Mobile health for mental health support: a survey of attitudes and concerns among mental health professionals in Poland over the period 2020-2023.

Introduction: Mobile health (mHealth) has emerged as a dynamic sector supported by technological advances and the COVID-19 pandemic and have become increasingly applied in the field of mental health. Aim: The aim of this study was to assess the attitudes, expectations, and concerns of mental health professionals, including psychiatrists, psychologists, and psychotherapists, towards mHealth, in particular mobile health self-management tools and telepsychiatry in Poland. Material and methods: This was a survey conducted between 2020 and 2023. A questionnaire was administered to 148 mental health professionals, covering aspects such as telepsychiatry, mobile mental health tools, and digital devices. Results: The majority of professionals expressed readiness to use telepsychiatry, with a peak in interest during the COVID-19 pandemic, followed by a gradual decline from 2022. Concerns about telepsychiatry were reported by a quarter of respondents, mainly related to difficulties in correctly assessing the patient's condition, and technical issues. Mobile health tools were positively viewed by professionals, with 86% believing they could support patients in managing mental health and 74% declaring they would recommend patients to use them. Nevertheless, 29% expressed concerns about the effectiveness and data security of such tools. Notably, the study highlighted a growing readiness among mental health professionals to use new digital technologies, reaching 84% in 2023. Conclusion: These findings emphasize the importance of addressing concerns and designing evidence-based mHealth solutions to ensure long-term acceptance and effectiveness in mental healthcare. Additionally, the study highlights the need for ongoing regulatory efforts to safeguard patient data and privacy in the evolving digital health landscape.

Behavioural Parameters of Circadian Rhythm Are Not Correlated with Dim Light Melatonin Onset: An Observational Study on Healthy Volunteers.

Dim light melatonin onset (DLMO) is considered the most reliable marker of the circadian rhythm phase in humans. DLMO may moderately correlate with sleep onset and sleep offset time. There are no sufficient data about the correlations between DLMO and clinical scales assessing sleep quality and daytime symptoms of poor night sleep. The aim of the study was to determine the association between DLMO and basic sleep parameters from actigraphy and sleep diaries, as well as the association between DLMO and the following insomnia clinical scales: the Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and chronotype questionnaires: Morningness-Eveningness Questionnaire (MEQ) and Composite Scale of Morningness (CSM). Participants of the study were healthy volunteers. Sleep parameters were measured by sleep diaries and actigraphy, and the following clinical scales: the AIS, ISI, and ESS, and chronotype questionnaires: MEQ and CSM. DLMO was calculated based on plasma melatonin concentration. The blood samples were collected hourly at five time points between 20:00 and 00:00 during the session in dim red light (<50 lux). Melatonin concertation was determined by LC-MS/MS. Twenty-one volunteers participated in the study. DLMO was calculated in 12 participants. There was a significant correlation between DLMO and ISI (r = 0.60, p = 0.038) and ESS (r = 0.61, p = 0.034). The correlation coefficient between the DLMO and the AIS was also high, however insignificant (r = 0.57, p = 0.054). There were no significant correlations between DLMO and chronotype scales MEQ and CSM. DLMO did not correlate with sleep onset and sleep offset; however, DLMO correlated with the Sleep Fragmentation Index (SFI) (r = 0.67, p = 0.017). DLMO is associated with poorer sleep maintenance, a stronger feeling of insomnia, and sleepiness during the day. Simultaneously, chronotype pattern and circadian rhythm parameters do not correlate with DLMO. Biological circadian rhythm does not reflect the real-life sleep-wake rhythm, indicating that the lifestyle is more often disconnected from the biological clock.

Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio in ADHD: a systematic review and meta-analysis.

Introduction: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with an unclear etiology. Systemic inflammation and immune dysregulation may play a role in the pathogenesis of ADHD. Morphology-derived parameters such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), have been proposed as peripheral biomarkers of the immune-inflammatory process in various diseases. However, studies examining their role in ADHD remain inconclusive. Methods: A systematic review and a meta-analysis were conducted to evaluate the association between NLR, MLR, PLR and ADHD. Relevant articles were identified, screened, and assessed for quality according to PRISMA guidelines. Moreover, a qualitative and quantitative analyses were performed. Results: The review contained eight eligible studies, five of which were included in the meta-analysis. The meta-analysis showed that ADHD patients had higher NLR and PLR values compared to health controls. No significant difference in MLR value was observed between the two groups. Analysis in relation to ADHD subtypes showed no significant differences in inflammatory markers in any of the included studies as well. The influence of medical treatment on these ratios could not be adequately assessed due to limited data. Conclusion: ADHD patients exhibit higher NLR and PLR than healthy controls, which may indicate the potential immune-inflammatory involvement in this disorder. Further studies on inflammatory markers and ADHD, especially those considering the impact of treatment and clinical symptoms, are essential to comprehensively understand this association.

