Defense mechanisms in affective disorders - the state of the art. / Mechanizmy obronne w zaburzeniach afektywnych ­ stan wiedzy.

Defense mechanisms are unconscious, automatic processes that allow us to cope with tension and stress. They play a significant role in maintaining mental health, but the use of some of them, especially immature ones which strongly distort reality, can be associated with psychopathological symptoms. Multiple studies show a relationship between immature defensive styles and mood disorders. Individuals with depressive and bipolar affective disorders use more immature mechanisms compared to non-clinical control groups. At the same time, they rely less on mature, adaptive defense mechanisms. Immature defense mechanisms may negatively affect the course and effectiveness of treatment, while improvements toward the use of more mature defenses due to psychotherapy and other treatment interventions are observed. Estimation of the maturity level of defense mechanisms may prove useful in the diagnostic process, especially in differentiating depressive disorders from anxiety disorders, differentiating between subtypes of mood disorders and in assessing the risk of suicidal behavior. Enhancing mature defense mechanisms and reducing reliance on immature ones may improve the overall functioning of patients with mood disorders and contribute to reducing the severity of psychopathological symptoms.

Let's Talk About Single Men: A Qualitative Investigation of Never Married Men's Experiences of Singlehood.

Existing research on singlehood has largely focused on the experiences of single women, and little is known about singlehood among men. The current investigation examined the experience of long-term singlehood through individual, semi-structured interviews with 22 never-married single men living in Poland who were aged 22-43 years. Thematic analysis revealed five key themes: (1) the sense of being deficient-is there something wrong with me?; (2) navigating outside the dominant discourse of traditional masculinity, marriage and family; (3) the benefits and downsides of singlehood; (4) adaptation to singlehood; and (5) the dilemma between waiting and actively searching for a romantic partner. An analysis of single men's narratives revealed that men experience their single status in the context of their various needs and hopes and as a status that determines their adult life course. This study contributes to the singlehood literature, highlighting the complexity of singlehood for men and the importance of traditional masculinity norms in experiencing long-term singlehood. These findings challenge stereotypical and unrealistic views of singlehood among men and have practical implications for psychotherapists, counsellors and educators working with single men.

Associations of antidepressants and antipsychotics with lipid parameters: Do CYP2C19/CYP2D6 genes play a role? A UK population-based study.

BACKGROUND: Dyslipidaemia is an important cardiovascular risk factor for people with severe mental illness, contributing to premature mortality. The link between antipsychotics and dyslipidaemia is well established, while evidence on antidepressants is mixed. AIMS: To investigate if antidepressant/antipsychotic use was associated with lipid parameters in UK Biobank participants and if CYP2C19 and CYP2D6 genetic variation plays a role. METHODS: Review of self-reported prescription medications identified participants taking antidepressants/antipsychotics. