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Biomedical subjects

Andrzej Kiejna

Publications and source records attributed to Andrzej Kiejna.

At least 19 recordsLinked to original sources
PubMed2006

Bipolar or unipolar? - the question for clinicians and researchers.

BACKGROUND: Correct diagnosis and criteria of affective disorders is always a subject of interest to researchers and practitioners. METHODS: The study aimed at assessing frequency of various traits and symptoms of bipolar affective disorders (BP-I, BP-II, BP-S spectrum) in patients (n=246) treated for recurrent affective disorders (unipolar-UP). The analysis was based on criteria of affective disorders of Ghaemi et al. and Hirschfeld's Mood Disorders Questionnaire. RESULTS: UP was confirmed in 32.9% of individuals, whereas 19.5% were BP-I, 35% BP-II and 12.6% BP-S. UP patients were significantly more often professionally active than those with BP (37.2% vs. 22.7%). Duration of a disorder was significantly shorter and the number of depressive episodes lower in the UP group. In comparison with UP, BP-I were associated with the previous occurrence of unusual and/or risky behaviour (OR=24.5), excessive, irrational expenditure (OR=21.1), lack of a critical attitude with respect to social behaviour (OR=20.3), increased sex drive (OR=17.7), and excessive self-confidence (OR=12). BP-II were associated with a lack of criticism with regard to social behaviour (OR=12.7) and unusual and/or risky behaviour (OR=10). Spectrum BP were most strongly associated with short term hypomanic episodes, including drug induced episodes (OR=15.8) and lack of criticism (OR=11.8). Early onset of depression (before 25 years of age) increased the risk of all three types of BP (by a factor of 3 to 5). LIMITATIONS: This was a naturalistic study, in which treatment was uncontrolled. CONCLUSIONS: Results of the study are a voice in the discussion on too narrow criteria defining bipolar affective disorders.

Adolescent↗
PubMed2006

Violence at the workplace--a questionnaire survey of nurses.

BACKGROUND: In the health sector, anywhere in the world nurses are one of the most exposed groups to violence. However, it is not obvious that psychiatric nurses (PNs) are more exposed to aggression and burnout. OBJECTIVES: To determine the nature and effects of aggressive acts towards nursing staff in psychiatric and other medical services in Poland. METHODS: Various questionnaires (Stress at Work Scale, General Health Questionnaire, Maslach Burnout Inventory, Work Satisfaction Scale), were distributed among psychiatric (N=78) and non-psychiatric nurses (N-PNs) (N=335). A 92.6% response rate was achieved. RESULTS: Significant differences were found between PNs and non-psychiatric counterparts with respect to their experiences of violence. The most frequently reported incident was verbal abuse, followed by threats and physical assault. Patients were significantly more frequent perpetrators in psychiatric wards than in others. The level of intra-staff aggression did not significantly vary between groups, neither did the level of work satisfaction and absenteeism. CONCLUSION: The frequency of violent acts and stress related to them point out the strong need for the development of preventive programs to address the issue of violence at work.

Absenteeism↗
PubMed2006

[Coercion in the treatment of anorexia nervosa].

Anorexia nervosa (AN) is a complex disorder of unclear aetiology, nowadays one of the most serious chronic diseases of adolescent girls and young women. Severe weight loss and associated behaviours may endanger anorexic patients' lives. A characteristic for the disorder the reluctance in accepting treatment can lead in such situations to the necessity of involuntary treatment. The authors have presented indications for hospitalization as well as have discussed consequences, short- and longterm effectiveness of coercion measures in therapy of anorexia. The necessity of further investigations on this problem has been stresssed, particulary connected with good prognosis in the involuntary treatment. The lack of one-valued legal bases for involuntary treatment of anorexia in polish legislation has been mentioned as well as the lack of proper medical outposts providing them complex treatment.

Anorexia Nervosa↗
PubMed2005

Bipolar mood disorders among Polish psychiatric outpatients treated for major depression.