Electrolyte Disturbances Related to Sodium and Potassium and Electroconvulsive Therapy: A Systematic Review.

INTRODUCTION: Electrolyte disturbances related to sodium and potassium affect patients with mental disorders undergoing electroconvulsive therapy (ECT). The objective of this study was to systematically summarize the data regarding ECT and electrolyte disturbances related to sodium and potassium. MATERIALS AND METHODS: A systematic literature review in accordance with PRISMA guidelines was conducted. Clinical studies of patients receiving ECT with electrolyte disturbances reported before or after treatment were included. RESULTS: We identified nine case reports and two retrospective studies describing electrolyte abnormalities occurring before or after ECT. ECT was effective and safe in patients with hyponatremia and hypernatremia, including the elderly patient population. This treatment was also effective in treating psychiatric symptoms that may persist after ionic equalization. Electrolyte disturbances after ECT were rare. Reports have suggested that succinylcholine used as a muscle relaxant was the main cause of hyperkalemia after ECT. CONCLUSIONS: Electrolyte control is a crucial aspect of guiding ECT therapy. In the context of sodium-related disorders, it is critical to control patient hydration as part of therapy. In addition, succinylcholine should not be used in patients with immobilization, such as catatonia or neuroleptic malignant syndrome. It is necessary to conduct further studies to clarify whether electrolyte concentration affects ECT parameters and clinical efficacy. In addition, it is necessary to assess the influence of various anesthetics on these conditions during ECT. The result of this review should be interpreted bearing in mind the small number of studies conducted to date and the low quality of the evidence they provide.

Celecoxib for Mood Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The effects of celecoxib on a broad spectrum of mood disorders and on inflammatory parameters have not yet been comprehensively evaluated. The aim of this study was to systematically summarize the available knowledge on this topic. Data from both preclinical and clinical studies were analyzed, considering the efficacy and safety of celecoxib in the treatment of mood disorders, as well as the correlation of inflammatory parameters with the effect of celecoxib treatment. Forty-four studies were included. We found evidence supporting the antidepressant efficacy of celecoxib in a dose of 400 mg/day used for 6 weeks as an add-on treatment in major depression (SMD = -1.12 [95%Cl: -1.71,-0.52], p = 0.0002) and mania (SMD = -0.82 [95% CI:-1.62,-0.01], p = 0.05). The antidepressant efficacy of celecoxib in the above dosage used as sole treatment was also confirmed in depressed patients with somatic comorbidity (SMD = -1.35 [95% CI:-1.95,-0.75], p < 0.0001). We found no conclusive evidence for the effectiveness of celecoxib in bipolar depression. Celecoxib at a dose of 400 mg/d used for up to 12 weeks appeared to be a safe treatment in patients with mood disorders. Although an association between celecoxib response and inflammatory parameters has been found in preclinical studies, this has not been confirmed in clinical trials. Further studies are needed to evaluate the efficacy of celecoxib in bipolar depression, as well as long-term studies evaluating the safety and efficacy of celecoxib in recurrent mood disorders, studies involving treatment-resistant populations, and assessing the association of celecoxib treatment with inflammatory markers.

The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review.

The impact of HPV diagnosis and subsequent treatment with the electrosurgical excision procedure (LEEP) on anxiety, depression, psychosocial quality of life, and sexual functioning has not been thoroughly investigated. The aim of this review was to systematically summarize the available knowledge on this topic, according to PRISMA guidelines. Data from observational and intervention studies were analyzed. A total of 60 records were included, of which 50 papers addressed the impact of HPV diagnosis on patients' psychosocial status, while 10 studies addressed the impact of the implemented LEEP procedure on patients' mental health and sexual functioning. The results indicated a negative impact of HPV diagnosis on the occurrence of depressive and anxiety symptoms, poorer quality of life, as well as on the sexual functioning of the affected women. The results of the studies to date have not confirmed the negative impact of the LEEP procedure on mental health and sexual life, although more research is needed in this area. It is necessary to implement additional procedures to minimize anxiety and distress in patients receiving a diagnosis of HPV or abnormal cytology and to improve awareness of sexually transmitted pathogens.

