Papers by Marek Marzanski
PubMed, May 1, 1995
Lethal catatonia is often regarded as clinically similar to, and perhaps indistinguishable from, ... more Lethal catatonia is often regarded as clinically similar to, and perhaps indistinguishable from, neuroleptic malignant syndrome. However, the two syndromes reveal differences in the mode of onset, signs and symptoms, and outcome. Lethal catatonia often begins with extreme psychotic excitement, which, if persistent, can lead to fever, exhaustion, and death. Neuroleptic malignant syndrome begins with severe extrapyramidally induced muscle rigidity. Early clinical differentiation is important, because lethal catatonia often requires neuroleptic treatment, and neuroleptic malignant syndrome necessitates immediate cessation of neuroleptics.
PubMed, Sep 1, 1995
The article presents a psychotherapeutic and spiritual approach to psychotic patients. Theoretica... more The article presents a psychotherapeutic and spiritual approach to psychotic patients. Theoretical assumptions and a practical application (implementation and results) are described on the basis of ten years' experience with an open religious group at the Psychiatric Department of Warsaw Medical School.
Western Journal of Medicine, 2000
On telling the truth to patients with dementia ABSTRACT ⅷ Objectives To discover what dementia su... more On telling the truth to patients with dementia ABSTRACT ⅷ Objectives To discover what dementia sufferers think is wrong with them, what they have been told and by whom, and what they wish to know about their illness. ⅷ Background Ethical guidelines regarding telling truth appear to be equivocal. Declarations of cognitively intact subjects, attitudes of family members, and current psychiatric practice all vary, but no previous research has been published concerning what patients with dementia would like to know about their diagnosis and prognosis. ⅷ Design Questionnaire study of patients' opinions. ⅷ Setting Old Age Psychiatry Service in Worcester, United Kingdom. ⅷ Participants Thirty consecutive patients with dementia. ⅷ Results The quality of information received has been poor, and many patients have no opportunity to discuss their illness with anybody. Despite that, almost half of the participants in this study had adequate insight, and most declared that they would like to know more about their predicament. ⅷ Conclusions Although many patients would like to know the truth, the rights of those who do not want to know should also be respected. Therefore, the diagnosis of dementia should not be routinely disclosed, but just as in other disorders, health care professionals should seek to understand their patients' preferences and act appropriately according to their choice.
Bipolar affective disorder is a severe mental illness and is reported as the 6th leading cause of... more Bipolar affective disorder is a severe mental illness and is reported as the 6th leading cause of disability worldwide. Mood stabilisers such as lithium and anticonvulsants have been used in the therapy of bipolar affective disorder. The evaluation of the outcome of the treatment is usually based on the data from randomised controlled trials. There has been need for naturalistic studies of the pharmacological interventions in bipolar affective disorder. Aims: 1. To compare their effectiveness in relapse prevention 2. To investigate some other predictors of relapse Method: Seventy one patients aged 18-70 years with the clinical diagnosis of bipolar affective disorder were included in the study. The longitudinal data on bipolar disorder admissions were analysed using statistical modelling approaches. The time to relapse and duration of hospital admission were analysed using Cox proportional hazards regression models. Results: The Number of previous admission had a significant effect on the time to the subsequent relapse (p = 0.05) with patients with more than seven previous admission having a significant shorter time to relapse than those with at most two previous admissions (hazard ratio = 1.16). The patients in full time employment had longer times to the first relapse (p = 0.01) and subsequent relapses (p = 001) than unemployed or part time employed. Time to relapse correlated also with he support received from community psychiatric nurse, the patients supported by community psychiatric nurse had shorter time to relapse (p = 0.022). Patients detained in the hospital under mental health act stayed longer than those admitted informally (p = 0.018). Conclusions: The time to relapse has been influenced by the number of previous hospitalisations, patients' employment status and support from community psychiatric nurse. The duration of the hospitalisations correlated with the employment status and the use of the Mental Health Act (1983). Patients employed had shorter hospitalisations than unemployed and those admitted compulsory stayed in the hospital longer than those admitted informally.
