Impact of lithium alone or in combination with haloperidol on oxidative stress parameters and cell viability in SH-SY5Y cell culture.

BACKGROUND: It has been reported that lithium may inhibit lipid peroxidation and protein oxidation. Lithium salts also appear to stimulate cell proliferation, increase neurogenesis, and delay cell death. Oxidative stress and neurodegeneration may play an important role in the pathophysiology of bipolar disorder and the disease course thereof. The aim of this research is to estimate the influence of lithium (alone and in combination with haloperidol) on the parameters of oxidative stress and viability of SH-SY5Y cell lines in neutral and pro-oxidative conditions. METHODS: The evaluated oxidative stress parameter was lipid peroxidation. The viability of the cell lines was measured utilising the MTT test. RESULTS: In neutral conditions, higher levels of thiobarbituric acid reactive substances were observed in those samples which contained both haloperidol and lithium than in other samples. However, these differences were not statistically significant. Cell viability was significantly higher in therapeutic lithium samples than in the controls; samples of haloperidol alone as well as those of haloperidol with lithium did not differ from controls. CONCLUSIONS: The results of our study may indicate that lithium possess neuroprotective properties that may be partly due to antioxidative effects. The combination of lithium and haloperidol may generate increased oxidative stress.

Is there a decline in cognitive functions after combined electroconvulsive therapy and antipsychotic therapy in treatment-refractory schizophrenia?

An analysis of literature shows that there is still little evidence concerning the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic therapy in a group of treatment-resistant schizophrenia patients. More precisely, its influence on cognitive functions is still equivocal. The aim of this study was to assess the influence of ECT combined with antipsychotic therapy on working memory, attention, and executive functions in a group of treatment-refractory schizophrenia patients. Twenty-seven patients completed the study: 14 men and 13 women, aged 21 to 55 years (mean age, 32.8 years), diagnosed with treatment-resistant schizophrenia. Each patient underwent a course of ECT sessions and was treated with antipsychotic medications. Before the ECT and within 3 days after the last ECT session, the participants were assessed with the following neuropsychological tests: Trail Making Test (TMT) and Wisconsin Cart Sorting Test (WCST). There were no significant differences in the TMT and WCST results after combined ECT and antipsychotic therapy in treatment-refractory schizophrenia patients. According to the results of the neuropsychological tests, there was no decline in attention, executive functions, or working memory. The current study shows no significant difference in attention, working memory, or executive functions after treatment with a combination of electroconvulsive and antipsychotic therapy. This suggests that combined electroconvulsive therapy may not have a negative influence on the neuropsychological functioning of patients with treatment resistant schizophrenia.

[Internal capsule integrity and its sex-related structural differences in early-onset schizophrenia - diffusion tensor imaging study]. / Zaburzenia integralnosci torebki wewnetrznej oraz róznice strukturalne zalezne od plci w schizofrenii o wczesnym poczatku - badanie DTI.

OBJECTIVES: In schizophrenia, the most repeatable DTI findings concern reduced FA in temporal and frontal lobes with associated abnormalities in connecting neural fibers. The goal of study was to evaluate the differences in FA of the internal capsule in EOS-patients and healthy controls and to place emphasis on the sex as a potential factor determining a predominant pathological pattern of described changes. METHODS: 30 EOS patients and 30 healthy controls were studied using DTI. FA measures within internal capsules were performed in selected ROIs. For statistical analyses the one-way ANOVA test was used (p<0.05). RESULTS: Significant differences of FA between EOS-patients and controls in the right ALIC with lower values of FA in EOS were observed. Within the women sub-groups, statistical differences of FA were observed only for the right ALIC. There were no statistically significant differences within men sub-groups. CONCLUSIONS: 1. Statistically significant differences were found between EOS - subjects (subgroups of woman only) and the control group within the WM diffusivity of the brain in the right ALIC. 2. These results indicate possible involvement of the structures of internal capsule in the EOS development.

Augmentation of antipsychotics with electroconvulsive therapy in treatment-resistant schizophrenia patients with dominant negative symptoms: a pilot study of effectiveness.

