Ceska a Slovenska Psychiatrie最新文献

At the beginning some rules and conclusions concerning neuroleptic blood levels are mentioned. Clozapine blood levels are discussed in a more detailed way. A survey of the most important studies about the relation between therapeutic effect and blood levels of clozapine is given. Finally, the author presents his own experience with blood levels of clozapine in patients on maintenance treatment with the aim to find the lowest effective dose.

Clonazepam was administered to 55 patients with depressive disorder (DSM-III-R) in average minimal and maximal doses of 2.40 and 6.54 mg/day for 21-28 days. Complete remission was achieved in 60% patients (Serejskij AB, drop of global HAMD and FKD score by more than 50%), in particular in case of concurrent anxiety. A marked antidepressive effectiveness of clonazepam was suggested also by a drop of the total HAMD and FKD score already after the first week of treatment. All items of the HAMD and FKD scale were significantly positively influenced with the exception of agitation, somatic anxiety, insight, paranoidity, obsession respectively hypochondriasis and paranoidity. No correlation was found between the effect of clonazepam and sex, the patients' age, duration of the depressive disorder, period of the index episode and severity of depression. As to undesirable effects, the authors recorded fatigue and sleepiness (40%) and hypotension (20% of the patients), in particular at the onset of treatment and after larger daily doses. In 3/10 bipolar patients a switch to hypomania was observed.

The author deals with the neuropsychology of traumatic brain damage in children. He mentions briefly the development of neuropsychology with regard to problems encountered in children. Based on an analysis of the literature he assesses four basic factors when establishing the diagnosis. These factors are: age, type and extent of damage, duration of coma and posttraumatic amnesia and premorbid personality. The author finds discrepancies between assessment of coma in different experimental publications and emphasizes the practical aspect of these basic factors in clinical reflections. He presents results of studies concerning mild, medium and severe cerebral affections in children. He emphasizes the importance of psychotherapy, neuropsychological rehabilitation and crisis intervention.

The problem to keep medical secret has its moral, legal and psychological aspects. Although in the submitted paper the importance of moral and psychological aspects of the legal component of the problem, described in this country usually as "mandatory medical secret". The paper analyzes on a historical background the state of legislative norms of medical secret from the last century to the present time. It emphasizes the continuity of legislative solutions which reflect to a certain extent social changes during the period of investigation and demonstrates the present trend of gradual minimalization of state interference and accentuation of personal responsibility, consistent with the List of basic rights and freedom. The author compares also the principles of solution of the problem with selected experience from abroad. In the conclusion he informs on the present state of legal norms which are an amendment of the penal code valid since 1994 and defines the basis of unlawful use of personal data, incl. defined sanctions. Thus strengthening of the legal support of the investigated problem of medical secret was achieved.

The author gives an account of the views of L. Hartmann, president of the American Psychiatric Association, professor of child psychiatry, specially of his theory of biopsychosocial integration. It is a selective abbreviated explanation of Hartman's concept which seems to be a good baseline of contemporary child psychiatry.

The authors recapitulate the term of pathological gambling in different classifications incl. the 10th revision of the ICD. It is a new concept which involves certain obscure points also from the linguistic aspect. They demonstrate on a forensic expert opinion elaborated by the Faculty why the statement of the accused that he committed extensive property offenses as a result of pathological gambling was not accepted by experts.