Disability and emotional symptoms in women with lipedema: A comparison with overweight/obese women.

BACKGROUND: Lipedema is characterized by the painful abnormal deposition of adipose tissue in the lower limbs and is often misdiagnosed as obesity. Considering the numerous bothersome physical symptoms of lipedema, women with lipedema may have greater disability and emotional problems than women with lifestyle-induced obesity. OBJECTIVES: Our study aims to assess disability, anxiety and depression symptoms in women with lipedema compared to women with overweight/obesity. MATERIAL AND METHODS: Women with lipedema (n = 45, with a mean age of 41 years) and women who are overweight/obese (n = 43, with a mean age of 44.95 years) were asked to complete the following questionnaires: The World Health Organization Disability Assessment Schedule (WHO-DAS II), Beck's Depression Inventory - II (BDI-II), and The Hospital Anxiety and Depression Scale (HADS). RESULTS: Despite the higher BMI in the overweight/obesity group, the group with lipedema was more disabled in numerous domains of the WHO-DAS II questionnaire, including Life activities - domestic, work and school responsibilities and Participation in society When the influence of BMI was adjusted, a difference in the domain of Mobility was also present. The study groups did not differ in anxiety and depression symptoms. CONCLUSIONS: We showed that behavioral impairment was the main factor affecting functioning in women with lipedema. Emotional symptoms did not differentiate the study groups. Leg volumes and adipose tissue pain intensity were associated with greater disability in women with lipedema, and should be considered in managing women with this condition and in future research estimating the effectiveness of lipedema treatment.

The Severity of Depressive Symptoms as an Independent Predictor of Sustained Virological Response During Treatment of Hepatitis C With Pegylated Interferon-α2a and Oral Ribavirin.

BACKGROUND: Sustained virological response (SVR) is the best indicator of successful therapy for hepatitis C virus (HCV) infection. Patients with chronic HCV infection treated with pegylated interferon-α and ribavirin (PEG-IFN-α/RBV) can achieve SVR 56% of the time. OBJECTIVES: This study aimed to evaluate baseline predictors of SVR in patients treated with PEG-IFN-α/RBV for HCV chronic infection. METHODS: A total of 101 patients receiving PEG-IFN-α/RBV for chronic HCV infection participated in the prospective cohort study. Symptoms of depression were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) before the treatment. The multivariate regression analysis was applied to determine predictors of SVR. RESULTS: Of a total of 101 patients included, 99 patients reached the primary end point-24 weeks after completing treatment. After the initial analysis of probable predictive variables, the logistic analysis included age, sex, HCV genetic type, and MADRS score. The HCV genotype (odds ratio = 0.22 [confidence interval = 0.073-0.68, p = .008) and MADRS score (OR = 0.88 [confidence interval = 0.80-0.98), p = .013]) predicted an SVR outcome. CONCLUSIONS: The severity of depressive symptoms before treatment and HCV genotype are independent predictors of SVR.

Polish Adaption of Pregnancy-Related Anxiety Questionnaire - Revised 2 (PRAQ-R2). / Polska adaptacja Pregnancy-Related Anxiety Questionnaire ­ Revised 2 (PRAQ-R2).

AIM: To create a Polish adaption of the Pregnancy-Related Anxiety Questionnaire - Revised 2 (PRAQ-R2), which is widely used abroad. METHODS: PRAQ-R2 was translated into Polish by independent bilingual speakers. Fortyeight pregnant women completed our survey containing the Polish version of PRAQ-R2, Hospital Anxiety and Depression Scale - Modified (HADS-M), and a short sociodemographic questionnaire. After a week, they were asked to complete the PRAQ-R2 questionnaire again. Parametric statistics were used to assess psychometric properties. RESULTS: Our study has shown a good test-retest correlation of 0.70. Participants completed the survey twice (in t1 and after one week - in t2). Cronbach's alpha was calculated as 0.847 at t1 and 0.895 at t2. There was a moderate correlation between PRAQ-R2 at both time points and the HADS-M scale and its subscales. CONCLUSIONS: Our Polish adaption of PRAQ-R2 has shown good validity and reliability. It has good internal consistency. Moderate correlation with HADS-M proves that pregnancyrelated anxiety (PrA) is a distinctive disorder from generalized anxiety disorder and depressive disorder. Given the great frequency and the burden of PrA, we believe that PRAQ-R2 should be routinely used among physicians working with pregnant patients.

