2010; 12, 4
Archives of Psychiatry and Psychotherapy 4/2010
Adrian Newman-Tancredi, Mark S. Kleven
5 Pharmacology of “atypicality” of antipsychotic drugs: status and perspective
“Atypical” antipsychotics are antagonists at serotonin 5-HT2A and dopamine D2 receptors. However, their effects on negative symptoms and cognitive deficits remain modest and they disrupt metabolic function. Recent drugs, such as aripiprazole, perospirone, bifeprunox, lurasidone and cariprazine act as D2 receptor antagonists (or partial agonists) combined with 5-HT1A receptor activation. The latter prevents extrapyramidal symptoms, favors prefrontal cortex dopaminergic neurotransmission, has a beneficial influence on mood and opposes cognitive deficits. Further, recent drugs exhibit little interaction at sites associated with side-effects such as metabolic disorders or autonomic disturbance. However, these drugs differ in their balance of 5-HT1A/D2 receptor properties and this is likely to translate to distinct therapeutic profiles.
Hans Jürgen Möller
13 Long-term pharmacotherapy of schizophrenic patients: Achievements, unsolved needs and future perspectives with special focus on long-acting injectable second generation antipsychotics
Schizophrenia is a disorder with a poor long-term outcome. Second generation antipsychotics (SGAs) offer some better treatment options for patients suffering from schizophrenia in terms of a broader efficacy profile and reduced risks of extrapyramidal side effects (EPS). However, in the long-term treatment conditions the problem of a high non-adherence rate has not been resolved sufficiently. The introduction of depot formulations of SGAs might serve as an option to further improve the situation. The respective data of long-acting injectable risperidone are reviewed. Future perspectives of a broader indication of this approach are discussed.
23 Semantic satiation in schizophrenia. The role of valence of stimuli
Aim. The primary aim of the research was to define the relation between semantic satiation effect, overactivation of semantic network and a symptom of derealisation in people suffering from schizophrenia. The semantic satiation was defined as the subjective and temporary experience of loss of meaning of repeatedly pronounced words or images which is the result of excessive activation in the semantic network. Because overactivation in semantic network is common feature of schizophrenia, it was expected that schizophrenic patients would be prone to satiation effect more than healthy subjects.
Methods. Satiation of negative, positive and emotionally neutral images was determined for patients suffering from schizophrenia and in healthy controls. The subjects were presented with pictures from different categories flashed on a computer screen 3, 13, 23 and 33 times.
Each presentation was followed by the category name and the subjects decided, whether the object presented on the photograph belonged to this category. It was expected that the loss of meaning of satiated images would delay participants’ lexical decision and that this effect should be stronger for the schizophrenic than for the control group.
Results. Reaction times to a decision based on repeated images were longer in a group of patients suffering from schizophrenia than in the control group. It was also observed that in the group of patients the satiation effect depends on valence of satiated images. Emotionally positive and negative pictures were satiated faster than neutral ones.
Discussion. The conducted experiment confirmed the greater susceptibility of patients to the effect of semantic satiation. It has been revealed that subjective experience of the loss of meaning of images depends on the valence of stimuli.
Andrzej Cechnicki, Łukasz Cichocki, Joanna Franczyk-Glita
29 Consistency of symptomatic dimensions of schizophrenia in a 12 year follow-up study
Aim. The aim of the study was to identify syndromes measured by the BPRS – E scale and to analyse changes in their consistency over the course of a 12 years prospective study.
Material/method. A group of 80 patients with diagnosis of schizophrenia was followed up in 1, 3, 7 and 12 years after their first psychiatric hospitalisation. Their psychopathological status was investigated with the BPRS – E scale.
Results. Four syndromes were found: positive, negative, depressive and that of excitement. However, at the following time points, consistency of these syndromes varied. The most consistent syndrome was the negative one. Four of ten symptoms connected with this syndrome, namely: motor retardation, blunted affect, uncooperativeness and emotional withdrawal, were present within it at every follow-up. In the case of the excitement syndrome two symptoms (hostility and tension) were present at all follow-up time points. None of the symptoms included in the depressive and positive syndromes were consistently present within these syndromes over the period of twelve years.
Conclusion. In the analysis of the symptoms of patients suffering from schizophrenia four factors were identified: negative, excitement, depressive and positive. Of the four factors, the most consistent over the period of twelve years was the negative factor.
Dagmar Kogoj, Otto Michael Lesch, Victor Blüml, Anita Riegler, Benjamin Vyssoki, Golda Schlaff, Henriette Walter
37 Lesch Alcoholism Typology Medical Treatment and Research
Aim. Alcohol abuse and alcohol dependence produce very high health costs. Nowadays, early detection and intervention are very well accepted. Due to the well proven theory regarding the heterogeneity of alcohol dependence and for the purpose of research and therapy, four subgroups of alcohol dependence have been established.
Methods. The Lesch Typology was developed as a result of a prospective long - term study and led to a decision tree identifying alcohol dependent patients’ subgroups. The results show that each subgroup requires different and specific treatments. Within the framework of a computer programme (www.LAT-online.at) the decision tree can be used very easily. Meanwhile, this method has been field – tested in numerous basic and clinical trials. After the diagnostic procedure, a protocol of the questionnaire displays reachable and realistic treatment goals. Furthermore, it provides information about the guidance and treatment of each patient subgroup.
