The aim of the present study was to compare the concentrations of KYNA, 3-OH-KYN and the cytokines TNF-α and IL-6 in patients with depression vs. healthy controls as well as in patients with depression treated pharmacologically vs. those treated using ECT. We also evaluated the relationship between the concentrations of KYNA, 3-OH-KYN and the cytokines TNF-α and IL-6 and clinical improvement measured on the MADRS scale in patients treated pharmacologically and those treated with ECT.
Subjects and methods: The study group comprised 29 patients aged 28 to 60 years with a diagnosis of a major depressive episode. Eleven of the patients received pharmacological treatment and 18 were treated with ECT.
Patients were assayed for serum levels of KYNA and the cytokines IL-6 and TNF-α. Clinical improvement was measured on the MADRS depression rating scale and the clinical global impression (CGI) scale.
Results: Significant differences were found in KYNA levels between depressive patients and healthy controls. Pharmacological treatment significantly contributed to the increase in KYNA levels and ECT – to the increase in TNF-α levels in depressive patients.
Depressive patients have significantly lower concentrations of KYNA than healthy individuals
Depressive patients who have undergone pharmacological treatment have significantly higher KYNA concentrations than before treatment.
Depressive patients who have undergone ECT treatment have significantly lower TNF-α concentrations than before treatment.
High pre-treatment levels of IL-6 are associated with a lower MADRS improvement index in pharmacologically treated patients with depression.
Introduction: Currently, there are no fully reliable biomarkers to identify individuals suffering from depression, and conventional antidepressant treatment has its limitations. The potential influence of acetyl-L-carnitine (LAC) on the treatment of mental disorders, including depressive disorders, was noted already in the 1980s.
Goal and method: The literature on the role of LAC in the treatment of mental disorders, in particular depressive disorders, was reviewed using the Google Scholar and Pub Med databases. Two lines of research were considered:
1the role of LAC in the therapy of various mental disorders and
2the role of LAC in the treatment of depression and dysthymia
Conclusions: Because LAC is safe to use and has a very good tolerance profile, authors have explored its role in the treatment of many neurological and psychiatric diseases. There are studies showing that LAC supplementation has a positive effect on ADHD treatment outcomes in boys diagnosed with fragile X syndrome and plays a role in the treatment of dementia. Research has also been conducted on the impact of LAC on the treatment of depressive and dysthymic disorders. Positive outcomes of such therapy have been reported. An important correlation has been observed between LAC concentrations and the severity and onset of depressive symptoms. For instance, reduced levels of LAC have been found in people with treatment-refractory depression. It has also been proposed that LAC could decrease vulnerability to depression.
Introduction: Smoking is a huge medical and social problem in Poland, with as many as about 24% of Poles being addicted to nicotine. Approximately 6 million people worldwide die every year from conditions that are closely related to tobacco addiction, such as cancer and cardiovascular, metabolic or lung diseases. The difficulty in combatting nicotine dependence is largely due to the complex mechanism of this addiction. The motivation of a patient to quit smoking is of great importance in the difficult withdrawal process. Strengthening this motivation is one of the most important tasks of physicians and addiction therapists.
Overview of literature: Nicotine replacement therapy (NRT) has been the most widely known way to break away from smoking addiction for many years now. It involves delivering nicotine to the body in ways that are less harmful than through tobacco smoke. As a consequence, the cravings for nicotine are reduced, making it easier for the patient to break with the addiction. Clinical trials have shown that the use of NRT is associated with a 50-70% increased chance of maintaining abstinence from smoking compared to placebo. There are many NRT products, including nicotine chewing gum, nicotine patches, lozenges, dissolvable nicotine sticks, or inhalers. Bupropion is a selective dopamine–noradrenaline reuptake inhibitor. This drug is one of the most commonly used in the pharmacotherapy of depression in the United States. At the same time, it has been found to have a positive effect on people trying to break up with the habit of smoking cigarettes. The mechanism of action remains unknown in this case, but studies clearly indicate the efficacy of bupropion, which is comparable to the efficacy of NRT. Varenicline is a partial agonist selective for α4β2 nicotinic acetylcholine receptors. It has a higher affinity for these receptors than nicotine. By stimulating them, it causes an increase in dopamine secretion (but to a lesser extent than cigarette smoking), helping in this way ease withdrawal symptoms.
Conclusions: Varenicline has higher efficacy than bupropion and NRTs. Simultaneous use of two NRT forms increases the effectiveness of this method to a level comparable to varenicline. Contrary to previous reports, it seems that varenicline does not increase self-aggressive behaviour and the risk of suicide. The effectiveness of antinicotinic drugs depends on the sex of the patient. For both sexes, the most effective drug is varenicline. It is slightly more effective in women than in men. By contrast, NRT and bupropion show greater therapeutic potential in men.
