Biomedical subjects
Publications and source records attributed to J Komender.
Young persons who in the past attempted suicide show the following characteristics: 1. they unwillingly make contact with an agency which they had consulted or had been treated due to their suicide attempt, 2. often maintain suicidal thoughts (11 of 37), 3. they have a higher estimation of their psychosocial situation then an objective assessment would indicate, 4. their psychosocial functioning does not improve with time.
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Families of 156 children and adolescents in the age from 10 to 18 years were studied. Epilepsy was diagnosed in 118 patients; control group consisted of 38 subjects with cognitive and emotional dysfunction due to minimal-brain damage. Author used the standardized interview of parents and ill child. All children underwent psychiatric and neurologic examination. The laboratory tests which confirmed the diagnosis of epilepsy or the organic background of mental disturbances in control group without epilepsy, as well as psychological tests were done. On the basis of these investigations it was found that epilepsy in children had the influence on child's and its family functioning. Such influence was more pronounced among children who fail to remain seizure-free after therapy, and in whom seizures were accompanied by chronic mental disorders. The vicious circle mechanism was found in several cases. The child's disorder caused negative reaction of family members, which in turn unfavourably influenced child's functioning and behaviour. According to the author these statements are of great importance for psycho-sociotherapy.
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In a group of 80 epileptic children aged 10-11-12 years in 75% of cases psychic changes were found, including disturbances of intellectual abilities of the oligophrenic-dementive type, and personality disorders. The cause of these disturbances was organic brain damage due mainly to pathological events in pregnancy and labour, and to mechanical craniocerebral trauma in early childhood. Other causes included: duration, type and frequency of seizures and longstanding pharmacological polytherapy not considering the interaction of drugs. The coexistent neurotic symptoms in 60% out of 80 studied children were caused by abnormal family situation and situation in school which had undoubtedly an effect on the prognosis and course of epilepsy in children.
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On the basis of an analysis of 3 cases it was shown that the occurrence of seizure-like symptoms with abnormal EEG and history data suggesting possible damage to the central nervous system are not always sufficient for an unequivocal diagnosis of epilepsy and for beginning of long-term antiepileptic treatment which is not without adverse effects on the developing organism of a child. For establishing of correct diagnosis and avoiding of too hasty introduction of anticonvulsant treatment not only careful history and family data and pathological EEG tracings should be considered, but the seizure-like symptoms and results of laboratory investigations should be carefully analysed. On many cases, especially in younger children, the diagnosis should be established in hospital.
Late results of epilepsy treatment in 150 children hospitalized in the Department of Psychiatry, Institute of Paediatrics, Medical Academy in Warsaw and followed-up in the outpatient clinic of this Department are described. The criteria of selection of the cases for analysis were age of 10 years, at least, and disease duration at least 4 years. It was found that in 72% of cases the seizures had been completely controlled (absent for at least 2 years). In 28% the seizures continued despite systematic treatment. The analysis showed that persistence of seizures was caused, among other factors, by the degree and extent of the organic damage to the central nervous system confirmed in neurological and psychological examination and electroencephalographic investigations, the type of seizures, mainly seizures of salaam type and partial seizures with complex signs, recurring status epilepticus, and coexistence of various types of seizures in a child. Interseizure psychic disturbances were more frequently observed in children in whom the seizures could not have been controlled completely.
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From a group of 248 cases of epilepsy observed in the last five years 69 (28%) children, 32 boys and 37 girls, were isolated (aged from several months to 14 years) in whom the first epileptic seizures appeared at the age of 3 years or less. The subgroups were subjected to detailed psychiatric-psychological analysis for establishing whether epilepsy beginning in the life period of the most intense developmental processes may have any decisive influence on the psychic development and social adaptation of the child. It was found that children with epilepsy beginning at the age below 3 years require not only a careful differential diagnosis but even more a comprehensive therapeutic management, which should include, besides systematic administration of drugs and periodic EEG control also a continuous psychological and psychiatric supervision and care which would ensure a possibly optimal development of mental skills and social adaptation in the family and outside it.
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Medical records of 210 adolescents hospitalised because of anorexia nervosa (1978-1995) were analysed. 8 patients have demonstrated life threatening metabolic and pathophysiologic complications. These complications were seen in cachectic patients or when their body mass index decreased in a very short time. They were parenterally fed. When physical state permitted, family and individual psychotherapy was introduced.
The authors present the review of literature concerning schizophrenia, schizophrenia type and delusional disorders in patients with a lifetime diagnosis of anorexia nervosa (AN). The authors describe also 3 patients (2 cases of paranoid schizophrenia and 1 case of catatonic syndrome). The clinical features in all patients are discussed. In 1 patient the catatonic symptoms occurred within the context of AN, (perhaps due to metabolic disturbances) and in 2 other cases the psychotic features occurred after recovery from AN. The authors discuss the occurrence of psychotic features in AN, and the possible function of starvation and metabolic disturbances in their aetiology.