Probiotics as a Tool for Regulating Molecular Mechanisms in Depression: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Depression is one of the main mental disorders. Pharmacological treatment of depression is often associated with delayed effects or insufficient efficacy. Consequently, there is a need to discover new therapeutic methods to cope with depression faster and more effectively. Several lines of evidence indicate that the use of probiotic therapy reduces depressive symptoms. Nonetheless, the exact mechanisms linking the gut microbiota and the central nervous system, as well as the potential mechanisms of action for probiotics, are still not entirely clarified. The aim of this review was to systematically summarize the available knowledge according to PRISMA guidelines on the molecular mechanisms linking probiotics and healthy populations with subclinical depression or anxiety symptoms, as well as depressed patients with or without comorbid somatic illnesses. The standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated. Twenty records were included. It has been found that probiotic administration is linked to a significant increase in BDNF levels during probiotic treatment compared to the placebo (SMD = 0.37, 95% CI [0.07, 0.68], p = 0.02) when considering the resolution of depressive symptoms in depressed patients with or without comorbid somatic illnesses. CRP levels were significantly lower (SMD = -0.47, 95% CI [0.75, -0.19], p = 0.001), and nitric oxide levels were significantly higher (SMD = 0.97, 95% CI [0.58, 1.36], p < 0.0001) in probiotic-treated patients compared to the placebo, however, only among depressed patients with somatic co-morbidities. There were no significant differences in IL-1ß, IL-6, IL-10, TNF-α, and cortisol levels after probiotic administration between the intervention and control groups (all p > 0.05). Firm conclusions on the effectiveness of probiotics and their possible association with inflammatory markers in the healthy population (only with subclinical depressive or anxiety symptoms) cannot be drawn. The advent of clinical trials examining the long-term administration of probiotics could evaluate the long-term effectiveness of probiotics in treating depression and preventing its recurrence.

Prevalence, attitudes and concerns toward telepsychiatry and mobile health self-management tools among patients with mental disorders during and after the COVID-19 pandemic: a nationwide survey in Poland from 2020 to 2023.

Introduction: Mobile Health (mHealth) is a rapidly growing field of medicine that has the potential to significantly change everyday clinical practice, including in psychiatry. The COVID-19 pandemic and technological developments have accelerated the adoption of telepsychiatry and mobile solutions, but patient perceptions and expectations of mHealth remain a key factor in its implementation. Aim: The aim of this study was to assess (1) the prevalence, (2) attitudes, preferences and (3) concerns about mobile mental health, including telepsychiatry and self-management tools, among patients with mental disorders over the period 2020-2023, i.e., at the onset, peak and after the expiration of the COVID-19 pandemic. Materials and methods: A semi-structured survey was administrated to 354 patients with mental disorders in Poland. The questions were categorized into three section, addressing prevalence, attitudes, and concerns about telepsychiatry and mobile health self-management tools. The survey was conducted continuously from May 2020 to the end of May 2023. Result: As many as 95.7% of patients with mental disorders used mobile devices at least once a week. Over the course of 3 years (from 2020 to 2023), there was a significant increase in the readiness of patients to embrace new technologies, with the percentage rising from 20% to 40%. In particular, a remarkable growth in patient preferences for telepsychiatry was observed, with a significant increase from 47% in 2020 to a substantial 96% in 2023. Similarly, mHealth self-management tools were of high interest to patients. In 2020, 62% of patients like the idea of using mobile apps and other mobile health tools to support the care and treatment process. This percentage also increased during the pandemic, reaching 66% in 2023. At the same time, the percentage of patients who have concerns about using m-health solutions has gradually decreased, reaching 35% and 28% in 2023 for telepsychiatry and for the reliability and safety of m-health self-management tools, respectively. Conclusion: This study highlights the growing acceptance of modern technologies in psychiatric care, with patients showing increased readiness to use telepsychiatry and mobile health self-management tools, in particular mobile applications, after the COVID-19 pandemic. This was triggered by the pandemic, but continues despite its expiry. In the face of patient readiness, the key issue now is to ensure the safety and efficacy of these tools, along with providing clear guidelines for clinicians. It is also necessary to draw the attention of health systems to the widespread implementation of these technologies to improve the care of patients with mental disorders.

