Introduction: In the last decades, researchers' attention has been focused on cognitive dysfunction in schizophrenia. Numerous studies indicate the existence of neurodegenerative deficits in schizophrenia including, but not limited to, motor functions, learning and memory, executive functions, attention, language, spatial skills and general intelligence.
Method: A review of available literature on the topic of the past two decades, available in the Pubmed, EBSCO, SCOPUS databases has been made using the keywords: schizophrenia, cognition, early intervention.
Results: Cognitive dysfunction is an important feature of the prodromal phase and the first episode of schizophrenia. Researchers have thus proposed to initiate early therapeutic interventions for people with so-called risky mental conditions. The article includes the reference to research on neurocognitive disorders essence in schizophrenia, the definition and review of methods used to identify specific cognitive deficits and issues related to risk of developing psychosis and early therapeutic intervention in high-risk states.
Conclusions: Researchers report the importance of detecting cognitive disorders in the early stages of schizophrenia. This broadens the range of therapeutic interventions and enables early intervention in the increased risk of psychosis.
The theory linking the development of mental disorders with the processes of human evolution assumes that these disorders may be the result of a side effect of natural and sexual selection processes. Creativity is one of the adaptive features associated with the increased incidence of psychopathological symptoms (as compared to the general population).
In this review paper, the definition of creativity has been characterized, and contemporary existing theories on its background, have been presented. Also, the paper describes the relationship between creativity and the presence of psychopathological symptoms. Special attention has been paid to the relationship between creativity and bipolar disorder.
The research results prove the existence of a correlation between a high level of creativity and a higher prevalence of psychopathological symptoms, particularly concerning the symptoms of bipolar disorder spectrum.
Despite the increasing offer of antipsychotic drugs, the effectiveness of pharmacotherapy in schizophrenia is still unsatisfactory. Drug resistance, lack of complete remission and the increasing risk of metabolic complications are the reasons why the new forms of therapy in schizophrenia among which unsaturated essential fatty acids omega 3 (EFAs ω-3) affecting the proper functioning of nervous system, are mentioned, are being looked for.
Fatty acids represent 50-60% of the dry weight of the brain and diet is one of the factors that influence the value of each of the fat fractions in the neuron membranes. Patients with schizophrenia tend to have irregular nutritional status concerning essential fatty acids ω-3, which might result from metabolic disorders or irregular consumption of fatty acids.
Apart from being a review of the literature on this subject, this very paper characterizes essential fatty acids ω-3, their metabolism, the most important sources in the diet and the opinions of experts in the field about the recommended intake. It pays attention to the role of essential fatty acids in both the structure and functioning of the central nervous system is, as well as their role in the pathophysiology of schizophrenia, with particular emphasis on the membrane concept by David Horrobin. The assessment of the errors in consumption and metabolism of essential fatty acids are described as well.
The evidence was found both in epidemiological and modeling studies. It supports the participation of EFAs in etiopathogenesis and pathophysiology of schizophrenia. Further research is needed, both observational and interventional, as to the role of essential fatty acids ω-3 in the functioning of the CNS as well as the development and course of schizophrenia.
Gamma-butyrolactone (GBL) is an organic chemical compound of the lactones group, undergoing biotransformation into gamma-hydroxybutyrate after the intake (GHB). Because of the easy access, low price and fast psychotropic effect, GBL is becoming increasingly popular substance having intoxicating effect. Taking of GBL causes dose-dependent euphoric, sedative, hypnotic effects. Its use can quickly lead to physical dependence with severe course of withdrawal syndromes. Withdrawal symptoms resemble those occurring in the course of addiction to alcohol or benzodiazepines. In some patients, delirium develops during substance withdrawal. There are described severe, life-threatening complications in the course of delirium in GBL-dependent patients. The management of withdrawal syndromes and delirium mainly involves administration of benzodiazepines. In this paper, we present a case of delirium in 24-year-old man addicted to GBL hospitalized in a psychiatric ward. Delirium in this patient went without complications and was successfully managed with diazepam and lorazepam.
A defined and formed identity is the foundation of human mental functioning. The sense of one’s own existence as an individual, together with the conscious image of oneself, plays a fundamental role in regulating behaviors. The ability to see the limits of one’s own body is a significant milestone in human development, because it allows the development of a global sense of self, and that is the basis for the process of identifying one’s own identity.
The paper presents the contribution of Polish researchers (psychiatrists and psychologists) to understanding the phenomenon of the sense of self, identity, and their disorders with particular emphasis on schizophrenia.
