[Orthorexia--a new diagnosis?]

INTRODUCTION

Orthorexia nervosa (Greek: ortho--correct, right; orexis--appetite, desire) is a term introduced in 1997 by the American doctor Steven Bratman and is defined as a pathological fixation with righteous and healthy eating. Clear classification criteria oforthorexia have not been developed yet and there has been an on-going discussion whether it belongs to the group of eating disorders or the obsessive-compulsive disorders.

AIM

The aim of this paper is to summarise briefly the current state of knowledge regarding orthorexia and to point out the difficulties connected with an attempt to classify it in a given disorders group as well as with the attempt to establish the classification criteria.

DISCUSSION

Despite the fact that the problem of orthorexia has been signalled in the Polish media, it has neither been discussed nor published in the Polish medical literature yet. Orthorexia starts when a diet becomes an escape from life--everyday activities are dominated by planning, buying and preparing "proper" meals. Each departure from this regime causes anxiety and guilty conscience and leads to even further tightening of the dietary habits. According to Bratmann, orthorexia is connected with an illusory feeling of safety (preventing from diseases), the urge to exercise a full control over one's life (elimination of the unpredictable), "a hidden conformism" (eating philosophy helps in a subconscious way to achieve a culturally accepted model of a beautiful body), a search for spirituality and identity, and a desire for self-deprivation.

CONCLUSIONS

The arguments presented in this paper substantiate the expediency of implementing the epidemiological studies which will show the scale of the problem, its prevalence and conditionings. Data obtained in this way should facilitate the verification of classification criteria and will also help to formulate the diagnostic criteria of orthorexia.

[Faith vs. science: soul's possession or dissociative disorder? A case study]

The aim of this paper is to discuss the impact and significance of religious beliefs on the dissociation and somatization symptoms presented by a hospitalised female patient. A 16-year-old girl was hospitalised at the Developmental Age Psychiatry and Psychotherapy Clinical Ward (The Clinical PiPWR Ward) for observation; she had been referred from the Regional Acute Poisoning Centre where she had been admitted upon taking some medications. For two years she had been subjected to exorcisms due to "possession by the Evil". Religious convictions had been sustained and enhanced by the patient's parents as well as a local Catholic community. The observation and diagnosis at the PiPWR Clinical Ward revealed mixed dissociation and somatization disorders as well as an abnormally shaping personality. The presented case, on the basis of the clinical observation and the analysis of literature on the subject, led to the following conclusions: the emotional issues and the system of religious beliefs influenced the shape of symptomatology, enforced the functioning of immature defensive mechanisms and intensified the dissociation and somatization disorders in the patient. The diagnosed mental disorders require that the girl should undergo individual and family psychotherapy.

[The Euro-orphans phenomenon and the courses in therapeutic work and psychiatric treatment--a case study]

Today, the phenomenon of Euro-orphan is more and more frequently reported in the literature. This term refers to children with one or both parents emigrated from the country for work purposes. In connection with the social transformations of orphan-hood types described in the literature (nature, spiritual, social), the definition has been broadened by the definition ofeuro-orphan. The Ministry of Education describes the euro-orphan as the destruction of the family structure, the disorder of the socialisation process of children and reduction of the emotional exchanges among family members, as a result of migration of their parents. It provides further that not every child whose parents are not present in the country is covered as an euro-orphan. However, this group has become an increasingly larger populations. Lack of physical proximity and accessibility of important persons may have some psychological and pedagogical implications. These in turn can be shaped over time, into pathological symptoms, which are diagnostic entities in developmental psychiatry. It is not know precisely how many children in Poland are Euro-orphans.

AIM

The aim of this paper is an attempt to understand the social phenomenon of Euro-orphanhood in the light of the observed psychopathologies of children and adolescents.

METHOD

The case study of the psychotherapy of a patient suffering from the Euro-orphanhood syndrome.

CONCLUSIONS

Euro-orphanhood is a social phenomenon that generates Euro-orphans with a wide range of psychopathological symptoms classified in different diagnostic categories. The type and intensification of the psychopathological symptoms depend on the quality of relationships with meaningful persons prior to the Euro-orphanhood period. The course of the psychotherapeutic work with Euro-orphans should cover an individual aspect taking into consideration the maturity of defensive mechanisms as well as the work-through of negative feelings cumulated due to becoming a Euro-orphan.

