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Marcin Olajossy, Emilia Potembska, Nikodem Skoczeń, Bartosz Olajossy and Ewa Urbańska

Abstract

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.

Conclusions:

  1. Depressive patients have significantly lower concentrations of KYNA than healthy individuals

  2. Depressive patients who have undergone pharmacological treatment have significantly higher KYNA concentrations than before treatment.

  3. Depressive patients who have undergone ECT treatment have significantly lower TNF-α concentrations than before treatment.

  4. High pre-treatment levels of IL-6 are associated with a lower MADRS improvement index in pharmacologically treated patients with depression.

Open access

Ewelina Dziwota, Kamila Dziwota and Marcin Olajossy

Abstract

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.

Open access

Marcin Olajossy and Ewelina Soroka

Abstract

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 ?

Open access

Michał Hys, Nikodem Skoczeń, Ewelina Soroka and Marcin Olajossy

Abstract

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.

Open access

Nikodem Skoczeń, Sebastian Masternak and Marcin Olajossy

Abstract

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.

Open access

Alena Stefańska, Ewelina Dziwota, Marcin Stefański, Alicja Nasiłowska-Barud and Marcin Olajossy

Abstract

The concept of “hysteria” comes from the Greek word “hystera” (uterus) and dates back to the time of Hippocrates, at least. Modern classifications differ regarding the area encompassed by the concepts of dissociation and conversion differ. Mental health professionals in the United States (DSM-5) use a standard classification of mental disorders codifying dissociative disorders as a distinct class of disorders, but subsumes conversion disorders under “somatoform disorders”. The history of hysteria is as long as the history of mankind. Apparently, both the essence and mechanisms of dissociative disorders remain unchanged despite the fact that many years have passed. According to Owczarek et al., dissociative symptoms are caused by the malfunctioning of defence mechanisms and anxiety. This article provides an overview of the available literature on the etiology and pathogenesis of dissociative disorders as well as disorders such as amnesia, dissociative fugue, trance and possession.

Open access

Aneta Gerhant, Ewa Krzewicka-Romaniuk, Dagna Siedlecka, Magdalena Derewianka-Polak and Marcin Olajossy

Abstract

Objective: The aim of the study was to determine differences in the range of socio-demographic variables, selected clinical variables, temperament and character traits, coping with stress strategies and the level of aggression in alcohol addicts with or without a history of suicide attempt(s). Methods: The study involved 90 people addicted to alcohol, treated in inpatient alcohol dependence treatment program. In order to collect data on socio - demographic variables and selected clinical variables, a self-made questionnaire was used. The severity of alcohol dependence was verified using the MAST and SADD scales. Characteristics of temperament and character were examined with the TCI questionnaire. The BPAQ and COPE questionnaires were used to examine the level of aggression and styles of coping with stress. Results: Out of 90 subjects with alcohol dependence syndrom, 20% had attempted suicide in the past. The respondents with a history of suicide attempts were statistically significantly younger, were characterized by a younger age of alcohol drinking initiation and the initiation of regular alcohol drinking, and a greater severity of alcohol dependence in the MAST and SADD scales. A significantly larger percentage of respondents who had attempted suicide inflicted self-injury in the past, used other psychoactive substances as well as hypnotics and sedatives. The subjects with a suicide attempt in the interview obtained statistically significantly higher scores in terms of the level of aggression, harm avoidance and self-directedness, and more often used the style of coping with stress based on avoidance and accepting the situation. Conclusions: The obtained results correspond with data available in the literature and may provide a foundation for theoretical models explaining the phenomenon of suicidal behavior in alcohol addicts as well as for suicide prevention programs in this group of patients.

Open access

Ewa Stelmach, Olga Hołownia, Maciej Słotwiński, Aneta Gerhant and Marcin Olajossy

Abstract

Introduction. Hyponatremia is an important part of psychiatric practice. In order to analyze its causes and symptoms, the literature on hyponatremia in psychiatric patients has been reviewed. The work has been divided into two separate manuscripts. In the first one the authors discuss the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia occurring with the use of psychotropic drugs (antidepressants, antipsychotics, normotimics), while the second paper discusses research on psychogenic polydipsia. The causes of hyponatremia in patients treated in psychiatric wards include: water intoxication associated with polydipsia, somatic comorbidities, side effect of internal medicine and psychiatric drugs. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin (SIADH). The SIADH syndrome is a group of symptoms, first described in 1967 by Schwartz and Bartter in The American Journal of Medicine, which results from the hypersecretion of antidiuretic hormone, also called vasopressin, which causes patients to develop normovolemic hyponatremia. The phenomenon of drug-induced hyponatremia in psychiatric practice is generally observed with the use of antidepressants, antipsychotics and anti-epileptic drugs (used in psychiatry as normotimic drugs).

Aim and method. The first manuscript includes a review of literature on the syndrome of inappropriate secretion of vasopressin (SIADH) and hyponatremia occurring after the use of psychotropic drugs, and is divided into two subsections: 1. The syndrome of inappropriate secretion of vasopressin (SIADH), 2. Hyponatremia and psychotropic drugs (antidepressants, antipsychotics, normotimics).

Conclusion. In the view of the reviewed literature it is extremely important to control the natremia level during pharmacotherapy using the above mentioned drugs, especially in the initial period of therapy.

Open access

Ewelina Dziwota, Barbara Drapala, Magdalena Gaj, Nikodem Skoczen and Marcin Olajossy

Abstract

Normothymic, antidepressant and antipsychotic pharmaceutics are, in accordance with international guidelines, employed both in the therapy and the prevention of bipolar disorder (BD). Long-term studies on the mechanisms of action of such medications, as well as on the pathogenetic background of BD, have led to the discovery of effective, albeit unconventional pharmacotherapeutic approaches. These methods have the potential to successfully treat mania and depression, as well as to counter affective episode relapse. Allopurinol - commonly used to treat gout, secondary hyperuricemia and Lesch-Nyhan syndrome, acts by inhibiting the synthesis of uric acid, levels of which are often increased in manic patients. Due to this, an evaluation of the potential effect of allopurinol on the reduction of mania symptoms seems to be reasonable. Additionally, the numerable research papers coming out of research regarding the role of purine neurotransmitters in mood alterations, indicate that adenosine agonists act analogously to dopamine antagonists.

N-acetylcysteine (NAC), a supporting agent in the pharmacotherapy of depressive episodes in bipolar disorder, substantially accelerates mood stabilization in patients. In turn, memantine, known for its procognitive effect, not only has antimanic and normothymic properties, but also boosts the neuroprotective action of traditional lithium therapy.

In view of the latest opinions, the subtle pro-inflammatory process is typical for the pathophysiology of bipolar disease. Acetylsalicylic acid (ASA) (a popular analgesic, antipyretic and antiphlogistic agent) may be useful in BD therapy. This is because that, via its effect upon cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ASA modulates leukocyte recruitment in neuro-inflammation.

Apart from the above-mentioned medications, this article introduces the results of recent investigations of ketamine, modafinil and tamoxifen, including their receptor mechanisms, as well as certain genetic aspects or elements of their pharmacodynamics, for use in BD therapy. We put forward that, possibly, more insightful cognition of these drugs will allow significant enrichment in the range of pharmacotherapy for BD in the near future.

Open access

Ewelina Soroka, Inga-Ujma Lesiczka, Magdalena Tracz, Bernarda Bereza and Marcin Olajossy

Abstract

Refractoriness affects about 25% of patients treated with antipsychotics, and it is a very big challenge for clinicians. The most commonly accepted definition of refractoriness is: lack of satisfactory clinical response to treatment with at least two antipsychotic drugs, from different groups, carried out at therapeutic doses and for a sufficiently long period.

Aim : The aim of the study is to analyze the case of a patient diagnosed with schizophrenia.

Methods: Analysis of medical records, available literature from recent years on treatment-refractory and super-refractory schizophrenia.

Results: A 53-year-old patient, a bachelor, suffering from paranoid schizophrenia with an extremely severe, non-remission course with drug resistance features. The patient's father and sister also suffer from severe paranoid schizophrenia. The patient became ill at the age of 22. Despite the high doses of clozapine, in a sufficiently long period of time, the patient maintained positive and negative symptoms, cognitive deficits and behavioral disorders. The patient was 14 times psychiatrically hospitalized, twice treated with electro-convulsive therapy, which did not bring results despite the combination of electroconvulsive therapywith psycho pharmacotherapy. In addition, the patient was addicted to benzodiazepines, administered during anxiety and anxiety attacks by the mother, during the described hospitalization, gradually discontinued. Patient after several attempts of committing suicide, with a tendency to self-destructive behavior. The illustrated case meets the criteria of super-refractory schizophrenia (SRS).

Conclusions: 1. The category of refractory schizophrenia encountered in the literature is not a separate diagnostic category - it does not exist in classification systems, therefore we consider the phenomenon / symptom of drug resistance - variously defined. 2. Social relations have a big impact on the functioning of the patient as well as the course of the disease and prognosis (the role of the family). 3. There are numerous methods for the potentiating of clozapine treatment, of which combining clozapine with EC therapy is effective and safe. The strategy for combining clozapine with EC is effective, but not in all patients.