Effects of cognitive remediation therapy versus other interventions on cognitive functioning in schizophrenia inpatients.

Computerised cognitive remediation therapy (CCRT) has been shown to improve cognitive function in individuals with schizophrenia beyond effects of other forms of therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether or not this is a suitable site to start the therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in a psychiatric ward. A randomised controlled trial of CCRT versus an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The intervention lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in cognitive function and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This result shows that providing a drill and practice cognitive remediation to inpatients does not produce benefits for cognitive functioning substantially greater than other forms of therapy provided in a ward, but it is more efficient in reduction of negative symptoms. Our results suggest that CRT might be considered as a promising intervention for reducing negative symptoms in schizophrenia individuals.

Body Image and Body Experience Disturbances in Schizophrenia: an Attempt to Introduce the Concept of Body Self as a Conceptual Framework.

Disturbances in body experience are described as key schizophrenia symptoms and early disease predictors. In case studies, different disorders relating to body experience are presented, but only a few empirical studies have aimed to distinguish the characteristics of body experience in schizophrenia, and these have been selected arbitrarily and without reference to cohesive theoretical model. To integrate this fragmentary approach, we propose a body self (BS) model, composed of: functions; representations (e.g., body image); and sense of body identity. The aim of the study was to determine whether the BS differentiates schizophrenic patients from healthy controls, and to investigate the relations between aspects of BS and a history of illness and clinical characteristics. The Body Self Questionnaire and the Positive and Negative Syndrome Scale were administered to 63 schizophrenic patients and 63 healthy subjects. The difference was found in the functions of the body-self (perceiving, interpreting, and regulating body experience), in the sense of body identity, and in one of three aspects of body image explored (e.g., acceptance of biological sex). Disturbances in BS were related to positive symptoms and to the number of hospitalizations for other diseases. Together, the results demonstrate that schizophrenia is more body experience than body image disorder, since the negative emotional attitude towards the body and acceptance of fitness were not distinctive for schizophrenia. The link between the disturbances in BS and the number of nonpsychiatric hospitalizations suggests that misinterpretation of body experiences in schizophrenia can promote a search for medical attention.

Schizophrenia causes significant burden to patients' and caregivers' lives.

BACKGROUND: Schizophrenia is a serious public health problem and is ranked among the most disabling diseases in the world. The sub-study presented here was part of a larger project to characterize the burden of schizophrenia on healthcare systems and on individuals living with the disease in Central and Eastern Europe (CEE). AIMS: This sub-study aimed to assess and analyze the impact of schizophrenia on many aspects of the lives of patients and caregivers. METHODS: Psychiatrists from selected centers in seven Central and Eastern European countries were asked to complete a questionnaire in order to collect information about the disease history, characteristics, treatment protocols and resources used for each randomly selected patient. All data were statistically analyzed and compared between countries. RESULTS: Data from 961 patients with schizophrenia (mean age 40.7 years, 45.1% female) were included in the analysis. The mean number of days spent in hospital per patient per year across all seven countries was 25.3 days. Hospitalization occurred on average once per year, with psychiatrist visits 9.4 times per year. Of the patients in the study, 61% were single, 12% divorced and 22% married or cohabiting. Almost 84% were living with relatives or a partner; only 17% lived alone and, on average, 25% of patients received support from social workers. Relatives provided care for approximately 60% of patients and 4% of them had to stop working in order to do so. Twenty-nine percent of the patients were unemployed, and 56% received a disability pension or were retired, with only 19% in full-time employment or education. CONCLUSION: Schizophrenia has a significant effect on the lives of patients and caregivers and impacts their social integration.

Treatment patterns of schizophrenia based on the data from seven Central and Eastern European Countries.

