Multiple Comorbidity Profile of Psychiatric Disorders in Epilepsy

The co-occurrence of psychiatric disorders in people with epilepsy (PWE) is not well documented or studied. Anxiety and depressive disorders are the most frequent comorbid disorders in PWE. In this paper, we characterized the rates of multiple psychiatric disorder comorbidity by reanalyzing data from a study sample of PWE. A total of 96 outpatient PWE completed the self-report symptom scale, and were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Axis I disorders (SCID-I). For analyses, patients were assigned to a comprehensive diagnostic group of anxiety and depressive disorders. In order to determine comorbidity across psychiatric diagnoses for the DSM-IV categories, Pearson's chi-squared test (χ²) was used. In the study sample, eight patients (8.3% of the study sample, n = 96) had comorbid major depressive disorder and anxiety disorder. When looking at comorbidity of each diagnosis separately, it was determined that 50% of individuals with an anxiety disorder had comorbid Major Depressive Disorder (MDD) and 38% patients with MDD had comorbid anxiety disorder. This finding encourages a more systematic reporting of psychiatric prevalence data in epilepsy, especially taking into account the high ratio of multiple comorbid anxiety and depressive disorders in PWE.

Psychometric properties of the Polish version of the Hamilton Anxiety Rating Scale in patients with epilepsy with and without comorbid anxiety disorder

OBJECTIVE

Anxiety disorders (ADs) are frequent comorbid disorder in patients with epilepsy (PWE). The availability of validated screening instruments to detect AD in PWE is limited. The aim of the present study was to validate the Polish version of the Hamilton Anxiety Rating Scale (HARS) in adult PWE for the detection of AD.

METHODS

A total of 96 outpatient PWE completed the self-report symptom scale, the HARS, and were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HARS.

RESULTS

Receiver operating characteristic analyses showed areas under the curve at 81.2%. For diagnoses of AD, the HARS demonstrated the best psychometric properties for a cutoff score ≥17 with sensitivity of 68.8%, specificity of 87.5%, positive predictive value of 52.4%, and negative predictive value of 93.3%.

CONCLUSIONS

The Polish version of the HARS performed moderately well as a screening instrument for ADs in PWE. In the epilepsy setting, the HARS maintains moderate sensitivity, high specificity, and excellent Negative perdictive value (NPV) but low Positive perdictive value (PPV) for diagnosing ADs with an optimum cutoff score ≥17. These results suggest that the HARS performed better to rule out anxiety, however, because of moderate sensitivity, some cases of anxiety might be missed.

Psychometric properties and diagnostic utility of the State-Trait Anxiety Inventory in epilepsy with and without comorbid anxiety disorder

OBJECTIVE

Anxiety disorders are frequent comorbid disorder in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate State-Trait Anxiety Inventory (STAI) in adult PWEs for the detection of anxiety disorders.

METHODS

A total of 96 outpatients with epilepsy completed the self-report symptom scale and were diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the State-Trait Anxiety Inventory State (STAI-S) and State-Trait Anxiety Inventory Trait (STAI-T) anxiety subscales.

RESULTS

Receiver operating characteristic analyses for STAI-T showed area under the curve at 84.7%. For diagnoses of anxiety disorders, the STAI-T demonstrated the best psychometric properties for a cutoff score ≥ 52 with sensitivity of 81.3%, specificity of 77.5%, positive predictive value (PPV) of 41.9%, and negative predictive value (NPV) of 95.4%.

CONCLUSIONS

The STAI-T proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in PWEs. In the epilepsy setting, STAI-T maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥ 52.

Heart rate variability and incidence of depression during the first six months following first myocardial infarction

BACKGROUND

Post-myocardial depression is a highly prevalent condition worsening the course and prognosis of coronary artery disease. One of the possible pathogenetic factors is dysregulation of the autonomous nervous system, resulting in heart rate variability reduction.

METHODS

Twenty two patients hospitalised due to a first myocardial infarction were included. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms.

RESULTS

Depressive symptomatology, defined as BDI ≥10, was present in 36.3% of the patients. Increase in heart rate variability (HRV) was observed in both groups during the first 6 months after the myocardial infarction. The HRV was significantly lower in the depressed group compared to patients without depression.

CONCLUSION

Presence of depression after the myocardial infarction (MI) is associated with a significant decrease of the time domain HRV measure SDNN (standard deviation of all normal RR intervals) and with its slower increase during at least a three months period.

Validation of the Polish version of the Hospital Anxiety and Depression Scale for anxiety disorders in patients with epilepsy

OBJECTIVE

Anxiety disorders are frequent comorbid disorders in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate the Polish version of the Hospital Anxiety and Depression Scale (HADS) in adult PWEs for the detection of anxiety disorders.

METHODS

A total of 96 outpatients with epilepsy completed the self-reported symptom scale, the HADS, and were diagnosed using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HADS anxiety subscale (HADS-A).

RESULTS

Receiver operating characteristic analyses showed areas under the curve at 80.8%. For diagnoses of anxiety disorder, the HADS-A demonstrated the best psychometric properties for a cutoff score ≥10 with sensitivity of 81.3%, specificity of 70.0%, PPV of 31.5%, and NPV of 94.9%.

CONCLUSIONS

The HADS-A proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in our sample of PWEs. In the epilepsy setting, the HADS-A maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥10.

Prevalence of anxiety disorders in epilepsy

OBJECTIVE

Anxiety disorders (ADs) are common in patients with epilepsy (PWE). The aim of this study was to estimate the prevalence of specific ADs in outpatients with epilepsy.

METHODS

A group of 118 consecutive outpatients with epilepsy were screened, and 96 patients meeting inclusion criteria were examined by a trained psychiatrist using Structured Clinical Interview (SICD-I) for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision) (DSM-IV-TR).

RESULTS

A diagnosis of any current AD was established in 16 (16.7%) out of 96 participants. Furthermore, panic disorder (PD) was the most frequent AD; it was observed in 13.5% of PWE and constituted 81.2% of the identified ADs in the study group. Older age and later age of seizure onset were associated with increased odds of AD diagnosis.

STUDY LIMITATIONS

The cross-sectional study design, a consecutive sample of patients presenting to a tertiary referral center, and small sample size of the population could have affected the results.

CONCLUSIONS

Panic disorder and other forms of AD are common among PWE. Age and age of seizure onset are important factors associated with AD among PWE.

Validation of the Polish version of the Beck Depression Inventory in patients with epilepsy

BACKGROUND

Despite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWE), such disorders often go unrecognized and untreated. In addition, the availability of validated screening instruments to detect depression in PWE is limited. The aim of the present study was thus to validate the Polish version of the Beck Depression Inventory (BDI) in adult PWE.

