Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries.

BACKGROUND: Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS: The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS: About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS: Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.

Polish Psychiatric Association consensus statement on non-pharmacological methods in the treatment of negative symptoms of schizophrenia. / Stanowisko grupy roboczej PTP na temat stosowania metod niefarmakologicznych w leczeniu objawów negatywnych schizofrenii.

This consensus statement has been prepared by a group of experts consisting of professionals with long experience in the treatment of psychiatric disorders, who were appointed by the Management Board of the Polish Psychiatric Association. The evaluation involved the analysis of literature databases and information derived from meta-analyses of these data for years 2010-2020. The searched publications were in English, German and Polish language versions and involved interventions performed in groups of adult patients. The efficacy of nonpharmacological methods applied for treatment of negative symptoms of schizophrenia were compared with effects of adifferent treatment/combined treatment/a group with no intervention. When formulating the recommendations, the experts analysed the source data in terms of their application in the Polish conditions. The current recommendations of academic societies and literature on the treatment of schizophrenia with predominant negative symptoms were taken into account. The experts included items that involved a comparison of a study group in terms of non-pharmacological interventions, and pharmacologically treated cases were taken into account only when divisions were made into standard treatment and additional intervention. The results were divided into 7 sections: 1. Psychoeducation, 2. Psychotherapy (individual, group and family therapy), 3. Psychiatric rehabilitation, 4. Emotional intelligence, social skills and mindfulness training, 5. Cognitive remediation/rehabilitation, cognitive training, 6. Clinical efficacy of physical activity, behavioral activation and metacognitive training, 7. Other rehabilitation methods (including biological methods). The recommendations were debated by experts, approved by the Management Board of the Polish Psychiatric Association,and -upon consideration of the submitted comments - adopted as aconsensus statement of the Association with the recommendation of their application in the treatment of schizophrenic patients in Poland.

Evaluation of hyperhomocysteinemia prevalence and its influence on the selected cognitive functions in patients with schizophrenia.

There is evidence that hyperhomocysteinemia may be associated with the development of schizophrenia and cognitive impairment. Therefore, the aim of this study was to analyze the relationship between cognitive functions and normal homocysteine concentrations vs. hyperhomocysteinemia in schizophrenia patients before and after supplementation with vitamins B6, B12 and folate. An 8-week prospective, non-randomized study enrolled 122 adult patients with schizophrenia (67F/55M, mean age 43.54 ±â€¯11.94 years). Homocysteine concentrations were measured in all individuals and afterwards hyperhomocysteinemia patients (n = 42) were divided into two subgroups: treated with oral vitamins supplementation (B6 - 25 mg/d, B12 - 20 µg/d, folate - 2,5 mg/d) (n = 22) and without supplementation (n = 20). The assessment of schizophrenia symptoms severity in study group was performed using the Positive and Negative Syndrome Scale (PANSS). Cognitive functions were evaluated using the Stroop test and the Trail Making Test (TMT). We observed a higher prevalence of hyperhomocysteinemia in schizophrenia patients (34.4%) in comparison to the general population. Individuals with schizophrenia and coexisting hyperhomocysteinemia had worse performance on the Stroop and the TMT tests as well as higher PANSS scores. In these patients, supplementation with vitamins effectively decreased the homocysteine concentrations to the normal values, however there was no statistically significant improvement in the PANSS and cognitive test scores, except a significant decrease in the number of the Stroop test errors. We conclude that significant results obtained in this study show that there is a relationship between homocysteine blood concentration and schizophrenia severity. Moreover, homocysteine concentration lowering might be beneficial in schizophrenia patients with hyperhomocysteinemia in terms of cognitive functions improvement.

3-Aminomethyl Derivatives of 2-Phenylimidazo[1,2-a]-pyridine as Positive Allosteric Modulators of GABAA Receptor with Potential Antipsychotic Activity.

Schizophrenia is a mental illness characterized by behavioral changes as well as anatomical and neurochemical abnormalities. There has been remarkable progress in the drug discovery for schizophrenia; however, antipsychotics that act through molecular targets, other than monoaminergic receptors, have not been developed. One of the hypotheses of schizophrenia states that GABAergic dysfunction might be implemented in the pathophysiology of this disease. Our recent findings and previous clinical observations have suggested that modulation of GABAergic system through α1-GABAA receptors would represent an original approach for the treatment of schizophrenia. This study presents the synthesis and biological evaluation of a series of fluorinated 3-aminomethyl derivatives of 2-phenylimidazo[1,2-a]-pyridine as potential antipsychotic agents. Compound 7 has a high affinity for GABAA receptor (Ki = 27.2 nM), high in vitro metabolic stability, and antipsychotic-like activity in amphetamine-induced hyperlocomotion test in rats (MED = 10 mg/kg). Compound 7 represents a promising point of entry in the course of development of antipsychotic agents with a nondopaminergic mechanism of action.

Acoustic startle responses and prepulse inhibition of acoustic startle responses in Warsaw alcohol high-preferring (WHP) and Warsaw alcohol low-preferring (WLP) rats.

AIMS: An assessment of the acoustic startle response (ASR) and prepulse inhibition (PPI) of ASR in laboratory animals is used to model human anxiety and psychotic states, respectively. The aim of the study was to evaluate ASR and PPI in alcohol-naive male and female Warsaw alcohol high-preferring (WHP) and Warsaw alcohol low-preferring (WLP) rats. METHODS: ASR and PPI were assessed in two separate experiments by using the SR-LAB apparatus (San Diego Instruments, San Diego, CA, USA). In the ASR session, animals (n = 13-16 rats per group) were exposed to startling stimuli of different intensities (72, 84, 98, 112 and 124 dB) in a random order. In the PPI session, prepulse stimuli (78, 81, 84 and 90 dB) preceded a pulse startling stimulus (120 dB) in a random order. The background white noise was set at 70 dB. PPI was calculated according to the formula: [(startle amplitude in pulse alone trials-startle amplitude in prepulse-and-pulse trials)/startle amplitude in pulse alone trials] 100%. RESULTS: The WHP males exhibited higher startle amplitudes in response to 112 dB stimuli when compared with their WLP counterparts. The WHP females showed higher startle reactivity to 112 and 124 dB stimuli when compared with the WLP females. There were no differences between the WHPs and WLPs in PPI of ASR. CONCLUSION: The results of the present study suggest that exaggerated startle responses can be a physiological/behavioral marker of a propensity to abuse alcohol.