OBJECTIVE: The aim is to analyze how schizophrenia is pharmacologically treated in seven CEE countries: Croatia, Estonia, Hungary, Poland, Serbia, Slovakia and Slovenia. METHODS: Psychiatrists from selected centers in each of participating countries were asked to complete a pre-defined questionnaire on their current clinical practice. Information on protocols and resource utilization in schizophrenia treatment was included and derived from randomly selected patient medical records. Expert opinions on country-wide treatment patterns were additionally sought. This sub-analysis focuses on pharmacological treatment patterns in the last six months and over the course of the disease. RESULTS: 961 patients' data show that during last six months the most commonly prescribed medications were oral atypical antipsychotics: olanzapine (n=268), clozapine (n=234) and risperidone (n=160). The most frequently prescribed atypical antipsychotics over course of disease were: risperidone (54.5%), olanzapine (52.4%) and clozapine (35.1%), along with haloperidol (39.3%). Experts reported risperidone (four countries) and olanzapine (three countries) as first-line treatment, with the same two medications prescribed as second-line treatment. Clozapine was the most reported medication for refractory patients. Approximately 22% of patients received polypharmacy with antipsychotics in at least one period over the disease course. Mean time since diagnosis was 13.1 years and on average 4.8 treatment courses received during that period. Anxiolytics (70%), antidepressants (42%), mood-stabilizers (27%) were also prescribed, with diazepam (35.4%), sertraline (10.5%), valproic acid (17.5%) the most commonly reported, respectively, in each group. The most frequently reported treatment change was switch from one oral atypical antipsychotic to another (51%). CONCLUSION: Oral atypical antipsychotics, mostly older drugs (risperidone, olanzapine, clozapine), were most commonly prescribed for schizophrenia treatment in participating countries. Given that results are from the first large-scale analysis of RWD, we believe these findings can be a benchmark for future real-world studies, which could contribute to the optimization of treatment for this debilitating disease.

Stigmatization of psychiatrists and general practitioners: results of an international survey.

The stigma of mental illness affects psychiatry as a medical profession and psychiatrists. The present study aimed to compare the extent and correlation patterns of perceived stigma in psychiatrists and general practitioners. An international multicenter survey was conducted in psychiatrists and general practitioners from twelve countries. Responses were received from N = 1,893 psychiatrists and N = 1,238 general practitioners. Aspects of stigma assessed in the questionnaire included perceived stigma, self-stigma (stereotype agreement), attitudes toward the other profession, and experiences of discrimination. Psychiatrists reported significantly higher perceived stigma and discrimination experiences than general practitioners. Separate multiple regression analyses showed different predictor patterns of perceived stigma in the two groups. Hence, in the psychiatrists group, perceived stigma correlated best with discrimination experiences and self-stigma, while in the general practitioners group it correlated best with self-stigma. About 17% of the psychiatrists perceive stigma as a serious problem, with a higher rate in younger respondents. Against this background, psychiatry as a medical profession should set a high priority on improving the training of young graduates. Despite the number of existing antistigma interventions targeting mental health professionals and medical students, further measures to improve the image of psychiatry and psychiatrists are warranted, in particular improving the training of young graduates with respect to raising awareness of own stigmatizing attitudes and to develop a better profession-related self-assertiveness.

The Polish Academic Version of the MATRICS Consensus Cognitive Battery (MCCB): Evaluation of Psychometric Properties.

Work and social functioning in schizophrenia are strongly influenced by cognitive impairment so improving cognition is a priority in the treatment of schizophrenia. Until recently the lack of a widely accepted index of cognitive change for use in schizophrenia was a major obstacle to the development of cognition enhancing treatments. The MATRICS (measurement and treatment research to improve cognition in schizophrenia) consensus cognitive battery (MCCB) was developed as a standard cognitive battery for use in clinical trials of cognition enhancing treatments for schizophrenia and has attracted worldwide interest. To analyze the reliability and validity of a translated and adapted Polish approved academic version of the MCCB. Sixty one patients were assessed at baseline and again after 30 days. The study protocol approximated the MATRICS psychometric and standardization study; the 10 tests that comprise the MCCB were administered to participants. Functioning and psychopathological symptoms were also assessed. Patients and test administrators also assessed the tolerability and practicality of all the cognitive tests. All tests in the battery were found to have high test-retest reliability. All the tests were rated as tolerable and practical by patients and administrators. However practice effects were generally higher in the Polish version of the MCCB than in the original version. Our analysis corroborates previous evidence that the MCCB represents a good tool for assessing cognitive deficits in research studies of schizophrenia also in non-English speaking countries.

