Paramedics are more prone to develop PTSD symptoms than general population. This indicates the need for preventive steps to be taken in the professional group of paramedics taking into consideration their coping styles and level of dispositional optimism.

In 1980 a third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) brought diagnostic criteria for a new diagnosis - posttraumatic stress disorder (PTSD). This disorder is a result of highly intensive stressor and in many cases leads to sever psychiatric distress. Despite relatively recent introduction of PTSD as a new diagnosis, this disorder was excessively described in scientific papers as well as in fiction novels. Analysis of those descriptions across ages allows for the conclusion that character and type of stressors has changed, however, people's reactions to highly intensive stressors are basically similar. First descriptions are found in notes of Egyptian physicians and then in papers of Homer, Herodotus and Plutarch. In consecutive parts of this paper, the authors present history of posttraumatic stress disorder describing contribution of Polish authors - Kepiński and Szymusik. Presented historical perspective of posttraumatic stress disorder allows for better understanding of reasons for introducing PTSD into classifications as well as controversies related to it.

Helping people with mental disorders poses a challenge to the members of medical emergency services (EMS). Psychiatric patients are often unpredictable and applying physical coercion is necessary in some cases. The aim of this paper was to present and comment on legal foundations of application of different forms of physical coercion by EMS members and describe how to fill out medical records required every time physical coercion was used. According to the amendments of Polish Mental Health Act made in 2010, the EMS members were granted the right to apply physical coercion. Further amendments to the Mental Health Act and the introduction of appropriate Ministry of Health decree define forms of physical coercion, indications to apply physical coercion and include a sample of proper medical records which are required in all cases of application of physical coercion. Application of physical coercion should always be treated as last-line treatment option while helping patients suffering from mental disturbances. Obeying the law every time a decision regarding physical coercion is made protects patients’ right to receive dignified care and treatment as well as the rights of medical professionals

The introduction of neuroleptics in the 1950's was a turning point in psychiatric treatment. The new drugs brought hope to millions of patients and their doctors. However, there were also some side-effects, one of which is Neuroleptic malignant syndrome (NMS), a rare complication of antipsychotic treatment and untreated it may lead to mortality as high as 20%. The incidence of NMS, estimated to be 0.01-0.02%, has decreased significantly probably due to higher awareness of the diseases and shift to atypical antipsychotics. The aim of this study was to present the signs and symptoms of this rare condition and describe management possibilities since this condition is observed not only in psychiatric departments but also in emergency rooms. NMS is thought to be related to change caused by neuroleptics within the central nervous system due to dopamine D2 receptor antagonism, especially nigrostriatal pathways and the hypothalamus. There are three symptoms which are considered as major and indicate a high probability of NMS: muscle rigidity, hyperthermia (core body temperature above 38.5 °C), and elevated creatine phosphokinase concentration (above 1000 U/l). NMS is a diagnosis of exclusion and clinicians must be vigilant in detecting early signs of NMS. The basic management in NMS is antipsychotic discontinuation and proper supportive care of the patient (vital signs monitoring, hydration, correction of electrolyte and acid-base disturbances). In more severe cases, the introduction of bromocriptine or dantrolene, as well as benzodiazepines, may indicated. Further usage of neuroleptic in patients with a history of NMS should be with care, and low doses of low-potency neuroleptics or atypical neuroleptics seem to be the best treatment choice.

Kucmin T, Kucmin A, Płowaś-Goral M. Zasady, wskazania i dokumentowanie stosowania środków przymusu bezpośredniego w domach pomocy społecznej.Wprowadzenie. W polskich domach pomocy społecznej przebywa obecnie prawie 80 tys. pensjonariuszy. Znaczącą większość z nich stanowią osoby przewlekle chore psychicznie oraz osoby niesprawne intelektualnie. Należą one do grupy zwiększonego ryzyka wystąpienia zaburzeń zachowania wymagających stosowania środków przymusu bezpośredniego. Celem niniejszego artykułu jest przedstawienie aktualnych przepisów prawa wraz z komentarzem oraz opis prawidłowego prowadzenia, w jednostkach organizacyjnych pomocy społecznej, obowiązującej w takich przypadkach dokumentacji medycznej. Stosowanie środków przymusu bezpośredniego jest w polskim prawie zdefiniowane w ustawie o ochronie zdrowia psychicznego z roku 1994 oraz wydanym w oparciu o zmiany w tejże ustawie rozporządzeniu Ministra Zdrowia, które precyzyjnie określa wskazania do stosowania środków przymusu bezpośredniego, z zaznaczeniem, iż użycie tychże środków za każdym razem winno być traktowane jako środek ostateczny. Obowiązujące w tym zakresie w Polsce przepisy prawa dopuszczają stosowanie czterech różnych form przymusu bezpośredniego, z których każda, w większym lub mniejszym stopniu, wiąże się z ograniczeniem swobody i wolności pacjenta. Dokonując wyboru środka przymusu bezpośredniego, należy uwzględniać stopień zagrożenia pacjenta dla samego siebie, jak też dla innych osób przebywających w jego najbliższym otoczeniu, a także stosować obowiązujące przepisy prawa, co pozwoli na ograniczenie prawdopodobieństwa popełnienia błędów.Adres do korespondencji: Tomasz Kucmin, Katedra i Klinika Chirurgii Urazowej i Medycyny Ratunkowej UM Lublin,