Method: A review of the available literature by Polish authors on the subject was undertaken by searching the following data-bases: Polish Bibliography of Medicine, CEJS, NUKAT and National Library Database, using the keywords: identity, self, personality, schizophrenia, ego, within time frame: 1970–June 2017. The article includes only those works which made the original contribution of Polish authors to research on the issue of self and the sense of identity, with particular emphasis on their disorders in schizophrenia.
Results: The works of three Polish authors: J. Reykowski, J. Kozielecki and Z. Zaborowski deserve particular attention in the context of the definition of self and the sense of identity.
The works of A. Kępiński, in turn, have contributed to understanding the problem of disorders of self in schizophrenia. Kępiński’s psychopathological concept was based on the analysis and description of the pathology of self, the pathology of the boundary self–the world, disorders of time-space order and the hierarchy of values. In these terms, he considered the structure of the psychotic world, especially in schizophrenia and melancholy. In his opinion, schizophrenic psychosis manifests itself primarily in the form of the blurring of the boundary self–the world and the pathology of self.
The paper also presents the contribution of J. Zadęcki, M. Rzewuska, J. Wciórka, S. Steuden, M. Huflejt-Łukasik to understanding the disorders of the sense of self in schizophrenia.
Conclusions: The views of Polish authors presented in the paper are an interesting contribution to world literature on research into disorders of self in schizophrenia.
Introduction: Schizophrenia is a chronic mental disease which significantly affects functioning and quality of life of patients. Lifestyle, including irregular eating habits, is a factor possibly intensifying symptoms of the disease and unwanted effects of pharmacotherapy. Due to positive effect on metabolic parameters demonstrated in numerous studies and participation in structure and functioning of central nervous system, omega-3 essential unsaturated fatty acids (EFAs) are the suggested form of schizophrenia cotheraphy.
Aim: The purpose of this paper was to evaluate EFAs (especially omega-3 family) consumption by individuals with schizophrenia and comparing contents of these acids in the diets of female and male patients.
Method: A study was conducted with the participation of 32 patients, recruited in the Psychiatric Outpatient Department of the Independent Public Clinical Hospital No. 1 in Lublin, with diagnosed schizophrenia. Data concerning the intake of EFAs was acquired in the course of 24-hour diet recall.
Results: Average intake of omega-3 EFAs in the examined population was 2.40 ± 2.85 g, of which only 201.6 ± 501.5 mg was constituted by EPA and DHA acids. The intake of omega-3 EFAs did not differ between men and women groups (p>0.05). Food rations of the 91% responders were characterised with the intake of EPA and DHA acids below the adequate intake level (AI).
Conclusions: Patients suffering from schizophrenia consume insufficient amounts of EPA and DHA acids. Evidence suggests that optimum intake of omega-3 EFAs could bring significant benefits for this group of patients. People suffering from schizophrenia should be attended with the care of a dietician, who will choose optimum strategy for supplying sufficient amount of nutrients in the diet.
Introduction: Warfarin has been considered as a “gold standard” in the prevention and treatment of thromboembolic events since 1954. Since the introduction of direct oral anticoagulants in the last few years (NOAC-Non-Vitamin K antagonist Oral Anticoagulants) prescriptions volume for apixaban, edoxaban, dabigatran and rivaroxaban have been gradually surpassing warfarin. The benefits include: anticoagulation from day one, fixed daily dosing, elimination for the need of international normalised ratio (INR) monitoring, fewer interactions with food and co-administered medicines with reduced risk of bleeding and better overall life quality.
Objectives: Assessing evidence for the safe use of Non-vitamin K Oral Anticoagulants (NOAC) with Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitors (SNRI).
Method: Review of literature published between 2014 and 2016 was made using the key words: Selective Serotonin Reuptake Inhibitor, Serotonin and Noradrenaline Reuptake Inhibitors, apixaban, dabigatran, edoxaban, rivaroxaban, bleeding, interaction, depression with time description from 2014 to 2018. Evidence within the literature was then compared with guidelines from the National Institute for Health and Care Excellence (UK), British National Formulary (UK), Clinical Excellence Commission (Australia), Thrombophilia and Anticoagulation Clinic (USA) and Summaries of Product Characteristics (SPC).
Results: 1. Serotonin plays a critical role in maintaining homeostasis. Use of SSRI/SNRI compromises its platelet reuptake increasing risk of bleeding. 2. Increased tolerability and safety of NOAC over Warfarin, although caution is advised when NOAC is used with SSRI/SNRI with less evidence suggesting pharmacodynamic interactions. 3. It is not recommended to use NOAC with strong CYP and P-gp inhibitors.
