Genetic and psychosocial factors for benzodiazepine addiction. An analysis based on the results of the authors' own research conducted in a group of benzodiazepine addicted and non-addicted individuals.

PURPOSE: In spite of the fact that the addictive potential of benzodiazepine (BDZ) drugs has been known for a long time, benzodiazepine addiction remains a common problem for psychiatry to deal with. The etiology of benzodiazepine addiction is very complex. Among the risk factors, the course of the treatment, demographic status and psychological features of a patient seem to play an important role. The aim of this study was to investigate both psychological and genetic factors differentiating benzodiazepine addicts from non-addicted users. METHODS: We analysed a cohort of 120 individuals treated with benzodiazepines divided into two groups: benzodiazepine addicts and non-addicted benzodiazepine users (the control group). In both groups we measured genetic polymorphisms of GABA A2 and MAOA. In both groups some psychometric measurements were performed - we investigated the level of depression, anxiety as a state and as a trait, personality features and the dominant coping style using the Beck Depression Scale, Hamilton Anxiety Scale, Five-Factor Personality Inventory NEO-FFI and the Coping Inventory for Stressful Situations [4,10,17,36,41,44]. RESULTS: There are some psychological and situational risk factors for benzodiazepine addiction such as high neuroticism, introversion and lack of the ability to release tension through interpersonal contacts, dominance of emotional coping style and high accumulation of critical life events during both childhood and adulthood. The genetic background still remains a field for further exploration.

Pharmacy switch of antipsychotic medications: patient's perspective.

BACKGROUND AND AIM: Several studies have raised concerns over consequences of brand-to-generic and generic-to-generic pharmacy-generated medication substitutions in psychiatric and non-psychiatric patients. The purpose of this retrospective study was to assess behavioral and emotional responses of patients with schizophrenia to antipsychotic medication substitution performed by pharmacies. METHODS: A group of Polish ambulatory patients with schizophrenia (n = 196) chronically treated with antipsychotic medications were asked whether antipsychotic medication substitution had been proposed by a pharmacist in the last 12 months. Ninety-nine patients answering positively were administered more questions addressing the patient's emotional and behavioral response to the pharmacy proposal. RESULTS: The most important findings of the present study can be summarized as follows: (1) approximately half of the patients were confronted with a pharmacy proposal to switch their antipsychotic medications in the last 12 months, (2) one quarter of these patients did not accept the pharmacy switch, (3) a substantial proportion of patients (>40 %) did not receive any explanation from a pharmacist offering medication substitution, (4) pharmacy-generated substitution proposals were mainly associated with negative patient attitudes and negative emotional responses, (5) substitution proposals provoked an unscheduled psychiatric visit in approx. 10 % of patients, (6) despite the negative attitudes reported by patients, the pharmacy switch rarely led to treatment discontinuation, but did provoke a change in drug dosing in 7 % of patients accepting the switch. CONCLUSIONS: A pharmacy proposal to switch their antipsychotic medications is a relatively common experience of Polish ambulatory patients with schizophrenia. Pharmacy-generated substitution proposals are mainly associated with negative patient attitudes, but rarely lead to antipsychotic treatment discontinuation in this group of patients.

One of many lessons from the European Mental Health Integration Index.