HTR1A, TPH2, and 5-HTTLPR Polymorphisms and Their Impact on the Severity of Depressive Symptoms and on the Concentration of Tryptophan Catabolites during Hepatitis C Treatment with Pegylated Interferon-α2a and Oral Ribavirin (PEG-IFN-α2a/RBV).

BACKGROUND: Seeing that there are no data about associations between serotonin gene polymorphism and tryptophan catabolite concentration during PEG-IFN-α2a treatment, the aim of the current study is to examine (a) the associations between polymorphisms within the HTR1A, TPH2, and 5-HTT genes and the severity of depression symptoms and (b) the relationships among rs6295, rs4570625, and 5-HTTLPR rs25531polymorphisms and indoleamine 2,3-dioxygenase (IDO) activity, as well as kynurenine (KYN), tryptophan (TRP), kynurenic acid (KA), and anthranilic acid (AA) concentrations. MATERIALS AND METHODS: The study followed a prospective, longitudinal, single-center cohort design. The severity of the depressive symptoms of 101 adult patients with chronic HCV infections was measured during PEG-IFN-α2a/RBV treatment. We used the Montgomery-Åsberg Depression Rating Scale (MADRS) to assess the severity of depressive symptoms. The subjects were evaluated six times-at baseline and at weeks 2, 4, 8, 12, and 24. At all the time points, MADRS score, as well as KYN, TRP, KA, and AA concentrations, and IDO activity were measured. At baseline, rs6295, rs4570625, and 5-HTTLPR rs25531polymorphisms were assessed. RESULTS: Subjects with C/C genotypes of 5-HT1A and lower-expressing alleles (S/S, LG/LG, and S/LG) of 5-HTTLPR scored the highest total MADRS scores and recorded the highest increase in MADRS scores during treatment. We found associations between TRP concentrations and the TPH-2 and 5-HTTLPR rs25531 genotypes. CONCLUSIONS: Our findings provide new data that we believe can help better understand infection-induced depression as a distinct type of depression.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond.

OBJECTIVE: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. METHODS: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. RESULTS: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. CONCLUSION: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

Stress level and general mental state in Polish pregnant women during COVID-19 pandemic.

INTRODUCTION: COVID-19 pandemic may contribute to mental state worsening. Mental health disorders in pregnancy are known to have adverse outcomes both for mothers and their children. It is the first study in Poland to investigate the impact of the pandemic on stress level and general mental state in pregnant women. METHODS: Three hundred sixteen pregnant women completed an online survey containing four instruments. The main research questions were investigated with Bayesian regression analyses. RESULTS: We found that 37% of pregnant women presented with some mental state disorders and almost 46% with elevated emotional tension. Seventeen % had elevated stress level, 11% elevated intrapsychic stress level and 13% elevated outward stress level. Both 'being scared of lack of social support...' and 'being scared of infection...' have an impact on stress level, however the first factor is a more substantial stressor. CONCLUSIONS: Multiple pregnant women during the Coronavirus SARS-CoV-2 pandemic presented with mental state disorders and elevated stress levels. As mental state disorders contribute to adverse neonatal outcomes and maternal mortality, it is imperative to focus on pregnant women's psychological and psychiatric conditions during the pandemic. It seems crucial to use screening tests to make early psychiatric diagnoses.

The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder.

BACKGROUND: Anxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure. OBJECTIVES: The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals. METHODS: The study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method. RESULTS: Mean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control). CONCLUSIONS: The patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.

High-frequency changes in single-trial visual evoked potentials for unattended stimuli in chronic schizophrenia.

