The clinical picture of bipolar affective disorders in children and adolescents hospitalized at the psychiatric ward in Sosnowiec. / Obraz kliniczny zaburzen afektywnych dwubiegunowych u dzieci i mlodziezy hospitalizowanych w oddziale psychiatrii w Sosnowcu.

OBJECTIVES: To determine the clinical picture of bipolar affective disorders (BD) in children and adolescents hospitalized at the Clinical Ward of Developmental Age Psychiatry and Psychotherapy (DAPP) in Sosnowiec, Poland. METHODS: Documentation analysis of 288 BD patients below 18 years of age. Detailed clinical and demographic data were collected and symptoms present during hospitalization were assessed. RESULTS: The mean age of illness onset was 13.6 ± 1.7 years. A total of 86.5% of the studied individuals received a first diagnosis different from BD/mania, and the average time until the proper diagnosis was 16.9 months. In 45.5% the first episode was depression with varied severity, in 29.2% a mixed episode and in 25.3% mania/hypomania. In 48.6% comorbid disorders were present. The most frequent reason for hospitalization was a mixed episode (47.6%). Among the symptoms, irritability was observed in over 80% of patients with mania or mixed episodes, but also in 60% of patients with depression. Suicidal thoughts were experienced by almost all the depression patients, 84.7% in the mixed episode and also 52.6% in mania/hypomania episode. Anxiety was mostly present in depression (40.7%) and mixed episode (22.6%), while moodcongruent delusions in depression and mania (around 20% of cases). Aggressive behaviours were manifested in around half of patients with mania and a mixed episode. CONCLUSIONS: In the studied population of children and adolescents, BD usually started with a depression episode accompanied by a high rate of comorbid disorders and in most cases there was an original misdiagnosis. Study results also point to a significant frequency of some pathological symptoms in this population.

Correlation between attention deficit hyperactivity disorder and bipolar disorder in children and adolescents: Systematic review. / Zwiazek pomiedzy zespolem nadpobudliwosci psychoruchowej z deficytem uwagi a choroba afektywna dwubiegunowa w populacji dzieci i mlodziezy: przeglad systematyczny.

Determining of correlation between Affective Bipolar Disorder (BD) and attention deficit hyperactivity disorder (ADHD) in children and adolescents by choosing the most appropriate hypothesis explaining the nature of connection of these two diagnoses based on systematic review of literature. An overview of literature published in MEDLINE/PubMed database and Google Scholar search engine between January 2008 and February 2019 concerning the correlation between BD and ADHD was performed. Articles in Polish and English were chosen from journals which were closely related to the topic and possible to allocate to one of the four hypotheses. Ultimately, 10 research papers were included in the review. The range of the papers' score was 3.5-9 according to adapted NOQAS scale, with mean score of 6.6 out of possible 9, which lead to a general average quality of the papers. In all the works the psychopathology of patients was evaluated according to DSM-IV diagnostic criteria. The relationship between ADHD and BD in the children and adolescent population is not clear and an unambiguous hypothesis defining this correlation is not possible at this point. Further, prospective research that provides evidence facilitating correct diagnosis as early as possible is essential as it has considerable influence on patients' course of disease and quality of life.

Evaluation of Peripheral Blood Concentrations of Phoenixin, Spexin, Nesfatin-1 and Kisspeptin as Potential Biomarkers of Bipolar Disorder in the Pediatric Population.

There are some initial suggestions in the literature that phoenixin, spexin, nesfatin-1 and kisspeptin may play a role in the pathogenesis of affective disorders. Therefore, they may also be cautiously considered as potential diagnostic or predictive biomarkers of BD. This study aimed to evaluate the levels of the aforementioned neuropeptides in the peripheral blood of children and adolescents with bipolar. This study included 122 individuals: 67 persons with diagnosed bipolar disorder types I and II constituted the study group, and 55 healthy persons were included in the control group. Statistically significant differences in the concentrations of neuropeptides between the control and study groups were noted in relation to nesfatin-1 and spexin (although spexin lost statistical significance after introducing the Bonferroni correction). In a logistic regression analysis, an increased risk of bipolar disorder was noted for a decrease in nesfatin-1 concentration. Lower levels of nesfatin-1 seemed to be a significant risk factor for the development of bipolar disorder types I and II. Furthermore, the occurrence of bipolar disorder was associated with significantly elevated levels of spexin. None of the analyzed neuropeptides was significantly correlated with the number of symptoms of bipolar disorder.

