[Cognitive dysfunctions in depression - underestimated symptom or new dimension?]. / Dysfunkcje poznawcze w depresji - niedoszacowany objaw czy nowy wymiar?

Cognitive deficits constitute an integral part of clinical picture of depression, but often not enough attention has been paid to these deficits, mainly because of the presumption that they are secondary to typical depressive symptoms. It is considered that cognitive impairment is one of the main causes of depressive patients' poor functioning. Cognitive deficits are observed already in the first depressive episode. They may correlate with the severity of depression, with the patient's age and level of education. They may persist regardless of the improvement of depression during treatment. Cognitive deficits in depression are divided into "cold" which are not related to emotions, and "hot" - related to emotions. The "cold" deficits are supposed not to respond to antidepressants and seem to persist even in clinical remission. Vortioxetine is a novel antidepressant with a unique mechanism of action: it acts through the serotonine reuptake inhibition, but works also as 5HT(1A) agonist, as well as partial agonist of the 5HT(1B) receptor and antagonist of the 5HT(1D), 5HT(3) and 5HT(7) receptors. In preclinical studies vortioxetine showed the normalization of serotoninergic, noradrenergic, and dopaminergic transmission, additionally through GABA-ergic and glutaminergic effects. It has antidepressive property, it proved to be efficacious in various types of depression (severe, depression with anxiety, and depression in elderly); it also proved to be efficacious in those patients who did not respond sufficiently to SSRIs and SNRIs treatment. Vortioxetine is also beneficial for cognitive functions in depressed patients.

[Functional polymorphism of genes inactivating biogenic amines and cognitive deficits in paranoid schizophrenia]. / Funkcjonalny polimorfizm genów enzymów inaktywujacych aminy biogenne a deficyty procesów poznawczych w schizofrenii paranoidalnej.

AIM: The aim of the work was to assess relationship between gene polymorphism of enzymes influencing dopaminergic-, serotoninergic, and noradrenergic transfer and cognitive functioning of paranoid schizophrenic inpatients (ICD-10). METHOD: The following methods have been used in the study: The Test of Everyday Attention (TEA) and The Visual Object and Space Perception Battery (VOSP), psychiatric scales (SAPS, SANS, BDI) and techniques of genetic engineering (PCR reaction, RFLP and VNTR techniques). Subject groups included 100 schizophrenic patients (57 male) and 50 healthy controls (20 male). RESULTS: The results revealed positive correlation between polymorphism of Vall 58MetCOMT and cognitive deficits in schizophrenic patients. No statistically significant relationship was elicited between gene polymorphism of Val158Met COMT and VNTR MAO-A in promoter area and schizophrenia onset. Allelic polymorphism ofVall58Met OMT and VNTR MAO-A in promoter area did not differ between the subject groups. The patients with genotype Val/ Val of polymorphism Val 158MetCOMT showed major cognitive deficits.

Social cognition and visual perception in schizophrenia inpatients treated with first-and second-generation antipsychotic drugs.

PURPOSE: Social cognition captures affect recognition, social cue perception, "theory of mind," empathy, and attributional style. The aim of our study was to assess social cognition in schizophrenia inpatients being treated with first-generation antipsychotic drugs (FGAs), n=28 (perphenazine and haloperidol, FGAs) or with second-generation antipsychotic drugs (SGAs), n=56 (olanzapine and clozapine, SGAs). SUBJECTS AND METHODS: Eighty-four patients completed the Facial Expression Recognition Test, the Voice Emotion Recognition Test, the Short Recognition Memory Test for Faces, and the Reading the Mind in the Eyes Test. Patients also completed the Visual Object and Space Perception Test (VOSP) as a control task, which would not engage social cognition. The patients were compared with fifty healthy controls matched for age and gender. RESULTS: There were no significant differences on social cognitive performance between the FGA- and SGA-treatment groups. Nor was olanzapine superior to clozapine, FGAs or both. However, patients treated with FGAs performed significantly worse on VOSP compared to both groups treated with SGAs, a 10% difference. CONCLUSIONS: We cannot conclude that SGAs were associated with better social cognition than FGAs. However, there were small but significant advantages for SGAs in non-social visual processing function, as evaluated with the VOSP.