BACKGROUND: Significant proportion of patients treated for depression may have various types of bipolar mood disorders. The aim of the study was to assess the frequency of bipolar disorders among outpatients having at least one major depressive episode, treated by 96 psychiatrists, representing all regions of Poland. METHODS: The study included 880 patients (237 male, 643 female), identified to following diagnostic categories: bipolar I, bipolar II, bipolar spectrum disorder and major depressive disorder. RESULTS: Bipolar mood disorders were found in 61.2% of patients studied, bipolar I more frequent in men and bipolar II in women, and bipolar spectrum in 12% of patients. Patients with age ranges 19-49 and 50-65 years did not differ as to the percentage of diagnostic categories. Patients with bipolar mood disorders compared to major depressive disorder had significantly more frequent family history of bipolar disorder, premorbid hyper- or cyclothymic personality, early onset of depression, symptoms of hypersomnia and hyperphagia, psychotic depression, post-partum depression, and treatment-resistant depression. Bipolar spectrum patients had most clinical features similar to classic types of bipolar disorders. LIMITATIONS: Neither structured interview for family history, nor formal criteria for a number of clinical manifestations were used. The population treated by psychiatrists may not be representative and present a subgroup with more severe mood disorders. CONCLUSIONS: Bipolar mood disorders may be very prevalent among depressive outpatients treated by psychiatrists in Poland, which is confirmed by the results of recent studies. Bipolar patients (including bipolar spectrum) significantly differ from major depressive disorder as to numerous clinical features related mostly to depressive episode.

Adult↗
PubMed2005

The EUNOMIA project on coercion in psychiatry: study design and preliminary data.

Previous national research has shown significant variation in several aspects of coercive treatment measures in psychiatry. The EUNOMIA project, an international study funded by the European Commission, aims to assess the clinical practice of these measures and their outcomes. Its naturalistic and epidemiological design is being implemented at 13 centres in 12 European countries. This article describes the design of the study and provides preliminary data on the catchment areas, staff, available facilities and modalities of care at the participating centres.

Journal Article↗
PubMed2004

One-year course of the first vs. multiple episodes of depression--Polish naturalistic study.

PURPOSE: The aim of the study was to compare a clinical course and treatment results of depression occurring as the first depressive episode, the second depressive episode or the third or further depressive episode. The study was 1-year, prospective, naturalistic observation made by Polish psychiatrists. METHODS: One-hundred and seventy-nine patients with the first depressive episode (group I), 170 patients with the second episode (group II) and 183 patients with the third or further episode of depression (group III) were compared. The main analysed variable was remission, defined as the score of < or =7 points on 17-item Hamilton depression rating scale (HDRS), after 6 and 12 months of observation. RESULTS: The groups of patients studied did not initially differ as to age, proportion of gender and intensity of depression. The percentages of remission after 6 months of observation in groups I-III were: 49%, 41% and 32%, and after 12 months 69%, 60% and 50%, respectively. CONCLUSIONS: The results obtained indicate that the course of subsequent depressive episodes is less favourable compared to the first depressive episode. The percentages of remission obtained in individual groups studied may have implications regarding duration of pharmacological treatment of depressive episode.

Antidepressive Agents↗
PubMed2003

Depression and anxiety in coronary artery bypass grafting patients.

PURPOSE: Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients. SUBJECT AND METHODS: After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory. RESULTS: Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed. CONCLUSIONS: High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.

Aged↗
PubMed2003

Total tau in cerebrospinal fluid differentiates Alzheimer's disease from vascular dementia.

BACKGROUND: Tau protein is a microtubule-associated protein located in neuronal axons, which has been used in various configurations as a diagnostic marker of degenerative changes in the CNS. The aim of our study was to evaluate the use of CSF/ total tau in patients with Alzheimer-type dementia (AD) and vascular dementia (VD) compared to controls, in order to investigate. MATERIAL/METHODS: A total of 102 persons were included in the study: 58 AD patients, 24 VD patients, and 20 non-demented controls. The Alzheimer group was divided into 3 subgroups by clinical stage of the disease. CSF samples were collected by routine lumbar puncture. The level of total tau protein was determined by sensitive sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: CSF/total tau in the AD group was significantly higher than in the VD group (median 385.6 pg/ml vs. 101.2 pg/ml) and the controls (1.37 pg/ml). There were also significant differences among the AD stage groups in CSF total tau: highest in the group with severe dementia, intermediate in the group with moderate dementia, and lowest in the group with mild dementia. Differences in CSF total tau in all groups are not attributable to the patients' age. CONCLUSIONS: CSF total tau clearly and simply differentiates AD from VD. CSF total tau in the incipient stage of AD and its increase in parallel with the progression of the disease may also provide a biochemical test to monitor the development of the disease.

Alzheimer Disease↗
PubMed2003

[Neuropathological effects of surgical treatment of coronary heart disease].