OBJECTIVES: The aim of the study was to determine the effectiveness of the augmentation of antipsychotics (AP) with electroconvulsive therapy (ECT) in treatment-resistant schizophrenia (TRS) patients with dominant negative symptoms. METHODS: The study encompassed 34 patients aged 21-55 years, 47.1% of whom were female, who were diagnosed with TRS. Each patient underwent a course of ECT sessions combined with AP medications which had previously been found to be ineffective. Prior to ECT and within 3 days after the final ECT session, the participants were evaluated on the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia and the Clinical Global Impression scales. RESULTS: Augmentation of AP therapy with ECT led to a significant decrease in symptom severity in TRS patients with dominant negative symptoms, 58.8% of whom demonstrated at least a 25% decrease in the total PANSS score. The greatest reductions were observed in the general and positive PANSS subscales (mean ± SD: 11.35 ± 7.43 and 6.79 ± 5.23 patients), and the least significant in the negative symptoms subscale (5.03 ± 4.36 patients). CONCLUSION: Augmentation of AP therapy with ECT in a group of TRS patients with dominant negative symptoms induced a significant decrease in symptom severity. The greatest reductions were obtained in general and positive symptoms and the least in negative symptoms.

Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis.

Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.

Temperament traits and preference for surgical or nonsurgical specialties in year 6 medical students.

BACKGROUND: Personality traits may also be associated with preference for a particular specialty. However, little is known about the relationship between the surgical career preferences of medical students and their temperament traits. PURPOSES: The aim of the study was to explore the relationship between surgical or nonsurgical specialties and temperament in 6th-year medical students. METHODS: The study included 409 students (283 women, 126 men) of the 6th year at the Medical University of Lodz. The subjects fulfilled a career preference and demographic questionnaire as well as the Formal Characteristics of Behaviour-Temperament Inventory by Zawadzki and Stelau. RESULTS: The surgical specialty was preferred by 30.1% of the students and by 64.5% of the nonsurgical; 5.4% were undecided. The specialty preference of the medical students was associated with temperament traits. An analysis of variance showed differences in Emotional Reactivity, F(1, 380)=3.888, p=049, η2=01; Endurance, F(1, 380)=10.973, p=001, η2=028; and Briskness, F(1, 380)=10.252, p=001, η2=026. Students preferring surgical specialty scored significantly higher on Endurance (M=11.21, SD=4.8) and Briskness (M=16.54, SD=2.82) scales than students choosing a nonsurgical specialty (M=9.12, SD=4.51) and (M=15.19, SD=3.21), respectively. Those preferring a surgical specialty scored lower on the Emotional Reactivity (M=8.91, SD=4.55) scale than students choosing nonsurgical specialty (M=10.53, SD=4.22). CONCLUSIONS: The findings suggest that certain temperament traits may be related to preference of surgical or nonsurgical specialties. This knowledge of temperament traits could be a useful tool in helping graduates choose a fulfilling career best suited to their psychological well-being and diagnosing work related issues in the medical profession.

[Neurological soft signs as a candidate for endophenotype of schizophrenia]. / Miekkie objawy neurologiczne jako kandydat na endofenotyp schizofrenii.

A concept of an endophenotype, also termed as an internal endophenotype, is used in genetic studies on psychiatric disorders. Neurological soft signs are also considered candidates for endophenotypes of schizophrenia. Neurological soft signs are, objectively measured, non-localizing abnormalities, not related to impairment of a specific brain region, reflecting improper cortical-subcorical and intercortical connections. This paper presents the main domains of NSS, methods of measurement of NSS, their neuroanatomical substrate, association of NSS with schizophrenia symptoms the and analysis of the literature in order to check whether NSS meet the criteria of the phenotype. A marker can be considered a phenotype if it meets the following criteria: 1) association with a disease in a population, 2) heritability, 3) state-independence, 4) familial association (the endophenotype is more prevalent in the affected individuals, their affected and non-affected family members in comparison to the normal population), 5) co-segregation (the endophenotype is more prevalent among ill family members of ill probands compared with healthy relatives). Currently, there is an ample evidence that the NSS, especially these representing impaired motor coordination, meet certain criteria of an endophenotype. However, there are still several unresolved questions concerning NSS: studies on relatives of schizophrenic patients included small groups of subjects, many of the studies included individuals with schizophrenia, as well as schizophrenia spectrum disorders, the available date-base of twins (schizophrenia-concordant and schizophrenia non -concordant) is not sufficiently large, there are too few studies evaluating the relationship of NSS and individual genes, there are no objective and quantitative methods of measurement of NSS. Therefore, NSS still represent only candidates for an endophenotype of schizophrenia. Finding correlations of selected NSS with other endophenotypes and their genetic correlates also needs further investigation and may provide a definitive answer to the question of the usefulness of NSS as the endophenotype of schizophrenia.