METHODS

A group of 118 outpatient PWE were invited to participate in the study. Ninety-six patients meeting the inclusion criteria completed the Polish Version of Beck Depression Inventory-I (BDI-I) and were examined by a trained psychiatrist using the Structured Clinical Interview (SICD-I) for Diagnostic and statistical manual of mental disorders - fourth edition (Text revision) (DSM-IV-TR). Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for BDI.

RESULTS

Receiver operating characteristic analysis showed the area under the curve to be approximately 84%. For major depressive disorder (MDD) diagnosis, the BDI demonstrated the best psychometric properties for a cut-off score to be 18, with a sensitivity of 90.5%, specificity of 70.7%, positive predictive value (PPV) of 46.3%, and negative predictive value (NPV) of 96.4%. For the 'any depressive disorder' group, the BDI optimum cut-off score was 11, with a sensitivity of 82.5%, specificity of 73.2%, PPV of 68.8%, and NPV of 85.4%.

CONCLUSIONS

The BDI score is a valid psychometric indicator for depressive disorders in PWE maintaining adequate sensitivity and specificity, high NPV, and acceptable PPV with an optimum cut-off score of 18 for MDD diagnosis.

Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression

BACKGROUND

Post-myocardial depression is a highly prevalent condition which worsens the course and prognosis of coronary artery disease. One possible pathogenetic factor is dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in cortisol profile disturbances.

METHODS

Thirty seven patients hospitalized due to a first myocardial infarction (MI) were enrolled in this study. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Morning and afternoon serum cortisol samples were taken on the fifth day of the MI.

RESULTS

Depression, defined as BDI ≥ 10, was present in 34.4% of the patients. A statistically significant difference was observed between the mean morning and the evening plasma concentrations in patients with depression compared to the no-depression group: F (1.29) = 5.0405, p = 0.0328.

CONCLUSIONS

Patients with depressive symptoms directly after MI have a flattened diurnal serum cortisol profile. This is particularly expressed in patients with longer lasting symptoms.

Decision-making in panic disorder. Preliminary report

BACKGROUND

The impaired decision-making with high risk-aversive behavior and elevated impulsivity are reported as a trait feature in anxiety disorders including panic disorder (PD). It is hypothesised that PD patients exhibit difficulties in executive functions which can influence patients behavioural strategies e.g. problem solving, decision making, planning, impulse control. The aim of this study was to asses decision making process, risk-taking and impulsivity in PD patients as compared to healthy controls.

MATERIAL AND METHODS

Twenty-one psychotropic drug-naive PD outpatients and 20 healthy subjects matched by age and sex were examined. Cognitive decision-making and risk-taking behaviour was measured with CGT (Cambridge Gambling Task) from CANTAB battery. The PD severity was assessed with Panic and Agoraphobia Scale (PAS). The level of anxiety and depression was assessed with HADS (Hospital Anxiety and Depression Scale). Impulsivity was evaluated with the Barratt Impulsiveness Scale, 11^th version (BIS-11).

RESULTS

There were no statistically significant differences on CGT in PD patients as compared to healthy control. However, having observed more closely, there are some differences between patients and healthy control. PD patients with higher anxiety level in HADS exhibited lower percentages of risky decisions comparing to PD with lower anxiety in HADS. PD patients with higher depression level in HADS demonstrated slowed decision-making when compared to PD patients with low level of depression in HADS. Total impulsivity and its attentional and motor dimensions were significantly higher in panic disorder patients versus healthy controls.

CONCLUSION

There were no statistically significant differences with regard to CGT assessed decision-making between drug-naive PD patients and healthy controls. The PD patients with higher HADS-D depression level demonstrated slowed decision-making as compared to PD patients with low level of depression.

Letter to Editor. Depression and cytokines - a different perspective. Author's response

no summary.

Clinical utility of chosen factors in predicting post-stroke depression: a one year follow-up

OBJECTIVES

The aim of the study was to identify possible interrelation between the presence of post-stroke depression (PSD) and chosen clinical and demographic parameters.

METHODS

Initially 116 patients (61.4 ± 12.6 years, women N = 42) hospitalized in Neurology Department, Medical University of Gdańsk (April 2003 - December 2005) due to first ischemic stroke, were included in the study. We analysed demographic data, the lesion's side and location according to neuroimaging and global neurological deficit estimated on the first day after the stroke and at discharge using NIHSS (National Institutes of Health Stroke Scale) and Barthel Index of Activity of Daily Living. Psychiatric evaluation was done:6 (42 ± 3 days) and 12 weeks (84 ± 7 days), as well as 6 (±14 days) and 12 months (±14 days) after stroke based on ICD-10 and functional assessment scale (Rankin Scale).

RESULTS

Depression was diagnosed in 29 patients (27.6%). No correlation was found between PSD and sex or age. On the first day and at discharge patients without PSD were functioning slightly better but the difference was not statistically significant. We found association between the presence of PSD and the results of Rankin scale with the exception of degree of improvement during whole observation. In the group of patients with PSD left hemisphere strokes were slightly more common, but the difference did not reach statistical significance. The location of lesions in frontal lobes and basal ganglia was associated with presence of depression.

CONCLUSIONS

We found the association between the presence of PSD and location of lesions (frontal lobes or basal ganglia), as well as with the degree of functional improvement during 12 months after stroke.

No relationship between baseline salivary alpha-amylase and State-Trait Anxiety Inventory Score in drug-naive patients with short-illness-duration first episode major depressive disorder: An exploratory study

Background

Salivary α-amylase (sAA) activity alternations are observed in major depressive disorder (MDD) being associated with depression severity and its specific psychopathological dimensions with anxiety being attributed to distress. No data is available on sAA in MDD according to Hamilton Rating Scale for Depression (HAMD-17) and State-Trait Anxiety Inventory (STAI). The exploratory study examines whether and to what extent baseline sAA level is interrelated to the psychopathological features including severity of symptoms and specific psychopathological dimensions.

Material and Methods

The basal, non-stimulated sAA activity was studied in 20 non-late-life adult, treatment-naïve MDD patients with short-illness-duration and in 20 age- and sex-matched healthy controls along with psychometric assessments with Hamilton Rating Scale for Depression (HAMD-17) and Spielberger State-Trait Anxiety Inventory (STAI).

Results

Significantly lower (p=0.011) sAA activity was observed in MDD as compared to controls. No significant correlations were observed between sAA activity and the total HAMD-17 score as well as with regard to the specific core depression, insomnia, anxiety and somatic HAM-D psychopathological dimensions. No significant correlations were also found between sAA and STAIX-1 and STAIX-2 scores.

Conclusions

Low baseline sAA levels in MDD with no correlations between sAA and psychopathological features including severity of symptoms and specific psychopathological dimensions was found.