Attentional and emotional functioning in schizophrenia patients treated with conventional and atypical antipsychotic drugs.

BACKGROUND: Effectiveness of antipsychotics in treating emotional and cognitive deficits in schizophrenia still remains controversial. The aim of our study was to assess emotional and cognitive functioning in schizophrenic inpatients currently treated with typical antipsychotics (perphenazine, perazine, fluphenazine, and haloperidol) and in another group of schizophrenic inpatients currently on atypical antipsychotics (olanzapine, risperidone, amisulpride, and quetiapine). MATERIAL/METHODS: One hundred patients with DSM-IV schizophrenia or schizoaffective disorders (39 treated using typical antipsychotics and 61 treated with atypical antipsychotics) under naturalistic treatment conditions, and 50 healthy controls were given the following: Test of Everyday Attention, Facial Emotion Recognition Test, Facial Memory Recognition Test, and "Reading the mind in the eyes" Test. RESULTS: Patients with a diagnosis of schizophrenia revealed the following deficits: facial emotion perception, empathy /theory of mind, visual selective attention/speed, attentional switching, and auditory-verbal working memory. Our results show a significant difference between schizophrenic and healthy controls in all tasks, with schizophrenic patients performing worse than controls. Interestingly, our patients on atypical neuroleptics performed similarly compared to schizophrenic patients treated with conventional neuroleptics on all tasks provided. There were some significant relationships between emotional and cognitive deficits and clinical variables. CONCLUSIONS: Our findings remain consistent with other recent studies in which atypical antipsychotics did not show a clear advantage over typical antipsychotics on both emotional and cognitive functioning.

[Functional polymorphism of genes inactivating catecholamines and emotional deficits in paranoid schizophrenia]. / Funkcjonalny polimorfizm genów enzymów inaktywujacych katecholaminy a deficyty procesów emocjonalnych w schizofrenii paranoidalnej.

AIM: The aim of our work was to assess qualitatively and quantatively emotional deficits in patients diagnosed with schizophrenia following ICD-10 criteria in early and late stages of the schizophrenic process and the evaluation of the relationship between genes polymorphism of enzymes influencing dopaminergic, serotoninergic, and noradrenergic transfer and emotional functioning of the examined patients. METHOD: In our study the following methods have been used: Short Recognition Memory test for Faces (TPRT), Facial Expression Recognition Test (FERT), "Reading the mind in the eyes" Test and psychiatric scales (SAPS, SANS, BDI) and molecular techniques (PCR reaction, RFLP and VNTR techniques). 100 paranoid schizophrenia patients (43 female and 57 man) and 50 healthy controls (30 female and 20 man) were invited to participate in the study. RESULTS: Our results revealed an association between polymorphism of Val158Met COMT and emotional deficits in schizophrenic patients. Furthermore, the relationship between polymorphism of MAO-A and empathy/theory of mind deficit was found. No relationship was elicited between polymorphism of Val158Met COMT and VNTR MAO-A in the promoter area and schizophrenia onset. Allelic distribution of polymorphism of Val158Met COMT and VNTR MAO-A in the promoter area did not differ between the groups. The patients with genotype Val/Val of polymorphism Val158Met COMT showed major emotional deficits. The patients with genotype of 4/4 of polymorphism VNTR MAO-A showed deeper empathy/theory of mind deficits.

Duration of untreated psychosis and proton magnetic resonance spectroscopy (1H-MRS) findings in first-episode schizophrenia.