[Augmentation of antipsychotics with glycine may ameliorate depressive and extrapyramidal symptoms in schizophrenic patients--a preliminary 10-week open-label study]. / Augmentacja leczenia przeciwpsychotycznego glicyna moze zmniejszac nasilenie objawów depresyjnych oraz pozapiramidowych u chorych na schizofrenie--wyniki wstepnego 10-tygodniowego badania otwartego.

AIM: The objective of this study was to analyze the changes in depressive and extrapyramidal symptomatology during glycine augmentation of antipsychotic treatment in patients with schizophrenia. MATERIALS AND METHODS: Twenty-nine schizophrenic patients (ICD-10) with predominant negative symptoms in stable mental state participated in a 10-week open-label prospective study. Patients received stable doses of antipsychotic drugs for at least 3 months before glycine application. During the next 6 weeks patients received augmentation of antipsychotic treatment with glycine (up to 60 g per day). The first and last two weeks of observation were used to assess stability of mental state. Symptom severity was assessed using the Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), and the Simpson-Angus Extrapyramidal Symptom Rating Scale (SAS). RESULTS: In the studied group after 6 weeks of administration ofglycine a significant improvement in depressive symptoms (reduced scores by 25.8% in HDRS, p < 0.001) and reduced scoring in mood symptoms of PANSS were observed. In SAS a reduction of extrapyramidal symptoms' severity (p < 0.05) was also noted. Two weeks after the glycine augmentation the symptom severity in the HDRS, PANSS, and SAS remained at similar levels. CONCLUSIONS: Glycine augmentation of antipsychotic treatment may reduce the severity of depressive and extrapyramidal symptoms. Glycine use was safe and well tolerated.

Epicatechin inhibits human plasma lipid peroxidation caused by haloperidol in vitro.

Epicatechin belongs to flavonoids protecting cells against oxidative/nitrative stress. Oxidative/nitrative stress observed in schizophrenia may be caused partially by the treatment of patients with various antipsychotics. The aim of our study was to establish the effects of epicatechin and antipsychotics action (the first generation antipsychotic (FGA)--haloperidol and the second generation antipsychotic (SGA)--amisulpride) on peroxidation of plasma lipids in vitro. Lipid peroxidation in human plasma was measured by the level of thiobarbituric acid reactive species (TBARS). The properties of epicatechin were also compared with the action of a well characterized antioxidative commercial polyphenol-resveratrol (3,4',5-trihydroxystilbene) and quercetin (3,5,7,3',4'-pentahydroxyflavone). Amisulpride, contrary to haloperidol (after 1 and 24 h) does not significantly influence the increase of plasma TBARS level in comparison with control samples (P > 0.05). After incubation (1 and 24 h) of plasma with haloperidol in the presence of epicatechin we observed a significantly decreases the level of TBARS (P < 0.001, P < 0.001, respectively). In our other experiments, we found that epicatechin also decreased the amount of TBARS in human plasma treated with amisulpride. In conclusion, the presented results indicate that epicatechin-the major polyphenolic component of green tea reduced significantly human plasma lipid peroxidation caused by haloperidol. Moreover, epicatechin was found to be a more effective antioxidant, than the solution of pure resveratrol or quercetin.

The oxidative stress may be induced by the elevated homocysteine in schizophrenic patients.