Key words:Salivary alpha-amylase, major depressive disorder, Spielberger State-Trait Anxiety Inventory, Hamilton Rating Scale for Depression.

Validation of the Polish Version of the Hamilton Rating Scale for Depression in patients with epilepsy

OBJECTIVE

Depressive disorders are the most common comorbidities among patients with epilepsy (PWE). The availability of standardized clinical instruments for PWE is limited with scarce validation studies available so far. The aim of the study was to validate the Polish Version of the Hamilton Rating Scale for Depression (HRSD) in adult PWE.

METHODS

A group of 96 outpatient PWE were examined by a trained psychiatrist using the Structured Clinical Interview (SCID-I) for DSM-IV-TR and the 17-item Polish Version of HRSD (HRSD-17). Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores.

RESULTS

The ROC analyses showed areas under the curve approximately 0.9. For diagnoses of MDD, HRSD-17 demonstrated the best psychometric properties for a cutoff score of 11 with sensitivity of 100%, specificity of 89.3%, positive predictive value of 72.4%, and negative predictive value of 100%.

CONCLUSIONS

The 17-item Polish Version of HRSD proved to be reliable and valid in the epilepsy setting with a cutoff score of 11 points.

Cortisol awakening response in drug-naïve panic disorder

BACKGROUND

It is unclear whether hypothalamic-pituitary-adrenal axis is involved in the pathophysiology of panic disorder (PD). The findings remain inconsistent. Cortisol awakening response (CAR) is a noninvasive biomarker of stress system activity. We designed the study to assess CAR in drug-naïve PD patients.

MATERIALS AND METHODS

We assessed CAR in 14 psychotropic drug-naïve outpatients with PD and 14 healthy controls. The severity of PD was assessed with Panic and Agoraphobia Scale. The severity of anxiety and depression was screened with Hospital Anxiety and Depression Scale.

RESULTS

No significant difference in CAR between PD patients and control group was found. No correlations were observed between CAR and anxiety severity measures in PD patients and controls.

LIMITATIONS

The number of participating subjects was relatively small, and the study results apply to nonsuicidal drug-naïve PD patients without agoraphobia and with short-illness duration. There was a lack of control on subjects' compliance with the sampling instructions.

CONCLUSION

The study provides no support for elevated CAR levels in drug-naïve PD patients without agoraphobia.

Reevaluating the prevalence and diagnostic subtypes of depressive disorders in epilepsy

OBJECTIVE

Depressive disorders are common among patients with epilepsy (PWE). The aim of this study was to estimate the prevalence of different forms of depressive disorders among PWE treated in the outpatient setting.

METHODS

A group of consecutive PWE that visited the epilepsy outpatient clinic was invited to participate in the study. Ninety-six patients met inclusion criteria and were examined by a trained psychiatrist using standardized measures.

RESULTS

A diagnosis of a current major depression was established in 21 (22.3%) out of 96 participants. Furthermore, almost 20% of the study group fulfilled criteria for mood disorder categories other than MDD, adding up to over 40% of PWE suffering from any mood disorder category. Older age and later age at seizure onset, as well as unemployment, were associated with an increase in the odds of MDD diagnosis.

STUDY LIMITATIONS

A number of limitations are to be considered: the sample size is relatively small, and the findings may not be representative of PWE in general because our population represents a sample coming from a single outpatient clinic with a higher ratio of drug-resistant epilepsy.

CONCLUSIONS

Major depression as well as other forms of depressive disorders are common among PWE. Unemployment, age, and age at seizure onset are important factors associated with major depression among PWE.

Increased plasma pro-inflammatory cytokine concentrations after myocardial infarction and the presence of depression during next 6-months

OBJECTIVES

The aim of this study was to investigate plasma concentrations of four pro-inflammatory cytokines (IL17a, IL6, TNFα and IL12p70) in patients with myocardial infarction and to analyse them according to presence of depression observed during first 6 months after myocardial infarction.

METHODS

In 44 patients with the first acute STEMI (ST segment elevation myocardial infarction) plasma levels of IL17a, IL6, TNFα and IL12p70 were measured on the 3rd and 5th day after the MI. Cytokine concentrations were analyzed according to the presence of depression during 6 months of observation.

RESULTS

Two groups of patients distinguished according to presence of depression during 6 months of observation differed in their inflammatory reaction to MI. In the depression group all four cytokines on the 3rd day after the MI were elevated compared to control and on the 5th day two of them: IL17a and IL6 were still elevated. In the group without depression on the 3rd day only two of four investigated cytokines were elevated and on the 5th day only IL6 concentration remained higher.

CONCLUSIONS

It can be assumed that more pronounced inflammatory response as an element of stress reaction after MI can predispose to depression. IL17a increase can play particularly important role in this process.

Diffusion-weighted imaging of the brain in bipolar disorder: a case report

BACKGROUND

Some investigations strongly support a role of glial abnormalities in the pathophysiology of bipolar disorder. The degree of white matter axonal and myelination disruption is measured through the rate of water molecule diffusion. High ADC measures correspond to relatively unimpeded water diffusion, while low ADC measures reflect preserved myelinated axons.

CASE REPORT

Parietal and occipital areas may be involved in the pathophysiology of bipolar disorder, particularly in cognition and perception, along with the prefrontal and temporal cortices for the disruption of emotional processing. In the literature the widespread alterations of the cortical white matter microstructure is documented.

CONCLUSIONS

This case reports demonstrates the features of the increased mean ADC values in the left occipital lobe. Future DWI studies are expected to investigate the correlation of white matter changes with the functional impairment, which often persists during euthymia in bipolar disorder.

Rapid-onset agranulocytosis in a patient treated with clozapine and lamotrigine

BACKGROUND

Clozapine is the treatment of choice in drug-resistant schizophrenia. Lamotrigine is a mood stabiliser recommended as combined treatment strategy in clozapine-resistant patients. There are cases of late-onset agranulocytosis reported in literature. Some are associated with clozapine or lamotrigine, others with the combination of both.

CASE REPORT

The article presents a case of rapid-onset agranulocytosis in a 60-year old clozapine-resistant patient, in whom lamotrigine was introduced as potentiation strategy. Discontinuation of both substances and GCSF treatment resulted in normalization of the absolute neutrophil count.

CONCLUSIONS

The case suggests a possibility of developing rapid-onset agranulocytosis in clozapine-resistant patients who require lamotrigine as augmentation strategy. This emphasises the significance of monitoring a patient's blood count and early management of any dyscrasias noticed.

Symptom Frequency Characteristics of the Hamilton Depression Rating Scale of Major Depressive Disorder in Epilepsy

BACKGROUND

Depressive disorders are common among patients with epilepsy (PWE). The aim of this study was to explore symptom frequencies of 17-item Hamilton Depression Rating Scale (HDRS-17) and recognize the clinical characteristics of Major Depressive Disorder in PWE.

