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Aim: The primary objective of the study was to evaluate the severity of extrapyramidal symptoms during treatment with olanzapine (10-20 mg) versus perphenazine (8-40 mg) using the Simpson Angus Scale (SAS). The secondary objective was to assess the safety profile and clinical efficacy of the investigated drugs., Material and Method: A total of 95 patients with schizophrenia who met the criteria for DSM-IV were randomized to a double-blind, 18 week prospective comparative trail conducted in Poland. The tolerance of treatment was assessed with the use of scales: BAS, SAS and UKU. The efficacy of treatment was evaluated with BPRS, PANSS and CGOI scales., Results: For olanzapine patients, the severity of extrapyramidal symptoms improved after 3 first weeks of treatment, and significantly decreased from the baseline to endpoint. Perphenazine patients showed an increase of extrapyramidal symptoms. The difference of the SAS scores change was statistically significant between olanzapine and perphenazine groups. Akathisia symptoms decreased significantly in the olanzapine group during the treatment period, whereas symptoms of akathisia increased in the perphenazine group. Statistically significant differences of mean change of BAS total score from baseline to endpoint were noted between treatment groups Treatment--emergent adverse events occurred more frequently in patients receiving perphenazine (46%), than in patients receiving olanzapine (17%). The proportion of patients complying with improvement criteria for CGI scale score was statistically greater in the olanzapine group (72.7%) than in the perphenazine group (47.9%). Results of this study showed that the tolerance profile in patients taking olanzapine is superior to perphenazine., Conclusions: Olanzapine was better tolerated than perphenazine. After olanzapine treatment more subjects fulfilled the criterion of improvement and schizophrenic symptoms were less severe than in patients treated with perphenazine.

The aim of this paper is a reflection upon the most important issues in Polish psychiatry in 2002. In the mental health care development, an unfavorable legal regulation on the profession of the psychologist was passed and another change in health care financing in Poland. The role of Polish psychiatrists in international actions inspired by the World Psychiatric Association could be noted, especially in the de-stigmatising "Open the doors", as well as the stance towards 2nd generation antipsychotics. A positive growing interest and tendency in post-graduate psychiatric training was noticed, especially constant training. The publication of a new, large clinical textbook on psychiatry was noted, leading the probable direction of post-graduate training and development of scientific research. Special attention was drawn to the return of neuro-surgical interventions in treatment resistant obsessive-compulsive disorders, namely the nonstandard position of stereotactic operations on the limbic system in these disorders. Such a position is the result of insufficient scientific documentation on the effectiveness of such procedures and weakly documented theoretical bases.

Aim: Assessment of impact of adolescent depression on the development of mental disorders, substance dependency and social pathology in adulthood, and difference of the risk between depression in early and middle adolescence., Method: In 1984 prevalence of depression was assessed in a representative sample of adolescent urban population. Kraków Depression Inventory (KID) was used as a screening tool. In 2000 all participants of the earlier phase of the study were informed by mail about the task of the project and asked to answer attached the questionnaire. Information on care was collected from district psychiatric hospitals and local intoxication centres. 985 letters were sent (introductory data about 50 persons were not complete). 50 letters were returned without an answer. 256 persons (168 women and 87 men) responded., Results: A statistically significant relation was observed between adolescent depression and worse general health condition and cigarette smoking. Mid-adolescent depression in men was related with a lack of significant partnership, while in women with motherhood and disrupted marriage. Early adolescent depression in women was related with less extended extra-familiar social relations. Women depressive in mid-adolescence, on the contrary, declared more relations of this kind., Conclusions: Adolescent depression screened by KID seems to influence a general health status and social relations, especially in women. The character of this impact is not clear. Gender is of a more important role in comparison with the stage of adolescence in which depression appeared.

Psychiatry defines itself as a medical discipline using achievements of biology and other sciences concerned with human kind. Its methodology is borrowed from them. Biological methodology seems to be more attractive taking onto account contemporary standards of science. But, answers to questions formulated by psychiatry appear to be not satisfactory due to reduction both biological and humanistic methodology requires. Nevertheless new achievements in both approaches open new horizons for research. The main difficulty for this direction is a solid wall erected between them in a course of psychiatry development.