Predictive efficiency of phoenixin, spexin and kisspeptin neuropeptides concentration levels in diagnosis of bipolar disorder in paediatric population. / Skutecznosc predykcyjna stezen neuropeptydów: feniksyny, speksyny i kisspeptyny dla diagnozy choroby afektywnej dwubiegunowej w populacji pediatrycznej.

OBJECTIVES: The aim of the study was to assess concentrations of the following neuropeptides: phoenixin, spexin and kisspeptin in venous blood serum of children and adolescents suffering from bipolar disorder, and by this their predictive efficiency in this disorder. METHODS: The study covered 75 individuals with a mean age of 15.26 years (95% CI: 14.86-15.67), of which the study group comprised of 57 individuals diagnosed with bipolar affective disorder and the control group - 18 individuals with no psychiatric diagnosis and no pharmacological treatment. Phoenixin, spexin and kisspeptin levels were determined in the peripheral venous blood serum. Neuropeptide concentrations were measured with the enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean phoenixin concentration in the studied group equalled 1.57 ng/ml (95% CI: 1.35-1.79), while in the control group - 2.69 ng/ml (95% CI: 2.38-3; U Mann-Whitney test p-value < 0.05). For spexin, these results were 639.65 pg/ml (95% CI: 558.86-720.44) in the studied group, and 354.28 pg/ml (95% CI: 310.33-398.22; U Mann-Whitney test p-value < 0.05) in the control group. The observed differences were statistically significant. The mean concentration of kisspeptin levels in the studied group was 126.02 pg/ml (95% CI: 39.82-212.23; median: 59.85), while in the control group - 54.83 pg/ml (95% CI: 39.23-70.43; median: 51.3; U Mann-Whitney test p-value = 0.29), and the observed difference was not statistically significant. CONCLUSIONS: The occurrence of bipolar disorder symptoms is statistically significantly linked with a decreased phoenixin concentration and to a small degree - with an increased spexin concentration in blood serum of patients. However, it is not linked with the kisspeptin concentration.

Systematic Review of Literature on Eating Disorders During Pregnancy-Risk and Consequences for Mother and Child.

Background: Eating disorders (ED) are a diagnostic category that includes several nosological units such as anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). This category most often concerns women, while the peak incidence falls on the reproductive age. Therefore the issue of ED during pregnancy is an interesting topic. Due to the creation of unrealistic ideal of "desired," slim figure both by the mass media and social media even during and right after gestation, more and more pregnant women introduce behaviours aimed at maintaining the "perfect" appearance. However in some cases it may have serious consequences for the health of both mother and child leading to the creation of the term "pregorexia" by the media to describe this issue. Aim: The aim of this paper was to conduct a systematic review of the literature dealing with eating disorders in pregnant women, with particular emphasis on pregorexia. Method: A systematic review of literature published within the last 5 years (2016-2021) in English or Polish and available through MEDLINE / PubMed, Google Scholar and Cochrane Library databases was conducted based on the previously assumed inclusion and exclusion criteria. Results: Initially, 634 publications were obtained during the review, of which 55 papers were selected in the course of the title analysis. After further evaluation of abstracts, 28 papers were qualified for full text analysis. Ultimately, 10 papers were selected for the final analysis. Conclusions: The issue of ED in pregnant women is a broad topic covering a heterogeneous group of women-both those with a previous history and those with the onset during pregnancy. The occurrence of ED symptoms during this period is associated with a high likelihood of negative consequences for both the mother and the child. The course of pregnancies and deliveries in these patients is more complicated. Therefore, it seems reasonable to develop a multidisciplinary screening strategy and standards of management and supervision over this group of patients.

Orthorexia - current approach. A review. / Ortoreksja ­ aktualne ujecie problemu. Przeglad badan.