SUBJECTS AND METHODS

A sample of 40 adults outpatients with epilepsy and depression was diagnosed using SCID-I for DSM-IV-TR and HDRS-17. The total HDRS-17 score was analysed followed by the exploratory analysis based on the hierarchical model.

RESULTS

The frequencies of HDRS-17 items varied widely in this study. Insomnia related items and general somatic symptoms items as well as insomnia and somatic factors exhibited constant and higher frequency. Feeling guilty, suicide, psychomotor retardation and depressed mood showed relatively lower frequencies. Other symptoms had variable frequencies across the study population.

CONCLUSIONS

Depressive disorders are common among PWE. In the study group insomnia and somatic symptoms displayed highest values which could represent atypical clinical features of mood disorders in PWE. There is a need for more studies with a use of standardized approach to the problem.

Impulsivity in anxiety disorders. A critical review

BACKGROUND

Anxiety symptoms and disorders are common. High comorbidity between anxiety and other psychiatric disorders has been observed in community. Still, the relationship between impulsivity and anxiety disorders is controversial and not well explored.

MATERIAL AND METHODS

The aim of this paper is to review measures of trait impulsivity in anxiety disorders. A literature review of the theoretical bases of the relationship between anxiety disorders and impulsivity is presented.

RESULTS

Impulsivity is a key feature of numerous psychiatric disorders. Traditional conceptualizations suggest that impulsivity might display a negative relationship with anxiety. However, an association of impulsivity in patients with anxiety disorders is present. Some studies support proposition that anxiety may influence impulsivity in individuals with predisposition toward behavioural disinhibition.

CONCLUSION

There is a link between anxiety and impulsivity in psychiatric patients characterized by problems with impulse control (e.g. pathological gambling, self-harming behaviour, eating disorders), mood disorders and anxiety disorders. Behavioural and pharmacological interventions for decreasing impulsivity may effectively be used in the treatment.

Overlapping phenomena of bipolar disorder and epilepsy--a common pharmacological pathway

BACKGROUND

Studies and data on prevalence, recognition and clinical features of bipolar disorder (BD) in epilepsy remain limited. Still, there is a growing evidence of BD and epilepsy being frequent co-morbid conditions with some features suggesting shared pathophysiological mechanisms that include the episodic course of both conditions, the possible kindling mechanism and the efficacy of some antiepileptic drugs (AEDs) in BD.

SUBJECTS AND METHODS

The aim of this paper is to review concepts of overlapping phenomena of bipolar disorder and epilepsy. A literature review of the theoretical bases of the relationship between BD and epilepsy is presented.

CONCLUSIONS

The comorbidity of epilepsy and mood disorders was a subject of interest of many studies for decades. Bipolar disorder and epilepsy have a number of clinical, biochemical and pathophysiological features in common. Bipolar disorder in epilepsy, excluding the ictal or periictal symptoms, can be categorized using standardized measures. Standardized psychiatric interview procedures based on DSM criteria like SCID-I or MINI provide comprehensive way to diagnose mood disorders in patients with epilepsy.

Impulsivity and Panic Disorder: an exploratory study of psychometric correlates

BACKGROUND

Impulsivity is associated with a wide variety of psychiatric disorders. However, the relationship between anxiety and impulsivity is not well explored. The objective of this study was to examine whether anxiety symptoms correlate with impulsivity in patients with panic disorder.

SUBJECTS AND METHODS

We examined 21 psychotropic drug-naove patients with panic disorder recruited from the outpatient setting. The severity of Panic Disorder was assessed with Panic and Agoraphobia Scale (PAS)-clinical rating version. Impulsivity was evaluated with Barratt Impulsiveness Scale, 11th version (BIS-11).

RESULTS

Our findings indicate the correlation between specific dimensions of impulsivity and selected subscales of Panic and Agoraphobia Scale. The positive correlation between attentional and non-planning dimensions of impulsivity, 'disability' and 'worries about health' in drug-naove patients with PD was observed.

CONCLUSIONS

The findings corroborate with the prior reports of higher impulsivity trait among patients with anxiety disorders.

Cortisol as an indicator of hypothalmic-pitituary-adrenal axis dysregulation in patients with panic disorder: a literature review

Dysregulation of hypothalamic-pituitary-adrenal axis (HPA) is seen in numerous mental disorders. Data of HPA axis disturbance in panic disorder are inconsistent. In panic disorder HPA axis hyperactivity has been observed with elevated cortisol levels. However, hypocortisolism has also been noted. Salivary cortisol as a biomarker of HPA-axis activity has received special attention. The aim of this paper is to review the findings on cortisol levels in panic disorder.

Low baseline salivary 3-methoxy-4-hydroxyphenylglycol (MHPG) in drug-naïve patients with short-illness-duration first episode major depressive disorder

BACKGROUND

Central noradrenergic dysfunction with autonomic nervous system dysregulation are reported in major depressive disorder (MDD). Salivary 3-methoxy-4-hydroxyphenylglycol (sMHPG) is indicative of central noradrenergic activity. Studies on MHPG in bodily fluids are inconsistent and scarce data is available regarding baseline sMHPG concentration in MDD.

METHODS

The basal, non-stimulated sMHPG concentration was studied in this cross-sectional case-control study on 20 non-late-life adult, short-illness-duration first-episode, treatment-naïve MDD patients and in 20 age- and sex-matched healthy controls. Depressed patients showed a score in the Hamilton rating scale for depression (HAMD-17) higher than 20.

RESULTS

The baseline sMHPG concentration was significantly lower in depressed individuals as compared to controls (p=0.025). In post hoc analysis significantly lower sMHPG was present in melancholic MDD (p=0.009) as related to controls whereas no difference was seen between non-melancholic MDD patients and controls. The concentration of sMHPG was not significantly correlated neither with duration nor the severity of depressive symptoms as measured by the total HAMD-17 score.

LIMITATIONS

The current study is limited by its cross-sectional design and small sample size.

CONCLUSION

Low baseline sMHPG concentration was found in MDD. The study provides no support for elevated sMHPG in drug-naïve patients with short-illness-duration first episode MDD. Taken into account the physiology of sMHPG secretion the study results corroborate with the evidence for decreased central noradrenergic activity in MDD when sMHPG is considered indicative of central noradrenergic function.

Low baseline salivary alpha-amylase in drug-naïve patients with short-illness-duration first episode major depressive disorder

BACKGROUND

Altered monoamine neurotransmission accompanied by hypothalamic-pituitary-adrenal axis dysfunction and autonomic nervous system hyperactivity have been associated with major depressive disorder (MDD). Salivary α-amylase (sAA) is indicative of autonomic activation and reflects central noradrenergic activity. Scarce studies on sAA in MDD produce confounded results and no data is available regarding baseline sAA activity.