[Evaluation of anxiety and depression in the perioperative period in patients subjected to myocardial revascularization]

AIM

The aim of the paper is to define a relationship between the anxiety level and depression intensification, as well as to define the impact of: age, sex, education level and family situation on the anxiety level and depression intensification in the pre- and postoperative period in patients subjected to myocardial revascularisation (CABG).

METHOD

Prospective studies were carried out in a group of 100 patients qualified for the surgical myocardial revascularisation in the planned course. The Polish version of the STAI questionnaire was applied to study anxiety as a state and as a trait. Depression intensification was evaluated with the Beck depression scale.

RESULTS

1. The intensity of depression significantly correlates with anxiety as a state and anxiety as a trait before and after CABG surgery. 2. When assessing anxiety as a state, its negative correlation with male patients and with age before CABG were found. A negative correlation of anxiety as a state with a patient's age was identified after CABG. 3. When assessing anxiety as a trait, its negative correlation with male patients before CABG was found. 4. The intensity of depression correlates significantly and negatively with the educational background of the patient before and after CABG surgery. 5. There is no statistically significant correlation between anxiety, depression and family situation in the perioperative period.

Depression or depressiveness in patients diagnosed with Anorexia Nervosa and Bulimia Nervosa - pilot research

OBJECTIVES

The target of this work is to consider if depressive symptoms intercurrent with patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) form a depression complex or whether they are physiological depression accompanying adolescence. We wished to observe the perception of these patients,of their functioning, both social and within their families and also looking for common point in the issues mentioned above trying to locate them within the course of the basic illness.

SUBJECTS AND METHODS

We studied 19 patients suffering from eating disorders, and aged between 12 and 24 years old. 15 of them suffered from the restrictive form of AN and 4 suffered from BN. The control group consisted of 30 healthy girls in the same age interval. In the study authors used the Beck Depression Inventory (BDI) and the Quebec Quality of Life Questionnaire.

RESULTS

Comparison of a number of points acquired in the survey using Beck Depression Scale revealed statistic significance at the level p<0.001 which points to a more frequent occurrence of depression symptoms among persons with eating disorders comparing to control group. The survey using the Questionnaire for Social Quality showed no statistically significant differences between study and control groups (p>0.05). The authors observed a statistically significant increased frequency of suicidal thoughts in the study group compared to the controls.

CONCLUSIONS

To diagnose depression, depressive symptoms presented by the patients must give the image of depression at the clinical level. The result of the Beck's scale needs to be confronted with the clinical picture. Depression in adolescence requires differentiation from depressiveness.

[Fragile X syndrome--child's and parent's problem]

Fragile X syndrome is the most common familial form of mental retardation. The incidence is estimated to be 1 in 4000 male births. The disease is caused by amplification oftrinucleotide repeats CGG in the first exon of FMR1 gene, located on the distal part of the long arm of the X chromosome. The main symptom of the disease is mental retardation, usually of moderate or profound degree. Characteristic clinical features of the disease observed in the affected person after puberty involve: an elongated face, large protruding ears and macroorchidism. Diagnosis is usually made late, when the child is 3-4 years old. Making diagnosis early is very difficult because of a lack of specific symptoms. We can observe developmental delay in children, with very late development of speech and behavioural problems with autistic features. Early diagnosis is very important, because its identification of high genetic family risk. The risk of recurrence for next children is as high as 50% and is stable for each pregnancy.

Depression and life quality in patients with eating disorders - A two year follow up

Introduction

The symptoms of depression are often found in patients suffering from eating disorders.

Aims

The aims of this research were to find out if depression in patients with eating disorders (ED) like anorexia nervosa (AN) or bulimia nervosa (BN) is an additional condition accompanying the ED diagnose, or if it is an integral element being part of emotional problems related to maturation. The estimation of patients’ social condition is also considered in comparison to matched group with no ED diagnose.

Methods

Subjects: Group B - 19 females diagnosed, age 12 – 24; group C - matched control group of 30 healthy females, group F - 19 patients out of group B examined in a follow up research two years after hospital treatment. Tools used: Beck Depression Inventory (BDI), Life Quality Questionnaire (Q), Body Mass Index measurement (BMI).