The mechanisms of oxidative stress in schizophrenic patients are not fully understood. In the present study, we investigated the effect of elevated level of homocysteine (Hcys) on some parameters of oxidative stress, namely thiobarbituric acid reactive substances (TBARS), an index of lipid peroxidation in plasma, the level of carbonyl groups in plasma proteins, as well as the amount of 3-nitrotyrosine in plasma proteins isolated from schizophrenic patients. Patients hospitalised in I and II Psychiatric Department of Medical University in Lodz, Poland were interviewed with special questionnaire (treatment, course of diseases, dyskinesis and other EPS). According to DSM-IV criteria all patients had diagnosis of paranoid type. They were treated with antipsychotic drugs (clozapine, risperidone, olanzapine). Mean time of schizophrenia duration was about 5 years. High-performance liquid chromatography was used to analyse the total level of homocysteine in plasma. Levels of carbonyl groups and 3-nitrotyrosine residues in plasma proteins were measured by ELISA and a competition ELISA, respectively. The lipid peroxidation in plasma was measured by the level of TBARS. Our results showed that in schizophrenic patients the amount of homocysteine in plasma was higher in comparison with the control group. We also observed a statistically increased level of biomarkers of oxidative/nitrative stress such as carbonyl groups or 3-nitrotyrosine in plasma proteins from schizophrenic patients. Moreover, our experiments indicate that the correlation between the increased amount of homocysteine and the oxidative stress exists. Considering the data presented in this study, we suggest that the elevated Hcys in schizophrenic patients may stimulate the oxidative stress.

Medical students hierarchy of values and sense of responsibility.

BACKGROUND: Ethical skills and personal values contribute to making students competent and humane physicians. However, there is not much research done on medical students' personal values and sense of responsibility. PURPOSES: The study was designed to examine differences in personal values and sense of responsibility between medical students and their peers. METHODS: The students performed demographic survey and reliable tests: Scheler's Value Scale and Responsibility Scale. RESULTS: Medical students scored higher in responsibility, also in values of hedonism and truth, and scored lower in values of holy, both religion and secularism. They did not differ from the control group in values of vitality, aesthetics, morals, physical fitness as well as strength and stamina. CONCLUSION: Medical students differ from their peers from other faculties at the level of responsibility and hierarchy of values. They rate higher at such values as hedonism and truth and lower values of holy.

[Risk factors of schizophrenia development in patients with amphetamines dependence and psychosis (amphetamine-induced psychosis and schizophrenia), and without psychosis]. / Czynniki ryzyka rozwoju schizofrenii u pacjentów uzaleinionych od amfetaminy i jej pochodnych z psychoza (pointoksykacyjna lub schizofrenia) oraz bez psychozy.

AIM: Amphetamine and its derivates can induce, usually after many intoxications, schizophrenia-like psychosis. These disorders appeared only in part patients with amphetamine dependence. Aim of the study was to establish prevalence of selective risk factors of schizophrenia development in amphetamine users: 1) with amphetamine-induced schizophrenia-like psychosis, 2) with schizophrenia, and 2) without psychotic symptoms. MATERIAL: In the study 3 groups of subjects were included: 30 amphetamine users with amphetamine induced schizophrenia-like psychosis, 30 amphetamine users with schizophrenia and 30 amphetamine users without psychotic symptoms (37 female and 53 male in mean age = 17.78 years). METHODS: Amphetamine dependence, schizophrenia and schizophrenia-like psychosis induced amphetamine were diagnosed according to ICD-10 criteria after at least 1 year of amphetamine abstinence. The next procedure was used: 1) Structured interview with subjects and their mothers/caregivers regarding: a) amphetamines use (duration of abuse, doses of psychoactive substance) b) family history of psychosis (especially schizophrenia) 2) The Questionnaire of Child Development for assessment of prevalence of selected risk factors of schizophrenia development 3) The Premorbid Adjustment Scale (Cannon--Spoor) for assessment of premorbid psychosocial functioning in thelast year before psychosis. CONCLUSIONS: Amphetamines users with amphetamine-induced psychosis were more similar in prevalence of selective risk factors of schizophrenia development to subjects with schizophrenia and amphetamine dependence than to amphetamine users without psychosis. Amphetamine-induced psychosis developed more frequently in amphetamine users who used higher amphetamine doses and with familial history of psychosis.

[Before you diagnose a patient with a conversion disorder, perform a thorough general medical and neurological examination. Case study]. / Zanim rozpoznasz u pacjenta zaburzenie konwersyjne, dokladnie zbadaj jego stan somatyczny i neurologiczny. opis przypadku.