METHODS

The basal, non-stimulated sAA activity was studied in this cross-sectional case-control study on 20 non-late-life adult, short-illness-duration first-episode, treatment-naïve MDD patients and in 20 age- and sex-matched healthy controls. Depressed patients showed a basal score in the Hamilton Rating Scale for Depression (HAMD-17) higher than 20.

RESULTS

The sAA was significantly lower in depressed individuals as compared to controls (p=0.011). In post hoc analysis significantly lower sAA was present in melancholic MDD (p=0.016) as related to controls whereas no difference was seen between non-melancholic MDD patients and controls. The sAA activity was not significantly correlated neither with duration nor the severity of depressive symptoms as measured by the total HAMD-17 score.

LIMITATIONS

The current study is limited by its cross-sectional design, small sample size, and factors related to saliva sampling methodology.

CONCLUSION

Low baseline sAA levels were found in MDD in basal, non-stimulated conditions. The study provides no support for elevated sAA in drug-naïve patients with short-illness-duration first episode MDD. The results support the evidence for decreased central noradrenergic transmission in MDD when sAA activity is considered indicative of central noradrenergic function.

Salivary 5-hydroxyindole acetic acid (5-HIAA) in drug-naïve patients with short-illness-duration first episode major depressive disorder

OBJECTIVES

Central serotonergic dysfunction is reported in major depressive disorder (MDD). Serotonin is primarily metabolized to 5-hydroxyindole acetic acid (5-HIAA) and its plasma, urinary or cerebrospinal fluid concentrations were extensively studied in depression. No data is available on salivary 5-HIAA (s5-HIAA) in MDD to date.

METHODS

The basal, non-stimulated s5-HIAA concentration was studied in this cross-sectional case-control study on 20 non-late-life adult, short-illness-duration first-episode, treatment-naïve MDD patients and in 20 age- and sex-matched healthy controls. Depressed patients showed a score in the Hamilton Rating Scale for Depression (HAMD-17) higher than 20.

RESULTS

No significant difference in s5-HIAA concentration between patients with MDD and controls was observed. In post hoc analysis significantly lower s5-HIAA was seen in non-melancholic MDD (p=0.026) as related to controls whereas no difference was seen between melancholic MDD patients and controls. The concentration of s5-HIAA was not significantly correlated neither with duration nor the severity of depressive symptoms as measured by the total HAMD-17 score.

CONCLUSION

No difference was observed in baseline s5-HIAA concentration between MDD patients and healthy controls. That observation corroborates with previous MDD studies on 5-HIAA concentrations in bodily fluids where unaltered 5-HIAA concentration is seen in the absence of serotonin-related behaviours including impulsivity, suicidality, and anxiety. Salivary 5-HIAA use remains to be determined.

C-reactive protein and cortisol in drug-naïve patients with short-illness-duration first episode major depressive disorder: possible role of cortisol immunomodulatory action at early stage of the disease

BACKGROUND

Hypercortisolemia and low grade systemic inflammation are observed in major depressive disorder (MDD). Studies on markers of systematic inflammation and Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation in MDD produce confounded results due to heterogeneity of MDD patients related to illness stages and severity with a large proportion suffering from remitted-recurrent and treatment-resistant/chronic depression with first-episode major depression being underrepresented. This study was designed to examine whether and to what extent CRP is related to baseline cortisol concentrations in a well defined cohort of short-illness-duration first-episode, treatment-naïve MDD patients.

METHODS

The levels of salivary C-reactive protein (CRP) and baseline plasma cortisol concentrations were studied in this cross-sectional case-control study on 20 non-late-life adult, treatment- naïve MDD patients with short-illness-duration first affective episode and in 20 age- and sex-matched healthy controls. Depressed patients showed a basal score in the Hamilton Rating Scale for Depression (HAMD-17) higher than 20.

RESULTS

No significant difference in CRP concentration between MDD and control groups was found. Significantly higher baseline cortisol (p=0.01) concentration was observed in MDD as compared to controls. Significant positive correlation was found between cortisol and CRP levels both in MDD subjects (r=0.57; p=0.008) and controls (r=0.61; p=0.004).

LIMITATIONS

The current study is limited by its cross-sectional design and small sample size.

CONCLUSION

The study supports data on elevated cortisol concentration in MDD providing no evidence for elevated CRP levels at the early stage of the disease.

Zinc in drug-naïve patients with short-illness-duration first episode major depressive disorder: impact on psychopathological features

OBJECTIVE

In major depressive disorder (MDD) hypozincaemia associated with symptoms severity, melancholia, anxiety and treatment-resistance is reported. Data linking zinc with specific psychopathological dimensions is limited.

METHODS

Plasma zinc was analyzed in this cross-sectional case-control study on 20 non-late-life adult, treatment-naïve MDD patients with short-illness-duration first affective episode and 20 matched healthy controls together with psychometric evaluations including Hamilton Rating Scale for Depression (HAMD-17) and Spielberger State-Trait Anxiety Inventory (STAI).

RESULTS

No significant difference in zinc levels was found between MDD subjects and controls. No significant correlations were observed between zinc concentration and the total HAMD-17 score as well as with the specific core depression, insomnia, anxiety and somatic psychopathological dimensions or STAIX-1 and STAIX-2 scores.

CONCLUSION

The study provides evidence for unchanged plasma zinc concentration at early stage of MDD and failed to demonstrate any correlation between plasma zinc and psychopathological features including severity of symptoms and specific psychopathological dimensions in MDD.

MR findings in neurosyphilis--a literature review with a focus on a practical approach to neuroimaging

BACKGROUND

Syphilis is a sexually transmitted disease caused by Treponema pallium. The invasion of the central nervous system is observed in 5-10% of untreated patients and may occur at any stage of the disease. The diagnosis of the early stage of syphilitic infection is complex as many patients present either nonspecific symptoms or are asymptomatic. The identification of the most common radiologic characteristics of neurosyphilis is important in the proper diagnosis of the infection.

METHOD

The paper reviews the MR findings in neurosyphilis presented in the literature with the emphasis on common traits, patterns and factors in MR neuroimaging in neurosyphilis.

RESULTS

Twelve papers were selected as suitable for analysis. Psychiatric symptomatology was the most common clinical manifestations of neurosyphilis. As MRI findings in neurosyphilis were not highly specific it proved being the most sensitive technique in detecting the changes in cerebral vasculitis commonly presenting with focal areas of high signal intensity in any distribution with areas of infarction and hemorrhage observed at times. In neurosyphilis medium and small vessels are usually involved. Parenchymal and meningeal enhancement was usually demonstrated. The most frequently involved arteries are middle cerebral artery and branches of the basilar artery. However, normal findings were also common.