BACKGROUND: Patients with schizophrenia reveal changes in information processing associated with external stimuli, which is reflected in the measurements of brain evoked potentials. We discuss actual knowledge on electro- (EEG) and magnetoencephalographic (MEG) changes in schizophrenia. NEW METHOD: The commonly used averaging technique entails the loss of information regarding the generation of evoked responses. We propose a methodology to describe single-trial (non-averaged) visual evoked potentials (VEP) using spectral and statistical analyses. We analysed EEG data registered in the O1-Cz and O2-Cz leads during unattended pattern-reversal stimulation, collected from a group of adult patients with chronic schizophrenia, and compared them to those of healthy individuals. Short-time single-trial VEP were transformed to the frequency domain using the FFT algorithm. Changes of the spectral power were visualized using spectrograms which were created by stacking single-trial spectra across all trials. Measures of the absolute and the relative spectral power were calculated and compared statistically. RESULTS: In schizophrenia, the energy density of VEP oscillations is shifted towards higher (gamma) frequencies, compared to healthy individuals. These differences are statistically significant in all analysed frequency bands for the relative power. This indicates distorted early processing of visual stimuli in schizophrenia. COMPARISON WITH EXISTING METHODS: The main advantage of the presented methodology is its simplicity and ease of interpretation of obtained results. The presented observations complement the knowledge on gamma oscillations acquired from computationally more complex methods of time-frequency analysis. CONCLUSIONS: High-frequency changes for single-trial VEPs are detected in chronic schizophrenia.

Biological factors and consequences of pregnancy-related anxiety - What do we know so far? / Czynniki biologiczne i skutki zaburzen lekowych specyficznych dla ciazy ­ aktualny stan wiedzy.

This review aims to sum up the current knowledge about biological factors of pregnancy related anxiety (PrA) and the most common consequences for both mother and child, thereby identifying the most crucial concerns and suggesting the course of further research in this field. We pursued a literature review using PubMed. Scientists have shown a significant connection between prenatal anxiety and hormonal changes. These alterations include HPA-axis regulation, thyroid function, oxytocin, prolactin, and progesterone levels. PrA is proven to be a multifactorial condition. Several psychological factors correlate with it, e.g., insufficient social support, unplanned pregnancy, lack of physical activity, and a high level of distress. Although pregnancy is a significant change in one's life and may be a stressful event, it seems inadequate to believe that clinically relevant prenatal anxiety should be explained only by these psychological factors. Pregnancy-related anxiety is a common mental health disorder in pregnancy, and further studies are needed to minimize the risk of its severe consequences.

The relationship between panic disorder and hypertension. A review of literature. / Zwiazek pomiedzy zaburzeniem lekowym z napadami leku a nadcisnieniem tetniczym. Przeglad pismiennictwa.

About 1/4 of the world's adult population suffers from hypertension. Due to the high prevalence of the disease, its impact on mortality and socio-economic costs, it is important to search for modifiable causes of its development. This review analyses studies in order to answer the question: Is there a higher prevalence of panic disorder in adults (≥18 years of age) with hypertension, than in normotensive group? There have been found 10 cross-sectional studies describing correlation between hypertension and panic disorder. Odds ratio for this two clinical entities ranged from OR = 3.31 (2.99-3.67) to OR = 1.19 (0.87-1.62). Moreover, frequency of coincidence of those two clinical entities was found between 4.2% and 18.75%. In the prospective studies there have been found a positive association between panic disorder and subsequent life-long development of hypertension OR= 1.7 (1.4-2.0). On the other hand, association between hypertension and subsequent development of panic disorder in the 12-months observation was OR = 3.23 (1.51-6.93), but in 3 years of observation it was insignificant OR = 1.12 (0.80-1.57). Based on the literaturereview, dueto the differences in methodology and the small number of prospective studies, it can only be suggested to clinicians that in some cases they should search for panic disorder in patients with hypertension, especially paroxysmal one.

The role of anthranilic acid in the increase of depressive symptoms and major depressive disorder during treatment for hepatitis C with pegylated interferon-α2a and oral ribavirin.