Results

BDI results: depression symptoms are more intense in the early phase of the treatment of ED (group B) than in the follow up -group F (two years after hospitalization) and also more intense than in group C (controls). Q Questionnaire shows no differences between groups B, C, and F.

Conclusions

Depression is an additional condition in patients diagnosed with ED mostly in the early phase of the treatment. No differences have been found in the social condition between groups B, C, and F.

[Friends of virtual Ana--the phenomenon of pro-anorexia in the Internet]

Anorexia nervosa is regarded as a serious mental disturbance, where denial of illness and strong resistance to treatment are symptomatic features. In many cases it leads to extreme devastation or even to death. Effective treatment of this disorder still remains a challenge for clinicians and researchers. Since the 90-ies of the previous century there has been a rise in the free access to the internet. At present over a billion people all over the world use it. What young people look for in the internet is not only information, but also friends, support or entertainment. For last a few years, a phenomenon of pro-anorexia has been present in the Internet, connecting people who claim that anorexia is a "lifestyle" rather than a deadly illness, which should be treat. They communicate with each other through the internet blogs, forums and popular social networking sites, creating a virtual community. The pro-ana community is made up of adolescent girls and young women who decide on dieting. Pro-anorexia is still a poorly known phenomenon, especially in Poland. It seems to be very important to take a note on this phenomenon in the face of an increasing prevalence of eating disorders in the last years.

The use of the Free Recall Method in the Analysis of Verbal Memory Deficits in Dual Diagnosis Patients

In schizophrenia there are specific cognitive deficits including verbal memory deficits. The objective of this study was to examine short-term verbal memory differences between subjects with and without a dual diagnosis.

A group of 80 patients with a diagnose of schizophrenia were examined. 40 of them never used illicit drugs, the other 40 also received a diagnose of addiction to psychoactive substances. The Free Recall Method was used to compare two examined groups. The results of addicted and not addicted schizophrenic patients were analyzed in all trials of the 5 stages of the examination with the use of Free Recall Method. Persons suffering from schizophrenia can usually repeat much fewer words in all five stages of the examination with Free Recall Method. This deficiency of short-term memory in this group of subjects is present from the very beginning of information coding.

As it was expected a deficiency in short-term verbal memory was found in all examined patients. However when comparing both groups no statistical differences concerning verbal memory deficits were found between the group of patients suffering from schizophrenia addicted and not addicted to psychoactive substances.

The fact that no significant differences concerning short-term verbal memory between two examined groups were found, which is consistent with some of the studies found in the literature, may be a good predictor for this group in terms of their possible chances of successful rehabilitation.

[Anorexia nervosa with regard to oligonucleotide microarray technique--own data]

AIM

The aim of the study was to discover the transcript expression profile of selected genes coding receptors of leptin and orexin A and B by using the oligonucleotide microarray technique (Affymetrix, HG-U133A) in patients who suffered from anorexia nervosa (AN).

METHOD

The peripheral blood of mononuclear cells (PBMC) of four AN patients complying with the ICD-10 and the AN diagnostic criteria DSM IV were analysed. Two patients suffered from the restricting type of AN (AN-R) and two suffered from the binge-eating/ purging type of AN (AN-BP). Four patients were our reference group and they did not suffer from eating disorders. The material used in the assay was the total RNA which was isolated from the PBMC of patients. The total RNA was used to investigate the transcript expression profile of selected genes by using the oligonucleotide microarray technique (Affymetrix, HG-U133A). For six and for eight oligonucleotide microarrays, the accumulation analysis method was used (clustering, Cluster v 3.0) to analyse the results.

RESULTS

Hierarchical clustering resulted in separate clusters for patients who suffered from AN-R, AN-BP and patients from the reference group.

CONCLUSIONS

Taking into consideration the hierarchical clustering for six and for eight oligonucleotide microarray performing different transcript expression profile of selected genes coding orexigenic peptides (OXA and OXB) and anorexigenic peptides (LEP) we suggest that the oligonucleotide microarray method differentiates two type of anorexia nervosa: the restricting type of AN (AN-R) and the binge-eating/purging type (AN-BP).