CONCLUSIONS

The most common MR diagnostic features are medium contrast enhancement, atrophy, white matter lesions, cerebral infarction, oedema. Radiologists, neurologists, and psychiatrists should take neurosyphilis into consideration when facing the differential diagnosis in central vascuclar disorders.

Sibutramine-associated psychotic symptoms and zolpidem-induced complex behaviours: implications for patient safety

BACKGROUND

Sibutramine is a weight loss agent recently withdrawn from the European market due to cardiovascular risk concerns. It was used for long-term obesity treatment. Zolpidem is a short acting hypnotic agent commonly used in the treatment of insomnia. A number of case reports describing psychotic reaction to sibutramine were reported in the literature.

CASE REPORT

We present a case of a 61-year-old Caucasian woman who developed two psychotic episodes related to sibutramine treatment. The second psychotic episode was complicated with complex behaviours after zolpidem use due to insomnia. Sibutramine and zolpidem discontinuation resulted in rapid resolution of psychotic symptoms.

CONCLUSIONS

This case suggests a possibility of incidence of psychotic symptoms and complex behaviour disturbances in patients prescribed sibutramine or other monoaminergic reuptake inhibitors.

Impulsivity in panic disorder: neuropsychological correlates

BACKGROUND

Impulsivity plays a prominent role in numerous psychopathological states and poses an important clinical dilemma. However, different aspects of impulsivity are related to mood disorders, addictions, personality disorders, eating disorders, the relationship between anxiety and impulsivity is controversial and not well explored. The impact of anxiety on cognitive functioning is less explored than in other disorders (e.g. depression). The findings on cognitive functioning and impulsivity in anxiety disorders are inconsistent and are most likely due to methodological differences between the studies.

MATERIAL AND METHODS

Eleven patients diagnosed with panic disorder (DSM-IV-TR) and nine healthy volunteers were enrolled to the study. Both groups did not differ significantly in terms of age, gender and educational level. The experimental group comprised of psychotropic drug naïve patients. The severity of PD was measured with Panic and Agoraphobia Scale. Impulsiveness was evaluated with the Barratt Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions CANTAB (Cambridge Neuropsychological Test Automated Battery) was used and Paired Associate Learning (PAL) test was chosen for episodic memory evaluation.

RESULTS

Mean BIS-11 scores observed in the group of psychotropic drug naïve patients with panic disorder were 71.36 (SD 7.31). Mean BIS-scores recorded in the control group were 60.77 (SD 9.57). The correlation between impulsivity and PAL results in the experimental group was found at the level r=0.708723; p<0.05. The respective value for the controls was r=0.200839; p<0.05.

CONCLUSIONS

Impulsivity in the experimental group was higher than adjusted average for the control group. Our findings indicate also the correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naïve patients.

Immediate and delayed visual memory and recognition in patients with panic disorders

BACKGROUND

In Panic Disorder (PD) both somatic and cognitive symptoms occur. Cognitive functions which may be involved with anxiety and maladaptive cognition such as e.g. attention, memory and perception might be decreased.

MATERIAL AND METHODS

Within the preliminary studies eleven patients diagnosed with panic disorder (DSM-IV-TR), and nine healthy controls were studied. The severity of disorder was measured by the Panic and Agoraphobia Scale. To assess working memory Delayed Match to Sample (DMS) with CANTAB (Cambridge Neuropsychological Test Automated Battery) was used.

RESULTS

Percent of correct answers was significantly different in both groups in delayed visual memory and recognition test. In the control group results were higher (M=92.22) than in the experimental group (86.06).

CONCLUSIONS

PD is associated with impaired performance on a DMS task that requires the stable maintenance of representations in working memory.

[Quality of Life in Depression Scale (QLDS)--development of the scale and Polish adaptation]

AIM

The aim of this study was to adapt the Quality of Life in Depression Scale to Polish conditions. The scale determines the quality of life, defined in terms of the concept of needs, and focuses on patients with depressive disorders. Since its basic version has been developed, the tool was adapted in many countries, also outside Europe.

METHOD

The adaptation procedure included the translation of the original version into Polish, followed by the English retranslation, and was performed by four independent, qualified translators. The final Polish version was verified during a pilot study.

RESULTS

This pilot study confirmed high reliability of the Polish version of Quality of Life in Depression Scale.

CONCLUSION

The Quality of Life in Depression Scale (QLDS) can be considered an interesting tool in view of its broad theoretical background, and a simple procedure to complete during a clinical evaluation. The use of a specialist translation procedure, and the results of our pilot study suggest that the QLDS can be used in further research, both when evaluating a clinical population and when dealing with individual patients.

[Discontinuation-Emergent Signs and Symptoms Inventory--Polish translation of the discontinuation signs and symptoms checklist]

A number of preclinical and clinical studies are focused on mechanisms of SSRI discontinuation syndrome as well as the patient populations and agents that are most affected by this phenomenon. Characteristics of onset, duration, and severity of any discontinuation symptoms and spontaneous reports of taper/poststudy-emergent adverse events should be compared with those of the active comparator in these studies. Besides, common clinical practice supplies a number of problems associated with SSRI discontinuation syndrome as related to treatment planning and management. The recommended instrument for evaluating SSRI discontinuation syndrome symptoms is the Discontinuation-Emergent Signs and Symptoms (DESS) inventory. DESS is a 43-item checklist that can be administered in a clinician-rated form, a self-rated form, or an interactive voice-response form. The paper presents the Polish version of DESS inventory along with its application and interpretation instructions. DESS inventory is of substantial advance in common psychiatric practice as it enables effective SSRI discontinuation management on drug tapering and in case of the non-compliance with the treatment. Its use in the systematic studies facilitates conclusive outcome results and is of prime importance as being comparable with literature outcomes.

Cognitive correlates in panic disorder as related to impulsivity - preliminary report

BACKGROUND

Impulsivity is the neurophysiologically based inability to confirm behaviour to its context or consequences. Overimpulsiveness characterizes many mental disorders and poses an important clinical dilemma. Although the relationship between mood disorders and impulsivity has been well studied the relationship between anxiety and impulsivity is controversial and not well explored. Some studies hypothesise that patients with the diagnosis of panic disorders are characterised by higher levels of impulsivity as a trait as compared to healthy individuals. The aim of this study was to assess cognitive correlates in panic disorder as related to impulsivity measures.

MATERIAL AND METHODS

Within the preliminary studies four patients diagnosed with panic disorder (DSM-IV-TR) were studied. The severity measure was the Panic and Agoraphobia Scale. The experimental group comprised of psychotropic drug naive patients. Impulsiveness was evaluated with the Barrat Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions we used CANTAB (Cambridge Neuropsychological Test Automated Battery).