[The stabilizing effect of dehydroepiandrosterone on clinical parameters of metabolic syndrome in patients with schizophrenia treated with olanzapine - a randomized, double-blind trial]. / Stabilizujacy efekt dehydroepiandrosteronu na kliniczne parametry zespolu metabolicznego u pacjentów chorych na schizofrenie leczonych olanzapina - badanie randomizowane z podwójnie slepa próba.

OBJECTIVES: Epidemiological studies have shown that low levels of dehydroepiandrosterone might increase the risk of developing metabolic syndrome. The aim of this study was to evaluate whether dehydroepiandrosterone supplementation in schizophrenic patients treated with olanzapine would influence the anthropometric and biochemical parameters of metabolic syndrome. METHODS: Male schizophrenic patients (no=55) participated in a twelve-week, randomized, double blind, placebo controlled study. They received 100 mg dehydroepiandrosterone (DHEA) or placebo as an augmentation of olanzapine treatment (an average dosage 15 mg/day). Main outcomes of the study were changes in lipid profile, fasting glucose levels, body mass index and waist circumference values. RESULTS: Forty five patients completed the study. There were no major changes in the overall cholesterol value, HDL cholesterol, LDL cholesterol or triglycerides in either group. The results of the repeated measures analysis of the system: fasting glucose level 2x, (at the beginning and end of the study), 2x (the study group and the control group), showed a significant interaction (F =5.7, df= 1.000 p= 0.021). The blood glucose level was decreased in the DHEA group. Furthermore, increases in waist circumference (delta= -1.11, t=-2.87; df=20; p=0.01) and BMI value (delta= -0.48, t=-2.38; df=19; p=0.028) were observed in the placebo group. CONCLUSIONS: Dehydroepiandrosterone supplementation results in stabilization of BMI, waist circumference and fasting glycaemia values in schizophrenic patients treated with olanzapine. To confirm the insulin-like effect of dehydroepiandrosterone, long-term research concentrating on the evaluation of glucose metabolism has to be performed.

[Guidelines for the use of second-generation long-acting antipsychotics]. / Wskazówki do stosowania leków przeciwpsychotycznych II generacji o przedluzonym dzialaniu.

Long-acting injectable antipsychotics constitute a valuable alternative for the treatment of psychotic disorders, mainly schizophrenia. They assure a more stable drug level, improve treatment compliance, and increase the chances for favorable and long-lasting improvement. Additionally, the long-acting second-generation antipsychotics combine the values of long-acting injectable drugs with the values of atypical antipsychotics. Four second generation long-acting antipsychotics have been described: risperidone, olanzapine, aripiprazole and paliperidone. The indications for their use, treatment strategy, tolerance, and potential interactions are discussed.

[Cognitive rehabilitation for people living with schizophrenia - the newest interventions]. / Rehabilitacja poznawcza osób chorych na schizofrenie - najnowsze interwencje.

The article reviews the latest interventions in cognitive rehabilitation for patients with schizophrenia. Studies referring to cognitive rehabilitation for people with schizophrenia from the last three years, found in the PubMed database, are presented. The authors categorised cognitive rehabilitation trainings in terms of targeted cognitive spheres - neurocognitive training, social cognition training, emotion perception training and combined training - and present current trends within this approaches. Cognitive function improvements after cognitive remediation are specific to the rehabilitation target and there are no clear differences between training types in the way they influence other cognitive domains or symptoms. There is a need to heighten transfer of gained / enhanced cognitive skills to functional ones. Therefore new methods of cognitive remediation are explored . The future direction in cognitive rehabilitation is to enhance benefits by combining various forms of cognitive remediation and by emphasizing patient specificity in planning and conducting cognitive interventions.

