Outcome, comorbidity and prognosis in anorexia nervosa. / Przebieg choroby, wspólchorobowosc i czynniki rokownicze w jadlowstrecie psychicznym.

Anorexia nervosa (AN) is a relatively common disorder, especially in adolescent and young adult women. The lifetime prevalence of AN in females ranges from 1.2 to 2.2%. The prevalence in males is 10-times lower. The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death. Longer follow-up periods seemed to correspond with increased improvement rates and increased mortality. Onset of the disorder during adolescence is associated with better prognosis. It is reported that as much as 70% to over 80% of patients in this age group achieve remission. Worse outcomes are observed in patients who required hospitalization and in adults. Recent studies indicate improved prognosis for cure and lower mortality rates than previously reported. However, the recovery can take several years and AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders). Studies indicate that bulimic symptoms often occur in the course of anorexia nervosa (especially within 2-3 years from the onset of AN). The authors present a review of literature on the course, comorbidity, mortality, and prognostic factors in AN. Better knowledge of the course of anorexia can contribute to more realistic expectations of the pace of symptomatic improvement, as well as to a creation of therapeutic programs which are better adapted to the needs of the patients.

Reliability of repeated forensic evaluations of legal sanity.

Criminal responsibility evaluation is a very complex and controversial issue due to the gravity of its consequences. Polish legislation allows courts to request multiple sanity evaluations. The purpose of this study was to assess the extent of agreement on sanity evaluations in written evidence provided by experts of criminal cases in Poland. A total of 381 forensic evaluation reports addressing 117 criminal defendants were analysed. In sixty eight cases, there was more than one forensic evaluation report containing an assessment of legal sanity, including forty one cases containing two assessments of criminal responsibility, seventeen containing three assessments, eight containing four assessments and two containing five assessments. We found that in 47% of the cases containing more than one sanity assessment, the initial criminal responsibility assessment was changed after a subsequent forensic evaluation. The agreement between repeated criminal responsibility evaluations was found to be fair. This study found a strong correlation between the number of forensic reports and the number of contradictory sanity assessments. There were fewer forensic opinions involved in the cases in which the same conclusion regarding criminal responsibility was reached in subsequent forensic evaluation reports compared to the cases in which more forensic opinions were involved. There is a clear need for further research in this area, and it is necessary to standardise criminal responsibility evaluations in order to improve their reliability and to shorten the legal proceedings.