BACKGROUND: The duration of untreated psychosis (DUP) is a factor associated with the natural course of schizophrenia and an independent predictor of treatment outcome. Recent studies focus on the effects of DUP on the functioning of the nervous system, but the findings are inconsistent. As proton magnetic resonance spectroscopy (1H-MRS) enables the assessment of signals from chemical compounds in vivo, it seems a useful tool to explore this problem. MATERIAL/METHODS: In this study the relationships between DUP and 1H-MRS measurements were investigated. Thirty patients with first-episode schizophrenia and 19 controls were examined. Median DUP was 10 weeks. Voxels were positioned in the following regions of interest: the left frontal lobe, left temporal lobe, and left thalamus. The ratios of N-acetylaspartate (NAA), choline-containing compounds (Cho), myoinositol (mI), and glutamate/glutamine/GABA complex (Glx) to creatine (Cr) and the non-suppressed water signal were determined. RESULTS: There were no significant differences between the whole group of patients and healthy subjects for the analyzed metabolite ratios in any region of interest. No differences were found between the groups of patients with short and long DUP and controls. No significant correlation was observed between DUP and metabolite ratios. CONCLUSIONS: The results of the study may suggest that the relatively short DUP does not influence brain metabolism in first-episode schizophrenia.

[Results of a Polish national survey--physician's opinions on the physical health of schizophrenic patients]. / Wyniki ogólnopolskiego badania--opinie lekarzy dotyczace zdrowia somatycznego pacjentów ze schizofrenia.

AIM: In view of the fact that schizophrenia is a disorder increasing the risk of mortality and development of somatic disturbances, the presented study was undertaken with the aim to analyse to what extent psychiatrists assess the somatic condition of their patients diagnosed with schizophrenia. METHOD: The participants of a nationwide study ordered by Bristol-Myers Squibb and carried out by a survey agency were 404 physicians. The study was based on a specially devised questionnaire, administered to doctors in June and July 2009. Responses from 184 psychiatry specialists were obtained during the conference "Psychiatry 2009" held in Krak6w, whereas the remaining respondents were questioned at their workplaces. The questionnaire consisted of ten questions concerning various aspects of somatic health, control of health parameters and effects of pharmacological treatment on the condition of schizophrenic patients. RESULTS: The majority (73.05%) of the respondents were found to consider the somatic condition of their patients as important or very important. In the opinion of 70.54% of the physicians, metabolic disturbances were the most significant aspect of somatic health. Doctors in private practice paid more attention to sexual and endocrine system dysfunctions than those employed in hospital wards. Most psychiatrists performed physical examinations and checked laboratory parameters "almost on every visit". CONCLUSIONS: The questioned physicians appreciate the importance of somatic condition assessment in schizophrenic patients and check the important laboratory parameters regularly. Taking into account the essence of the problem, establishing closer cooperation in this area with first-contact physicians should be considered. In view of definitely positive opinions expressed by psychiatrists, concerning their involvement in the evaluation of the somatic condition of schizophrenic patients, asking the patients themselves whether that meets their needs in this respect would render the obtained results more objective.

The effect of acute ethanol intoxication on salivary proteins of innate and adaptive immunity.