[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.

[Oxytocin model of formation of psychotic symptoms and its implications for research on oxytocinergic pathway in schizophrenia]. / Oksytocynowy model powstawania objawów psychotycznych a implikacje dla badan nad rola systemu oksytocynergicznego w schizofrenii.

There are more and more data to support the dysregulation of the oxytocinergic pathway in schizophrenia. The development of the above branch of knowledge began to evolve alongside the mainstream of studies concerning gene polymorphisms for dopaminergic, glutamatergic and serotoninergic systems. Both experimental studies and clinical trials have demonstrated an antipsychotic effect of oxytocin. Starting with the pioneering neuroendocrinobehavioral experiment which demonstrated that oxytocin nasal spray increases the level of trust in healthy volunteers dozens of experiments were carried out confirming the modulatory role of oxytocin for the recognition of emotion, social memory, pro-social behaviours, collaborative behaviours and behaviours that require generosity and altruism. According to,oxytocin model' of development of psychotic symptoms--oxytocinergic system dysregulation may affect the incorrect attribution of meaning of emotional information from the environment. This can be manifested in the form of social cognition dysfunction and leads to abnormal social behaviour as withdrawal from social contact, isolation and formulation of paranoid delusions. From the clinical psychiatry point of view it became crucially need for research on selective oxytocin receptor agonists, as they may be used in the treatment of diseases which manifest in social withdrawal, lack of trust and the absence of affiliation behaviour as in schizophrenia.

[Androgens - a common biological marker of sleep disorders and selected sexual dysfunctions?]. / Androgeny - wspólny marker biologiczny zaburzen snu oraz wybranych dysfunkcji seksualnych?

The relationship between sleep disturbances and sexual dysfunctions still remains unclear. The links which indicate the importance of central nervous system and sleep mechanisms in regulations of the endocrine system seem to have bilateral character; the nature of such associations is not fully understood. The aim of the paper is to describe the influence of androgens on the relations between sexual functioning and sleep functions in patients of both sexes. The physiological role of the androgens is described with the emphasis put on the specific action of these hormones in sleep regulation, as well as the mutual relations between the regulatory role of sleep on the sexual apparatus. The newest data suggest that the androgenic hormonal profile is linked to the sleep rhythm, but not to the chronobiological diurnal rhythm in male patients. This may constitute the purpose for further research on the role of androgens in the connections between sexual and sleep disturbances. Up to date there is little known about androgens' role in sleep regulation in women. The influence of sexual activity disturbances as behavioral factors influencing the severity and the persistence of insomnia as well as their position among other factors important for the triggering of insomnia requires further scientific exploration.

[The assessment of chosen psychometric features of B-CATS test battery in schizophrenia - preliminary report]. / Ocena wybranych wlasciwosci psychometrycznych baterii testów do pomiaru funkcjonowania poznawczego pacjentów psychotycznych B-CATS - wstepne opracowanie.

AIM: The assessment of cognitive impairment in schizophrenia proves helpful in the diagnosis of disease, identification of individuals at risk for adverse outcome and choosing the most adequate treatment. It is also a valuable complement of the psychiatric diagnosis. For this reason, there is a great need for a practical well-validated instrument to measure cognitive deficits that can be administered and interpreted easily in a clinical setting. The aim of the study was to verify the reliability, validity and practicality of the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) in a clinical setting. METHODS: 68 psychotic patients were included in the study during their stay in a psychiatric ward. A double measurement was conducted. Test-retest assessment included tests of B-CATS battery (TMT part B, Category Fluency, Digit Symbol Test). To evaluate the intensity of psychopathological symptoms the PANSS was performed. SLOF, GAF, GARF, SOFAS were used to assess functioning of the subjects. RESULTS: The B-CATS is characterized by a satisfactory relative stability. The absolute stability should be seen as sufficient in case of one test: Fluency. The diagnostic validity of the battery is satisfactory. B-CATS is easy to administer and "friendly" for the patient. CONCLUSIONS: B-CATS is a brief and practical instrument that can provide clinicians with meaningful data regarding the global cognitive functioning of the psychotic subjects.

