[A trial for the complex risk assessment of repeated suicide predictors in patients after suicidal poisoning attempts, hospitalized in the Department of Clinical Toxicology CM UJ in Krakow. I. Influence of socio-demographic factors]. / Próba kompleksowej oceny predyktorów ryzyka ponowienia samobójstwa u pacjentów po samobójczym zatruciu lekami, hospitalizowanych w Klinice Toksykologii CM UJ w Krakowie. Czesc I. Wplyw czynników socjodemograficznych.

The study included 180 patients aged 18-79 (average 36) hospitalized for suicide attempts (drug intoxication) in Department of Clinical Toxicology CMUJ from March to December 2000. Examined group was composed of 49 men and 131 women. Structured investigation and medical documentation were used to estimate crucial socio-demographic risk factors of repeated suicide attempt. The following socio-demographic traits were taken into consideration in analysis: age, sex, marital status, place of living, education, employment, family background. We distinguished among patients under examinations: patients after first suicide attempt (I) and group after another suicidal attempt (II). The second group consisted of 15 men (27.8% of the total) and 39 women (72.2% of the total). Young people under 30 constituted 37.2% of the whole examined population. In population of women after repeated suicide attempt the percentage of divorced ones increased considerably (from 2.2% to 10.2%). Both in men and women after repeated suicide attempt the percentage of persons with only elementary education increased (from 34.1% to 53.7%). We observed high unemployment rate (from 26.6% to 29.6%) in both groups. Percentage of pensioners increased from 23.5% after first suicidal attempt to 33.3% after repeated suicidal attempt in men and from 25.5% to 35.9% in women. Men after repeated suicide attempt more often live with their parents, while women from the second group more often live alone with their children. It seems that some of the analysed predictors which are expression of social unadjustment may make risk factor for repeated suicidal attempts.

[A trial for the complex risk assessment of repeated suicide predictors in patients after suicidal poisoning attempts, hospitalized in the Department of Clinical Toxicology CM UJ in Krakow. II. Clinical predictors]. / Próba kompleksowej oceny predyktorów ryzyka ponowienia samobójstwa u pacjentów po samobójczym zatruciu lekami, hospitalizowanych w Klinice Toksykologii CM UJ w Krakowie. Czesc II. Predyktory kliniczne.

The study included 180 patients aged 18-79 (average 36) hospitalized for suicide attempts (drug intoxi-cations) in the Department of Clinical Toxicology CM UJ from March to December 2000. Examined group was composed of 49 men and 131 women. The following tests were used in this study: structured questionnaire, psychological tests: Beck Depression Inventory, Hamilton Depression Scale, Hopelessness Scale, Suicidal Intent Scale, Life Events Scale, SOC 29 (by Antonovsky). Besides, we used data from patients' history. The aim of our study is to analyse clinical data of suicidal attempters--after first and repeated suicidal attempts. We took into consideration the severity of coma, severity of intoxication, the kind of substances used in the attempt, the presence of alcohol, previous psychiatric treatment, cases of suicide among the patients' close friends or relatives and duration of hospitalization. Then the psychiatric diagnosis was stated. The analysis of severity of intoxication (divided into three stages: severe, moderate, and light according to the Poisoning Severity Score (PSS) indicated that in the group of repeated suicide attempters the percentage of severe intoxications was greater (9.2%) then in first time attempters. In the population of second time female attempters there is a greater percentage of persons who took neuroleptics (15.4%) compared to group first attempters (5.4%). In both groups the majority were taking anxiolytisc, sleep-inducing and mixed drugs. There was a greater percentage of persons drinking alcohol during the attempt among repeated suicidal attempters (38.8%) than among the first time attempters (26%). The percentage of persons with diagnosis of mental disease (treated in ambulatory or in hospital) is higher in the group of repeated suicide attempters (25.9%) then after first attempters (6.3%). In both groups a lot of persons had reactive depression, often associated with personality disorders, rarely endogenic depressions or psychosis. We observed that addiction to alcohol is often a problem in men who attempt suicide (I group--32.3%, II group--33.3%). The analysis of medical documentation indicated in the group of repeated suicide attempters a high percentage of people with cases of suicide among their close friends or relatives.

[The sense of coherence and risk of suicide attempt]. / Poziom poczucia koherencji a ryzyko próby samobójczej.