The impact of bipolar spectrum disorders on professional functioning: A systematic review.

Aims: The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. Materials and methods: A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. Results: Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). Conclusion: Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.

Behavioral and Self-reported Data Collected From Smartphones for the Assessment of Depressive and Manic Symptoms in Patients With Bipolar Disorder: Prospective Observational Study.

BACKGROUND: Smartphones allow for real-time monitoring of patients' behavioral activities in a naturalistic setting. These data are suggested as markers for the mental state of patients with bipolar disorder (BD). OBJECTIVE: We assessed the relations between data collected from smartphones and the clinically rated depressive and manic symptoms together with the corresponding affective states in patients with BD. METHODS: BDmon, a dedicated mobile app, was developed and installed on patients' smartphones to automatically collect the statistics about their phone calls and text messages as well as their self-assessments of sleep and mood. The final sample for the numerical analyses consisted of 51 eligible patients who participated in at least two psychiatric assessments and used the BDmon app (mean participation time, 208 [SD 132] days). In total, 196 psychiatric assessments were performed using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Generalized linear mixed-effects models were applied to quantify the strength of the relation between the daily statistics on the behavioral data collected automatically from smartphones and the affective symptoms and mood states in patients with BD. RESULTS: Objective behavioral data collected from smartphones were found to be related with the BD states as follows: (1) depressed patients tended to make phone calls less frequently than euthymic patients (ß=-.064, P=.01); (2) the number of incoming answered calls during depression was lower than that during euthymia (ß=-.15, P=.01) and, concurrently, missed incoming calls were more frequent and increased as depressive symptoms intensified (ß=4.431, P<.001; ß=4.861, P<.001, respectively); (3) the fraction of outgoing calls was higher in manic states (ß=2.73, P=.03); (4) the fraction of missed calls was higher in manic/mixed states as compared to that in the euthymic state (ß=3.53, P=.01) and positively correlated to the severity of symptoms (ß=2.991, P=.02); (5) the variability of the duration of the outgoing calls was higher in manic/mixed states (ß=.0012, P=.045) and positively correlated to the severity of symptoms (ß=.0017, P=.02); and (6) the number and length of the sent text messages was higher in manic/mixed states as compared to that in the euthymic state (ß=.031, P=.01; ß=.015, P=.01; respectively) and positively correlated to the severity of manic symptoms (ß=.116, P<.001; ß=.022, P<.001; respectively). We also observed that self-assessment of mood was lower in depressive (ß=-1.452, P<.001) and higher in manic states (ß=.509, P<.001). CONCLUSIONS: Smartphone-based behavioral parameters are valid markers for assessing the severity of affective symptoms and discriminating between mood states in patients with BD. This technology opens a way toward early detection of worsening of the mental state and thereby increases the patient's chance of improving in the course of the illness.

Analysis of the efficacy and safety of electroconvulsive therapy in elderly patients: a retrospective study in the Polish population. / Analiza skutecznosci i bezpieczenstwa zabiegów elektrowstrzasowych u pacjentów w wieku podeszlym: badanie retrospektywne w populacji polskiej.

OBJECTIVES: The aim of the study was to assess the efficacy and safety of electroconvulsive therapy in a population ≥ 65 years old. METHODS: The study was naturalistic, retrospective. The study group included 65 patients, women and men, hospitalized in the departments of the Institute of Psychiatry and Neurology and undergoing ECT treatment. The authors analyzed the course of 615 ECT procedures performed in 2015-2019. The effectiveness of ECT was assessed using the CGI-S scale. Safety was assessed by analyzing side effects of the therapy, taking into account the somatic diseases in the study group. RESULTS: As many as 94% of patients initially met the drug resistance criteria. In the study group, no serious complications such as death, life-threatening condition, necessity to be hospitalized in another ward or permanent health impairment were reported. In total, in the whole group, adverse effects were reported in 47. 7% of older patients, in the majority of cases (88%) they were of slight intensity and resolved without any particular intervention. The most frequently observed side effect of ECT was an increase in blood pressure (55. 4% of patients). Four patients did not complete ECT therapy due to side effects. In the majority of patients (86. 2%) at least 8 ECT treatments were performed. ECT turned out to be an effective method of treatment in the population of patients over 65 years of age - response to treatment was found in 76. 92% and remission in 49. 23% of the study group. The severity of the disease according to the CGI-S scale was on average 5. 54 before and 2. 67 after the ECT treatment. CONCLUSIONS: Tolerance of ECT is worse after 65 years than in younger age groups. Most of the side effects are associated with underlying somatic diseases, mainly cardiovascular problems. This does not change the fact that ECT therapy is highly effective in this population and can be a very good alternative to pharmacotherapy, which, in this age group, is often ineffective or causes side-effects.