The Mental Health Integration Index developed by the Economist Intelligence Unit describes and explores the challenges of European countries of integrating people with mental illness into society and employment, within the European Union's 28 Member States, plus Norway and Switzerland. Countries have been ranked according to estimation based on indicators of their degree of commitment to support those living with mental illness into society and employment. The Index is based on a list of indicators including the environment for those with mental illness, their access to medical help and services, their opportunities--specifically job-related--and the governance of the system, including human rights issues and efforts to combat stigma. The indicators were developed in consultation with a panel of independent experts on mental health. Key findings of the research are that Germany's strong healthcare system and generous social provision put it at the top of the Index, with the UK and Scandinavian states not far behind. However, examples of best practice "islands of excellence" in integration are not limited to the leading countries and exists in all European Countries. The Index reveals also the discrepancy between perfect legislation and poor implementation of it in practice in many European countries. It proposes that the investment figure is a proxy for seriousness in establishing good policy and practice. According to the Index some reform plans including entire national mental health programmes are largely aspirational and are grossly under-funded. Moreover various levels of government responsible for the implementation of its component parts are largely ignoring its implementation. When we consider the legislation as an promise to professionals and people with mental health problems, this promise is largely unfulfilled. The is a need for strong leadership in mental health changes process, policy capacity and real financial investments in the way of The European countries to develop community based mental health services and system of care.

Modern indications for the use of opipramol.

Opipramol is considered as a pharmacological agent that does not fit the classification taking into account the division of antidepressants, antipsychotics and anxiolytics. It has a structure related to tricyclic antidepressants but it has a different mechanism of action, i.e. binding to sigma1 and to sigma2 sites. It has been regarded as an effective drug in general anxiety disorders together with other agents like SSRI`s, SNRI`s, buspirone and pregabalin for many years. It can however also be indicated in other conditions, e.g. it may be used as a premedication in the evening prior to surgery, positive results are also observed in psychopharmacological treatment with opipramol in somatoform disorders, symptoms of depression can be significantly reduced in the climacteric syndrome. The latest data from literature present also certain dangers and side effects, which may result due to opipramol administration. Mania may be induced not only in bipolar patients treated with opipramol, but it can be an adverse drug reaction in generalized anxiety disorder. This analysis shows however that opipramol is an important drug still very useful in different clinical conditions.

Different facets of schizophrenia illustrated by the analysis of the homes of three patients diagnosed with schizophrenia.

Diagnosis and observation of patients' behaviour during outpatient visits or hospitalisations strips the diagnostic process of the opportunity to consider their places of residence as their natural environment. In this way, patients present their symptoms and problems outside of the context of their daily life. Community-based psychiatric care, on the other hand, provides a chance to include, in the diagnostic process the environment created by a patient in their home. This image of a patient's external reality can reflect a certain mental reality. Such elements as furniture and other objects, their number, quality, distribution may reflect the inner mental world of the objects featuring in a person's mind. In some cases, this can become a valuable contribution to a diagnostic process. A description of three patients, all treated for schizophrenia, has been presented in this paper in order to explore this possible relationship. The first individual, "Patient N" lives in a flat in a state of extreme depletion of elements. "Patient N" suffers from chronic schizophrenia with severe negative symptoms. The second individual, "Patient D", has been also diagnosed with schizophrenia. Yet his home is filled with a huge number of elements, writings on the wall, things, figurines and objects of symbolic meaning. A closer examination of his psychopathological symptoms (fantastic, colourful, bizarre content) and history of his illness (unstable diagnosis of schizophrenia), and unpredictable response to antipsychotics may indicate a dissociative type of schizophrenia. Finally, "Patient K's" main living space is dominated by cats that live with him. Patient K was exposed to physical violence as a child and to him cats represent safe, non-threatening objects. He has been also treated for paranoid schizophrenia. The differences between these patients' personal histories and the courses of their illnesses are clearly manifested in the way they create their immediate environment.

Sex-specific differences in cognitive functioning among schizophrenic patients.

BACKGROUND: Cognitive deficits in schizophrenia are regarded by many psychiatrist as an important symptom, which requires appropriate treatment and rehabilitation. There are different conditions, which may have an influence on cognitive impairment in schizophrenic patients. One the factors differentiating subgroups of schizophrenic patients when neuropsychological functioning is analyzed is sex. SUBJECTS AND METHODS: This Review was focused on cognitive functioning of schizophrenic patients of different sexes. In order to achieve this result PubMed was searched using following terms: cognitive functions, schizophrenia, gender differences, sex hormones, memory, attention, neuropsychological, psychopatological symptoms. RESULTS: Most of the analyzed papers reflecting the cognitive differences between men and women suffering from schizophrenia postulate a worse performance in neuropsychological test by male patients. However according to some authors there are no gender differences in cognitive functioning in schizophrenic patients or those differences are not clinically significant. CONCLUSIONS: The problem of sex-specific differences in cognitive functioning in patients in schizophrenia needs further investigation.

