collected by WHO/EURO indicate that suicide attempts occurred most frequently in the evening, late in the evening or in the early part the night. In conclusion, it has been emphasized that the majority of suicide attempts, especially by females, occurs late in the evening or early in the night. This finding seems to be of particular importance for suicide prevention--it can contribute to the increase in the effectiveness of the organization of work in the Crisis Intervention Centres and make therapists and patients' families aware of the existence of periods of an increased suicide risk. The research has been conducted owing to the cooperation between the department of Clinical Toxicology, CMUJ and the Department of Adult Clinical Psychiatry, CMUJ in Kraków. The results obtained, together with the results of the research conducted by the centres participating in WHO/EURO are vital for suicide prevention and treatment.

[Risk factors for suicide attempts in elderly and old elderly patients]. / Czynniki ryzyka usilowania samobójstwa u osób starszych i w okresie póznej starosci.

The aim of the study was to assess the phenomenon of suicide attempt in the elderly inhabitants of Kraków. Special attention has been paid to the group of "seniors"--aged 75 years or over. The authors have analyzed all the 136 cases of suicide attempts by individuals aged over 60 years, selected from the cases of suicide attempts by self-intoxications by patients hospitalized in the Department of Clinical Toxicology, CMUJ in Kraków in the years 2000-2002. The group concerned included 45 males and 91 females. A large number of subjects (over a half of the total) ranged in age from 60 to 65 years. The group of seniors comprised 35 individuals (aged 75 years or over), including 7 males and 28 females. On the basis of the data from medical documentation, the subjects were analysed from the point of view of their health condition and in the psycho-social context. In the majority of cases the subjects are pensioners residing in Kraków, often living alone. In the case of 98% of the subjects, it was their first suicide attempt. Pharmaceuticals used for self-poisoning were most frequently psychotropic, or mixed-type drugs. The assessment of the severity of poisoning indicates that in about 20% patients poisoning was severe. 70% of the subjects suffered from depressive, reactive, or situational disorders, affective depression or organic brain disorders, often with dementive signs. A significant number of subjects suffered from hypertension, coronary artery disease, arteriosclerosis, or alimentary tract diseases. In the group of the seniors, the most conspicuous problems included serious somatic diseases (malignant diseases and chronic respiratory system diseases), depression, organic dementia, loneliness, and bad family situation. Taking into consideration the scantiness of research into attempted and completed suicide in the elderly and in the old elderly, the present authors stress the importance of the continuation of the research to prevent suicide in the aforesaid age group.

[Attempted suicide among teenagers and young adults]. / Samobójstwa usilowane u mlodziezy i mlodych doroslych.

The aim of the study was to present the phenomenon of suicide attempts by self-poisoning in a group of females and males ranging in age from 15 to 29 years, and treated in the Department of Clinical Toxicology Jagiellonian University College of Medicine in Kraków in the years 2000-2002. The group analyzed comprised of 1117 patients, 629 (69.1%) women and 425 (38.1%) men. In the female group, teenagers under 19 constituted 48.9%, whereas young females ranging in age from 20 to 29 years--51.1%. In the male patients group teenagers under 19 constituted 29.4%, the young men (20-29 years of age)--70.6%. The group was analyzed from the point of view of demographic, clinical and social factors such as gender, age, level of education, marital status and occupation (if applicable), the course of self-poisoning and kind of toxic substance involved. In the majority of cases, self-poisoning had been caused by taking one type of medicines, and less frequently by taking mixed-type medicines or by simultaneously taking medicines and ethanol. The most typical drugs used in the attempts included benzodiazepines, phenothiazines, nonsteroidal antiinflammatory and antiepileptic drugs. The assessment of the poisoning severity based on the PSS classification, indicates the predominance of the minor and moderate poisoning. Up to 50% of subjects suffered from mental disorders--most frequently from affective disorders, neurotic disorders, and personality disorders. As an essential part of the problem of suicidal behaviors in teenagers and young adults, suicide attempts among young population require an in-depth analysis. The scale of the problem indicates the necessity of initiating appropriate preventive actions and organizing appropriate psychological and psychiatric care.

