Cognitive Functions in Patients after Carotid Artery Revascularization-A Narrative Review

Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.

Relationship between the Severity of Anxiety Symptoms, Aggression and Alcohol Consumption during the COVID-19 Pandemic Period

Background and objectives: There have been many reports of mental health in the pandemic period. The research conducted so far has indicated an increase in the severity of anxiety and aggression and an escalation of alcohol consumption during the COVID-19 pandemic. The aim of this study was to determine the relationship between the severity of anxiety, the amount of alcohol consumed and the severity of aggression. Materials and Methods: A total of 538 Polish residents—413 women (76.77%) and 125 men (23.23%)—participated in the study via an online survey. It included socio-demographic parameters and psychological scales: AUDIT—to determine the model of alcohol consumption, GAD-7—to measure the severity of anxiety and the Buss–Perry Aggression Questionnaire. Results: There was a correlation between the severity of anxiety and generalized aggression, and its two components—anger and hostility—in the entire study group. Moreover, relations were found between the intensity of alcohol consumption and generalized aggression and its components—anger and verbal and physical aggression. Those relationships turned out to be gender specific. The increased anxiety intensity affected the pattern of alcohol consumption and the severity of aggression. Conclusions: Psychotherapeutic and psychoeducational interactions and some elements of psychiatric treatment should aim at reducing the severity of anxiety in society, and thus minimizing the health and social consequences—aggressive behaviour and excessive alcohol consumption.

Lysergic Acid Diethylamide, Psilocybin and Dimethyltryptamine in Depression Treatment: A Systematic Review

Despite many different kinds of substances available for depression treatment, depression itself still appears to be a clinical challenge. Recently, formerly illicit substances came to scientists' attention, including lysergic acid diethylamide (LSD), psilocybin and dimethyltryptamine (DMT). Some studies suggest that these substances might be effective in depression treatment. The aim of this study was to evaluate the efficiency of LSD, psilocybin and DMT in depression treatment in the light of current medical literature. The authors followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for this systematic review. The authors searched the PubMed and Cochrane Library databases to identify relevant publications. Finally, 10 papers were included. Most of the selected studies showed significant correlation between psilocybin and DMT use and reduction in depression symptom intensity. By analyzing qualified studies, it can be concluded that psilocybin and DMT could be useful in depression treatment, but further observations are still required.

Persistent genital arousal disorder – the present knowledge

Persistent genital arousal disorder (PGAD) is a relatively recently described sexual disorder, characterized by symptoms of spontaneous genital arousal which persist in the absence of sexual desire and may affect women and men. Epidemiological studies conducted so far indicate that the prevalence of PGAD in the population may reach 1-4%. The etiology of PGAD remains unclear and complex, hypothesized causes include vascular, neurological, hormonal, psychological, pharmacologic, dietary, mechanical factors or a combination of these factors. Proposed methods of treatment include pharmacotherapy, psychotherapy, electroconvulsive therapy, hypnotherapy, injection of botulinum toxin, pelvic floor physical therapy, application of anesthetizing agents, reduction of identifiable factors exacerbating the symptoms, and transcutaneous electrical nerve stimulation. There is no standardized treatment algorithm for PGAD due to lack of clinical trials (evidence-based medicine). The classification of PGAD is under discussion: it could be classified as a separate sexual disorder, a subtype of vulvodynia or a disorder with pathogenesis similar to overactive bladder (OAB) and restless legs syndrome (RLS). Due to specificity of symptoms, patients may feel shame and discomfort during the examination or even delay reporting symptoms to the specialist. Thus, it is crucial to spread knowledge about this disorder, which would allow doctors to diagnose and help PGAD patients sooner.

Uncompleted extended suicide – discussion on the boundaries of psychosis based on a case study

The article describes the case of a 40-year-old woman who attempted suicide and killed two of her own children and was examined by three teams of forensic psychiatrists and psychologists for the purpose of judiciary. This women was somatically healthy, did not use psychiatric or psychological help. The authors were the third team of experts and, after conducting double psychiatric and psychological examinations and analysis of documents from the case files, which include the course of forensic-psychiatric observation, recognized the symptoms of dependant personality disorders and acute stress reaction, which resulted in a complete loss of the ability to recognize the meaning of the act and to manage proceeding. The paper discusses the diagnostic process as well as the analysis of psychotic disorders in relation to specific clinical diagnoses in accordance with the current classification of mental illnesses and disorders. Attention was paid to the problem of differentiating individual disorders and the way of defining psychotic disorders. The existence of difficulties in drawing the line between psychotic and non-psychotic disorders in the context of forensic psychiatric evaluation is emphasized.