BACKGROUND: Human salivary proteins: peroxidase, lysozyme, lactoferrin, and IgA, participate in the protection of oral tissues, as well as upper digestive and respiratory tracts, against a number of microbial pathogens. In the current study, we investigated the effect of acute consumption of a large dose of ethanol on representative human salivary proteins of the innate and adaptive immune systems. METHODS: Eight healthy male volunteers drank an average of 2.0 g (1.4 to 2.5 g/kg) body weight of ethanol, in the form of vodka, in the 6-hour period. Samples of resting whole saliva were collected 12 hours before, then 36 and 108 hours after, the alcohol consumption. The levels of total protein, immunoglobulin A, lysozyme and lactoferrin as well as peroxidase activity were determined in saliva. RESULTS: At 36 hours after alcohol consumption, salivary protein and lysozyme concentrations as well as peroxidase activity were significantly decreased (p = 0.002, p = 0.043, and p = 0.003, respectively), in comparison to the values obtained at 12 hours before drinking. Between 36 and 108 hours after alcohol consumption, the salivary protein and lysozyme concentrations, as well as peroxidase activity showed a tendency to increase, although at 108 hours after the drinking session, the concentration of protein and peroxidase activity were still significantly lower than before drinking. There was no significant change in the level of lactoferrin, after the drinking session. The salivary concentration of IgA tended to increase at 36 hours after alcohol consumption, and at 108 hours it was significantly higher (p = 0.028), when compared to IgA concentration in the saliva collected before drinking (from 8% to 26% and 32% of total protein content, respectively). CONCLUSION: Our report is the first to show that acute ingestion of relatively large, yet tolerable dose of alcohol, significantly disturbs salivary antimicrobial defense system. Reduced lysozyme level and decreased peroxidase activity may contribute to increased susceptibility to infections, when acute alcohol intake coincides with exposure to pathogens.

[Pre-psychotic states--contemporary diagnostic and therapeutic issues. Part I. Clinical identification of pre-psychotic states]. / Stany prepsychotyczne--wspolczesne koncepcje diagnostyczne i terapeutyczne. Czesc I. Kliniczna identyfikacja stanów prepsychotycznych.

Early intervention in psychotic disorders, particularly schizophrenia, has been increasingly recognized as important by clinicians. The benefits of early intervention in schizophrenia to patients include prevention of neurobiological changes, minimization of secondary morbidity and prevention of relapse. Other benefits of prepsychotic intervention include the capacity to research the onset phase of psychosis. We would like to support in our paper a statement by Maeres: What is needed is not diagnosing the early stages of schizophrenia but the diagnosis of prepsychotic schizophrenia. We are interested in recognizing the schizophrenia 'prodrome' prospectively using to concepts: subjects 'at risk mental state' (ARMS) and subjects from 'ultra high risk' (UHR) group. For clinical reasons that involves both some clinical features of pre-psychotic states (attenuated psychotic symptoms) and some "trait factors", i.e. schizotypal personality or family predisposition factors. Recent data revealed that some characteristics of pre-psychotic states had stronger predictive value: longer symptoms duration, lower level of GAF (< 40), and presence of attenuated psychotic symptoms. The possibility of providing intervention prior to the onset of psychosis has risen from recent interest in early intervention in these pre-psychotic states.

[Pre-psychotic states--contemporary diagnostic and therapeutic issues. Part II. The biological markers of the risk of schizophrenia. Therapy of pre-psychotic states]. / Stany prepsychotyczne--wspólczesne koncepcje diagnostyczne i terapeutyczne. Czesc II. Markery biologiczne ryzyka rozwoju schizofrenii. Terapia stanów prepsychotycznych.

The authors review the literature on the topic of early identification and intervention in "pre-psychotic" and "pre-schizophrenic" persons. Most of the early intervention programmes include more or less "false positive results". There is still no classic biological marker of schizophrenia available. Authors review the possible markers of schizophrenia, including some neurophysiological and neurocognitive disorders (eye-tracking dysfunction, sensory motor gating dysfunction, working memory and other neurocognitive dysfunctions) and also structural, neurochemical and functional brain abnormalities. Unfortunately, the marker of transition to psychosis is still unknown. Only the complex analysis of all possible factors: family, social, clinical and biological can be helpful in identification of the future schizophrenic persons. The authors also review the research on the treatment of "pre-psychotic" persons. The most frequent methods used in these cases are the generation antipsychotics in low doses and psychotherapy. The results are promising, but need further confirmation, both in every day practice and in randomized controlled trials.

Relationship between frontal N-acetylaspartate and cognitive deficits in first-episode schizophrenia.