Recent improvement in surgical and anaesthetic techniques has significantly reduced the number of post-operative complications, including those from the CNS. Nevertheless the risk of cerebral complications after cardiac revascularization by means of coronary artery bypass grafting (CABG) still exists and is considered an important risk factor in cardiac surgery. Organic cerebral complications may manifest themselves in the form of relatively overt neurological symptoms, such as stroke (1-3%), dysfunction of peripheral nervous system (5-10%) or slight, more difficult to diagnose cognitive deficits (33 to 83%). Acute qualitative dysfunction of awareness develops in about 7-12% of patients shortly after surgery. Depression or anxiety syndromes are observed in about 25% of patients. Presented results inevitably suggest a necessity for programmed psychological assistance and counselling in this category of patients.

Coronary Artery Bypass↗
PubMed2003

[Depression and anxiety after coronary artery bypass grafting].

The paper present results of last decade studies on mood and anxiety disturbances in patients who underwent coronary artery bypass grafting (CABG). Cardiovascular disease is currently the leading cause of death and morbidity in the industrialized world. CABG is the most common among surgical methods of its treatment. The incidence of mental disorders in patients after CABG is high. Its cause and pathogenesis are not clearly known. Depression is the risk factor of cardiovascular system diseases and also one of its causes. The heart operation itself is the strong stressful, life-threatening factor. The earlier course of cardiovascular disease and then heart surgery cause changes in style of life and combine with burdensome and arduous rehabilitation process. The social situation of the patients often deteriorates. Depression makes recovery difficult.

Anxiety↗
PubMed2002

[Medical services reform and changed of some patients' movement coefficients in psychiatric hospitals].

Selected empirical data relating psychiatric hospital morbidity from Lower-Silesian province in the years 1998-2000 was analysed. Official statistics became the main source of information about occurrences and epidemiological processes, because of lack of population studies from the psychiatric domain. Three main limitations of assessing disruption of such processes were pointed: inter-regional moving of patients; imperfection of procedures connected with accumulation of empirical material; influence of various administrative factors. These last exert essential influence on changes of patients "movement coefficients in hospitals during implementation of the Health Care reform in Poland. Number of admitted patients in general and for the first time increased, simultaneously time of stay in the hospital grew shorter. No reasons have been found, for which these observed changes would be able to have reference in real epidemiological processes, quality of treatment. These changes are rather caused by the realisation of the reform, and precisely adaptative mechanisms of the subjects to Health Insurances requirements.

Health Care Reform↗
PubMed2002

Psychiatric symptoms in a patient with the clinical features of MELAS.

BACKGROUND: This article presents a case study of a 32-year-old Polish male patient clinically diagnosed with the MELAS syndrome, the second such patient reported in this country. CASE REPORT: The patient presents with a long history of neurological episodes, consisting of acute neurological deficits suggestive of CVA with no evidence of focal lesion and very rapid remission of symptoms. These episodes began when the patient was 19 years old and have recurred since that time at intervals of 1-5 years. A recent psychiatric episode with unusual visual hallucinations brought the case to the attention of the present authors, who initiated further diagnostic testing. A muscle biopsy revealed ragged red fibers. CONCLUSIONS: The features in this case meet the diagnostic criteria for a clinical diagnosis of MELAS, pending confirmation of a pathogenic mutation.

Adult↗
PubMed2002

Colostrinin proline-rich polypeptide complex from ovine colostrum--a long-term study of its efficacy in Alzheimer's disease.

BACKGROUND: Colostrinin, a proline-rich polypeptide complex (PRP) isolated from ovine colostrum, with immunoregulatory and procognitive properties, has shown positive effects in the treatment of Alzheimer's disease (AD). The aim of the present study was to evaluate the effects of long-term Colostrinin treatment of AD patients. MATERIAL/METHODS: The patients were taking Colostrinin tablets (containing 100 mg of PRP complex) every other day for three weeks, followed by a 2-week hiatus to avoid the development of hyporeactivity. This mode of application, '3+2 weeks,' was used consistently throughout the trial. The efficacy of treatment was assessed by the MMSE scale, and each patient was evaluated at 4-month intervals. 33 patients were treated for 16 months. However, 13 patients from this group had already been treated with Colostrinin for 12 months during placebo-controlled studies, and thus participated in the trial for a total of 28 months. RESULTS: The results we obtained showed that Colostrinin induced slight but statistically significant improvement or stabilization of the health status of the patients in the trial. The adverse reactions observed, if any, were remarkably mild, including anxiety, logorrhea, and insomnia, and subsided spontaneously within a short period of time (3-4 days). CONCLUSIONS: Colostrinin is a very promising preparation which can be used to retard the development of AD.