Letter to Editor. Position of the Polish Psychiatric Association on the use of benzodiazepine derivatives and drugs with a similar mechanism of action in the treatment of mental disorders. / List do Redakcji. Stanowisko Polskiego Towarzystwa Psychiatrycznego w sprawie stosowania pochodnych benzodiazepiny i leków o podobnym mechanizmie dzialania w leczeniu zaburzen psychicznych.

no summary.

Correlation between early subjective response to antipsychotics and the number of hospitalizations and hospitalization days in a period of 10-11 years in schizophrenia patients.

INTRODUCTION: Research into the significance of early subjective response to antipsychotic medication has so far only involved observation periods of up to 1 year. METHOD: The Drug Attitude Inventory (DAI-10) questionnaires, completed by patients with the diagnosis of schizophrenia in 1997-1998, were the bases for this study. In 2009, data on 36 patients (18 women and 18 men) with 10-11 years of follow-up information were found whose completed DAI questionnaires were on record in the hospital register. The data included the number of hospitalizations, which enabled to calculate the total number of days spent in hospital for each patient. Statistical analysis examined possible correlations between the DAI scale results and the number of hospitalizations in 1997/1998-2009 and the number of days spent in the hospital during that period of time. RESULTS: The total number of hospitalizations in the period of 11-12 years has shown no correlations with the results of the DAI-10 scale (p = 0.23). However, the number of days spent in hospital in the period of observation has shown a reverse correlation between the results of the DAI-10 scale in 1997-1998 and the number of days spent in hospital (p = 0.037). The higher the result of the DAI-10 scale was in 1997-1998 (indicating the absence of a dysphoric response to antipsychotic medications), the fewer days of hospitalization were found in the researched period. CONCLUSIONS: Early subjective response to antipsychotic drugs shows a relation to the number of days spent in hospital in the period of observation over 10 years. The data suggest that an early dysphoric response to antipsychotic medications is associated with more days spent in the hospital during subsequent years.

[Intensification of interpersonal sense of guilt in patients with schizophrenia]. / Nasilenie interpersonalnego poczucia winy w schizofrenii paranoidalnej.

AIM: The article presented results of a research designed to compare the feeling of guilt in healthy adults and in persons diagnosed with paranoid schizophrenia. METHOD: One hundred people diagnosed with paranoid schizophrenia participated in the research and 100 people without diagnosed psychopathology (control group). RESULTS: The findings of the research showed that the persons from the clinical group obtained much higher results in all the tests measuring a sense of guilt and that interpersonal guilt in persons suffering from paranoid schizophrenia in a majority of cases significantly is not correlated with clinical symptoms - thus it can be assessed in a relatively independent manner from a patient's behaviour and cognitive state. However, it has been proved that the strongest indications of positive symptoms of schizophrenia are: Sense of guilt related to helplessness (IGQ), Sense of guilt related to induced self-hate (IGQ), Guilt as a state (GI) and Guilt as a feature (GI), whereas indicators of negative symptoms and a general result--Guilt as a state (GI). CONCLUSION: One might suppose that such a pattern of results indicates the primacy of a characteristic (guilt as a characteristic according to the Inventory of a Sense of Guilt), which is proved by a lack of correlation between schizophrenia symptoms (being more of a state nature) and the most important dimensions of the sense of guilt (being more of a characteristic nature). Moreover, the research results give grounds to confirm the existence of significant differences in the intensity of the experienced sense of guilt (Guilt as a state and Sense of guilt related to induced self-hate guilt) among outpatients and all-day treatment patients.

