[Development of child psychiatry in Poland].
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Biomedical subjects
Publications and source records attributed to A Popielarska.
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The report concerns 100 children (64 boys, 36 girls, 2-15 years old) with psychiatric disorders due to mechanical injuries of the brain. The symptoms occurred for the most part within 1-3 years after the injury. They were: encephalopathy (35 cases), characteropathy (5), neurosis (16), epilepsy (44). Epilepsy was the most important posttraumatic problem, particularly the focal form of epilepsy. There was conformity between focal changes in the EEG curves and the clinical character of seizures. The age of the child at the moment of the injury, the gravity of the injury, and previous organic disorders caused by abnormal delivery seem to be the main factors determinant of the severity of the psychiatric sequelae of a trauma. Mechanical trauma seems to activate former latent lesions of the brain due to abnormal delivery.
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Analysis of the results of treatment of 132 patients hospitalized because of anorexia nervosa is presented. Average time of observation after hospitalization was 7,9/12 years. Mean age when the disease started was 13,7/12 years, when the analysis was performed--22 years. Catamnestic data were received directly from patients--46, from family members--25, from health service--3.18 sent answers by post, 40 neither contacted us nor answered to questionnaire. Analysis was founded on Morgan, Russel criteria, modified by Ratnasuriya. It showed that good results of treatment were received in 76% of all analyzed patients, in 11% they were intermediate, and poor in 12%. Two persons (2%) died. The social functioning of patients was found to be the best. More than half of the examined group had depressive and/or anxiety disorders. These disorders are significant in all the patients who remain chronically ill.
The described material was divided into two groups. Group I (45,6%) without seizures since 3 years at least, group II (54.4%) with continuing seizures (in 52% of this group the intensity of seizures remained unchanged and in 48% it decreased). The factors determining successful treatment included: unestablished or traumatic aetiology of seizures, partial-simple type of seizures, normal neurological status and normal psychomotor development at the time of onset, small number of seizures prior to beginning of treatment, good effects of drugs. The factors which might determine therapeutic failure included: presence of organic CNS type of seizures (primarily generalized, myoclonic, salaam seizures, and partial secondarily generalized seizures), the dynamics of the disease (frequent refractory seizures), late beginning of treatment. The morphological features of initial EEG tracings in without prognostic significance. In most cases with a favourable course improvement of normalization of EEG tracings was observed, with disappearance of seizure activity followed by regression of focal changes and by normalization of background activity.
The authors studied the problem of parental attitudes assuming that in epilepsy, besides the coexistent CNS damage, the intensity and frequency of convulsive seizures, and the mode and duration of treatment which influence the functions of the child, the attitude of the parents is also very important. In the studied material of 272 cases (146 boys and 126 girls) treated in the psychiatric department and out-patient clinic in the Institute of Paediatrics, Medical Academy in Warsaw for at least 3 years three main patterns of parental attitude towards the epileptic child have been recognized: 1. overprotective attitude (58%). 2. inconsistent attitude (32%). 3. rejecting attitude (8%). Depending on these attitudes certain disturbances of psychomotor development manifested themselves or intensified, mainly in the form abnormal development of emotions and cognitive functions as well as social adaptation. In the conclusions the authors stress the widespread occurrence of incorrect parental attitudes and the necessity of psychotherapeutic influence on the parents.