Acetylsalicylic Acid and Mood Disorders: A Systematic Review.

The effects of acetylsalicylic acid (ASA) on mood disorders (MD) and on inflammatory parameters in preclinical and clinical studies have not yet been comprehensively evaluated. The aim of this study was to systematically summarize the available knowledge on this topic according to PRISMA guidelines. Data from preclinical and clinical studies were analyzed, considering the safety and efficacy of ASA in the treatment of MD and the correlation of inflammatory parameters with the effect of ASA treatment. Twenty-one studies were included. Both preclinical and clinical studies found evidence indicating the safety and efficacy of low-dose ASA in the treatment of all types of affective episodes in MD. Observational studies have indicated a reduced risk of all types of affective episodes in chronic low-dose ASA users (HR 0.92, 95% CI: 0.88, 0.95, p < 0.0001). An association between ASA response and inflammatory parameters was found in preclinical studies, but this was not confirmed in clinical trials. Further long-term clinical trials evaluating the safety and efficacy of ASA in recurrent MD, as well as assessing the linkage of ASA treatment with inflammatory phenotype and cytokines, are required. There is also a need for preclinical studies to understand the exact mechanism of action of ASA in MD.

Use of transcutaneous auricular vagus nerve stimulation (taVNS) in the treatment of drug-resistant depression - a pilot study, presentation of five clinical cases. / Zastosowanie przezskórnej usznej stymulacji nerwu blednego (taVNS) w leczeniu pacjentów z depresja lekooporna ­ badanie pilotazowe, prezentacja pieciu przypadków klinicznych.

OBJECTIVES: The aim of the study was to assess safety and efficacy of transcutaneous vagus nerve stimulation (taVNS) as the method added to standard pharmacotherapy in the group of patients with treatment-resistant depression. MATERIAL AND METHODS: We present results of pilot study involving the use of commercially available transcutaneous vagus nerve stimulators. With external, non-invasive nature of new solution, the patient is avoiding possible side effects of surgical operation. taVNS is a relatively new, noninvasive VNS method based on the location of afferent vagus nerve distribution on the surface of the ear. The pilot study group consisted of 5 patients with treatment-resistant depression. All patients suffered from severe depression with no response to appropriate courses of at least two different antidepressants. The assumed observation time was 12 weeks. The duration of stimulation was 4 hours/day, divided in 2 sessions. Mental state was assessed by clinician with the use of the Hamilton Depression Rating Scale (HAMD-17) and the Clinical Global Impression Scale (CGI). RESULTS: In 2 cases substantial improvement of mental state was observed (significant improvement in scoring scales, improvement of mood and drive, decrease of anxiety). 3 patients resigned from the study because of difficulties in handling devices. CONCLUSIONS: In 2 cases substantial improvement of mental state was observed (significant improvement in scoring scales, improvement of mood and drive, decrease of anxiety). 3 patients resigned from the study because of difficulties in handling devices.

Electroconvulsive Therapy and Age: Effectiveness, Safety and Tolerability in the Treatment of Major Depression among Patients under and over 65 Years of Age.

Electroconvulsive therapy (ECT) remains the most effective therapy in treatment-resistant depression. However, the safety of ECT has been consistently questioned, particularly among elderly patients. We assessed the efficacy and safety of ECT in patients before and after 65 years old. The study was conducted between 2015 and 2018 and included 91 patients (61 under and 29 over 65 years old) with major depression undergoing ECT. The Hamilton Depression Rating Scale was used to evaluate efficacy. Cognitive functions were assessed using: MMSE, RAVLT, Trail Making Test, Stroop Test and Autobiographical Memory Interview-Short Form. ECT was more effective in older patients as compared to younger (p < 0.001). No serious adverse events were observed in either group. Increased blood pressure and arrhythmias were more common in the older compared to the younger group (p = 0.044 and p = 0.047, respectively), while disturbances of consciousness did not differ between groups (p = 0.820). Most of the cognitive functions remained unchanged compared to baseline, whereas the outcomes of MMSE, RAVLT and Stroop tests showed greater improvements in the older compared to the younger group (all p < 0.05). The decline in the retrieval consistency of autobiographical memory was more pronounced in the younger group (p = 0.024). ECT is a highly effective, safe and well-tolerated method of treating depression regardless of age.