The Dark Triad of Personality's Relationship with Compliance towards COVID-19 Pandemic Recommendations along with Anxiety and Depressive Symptoms in Polish Citizens

The outbreak of the COVID-19 pandemic forced everyone to comply with rules of a sanitary regime and social distancing on a daily basis. The aim of our research was to assess the differences in the levels of Dark Triad traits between people who obeyed and disobeyed the pandemic restrictions. Additionally, we considered the possible correlation between the Dark Triad and the intensity of symptoms of depression and anxiety. A total of 604 Polish participants, whose average age was 28.95 ± 11.27 years, completed an online survey which measured Dark Triad traits using the Polish version of the Dirty Dozen test. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The results revealed a possible relationship between personality traits and compliance with pandemic restrictions. Individuals with higher levels of psychopathy tended to disobey newly introduced rules. On the other hand, a higher level of subclinical narcissism might have contributed to a better civil compliance. The results showed a significant positive correlation between the intensity of the Dark Triad and the occurrence of depressive symptoms. Furthermore, narcissism was linked to anxiety symptoms. These results can contribute to a better understanding of behavioural patterns during the COVID-19 pandemic within the group of individuals who exhibit the Dark Triad traits. Our conclusions might help to identify individuals who are particularly vulnerable to mental health problems.

Demographic and health characteristics of 3,4-methylenedioxymethamphetamine users (MDMA, ecstasy)

OBJECTIVES

MDMA is one of the most commonly used drugs in the world. Clinical studies are currently being conducted around the world on the use of this substance in the treatment of PTSD and alcoholism. However, little demographic information is available on users who use the substance for recreational purposes. The aim was to determine basic demographic and helath characteristics with validated tools.

METHODS

The authors prepared an original questionnaire on the demography of MDMA users and combined it with the General Health Questionnaire-28 (GHQ-28) and the Hospital Anxiety and Depression Scale (HADS). The survey was sent to Polish MDMA users via the Internet.

RESULTS

304 responses were received from people over 18 years of age. MDMA is widespread among young adults, in many different places of residence and regardless of gender. The users take MDMA in both pill and crystal form and very rarely test drugs bought from a dealer. Most users feel that MDMA has had a good impact on their lives.

CONCLUSIONS

MDMA is rarely used as the only psychoactive substance. MDMA users rate their health higher than people using other psychoactive substances.

Is it good to be resilient during the COVID‑19 period? The role of ego-resiliency in the intensity of symptoms of anxiety, alcohol use and aggression among Polish people

OBJECTIVES

The SARS-CoV-2 pandemic has affected the development of negative phenomena such as anxiety symptoms, a tendency to use alcohol and aggressive behaviors. It is postulated to investigate the factors limiting the development of the indicated adverse effects. One of the psychological resources that may have a significant, pro-health character in relation to mental functioning is ego-resiliency (ER). It is described as a personality trait associated with a high ability to adequately regulate self-control, depending on the conditions. There are studies providing information about the prohealth, adaptive nature of ER during the COVID‑19 period. The aim of the study was to assess the relationships between ER and anxiety, the tendency to use alcohol and aggression in the group of Polish people in the initial lockdown period in Poland.

MATERIAL AND METHODS

Overall, 538 adult Polish people participated in the study. The Ego-Resiliency Scale referred to as ER89-R12, according to Block's concept, was used to measure ER. The other scales used were the General Anxiety Disorder Scale, the Alcohol Use Disorder Identification Test, and the Buss-Perry Aggression Questionnaire. Statistical analyses were performed using Spearman's rank correlation coefficient, the multiple regression procedure, the Mann-Whitney U test and the Kruskal-Wallis rank ANOVA. Cronbach's α coefficients were also assessed.

RESULTS

Statistically significant negative relationships between ER and the severity of anxiety symptoms and generalized aggression were found. There was a weak positive relationship between ER and the tendency to use alcohol. Among the surveyed Polish people, higher ER was characteristic of the older respondents (aged >29 years) and people with higher education.

CONCLUSIONS

Ego-resiliency in the times of the SARS-CoV-2 pandemic can counteract the development of anxiety and aggression. Optimal regulation seems to play an important role in this relationship. The relationship between resiliency and the tendency to use alcohol requires further observation. Int J Occup Med Environ Health. 2021;34(2):289-300.