INTRODUCTION: Dissociative and conversion disorders are classified together according to ICD-10 as states that are not confirmed by the presence of somatic diseases, which they suggest. According to the DSM-IV, both disorders are classified separately. Conversion disorders are a group of psychiatric disorders whose symptoms mimic the presence of malfunction or loss of motor or sensory function, whereas the nature and dynamics of the observed symptoms is not fully explained by the results of objective assessments and consultations, nor is the direct effect of a psychoactive substance. Impaired mental integration of different functions which normally interact simultaneously in the perception of reality and inner experience of the individual is found in dissociative disorders. AIM: The article describes the case of 25-year old man, in whom after initial suspicion of myasthenia gravis and its exclusion, a diagnosis of conversion disorder was made on the basis of the clinical picture and treatment with an SSRI antidepressant and individual psychotherapy were recommended. No improvement in mental and neurological status after six month therapy resulted in an in-depth diagnostics in a clinical setting and diagnosis of brain stem tumor (aastrocytoma fibrillare). CONCLUSIONS: (a) Neuroimaging is a source of important clinical data and in many cases should constitute an inherent element of a psychiatric diagnosis. (b) Diagnosis of conversion (dissociative) disorders requires a precise differential diagnosis, excluding the somatic causes of observed neurological ailments. (c) A late diagnosis of neurological or somatic causes of symptoms which arouse a suspicion of conversion (dissociative) disorders may make a radical treatment impossible or may considerably aggravate the remote prognosis and quality of the patients' life.

Quetiapine, olanzapine and haloperidol affect human plasma lipid peroxidation in vitro.

OBJECTIVE: Oxidative injury in schizophrenia may be caused not only by pathophysiological processes but partly also by treatment with antipsychotics. The purpose of the present study was to examine and to compare the effects of quetiapine (QUE), olanzapine (OLA) and haloperidol (HAL), at final concentrations corresponding to doses used for treatment of acute episodes of schizophrenia, on plasma lipid peroxidation in vitro, measured by the level of thiobarbituric acid-reactive substances (TBARS). METHODS: Blood from 30 healthy volunteers was collected into ACD (citric acid/citrate/dextrose) solution. The drugs in form of active substances were dissolved in 0.01% dimethyl sulfoxide, added to plasma at the final concentrations [QUE (175 and 275 ng/ml), OLA (20 and 40 ng/ml), HAL (4 and 20 ng/ml)] and incubated for 1 and 24 h at 37 °C. The level of TBARS was measured spectrophotometrically (according to the Rice-Evans method, 1991). RESULTS: The comparative study in vitro showed that QUE causes a decrease in the TBARS level in plasma, whereas HAL increases the plasma TBARS level. After 24 h of incubation of plasma with QUE or HAL (at lower and higher concentrations),thedifferences in TBARS levels between the drugs were significant (p = 5.9 × 10⁻4, p = 2.2 × 10⁻5, respectively). CONCLUSION: QUE and OLA, contrary to the prooxidative action of HAL, did not induce oxidative stress; moreover, QUE has antioxidant properties.

Psychiatric disorders in patients with systemic lupus erythematosus: association of anxiety disorder with shorter disease duration.

Physicians' awareness about neuropsychiatric syndromes in systemic lupus erythematosus (SLE) is not rarely limited to seizures and psychoses included in the American College of Rheumatology (ACR) classification. Involvement of the central nervous system (CNS) with its rich symptomatology still belongs to the faintly recognised and understood aspects of lupus. The objective was to investigate prevalence and clinical correlations of psychiatric disorders in SLE patients. Fifty-two SLE patients were included. Disease duration and current and cumulative corticosteroid doses were calculated. Disease activity was assessed with the Systemic Lupus Activity Measure (SLAM). All subjects were examined by a psychiatrist. Psychiatric disorders were classified according to ACR criteria for neuropsychiatric systemic lupus erythematosus (NPSLE). Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) were used to screen for cognitive impairments. Mental disorders were diagnosed in 16 (30.77%), depressive disorder in 6 (11.54%), cognitive dysfunction in 5 (9.62%), anxiety disorder in 4 (7.69%) and psychosis in one patient (1.92%). SLE duration was shorter in patients diagnosed with anxiety disorder (P < 0.05), and cumulative dose of corticosteroids was lower in patients with anxiety disorder (P < 0.01). There was high positive correlation between SLE duration and cumulative dose of corticosteroids (r = 0.684, P < 0.001). Shorter SLE duration in patients with anxiety disorder seems to reflect its adaptative nature.

