Serotonergic organization of the central nervous system.

The last 50 years of researches of biochemism and the CNS functionality are intensively engaged in studying the role of monoamine neurotramsmitter serotonin (5-hydroxytryptamin) (5-HT). The serotonergic receptors function depends on spot where the receptor function, the dynamic relationship with other transmitters and stimulation that can activate or inhibit specific neurons. The results of research in biochemistry, neurophysiology and neuroradiology have provided insight into the complexity of the operation of key structures such as the amygdala, prefrontal cortex and hippocampus, whose role varies depending on the received external impulses and the impulses that are sent to relevant areas. This implies that the transmitters and especially 5-HT, have much wider effects that are determined not to structures but by the impulse dynamics. It also means that psychopharmaceutical drugs whose therapeutic effect is based on the change of the concentration of serotonin in the synapse and the postsynaptic receptors depending on where they operate, have an effect on affective or cognitive symptoms. Serotonergic antidepressants by changing the concentration of serotonin change primarily affective manifestations but also they have significant influence on all the spectrum of serotonergic disorders not only emotional, but also the cognitive level, which is also a confirmation that the therapeutic effects do not depend only on the simple change of serotonin concentration but also of the level where these changes occur in dynamic comparison of key transmitters. Atypical antipsychotics which have low affinity for dopaminergic and high affinity for serotonergic receptors are seen through the dynamic relationship of serotonin, dopamine and noradrenalin in nigrostriatal, mezocortical, mezolimbic and tuberoinfudibular pathways.

Psycho-social and clinical variables associated with depression in patients with type 2 diabetes.

BACKGROUND: Type 2 diabetes (T2DM) doubles the odds of comorbid depression. Depression is a strong predictor of developing T2DM. The aim of the study was to compare depressed patients with T2DM to non-depressed ones with respect to demographic, psycho-social, clinical, anthropometric and metabolic characteristics; to examine the relationship between glycemic control and depression severity in depressed patients; to estimate the risk factors of depression. SUBJECTS AND METHODS: A group of depressed diabetic patients comprising those with a Major depressive episode, first or repeated (ICD-10; 1992) and endocrinologist-diagnosed T2DM, duration ≥5 years on oral, insulin therapy or both (N=46) and non-depressed ones (N=44) (90 in total) of both genders (<65 years) were included in this cross-sectional study. Laboratory and non-laboratory measures were performed.. The patient Health Questionnaire (PHQ-9) and a structured interview (MINI) were used to establish diagnosis, while the Beck Depression Inventory (BDI; cut off ≥16) was used to assess the severity ofdepression. Scaling of Life Events (SLE) for self-assessment of life events and Problem in Areas in Diabetes (PAID) for self-assessment of diabetes distress were also performed. RESULTS: Statistically significant higher rates of psychiatric heredity, neuropathy, higher level of diabetes related distress and a greater number of life events in depressed patients compared to non-depressed ones were found. There was a statistically significant positive correlation between BDI somatic subscore and the HbA1c level (r=0.343; p=0.020). The level of diabetes related distress (OR=1.084; p=0.000), total number of life events (OR=4.528; p=0.001) and neuropathy (OR=8.699; p=0.039) were statistically significant predictors of depression using logistic regression. CONCLUSIONS: The results obtained showed that depression in diabetic patients was predicted by both psychological (diabetes related distress, life events) and disease-specific variables (neuropathy). The severity of self-reported somatic depressive symptoms significantly correlated with the HbA1c level in depressed diabetic patients.

Treatment compliance of outpatients with schizophrenia: patient's attitudes, demographic, clinical and therapeutic variables.

AIM: To compare patient's attitudes, demographic, clinical characteristics, psychopathology, insight and type of antipsychotic therapy in compliant and non-compliant outpatients with schizophrenia; to explore correlations between patient's attitudes and related variables. METHODS: A sample of 44 outpatients of both genders (> 60 years), with a diagnosis of ICD-10 Schizophrenia (F20) was included into the study. All the patients were on maintenance treatment with different classes of antipsychotics (oral, depot or both), for at least 6 months from the latest hospitalisation. The exclusion criteria were determined. The BPRS and the PANSS were used to assess psychopathology and insight (G12 item). The self-report questionnaire MARS was used to assess patient's attitudes. RESULTS: Compliant patients (N=37) showed the following significant differences compared to non-compliant patients (N=7): higher the MARS (p<0.001), lower the PANSS (Positive sub score) (p<0.01) G12 scores (p<0.01) (the Student t test) and percentage of patients with previous non-compliance (p<0.05) (chi2 test). Considerable correlation between the MARS and the BPRS (p<0.001), the PANSS (Positive, General psychopathology) (p<0.001; p<0.01), G12 scores (p<0.05) (negative) and current compliance (p<0.001) was also found (The Spearman's correlation). CONCLUSIONS: Our results suggest that special attention should be paid to attitudes, severity of psychopathology, insight and history of non-compliance in compliance evaluation of outpatients with schizophrenia.

Personality profile of depressive patients with a history of suicide attempts.