[Somatic disease or Munchausen syndrome by proxy? Mother's or child's disease? Diagnostic controversies]

INTRODUCTIONn: The Munchausen Syndrome by Proxy occurs when parents make a child believe he or she suffers from a disease while in fact this is not true. A medical diagnosis ruling out a possible disease of the child does not calm the parents down and only confirms--in their belief--the doctor's incompetence which in turn makes them seek a second opinion. This may be repeated over and over again and be accompanied by administration of medicines, overprotection, introducing a diet, limiting exercise as well as limiting motoric and mental development.

AIMS

Authors present diagnostic difficulties in diagnosing the Munchausen syndrome.

CASE DESCRIPTION

A 6-year old girl was hospitalized for the first time at the Developmental Age Psychiatry and Psychotherapy Ward of the John Paul II Pediatric Center in Sosnowiec, Poland (until then she had received psychiatric treatment at the Center on an outpatient basis only). Medical history provided by her mother as well as supplied documents show numerous hospitalizations at Pediatric Wards since the girl was 6 weeks old due to intensified vomiting and frequent diarrheas. Since the age of 4, the girl has been provoking vomiting as well as temporarily refusing meals and liquids.

COMMENTARY

Authors present diagnostic difficulties in diagnosing the Munchausen syndrome mainly caused by discharging the patient from the Ward on her mother's request as well as non-specific nature of the symptoms.

[Cognitive functions, their development and modern diagnostic methods]

Cognitive psychology is an interdisciplinary field whose main aim is to study the thinking mechanisms of humans leading to cognizance. Therefore the concept of human cognitive processes envelopes the knowledge related to the mechanisms which determine the way humans acquire information from the environment and utilize their knowledge and experience. There are three basic processes which need to be distinguished when discussing human perception development: acquiring sensations, perceptiveness and attention. Acquiring sensations means the experience arising from the stimulation of a single sense organ, i.e. detection and differentiation of sensory information. Perceptiveness stands for the interpretation of sensations and may include recognition and identification of sensory information. The attention process relates to the selectivity of perception. Mental processes of the higher order used in cognition, thanks to which humans tend to try to understand the world and adapt to it, doubtlessly include the processes of memory, reasoning, learning and problem solving. There is a great difference in the human cognitive functioning at different stages of one's life (from infancy to adulthood). The difference is both quantitative and qualitative. There are three main approaches to the human cognitive functioning development: Jean Piaget's approach, information processing approach and psychometric approach. Piaget's ideas continue to form the groundwork of child cognitive psychology. Piaget identified four developmental stages of child cognition: 1. Sensorimotor stage (birth - 2 years old); 2. Preoperational stage (ages 2-7); 3. Concrete operations (ages 7-11; 4. Formal operations (11 and more). The supporters of the information processing approach use a computer metaphor to present the human cognitive processes functioning model. The three important mechanisms involved are: coding, automation and strategy designing and they all often co-operate together. This theory has provided a theory. The psychometric approach concentrates on studying the differences in intelligence. The aim of this approach is to test intelligence by means of standardized tests (e.g. WISC-R, WAIS-R) used to show the individual differences among humans. Human cognitive functions determine individuals' adaptation capabilities and disturbances in this area indicate a number of psychopathological changes and are a symptom enabling to differentiate or diagnose one with a disorder. That is why the psychological assessment of cognitive functions is an important part of patients' diagnosis. Contemporary neuropsychological studies are to a great extent based computer tests. The use of computer methods has a number of measurement-related advantages. It allows for standardized testing environment, increasing therefore its reliability and standardizes the patient assessment process. Special attention should be paid to the neuropsychological tests included in the Vienna Test System (Cognitron, SIGNAL, RT, VIGIL, DAUF), which are used to assess the operational memory span, learning processes, reaction time, attention selective function, attention continuity as well as attention interference resistance. It also seems justified to present the CPT id test (Continuous Performance Test) as well as Free Recall. CPT is a diagnostic tool used to assess the attention selective function, attention continuity of attention, attention interference resistance as well as attention alertness. The Free Recall test is used in the memory processes diagnostics to assess patients' operational memory as well as the information organization degree in operational memory. The above mentioned neuropsychological tests are tools used in clinical assessment of cognitive function disorders.