Background: Tryptophan metabolism via the kynurenine pathway is considered the link between the immune and endocrine systems. Dysregulation of serotonergic transmission can stem from the direct influence of interferon-α on the activity of serotonergic receptors 5-HT1A and 5-HT2A, and from its indirect effect on tryptophan metabolism. Induction of the kynurenine pathway increases the concentration of neurotoxic kynurenine metabolites, and the activity of kynurenine derivatives is linked to the onset of depression. The aim of our study was to evaluate the relationships between depressive symptoms and kynurenine, tryptophan, anthranilic acid and kynurenic acid concentrations, indolamine 2,3-dioxygenase (IDO) activity and tryptophan availability to the brain. Methods: The study followed a prospective longitudinal cohort design. We evaluated 101 patients with chronic hepatitis C who were treated with pegylated interferon-α2a, and 40 controls who were awaiting treatment. We evaluated the relationships between total score on the Montgomery-Åsberg Depression Rating Scale and kynurenine, tryptophan, anthranilic acid and kynurenic acid concentrations, IDO activity and tryptophan availability to the brain. A logistic regression model was adapted for the diagnosis of major depressive disorder at each time point, taking into account changes in parameters of the kynurenine pathway between a given time point and the baseline measurement. Results: Of the treated patients, 44% fulfilled the criteria for major depressive disorder at least once during the 24 weeks of treatment. Anthranilic acid concentrations were significantly increased compared to baseline for all time points except week 2. Tryptophan availability showed a significant decrease (ß = -0.09, p = 0.01) only in week 12 of treatment. Over time, kynurenine, tryptophan and anthranilic acid concentrations, as well as IDO activity and tryptophan availability to the brain, were significantly associated with total score on the Montgomery-Åsberg Depression Rating Scale. A logistic regression model revealed that participants with decreased tryptophan availability to the brain at 12 weeks of treatment and participants with increased anthranilic acid concentrations at week 24 of treatment were at increased risk for diagnosis of major depressive disorder (odds ratios 2.92 and 3.59, respectively). Limitations: This study had an open-label design in a population receiving naturalistic treatment. Conclusion: The present study provides the first direct evidence of the role of anthranilic acid in the pathogenesis of inflammation-induced major depressive disorder during treatment for hepatitis C with pegylated interferon-α2a.

Quantitative magnetic resonance assessment of brain atrophy related to selected aspects of disability in patients with multiple sclerosis: preliminary results.

PURPOSE: The aim of this volumetric study was to evaluate the relationship between brain atrophy quantification in multiple sclerosis (MS) patients and the progression of disability measured by neurological standardised tests. MATERIAL AND METHODS: Seventeen patients (mean age 40.89 years) with clinically definite MS and 24 control subjects (mean age 38.45 years) were enrolled in the study. Brain examinations were performed on a 1.5T MR scanner. Automatic brain segmentation was done using FreeSurfer. Neurological disability was assessed in all patients in baseline and after a median follow-up of two years, using EDSS score evaluation. RESULTS: In MS patients we found significantly (p < 0.05) higher atrophy rates in many brain areas compared with the control group. The white matter did not show any significant rate of volume loss in MS patients compared to healthy controls. Significant changes were found only in grey matter volume in MS subjects. At the follow-up evaluation after two years MS patients with deterioration in disability revealed significantly decreased cerebral volume in 14 grey matter areas at baseline magnetic resonance imaging (MRI) compared to MS subjects without disability progression. CONCLUSIONS: Grey matter atrophy is associated with the degree of disability in MS patients. Our results suggest that morphometric measurements of brain volume could be a promising non-invasive biomarker in assessing the volumetric changes in MS patients as related to disability progression in the course of the disease.

Evaluation of brain volume alterations in HCV-infected patients after interferon-free therapy: A pilot study.

