The Influence of Electroconvulsive Therapy (ECT) on Brain-Derived Neurotrophic Factor (BDNF) Plasma Level in Patients with Schizophrenia-A Systematic Review and Meta-Analysis.

The main aim of this systematic review and meta-analysis is to establish whether there is a correlation between the brain-derived neurotrophic factor (BDNF) level and electroconvulsive therapy (ECT) treatment and the reduction in psychotic symptoms in patients diagnosed with schizophrenia. A systematic search of PubMed/Medline, Cochrane Library, Web of Science, Scopus and Embase was conducted up to March 2023. Inclusion criteria: studies in which adult patients with schizophrenia treated with antipsychotic medication received ECT therapy and had the BDNF level measured before and after ECT treatment. Exclusion criteria: animal and in vitro studies or studies not involving complete information about the treatment and concentration of BDNF in plasma. The risk of bias was assessed using Egger's regression-based test for meta-analysis with continuous outcomes. Six studies comprising 248 individuals with schizophrenia were included. A statistically significant increase in BDNF levels after ECT treatment was observed only in two studies (p < 0.001 and p < 0.027, respectively), whereas in four other studies, an upward trend without statistical significance was noticed. The estimated overall size effect revealed that ECT therapy caused a slight change in the BDNF level but without statistical significance (ES = -0.328). Different numbers of ECT procedures (4-10), final measurement of the BDNF level made at a different time point, using bilateral or unilateral electrode positioning during ECT and treatment with different combinations of typical or atypical antipsychotic medications may be potential reasons for the lack of statistical significance in the changes in BDNF levels after treatment. Data regarding the measurement of BDNF levels pre and post ECT therapy in patients with schizophrenia are very limited without an extended follow-up period and evaluation of mental health change. Our meta-analysis showed that treatment with ECT therapy and antipsychotic medication increases serum BDNF levels in patients with drug-resistant schizophrenia compared to patients treated with medication only; however, this effect is not statistically significant.

Augmentation Therapies as Treatments for Coexisting Somatic Problems in Schizophrenia-A Systematic Review.

The aim of this review is to appraise the data from available randomized clinical trials (RCT) regarding the possible combinations of neuroleptic and non-antipsychotic treatment which could enhance antipsychotic therapy efficacy whilst simultaneously addressing somatic symptoms in individuals with schizophrenia. A systematic search of the PubMed database up to February 2022 was conducted. Inclusion criteria: randomized controlled trials using augmentation therapy in chronic schizophrenia in adults, written in English, and only studies with psychometric assessments of schizophrenia were incorporated. Exclusion criteria: non-clinical, first episode of schizophrenia, patients on medication other than antipsychotics augmented, and not adjunctive therapy. Overall, 37 studies of 1931 patients with schizophrenia who received a combination of antipsychotic medication with other drugs were selected. A statistically significant reduction of negative and positive symptoms of schizophrenia, measured with the PANSS scale, when using a combination of antipsychotic treatment along with aspirin, simvastatin, N-acetylcysteine, or pioglitazone was found. A combination of antipsychotic medication with aspirin, simvastatin, N-acetylcysteine, or pioglitazone seems to be effective in the reduction of symptoms of schizophrenia in adults, but long-term studies are required to confirm this effect.

Concentration of Selected Adipokines and Factors Regulating Carbohydrate Metabolism in Patients with Head and Neck Cancer in Respect to Their Body Mass Index.

Head and neck cancers (HNCs) are a group of tumors not common in European populations. So far, not much is known about the role of obesity, adipokines, glucose metabolism, and inflammation in the pathogenesis of HNC. The aim of the study was to determine the concentrations of ghrelin, omentin-1, adipsin, adiponectin, leptin, resistin, visfatin, glucagon, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), plasminogen activator inhibitor-1 (PAI-1), and gastric inhibitory peptide (GIP) in the blood serum of HNC patients depending on their body mass index (BMI). The study included 46 patients divided into two groups according to their BMI values: the normal BMI group (nBMI) included 23 patients with BMI < 25 kg/m2 and the increased BMI group (iBMI) included patients with BMI ≥ 25 kg/m2. A control group (CG) included 23 healthy people (BMI < 25 kg/m2). Statistically significant differences in the levels of adipsin, ghrelin, glucagon, PAI-1, and visfatin were shown between nBMI and CG. In the case of nBMI and iBMI, statistically significant differences were observed in the concentrations of adiponectin, C-peptide, ghrelin, GLP-1, insulin, leptin, omentin-1, PAI-1, resistin, and visfatin. The obtained results indicate a disruption of endocrine function of adipose tissue and impaired glucose metabolism in HNC. Obesity, which is not a typical risk factor for HNC, may aggravate the negative metabolic changes associated with this type of neoplasm. Ghrelin, visfatin, PAI-1, adipsin, and glucagon might be related to head and neck carcinogenesis. They seem to be promising directions for further research.