BACKGROUND: The aim of this study was to evaluate the relationship between N-acetylaspartate (NAA) levels in selected brain regions and cognitive performance in patients with first-episode schizophrenia. MATERIAL/METHODS: Thirty patients (20 male, 10 female; mean age: 22.5 years) with the diagnosis of first-episode schizophrenia and 19 comparable healthy controls were studied. The Wisconsin Card Sorting Test (WCST) was used to assess cognitive functions. MR imaging and MR spectroscopy examinations were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal lobe, left temporal lobe, and left thalamus. The ratio of NAA to creatine and the ratio of NAA to unsuppressed water signal were analyzed. RESULTS: Patients performed significantly worse than controls on measures of the WCST. In the patient group, NAA levels in the frontal lobe were significantly related to poorer WCST performance. CONCLUSIONS: Cognitive impairment related to dysfunction of the prefrontal cortex in first-episode schizophrenia is associated with NAA level in the frontal lobe.

N-acetylaspartate (NAA) levels in selected areas of the brain in patients with chronic schizophrenia treated with typical and atypical neuroleptics: a proton magnetic resonance spectroscopy (1H MRS) study.

BACKGROUND: NAA, marker of neurons integrity and viability, is one of the most important brain metabolites visible in 1H MRS. In most studies of schizophrenia, the decrease of NAA level was observed in the temporal, frontal lobes and in the thalamus. This finding was observed more often among chronic patients, what suggests the influence of disease duration or the effect of neuroleptic treatment. The aim of the present study was the comparison of NAA levels in brain of schizophrenic patients taking typical and atypical neuroleptics. MATERIAL/METHODS: We analyzed the NAA levels in selected brain areas in 58 schizophrenic patients and 21 healthy controls. 10 patients were treated with typical neuroleptics, 10 patients with clozapine, 17 received olanzapine and 21 - risperidone. 1H MRS was performed on a 1,5 MR scanner with PRESS sequence. Voxels of 2x2x2 cm were localized in the left frontal, left temporal lobe and left thalamus. RESULTS: There were no differences in NAA levels between patients on typical and atypical medications analyzed together and separately (olanzapine, clozapine and risperidone groups). We also did not find any differences between patients taking selected atypical neuroleptics and controls. The NAA level in the thalamus in the group of patients receiving typical antipsychotics was the lowest among all groups and differed significantly from healthy controls. CONCLUSIONS: The results of our study suggest that atypical neuroleptics may have favorable effect on NAA concentration in brain of schizophrenic patients. Decrease in NAA level in patients taking typical medication may be caused by the progression of the disease or by the direct action of these drugs.

[Duration of untreated psychosis in first-episode schizophrenia: clinical and cognitive correlates]. / Czas nieleczonej psychozy a objawy kliniczne i funkcje poznawcze w grupie pacjentów z pierwszym epizodem schizofrenii.

OBJECTIVE: Duration of untreated psychosis (DUP) is associated with poor premorbid functioning and poor outcome in patients with schizophrenia. The authors determined whether the duration of untreated psychosis was associated with severity of clinical symptoms and neurocognitive functioning in patients with first-episode schizophrenia. METHOD: A total of 30 first-episode patients were evaluated by means of WCST, Vocabulary, Arithmetic, Block Design, attention and verbal fluency tests. RESULTS: The mean duration of untreated psychosis was 31.3 weeks. The group was divided on the basis of median duration of untreated psychosis (10 weeks) to short and long DUP group. There were no significant differences between the groups in results of clinical symptoms and neurocognitive functioning. There were no correlations between severity of clinical symptoms and neurocognitive functioning with duration of untreated psychosis. CONCLUSIONS: In the group of patients with first-episode schizophrenia, the duration of untreated psychosis is not associated with severity of clinical symptoms and neurocognitive functioning.

[Schizophrenia--neurodevelopmental and neurodegenerative theory revisited]. / Schizofrenia--blizej do koncepcji neurorozwojowej czy neurodegeneracyjnej?

