Psychiatr Pol
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Neurobiology of the placebo effect dates back to 1978, when Levine discovered that its analgesic action is reversed by naloxone. Since then, various studies have been performed to estimate the impact of placebo on brain metabolism and neurotransmission in analgesia, depression or the Parkinson's disease. ⋯ Environmental conditions, which may result in placebo efficacy increase of seven percent per decade during the last years, are also looked into. Although certain ethical and legal dilemmas appear considering the use of placebo, it is beyond any doubt that realising the influence of expectation and conditioning on the neurobiology of the placebo effect, as well as on the proper therapy, should enable better patient handling and treatment in the future.
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Continuation and maintenance electroconvulsive therapy (ECT) is used to reduce the risk for relapse and recurrence of affective disorders and schizophrenic disorders. Despite the potential value of these ECT schedules, both are relatively neglected in clinical practice. This article reviews the recent research on the subject. Although most of the research are small open studies and case reports, continuation and maintenance ECT does emerge as a safe and effective treatment for relapse and recurrence-prone patients who have responded to the basic course of ECT.
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In this paper, a concept has been presented stating that the process of creativity may be connected with psychopathological features such as mood disorders, mainly bipolar, and psychosis-like thought abnormalities. Biographic studies point to a more frequent occurrence of affective disorders in creative subjects and members of their families. There is also data concerning the occurrence of schizophrenia in the families of prominent persons. ⋯ The neurotransmission system mostly connected with elevated mood and psychotic thinking is the dopaminergic system, especially its mesolimbic and cortical pathways. Both neurobiological and pharmacological evidence has been accumulated for an association of these pathways with motivational, emotional and cognitive processes, and indirectly, with the processes of creativity. In recent years, a number of interesting results has also been obtained from molecular-genetic studies about genetic determinants of creativity processes in association with bipolar mood changes and psychotic conditions.
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The aim of this paper is to remind expert psychiatrists, the three basic elements required for the application of security measures such as placing the convict in a psychiatric hospital. They are: 1) An act was of serious social damage, 2) the damage was committed in a state of non-liability, 3) there is a high risk of the person repeating the act of similar social damage. The fulfilment of these three is an obligation for the court to apply the security measure of placing the person in a psychiatric hospital (art. 94 section 1 of the penal code). ⋯ There is a huge need for legal regulations on these manners, after the forensic psychiatric observation ends. The non-liable delinquent who committed an act of serious social damage is in risk of committing this act once more, whilst he is not in custody. The issue is in showing a legal basis for keeping the non-liable delinquent from such an act in a psychiatric hospital, in spite of ending the observation, until the legal sentence on the security measure is in place.
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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,ethical problems related to clinical practice, as well as issues on postgraduate education.