The diagnostic and therapeutic application of transcranial magnetic stimulation

The functional abnormalities of the central motor structures and its contribution of rigidity, tremor and bradykinesia in Parkinson's disease seem mainly due to the degeneration of the nigro-striatal pathway. Transcranial magnetic stimulation (TMS) of the motor cortex may provide useful data on the pathophysiology of motor dysfunction in Parkinson's disease. Recent reviews on the basic mechanisms of TMS in Parkinson's disease show reduced inhibitory motor network at the cortical and spinal level. The observed changes are thought to be in relation with a dysfunction of subcortico-cortical and subcortico-spinal pathways. The abnormalities of the central motor function seem to be modified by several clinical related factors as prevalence of cardinal Parkinson's disease signs (e.g. rigidity versus tremor or bradykinesia), L-dopa therapy ('on/off' states) and laterality of the Parkinson's disease signs. Observations made using TMS give new pathophysiological insights in functioning of the central motor structures in Parkinson's disease and started new form of TMS - repetitive TMS (rTMS) as a treatment of the Parkinson's disease motor signs. A few studies using rTMS with repetition rate of 0.2, 1, and 5 Hz showed improvement of motor signs in the Parkinson's disease patients. Although these results support the beneficial effects of rTMS on parkinsonian symptoms, long-term studies with large numbers of subjects should be conducted to assess the efficacy of the rTMS on Parkinson's disease in future.     

Atrial fibrillation as a relevant risk factor for stroke

Atrial fibrillation, one of the most frequent heart rhythm disturbances and the most common source of embolic material in cerebral circulation, is associated with a fivefold increased risk of ischemic stroke. Except thromboembolic complications, atrial fibrillation affects hemodynamic activity of the heart, reduces cardiac output and might decrease cerebral blood flow. It is possible that atrial fibrillation disturbs autoregulation mechanisms of cerebral circulation in patients suffering from an acute stroke. This could be the reason of higher early mortality and more severe clinical outcome versus strokes in patients with the sinus rhythm. An ongoing increase of population with atrial fibrillation is observed. Such patients often need intensive antithrombotic prevention with oral anticoagulants. Worldwide prescribing effective anticoagulant therapy is insufficient in relation to the needs. The leading reason underlying the under-utilization of oral anticoagulation in patients with atrial fibrillation is the lack of knowledge about importance of this kind of stroke prevention and fear of bleeding among doctors, particularly among general practitioners.     

Brain metabolism alterations in patients with anorexia nervosa observed in 1H-MRS

The causes of metabolic brain changes in patients with anorexia nervosa are still not fully explained. The purpose of this study was to use the 1H-MRS method in investigating metabolic changes in the brain of patients with anorexia nervosa. We studied 10 patients for visible alternations in brain metabolism and compared the results to healthy controls. 1H-MRS was acquired by the method of single voxels in white and grey matter. Proton MRS was performed after image guided localization using stimulated echo acquisition mode (STEAM) sequence with a short echo time of 20 ms. For data evaluation we used standard Siemens software and the additional PC. Choosing of the MRS sequences was related with particular interest in metabolites of short time echo: myoinositol and lipids. Besides this we evaluated peaks of: N-acetylaspartate (NAN), creatine (Cr) and choline (Cho). The results show significant differences in the levels of metabolites connected with fatty metabolism. In white matter we observed the reduction of lip-peak. The data was evaluated approximately and presented as lip:Cr. We did not observe any differences in other metabolites. As far as we know similar results had been reported and our study confirmed significant disorders in metabolism of these chemicals in patients with anorexia nervosa.     

Current problems in psychiatric health care in Poland (2004)

The paper is a presentation of the most important and actual psychiatric health care problems in Poland: the financial situation of hospitals, the risk faced by the out-patient psychiatric care and the ethical problems related to investigations of psychotropic drugs.     

Psychopharmacotherapy of anxiety, obsessive-compulsive and sleep disorders during pregnancy and lactation

The aim of the third part of our work, associated with psychopharmacotherapy during pregnancy and lactation is to present guidelines of expert--groups concerning the current rules of treating anxiety, obsessive--compulsive and sleep disorders and actual data about spreading of these disorders, pre- and perinatal effects of drugs used and the classification of them according to FDA and the safety of these medications for the breast fed newborn.     

Psychopharmacotherapy of psychotic disorder during pregnancy and lactation

The aim of our work based on the global literature-review is to present the guidelines of the psychopharmacotherapy during pregnancy and lactation recommended by various experts-groups as followed: 1. American Academy of Pediatrics, American Psychiatric Association, American College of Obstetricians and Gynecologists, The Maudsley Guidelines, Department of Psychiatry, Medical University of Mainz, Institute of Psychiatry and Neurology in Warsaw. In the first part the guidelines concerning to psychopharmacotherapy of psychotic disorders have been presented and actual data about spreading of these illnesses, pre- and perinatal effects of drugs used, the classification of neuroleptic drugs according to FDA and the safety of these medicines for the breast fed newborn.     

Involuntary commitment as a source of perceived coercion

Involuntary commitment is a topic that provokes a lot of controversy. Authors, supported by a review of literature, explain the need for conducting research on the use of coercion in psychiatry. They also attempt to answer the question whether a formal status of admission to hospital may possibly reflect the presence or lack of coercion. Further in the article they review the tools needed to make a subjective assessment of coercion associated with admission and they present results of their research with the use of these tools. The authors also point to the fact that the patient's retrospective confirmation of the need for hospitalisation may be a basis for their involuntary commitment but it does not, however, have any influence on the moral assessment of the need for coercion. Moreover, it does not arise out of this that the patient has come to terms with involuntary commitment after its completion. The need, then, to minimize the patient's perception of coercion while committed, becomes a very important matter which should be taken into account during treatment. This is both related to the fact that the perception of coercion is an undesirable factor but also that it may negatively influence the patient's cooperation during treatment.