Preliminary Study of Efficacy and Safety of Self-Administered Virtual Exposure Therapy for Social Anxiety Disorder vs. Cognitive-Behavioral Therapy.

Social anxiety disorder (SAD) is one of the most frequent mental disorders. Exposure to virtual reality can be a solution complementing standard CBT (cognitive-behavioral therapy) or can be used as an independent therapeutic tool. The study's objective was to assess the safety and efficacy of using self-administered virtual reality exposure vs. CBT and CBT with virtual exposure. We assessed the efficacy of the applied intervention with the Leibowitz Social Anxiety Scale (LSAS). We compared three groups: CBT (n = 25), CBT + VR (n = 29), and self-administered therapy without aid of a therapist (n = 19). The results indicated that all three groups showed changes on the LSAS. The simple effect analysis showed that there were no differences between experimental conditions at T0 (session 1) and T1 (session 9) and that the only significant difference occurred at T2 (session 14). The pairwise comparisons showed that the participants in the VR condition scored higher on the LSAS score during the measurement at T2 than participants in CBT condition. Our study has several limitations. The presented initial study shows that the methods of CBT for social anxiety used so far are also effective, while the VR tool for self-therapy requires further research.

Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study.

Despite treating depression with antidepressants, their effectiveness is often insufficient. Comparative effectiveness studies and meta-analyses show the effectiveness of antidepressants; however, they do not provide clear indications as to the choice of a specific antidepressant. The rational choice of antidepressants may be based on matching their mechanisms of action to the symptomatic profiles of depression, reflecting the heterogeneity of symptoms in different patients. The authors presented a series of cases of patients diagnosed with depression in whom at least one previous antidepressant treatment was shown to be ineffective before drug targeted symptom cluster-matching treatment (SCMT). The presented pilot study shows for the first time the effectiveness of SCMT in the different clusters of depressive symptoms. All the described patients obtained recovery from depressive symptoms after introducing drug-targeted SCMT. Once validated in clinical trials, SCMT might become an effective and rational method of selecting an antidepressant according to the individual profile of depressive symptoms, the mechanism of their formation, and the mechanism of drug action. Although the study results are preliminary, SCMT can be a way to personalize treatment, increasing the likelihood of improvement even in patients who meet criteria for treatment-resistant depression.

Pharmacological treatment of a depressive episode and recurrent depressive disorder - guidelines of the Polish Psychiatric Association and the National Consultant for Adult Psychiatry. / Leczenie farmakologiczne epizodu depresji i zaburzen depresyjnych nawracajacych ­ wytyczne Polskiego Towarzystwa Psychiatrycznego i Konsultanta Krajowego ds. Psychiatrii Doroslych.

Under the auspices of the Polish Psychiatric Association and the National Consultant in Psychiatry, on the basis of analysis of international guidelines, the expert group consisting of psychiatrists and an epidemiologist compiled recommendations for the treatment of adepressive episode and recurrent depressive disorder. The recommendations take into account the information that the patient should receive before starting the treatment, the selection criteria for the treatment method and the choice of the antidepressant, the method of assessing the efficacy of treatment, treatment monitoring, and the duration of treatment. Formulating the recommendations, the experts analyzed the source data for their applicability in Poland. The current recommendations of scientific societies and an analysis of the literature on the treatment of depressive episodes and recurrent depressive disorder broken down by the treatment of acute episodes and maintenance treatment, as well as the recommendations on the method of creating guidelines have been taken into account. Furthermore, the guidelines developed in collaboration with the Supreme Medical Council and the Polish Psychiatric Association, entitled: "Diagnostic work-up and treatment of depression in adults - guidelines for family physicians", and recommendations of theNationalConsultantin Adult Psychiatry have been taken into account. The recommendations were discussed among the experts and accepted by the General Board of the Polish Psychiatric Association. Subsequently, the recommendations were modified in line with the Board's commentsand endorsed by the Association for use in the management of patients with depression in Poland.

