Chronic Fatigue Syndrome in Patients with Deteriorated Iron Metabolism.

Fatigue is a common, non-specific symptom that often impairs patients' quality of life. Even though fatigue may be the first symptom of many serious diseases, it is often underestimated due to its non-specific nature. Iron metabolism disorders are a prominent example of conditions where fatigue is a leading symptom. Whether it is an iron deficiency or overload, tiredness is one of the most common features. Despite significant progress in diagnosing and treating iron pathologies, the approach to chronic fatigue syndrome in such patients is not precisely determined. Our study aims to present the current state of knowledge on fatigue in patients with deteriorated iron metabolism.

Pathogenesis, Diagnosis, and Clinical Implications of Hereditary Hemochromatosis-The Cardiological Point of View.

Hereditary hemochromatosis (HH) is a genetic disease leading to excessive iron absorption, its accumulation, and oxidative stress induction causing different organ damage, including the heart. The process of cardiac involvement is slow and lasts for years. Cardiac pathology manifests as an impaired diastolic function and cardiac hypertrophy at first and as dilatative cardiomyopathy and heart failure with time. From the moment of heart failure appearance, the prognosis is poor. Therefore, it is crucial to prevent those lesions by upfront therapy at the preclinical phase of the disease. The most useful diagnostic tool for detecting cardiac involvement is echocardiography. However, during an early phase of the disease, when patients do not present severe abnormalities in serum iron parameters and severe symptoms of other organ involvement, heart damage may be overlooked due to the lack of evident signs of cardiac dysfunction. Considerable advancement in echocardiography, with particular attention to speckle tracking echocardiography, allows detecting discrete myocardial abnormalities and planning strategy for further clinical management before the occurrence of substantial heart damage. The review aims to present the current state of knowledge concerning cardiac involvement in HH. In addition, it could help cardiologists and other physicians in their everyday practice with HH patients.

Comprehensive Echocardiography of Left Atrium and Left Ventricle Using Modern Techniques Helps in Better Revealing Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy.

Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). We aimed to explore whether a complex evaluation of the left ventricle (LV) using modern echocardiography techniques, additionally to the left atrium (LA) boosts the probability of AF diagnosis. Standard echocardiography, 2D and 3D speckle tracking, were performed for LA and LV evaluation in HCM patients and healthy volunteers. Of 128 initially qualified HCM patients, 60 fulfilled included criteria, from which 43 had a history of AF, and 17 were without AF. LA volume index and peak strain, LV ejection fraction, and strains were significant predictors of AF. In addition, 2D global longitudinal strain (GLS) for LV at cut off -16% turned out to be the most accurate predictor of AF (OR 48.00 [95% CI 2.68-859.36], p = 0.001), whereas the combination of LA peak strain ≤ 22% and LV GLS ≥ -16% had the highest discriminatory power (OR 76.36 [95% CI 4.13-1411.36], p = 0.001). AF in HCM patients seems to be LA as well as LV disease. Revealing lower strain for LV, in addition to lower LA strain, may have an important impact on accurate characteristics of HCM patients with AF history.

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, 11th 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.

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.

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.

[Mineralization of the basal ganglia as the supposed cause of poor tolerance of zuclopenthixol in a patient with long-term untreated paranoid schizophrenia]. / Mineralizacja jader podstawy jako domniemana przyczyna zlej tolerancji zuklopentyksolu u chorej z wieloletnia nieleczona schizofrenia paranoidalna.

Formations described as intracranial calcifications can appear in the course of diseases of the central nervous system, other systems and organs (e.g. endocrine), but also as a disorder of idiopathic character. They are frequently located in subcortical nuclei and usually constitute an incidental finding. This report presents the case of a patient suffering from paranoid schizophrenia for approximately 40 years, who did not agree to any treatment and was hospitalized against her will because she was the threat to the lives of others. She was treated with zuklopentixol resulting in positive symptoms reduction and considerable improvement in social functioning. Unfortunately neurological symptoms appeared: bradykinesis, rigidity--of the type of the lead pipe, balance, posture and gait abnormalities, disturbances in precise hands movements, double-sided Rossolimo's sign, plantar reflex without the participation of the big toe on the left. Neuroimaging studies have demonstrated changes in the form of lenticular nuclei calcification and reduction of signal intensity in posterior parts of both putamens. Neurological symptoms decreased significantly after switching to atypical neuroleptic (olanzapine), and the patient did not require any additional treatment. Mineralization of the basal ganglia can often be associated with psychiatric disorders and it shouldn't be neglected because it can require modification of pharmacotherapy or additional neurological treatment.

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.

[The assessment of influence of long-term exercise training on autonomic nervous system activity in young athletes preparing for competitions]. / Ocena wplywu dlugotrwalego intensywnego wysilku fizycznego na czynnosc autonomicznego ukladu nerwowego w grupie sportowców przygotowujacych sie do startu w zawodach.

UNLABELLED: The exercise training has positive impact on autonomic nervous system (ANS) activity. However, specific type of these changes significantly depends on intensity of used physical exertion. THE AIM OF THE STUDY: To assess the influence of long-term and single moderate physical exertion on ANS function in young athletes. MATERIAL AND METHODS: Sixteen middle-aged, 19-34 years old (24 +/- 5) athletes were included in the study. Assessment of ANS parameters (baroreflex sensitivity--BRS-WBA, heart rate variability--HRV) and mean heart rate period (mean HP) were calculated three times: recording 1--during the final stage of training period, recording 2--60 minutes after single moderate exertion, recording 3--after 2 months of training before competitions. RESULTS: In the whole group, significant increase of TP, HF SDNN and rMSSD indices was found in recording 2 comparing to recording 1, whereas after 2 months of intensive training no statistically significant changes were observed. In the group of athletes training only endurance sport (12 persons) in recording 2 the significant increase of TP, HF, SDNN, rMSSD and BRS-WBA was found. After 2 months of intensive training, no changes of these parameters were observed. CONCLUSIONS: In response to long-term training cycle with increasing intensity, preparing athletes for competitions, no significant changes of measured ANS parameters were found, which may indicate lack of overtraining during such a high intensity of training, and its safety. The changes of ANS parameters indicating increase of parasympathetic nervous system function after single exertion with moderate intensity (65% of maximum heart rate) were observed.