The study was performed to evaluate cerebral volume changes in HCV-infected subjects before and after interferon-free therapy with direct-acting antiviral agents (DAA). We aimed also to estimate the impact of successful DAA therapy on the neuropsychological state of patients. Eleven HCV genotype 1 (GT1) patients treated with ombitasvir/paritaprevir (boosted with ritonavir) and dasabuvir, with or without ribavirin underwent brain magnetic resonance (MR) before and 24 weeks after completion of therapy. All patients achieved sustained viral response. Precise automatic parcellation was made using the fully-available software FreeSurfer 6.0. Statistically significant volume deceleration six months after treatment was found in the subcallosal cingulate gyrus, transverse frontopolar gyri and sulci, anterior segment of the circular sulcus of the insula and horizontal ramus of the anterior segment of the lateral sulcus. After DAA therapy we found statistically significant improvement in the performance of all three tasks of the Rey Complex Figure Test that permits the evaluation of different functions (attention, planning, working,memory). Additionally, significant amelioration in Percentage Conceptual Level Responses in The Wisconsin Card Sorting Test (a neurocognitive test for assessing intellectual functioning) was also discovered. Successful interferon-free therapy may lead to transient cerebral atrophy, probably by reducing neuroinflammation and oedema. This is the first pilot study of the alterations in brain volume after successful interferon-free therapy in chronic HCV patients. Longitudinal follow-up study is needed to observe further effects of therapy on cerebral structures volume changes.

Biological and psychological components of depression in patients receiving IFN-alpha therapy for hepatitis C.

BACKGROUND: Depressive symptoms are frequent side effects of interferon α therapy (IFN-α). Both biological and psychological processes may occur concomitantly during hepatitis C treatment. OBJECTIVES: This study was carried out to determine the impact of biological (immune response) and psychological factors on formation of depressive symptoms and major depressive disorder (MDD) during hepatitis C treatment. MATERIAL AND METHODS: A total of 99 patients receiving pegylated IFN-α and ribavirin for chronic C type hepatitis participated in the prospective cohort study. Symptoms of depression were assessed with the MontgomeryÅsberg Depression Rating Scale (MADRS) during treatment and 24 weeks after treatment. Neuroticism was measured with the Eysenck Personality Questionnaire - Revised (EPQ-R/N). Diagnosis of MDD was made using the Present State Examination (PSE-10) and DSM-IV-TR criteria. Factor analysis was used to detect factors adding up to total severity of depressive symptoms. Predictors of MDD were investigated using logistic regression analysis. RESULTS: Factor analysis returned 3 factors: 1st - MADRS scores at weeks 0-12, 2nd - MADRS and N scores before treatment, 3rd - MADRS at the 24th week of treatment and 24 weeks after treatment. The total severity of depressive symptoms consisted of 3 components: personality-related before treatment, IFN-α-related during treatment and dependent on the effect of treatment. Regression analysis showed that a history of psychiatric disorders (OR = 4.8) and MADRS scores before treatment (OR = 1.25) were predictors of MDD, as opposed to level of neuroticism. CONCLUSIONS: The severity of depressive symptoms and MDD during the hepatitis C treatment was related to general depressive vulnerability, not to psychological factors related to neuroticism.

Interferon-free therapy as the cause of white matter tracts and cerebral perfusion recovery in patients with chronic hepatitis C.

The purpose of this study was to assess cerebral microstructural and perfusion changes in patients with chronic hepatitis C virus (HCV) infection before and after interferon-free therapy, using advanced magnetic resonance (MR) techniques. Eleven HCV-positive patients underwent diffusion tensor imaging (DTI) and perfusion-weighted imaging (PWI) using a 1.5T MR unit, before and 24 weeks after completion of interferon-free therapy. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts. PWI values of relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed from 8 areas, including basal ganglia, and cortical and white matter locations. In HCV-positive patients therapy with ombitasvir, paritaprevir boosted with ritonavir and dasabuvir, with or without ribavirin, was scheduled. Cognitive tests were used to assess cognitive function. We found increased FA values after interferon-free therapy compared to values obtained before treatment in HCV patients in almost all white matter tracts. We also observed elevated rCBV values in basal ganglia after therapy. There were significant correlations between improvement in the score of cognitive tests and increased FA values in both inferior fronto-occipital fascicles and left posterior cingulum after treatment. Liver fibrosis regression in elastography, APRI and improvement in cognitive tests were observed. This is the first report of interferon-free therapy as the cause of white matter tracts recovery as well as cerebral perfusion improvement in HCV-infected patients, indicating better functioning of frontal lobes after interferon-free treatment.