RESULTS

BIS-11 scores observed in the group of psychotropic drug naive patients with panic disorder were higher than the adjusted average for the population and correlated with the number of mistakes in CANTAB (Spatial Working Memory Test); rs=0.949; p=0.0513.

CONCLUSIONS

The preliminary findings indicate a correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naive patients.

Mood disorders in epilepsy - diagnostic and methodological considerations

BACKGROUND

Mood disorders are common in people with epilepsy (PWE) with prevalence rates ranging from 11% to 62%. The variation in epidemiological data results probably from the diversity of methodologies employed and selection of the populations across the studies. Moreover, the symptomathology of mood disorders in epilepsy is often atypical, intermittent and pleomorphic and fails to meet DSM-IV-TR categories. Several studies suggested the existence of distinct interictal dysphoric disorder (IDD) in patients with epilepsy. The majority of research studies in mood disorders in epilepsy were based on screening instruments in the diagnosis of mood disorders in PWE. However, the results in validity and reliability in detecting major depression in epilepsy using self-report inventories of mood symptoms is vague. The aim of this study was to review studies on mood disorders in epilepsy with particular focus on diagnostic methods.

SUBJECTS AND METHODS

The focus of this Review was on patient studies on mood disorders in epilepsy (2000-2012). We searched PubMed using the following search terms (effective date: 20th May 2012): (epilepsy (Title/Abstract) OR seizure (Title/Abstract)) AND depression (Title/Abstract) OR Dysthymia OR mania OR bipolar disorder OR affective disorder OR Interictal Dysphoric Disorder OR AND (humans (MeSH Terms) AND English (lang) AND (2000/01/01(PDAT): 2012/04/31(PDAT)).

RESULTS

Depression is the most frequent comorbid psychiatric disorder in epilepsy. Recent studies pointed out that bipolar disorders are not rare in epilepsy. Most of the research in PWE did not rely on standardized psychiatric measures and only about 18% of studies were based on diagnostic psychiatric interviews (mainly MINI and SCID-I). Mood disorders in epilepsy excluding the ictal or periictal symptoms can be categorized using standardized measures.

CONCLUSIONS

Common self-report depression measures may be used to screen for depression in clinical settings. The use of screening instruments in epilepsy must be followed by structured psychiatric interviews designed to establish a DSM-IV-TR diagnoses. Standardized psychiatric interview procedures based on DSM criteria like SCID-I or MINI provide a comprehensive way to diagnose mood disorders in patients with epilepsy.

The efficacy of Cognitive-Behavioural Therapy (CBT) as related to sleep quality and hyperarousal level in the treatment of primary insomnia

BACKGROUND

Primary insomnia (PI) is a common sleep disorder affecting diurnal functioning. It may contribute to the development of several comorbidities such as major depression or arterial hypertension. It affects about 7% of the adult population. Pharmacotherapy remains the most common treatment for insomnia. However, many studies suggest CBT may be a supreme therapeutic approach resulting in a better long-term outcome. The aim of the study was to determine the efficacy of a CBT-protocol in the treatment of PI by means of sleep onset latency and the number of awakenings during night parameters along with sleep quality and the level of psychophysiological hyperarousal. The secondary outcomes were focused on CBT efficacy as determined by the predisposition to insomnia as related to higher vulnerability to stress (measured with FIRST) MATERIAL AND METHODS: Twenty-six individuals from a tertiary reference sleep disorders outpatients' clinic (22 women; mean age 41.4; 4 men; mean age 42.5) with primary insomnia (DSM-IV-TR) were included in the study. The exclusion covered other primary sleep disorders, secondary insomnia (psychiatric illness, unstable somatic illness, shift work), substance abuse/dependence, high results in HADS-M scale (score above 11). The participants were scored with HADS-M, Ford Insomnia Response to Stress Test (FIRST) at the beginning of the study. The Athens Insomnia Scale (AIS), Hyperarousal Scale, Leeds Sleep Questionnaire (LSEQ) were applied at the beginning, at the end and three months after the end of the study. The participants were also examined by 7 days actigraphic records before and after treatment. During the course of the treatment patients completed a Sleep Diary (SD). The CBT program employed was based on the Perlis protocol. Standard individual sessions of 50 minutes were provided on a weekly basis for 8-10 weeks by a board certified CBT therapist. After 3 months a follow-up session was scheduled.

RESULTS

The significant improvement as related to the CBT treatment was present in the measures of sleep onset latency (67.2 vs. 23.4 min.; p<0.000), numbers of awakenings during night (2 vs. 0.4; p<0.000) and sleep efficiency (77.3 vs. 91%; p<0.000) - data from SD, quality of falling asleep (3.2 vs. 6; p<0.000), quality of sleep (3.3 vs. 5.8; p<0.000) and quality of morning awakening (3.2 vs. 6; p<0.000) - data from LSEQ. The improvement reached the significance level in the measure of psychophysiological arousal (52.3 vs. 42.4; p<0.000) and AIS (15.7vs. 6.8; p<0.000). No significant differences were identified between actigraphic records (light/dark ratio) before and after CBT. FIRST scores allocating patients to high and low stress vulnerability groups were non-contributory to the observed treatment efficacy.

CONCLUSION

CBT is an effective treatment in primary insomnia. No relationship between CBT efficacy and predisposition to insomnia as determined by higher vulnerability to stress was identified.

Beta-amyloid peptides enhance the proliferative response of activated CD4CD28 lymphocytes from Alzheimer disease patients and from healthy elderly

Alzheimer's disease (AD) is the most frequent form of dementia among elderly. Despite the vast amount of literature on non-specific immune mechanisms in AD there is still little information about the potential antigen-specific immune response in this pathology. It is known that early stages of AD include β-amyloid (Aβ)- reactive antibodies production and inflammatory response. Despite some evidence gathered proving cellular immune response background in AD pathology, the specific reactions of CD4⁺ and CD8⁺ cells remain unknown as the previous investigations yielded conflicting results. Here we investigated the CD4⁺CD28⁺ population of human peripheral blood T cells and showed that soluble β-amyloids alone were unable to stimulate these cells to proliferate significantly, resulting only in minor, probably antigen-specific, proliferative response. On the other hand, the exposure of in vitro pre-stimulated lymphocytes to soluble Aβ peptides significantly enhanced the proliferative response of these cells which had also lead to increased levels of TNF, IL-10 and IL-6. We also proved that Aβ peptide-enhanced proliferative response of CD4⁺CD28⁺ cells is autonomous and independent from disease status while being associated with the initial, ex vivo activation status of the CD4⁺ cells. In conclusion, we suggest that the effect of Aβ peptides on the immune system of AD patients does not depend on the specific reactivity to Aβ epitope(s), but is rather a consequence of an unspecific modulation of the cell cycle dynamics and cytokine production by T cells, occurring simultaneously in a huge proportion of Aβ peptide-exposed T lymphocytes and affecting the immune system performance.