[Influence of anxiety on cognitive functions' disturbances in adolescents and young adults diagnosed with paranoid schizophrenia]

BACKGROUND

It is still interesting the correlations between cognitive processes and anxiety in adolescents and young adults diagnosed with schizophrenia. The aim of the paper was to answer the following questions: Is there a correlation between short-term memory processes and attention in adolescents and young adults diagnosed with schizophrenia? Is there a correlation between short-term memory processes and anxiety as a state and anxiety as a trait in adolescents and young adults diagnosed with schizophrenia? Is there a correlation between attention and anxiety as a state and anxiety as a trait in adolescents and young adults diagnosed with schizophrenia?

MATERIAL AND METHODS

The studied group consisted of individuals diagnosed with paranoid schizophrenia and the reference group consisted of healthy individuals. Since the inclusion criteria was a schizophrenia diagnosis confirmed at least three times during subsequent hospitalizations, the studied group consisted of individuals aged 18-24 (late adolescents and young adults); however, the first onset of schizophrenia took place before the 15th birthday in all cases (the first episode before the 15th birthday, currently at least third hospitalization with the diagnosis of schizophrenia). A total of 50 individuals participated in the study: 25 of them diagnosed with schizophrenia and 25 mentally sound. MMSE (Mini Mental State Examination) was used as the screening tool. It MMSE was used to rule out dementia, while PANSS was used to confirm the diagnosis. CPT (Continuous Performance Test), Free Recall and Piktogram were used to assess the subjects neuropsychologically. Additionally, the anxiety level (as the information processing variable) was assessed with STAI (State - Trait Anxiety Inventory) in order to measure anxiety as a state and as a trait levels.

RESULTS

The experiments and assess short-term memory processes and attention processes in adolescents and young adults diagnosed with schizophrenia. 2. There is a correlation between short-term memory processes and anxiety as a state and anxiety as a trait in adolescents and young adults diagnosed with schizophrenia. 3. There is a correlation between attention and anxiety in adolescents and young adults diagnosed with schizophrenia.

[Ghrelin--The guardian of energy balance]

Ghrelin was discovered in 1999 and is a subject of various studies. This endogenous ligand for the growth hormone secretagogue receptor (GHS-R) is mostly released by the fundus mucosa in the stomach. Many studies show us, that besides its stimulation of Gh secretion, ghrelin is directly related to the energy balance controlling mechanism. It also influences motoric action of the digestive track, secretion of hydrochloric acid, endo- and exogenic pancreatic function. GHR-S receptors are found in arcuate neurons and other lateral hypothalamus neurons. These areas are critical for the regulation of feeding. Ghrelin stimulates food intake together with other orexy- and anorexygenic peptides like: NPY, AGRP, OXA, and OXB. The plasma ghrelin level depends on the nutrition state. Increased ghrelin levels are observed shortly before food intake, and the decreases can be noted 2 hours after eating. During fasting and/or malnutrition plasma ghrelin level rises. This also happens in eating disorders: anorexia nervosa, bulimia nervosa. This article presents facts and hypotheses supporting the neuroendocrinologic and metabolic mechanisms affecting the plasma ghrelin levels and the role of ghrelin in feeding behaviour.

[Total plasma ghrelin level in anorexia nervosa female]

Ghrelin is a peptide exhibiting strong orexigenic, adipogenic and somatotropic properties. About 80% of the peptide is produced in the stomach and it is an essential link of the brain-gut axis. Ghrelin through vagal fibres and circular system stimulates the hunger center in hypothalamus, controlling food uptake and body weight gain. This mechanism fails in eating disorders. The aim of the study was the analysis of total ghrelin levels in anorexia nervosa (AN) girls during cognitive-behaviorally treatment.

MATERIAL AND METHODS

A group of 50 AN girls with the restrictive form ofAN (according to the DSM-IV, ICD-10 criteria) behaviorally treated and participating in psychotherapy. The mean BMI in anorectic group was 15.1 kg/m2 and mean ghrelin level 6562 pg/ml. The group of 20 healthy girls with mean BMI of 21.4 kg/m2 and mean ghrelin level 4856 pg/ml served as a control group. The mean age in study group was 17.5 and 18.5 in control girls. Statistical analysis of significance was carried out by the Student's t-test, Mann-Whitney U test, Spearman's correlation and linear Person's correlation. To assess the dynamic change of parameters Anova-Friedman and Anova-Kruskal-Wallis tests were used. The p < 0.05 was accepted as statistically significant.