Visual and brainstem auditory evoked potentials in HCV-infected patients before and after interferon-free therapy - A pilot study.

INTRODUCTION: The aim of this study was to investigate brain bioelectrical activity disturbances in HCV-positive patients before and 24 weeks after interferon-free therapy (DAA), using visual (VEP) and brainstem (BAEP) evoked potentials and advanced magnetic resonance techniques. MATERIALS AND METHODS: 11 HCV-infected patients (6 women, 5 men, mean age 51 years old) and 30 healthy controls, sex and age-matched, were studied. Clinical neurological examinations, VEP, BAEP, diffusion tensor imaging (DTI) and perfusion weighted imaging (PWI) were performed. RESULTS: 11 patients achieved a sustained viral response, and liver fibrosis regression in APRI and in elastography were observed. The mean P100 latency was significantly shorter in HCV-patients after therapy compared to the values before treatment (p<0.05). The mean wave BAEP V latency and I-V interpeak latency were significantly longer in the HCV-infected patients before therapy compared to HCV-patients after therapy. CONCLUSIONS: This study confirms that treatment with DAA in patients with chronic HCV infection positively affects the bioelectrical activity of the brain. An increase in the amplitude of EP after treatment indicates an improvement in the activity of the cerebral cortex. EP examination may be a useful method of assessing the function of the nervous system before and after antiviral treatment.

Alterations in the metabolism of tryptophan in patients with chronic hepatitis C six months after pegylated interferon-α 2a treatment.

BACKGROUND: Risk of depression and suicide in patients on interferon remains also after the treatment, the pathogenesis of which is still unclear. We aimed to determine the influence of the PEG-IFN-α2a on tryptophan metabolism along the kynurenine pathway during treatment and up to 6 months after the end of treatment. METHODS: We evaluated 101 patients with chronic hepatitis C treated with PEG-IFN-α2a, and 40 controls, so as to determine the activation of indolamine 2,3-dioxygenase (IDO) and tryptophan (TRP) and their metabolites' concentrations/levels: kynurenine (KYN), kynurenic acid (KYNA) and anthranilic acid (AA). The subjects were evaluated before and after weeks 2, 4, 8, 12, 24, 48, as well as 6 months after the end of the treatment. RESULTS: In the group of patients treated 24 weeks, six months after the end of treatment IDO activity was significantly higher compared to baseline (69.5 vs 57.2 ß = 0.21 P = 0.000); TRP concentration was significantly lower compared to baseline (30.0 vs 35.6 ß=-0.21 P = 0.001); KYNA concentration was significantly higher compared to baseline (37.2 nmol/L vs 29.4 nmol/L ß = 0.22 P = 0.02), and AA concentration was significantly higher compered to baseline (51.0 nmol/L vs 38.4 nmol/L ß = 0.22 P = 0.05) In the group of patients treated 48 weeks six months, after the end of treatment both the IDO activity and KYNA concentration were significantly higher compared to baseline (respective values - IDO: 78.8 vs 56.2 ß = 0.14 P = 0.02; KYNA: 39.2 nmol/L vs 27.0 nmol/L ß = 0.26 P = 0.000). CONCLUSIONS: This is the first report of a prolonged activation of IDO six months after the end of PEG-IFN-α2a treatment. The clinical significance of the finding can be implicated in the pathophysiology of depressive episodes.

The effects of short-term group psychodynamic psychotherapy on the personality traits of patients treated in a day ward. / Wplyw krótkoterminowej grupowej psychoterapii psychodynamicznej na cechy osobowosci pacjentów leczonych na oddziale dziennym.