Physical, Cognitive and Social Rehabilitation in Relation to Sleep Quality and Cognitive Functions in the Elderly

The aim of the study was to assess cognitive functions and sleep quality after a 3-month holistic intervention including physical, social and cognitive rehabilitation in patients 65+. Twenty-nine people participated in the study. The study was divided into two stages. In the first stage, a self-administered questionnaire consisting of sociodemographic questions was used, and cognitive functions were assessed using the Rey-Osterrieth complex figure test, Addenbrooke's Cognitive Examination III (ACE III) test, Montreal Cognitive Function Assessment Scale (MoCA) and digit repetition test. All patients were also assessed for sleep quality using the Athens Insomnia Scale (AIS). After three months, the patients were assessed for cognitive functions and sleep quality, which was the second stage of the study. Analysis of the results obtained by patients in the study showed a statistically significant improvement in sleep quality and cognitive function. Rehabilitation activities, including physical training, cognitive exercises and occupational therapy, reduce the severity of mild cognitive disorders and reduce insomnia.

Will MDMA-assisted psychotherapy become a breakthrough in treatment-resistant post-traumatic stress disorder? Critical narrative review

Post-traumatic stress disorder (PTSD) is a common mental health condition that begins after exposure to a traumatic event. Despite recommended various therapeutic approaches, including both pharmacotherapy and psychotherapy, treatment is not as effective as expected. Over recent years the pharmaceutical industry has not been able to offer a new approach, founded on multiple mechanisms of action. That is why a part of researchers focused on psychoactive substances synthesized years ago and then banned. These days MDMA-assisted psychotherapy for the treatment of PTSD clinical trials are conducted, and due to previous results, the Food and Drug Administration (FDA) granted a breakthrough therapy designation. In this article, we present the mechanism of actions, the therapeutic rationale, applied psychotherapeutic methods, and potential dangers. If ongoing phase 3 studies are completed and clinical efficacy criteria are achieved, the FDA could approve the treatment as early as 2022.

Long-term psychoeducation in limiting body mass gain in patients treated with atypical antipsychotics

OBJECTIVES

The aim of the study was to assess efficacy of psychoeducation in limiting body mass gain in patients with schizophrenia undergoing atypical antipsychotics monotherapy treatment.

METHODS

Education program Caring for Health and Silhouette, commissioned by Moneo Pharma Group, was implemented for patients with schizophrenia. The aim of the program was providing patients with information regarding lifestyle and nutrition.

RESULTS

The one-year follow-up was completed by 7,541 patients. The mean BMI (body mass index) gain in one-year follow-up was 0.56 and the difference between men (0.52) and women (0.60) was statistically significant (p < 0.001). The mean one-year body mass gain was 1.63 kg, whilst the mean one-year increase in waist circumference was 1.25 cm. There were no statistically significant differences between sexes. The subjective evaluation of patient compliance increased systematically with every visit, both for men and women. High-compliance patients less frequently experienced body mass gain (p < 0.001), while obese patients experienced the greatest decrease in BMI.

CONCLUSIONS

Education program resulted in a decrease of body mass gain in obese patients treated with atypical antipsychotics. Patients with BMI ≥30 more often than other patients experienced the reduction of body mass during education program. The quality of cooperation during the first and second visit has a predictive value for the estimation of body mass changes during education program. This method of education is easy to implement in clinical practice.

Cardiac syndrome X - the present knowledge

The aim of this work was to define the notion of cardiac syndrome X based on latest research, determine its connection with mental disturbances and present the current therapeutic directions. Cardiac syndrome X was distinguished in 1973 to describe a group of patients with coronary syndrome symptoms despite normalcoronary vessels in coronarography. Many years have passed since then, but the syndrome definition and the diagnostic criteria still arouse controversy. It is estimated that 10 to 20% of persons who undergo coronarography suffer from cardiac syndrome X, a vast majority of them being perimenopausal women. That patient population suffers from anxiety disorders, depressive symptoms and sleep disturbances much more frequently than does general population. Treatment includes a range of medicines with various mechanisms of action, but their effectiveness is limited; non-pharmacological actions are a significant part of the therapy. The patient group with cardiac syndrome X requires periodic follow-ups because prospective observation has shown that it is a risk group concerning development of atherosclerosis and acute coronary syndrome.