[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.

[Suicide attempts by self-poisoning among the elderly]. / Próby samobójcze przez samozatrucie u osób w podeszlym wieku.

The aim of the study was to present suicidological problems in the elderly. The investigation assessed patients treated for self-intoxication in the Department of Toxicology of Collegium Medicum, Jagiellonian University in Cracow. Medical documentation of the entire population of subjects aged over 65 and hospitalized in the years 1999-2001 was examined from the point of view of demographic and clinical factors. The examined population consisted of 68 subjects including 20 males and 48 females ranging in age from 65 to 90 years (mean age = 72.6). The majority of subjects were retired and, in many cases, lived alone. The majority of female subjects were widows living in Kraków or in small towns or villages around Kraków. A significant number of subjects had been undergoing psychiatric treatment or even repeated hospitalization prior to the suicide attempt. A significant percentage had suffered from severe somatic diseases. For 55 of the subjects (79.7%), it was the first suicide attempt, and for 14 subjects (20.3%)--a repeated one. The drugs most frequently used in the attempts were psychotropic, cardiological and mixed-type drugs. The assessment included the state of consciousness and the degree of intoxication on the subjects' admission to hospital. The mean duration of hospitalization was 13.7 days. The most frequently determined somatic diseases were hypertension (33.3%) and coronary artery decease (30.4%), atherosclerosis (15.9%) and diabetes (10.1%). In the process of a complex diagnostic and therapeutic procedure, the mental state of the patients was assessed. Depressive disorders (reactive) and endogenic depression (affective) were recognized in 51 subjects (73.9%). Organic brain disorders, often with dementive signs, were detected in 44 subjects. Schizophrenia was recognized in only a small percentage of subjects (5.8%). The description of the data indicate a close connection between depression and social factors in the case of the elderly. Therefore, an adequate treatment of depression should be give priority in programs for preventing suicide among the elderly.

[The completed and attempted suicide in Krakow: similarities and differences]. / Samobójstwa dokonane i usilowane w Krakowie--podobienstwa i róznice.

The study presents the results of the interdisciplinary research conducted on the basis of cooperation between the Institute of Forensic Medicine, the Department of Clinical Toxicology, and the Clinic of Psychiatry in Kraków. The aim of the research was to determine similarities and differences between attempted and completed suicide from the point of view of socio-demographic and clinical traits. The authors analysed 220 cases of completed suicide committed in Kraków and its environs in the year 2000. The material presented in the study was based on the archive data from post mortem examinations conducted in the Institute of Forensic Medicine in Kraków. The sample consisted of 177 males and 43 females ranging in age from 13 to 89 years. The mean age was 43.6 years for the entire group, 42 years for males and 50 years for females. The majority of subjects were males, either unemployed, or pensioners. A similar tendency was observed in the group of female subjects. Mental disorders and alcoholic addiction in anamnesis were discovered in a significant number of cases, both in the group of males and in the group of females. Subjects, in whom serious somatic diseases had been detected, constituted a separate group of cases. According to the archive data, in the last century, suicide was most frequently committed by hanging. Similarly, in the sample examined, in 133 cases, suicide was committed by hanging. In 37% of cases, the level of alcohol in the suicides' blood was between 0.5 and 3 or more g/L. In 2000/2001, within the analogical period of 12 months, the group of 200 patients after a suicide attempt by drug intoxication was examined in the Department of Clinical of Toxicology Jagiellonian University College of Medicine. This group included 49 males and 150 females, ranging in age from 18 to 79 years (mean age 35). The examination was conducted by means of structured investigation and medical documentation. Contrary to completed suicide, in the group of suicide attempters, females outnumbered males. Young people under thirty, living in a large city, possessing elementary or secondary education, and either unemployed, or pensioners, constituted the majority of the examined group. A significant percentage of females was divorced and lived with their children only. The majority of the examined population of suicide attempters had used alcohol during the attempt, had suffered from depression, personality or behavioural disorders, had undergone psychiatric treatment, or had had cases of suicide among their friends or relatives.