Conclusions: With limited literature evidence, caution is advised when co-prescribed NOACs with SSRI/SNRI, especially with other cofactors and interacting medicines further increasing risk of bleeding.
Aim. The aim of the study was looking for correlations between experiencing of various forms of harming in childhood and severity of personal trait of anxiety in victims of domestic violence.
Material and methods. The number of 112 people (49 women and 63 men) who were attending the mental health clinics in the area of Mazovian district were investigated. The sociodemographic questionnaire and Polish adaptation of the State-Trait Anxiety Inventory (by C.D. Spielberger) were used.
Results. High severity of anxiety as a trait, more often than low severity correlates with experiencing of violence (physical and mental) during childhood. Most often it is mental violence with father as perpetrator (p<0.01). People with the high level of anxiety as a trait have more often still been experiencing violence, living with their perpetrator and using violence towards other people (p<0.05).
Conclusions. Awareness of psychological consequences of using violence towards the youngest permit to hope for optimization of actions preventing spreading of such pathology (for example therapeutic work with learned helplessness and copying of destructive family patterns).
Introduction: Sleep paralysis (SP) is a condition that widely occurs among people all over the world. It has been known for thousands of years and is rooted in the culture of many countries. It arouses strong emotions, though still little is known about it. The clinical picture of the disorder can be very diverse. It is often accompanied by hypnopompic and hypnagogic hallucinations, somatic complaints and the feeling of intense anxiety. A feeling of paralysis in the body with inhibited consciousness is always observed with the experience. SP pathophysiology is not fully understood, however, most theories explaining this phenomenon are based on the assumption that it results from dysfunctional overlap of REM sleep and wakefulness. It is experienced by healthy people, but it is more often associated with somatic and mental disorders, which is why it is becoming an object of interest for researchers.
Aim: The aim of this work is to present the most important information about the disorder known as sleep paralysis - its history, cultural context, pathophysiology, prevalence, symptomatology, coexistence with other somatic and mental disorders as well as diagnostics and available forms of prevention and treatment.
Materials and methodology: The available literature was reviewed using the Google Scholar bibliographic databases searching the following keywords: sleep paralysis, REM sleep parasomnias, sleep disorder, night terrors and time descriptors: 1980-2018.
Results 1. Sleep paralysis has already been described in antiquity, and interpretations related to its occurrence are largely dependent on culture and beliefs.
2. Symptomatology of the disorder is very diverse: both mental and somatic symptoms are present.
3. The pathophysiology of the disorder has not been fully explained. The basis of most theories regarding sleep paralysis is the assumption that it results from the dysfunctional overlap of REM sleep and wakefulness.
4. The prevalence of SP at least once in a lifetime is 7.6% in the general population, although it is estimated that it is much more frequent in people with various mental and somatic disorders.
5. Treatment of SP is associated with a change in lifestyle and the use of pharmacotherapy and psychotherapy.
Introduction: Beta blockers are mainly used in treating cardiovascular diseases. However, it has been observed that these drugs have also an anxiolytic potential. Over the years, a number of clinical trials have been conducted aimed at determining the effectiveness of beta blockers in treating anxiety disorders.
The aim of the article: The main objective of the article is to present the significance and position of adrenolytic drugs in the pharmacotherapy of anxiety disorders on the basis of available literature. Moreover, the authors also decided to take into account the data from current research results, considering the problem of side effects of using adrenolytic drugs - especially the controversial reports on their effect on the development of affective disorders.
Method: An analysis was conducted of articles from Medline/PubMed database, selected on the basis of the following key words: anxiety disorders, beta blockers, adrenolytic drugs, as well as on the basis of their dates of publication: 1960-2017. In order to conduct a reliable and complete review of literature, the authors decided to include works from quite an extended period of time. The articles included in the review were published in Polish and English.
Results: The review of articles concerning the treatment of anxiety disorders clearly suggests that propranolol is effective in reducing the frequency of panic attacks and the tendency for avoidance behavior in patients with agoraphobia. Other studies report on potential benefits in terms of early interventional prevention and treating posttraumatic stress disorder with propranolol. However, there is lack of randomized clinical trials concerning the therapeutic effect of other adrenolytic drugs in treating anxiety disorders. Early research works reported that (mainly lipophilic) beta blockers may have a depressogenic effect; however, the latest studies have not confirmed it.
The contemporary research on the therapeutic potential of beta blockers in treating anxiety disorders is insufficient. What seems to be most promising, however, are reports concerning the desirable effects of using adrenolytic drugs in treating posttraumatic stress disorder, which implicates the necessity of conducting further research verifying the validity of their application.