Analysis of High-Risk Sexual Behavior among Polish University Students

High-risk sexual behavior consists of activities and habits that put a person at increased risk of sexually transmitted infections (STIs) or unplanned pregnancy. Poland is currently experiencing a problem with increased STI rates, largely due to poor sexual education. Our exploratory study aims to evaluate the sexual behavior of students attending universities across Poland. The study covered 7678 students from 50 different faculties and universities across the country. The authors created an original questionnaire which consists of 31 questions which, among others, included demographic factors, sexual initiation, high-risk sexual behavior, STI's and religious beliefs. 78% of students have participated in sexual activity, among them 19% of students had 'casual sex' consisting of intercourse without the use of a condom, 27% had participated in sexual intercourse after the consumption of alcohol. Our study found that students who are influenced by religious belief tend to engage in sexual activity into their later years. The groups most exposed to the consequences of risky sexual behavior are mostly homosexual men, bisexual women, art students, and military students. Alcohol consumption is a strong factor contributing to risky sexual behavior. Sexual education in Poland should be improved.

EMOTIONAL PROBLEMS AND SLEEP DISTURBANCES IN PARAMEDICS IN THE ERA OF THE COVID-19 PANDEMIC

Infectious diseases have accompanied mankind for centuries, and the effects of their dramatic course are felt on many levels of everyday life. The COVID-19 pandemic caused by SARS-CoV-2 virus infection carries a tremendous psychological burden for both those infected and health care workers. Particularly vulnerable to psychological strain are paramedics who have direct contact with and caring for patients infected with coronavirus. From a review of the literature, it is known that Emergency Medical Team members, as a result of the stress experienced during a pandemic, manifest symptoms such as depression, anxiety, and sleep disturbances. In order to limit the adverse impact of the pandemic on the mental condition of this professional group, it is necessary to create appropriate conditions for solitary rest, relaxation and satisfaction of basic needs such as: food, sleep and protective clothing. An important role is also played by unrestricted access to psychological support in the broad sense of the word and often also to psychiatric care.

MODERN ENDOVASCULAR TREATMENT METHODS FOR ERECTILE DYSFUNCTION: A CRITICAL ANALYSIS

OBJECTIVE

75% of men with coronary artery disease confirmed by coronarography have erectile dysfunction in history, while 75% of patients with a vascular etiology of ED have significant stenoses in penile arterial vascularization. Patients with coronary artery disease have shown a relationship between the range of the lesions in the coronary vessels and erectile dysfunction intensity. This paper aims at attempting to systematize the knowledge of the benefits and drawbacks of nonsurgical endovascular treatment methods for erectile dysfunction with confirmed vascular causes. It analyzes seven studies which assess the results of erectile dysfunction treatment with percutaneous angioplasty. It also mentions the limitations of the cited works and formulates relevant conclusions.

CONCLUSION

Conclusions: The analysis shows that endovascular procedures in erection-related arteries are safe in a specially selected group of men. It is necessary to conduct further studies to define an appropriate group of patients who have a chance of benefiting optimally from the endovascular treatment of erectile dysfunction in a long-term follow-up.

SEXUAL DISORDERS AFTER HEART TRANSPLANT

OBJECTIVE

The aim: To systematize and bring the reader closer to knowledge about the occurrence of sexual disorders in people after heart transplantation based on available bibliography.

PATIENTS AND METHODS

Material and methods: A review of the literature on this topic from the last 30 years made with using the PubMed database, using a total of 17 articles.

CONCLUSION

Conclusions: The incidence of sexual dysfunction (SD) is higher in heart recipients than in the general population and erectile dysfunction is the most common. When the symptoms of dysfunction occur before the transplant - they do not improve, rather they get worse, which reduces the improvement in the quality of life of these patients compared to patients without sexual dysfunction. Improvement in quality of life is observed in patients with SD after heart transplantation, but not as pronounced as in subjects without sexual dysfunction. Some patients notice an increase in libido, with the genital response being insufficient or completely disappearing, which results in a decrease in the quality of relationships between partners and a deterioration in the quality of life. The cause of SD in heart recipients is unclear, but it is associated with the type of immunosuppression used, the level of sexual activity and the state of health of patients prior to transplantation. Nowadays patients after ortotrophic heart transplant live longer and their quality of life improves, but not in sexual terms. The articles concerned almost exclusively men, that is why the topic requires exploration in subsequent research.

Impact of dual diagnosis in patients with schizophrenia and affective disorders during hospital treatment on the course of illness and outcomes of treatment - a preliminary report

OBJECTIVES

Comparison of the course of illness and functioning as well as occurrence of somatic diseases between patients with dual diagnosis, alcohol or drug addiction without mental disorders and patients with schizophrenia or affective disorders; drawing attention to the problems of people with dual diagnosis and importance of longer psychiatric inpatient treatment of this group of patients.