OBJECTIVES: In the literature, there is no research that would indicate how a change in specific personality elements may affect the therapeutic effect of short-term group psychodynamic psychotherapy (STGP). The aim of the study was to evaluate the effect of short-term group psychodynamic psychotherapy on personality traits in apopulation of patients with neurotic and personality disorders in a day ward of neurosis treatment. METHODS: The study involved 139 people with anxiety and personality disorders, including 110 who participated in the control measurements. The dimensions of personality (neuroticism, extraversion, psychoticism, lie) were assessed on the basis of the Eysenck Personality Questionnaire (EPQ) adapted to the Polish conditions. The measurements were made at two time points: (1) before treatment, (2) after 12 weeks of treatment. RESULTS: During therapy the level of neuroticism, extraversion, psychoticism and lie did not change significantly in the group of neurotic patients. In the group of people with personality disorders, the level of neuroticism significantly decreased (p = 0.0008), whereas the level of extraversion increased (p = 0.037). The values for psychoticism and lie did not change significantly in the course of psychotherapy in any group of patients. CONCLUSIONS: The dynamics of changes in neuroticism and extraversion under the influence of short-term group psychodynamic psychotherapy (STGP) in a day ward of neurosis treatment seems to be an important marker for assessing the effectiveness of the treatment in people suffering from personality disorders. There is a need to develop more precise parameters for the assessment of recovery in the group of people with anxiety disorders.

Stage of liver fibrosis in patients with congenital bleeding disorders and infected with hepatitis C virus.

INTRODUCTION: Hepatitis C virus (HCV) is the major cause of chronic liver disease in patients with hemophilia. However, since liver biopsy should not be routinely used in these patients, the accurate assessment of the stage of fibrosis has been limited so far. OBJECTIVES: The aim of this study was to determine the stage of liver fibrosis in HCV­infected patients with hemophilia by using noninvasive methods of fibrosis assessment, and to analyze the influence of risk factors on liver fibrosis. PATIENTS AND METHODS: The study included 71 HCV­infected patients with hemophilia and other congenital bleeding disorders. Patients were divided into 3 groups: HCV-RNA negative after successful treatment, HCV-RNA negative after spontaneous elimination of infection, and HCV­RNA positive. Liver fibrosis was measured with shear wave elastography and FibroTest. The risk factors for liver fibrosis were analyzed, including demographic factors, HCV genotype, coinfections, and comorbidities. RESULTS: Cirrhosis or significant fibrosis (METAVIR score >F2) was observed in 26.8% of the patients. The stage of fibrosis was associated with age and estimated duration of infection (P <0.001). Active and past HBV infection did not affect fibrosis. The stage of liver fibrosis was lower in patients with spontaneous clearance of HCV (P = 0.007). CONCLUSIONS: Patients in our study had a similar stage of liver fibrosis to that reported by other studies on hemophilia. The older age and long duration of infection are the main risk factors for advanced fibrosis. Noninvasive methods such as shear wave elastography and FibroTest may allow a proper assessment of the fibrosis stage in hemophilia patients, particularly when used together and in correlation with other clinical parameters. They may also be useful in other groups of HCV­infected patients.

Assessment of body surface potential mapping in diabetic patients with recognized depression.

OBJECTIVES: Parameters of body surface potential mapping (BSPM) in DM II patients are significantly different comparing with healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM II patients with depression was tested in the present study. For this purpose, analysis of the relationship between the Int-QRST (isointegral) maps distribution and the depressive symptoms intensification, as well interrelation between depressive and diabetic symptoms were performed. MATERIAL AND METHODS: BSPM registrations were obtained from the three study groups (aged 37-52 years), namely 40 diabetic patients with clinically documented depression, 30 depressive patient without DM and 90 normal subjects. BSPM recordings were displayed in a form of the Int-QRST maps. Examination with BDI and HbA1c test were also performed in all investigated subjects. RESULTS: Isointegral QRST maps turned out to display abnormal, i.e. non-dipolar distribution. Moreover, extent of Int-QRST maps multipolarity increased in the examined diabetic patients along with DM II duration, BDI scores and HbA1c level. CONCLUSIONS: Non-dipolar distribution of Int-QRST maps, more pronounced in diabetic patients with depression, can be a specific indicator of the increased risk of severe ventricular arrhythmias occurring prior to abnormalities detectable on the standard 12-lead ECG recordings, which is of great importance especially in prevention of life-threatening arrhythmias.