[Changes in positive and negative symptoms, general psychopathology in schizophrenic patients during augmentation of antipsychotics with glycine: a preliminary 10-week open-label study]. / Zmiana w zakresie objawów pozytywnych, negatywnych oraz psychopatologii ogólnej u pacjentów ze schizofrenia otrzymujacych augmentacje leczenia przeciwpsychotycznego glicyna: wyniki wstepnego 10-tygodniowego badania otwartego.

UNLABELLED: The Glutamatergic system is the most important excitatory system of the human brain. Dysfunction of this system plays an important role in the pathogenesis of numerous psychiatric disorders, including schizophrenia. According to the glutamatergic hypothesis of schizophrenia augmentation of the antipsychotic treatment with glycine--a coagonist of NMDA receptor helps to achieve better improvement. AIM: The aim of the study was to assess changes in mental status i.e. positive, negative and general psychopathology symptoms during augmentation of antipsychotic treatment with glycine in schizophrenic patients in a stable mental state with predominant negative symptoms. METHODS: The study group consisted of 29 patients with a diagnosis of schizophrenia (ICD-10) with predominant negative symptoms. It was a 10-week prospective open-label study, which included 7 visits. Participants enrolled to the study received a fixed dose of antipsychotic drugs for at least 3 months prior to application of glycine. In addition to the existing antipsychotic treatment, patients were administered glycine orally (up to 60 g/day) for 6 weeks. 2 weeks before and after application of glycine, their mental status was also evaluated. At each visit we assessed severity of schizophrenia symptoms using PANSS. RESULTS: After 6 weeks of glycine administration we observed statistically significant improvement in positive (PANSS P subscale, -7.8%, p < 0.05), negative symptoms (N subscale, -16.1%, p < 0.001), general psychopathology (G subscale, -12.2%, p < 0.001) and PANSS total score (T, -12.8%, p < 0.001). 2 weeks after the end of glycine augmentation mental status remained stable. CONCLUSION: In the course of treatment with glycine, moderate improvement in negative, positive and general psychopathology symptoms was observed. Use of glycine was safe and well tolerated. Side effects involved gastrointestinal complaints--mainly nausea and vomiting.

[Declared management methods used by the Polish psychiatrists among a group of people with a high risk syndrome of psychosis development: results of the National Polish Questionnaire]. / Deklarowane przez polskich psychiatrów sposoby postepowania wobec osób z grupy wysokiego ryzyka rozwoju psychozy: wyniki ogó1nopolskiego badania sondazowego.

AIM: The aim of the study was to assess the declared management methods used byPolish psychiatrists among a group of people at high risk of psychosis development. METHOD: Management methods used among two kinds of UHR persons, i.e., (A) attenuated or brief, limited psychotic symptoms group and (B) state and trait risk factors group, were assessed during nationwide psychiatric conferences held in 2009, which gathered Polish psychiatrists practicing throughout the whole country. RESULTS: (A) For those experiencing attenuated or brief, limited psychotic symptoms (APS or BLIPS), the vast majority of respondents (88%) declared using pharmacological intervention. Moreover, all doctors choosing pharmacotherapy declared using antipsychotic drugs (AP). Second generation antipsychotics (SGA) (84%), i.e., risperidone (48%) and olanzapine (32%) were medications to be selected as the first choice. Most doctors declared that they use medium doses ofAP (46%) for minimum 6-12 months (31%). (B) Among the group of people with state and trait risk factors, the vast majority of respondents (81%) also declared using AP: mostly SGA (75%) and typical AP (20%). Medications used as the first choice in this group were also mostly risperidone and olanzapine (44% and 28% respectively). 65% of the doctors declared using low doses of antipsychotics for the minimum of 6-12 months (39%). CONCLUSIONS: A high percentage of Polish psychiatrists state that they use pharmacological intervention in persons at high risk of developing psychosis. Preferred medications are mainly SGA (risperidone and olanzapine), prescribed in medium and low doses for a minimum of 6-12 months.