The analysis was based upon 79 patients hospitalized for suicide attempts (drug intoxication) in the Department of Clinical Toxicology CM UJ in Kraków from July to December 2000. The purpose of the study was to estimate the sense of coherence level (according to Antonovsky) as a potential suicide attempt predictor. The population of patients was divided into two groups: patients after first suicide attempt (I) and group after reattempting suicide (II). The examination was based on structure interview, analysis of medical documentation and a number of tests including SOC 29 (by Antonovsky), Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), and Beck Hopelessness Scale (HS 20). The most important psychological and independent variable measured in the study was the sense of coherence, introduced first by Aaron Antonovsky as a significant predictor of mental health. The sense of coherence (measured by SOC 29 questionnaire) comprises comprehensibility, manageability and meaningfulness. Both in foreign and in polish studies the SOC 29 level was lower in clinical groups compared to healthy people. The norm in Polish population was 139 scores in SOC 29. In the present study the average total result (men and women) was 112 scores in the group of patients after first suicide attempt, and in the group of repeated suicide attempters the average total result was even lower--only 99 scores, which makes a statistically significant difference. We also observed a statistically significant dependence between the results of SOC 20 questionnaire, the level of depression measured by Beck Depression Inventory and Hamilton Depression Scale, and the level of hopelessness measured by Beck Hopelessness Scale. The above results indicate that the sense of coherence level may make significant risk factor for repeated suicide attempt.

[Significance of subjective evaluation of life events as risk factors for predicting future suicide attempts]. / Znaczenie subiektywnej oceny wydarzen zyciowych jako czynników wplywajacych na ponowienie próby samobójczej.

Among the total population of 180 patients undergoing medical examination between March and December 2000, hospitalized for suicide attempts (drug intoxication) in the Department of Clinical Toxicology CM UJ in Kraków, 159 persons were examined by means of modified questionnaire of life events based on a scale elaborated by Thomas Holmes and Richard Rache. The patients were divided into 2 groups--first group comprised patients after first suicide attempt and second group consisted of those who had reattempted suicide. In regard to sex and age there were no significant differences between these two groups and the total population of 180 patients. In order to obtain the patients' subjective evaluation of the influence of their course of life on their attempting suicide, we asked the patients to select from the list of life events those that had affected their mental and physical state during of whole their life. Objectivization of life events was based on the 'units of life change' by T. Holmes and R. Rache. The sum of units of life events was 373 scores (SD +/- 200, in the range of 39-1042 units). From the total list of life events (max. score--1513) we selected the events estimated at 40 and more units of life change. Those were; marriage, divorce, separation, marital reconciliation, patient's illness, change of behavior and illness of a close relative, death of a husband/wife, child, close relative, imprisonment, pregnancy, unemployment, retirement. In the patients' subjective evaluation part, the events most frequently selected by the patients as those that had affected their mental state were: death of a close relative (56.6%), illness of a relative (40.8%), patient's illness (37.7%). A high number of patients stated events testifying to a conflict in marriage--45.7% of patients stated marital separation, and reconciliation, and 27% of patients stated unemployment as a fact that had influenced their mental state. 30.6% of these patients belonged to the first group (after first suicide attempt) and only 18.7% belonged to the second group (after repeated attempt). The authors of the study have presented a discussion over the results of the analysis and demonstrated the need for cultural adaptation of so that it can be effectively used in General Practitioners' training.

[Use of buprenorphine as a substitute treatment for opiate dependence in the Toxicology Clinics--introductory clinical report]. / Zastosowanie buprenorfiny w leczeniu substytucyjnym uzaleznienia od opiatów w Klinice Toksykologii--wstepne doniesienie kliniczne.

That the problem of drug addiction is still growing up, so there is the necessity for widen of treatment panel for psychoactive substances abuse, especially for opiates. Because of the fact, that substituting treatment became to be popular in patients' opinion, more attention were paid on new medicine-buprenorphine. It is an agonist- antagonist of opiates' receptors. Buprenorphine has been successfully used in long-term treatment in United States and in Western Europe. Treatment with buprenorphine has been started in Poland in Toxicological Department in Kraków. This article shows outcomes of substituting treatment with buprenorphine in period from December 2000 to February 2001.

[Preliminary evaluation of methadone program in Kraków]. / Wstepna ocena programu metadonowego w Krakowie.