[Neuropsychological cognitive hypothesis of antidepressant drug action--literature review]. / Neuropsychologiczna poznawcza hipoteza dzialania leków przeciwdepresyjnych--przegad pismiennictwa.

Depression is a state characterised by the psychobiological symptoms included in the international classifications. People suffering from depression, apart from the primary and auxiliary symptoms of this disorder, have specific emotional-cognitive schemas. They tend to interpret a neutral sign as a negative one more often. According to some researchers, using antidepressants can change an "automatic" way of interpretation of a negative information. These authors describe two stages of an antidepressant drug effect. The first phase depends on a direct drug effect. The second one requires some positive experiences and reinforcements. The later activity of antidepressant drugs is an effect of an interval between a direct influence on emotional data processing and a later indirect influence on a mood. The drug activity follows a way from the automatic to conscious brain processes. The cognitive treatment influence "up down" on the emotional data processing through the effects connected with conscious evaluation of the signs and experiences.

[Some questions about the essence of delusions in the light of recent neurobiological findings]. / Kilka pytan o nature urojen w swietle wspólczesnych neurobiologicznych koncepcji psychozy.

Formation of delusions in the phase of acute psychosis is based on two subsequent processes. The first one is dopamine hyperactivity in mesolimbic neural pathways, the second one is a cognitive process of up-down attribution of meanings of this subjectively perceived state of mind by the higher levels of brain. After the successful antipsychotic treatment, the subjectivity of patients changes. When the state of acute psychosis resolves patients must re-interpret this new emerging subjective experience. These interpretations are often incorrect and bizarre. In most cases they are regarded as delusions (sometimes "chronic delusions"). The question asked in the presented paper is whether they are truly delusions. The essence of delusion must include in the same time an active neurobiological basis of delusion (hyperdopaminergic state) and its cognitive level. It's not clear what is the proper term for the phenomenon when only incorrect or bizarre cognitive convictions are present after successful treatment of psychosis, but without dopaminergic hyperactivity.

[Psychodynamic psychopharmacology in clinical practice--interpretations of adverse events of pharmacotherapy. Case report]. / Psychodynamiczna psychofarmakologia w praktyce--mozliwosci interpretacji dzialan niepozadanych farmakoterapii. Opis przypadku.

INTRODUCTION: Psychodynamic psychopharmacology offers possibility of implementation of psychodynamic thinking and interpretations in the process of pharmacotherapy of mental disorders. It can be helpful in improving results of treatment and solving difficulties in it's course. METHOD: The case report of a female patient after psychotic episode is presented. During the treatment with quetiapine the patient presented complains about adverse effects like weight gain and somnolence. These symptoms (at least partially) resulted from her emotional problems and changed after psychodynamic interpretation. After stopping the medication the patient's reactions to stress and process of separation from her mother changed dramatically. It was probably due to the discontinuation of medication. RESULTS: In some cases adverse events of medication have not only biological but also emotional roots. If properly recognized they can be interpreted and changed by psychological tools. CONCLUSIONS: Psychodynamic psychopharmacology can be useful in deeper understanding and solving problems in the process of pharmacotherapy of mental disorders.

[Interpretations of hallucinations resolution by patient with chronic schizophrenia--case report]. / Interpretacja ustepowania omamów sluchowych przez chorego z przewlekla schizofrenia--opis przypadku.