AIM: To examine the dimensions and appropriate aspects of personality according to the five-factor model of personality of depressive patients with a suicide attempt history compared to depressive patients without a suicide attempt history and healthy persons. METHOD: Sample of 35 outpatients of both gender (< 60 years), with a diagnosis of ICD-10 non-psychotic recurrent depression in remission (F 33.4) and a group of healthy persons (N = 20) were included in the study. Patients were classified into a group of patients with a suicide attempt history (N = 15) and a group of patients without a suicide attempt history (N = 20). The exclusion criteria were determined. The NEO PI-R (240 self-report items) has been used to evaluate personality dimensions and aspects. RESULTS: Both patient groups had a significantly higher score on the dimension of Neuroticism (p < 0.001), as well as significantly lower scores on the dimensions of Extroversion, (p < 0.001) Openness (p < 0.01) and Conscientiousness (p < 0.001; p < 0.01) compared with a group of healthy persons (ANOVA; Fisher's test-LSD). CONCLUSIONS: Depressive patients with a suicide attempt history were significantly different in all personality domains except in Agreeableness from healthy persons (higher Neuroticism and lower Extroversion, Openness and Conscientiousness). There were no considerable differences in personality domains when major depressives with and without suicide attempt history were compared.

Adherence to depot versus oral antipsychotic medication in schizophrenic patients during the long-term therapy.

BACKGROUND/AIM: There is a high rate of schizophrenic patients who do not adhere to their prescribed therapy, despite the implementation of antipsychotic long-acting injections and the introduction of atypical antipsychotics. The aim of this study was to investigate the differences in sociodemographic, clinical and medication adherence variables between the two groups of schizophrenic patients on maintenance therapy with depot antipsychotic fluphenazine decanoate and oral antipsychotics only as well as a correlation between the medication adherence and other examined variables. METHODS: A total of 56 patients of both genders, aged < 60 years, with the diagnosis of schizophrenia (F20) (ICD-10, 1992) clinically stable for at least 6 months were introduced in this cross-sectional study. The patients from the depot group (n = 19) were on classical depot antipsychotic fluphenazine decanoate administering intramuscularly every 4 weeks (with or without oral antipsychotic augmentation) and the patients from the oral group (n = 37) were on oral therapy alone with classical or atypical antipsychotics, either as monotherapy or combined. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Item G12 of the PANSS was used to assess insight into the illness. The patients completed the Medical Adherence Rating Scale (MARS) was used to assess adherence to the therapy. A higher MARS score indicates behavior [Medical Adherence Questionnaire (MAQ subscale)] and attitudes toward medication [Drug Attitude Inventory (DAI subscale)] that are more consistent with treatment adherence. The exclusion criteria were determined. The Pearson's chi2 test was used to compare categorical variables, Student's t-test to compare continuous variables and Pearson's correlation to test the correlation significance; p = 0.05. RESULTS: Significant between-group differences in age, illness duration, chlorpromazine equivalents, PANSS score and DAI subscore were found. Item G12 of the PANSS subscore and MARS score correlated significantly negatively. A significant positive correlation between receiving depot antipsychotic and DAI subscore as well as between illness duration and both DAI subscore and MARS score were also found. CONCLUSION: Schizophrenic patients on classical depot antipsychotic maintenance therapy might present subpopulation of patients with significantly longer illness duration, more favorable medication attitude and outcome in relation to those on oral antipsychotics alone.

[Perception of quality of life and social adjustment of patients with recurrent depression].

INTRODUCTION: Depression is the most commonly present psychiatric entity in clinical practice, accompanied by significant impairment of both social and professional functioning. In addition, depression frequently develops as complication of other psychiatric disorders and various somatic diseases. OBJECTIVE: To investigate subjective perception of quality of life and social adjustment, severity of depressive symptoms as well as level of correlation of severity of depressive symptoms and quality of life and social adjustment of patients with recurrent depression in comparison to the group of patients with diabetes and healthy subjects. METHOD: The study included 45 subjects of both sexes, ranging from 18 to 60 years of age, divided in three groups of 15 subjects each. The experimental group comprised the patients diagnosed with recurrent depression in remission (DSM-IV), one control group was consisted of patients diagnosed with Type 2 Diabetes mellitus and another one comprised healthy subjects. The instruments of assessment were: The Beck Depression Inventory-BDI, The Social Adaptation Self -evaluation scale -SASS, The Psychological General Well-Being Scale-WBQ. RESULTS Significant difference of both BDI and WBQ scales was found between the experimental and the control group of healthy subjects (ANOVA, Mann Whitney; p < 0.01), as well as between two control groups (p < or = 0.02). The level of inverse correlation of mean score values of BDI and SASS scales was significant in the control group of patients with diabetes while such levels of BDI and WBQ scales (Spearman correlation coefficient, p < 0.01) were found in all groups of our study. CONCLUSION: In the group of patients with recurrent depression, significant decline of quality of life and significantly higher severity of depressive symptoms were present in comparison to the group of healthy subjects as well as significant level of inverse correlation of severity of depressive symptoms and quality of life.