The aim of the study was to define orthorexia nervosa (ON) based on the latest scientific findings regarding incidence, groups and risk factors as well as relationships between ON and other clinical entities. The paper is based on the review of the MEDLINE/PubMed databases. Publications published between 2009 and 2019 were analyzed in terms of epidemiology, risk factors and formulation of the ON concept. ON is a clinical entity of an unclear origin and various authors have continued their discussion on the relation between ON and other groups of disorders (AN, BN, OCD, ASD). Epidemiological data vary and depending on a population present extreme values from anywhere between 1% and 90%. Risk factors are alternatively identified in various groups and authors are not unanimous as for the effect of determinants such as anthropometric and sociodemographic variables on the presence of ON symptoms. Presented findings are affected by the fact that there is a relatively small number of studied groups, they are not fully representative and applied tools are different: BOT, ORTO-15, EHQ, DOS. Since the nosological status of ON remains unclear and there are no standard and operationalized diagnostic criteria and reliable assessment tools, ON requires further study. Similarly, because it is still not known how to best treat ON - which is caused by ambiguities in the concept of the phenomenon itself - prevention and therapy programs, which are non-existent, should be developed (in risk groups in particular).

Validation of the Polish Version of the Washington 4-Digit Diagnostic Code for the Assessment of Fetal Alcohol Spectrum Disorders. / Walidacja polskiej wersji Kwestionariusza Waszyngtonskiego do Oceny Spektrum Poalkoholowych Wrodzonych Zaburzen Rozwojowych.

OBJECTIVES: The aim of this paper is a quantitative assessment of FASD facial phenotype in the Polish population using the Polish version of the 4-Digit Diagnostic Code. METHODS: The study covered 2 groups of children: 30 children aged 4-7 and 30 children aged 8-11 with a facial phenotype characteristic for the Fetal Alcohol Syndrome (FAS). The control group consisted of 60 children (4-11 years old) developing normally. We compared 3 facial features (small palpebral fissure lengths, smooth philtrum and thin upper lip). The repeatability, conformity and diagnostic accuracy of particular dysmorphic features of the study were assessed. RESULTS: Obtained values for palpebral fissure were "poor", "good" and "very good", for philtrum "good" and "very good" and for upper lip "good" and "very good". As for conformity, values for palpebral fissure were "moderate" and 'good", for philtrum - "good" and for upper lip also "good". In the experimental group, the FAS diagnostic criteria were met by 13 subjects, partial FAS criteria were met by 37 subjects and the criteria of static encephalopathy with no FAS phenotype were met by 2 subjects. None of the subjects in the control group met these criteria. CONCLUSIONS: The pictorial scale for the assessment of the facial dysmorphic features proved to be a useful tool in the clinical diagnostics of FAS in the Polish conditions. Due to the problems associated with the measurement of the palpebral fissure, it is necessary to verify the normal growth charts for the Polish population.

The assessment of orthorexia nervosa among 1899 Polish adolescents using the ORTO-15 questionnaire.

OBJECTIVE: Orthorexia nervosa (ON) is considered an eating disorder (ED), with an excessive fixation on the consumption of healthy food and an obsession with its biological purity. Since the adolescent period poses a risk for EDs, the aim of this study was to assess the prevalence of ON in a population of Polish urban adolescents and some possible contributory factors. METHOD: 1899 high school students, 992 girls and 907 boys aged 15-21 years were studied. Demographic and clinical data were collected using a validated questionnaire including information on preferred living choices, in the context of pro- and antihealth activities. The Polish version of the ORTO-15 questionnaire was used. RESULTS: The mean value of the ORTO-15 was 39.2 ± 3.6 points, with no sex difference. The main factors connected with orthorexia, according to the 'Orthorexia 33.35 and 40' definitions were excess weight, sporting activities, out-of-school activities, smoking status, working parents and a high family income. CONCLUSIONS: This study, of a large number of adolescents, showed a prevalence of ON similar to that recorded in adult populations. Since factors predisposing to ON in adolescence differ from those for other eating disorders, it is not clear whether ON should be treated as a new form of ED.

[Validation of ORTO-15 Questionnaire in the group of urban youth aged 15-21]. / Walidacja kwestionariusza ORTO-15 w grupie mlodziezy miejskiej w wieku 15-21 lat.