Aged↗
PubMedDate not supplied

[Epidemiology of obsessive-compulsive disorder].

In the article the problems of prevalence of obsessive-compulsive disorder (OCD), comorbidity with other mental disorders and the most commonly used diagnostic instruments were presented. Epidemiological data indicate OCD as the fourth most common mental disorder, which appears as frequent as asthma or diabetes. In an international study from 1994 the year's prevalence of OCD was from 1.1% to 1.8%. In each country obsessions and compulsions appear with different intensity, what can testify for certain cultural conditionings of disorder. Men suffer from OCD equally often as women, however both first symptoms and full symptom disorder appear several years earlier in men than in women. The prevalence of OCD among children is from 2% to 4%. At least half of the patients suffer from OCD also in maturity. OCD should be differentiated from generalized anxiety disorder, panic disorder, phobias, anancastic personality and hypochondria.

Cultural Characteristics↗
PubMedDate not supplied

[Study of the protein glycation in Alzheimer's disease].

Advancement in research on glication process in pathogenesis of AD is presented. Its results may open new, promising possibilities of treatment of neurodegenerative diseases including AD with inhibitors of glication.

Alzheimer Disease↗
PubMedDate not supplied

[Treatment in psychiatric day hospital in comparison with inpatient wards in different European health care systems--objectives of EDEN project].

The paper presents the objectives and design of an ongoing multicenter randomized, controlled trial EDEN (European Day Hospital EvaluatioN). The EDEN-study aims to evaluate the efficacy of acute psychiatric treatment in a day hospital setting in five European centres: Dresden, London, Michalovce, Prague and Wroclaw. The main hypothesis is that day hospital treatment for acute psychiatric patients is as effective as conventional inpatient hospital care. The objectives of the study are to evaluate the viability and effectiveness of day hospitals for acute psychiatric treatment, to identify subgroups of patients with a more or less favourable outcome so that the treatment setting might be specifically applied and to ascertain the cost-effectiveness of day hospital treatment compared to conventional inpatient treatment. The study utilises a Randomised Controlled Trial (RCT) design with repeated measures at a maximum of six time points: at admission (t1), one week after admission (t2), four weeks after admission (t3), discharge (t4), three months after discharge (t5), and 12 months after discharge (t6). A combination of well-established standardised assessment instruments and open questions is used in 6 time periods. If the findings accept the main hypothesis of the study, some practical consequences could be inevitable: at a mental health policy level, these results could lead to an increase in the capacity of day hospitals; at the clinical level clinicians could redefine their concepts of care to consider the day hospital as an alternative to conventional inpatient treatment; from economic point of view could lead to reduction of treatment costs.

Czech Republic↗
PubMedDate not supplied

[Comparison between a SCAN diagnosis and a clinical diagnosis].

The aim of this paper is to present comparison of clinical diagnoses and SCAN (Schedules for Clinical Assessment in Neuropsychiatry, version 2.1) diagnoses of patients treated in day care and inpatients wards. SCAN was translated at Medical University of Wrocław according to WHO permission. It is a part of multicenter study evaluating effectiveness of treatment in conventional psychiatric hospital and day hospital for acute psychiatric patients. Clinical diagnoses were made using ICD-10 classification system. Till now 56 patients were examined, 15 men and 39 women in age from 21 to 65 years old, median age 45 years old. Among them 31 patients were treated in day care wards, and 25 patients were treated in inpatients wards. During standard medical procedure diagnoses of 25 patients were classified into the block F2, and 19 patients into the block F3 of ICD-10 classification. Schizophrenia were diagnosed in 16 patients of, 19 patients had diagnosis of depressive disorder, and 21--of other mental disorders. Clinical diagnoses were in most of the cases single one; there were only 6 cases with double (comorbid) diagnoses. SCAN diagnoses were multiple, ranged from 1 to 12 (median 3) for one patient. Many concomitant SCAN diagnoses referred to tobacco use, sleep disorders, and somatoform disorders. Cohen's kappa coefficient for the block F2 was 0.78, for schizophrenia--0.62, for the block F3--0.42, and for depression--0.36. Results showed low agreement between clinical and SCAN diagnoses, particularly for mood disorders. The explanations of such discrepancies could be: no strict compliance with rules of ICD-10 by clinicians and avoidance of comorbid diagnoses by clinicians or errors in the SCAN coding algorithms. Further analyses are needed to characterize more precisely the sources of discrepancies.

Adult↗