AIM: The aim of this case description is the analysis of psychotic symptoms resolution in the context of theory of psychosis as a state of aberrant salience. According to that theory both formation and treatment of psychotic symptoms can be seen in two interconnected dimensions: neurobiological perspective of dopamine hyperactivity and subjective perspective of excessive salience. METHOD: The case of a patient with chronic schizophrenia with predominant auditory hallucinations is described. The patient changed the doses of the medications according to his own will several times. The presence and disappearance of hallucinations was interpreted by him. The presence of "voices" was interpreted by him as a presence of his psychotic "spouse". The disappearance of hallucinations was interpreted by him as a visit of the "spouse" in the heaven. He interpreted the recurrence of "voices" as the reunion with his "spouse". RESULTS: Formation, resolution as well as fluctuations of intensity of hallucinations are subjectively interpreted by the patient. CONCLUSIONS: This interpretations after disappearance of psychotic symptoms even if they are bizarre and impossible to occur are cognitive explanations but not delusions.

The role of OPRM1 polymorphism in the etiology of alcoholism.

BACKGROUND: Numerous studies have investigated the association between the OPRM1 A118G polymorphism (rs1799971) and alcohol dependence, but the results have been inconsistent. The endogenous opioid system has been implicated in the development of alcohol dependence for its prominent role in the central rewarding mechanism. OBJECTIVES: The aim of this study was to evaluate the role of the A118G polymorphism of the OPRM1 gene in the pathogenesis of alcohol dependence syndrome (ADS). MATERIAL AND METHODS: The OPRM1 (rs1799971) polymorphism was investigated in an association study of a group of ADS patients (n = 177) and in subgroups (delirium tremens and/or seizures, age at onset <26 years, dissocial alcoholics, positive familial history of alcoholism, delirium tremens, and seizures). The control group consisted of healthy volunteers, with matched gender and age, and with psychiatric disorders excluded (n = 162). RESULTS: Our research shows that there are differences in the genotypes and alleles of the OPRM1 polymorphism in the case-control study. Furthermore, we observed associations in our homogeneous subgroups - in the group of patients with ADS and accompanying delirium tremens and/or seizures at the genotype level, as well as in the subgroup of patients under 26 years of age with an early onset of dependence. CONCLUSIONS: It is strongly possible that the G allele described in numerous studies can be associated with a response to treatment, but not typology, or the very predisposition toward alcoholism. It is necessary to carry out further research which would embrace a larger group of patients; it should be divided into other homogeneous subgroups, including, e.g., naltrexone pharmacotherapy.

[The psychodynamic psychopharmacology by D. Mintz and B. Belnap--description of discipline in relation with treatment resistance]. / Koncepcja psychodynamicznej psychofarmakologii D. Mintza i B. Belnap--omówienie w odniesieniu do pacjentów ujawniajacych opornosc na leczenie.

In the process of education of psychiatrists and in psychiatric textbooks the information or chapters about combined treatment integrating psychotherapy and pharmacotherapy are very rare. There are not many chapters about the psychological meaning of medication. It is striking in this regard, since many patients currently receive both treatments. Another important artificial separation is a lack of integration of psychological knowledge in the understanding of psychological and physical effects of pharmacotherapy. The proposition of a new discipline--psychodynamic psychopharmacology by D. Mintz and B. Belnap is desribed and presented in the paper. They propose not only the new discipline but also practical recommendations for the psychodynamic treatment of pharmacologic treatment resistance. The paper presents also the concept of a pharmacologically informed psychotherapist for those who are psychotherapists but want to cross over boundaries between psychotherapy and pharmacotherapy.

[Schizophrenic patient's constant refusal of psychotropic medication--case report and psychodynamic remarks]. / Pacjentka ze schizofrenia uporczywie przerywajaca leczenie farmakologiczne--opis przypadku i analiza psychodynamiczna.

AIM: The aim of the study was the description of defence mechanisms, phantasies and object relations in a non-compliant patient with schizophrenia, who many times had refused using antipsychotic drugs in spite of symptom improvement. METHOD: Psychodynamic analysis of the case. CONCLUSIONS: Mental functioning of the patient based on a narcissistic type of relation, massive primitive defence mechanisms, especially splitting, 'no entry defence' and omnipotent denial. The authors described the influence of these factors on the efficacy of psychotropic medication and compliance of patient.