Methadone maintenance programs have effectively reduced opiate dependency and are available in many countries, also in Poland. In Kraków 50 persons were qualified to methadone maintenance treatment. Their age varied from 21 to 46 years, mean 27.8 years. Participants of the programme were mainly educated on basic technical level, unemployed, after 3 to 30 attempts of detoxification treatment. After initial observation at the Detoxification Unit of the Department of Clinical Toxicology and establishing effective daily oral dose of methadone, all patients in Outpatient Clinic of Abuse receive daily adequate dose of methadone, where in parallel, individual and group psychotherapy is used. Methadone programme which was applied seems to prove the fact, that it can significantly improve life quality of addicted patients as well as increase the level of public safety.

[Analysis of observations in the admissions room of the Krakow Clinical Toxicology Department of substance dependent persons in relation to changes in central nervous system metabolism caused by substances of abuse]. / Analiza obserwacji w izbie Przyjec Kliniki Toksykologii CM UJ w Krakowie osób uzaleznionych, w swietie danych o zmianach w metabolizmie osrodkowego ukladu nerwowego wywolanych przez substancje uzalezniajace.

Authors presented the course of clinical observation of 393 acutely intoxicated patients dependent on psychoactive substances (28%) or ethanol (72%) who were discharged from the hospital at their own request before diagnosis and treatment were completed. In the first stage of detoxification the different intensity symptoms of toxic coma (25% of patients), behavioral changes-agitation and aggression (16%) and also the disturbances in consciousness accompanied by tremor and vegetative storm (15%) were observed. Authors pointed out that among others the neurobiological changes in brain reward systems of patients who discontinued diagnosis and treatment could be endangering for both the patient and the doctor. They postulate that criteria of life threatening state should by more accurately defined and the methods of full security for patient and doctors should be worked out.

The evaluation of the health state of the workers occupationally exposed to low concentration of carbon disulphide (CS2). Part one: General medical examination and laboratory tests.

Prospective clinical studies were undertaken in 114 healthy men aged from 19 to 46 years (mean 26) occupationally exposed to CS2. The 62 men from the control group were undergoing examination in the same way before employment and after 5 years. The mean wages of the air concentration of CS2 at working posts was from 0 to 65 mg/m3. After 5 years of exposure no considerable differences were found in general medical examination with diastolic/systolic blood pressure measurement, resting ECG record and chest X ray examination. However in LAB test the lipid metabolism disturbances occurred. After 5 years the serum concentration of triglicerides and betalipoproteides of exposed workers were significantly higher than in the control group. The serum concentration of total cholesterol of both group was increased. The mentioned changes of lipid metabolism are the factors which indicate atherosclerotical changes in the man occupationally exposed to low concentration of CS2.

The evaluation of the health state of the workers occupationally exposed to low concentration of carbon disulphide (CS2). Part two: The complex way of the examination of the central nervous system (CNS).

The results of evaluation of health state of CNS of 114 healthy workers occupationally exposed to CS2 were demonstrated. The concentration of CS2 in the air was 0-65 mg/m3. 62 people from the control group underwent an examination in the same way--before employment and after 5 years. Psychiatric examination, psychological organic tests (Bender, Graham Kendall, Benton) and EEG record were performed. The examination results were evaluated separately and together by means of arbitrary scale of pathological changes which constituted a complex evaluation of CNS. A considerable deterioration of CNS was stated which was reflection of pathological changes of a functional type. After 5 years this complex way of evaluation of CNS in exposed workers significantly more pathological changes was evidenced then ones in the control group. In 20 exposed men who obtained the worst results in the evaluation of CNS, the head computer tomography was performed. In 60% mentioned people cortical and/or subcortical atrophy was found, described in most people to be small. At the same time it is important to state that mentioned CNS examination enables an early evaluation of functional and morphological state of CNS in people who are occupationally exposed to low concentration of CS2.

[Plasmapheresis in the treatment of hepatic coma]. / Plazmafereza w leczeniu spiaczki watrobowej.

Fourteen patients, including 6 with viral hepatitis B and 8 with liver cirrhosis were treated with plasmapheresis for hepatic coma. Altogether 29 plasmaphereses were carried out. Complete recovery was achieved in one patient with viral hepatitis B and in 3 patients with liver cirrhosis. Plasmapheresis should be performed in patients with severe lesions to the liver. Classification of patients to the treatment should include clinical examination, biochemical and enzymatic tests, and evaluation of liver reserve with isotope hepatography. In case of the acute poisoning with hepatotoxic agents indications to plasmapheresis should be evaluated from the toxicologic point of view.