Morphological changes of the brain in mood disorders. / Zmiany morfologiczne mózgu w zaburzeniach nastroju.

Brain morphological changes in affective disorders occur mainly in the fronto-limbic cortex, hippocampus and amygdala - the structures regulating emotional and cognitive functioning, as well as development of somatic symptoms in the course of disorders. The largest number of reports of structural changes in the cerebral cortex include the dorsolateral prefrontal cortex, the orbitofrontal cortex and the anterior cingulate cortex. The results of neuroimaging and sectional studies reveal changes in the volume of structures involved in the creation of neuronal circuits that affect development of mood disorders. Microscopic studies show changes in cell count, density, and morphology in these areas. Some of those changes are observed only in certain layers of the cerebral cortex. A valuable addition to this data are histochemical studies of neuronal survival markers, proinflammatory cytokines, trophic factors, and markers specific for particular cellular structures. The role of monoaminergic, GABA-ergic and glutamatergic neurotransmission is confirmed by the studies on concentration of neurotransmitters, their receptors and transporters. Some of the results correlate quantitatively with the type and severity of symptoms, duration of the disorder, as well as pharmacotherapy and nonpharmacological treatment.

Neurobiological Effects of Binge Drinking Help in Its Detection and Differential Diagnosis from Alcohol Dependence.

The prevalence of binge drinking in the general population is 3-4 times higher than that of alcohol dependence. Neuroimaging studies show that binge drinking in adolescence impairs brain development and white matter integrity. Regions with reduced functional activity include the limbic system, ventral diencephalon, frontal lobe, and middle and inferior temporal lobes, whereas the right superior frontal and parietal lobes are typically hyperactivated. The observed activation of the frontoparietal areas might reflect the alternative memory system operating, whereas the reduced occipito-hippocampal response is associated with impaired visual and linguistic processing/learning. Some other findings from literature research include a decrease of N-acetylaspartate (NAA) in the frontal lobe and its increase in the parietal lobes, as well as the reduced components of event-related potentials, reflecting deficit in attention, working memory, inhibition, and executive functioning. Animal studies show that even a single day of binge drinking results in a neurodegeneration and reactive gliosis in the limbic cortex as well as in gene expression dysregulation and histone acetylation. Another biological evidence on binge drinking effect include inflammatory response, oxidative stress, formation of toxic ceramides, activation of caspase 3, and secretion of corticoliberin. Some of the binge drinking-induced cognitive abnormalities can be reversible after three weeks of abstinence. Although binge drinkers have a similar pattern of neuropsychological deficits with chronic alcohol consumers (mainly memory deficits), binge drinkers have prominent impairment of inhibitory control, which may be a marker of binge pattern of alcohol drinking. The optimal therapeutic strategies should target the inhibitory control processes to facilitate discontinuation of alcohol consumption and to block its possible progression to the alcohol dependence syndrome.

The reasons for use of cannabinoids and stimulants in patients with schizophrenia. / Przyczyny zazywania kannabinoidów i substancji psychostymulujacych u pacjentów ze schizofrenia.

OBJECTIVES: Both cannabinoids and psychoactive substances from the group of stimulants can have a significant effect on the induction, course and treatment of severe mental illness. They also can be treated as self-medication. Many patients feel subjective benefits of using psychoactive substances in the areas of social competence, to cope with side effects of neuroleptics, stress accompanying mental illness or to control its symptoms. Our research tries to explain the causes of taking psychoactive substances by patients with schizophrenia. METHODS: A total of 50 schizophrenia patients using cannabinoids, including 25 of them using also stimulants, took part in our research. They filled out questionnaires about the causes of drug use and subjectively perceived mental complaints. We analyzed medical documentation. RESULTS: It was found that subjects using both cannabinoids and stimulants pointed to spirituality as a cause significantly more often than subjects taking only cannabinoids. Marijuana and hashish were significantly more often taken to improve social relations. In both groups, the most common reasons were: curiosity, the need to relax, problem solving, improving relationships, and remedy for 'shyness'. In the group using only cannabinoids, it was observed that people who felt misunderstood often smoked marijuana to solve problems. Individuals using stimulants often complained of poor concentration. CONCLUSIONS: Ignorance of the consequences of using psychoactive substances in people at risk of schizophrenia or in those already ill is an additional risk factor. The results may indicate an increased demand for psychoeducation and social support regarding many areas of life of patients suffering from schizophrenia.

Association between serum testosterone levels, body mass index (BMI) and insulin in male patients with schizophrenia treated with atypical antipsychotics--olanzapine or risperidone.