METHODS

108 persons were examined during inpatient psychiatric treatment. Injuries, occurrence of somatic diseases, aggressive behaviors, suicidal attempts, and discharges from hospital on patients' request against medical advice were evaluated. Sociodemographic data and data associated with the course and treatment of an illness were compared between dual diagnosis group (n = 30), group of patients with mental illness (n = 41) and patients with alcohol or drug addiction (n = 37) using questionnaires designed by the authors.

RESULTS

In the dual diagnosis (DD) group, patients more often tried to commit suicide, started to use drugs or alcohol in younger age. In this group significantly more people were before marriage or after divorce. In the DD group and the group of patients with mental disorders (C), there were significantly more patients treated in hospitals longer than 180 days during their life. No statistically significant differences were found between groups when comparing incidence of somatic diseases, injuries, discharges from hospitals on patients' request or aggressive behaviors.

CONCLUSIONS

Due to non-compliance, frequent interruption of treatment, higher suicidal risk in the dual diagnosis group, there is a need of longer inpatient treatment in order to improve mental status, regular pharmacological treatment, provide social support, motivation, and prepare patients for psychotherapy of addiction. It is essential to take actions to create therapeutic standards of treatment and adjust financial funding for this group of patients in Poland.

[Insomnia in shift workers of a zinc smelter]

BACKGROUND

The aim of this study was to assess the prevalence of insomnia among the employees of a zinc smelter in Miasteczko Śląskie using the <i>Athens Insomnia Scale</i>.

MATERIAL AND METHODS

The examined group of plant employees and the control group were asked to fill in a questionnaire composed of the AIS and questions relating to the place and nature of their work, accidents over the last year, medications, diseases and conditions, sleep, naps and sleepiness during the day.

RESULTS

The result leading to a diagnosis of insomnia as indicated by the AIS was found in significantly more instances in the test group than in the control group (29.5% vs. 8.4%). While comparing the test subgroup, which was not employed in shift-work, with the control group did not result in a statistically significant difference, slightly more respondents from the day-work test subgroup obtained the result of ≥ 8 pts.

CONCLUSIONS

The prevalence of insomnia assessed by means of the AIS in the group of employees of a zinc smelter is significantly higher than in the control group. Based on the AIS, the highest percentage of individuals with insomnia occurred in the subgroup employed in shift-work. Med Pr. 2019;70(5):611-6.

[Socio-demographic indicators of alcohol dependence in patients treated for addiction in a post-industrial city]

BACKGROUND

The aim of the study was to evaluate the influence of the place of living on the prevalence of the alcohol dependence syndrome (ADS) and to find its possible connections with socio-demographic data within a post-industrial city with a population > 100 000 inhabitants.

MATERIAL AND METHODS

The study was carried out in 2004-2012 on a group of 431 patients living in Bytom with diagnosed ADS treated either in psychiatric wards or in outpatient psychiatric clinics. The patients' gender, age, employment, marital status, level of education and the fact of living in a given town district were analysed. The majority of the demographic data was obtained from the City Office.

RESULTS

The study demonstrated the influence of the place of living, age, gender, level of education and employment on the prevalence of ADS in a post-industrial city.

CONCLUSIONS

Alcohol addicts who seek treatment are predominantly men > 40 years of age, with low education, mostly unemployed, living in the urbanized districts within the city center or the post-industrial area of the city, which are the areas with the highest risk of ADS. Living in a suburban neighborhood may protect against alcohol addiction due to the lower risk of exposure to environmental factors contributing to the prevalence of ADS. Additional protective factors include at least secondary education and paid employment prospects. The neighborhood of people with ADS has a particularly devastating effect on women, who are more likely to become addicted in such environments. Med Pr. 2019;70(2):221-8.

Sense of coherence in selected allergic diseases

According to "holistic" model of physician's approach to the patient, physical, psychological and social aspects should be taken into account when we assess disease and effects of diagnostics and treatment. Those attributes form health related quality of life. Patient's disposition to disease depends on many psychological factors, among them sense of coherence (SOC). Sense of coherence is a health-promoting life orientation, perceiving the world as comprehensible, manageable and meaningful. The prevalence of allergic diseases is dramatically increasing. This epidemy strongly influences comfort of patient's life. In our paper we try to present the current knowledge on sense of coherence as a factor potentially influencing the course of allergic diseases.