[Cognitive dysfunction after cardiac surgery]. / Zaburzenia funkcjonowania poznawczego po zabiegach kardiochirurgicznych.

In spite of the progress in medicine post operative cognitive deficiency (POCD) remains an important clinical problem. Since the introduction of cardiac surgery there have been frequent reports of its adverse neurological outcomes. Recent technological advances have contributed to a lesser occurrence of clinically evident complications such as coma, stroke, epilepsy or blindness. This brought to attention a more common yet occult disorder--POCD. The above malady mostly concerns memory and executive functions. POCD has a negative impact on the quality of life and labor market attachment, however it's relation to mortality seems to be most disturbing. Prevalence of POCD is mainly associated with microembolisms, hipoperfusion and inflammatory reaction of the central nervous system following cardiac surgery. In addition many studies have shown the importance ofbiochemical disorders, cerebral oedema and the influence of comorbidities in the development of POCD. In the light of available evidence, there is no substantial difference between the cognitive outcomes of various types of cardiac surgery. Recent studies show that POCD in this clinical setting is mostly mild and transient. There are, however, patients who suffer from persisting POCD. Modern medicine has not developed standards for treatment of this complication. Setting up methods for prevention, detection and treatment of POCD should be the concern of both physicians and researchers in the following years.

Polish validation of the TEMPS-A: the profile of affective temperaments in a college student population.

BACKGROUND AND AIMS: The TEMPS-A scale is a self-evaluation measure to assess five affective temperaments: depressive, cyclothymic, hyperthymic, irritable and anxious. The scale has already been validated in over 10 languages. In this paper, the first report on the validation of the Polish version of TEMPS-A is presented. METHODS: The TEMPS-A questionnaire version that includes 110 questions has been adapted following the translation-back translation methodology from English to Polish, checked by the originators of the five scales (H.S.A., K.K.A.). In the next step, the Polish version of TEMPS-A was administered to 521 Polish undergraduate students. Internal consistency of temperamental scales was measured with Cronbach-alpha coefficients. Correlation among the temperaments was examined using Pearson's bivariate correlation. Differences between sexes were tested with ANOVA. RESULTS: The Cronbach-alpha and the Kuder-Richardson 20 reliability coefficients for the depressive, cyclothymic, hyperthymic, irritable and anxious temperaments were between 0.69 and 0.83. The percentage of subjects whose Z-scores were above 2 SD, was the highest among depressive (4%) and anxious (3.5%) temperaments, followed by the cyclothymic (2.9%), hyperthymic (1%), and irritable (0.6%). The strongest positive correlations between the temperamental scales were found between depressive and anxious, as well as between cyclothymic and irritable ones (correlation coefficients 0.63 and 0.57, respectively). Male subjects attained significantly higher scores for hyperthymic temperament, compared to females, while females scored significantly higher than males on cyclothymic and anxious temperaments. LIMITATIONS: Our healthy young subjects are not representative of the Polish population. As external validation has been achieved in other language versions, it was not repeated in the present Polish version. CONCLUSIONS: The Polish version of TEMPS-A has a good internal consistency. The findings generally cohere with those from previously validated versions in other languages.

The Wisconsin Card Sorting Test and the N-back test in mild cognitive impairment and elderly depression.

The aim of this study was to assess cognitive functions in 30 non-depressed patients with mild cognitive impairment (MCI), compared with 30 age-, gender- and education-matched patients with acute depressive episode, and with 30 healthy subjects. Neuropsychological assessment included the Mini Mental State Examination (MMSE), memory tests as well as the Wisconsin Card Sorting Test (WCST) and the N-back test. Patients with MCI obtained significantly worse results on all domains of the WCST and the N-back test compared to both depressed and healthy subjects. Depressed patients showed significantly worse performance than controls on most scores. In the MCI group, no association with MMSE was found with any of WCST domains, or with reaction time in the N-back test. Three tests, WCST-P, N-back %CORR and WCST 1st CAT obtained highest ranks (>90) as predictors for differentiating between groups. The results suggest a usefulness of employing WCST and N-back tests for a neuropsychological evaluation of patients with MCI.