This work basing on a study of medical records is a story of a young patient, repeatedly hospitalized with various diagnoses, in whom the psychiatric symptoms significantly decreased after waking from coma, resulting from an unfortunate accident.
There are presented subsequent stages of treatment and hospitalizations and the analysis of the problem if the restart is possible in terms of mental state, in a patient who for years had experienced omental-delusive experiences of high severity and anxiety, leading to several suicidal attempts with serious consequences.
The discussion also describes the issue of double diagnosis and the criteria for amphetamine-induced psychosis.
Can schizophrenia be cured and its symptoms reset ?
On 10-11th March in Warsaw, in the Conference Center Muranow, there was held a scientific conference “Schizophrenia-Forum”, organized for the nineteenth time. In this edition, particular attention was paid to educational aspects, by virtue of the fact that among the participants of the Conference there was a large number of young physicians specializing in psychiatry.
The formula of the two-day Conference based on the experts’ debates in a particular way affected the participants, so the conference was very interesting, it enabled the exchange of experiences and reflections on the problems of schizophrenia. The conference was attended by leading scientists and clinicians, for example: Marek Jarema, Janusz Rybakowski, Andrzej Czernikiewicz, Jerzy Samochowiec, Dominika Dudek and others, which is why it allowed to enrich the knowledge of the diagnosis and treatment of psychotic disorders and good presentation of mature clinical thinking. The organizer of the Conference was the Foundation III Department of Psychiatry, “Syntonia” and the guest of honor was Dr. Peter Falkai - Head of the Department of Psychiatry and Psychotherapy Ludwig Maximilian University in Munich. The lecture by Professor Falkaia entitled Schizophrenia treatment guidelines, at a plenary lecture, was presented in English, translated simultaneously, and was divided into parts: the characteristics of schizophrenia, guidelines for pharmacotherapy of schizophrenia, pharmacotherapy of schizophrenia - states of acute pharmacotherapy of schizophrenia - long-term treatment, side effects of long-term pharmacotherapy and conclusions. After a two-day Conference the hugely popular workshop sessions took place. They were addressed to physicians during specialization. All workshop sessions were very popular, as well as the entire conference, which became a forum for the exchange of information, ideas and experiences, sometimes intriguing, inspiring and innovative but never blank. At the end of the Conference the certificates were distributed and there was the opportunity for guests - visiting the permanent exhibition “1000 years of history of Polish Jews,” Polin, located at the Conference Centre Muranow. XIX Conference on Schizophrenia Forum 2016 was an interesting event cognitively and it maintained a high level of scientific and substantive jurisdiction important events in Polish psychiatry.
New achievements within structural and functional imaging of central nervous system offer a basis for better understanding of the mechanisms underlying many mental disorders. In everyday clinical practice, we encounter many difficulties in the therapy of eating disorders. They are caused by a complex psychopathological picture, varied grounds of the problems experienced by patients, often poor motivation for active participation in the treatment process, difficulties in communication between patients and therapeutic staff, and various biological conditions of eating disorders. In this paper, the latest reports on new concepts and methods of diagnosis and treatment of anorexia nervosa have been analyzed. The selection of the analyzed publications was based on the criteria taking into account the time of publication, the size of research cohorts, as well as the experience of research teams in the field of nutritional disorders, confirmed by the number of works and their citations. The work aims to spread current information on anorexia nervosa neurobiology that would allow for determining the brain regions involved in the regulation of food intake, and consequently that may be a potential place where neurobiochemical processes responsible for eating disorders occur. In addition, using modern methods of structural imaging, the authors want to show some of the morphometric variations, particularly within white matter, occurring in patients suffering from anorexia nervosa, as well as those evaluated with magnetoencephalography of processes associated with the neuronal processing of information related to food intake. For example as regards anorexia nervosa, it was possible to localize the areas associated with eating disorders and broaden our knowledge about the changes in these areas that cause and accompany the illness. The described in this paper research studies using diffusion MRI fiber tractography showed the presence of changes in the white matter pathways of the brain, especially in the corpus callosum, which indicate a reduced content of myelin. These changes probably reflect malnutrition, and directly represent the effect of lipid deficiency. This leads to a weakening of the structure, and even cell death. In addition, there are more and more reports that show the normal volume of brain cells in patients with long-term remission of anorexia. It was also shown that in patients in remission stage there are functional changes within the amygdala in response to a task not related symptomatologically with anorexia nervosa. The appearing in the scientific literature data stating that in patients with anorexia nervosa there is a reduced density of GFAP + cells of the hippocampus and increased expression of vimentin and nestin, is also worth noting.