AIM: The aim of the study was the validation and adaptation of the ORTO-15 Questionnaire in the group of the Polish schoolgirls and schoolboys. METHODS: The study included 399 participants (15-21 years old), all of them high school students in the city of Sosnowiec. The ORTO-15 is a tool created in Italy by L.M. Donini, comprising of 15 items describing intensification of orthorexia risk (population diagnosis). The validation procedure incorporated three basic methods to be applied in the reliability analysis - the comparison of double tests with the same method, the statistical properties analysis of test items as well as analysis of the relation of test items with the general test result. Moreover, the compliance of the ORTO-15 Questionnaire results with other questionnaire focused on eating habits (EAT-26) was studied. RESULTS: The reliability analysis of the ORTO-15 Questionnaire based on repeatability of the responses presents a very good (kappa: 0.81 - 1.00 for 5 items) and a good repeatability (kappa: 0.61 - 0.80 for 10 items). The reliability analysis based on the value of the Cronbach's α reached a satisfactory level (0.7 - 0.9). A full agreement of in the occurrence of orthorexia risk and the risk of eating disorders concerned 47.2% (Kappa = 0.04; 95% CI: 0.004 - 0.09) for the Ortho-40 and 88.2% (Kappa = 0.32; 95% CI: 0.17 - 0.47) for the Ortho-35. CONCLUSIONS: The ORTO-15 questionnaire is a reliable tool to identify the risk of ON in population studies in the group of urban youth aged 15 - 21.

[Faith vs. science: soul's possession or dissociative disorder? A case study]. / Pomiedzy wiara a nauka: zniewolenie duszy czy zaburzenia dysocjacyjne? Prezentacja przypadku.

The aim of this paper is to discuss the impact and significance of religious beliefs on the dissociation and somatization symptoms presented by a hospitalised female patient. A 16-year-old girl was hospitalised at the Developmental Age Psychiatry and Psychotherapy Clinical Ward (The Clinical PiPWR Ward) for observation; she had been referred from the Regional Acute Poisoning Centre where she had been admitted upon taking some medications. For two years she had been subjected to exorcisms due to "possession by the Evil". Religious convictions had been sustained and enhanced by the patient's parents as well as a local Catholic community. The observation and diagnosis at the PiPWR Clinical Ward revealed mixed dissociation and somatization disorders as well as an abnormally shaping personality. The presented case, on the basis of the clinical observation and the analysis of literature on the subject, led to the following conclusions: the emotional issues and the system of religious beliefs influenced the shape of symptomatology, enforced the functioning of immature defensive mechanisms and intensified the dissociation and somatization disorders in the patient. The diagnosed mental disorders require that the girl should undergo individual and family psychotherapy.

[Orthorexia--a new diagnosis?]. / Ortoreksja--nowe rozpoznanie?

INTRODUCTION: Orthorexia nervosa (Greek: ortho--correct, right; orexis--appetite, desire) is a term introduced in 1997 by the American doctor Steven Bratman and is defined as a pathological fixation with righteous and healthy eating. Clear classification criteria oforthorexia have not been developed yet and there has been an on-going discussion whether it belongs to the group of eating disorders or the obsessive-compulsive disorders. AIM: The aim of this paper is to summarise briefly the current state of knowledge regarding orthorexia and to point out the difficulties connected with an attempt to classify it in a given disorders group as well as with the attempt to establish the classification criteria. DISCUSSION: Despite the fact that the problem of orthorexia has been signalled in the Polish media, it has neither been discussed nor published in the Polish medical literature yet. Orthorexia starts when a diet becomes an escape from life--everyday activities are dominated by planning, buying and preparing "proper" meals. Each departure from this regime causes anxiety and guilty conscience and leads to even further tightening of the dietary habits. According to Bratmann, orthorexia is connected with an illusory feeling of safety (preventing from diseases), the urge to exercise a full control over one's life (elimination of the unpredictable), "a hidden conformism" (eating philosophy helps in a subconscious way to achieve a culturally accepted model of a beautiful body), a search for spirituality and identity, and a desire for self-deprivation. CONCLUSIONS: The arguments presented in this paper substantiate the expediency of implementing the epidemiological studies which will show the scale of the problem, its prevalence and conditionings. Data obtained in this way should facilitate the verification of classification criteria and will also help to formulate the diagnostic criteria of orthorexia.