[Neuropsychiatric adverse events in patients with chronic hepatitis C treated with pegylated or recombinant interferon-alpha]. / Neuropsychiatryczne skutki uboczne u chorych z przewleklym zapaleniem watroby typu C leczonych pegylowanym lub rekombinowanym interferonem-alfa.

UNLABELLED: The aim of the study was an assessment of the incidence and types of neuropsychiatric serious adverse events (NSAE) in patients with compensated chronic hepatitis C (CHC) treated with recombinant or pegylated interferon-alpha (IFN-alpha) plus ribavirin (RBV). METHOD: NSAE were defined as neuropsychiatric consequences of IFN-alpha+RBV therapy that resulted in discontinuation therapy or initiation of disorders requiring hospitalization or chronic neuropsychiatric treatment. A group of 273 patients (144 males and 129 females, mean age 41) without significant past psychiatric and neurological disorders was prospectively observed. Of them 89 patients were treated with recombinant IFN-alpha+RBV. Both subgroups did not differ with regard to demographic or hepatological parameters. RESULTS: Overall NSAE were present in 13 patients (4.8% of the sample): psychiatric SAE emerged in 10 patients and 3 patients suffered from neurological SAE. NSAE emerged in nine patients treated with recombinant IFN-alpha and in four patients treated with pegylated IFN-alpha (p=0.03). CONCLUSIONS: NSAE in CHC patients during IFN-alpha+RBV therapy occur rarely. However, potentially severe neuropsychiatric consequences of the treatment in some patients indicate the need for neuropsychiatric monitoring during the therapy. Treatment with pegylated IFN-alpha may be associated with less neuropsychiatric SAE than treatment with recombinant IFN-alpha in patients with compensated CHC.

[Influence of anitiretroviral therapy on bone tissue metabolism in patients with HIV]. / Wplyw terapii antyretrowirusowej na metabolizm tkanki kostnej u pacjentów zakazonych HIV.

The use of antiretroviral therapy has resulted in reduction in HIV related morbidity and mortality but antiretroviral treatment have been associated with long term toxicities. High prevalence of premature osteopenia, osteoporosis and osteonecrosis have been recently detected in patients infected with HIV. The pathogenesis of this bone disorders is still unclear and probably multifactoral. Earlier studies have implicated specific antiretroviral medications as causative factors in the development of osteopenia. Patients not receiving antiretrovirals also have a higher than expected prevalence of reduced BMD, which suggests that HIV itself may be a contributing factor, mediated by immune activation and cytokines. Improved understanding of the pathogenesis of these bone disorders should result in better prevention and treatment.

[The study of the prevalence of depressive disorders in primary care patients in Poland]. / Badanie rozpowszechnienia zaburzen depresyjnych u pacjentów podstawowej opieki zdrowotnej w Polsce.

UNLABELLED: Studies performed in recent years in different countries suggest a considerable prevalence of depressive disorders in primary care patients. The aim of our study was the assessment of depressive disorders among primary care patients in Poland. MATERIAL AND METHODS: Three-hundred thirty-three randomly chosen private and public primary care clinics from the whole country took part in the study. In each centre, 20 or 25 patients aged 18-65 years coming for a regular visit were asked to participate in the study. All patients filled in the Beck Depression Inventory (BDI). Additionally, basic demographic data and information on the presence of chronic somatic diseases were collected. Those patients who scored 12 or more points on BDI (cut-offpoint for depression in Poland) were evaluated by a primary care physician for presence of a depressive disorder upon the ICD-10 criteria and subsequently referred for a psychiatric consultation to the nearest psychiatric outpatient clinic for establishing plausible diagnosis of depression. RESULTS: Out of 7360 patients approached, 7289 (95.5%) agreed to participate. The mean age of the sample was 43.3 +/- 13.2 and 71% were females. Forty one percent of patients (2985) had 12 or more points on the BDI and were referred for a psychiatric evaluation. Only half of them came for a psychiatric consultation. Depressive disorder was recognised in 906 patients. Estimated prevalence of depressive disorders in the whole sample was 23.3%. The patients in whom depressive disorders were confirmed by psychiatric assessment had significantly more often hypertension, ischaemic heart disease, anaemia, stroke and hypothyroidism. CONCLUSIONS: The results obtained show that depressive disorders' prevalence in primary care patients in Poland is significant. The patients who had depressive disorders significantly more often than patients without depression suffered from some somatic diseases. In light of the results, both recognition and adequate treatment of depressive disorders in primary care patients should be regarded as equally important as the recognition and treatment of cardiovascular diseases or other common somatic illnesses.