RESULTS

Initial mean plasma ghrelin levels in AN girls was significantly higher than in control group. After 24 weeks of treatment the mean BMI increased to 17.5 kg/m2, ghrelin level decreased to the value of 3919 pg/ml.

CONCLUSION

In AN female the decreasing of total plasma ghrelin level is a result of changing pathological feeding behaviour.

The transcript expression profile of the leptin receptor-coding gene assayed with the oligonucleotide microarray technique--could this be an anorexia nervosa marker?

Anorexia nervosa is a serious eating disorder with the highest mortality rate of any psychiatric disorder. The DSM-IV classification differentiates two AN types: the restricting type (AN-R) and the binge-eating/purging type (AN-BP). Leptin (LEP) levels can be thought of as a signal to the body of its energy reserves. The leptin receptor (including all its mRNA isoforms) is expressed in many tissues. Our aim was to discover the transcript expression profile of the LEP receptor-coding gene in the peripheral blood mononuclears in AN-R and AN-BP patients. Three young women suffering from Anorexia nervosa (one with AN-BP and two with AN-R) took part in the study, along with three non-anorexic subjects as our reference group. LEP receptor gene expression was examined using the oligonucleotide microarray method (HG-U133A, Affymetrix). The results were normalized using RMAExpress. Next, the accumulation analysis method was used (clustering). Hierarchical clustering resulted in three groups of separate clusters. The first group (cluster I) consisted of AN-R patients. The next group (cluster II) consisted of reference group patients suffering from different psychic disorders not related to eating disorders. Cluster III consisted of two patients--the first with AN-BP and the second with an adaptive disorder.

[Anorexia nervosa--diagnostic and therapeutic suggestions]

Diagnostic and therapeutic suggestions concerning anorexia nervosa including a wide variety of favourable conditions for its occurrence are presented based on the literature data.

[The role of orexines in appetite regulation]

Anorexia nervosa (AN) belongs to the group of eating disorders. Many different factors are taken into consideration as far as the origin of this disorder is concerned, among them: individual factors (genetic, biological), personality factors, sociocultural factors, family factors. Among the biological factors, the role of neuropeptides is considered. Last few years (1998) have resulted in the discovery of two neuropeptides--orexines OXA and OXB which--apart from being regarded as appetite stimulants--are also supposed to be responsible for the energy metabolism of an organism. Orexines, a.k.a. hypocretins, arise from the disintegration of their common precursor--the polypeptide: preorexine. Their name derives from the Greek word for appetite: orexis. The orexine A (OXA) is a 33 amino acid peptide consisting of 2 chains connected by the Cys 6--Cys 12 and Cys 7--Cys 14 bridges. It is a potential food intake and gastric juice secretion stimulant. The connecting bridges in OXA play a crucial role in the receptor OXA-1 activation. The orexine B (OXB) is a 28 amino acid peptide with no connecting bridges between the chains. It mainly plays a role in the energy metabolism of an organism and does not influence the secretion of gastric juice. The OXR-1 receptor is a selective receptor for OXA, while the OXR-2 receptor is not privileged for any of the two orexines--both of them can connect to it. Orexines are produced by a small number of hypothalamus neurons, mainly in the lateral hypothalamus (LHA), but also the posterior hypothalamus--the so-called "eating center". Orexines control: the wakefulness-sleep state, food intake (OXA over 100 times stronger than OXB) and the neuroendocrine system. Their discovery may help in understanding the mechanism of anorexia nervosa.

[Huntington chorea in a boy aged 14 years]

The authors present a case of Huntington disease in a 14 year old boy. The basis of genetic, pathoetiology, clinical course of disease, significance of molecular analysis of DNA are discussed.

[Congenital toxoplasmosis in a 6-week-old infant]

A case of congenital toxoplasmosis was observed in an infant aged 6 weeks with fatal outcome. Histological changes produced by Toxoplasma gondii in the brain are described.