Screening and treatment of depression - recommendations for Polish health professionals.

INTRODUCTION: Epidemiological data clearly indicate that depression is becoming an increasingly important health and social problem today. Depressive disorders occur at all ages, in men and women, in different cultures, affecting individuals, their families, and, more broadly, the social and economic system of the country. The gap between the recorded number of treated patients and the prevalence of depression highlights the scale of unmet needs. With limited availability of specialists in psychiatric care, the most appropriate measures seem to be those aimed at increasing the competence of other health professionals in the diagnosis and treatment of depression. MATERIAL AND METHODS: An overview of the literature and available recommendations for the prevention, screening, and treatment of depression was performed. This work was commissioned by the Polish Ministry of Health under the Depression Prevention Program 2016-2020. RESULTS: Based on the literature review, we compiled the recommendations for Polish health professionals. These recommendations focus on the management of depression in the primary care setting and provide guidelines for health professionals other than psychiatrists concerning the prevention, screening, and treatment of depression. CONCLUSIONS: We developed a clear recommendation for non-psychiatrists concerning the screening, treatment, and further management of patients with depression. Early detection of depression and implementation of treatment improves the outcomes and prognosis and reduces the mortality rate.

Changes in the Practice of Electroconvulsive Therapy in Poland: A Nationwide Survey Comparing Data Between 2005 and 2020.

BACKGROUND: The use and the characteristics of the practice of electroconvulsive therapy (ECT) in Poland have not been evaluated since 2005, when a nationwide survey revealed its rare utilization (0.11 patients/10,000 inhabitants/year). The aims of this study were to determine the current use of ECT and to compare the findings with those of the previous survey. METHODS: Two questionnaires were sent to all 48 inpatient psychiatric centers in Poland. The first one - to units providing ECT to explore its practice, and the second - to units not performing ECT to explore the reasons for not using this treatment. RESULTS: Nineteen (39.6%) of all psychiatric inpatient centers confirmed the use of ECT. The utilization rate was 0.13 patients/10,000 inhabitants. Similar to the findings from 2005, the main indications were affective disorders, and bitemporal electrode placement was the dominant method used for the delivery of ECT. Age-based and titration-based methods were applied exclusively in 50% and 25% of the centers, respectively (compared with 15% and 35% in 2005, respectively), while both methods were used in the remaining 25%. Improvements in safety were reflected by the use of comprehensive pre-ECT evaluation and treatment monitoring. None of the centers used sine-wave devices; this contrasts with their use by 29% of the centers in 2005. The main reasons for not using ECT were insufficient funding and a lack of experienced staff. CONCLUSION: The frequency of ECT use in Poland remains very low. In view of the improvement in the quality of health services in the past decade, such a markedly rare use of an effective treatment was unexpected. There is an urgent need of education to create more positive attitude towards ECT among health professionals and among public, and to increase the training of mental health professionals in ECT.

Recommendations for the prevention and treatment of postpartum depression.

Epidemiological data clearly indicate that depression is becoming an increasingly important health and social problem today. According to the World Health Organization (WHO), depression currently affects 350 million people worldwide and is considered the second most common cause of disability in Europe after ischemic heart disease. It is estimated that this health problem may affect as many as five million people in Poland. The gap between the reported number of patients treated and the prevalence of depression, highlights the scale of unmet needs. With the limited availability of specialists in psychiatric care, the most appropriate measures seem to be those aimed at increasing the competence of doctors of other specialties in the diagnosis and treatment of depression. Early detection and treatment results in faster remission, reduces relapses and mortality. The recommendations concerning prevention of depression were commissioned by the Polish Ministry of Health as a part of the Depression Prevention Program for 2016-2020. The Program has developed recommendations addressed to specialists in various fields of medicine, other than psychiatry, focusing on three risk groups: children and adolescents, women in the perinatal period and the elderly. These recommendations focus on the management of suspected postpartum depression and provide specific guidelines for medical staff having contact with pregnant and postpartum women (gynecologists, midwives, pediatricians).

Right unilateral versus bilateral formula-based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial.