Long-term administration of the low-dose risperidone in schizotaxia subjects.

The term schizotaxia is currently defined as a syndrome of neuropsychological deficits and negative symptoms found in relatives of schizophrenic patients. The aim of this study was to assess the effect of long-term treatment with the low-dose risperidone on cognitive and social functioning in seven schizotaxia patients. There were four males and three females, aged between 17 and 44 years, first-degree (four patients) or second-degree (three patients) relatives of schizophrenic patients. Schizotaxia was recognized in them on account of neuropsychological and social function impairment. They all consented to risperidone administration, 1-2 mg/day. Duration of risperidone treatment has ranged between 3-7 years. In all subjects, the continuous treatment with risperidone brought about a marked improvement in their cognitive, social, and vocational functioning. Neuropsychological testing after 6-24 months showed significant improvement on such tests as Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Stroop Test. Discontinuation of treatment after 3-4 years did not cause deterioration of functioning.

Enhancing effect of mirtazapine on cognitive functions associated with prefrontal cortex in patients with recurrent depression.

INTRODUCTION: We put forward a hypothesis that a therapeutic administration of mirtazapine to depressed patients, due to pharmacological profile of the drug, could enhance cognitive functions associated with prefrontal cortex activity. METHODS: The study was performed on depressed patients receiving mirtazapine for the period of 6 months. Neuropsychological assessments after 3 and 6 months of treatment were performed by the Wisconsin Card Sorting Test, N-back test, TMT and Stroop tests. RESULTS: During acute depressive episode, a significant impairment on all neuropsychological tests was evident. Substantial improvement in performance has been noted after 3 and 6 months of mirtazapine treatment, and, after 6 months, a majority of the investigated patients achieved the results within the range of matched healthy control subjects. Improvement on neuropsychological tests after treatment with mirtazapine showed no correlation with the degree of amelioration of depression. DISCUSSION: Mirtazapine may exert a favorable influence on cognitive functions associated with prefrontal cortex in depressed patients. The lack of direct correlation with improvement of depressive symptoms suggests that mirtazapine may possess specific pro-cognitive properties.

[Prevalence of depressive disorders among perimenopausal women seeking gynecological services]. / Rozpowszechnienie zaburzen depresyjnych wsród kobiet w wieku okolomenopauzalnym zglaszajacych sie do lekarzy ginekologów.

AIM: The aim of the study was to evaluate the prevalence of depressive disorders in perimenopausal women reporting to gynecologists and to assess a possibility of screening and diagnosing depression in gynecological practice. METHOD: The study entailed 2262 female patients of the age of 45-55 attending 120 gynecologists in Poland. Patients were first asked to fill in the Beck's Depression Inventory and next examined by their gynecologists to verify the presence of the basic symptoms of depressive episode according to ICD-10 diagnostic criteria. Patients who obtained 12 points or more in BDI total score were referred for a psychiatric consultation, including the MINI questionnaire. The study was monitored by 'Servier Polska'. RESULTS: 32.5% of women aged 45-55 years visiting gynecologists scored 12 points or more on the BDI scale. Patients with high BDI scores reported long-lasting somatic and emotional symptoms associated with menopause more frequently than patients with low BDI scores. Women with high BDI scores also more frequently experienced gynecological surgery in the past, more frequently attended gynecological clinics, and reported more peri- and postmatal mood disorders. 57% of patients did not visit psychiatrists. Depressive disorders were diagnosed in 76% of patients who came for the psychiatric evaluation. CONCLUSIONS: The study suggests that more than 19% of perimenopausal women attending their gynecologists suffer from depressive disorders. Gynecologists in Poland can diagnose depression accurately and start pharmacological treatment of the disorder in half of the patients.