Polymorphisms of the 5-HT2A receptor gene and clinical response to olanzapine in paranoid schizophrenia

BACKGROUND

5-HT2A receptor is strongly implicated in the mode of action of atypical antipsychotic drugs. The aim of the study was to investigate whether the 5-HT2A receptor gene's polymorphisms (His452Tyr and T102C) have an influence on the response to olanzapine in patients with schizophrenia.

METHODS

We studied 99 Caucasian schizophrenia patients treated with olanzapine. Psychopathology was measured before and after 6 weeks of treatment. Clinical improvement was quantified as change in Positive and Negative Syndrome Scale (PANSS) total scores and subscores as shown by percentage improvement below the baseline score. The clinical response to antipsychotic treatment was defined as 30% improvement from baseline in PANSS scores.

RESULTS

The His/Tyr polymorphism was significantly associated with a percentage improvement in PANSS positive symptom subscore (better response in His/His homozygotes; p<0.05) after treatment with olanzapine. As for the T102C polymorphism, a better response in terms of PANSS positive subscore improvement was observed for C/C homozygotes (p<0.01). A significant association of 5-HT2A genotype distribution of the T102C polymorphism with a categorical measure of response, but only in terms of PANSS positive symptom subscores, was observed (p<0.01).

CONCLUSIONS

Variations in the 5-HT2A receptor gene may influence individual and particularly positive symptom response to olanzapine.

[Trazodon--the antidepressant: mechanism of action and its position in the treatment of depression]

The pharmacological properties and possible clinical use of trazodon in the treatment of depression are presented. Trazodon is the only antidepressant from the SARI (Serotonin Antagonists and Reuptake Inhibitors) group available in Poland. It has a wide pharmacodynamic profile (being an antagonist of 5-HT2A and 5-HT2C serotoninergic receptors, alpha1 and alpha2 adrenergic receptors as well as H1 histaminergic receptors, and in higher doses it blocks the SERT serotonine transporter) which explains its wide therapeutic spectrum ranging from symptomatic treatment, through the potentialization of other drugs activity, all the way to monotherapy of depressive syndromes. An especially complex action on the serotoninergic system results in the lack of unwanted side-effects during treatment with trazodon (e.g. sexual dysfunction, significant body weight gain), which may be present during the treatment with other drugs (selective serotonin reuptake inhibitors). It is metabolised by the CYP450 isoenzyme: mainly the 2D6 and 3A4. This requires its dose to be adjusted when administered simultaneously with other drugs influencing the activity of those isoenzymes. Trazodon CR is an orally administered controlled release form, which simplifies its dosage and reduces the risk of adverse effects. Usually doses of 75 to 600mg daily are used; in the elderly those doses should be lower. Trazodon turned out to be effective in the treatment of various depressive syndromes, amongst them depression with insomnia, with anxiety and unrest, as well as depression in the elderly. In the recommended dose spectrum, trazodon is well tolerated. Unwanted adverse effects of the drug appear rarely and they are: somnolence, dizziness, gastrointestinal dysfunctions, and dry mouth.

[Abdominal dystonia in a patient with schizophrenia: a case report]

The case of 31-year-old woman suffering from schizophrenia with movement disorder is described. The patient had a 7-year history of schizophrenia. In course of the psychiatric treatment the patient presented dystonic movements within abdominal muscles. The dystonic movements were of mixed character, including voluntary and involuntary ones what might have suggested their psychogenic origin. Subsequent to the exclusion of the neurological origin of the movement disorder and poor response to antipsychotic treatment, clozapine was introduced resulting in full remission of positive symptoms and functional improvement with a diminished intensity of the involuntary movements. Psychogenic movement disorders are uncommon in schizophrenic patients. Movement disorders may occur as an adverse reaction to antipsychotic treatment, especially with typical ones. However, the abdominal muscles dystonia is an uncommon manifestation of dystonia of idiopathic, drug-induced or psychogenic origin. In such cases, a liaison between the neurologist and psychiatrist is advocated and the therapeutic process using antipsychotic treatment is necessary.

Social support level in relation to metabolic syndrome--results of the SOPKARD study

BACKGROUND

Low level of social support is one of the psychosocial cardiovascular risk factors. Moreover, social support level (SSL) has been reported to be associated with components of metabolic syndrome (MS).

AIM

To evaluate the association of SSL with MS in 50- and 60-year-old citizens of Sopot.

METHODS

The study covered 476 citizens of Sopot (218 males - M; 258 females - F), aged 50-60 years, invited to take part in the screening project SOPKARD aimed at increasing detectability of hypertension, dyslipidaemia and diabetes mellitus in 2002-2003. Patients with MS were diagnosed according to the AHA/NHLBI criteria (2007). The Berkman and Syme's questionnaire was used for assessment of SSL which was categorised into 3 groups: low, medium and high.

RESULTS

Metabolic syndrome was diagnosed in 34% (W 29%, M 39%, p <0.05) of examined subjects. The prevalence of MS criteria was as follows: elevated blood pressure 68% (F 67%, M 69%, NS), elevated fasting glucose 48% (W 45%, M 53%, p=0.08), elevated waist circumference 30% (W 33%, M 25%, p=0.06), hypertriglyceridaemia 42% (F 41%, M 42%, NS) and low level of HDL cholesterol (HDL-C) 23% (W 23%, M 23%, NS). Low SSL was observed in 50% of studied subjects (W 58%, M 39%), middle SSL in 31% (F 29%, M 35%) and high in 19% (F 13%, M 26%). In men with low SSL, MS and low level of HDL-C were found twice as frequent as in men with high SSL (45 vs. 22%, p <0.05; 24 vs. 12%, p <0.05). High level of triglycerides was observed significantly more frequently in women with low SSL than in those with high SSL (51 vs. 21%, p <0.05). Results of regression analysis showed that in men (all and 60-year olds) SSL was significantly associated with MS prevalence (p <0.05). In women, SSL was related to elevated fasting glucose prevalence (p <0.001). Moreover, in 50-year-old women SSL was significantly associated with MS (p=0.05) and elevated waist circumference (p <0.0001). All these relationships were independent of education.

CONCLUSIONS

The examined group of middle-aged persons, especially women, was characterised by high frequency of low SSL. Metabolic syndrome and its components were found more frequently in persons with low SSL, compared to those with high SSL. Low SSL was significantly associated with occurrence of MS and dyslipidaemia in men and women, and elevated fasting glucose and elevated waist circumference in 50-year old women.