InTech eBooks, Jan 16, 2013
International Medical Journal (1994)
ABSTRACT
British Journal of Medical Practitioners
Aim and method: The Clinical Assessment of Skills and Competencies (CASC), introduced in June 200... more Aim and method: The Clinical Assessment of Skills and Competencies (CASC), introduced in June 2008 is the new and only clinical examination in obtaining membership of Royal College of Psychiatrists. Although there is evidence of strong validity and reliability for OSCE (Objective Structured Clinical Examination) - type examinations, the acceptability, validity and reliability of the CASC is open to challenge. We conducted a national online survey of candidates and examiners to obtain their views and aimed to evaluate whether the CASC fulfils its purpose. Results: The survey showed that 48% of the candidates (n=110) and 59% the examiners (n=22) agreed that the CASC examines the required competencies to progress to higher training. However only 15% of the candidates and 18% of the examiners accepted that CASC examines all the advanced psychiatric skills compared to the previous Part 2 clinical examination. Nevertheless, only a third of the candidates and examiners considered replacing...
Progress in Neurology and Psychiatry, 2015
Study design and method BSMHFT consists of 16 CMHTs. All generic CMHTs were functionalised in a p... more Study design and method BSMHFT consists of 16 CMHTs. All generic CMHTs were functionalised in a phased manner. By 2013, the time of this study, the whole trust was functionalised.
Mental Illnesses - Evaluation, Treatments and Implications, 2012
Mental Illnesses-Evaluation, Treatments and Implications 290 both acute and prophylactic treatmen... more Mental Illnesses-Evaluation, Treatments and Implications 290 both acute and prophylactic treatment of bipolar II disorder. Other agents like Topiramate and Tamoxifen have also been studied but with no convincing results. 3. Advances in the treatment of bipolar disorder The evidence for each of these various medications and therapeutic strategies is reviewed in the treatment of acute mania and mixed episodes, bipolar depression and in maintenance therapy. 3.1 Acute mania and mixed episodes Mania is characterised by elated, expansive mood, increased activity, pressure of speech and flight of ideas, grandiose delusions and impaired insight. In mixed episodes, both manic and depressive symptoms co-exist i.e.: a patient may be agitated and over-talkative but has severe depressive cognitions at the same time. The majority of the manic and mixed episodes require treatment in the hospital setting. Medications play an important role in their initial management. 3.1.1 Lithium Lithium salts occur naturally in rocks, spa waters, plants and animal fluids and in the human body. It is a metal ion which is distributed widely and can penetrate cell membranes. The mechanism of action of lithium is still unclear but probably it works via second messenger systems and enhancement of 5-HT responses. Lithium was first used by John Cade in 1949 to treat acute mania and it still has an important role in the therapy of bipolar disorder. Traditionally Lithium and anticonvulsants have been called "mood-stabilisers" to differentiate them from the first generation antipsychotics which were thought to have only anti-manic effects. The distinction has been blurred since the introduction of second generation (atypical) antipsychotics which have shown efficacy in both acute and long term treatment. Lithium is more effective than placebo in acute mania (Bowden et al. 1994; Kushner et al. 2006; Keck et al. 2007) and nearly 50% of the symptoms improved markedly. More than 50% of patients suffer a relapse within 10 weeks of stopping lithium treatment (Suppes et al. 1991). Lithium is also effective in reducing both psychotic and depressive symptoms similar to Quetiapine (Bowden et al. 2005). A Lithium plasma level in the range of 0.6 to 1.3mmol/L is required to obtain a therapeutic anti-manic effect (Bowden et al. 1994). The common side-effects include tremor, weight gain, polydipsia, polyuria, and worsening of skin problems. In long term, it causes renal impairment, thyroid and parathyroid problems. Lithium has a relatively slow onset of action and weak sedative property. Therefore, it is frequently necessary to add an adjunct antipsychotic or benzodiazepine in treating acute mania. The need to regularly monitor its plasma levels to prevent toxicity, as well as its side-effects makes Lithium less useful when equally effective alternatives are available. 3.1.2 Anticonvulsants Anticonvulsants have been used in the treatment and prophylaxis of bipolar disorder since the 1970's when Sodium Valproate was first used in mania. Although various anticonvulsants have been investigated, only Valproate and Carbamazepine were found to be effective in the acute mania. Other agents have shown little or no efficacy.