[Between health and schizophrenia]. / Miedzy zdrowiem a schizofrenia.

The article, based on the literature review, presents actual concerns on prognosis and opportunity to achieve recovery in persons with schizophrenia. Catamnestic long-term studies published during last decades more often indicated a favorable course of schizophrenia than it was in the past. One explanation may be the progress in pharmacotherapy, which allows the achievement of a better outcome in the treatment. On the other hand, the researchers have been committed to more detailed studies on the course of schizophrenia by more frequently repeated public testimonials of the ill persons, which forced the prognosis to be more optimistic. A good example is the discussion about the recovery in schizophrenia and the change in perception of the disease, despite differences in the attitudes between clinicians and patients. Seeing the opportunity to conduct a normal life in spite of serious mental disease is challenging for patients and their relatives, as well for psychiatrists and therapists. It motivates to overcome the limitations that the disease brings and the barriers in society.

Fighting stigma of mental illness in midsize European countries.

PURPOSE: Stigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published. METHODS: The review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible. RESULTS: The anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country. CONCLUSIONS: Although much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

[MATRICS consensus cognitive battery--standard for the assessment of cognitive functions in clinical trials in schizophrenia]. / Bateria testów MATRICS--standard oceny funkcji poznawczych w badaniach klinicznych w schizofrenii.

Cognitive dysfunctions often occur long before the onset of psychotic symptoms of schizophrenia. They include mostly deficits in attention, memory (including working memory) and executive functions. The level of cognitive impairment strongly influences the subjective quality of life and the ability to perform in social and professional roles. Therefore improvement of cognitive functioning is an important challenge in the treatment of schizophrenia. Until recently, the lack of a widely accepted standard for the measurement of cognitive change in schizophrenia has constituted an important obstacle in the development of cognition-enhancing treatments. The MATRICS Consensus Cognitive Battery (MCCB) has been created as a standard tool for the assessment of the level of cognitive functioning in schizophrenia patients and its changes in short time intervals. MCCB includes ten cognitive tests which measure seven separable cognitive domains: speed ofprocessing, attention/vigilance, working memory (both verbal and nonverbal), verbal learning, visual learning, reasoning and problem solving, and social cognition in schizophrenia. In validation studies, the MCCB demonstrated excellent reliability, minimal practice effects and significant correlations with measures of functional capacity. In this article we describe the MCCB and present a project aimed to adapt the MCCB to Polish.

Schizophrenia plus - comorbidity of schizophrenia and personality disorders. Clinician's reflections. / Schizofrenia plus ­ jednoczasowe rozpoznawanie schizofrenii i zaburzen osobowosci. Refleksje praktyka klinicysty.

The diagnostic criteria for schizophrenia and the diagnostic criteria for personality disorders refer to the same dimensions of mental functioning, except for the presence of typical psychotic symptoms in schizophrenia (hallucinations, delusions and catatonic behaviours). Since schizophrenia is a psychosis with a predominantly chronic course, with exacerbations and steady course periods, a simultaneous diagnosis of personality disorders, which are also "permanent" in nature, and a significant part of which affect the same areas of mental functioning, in the same patient is at least controversial. Although therapeutic interventions in patients with schizophrenia are mainly based on pharmacotherapy, psychotherapy and work with the patient's family are also important. Since pharmacotherapy is virtually ineffective for personality disorders, psychotherapy is the main form of management. This however does not constitute a justification for a simultaneous use of these two diagnoses in the same patient.

[Trazodon--the antidepressant: mechanism of action and its position in the treatment of depression]. / Trazodon--lek przeciwdepresyjny: mechanizm dzialania i miejsce w leczeniu depresji.