[Psychotic disorders related with chronic use of mephedrone. Case report]. / Zaburzenia psychotyczne zwiazane z przewleklym przyjmowaniem mefedronu. Opis przypadku.

AIM: The aim of the study was to present the case of a patient with psychotic disorders, o most probably connected with persistent mephedrone use. METHOD: The analysis of the clinical case and medical documentation. RESULTS: The presented patient had used mephedrone regularly (few times a week) for four months. Because of delusions of reference, delusions of persecution, agitation and anxiety, she required psychiatric hospitalisation. During the first hospitalisation she denied using legal highs, she was diagnosed as having schizophrenia and treated with olanzapine. After discharge, she didn't stop to use legal highs and psychotic symptoms occurred once again. The patient needed another hospitalisation. Despite the fact that antipsychotic treatment wasn't administered, the symptoms resolved. Nevertheless, somnolence, apathy and social isolation were observed. CONCLUSIONS: Recently legal highs are very popular, especially among adolescents and young adults. That is the reason why physicians have become more anxious because there is little information about their contents. In most of them, synthetic or botanical substances are included. In clinical practice not only somatic but also psychiatric complications connected with legal high use are observed. It is difficult to verify why this patient developed psychotic symptoms after recurrent intoxication. It is possible that she has an individual predisposition to develop psychosis. In this case, we have no information about previous features of ultra high risk state in this patient.

[Trazodon--the antidepressant: mechanism of action and its position in the treatment of depression]. / Trazodon--lek przeciwdepresyjny: mechanizm dzialania i miejsce w leczeniu depresji.

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.

[Could we use a serum level of glycine as a prognostic factor of its efficacy in schizophrenic patients?]. / Czy osoczowe stezenia glicyny moga byc czynnikiem rokowniczym skutecznosci jej stosowania u chorych na schizofrenie?

UNLABELLED: Glutamatergic system--the main excitatory brain system is involved in the pathophysiology of schizophrenia. The ionotropic glutamatergic NMDAreceptor participates in mechanisms of controlling neurotransmitter systems such as the dopaminergic, noradrenergic, serotoninergic ones and plays an important role in cognitive functioning. Glycine is a natural coagonist of the NMDA receptor and according to the hypoNMDA hypothesis treatment with its high doses (max. 60g orally per day) can improve symptomatology of schizophrenia, e.g., negative symptoms and cognitive functions. AIM: If there is a correlation between plasma levels (before and after using glycine) and severity of symptoms (at the first and last assessment), then low baseline plasma concentrations could be an indication for choosing glycine in treatment, moreover a useful prognosing tool and finally a support of glutamatergic hypothesis of schizophrenia. METHODS: 28 patients with a diagnosis of schizophrenia according to ICD-10 diagnostic criteria (Table 1) in stable clinical condition and antipsychotic medication (typical and atypical agents) for min. 3 months, had completed a 6 week, prospective and open label study (32 patients enrolled). Between 2 visits patients received glycine in high oral doses (0.8 g/kg/day). Before and afterwards the glycine treatment, psychiatric and cognitive function examination was performed based on PANSS, Trail making test (TMT), Stroop test and Wisconsin card sorting test (WCST). In parallel glycine plasma levels were assessed. RESULTS: There was a significant reduction in positive, negative, general psychopathology and total PANSS score during the study (Table 2). Also cognitive parameters significantly improved during 6 weeks of glycine use. Serum levels of glycine were markedly higher at the end of our project, but only improvement in part 2 of TMT correlates with changes in aminoacid serum concentrations (p = 0.02). CONCLUSIONS: Our results suggest that augmentation of antipsychotic treatment (typical and atypical neuroleptics) with glycine can have a positive influence on schizophrenic symptoms there in cognitive dysfunction, but glycine plasma levels were not a useful predictor of recovery in our patients. Correlation between improvement in performance of TMT and serum level increase suggests that glycine and NMDA receptor can be involved in psychopathology of schizophrenia and cognitive functioning, e.g., working memory