Psychiatric Bulletin, 1999
Psychiatric Bulletin, 2005
Aims & MethodTo investigate patients' views on receiving copies of letters sent by their heal... more Aims & MethodTo investigate patients' views on receiving copies of letters sent by their healthcare professionals, 72 patients were asked about their willingness to receive a copy of the letter sent to their general practitioner and about preferences for the type of information to be included in such letters. We also asked what concerns, if any, they had about the process.ResultsThree-quarters of the respondents (n=55) said they would like to receive a copy of the letter. Patients accepted the inclusion of information about their illness but were reluctant for data about their family, work and finances to be included.Clinical ImplicationsAlthough the majority of the patients we interviewed wished to have the copy letter, many of them expressed concerns about confidentiality, the risk of distress and the cost of the process to the National Health Service. The rights of those who do not want copy letters should also be respected.
Psychiatric Bulletin, 2006
Aims and MethodTo establish whether psychiatrists believe that medicine should be practised accor... more Aims and MethodTo establish whether psychiatrists believe that medicine should be practised according to the principles of the Hippocratic Oath, an anonymised postal questionnaire survey was conducted of all medical staff at the Caludon Centre, an 80-bed in-patient mental health unit in Coventry.ResultsThirty-three respondents (82.5%) believed that medicine should be practised according to the Oath. Support for the 15 separate statements derived from the Oath varied considerably.Clinical ImplicationsThe principles of the Oath remain an important guide to the ethical basis of medical practice for most medical staff surveyed.
Philosophy, Psychiatry, & Psychology, 2002
Philosophy, Psychiatry, & Psychology, 2002
... of agency (God) that would have lain undetected but for the profound dislocation of self asso... more ... of agency (God) that would have lain undetected but for the profound dislocation of self associated with the dark night. What remains unclear in Turner's exposition of the thought of St. John of theCross is whether God can use depression itself as a means of promoting the ...
Philosophy, Psychiatry, & Psychology, 2002
THIS IS AN ORIGINAL and conceptually precise paper. It is a significant attempt to bring religion... more THIS IS AN ORIGINAL and conceptually precise paper. It is a significant attempt to bring religion and psychiatry into conversation. With particular reference to three Oriental epistemologiesTibetan and Zen Buddhism and Tantric HinduismCaroline Brett seeks ...
Journal of Medical Ethics, 2000
Objectives-To discover what dementia suVerers feel is wrong with them; what they have been told a... more Objectives-To discover what dementia suVerers feel is wrong with them; what they have been told and by whom, and what they wish to know about their illness. Background-Ethical guidelines regarding telling truth appear to be equivocal. Declarations of cognitively intact subjects, attitudes of family members and current psychiatric practice all vary, but no previous research has been published concerning what patients with dementia would in fact like to know about their diagnosis and prognosis. Design-Questionnaire study of the patients' opinions. Setting-Old Age Psychiatry Service in Worcester. Participants-30 consecutive patients with dementia. Results-The quality of information received has been poor and many patients have no opportunity to discuss their illness with anybody. Despite that almost half of the participants in this study had adequate insight and a majority declared that they would like to know more about their predicament. Conclusions-Although many patients would like to know the truth, the rights of those who do not want to know should also be respected. Therefore the diagnosis of dementia should not be routinely disclosed but (just as in other disorders) health care professionals should seek to understand their patients' preferences and act appropriately according to their choice.
International Journal of Psychiatry in Clinical Practice, 2002
In current psychiatric practice clinicians tend to share with patients information regarding thei... more In current psychiatric practice clinicians tend to share with patients information regarding their illness. However, little is known about what the patients would in fact like to know about their diagnosis and prognosis. We have conducted a cross-sectional survey among psychiatric inpatients, to explore what they believe is wrong with them, what they have been told and by whom, and what they wish to know about their illness. The results have shown that 80% of the patients received some information about their illness and 37% of the participants had satisfactory insight. However only 46% of the participants declared that they wished to know what was wrong with them. We conclude that although many patients would like to know the truth, the rights of those who do not wish to know should also be respected. Therefore the diagnosis of mental disorder should not be routinely disclosed, but mental health professionals should take into consideration their patients' preferences and act appropriately to their choice. (Int J Psych Clin Pract 2002; 6: 103-106).
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Papers by Marek Marzanski