History of undergraduate training in psychiatry at medical schools in Poland was briefly reviewed showing a traditional independence of chairpersons of psychiatry in forming programmes and deciding about forms of education. Since 1990 this independence has been controlled by the faculties and, to some extent only, regulated by the national curriculum in medicine. Goals, contents and forms of undergraduate training in psychiatry were examined (following Bilikiewicz's study in 1994) with the author's own questionnaire. Professors of psychiatry, respondents to the questionnaire were of very similar opinions in regard to the goals of training. At the same time, meaningful differences were found in the methods used, position of the subject in the curriculum and even time designed for psychiatry training (at some schools below the national minimum). There were also significant differences in the contents of the programme. The most important problem seems to be absence of child and adolescent psychiatry at some schools. Integration of psychiatry with other pre-clinical and clinical subjects was assessed too. The information received suggests that Polish professors of psychiatry approved of the way their subject had been integrated with others. This seems to be overestimation, especially if compared with the Kraków experience presented in a more detailed way.

Prospective longitudinal observation of children socially and emotionally immature and depressive at entering school was carried on till their early adolescence. The study's aim was to describe: 1. childhood depression dynamics, 2. developmental changes in depression, 3. factors related to the depression course, 4. relation of childhood depression to adolescence depression. A screening study of representative population of school entering children led to identification of a risk group followed-up 3 and 6 years later. The Kraków Depression Inventory (AO "B1" and IO "B1") was used to diagnose, and for analysis of depression. Results of the study revealed a tendency to chronic course of depression in the studied group. Data collected at the first and the second stage showed coincidence of the depression chronicity and a set of nonspecific factors of "biological vulnerability" on the one hand, and dysfunctional family on the other. The latter was characterized by unclear family boundaries and difficult relational individuation. Data collected at the third stage of the study showed persistence of depression in the same individuals. Entering adolescence seemed to have no impact on depression prevalence in the studied group. It was, however, evident that cognitive and general activity disturbances increased among those studied who were not diagnosed depressive in the second and third stage. This finding requires further studies.

Mental Health Act indicates childhood and adolescence as the periods of life requiring a special prophylactic, therapeutic and rehabilitative care. Planning future organization of mental health care for children and adolescents can be based on patterns developed in countries of longer tradition, as well as on suggestions of international bodies interested in improving health care. Desirable status, however, will remain at the project stage if the reality is not taken into account. Assessment of the particular community can be done with epidemiological studies which require highly trained professionals and are costly. Thus, epidemiological data can be used rather for modification of well developed care systems. Early start of training in mental health problems of children, adolescents and their families in undergraduate training of physicians seems to be very important, taking into account that development of specialized services requires support and cooperation of other doctors, e.g. general practitioners, and forms a background for postgraduate training in child and adolescent psychiatry. Professional, or rather multiprofessional associations of child and adolescent mental health care givers aiming at improvement of care system have a very important role in lobbying for changes essential for realization of any design.

A prospective follow-up study was conducted of a group of 32 children diagnosed at 7 years of age as socially and emotionally immature and depressive. In the three year follow-up a group found still depressive was compared with those no longer depressive. Biological vulnerability, early childhood development, family internal and external boundaries and child relational individuation were taken into account. Chronicity of childhood depression can be related to vulnerability and to family disfunction. Mutual interrelation of those factors requires further studies.

Prospective follow-up study of a group of 33 children diagnosed as socially and emotionally immature, and depressive at age 7 years were conducted. Results of assessment at 10 years of age revealed chronicity of depression in this group. Chronicity of depression was reflected in the change of symptomatology. The thesis about the dependence of depressive symptoms on the developmental stage was supported. Answers to the question about the nature of childhood depression should be looked for in farther longitudinal studies.