The pharmacological properties and possible clinical use of trazodon in the treatment of depression are presented. Trazodon is the only antidepressant from the SARI (Serotonin Antagonists and Reuptake Inhibitors) group available in Poland. It has a wide pharmacodynamic profile (being an antagonist of 5-HT2A and 5-HT2C serotoninergic receptors, alpha1 and alpha2 adrenergic receptors as well as H1 histaminergic receptors, and in higher doses it blocks the SERT serotonine transporter) which explains its wide therapeutic spectrum ranging from symptomatic treatment, through the potentialization of other drugs activity, all the way to monotherapy of depressive syndromes. An especially complex action on the serotoninergic system results in the lack of unwanted side-effects during treatment with trazodon (e.g. sexual dysfunction, significant body weight gain), which may be present during the treatment with other drugs (selective serotonin reuptake inhibitors). It is metabolised by the CYP450 isoenzyme: mainly the 2D6 and 3A4. This requires its dose to be adjusted when administered simultaneously with other drugs influencing the activity of those isoenzymes. Trazodon CR is an orally administered controlled release form, which simplifies its dosage and reduces the risk of adverse effects. Usually doses of 75 to 600mg daily are used; in the elderly those doses should be lower. Trazodon turned out to be effective in the treatment of various depressive syndromes, amongst them depression with insomnia, with anxiety and unrest, as well as depression in the elderly. In the recommended dose spectrum, trazodon is well tolerated. Unwanted adverse effects of the drug appear rarely and they are: somnolence, dizziness, gastrointestinal dysfunctions, and dry mouth.

Treatment of insomnia - effect of trazodone and hypnotics on sleep. / Leczenie bezsennosci ­ wplyw trazodonu i leków nasennych na sen.

Sedative antidepressants are commonly used drugs in the treatment of insomnia. However, some recommendations claim that only hypnotics have been proven effective in the treatment of sleep initiation and maintenance disorders. The aim of this article is to compare the effect of hypnotics and trazodone on sleep, and to analyse the evidence for the use of trazodone in the treatment of insomnia. Three studies investigated the effects of trazodone on sleep in primary insomnia, 5 studies on insomnia in the course of affective disorders and 6 studies on insomnia in other indications (PTSD, Alzheimer's disease, alcohol and opiate dependence, somatoform disorder, and insomnia during pregnancy). In the treatment of insomnia, trazodone is less effective than hypnotics in the treatment of sleep onset insomnia (i.e., disorders of falling asleep). For this indication it needs to be administered earlier than hypnotics, at least 1 hour before bedtime. It is, however, very effective in the treatment of sleep-maintenance insomnia, especially in patients with comorbid mental disorders or patients treated with activating antidepressants. Hypnotics and trazodone have the opposite effect on deep sleep. Trazodone increases the duration of deep sleep, which is associated with better sleep quality as assessed by patients. In contrast, hypnotics decrease slow-wave activityin sleep EEG, which is the biomarker of deep sleep. The main mechanism through which trazodone promotes sleep is its antagonistic effect on 5-HT2 serotonin receptors, while hypnotics are agonists of gamma-aminobutyric acid GABAA receptors, and other sedative antidepressants block H1 histamine receptors. This is associated with a low risk of weight gain, which is rare with trazodone treatment.

[Practical aspects of the use of ziprasidone in schizophrenia]. / Uwagi o praktycznym zastosowaniu ziprasidonu w schizofrenii.

Ziprasidone is an atypical antipsychotic with affinity to the D2, 5HT2A, 5HT2C, 5HT1A, 5HT1B/1D receptors. It is available in both oral and intramuscular forms. It is well absorbed from the digestive tract and its absorption increases after the meal. Ziprasidone is used for the treatment of schizophrenia and bipolar manic states in doses 40-80 mg administered twice a day. The i.m. form should be given 40 mg/day only during three days. Ziprasidone shows similar an efficacy toward the positive symptoms as olanzapine. The i.m. form of ziprasidone showed better efficacy toward psychotic symptoms and lower risk for extrapyramidal symptoms than haloperidol. It is well tolerated. The most frequent side-effects are somnolence, nausea, and dyspepsia. The risk for metabolic side-effects was low. In some patients treated with ziprasidone, the prolongation of the QTc was noted.