Conclusion. Nowadays, the heterogeneity of the disease alcohol dependence is without any doubt an accepted certainty. By utilizing the Lesch Typology, specific treatment approaches of the diverse subgroups may be applied accordingly.
Discussion. Using the subgroups defined in the Lesch Typology for basic and clinical research subgroup customized treatments can be prescribed, and consequently even better treatment outcomes in alcohol dependent patients can be awaited.
49 Controversial issues concerning the concept of palliative care of anorexic patients
Anorexia is a grave and often fatal illness. Death rates would undoubtedly be higher if anorexics were not force-fed once their weight became dangerously low. A very important feature distinguishing anorexia from other mental disorders is highly ambivalent attitude of sufferers to their own illness. On the one hand, anorexic individuals seem to accept their progressing malnutrition, which supports suggestions of researchers that egosyntonicity which refers to the patients’ sense of the anorexia nervosa being a part of themselves or of their identity, is a fundamental aspect of this disorder. Thus denial and resistance towards treatment, which are frequent among anorexic patients represent their conscious attempts to preserve its egosyntonic symptomatology. On the other hand, a lot of researchers underline destructiveness of anorexia, namely it not only doesn’t give happiness, but also restricts the anorexic person’s life to one dimension: in this context she/he can’t derive satisfaction from another resource than the more and more mechanic, obsessive self-starving, which finally leads to exhaustion and desire for death. Some researchers ask whether anorexic patients can actually make competent decisions about their quality of life. If so, then the decision to refuse therapy may be on a par with other decisions to refuse life-prolonging therapy made by sufferers of debilitating chronic, or acute onset terminal illness. The aim of the article is to answer a question if data concerning the quality of life among anorexic individuals justify a proposition of palliative care over these persons.
61 Body image among young females with anorexia nervosa and the structure of body image among their mothers
Aim. A comparative study of body image among young females with anorexia nervosa and their mothers.
Method. Contour Drawing Rating Scale – CDRS by J.K Thompson, J. Gray.
Results. The results of this research revealed the statistically significant correlation between body image evaluation among mothers and the body perception among their daughters with anorexia nervosa. The correlation refers to the “ideal self” (“what I want to look like”) as well as to the “ought self” (“what I should look like”). Both mothers and daughters aspire to the ideal body image. The women’s desired body shape is slimmer than their current figure which conforms to the age-appropriate norms. When evaluating their bodies, both groups of females take into account the social norms concerning appearance.
Conclusions. Culturally and socially influenced perception of body can significantly affect the development of identity in adolescent females and young women, leading to disharmony.
Barbara Józefik, Maciej Wojciech Pilecki
69 Perception of autonomy and intimacy in families of origin of patients with eating disorders with depressed patients and healthy controls. A Transgenerational perspective – Part I
Aim. The aim of the study was to assess the dimensions of family autonomy and intimacy in families of origin of patients with eating disorders, depression and in families of healthy girls.
Method. We used the Autonomy and Intimacy scales of the Family of Origin Scale (FOS) to compare 112 females having different types of eating disorders with 40 depressed females and 85 schoolgirls in the Polish cultural context.
Results. Bulimic and depressed females had statistically poorer results for FOS major scales and subscales compared with schoolgirls. Bulimic females had statistically poorer results than anorexia restrictive-type females for both FOS major scales, the intimacy subscales, and the autonomy subscales of clarity of expression, responsibility, and respect for others. Anorexia nervosa binge/purge-type patients had poorer results than schoolgirls on the autonomy subscale of responsibility and the intimacy subscale of responsibility but better results on the intimacy major scale and the subscale range of feelings compared with bulimic patients.
Conclusions. These results suggest that difficulties in achieving autonomy and intimacy are not specific to eating disorder. The positive results for anorexia restrictive-type females suggests a defensiveness in the family relationships description.
Barbara Józefik, Maciej Wojciech Pilecki
79 Perception of autonomy and intimacy in families of origin of parents of patients with eating disorders, of parents of depressed patients and of parents of healthy controls. A Transgenerational perspective – Part II
Aim. The aim of the study was to describe the dimensions of family autonomy and intimacy in families of parents of patients with eating disorders and depression in comparison with parents of healthy controls.
Method. We used the autonomy and intimacy scales of the Family of Origin Scale (FOS) to compare parents of 112 females having different types of eating disorders with parents of 40 depressed females and 85 schoolgirls in the Polish cultural context.
Results. Mothers of bulimic girls had poorer results on both FOS major scales as compared to schoolgirls’ mothers. Mothers of anorexia nervosa binge/purge type patients had poorer results on three autonomy and two intimacy subscales as compared to schoolgirls’ mothers. Fathers of restrictive anorexia patients had poorer results on both FOS major scales as compared to schoolgirls’ fathers. Fathers of bulimic patients scored worse on general autonomy and its two subscales than schoolgirls’ fathers, and fathers of depressed girls had poorer scores on two subscales as compared to schoolgirls’ fathers.
Conclusions. Thus, parents of eating disorder patients had significant difficulties in autonomous functioning and intimacy as compared to parents of healthy females and of depressed females, respectively.