The paper presents a critical review regarding the pathogenesis of schizophrenia. The neurodevelopmental theory which is now mostly recognized, needs some explanations, some elements of neurodegenerative theory are revisited. The developmental factors are confirmed as important in the pathogenesis of schizophrenia, but still it is unclear, how relatively subtle early damage causes so heavy thinking and emotional distortion like schizophrenia. There is also lack of evidence for neurodegeneration. Neuroimaging studies show the evidence for progression of brain abnormalities but at the same time there is no progression in neurocognitive disorders. Most likely late developmental disorders interfere with early brain damage, which leads to a neurocognitive disorder and clinical symptoms of schizophrenia.

[Premorbid adjustment and quality of life in schizophrenia]. / Przystosowanie przedchorobowe, a jakosc zycia chorych na schizofrenie.

UNLABELLED: The Premorbid Adjustment Scale by Cannon-Spoor (PAS) is a rating scale which was designed to evaluate the degree of achievement of developmental goals at each of several periods of a subject's life before the onset of schizophrenia. AIM OF THE STUDY: The evaluation of PAS in schizophrenic patients. MATERIAL AND METHODS: In this study premorbid adjustment level was correlated with QOL (Quality of Life Scale (QLS) by Henrichs) in a group of 120 subjects that fulfilled ICD-10 criteria for schizophrenia. CONCLUSION: This study supported that poor premorbid adjustment can be manifested by poorer QOL among schizphrenics, especially, the lower adjustment in adolecscence, the poorer QOL.

[The effectiveness of psychoeducation in schizophrenic and depressive patients--preliminary report]. / Ocena efektywnosci psychoedukacji w grupach pacjentów psychotycznych i depresyjnych--badanie pilotazowe.

UNLABELLED: Earlier studies suggest that psychoeducation as a form of psychosocial care is of value in improving the patient's attitude towards mental illness as well as in reducing and delaying the relapse rates of both--psychotic and depressive disorders. AIM: The aim of this study was the evaluation of influence of psychoeducation on clinical symptoms, quality of life and drug attitude in schizophrenic and depressive patients. METHOD: 52 patients, aged 18-50 years, hospitalized in the Department of Psychiatry of Medical Academy in Bialystok, were involved in the study. They were randomly assigned into 2 groups: on medication without psychoeducation (12 schizophrenics, 12 depressive patients) and on medication and psychoeducation (16 schizophrenics and 12 depressive patients). The patients were assessed by means of BPRS, BNS, IMHC 2000, Raskin/Covi Scale, DAI-10. The assessment was performed twice--shortly after admission and before discharge from the hospital. RESULTS: The patients in both groups showed improvement in symptoms and in quality of life. Patients on psychoeducation changed their drug attitude positively significantly more often. CONCLUSION: Knowledge about the positive influence of medication on psychiatric symptoms helps to improve compliance and improves the course of disease.

[The relationship between quality of life of schizophrenic patients and clinical parameters of psychosis]. / Zwiazek jakosci zycia chorych na schizofrenie z parametrami klinicznymi psychozy.

The aim of this study was an analysis of relationship between the quality of life of schizophrenic patients and clinical parameters (positive symptoms, negative symptoms, symptoms of depression, time from start of treatment, total time of all hospitalizations). The research was carried out on 120 in- and out-patients (from 19 to 65 years of age) who fulfilled ICD-10 and DSM-IV criteria for schizophrenia. They were in a stable state of improvement during actual treatment. The following instruments were used: Quality of Life Scale--QLS (Heinrich et al., 1984), Calgary Depression Scale--CDS (Addington et al., 1990), Brief Psychiatric Rating Scale--BPRS (Overall, Gorham, 1962)--short form to assess positive symptoms, Brief Negative Symptoms Assessment--BNS. The basic statistical method used was correlation analysis between measurable variables with Pearson's index (P). In investigated group the quality of life correlates essentially with negative symptoms (P = -0.838), positive symptoms (P = -0.350), total time of all hospitalizations (P = -0.371), but there is not correlation between the quality of life and symptoms of depression and time from start of schizophrenia treatment. This study shows that the improvement of quality of life of schizophrenic patients is possible by effective treatment mainly negative symptoms, also positive symptoms and shortening of hospitalizations. It seems that QLS is less sensitive to changes in symptoms of depression.