Human rights, an issue of political debates in the last decades, listed in the United Nations Declaration of 1946 are rooted in the humanistic tradition of philosophy and religion. The UN declared their universal character and made state organizations responsible for their observation. Among all human rights that for freedom is usually perceived as crucial. Psychiatry developed in Europe primarily a caring function. The medical model developed in psychiatry through the 19th c. supplied the criteria for medical diagnosis of mental disturbance, and elaborated a system of treatment which included long term hospitalization. Medicalization of psychiatry (recently coming back) is a force which gives courage to those who suffer, to their families, and to professionals as well. This power however, can be easily abused, when a psychiatrist adopts a position of someone who knows better that which is good for his/her patient. Legal regulations of the circumstances of psychiatric treatment, especially treatment against the patient's will should prevent the abuse of the mentally disturbed person's right for freedom. The goal is usually achieved by clear description of clinical and other conditions under which a person can be committed, and by establishing the committed person's right to claim the decision to be unjust. Poland is a country without legal regulation in the area of mental health (there are only administrative acts). For more than sixty years several projects on mental health law have been worked on. The last one which came to the Sejm (parliament) in 1980 was withdrawn by the "Solidarity" Trade Union. At present, the membership of Poland in international organizations makes an introduction of mental health law an obligation. Having no legal regulation, Polish psychiatry has been a self-regulating system. It is worth to note that even in the hard Stalinist period (1947-1956) there was no abuse of psychiatry for political reasons. The main reason for Polish psychiatry staying free from political abuse is seen in the role of internalized norm of human dignity. But others should also be taken into account. It was a specificity of the political situation that the ruling powers did not insist that psychiatrists cooperate. On the other hand the integration of the Polish psychiatric community was helpful in observing the rule of non-collaboration. One of the most important factors is seen as the experience and memory of NAZI crimes in the field of psychiatry in Poland. Extermination of psychiatric patients had to leave the feeling of the importance of psychiatrist's own responsibility.(ABSTRACT TRUNCATED AT 400 WORDS)

The incidence of some risk factors of ischaemic heart disease (IHD) was investigated in a group of 91 type 2 diabetics. A group of 57 patients who had a myocardial infarction was compared with a control group of 34 diabetics without clinical and electrocardiographic signs of IHD. In the group of diabetics with IHD there was a significantly higher proportion of hypertonic patients (70%), as compared with the control group (47%). The diabetics with an infraction in the case-history had a significantly higher mean age and a longer mean duration of diabetes. There was not a significant difference between the two groups as regards mean values of cholesterol, triacylglycerols, blood sugar, urea, creatinine, proteinuria and cerebrovascular attacks. As to metabolic factors, there were significantly higher mean uric acid values in the whole group with a myocardial infarction in the case-history, whereby this increase was more marked in men with IHD. Regression analysis did not reveal a significant correlation between uric acid values and the serum cholesterol or triacylglycerol levels or the incidence of hypertension. A significant biserial correlation between the presence of myocardial infarction and uric acid serum levels persisted also after elimination of the effect of age and creatinine serum levels. Based on these results and analyses of data in the literature, the authors favour the view that uric acid is rather a marker than true risk factor of atherosclerosis in type 2 diabetics.

The aim of the epidemiologic studies on depression in children and adolescents is to elucidate the nature of the disorder, in particular to verify the hypothesis of the dependence between the nature of adolescence and the occurrence of depression. Subjects with depressive features were identified from the representative sample of junior-school population, as well as from the early- and middle adolescents. The data regarding the course of the development of depressive and non-depressive probands obtained from parents interview were compared. Significant differences were found in the course of the development of depressive and non-depressive children as well as probands in the middle phase of the adolescence. There were no specific features in the course of the development in juvenile patients with the onset of depression in the early adolescence phase. Therefore, depression is more frequent among children in whom the early biological and social development is more disturbed. The infantile central nervous system's damage causes higher risk for depression in childhood. Depression in the early adolescence phase may be recognized as a specific developmental reaction, possibly connected with psychoendocrinologic puberty crisis. The onset of depression in the middle adolescent phase is connected with the difficulties of realization of developmental tasks. The infantile central nervous system's damage increases the risk for depression in that particular phase of life.

Depression in children has an unfavourable influence on the psychosocial development of the individual, therefore it requires suitable therapeutic and prophylactic approach. The dependencies between school-age immaturity and the prevalence of depression in children were evaluated in the prospective study. The school maturity, and one year later the prevalence of depression were studied in a representative sample of 502 "0"-grade children from the large urban population. The school immaturity was found in 10.56% of probands. More common symptoms were: withdrawal and antisocial behaviour. Depression was found in 32.79% of first-grade students, more frequent children with adaptation difficulties, especially among school-immature boys. The premature biological development, the symptoms of organic brain damage, and low I.Q. do not explain sufficiently neither the school-immaturity nor the prevalence of depression in children. It was found that emotional and social immaturity to the school duties facilitates the onset of depression among I grade students, while the role of the family and school in the genesis of both phenomena studied requires further investigations.