BACKGROUND: Electroconvulsive therapy (ECT) remains the most effective treatment of depression in the elderly population; however, it is still unclear which type of ECT is most beneficial in this population. The aims of this study were: (i) to assess the feasibility of a randomised controlled trial in elderly depressed patients treated with right unilateral (RUL) or fronto-temporal bilateral (BT) formula-based ECT; (ii) to compare formula-based RUL and BT ECT in terms of efficacy, safety and tolerability in this population. METHODS: The study lasted 3 years and managed to randomise 29 patients over 65 years old to receive either BT (n = 14) or RUL (n = 15) ECT. Brief pulse width (0.5 ms) and age-based dosing method were applied. The clinical efficacy was assessed using Hamilton Depression Rating Scale, somatic state was monitored throughout the ECT course. In neuropsychological examination general cognitive performance, executive functions, verbal fluency, memory, autobiographical memory were evaluated. RESULTS: The recruitment was poor due to small number of patients able to give informed consent. ECT proved to be a highly effective and safe method of treatment among elders. Formula-based RUL ECT did not differ from BT in antidepressant efficacy and had cognitive advantages - the indices of general cognitive performance, verbal fluency and memory were significantly better than before the treatment in the RUL group. Decline in retrieval consistency of autobiographical memory was more pronounced in the BT group, although it was observed across both groups. CONCLUSIONS: Formula-based RUL ECT might not differ from BT in antidepressant efficacy and has an advantage in terms of tolerability.

Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: A randomized open label controlled trial.

Electroconvulsive therapy (ECT) remains the most effective treatment of depression, though it is still unclear which of its type is the most beneficial. The aim of this study was to compare the formula-based right unilateral ECT (RUL) with the fronto-temporal bilateral ECT (BT), in terms of their efficacy, safety and tolerability in patients with bipolar or unipolar depression. Ninety-one patients were randomly assigned to either BT (n = 45) or RUL (n = 46) ECT. Brief pulse width (0.5 ms) and a formula-based dosing method were applied. The clinical efficacy was assessed using the Hamilton Depression Rating Scale (HDRS-21).The somatic state was monitored throughout the ECT course and cognitive examination included: general cognitive performance, executive functions, visual-spatial functions, verbal fluency, verbal memory and autobiographical memory. Efficacy outcomes were not found to be significantly different between groups when using higher doses of energy in RUL ECT. Patients in RUL group were less likely to be confused and experienced increased blood pressure. The indices of general cognitive performance and verbal auditory memory were also significantly better this group, while BT ECT did not change these functions. Both ECT types resulted in a decline in the retrieval consistency of autobiographical memory that persists for at least three months and was significantly more marked in BT group as compared to RUL. In conclusion, formula-based RUL ECT does not differ from BT in antidepressant efficacy and has an advantage in terms of safety (lower incidence of increased blood pressure and fewer disturbances of consciousness) and tolerability (impact on cognitive functions).

Intergenerational implications of alcohol intake: metabolic disorders in alcohol-naïve rat offspring.

Alcohol drinking may be associated with an increased risk of various metabolic diseases. Rat lines selectively bred for alcohol preference and alcohol avoidance constitute an interesting model to study inherited factors related to alcohol drinking and metabolic disorders. The aim of the present study was to compare the levels of selected laboratory biomarkers of metabolic disorders in blood samples from naïve offspring of Warsaw alcohol high-preferring (WHP), Warsaw alcohol low-preferring (WLP), and wild Wistar rats. Blood samples were collected from 3-month old (300-350 g) alcohol-naïve, male offspring of WHP (n = 8) and WLP rats (n = 8), as well as alcohol-naïve, male, wild Wistar rats. Markers of metabolic, hepatic, and pancreatic disorders were analysed (levels of homocysteine, glucose, total cholesterol, triglycerides and γ-glutamyl transferase (GGT), aspartate (AST), alanine aminotransferase (ALT), and amylase serum activities). Alcohol-naïve offspring of WHP, WLP, and wild Wistar rats differed significantly in the levels of triglycerides, total cholesterol, homocysteine, as well as in the activity of GGT, ALT, AST, and amylase enzymes. Most markers in the alcohol-naïve offspring of WHP rats were altered even thought they were never exposed to alcohol pre- or postnatally. This may suggest that parental alcohol abuse can have a detrimental influence on offspring vulnerability to metabolic disorders.