OBJECTIVE: A sufficient amount of testosterone (T) is essential for adequate sexual functioning but also for cognitive and psychological well-being. Most recent studies have demonstrated that higher BMI and other symptoms of metabolic syndrome are associated with alterations in sex steroid hormone concentrations. Although, neuroleptics are known to cause a significant and sustained weight excess, the relationships between body mass index and the level of testosterone in psychiatric patients have not been thoroughly studied. The main purpose of the present study was to examine the correlations between testosterone, estradiol BMI, and insulin in male patients diagnosed with schizophrenia and treated with olanzapine or risperidone. METHODS: The study included 78 males diagnosed with schizophrenia according to the DSM-IV diagnostic classification hospitalized in psychiatric inpatient units (42 on risperidone and 36 on olanzapine). The initial and final evaluation of testosterone (T), estradiol, prolactin (PRL) and insulin serum levels were performed at week 3 and 8 after the onset of the new treatment, respectively. RESULTS: At week 3, the mean serum prolactin was markedly higher, whereas testosterone level was lower in risperidone patients compared to those treated with olanzapine. T level was negatively affected by the studied medication (risperidone), increased prolactin and a higher BMI. At week 8, the mean serum prolactin level was markedly higher in risperidone patients. Higher values of BMI and serum insulin were the most prominent factors independently associated with decreased plasma testosterone levels at that measurement point. Individual changes of T level between week 3 and 8 were positively correlated with the corresponding changes in estradiol levels. CONCLUSIONS: T serum levels appear to be independently linked with BMI, insulin and prolactin in both investigated neuroleptics. Further research is needed to elucidate the relationship between reproductive hormones and metabolic parameters in patients with schizophrenia under neuroleptic treatment.

[Psychoactive plant species--actual list of plants prohibited in Poland]. / Roslinne srodki odurzajace--aktualnie obowiazujaca lista w Polsce.

According to the Act on Counteracting Drug Addiction (20-th of March, 2009, Dz. U. Nr 63 poz. 520.) the list of federally prohibited plants in Poland was expanded to include 16 new species. Until that time the only illegal plant materials were cannabis, papaver, coca and most of their products. The actual list of herbal narcotics includes species which significantly influence on the central nervous system work but which are rarely described in the national literature. The plants usually come from distant places, where--among primeval cultures--are used for ritual purposes. In our civilization the plants are usually used experimentally, recreationally or to gain particular narcotic effects. The results of the consumption vary: they can be specific or less typical, imitate other substances intake, mental disorders or different pathological states. The plant active substances can interact with other medicaments, be toxic to internal organs, cause serious threat to health or even death. This article describes the sixteen plant species, which are now prohibited in Poland, their biochemical ingredients and their influence on the human organism.

[Quality of life, depression and anxiety symptoms in patients with chronic rhinosinusitis with polyps treated by endoscopic sinus surgery]. / Jakosc zycia oraz objawy depresyjne i lekowe u chorych leczonych metoda endoskopowa z powodu przewleklego zapalenia blony sluzowej nosa i zatok z polipami.

UNLABELLED: Chronic somatic diseases, including chronic rhinusitis, often correlate with symptoms of depression, anxiety and with quality of life deterioration. The aim of the study was to evaluate depression and anxiety symptoms, as well as quality of life of patient with chronic rhinosinusitis before and after surgery. MATERIAL AND METHODS: The group of 20 patients was included into the study. Patients were examined twice: before and 6 months after surgery. Depression and anxiety were assessed by the means of Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Quality of life was assessed by the means of WHOQOL-100 questionnaire. Intensity of somatic symptoms was measured with VAS scale. RESULTS: Before surgery patients demonstrated frequent symptoms of depression and anxiety. Depression and anxiety intensity correlated significantly with somatic symptoms measured with VAS scale. After surgery depression and anxiety rates decreased, BDI and HADS scores significantly decreased as well. Quality of life in WHOQOL-100 scale significantly improved. CONCLUSIONS: Chronic rhinosinusitis coexists with symptoms of anxiety and mild depression. Proper surgical treatment and somatic state amelioration are related with mental state and quality of life improvement.

Sibutramine-induced mania as the first manifestation of bipolar disorder.

BACKGROUND: Sibutramine, used in obesity treatment, has been associated with many neuropsychiatric side effects including hypomanic and manic episodes. Hypomanic/manic episodes related to sibutramine treatment were earlier reported in patients who had previous history of bipolar disorder, after sibutramine overdose, after over-the-counter product illegally containing very high dose of sibutramine, together with psychotic symptoms, in organic patient, or after interaction of sibutramine with other drugs. CASE PRESENTATION: We report the first case of a patient with clear manic episode, after treatment with recommended dose of sibutramine, without previous history of mood disorders, organic changes or drug interactions, that was followed by episode of depression. CONCLUSION: Minimal recommended dose of sibutramine induced manic episode that was the first manifestation of bipolar disorder. The manic episode, associated with sibutramine treatment, was induced in a person without previous history of mood disorders. Potential risks associated with the treatment of obesity using sibutramine warn physicians to be alert not only to common and cardiovascular but also to psychiatric adverse effects. A careful assessment of patient's mental state and detailed psychiatric family history should be done before sibutramine treatment. In patients with a family history for bipolar disorder the use of even minimal dose of sibutramine should be contraindicated.