Schizophrenic psychoses are a heterogeneous group of diseases that affect about 1% of the world’s population. The first symptoms of the disease usually manifest between ages 20 and 30. The diagnostic criteria for schizophrenia and its subtypes are characterized in detail in ICD-10. Diagnosis is based primarily on the presence of productive symptoms such as delusions or hallucinations occurring for at least one month which cannot be explained in another way. Schizophrenia is a disease which largely affects social functioning of patients, such as occupational performance, family life, interpersonal relationships or housing situation. Apart from the sociological aspect, social lives of schizophrenia sufferers are significantly impoverished due to cognitive impairment associated with improper functioning of NMDA receptors. The study describes a case of a patient suffering from paranoid schizophrenia which sheds light on the social functioning of this group of patients.
Introduction: Recently the issue of emotional intelligence has become a widespread theme of discussion. This review paper is made a contribution to this debate. Discovering of effective predictive and protective factors for depression would have far-reaching consequences for society, science and economy.
Material and Methods: To investigate this issue, we searched articles available in the Google Scholar and PudMed databases under the following terms: emotional intelligence, depression, emotional intelligence and depression for the years 1999-2019. Accessible literature allowed to show basic information of emotional intelligence, detect a system of relationships between emotional intelligence level and depression, and present recommendations.
Results and Discussion: The result of this analysis is a statement that all components of emotional intelligence can be a defense against depression. People with high abilities in regulation their own emotions have large social support, what protect them against depression. The capable managing one’s own and others’ emotions create large and deep interpersonal relationships, what provide more emotional support and tangible assistance during everyday challenges. Stressful life events are among the most powerful predictors of depression, and high level of emotional intelligence enable to cope with them more effectively.
Conclusions: The present text will constitute an impulse to explore this theme more. Moreover, there is a recommendation for researchers to create more effective and simplified tests for examining the level of emotional intelligence in case of spreading them much more and use them in a routine psychiatric practice. A confirmation of the title hypothesis can stand a key to struggle with depression.
Introduction: Dissociative identity disorder, also known as multiple personality disorder, involves simultaneous manifestation of multiple alternative personalities in one human body. The disorder is still a puzzle to contemporary researchers. In comparison to the United States, where the detection rate of this disorder is growing, in Poland, it is still a niche issue, unknown to many scientists and clinicians. Rather alarmingly, this situation has remained the same for many years now.
Objective: The aim of the present study is to draw attention to the adaptive character of dissociative identity disorder as a defense mechanism in children who have experienced extremely traumatic events in early childhood. The work also sets itself the task of disseminating knowledge about multiple personality disorder in the Polish scientific community, with the hope of encouraging wider research in this area in Poland.
Material and Methods: To investigate this issue, we searched articles available in the PubMed, Google Scholar, and Polish Medical Bibliography (Polska Bibliografia Lekarska) databases for the years 1960–2018. The following search terms were used: multiple personality, dissociative identity disorder, dissociative identity disorder and children. On the basis of a meta-analysis of the available literature, we offer a general characterization of the disorder, describe its symptomatology, present several theories of its etiology and conclude it through the prism of its adaptive function.
Results and Discussion: From the analysis of the gather data, we can conclude that multiple personality disorder can be a broad variant of the child's defense mechanisms against extreme, traumatic events from childhood, which they try to cope with by creating alter personalities. Abused children create other representations of the Self to be able to rid themselves of suffering, a process that is necessary for them to survive and further develop mentally and physically.
Conclusions: There is no doubt that Polish research on this disorder is much needed. It could provide more information on the epidemiology, diagnosis, and treatment of multiple personality. In addition, a better understanding of the issue might bring us closer to the understanding of how the human mind works.
Objective: The objective of the study was to determine the differences in selected clinical variables and self-image in people with alcohol dependence differing in severity of physical, emotional and sexual abuse experienced before age 18.
Method: The study included 90 people with alcohol dependence. The following research tools were used: Early Trauma Inventory (ETI), Adjective Check List (ACL), MAST, SAAD, and a questionnaire designed by the authors. In order to identify groups with varying indices of physical, emotional and sexual childhood abuse, a cluster analysis method was used.
Results: Two groups of subjects with alcohol dependence were identified: Group 1 with high indices of physical, emotional and sexual childhood abuse and Group 2 with low indices. In terms of self-image the subjects in Group 1 compared to subjects in Group 2 were characterized by a lower self-esteem, self-acceptance, resistance to stress, less intense needs for achievement, endurance, order, nurturing others, interaction with opposite-sex partners, subordinations but more intense need for change. The age of alcohol use initiation and the onset of regular alcohol drinking was statistically significantly lower in Group 1. The severity of alcohol dependence was significantly lower in Group 2. The subjects in Group 1 significantly more frequently confirmed the history of a hereditary predisposition to alcohol dependence, suicidal ideation, suicide attempts and self-harm.
Discussion: The obtained results closely correspond to the data available in the literature.
Conclusions: An assessment of exposure to various forms of childhood abuse appears to be an indispensable element of collecting medical history of people with alcohol dependence.