Analysis of psychiatric consultations in a multidisciplinary hospital patients

AIM : The aim of the research is the analysis of psychiatric consultations conducted in the multi-disciplinary hospital, establishing the cause of the consultations according to ICD-10 and the analysis of psychiatric consultations regarding their number on particular wards.

METHODS

Retrospective analysis of medical documentation concerning given consultations in the multidisciplinary hospital in Tarnowskie Góry in the years 2002-2010 has been conducted. In the statistics studies Shapiro-Wilk test, Kruskal-Wallis test, Mann-Whitney U test, Chi-square test of independence and the others have been used.

RESULTS

In the analyzed years, 3,672 consultations have been done, the mean age of the consulted patients has been 46.9 years. Taking into consideration the sex of the consulted patients, 41.99% of them were female and 58.01% were male. The main diagnoses of all consultations present as follows: F00-F09: 18.82%, F10-F19: 29.58%, F20-F29: 17.70%, F30-F39: 10.29%, F40-F48: 13.83%, F50-F59: 0.16%, F60-F69: 3.21%, F70-F79: 1.77%, F80-F89: 0%, F90-F98: 1.01%, other: 3.62%. The consultations most often have taken place on the following wards: Hospital Admitting Department (13.21%), Hospital Emergency Service (6.97%), Surgery Department (8.42%), Internal Medicine Department (6.51%), Neurology Department (4.82%).

CONCLUSIONS

The most frequent causes of consultation were addictions, the next were organic and psychotic disorders, neurotic and affective disorders. Consultations most often have taken place at the Hospital Admitting Department/Hospital Emergency Service, Surgery Department, Internal Medicine Department and Neurology Department.

[The sense of coherence in women undergoing coronary arteriography]

AIM

The examination referred to two groups of female patients: with and without significant coronary stenoses in coronarography. There were two stages of the examination: before and 6-9 months after coronarography. The factor dividing patients into two groups: without significant atheromatosis and with coronary atheromatosis, was the result of invasive diagnostics of coronary heart disease.

METHODS

The sense of coherence scale (SOC-29) and sociodemographic questionnaires were used to evaluate the condition of the two groups.

RESULTS

In group of patients with irrelevant coronary stenoses statistically lower values of sense of comprehension were noticed in the first and the second examination and also sta- tistically lower values of sense of manage were observed, comparing to the group of patients with significant stenoses. The initial value of general coherence was comparable in both groups and did not significantly change in 6-9 months after coronarography. The characteristic parameters: lack of social support, intensity of depressiveness and anxiety before getting information about necessity of coronarography and worse education were connected with lower sense of coherence.

CONCLUSIONS

The baseline strength of the total sense of coherence was not different between groups. Patients with no significant stenosis of coronary arteries demonstrate a lower sense of comprehensibility before and after the coronary arteriography and lower sense of manageability after the procedure compared to the group of patients with significant atherosclerotic lesions. No social support, tendency for depression and anxiety and lower level of education were associated with lower sense of coherence in both groups.

[Hypochondria yesterday and today]

The publication aims to discuss hypochondriacal disorders. This paper presents the history of the concept of hypochondria from antiquity to modern times, also includes brief information regarding etiopathogenesis, etiology, classification and treatment of hypochondria with particular emphasis on psychotherapy. Our goal was to make the subject hypochondriacal disorders, as a disease entity often encountered in everyday medical practice.

[Gender identity disorders or andromimetic behaviour in a victim of incest--a case study]

Nowadays, it is becoming increasingly difficult to clearly classify the issues associated with the phenomenon of gender dysphoria due to the fact that one identifies oneself in the context of increasingly fluid categories of gender identity-- an intrinsic sense of being a woman or a man. The authors present a woman whose internal problems connected with her sexuality and incomplete identification with the role attributed to her gender originate from her family history. Long-lasting, traumatic experiences of incestuous abuse and violence on the part of close relatives disturbed her development in many areas of personality and functioning. The aim of the study was to verify the hypothesis of the existence of gender identity disorder accompanied by depressive disorders. In addition to the medical history, the study of patient's problems included the following diagnostic tools: the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach Inkblot Test in a CSR Exner system (TPA). The study revealed that as for sexual identification, the patient unambiguously identifies herself as a woman. Her behaviour to become like a man does not deny her sex, or even involve a temporary need of belonging to the opposite sex. It should be interpreted in the broader context of her traumatic experiences, not just sexual, but also concerning different aspects of a female gender role.