[Comparison of subjective and objective quality of life in a group of schizophrenic patients]. / Porównanie subiektywnej i obiektywnej oceny jakosci zycia w grupie chorych na schizofrenie.

AIM: The aim of this study is a comparison of subjective and objective quality of life in schizophrenic patients. METHODS: The research was carried out on 120 in- and out-patients (from 19 to 65 years) who fulfilled ICD-10 and DSM-IV criteria for schizophrenia. The quality of life was assessed by means of two instruments: Quality of Life Scale (QLS, Heinrichs et al. 1984), Self-Report Quality of Life Measure for People with Schizophrenia (SQLS, Wilkinson et al. 2000). The basic statistical methods used were: correlation analysis between measurable variables with Pearson's index (P), t-Student test, analysis of variance, factor analysis. RESULTS: In the investigated group there is no correlation between subjective and objective quality of life. Sex does not influence a correlation between these variables. Subjective and objective quality of life correlate with each other only in out-patients' group (P = -0.386). The factor analysis of SQLS distinguished 7 factors: mood; everyday activities, side effects connected with movement; side effects- others; support; interpersonal contacts; others; this division differs completely from a division on subscales. The factor analysis of QLS distinguished 3 factors: intrapsychic functioning; social functioning; functioning in roles; this division is similar to a division on subscales. CONCLUSIONS: It seems that in the schizophrenic patients' group using subjective and objective ways to assess the quality of life determines a difference of the obtained results. Only the subjective measurement fulfills the assumption of quality of life definition, that is why the usefulness of QLS in assessing quality of life is rather restricted.

[Clinical and neuropsychological correlates of proton magnetic resonance spectroscopy detected metabolites in brains of first-episode and schizophrenic patients]. / Badania wybranych obszarów mózgu metoda spektroskopii protonowej rezonansu magnetycznego (1H MRS) w aspekcie dysfunkcji poznawczych i obrazu klinicznego u osób ze schizofrenia wczesna i przewlekla--doniesienie wstepne.

OBJECTIVE: This study examined 1H MRS detected metabolite levels (in left frontal, temporal lobes and thalamus) and clinical and cognitive features of patients with first-episode and chronic schizophrenia. METHOD: We studied 31 first-episode patients (group 1) and 17 chronic patients (group 2) with ICD-10 diagnosis of schizophrenia (and 13 healthy subjects). Patients were also assessed by the means of PANSS, CGI, Calgary scales and WCST, TMT, Stroop tests. RESULTS: We did not observe statistically significant differences in metabolite levels between group 1 and 2. We observed only a trend toward higher Cho level in temporal lobe in group 2 and lower NAA level in group 1. When comparing with the control group we observed a significantly higher Cho level in the frontal lobe (group 1,2) (p < 0.05). We observed a trend toward lower NAA levels in the frontal lobe (group 1,2), and lower NAA level in the temporal lobe (group 1). Patients with chronic schizophrenia performed significantly worse in WCST, TMT and Stroop tests (p < 0.05). CONCLUSION: These results suggest, that abnormalities in metabolite levels in frontal and temporal lobes are present at the onset of disease and don't progress over time. The cognitive dysfunction is more prominent in chronic patients.

[Is dehydration an ethical problem?]. / Czy odwodnienie moze byc problemem w kategoriach etycznych?

In the paper, issues connected with chronic dehydration were discussed from the point of view of medical ethics. Rudimentary definitions concerning the issues were mentioned. An attempt was made at analysing critically the views on chronic voluntary dehydration as a possible form of causing death. Some pathophysiological and psychopathological aspects were discussed. "The pyramid" of physician doubts were presented.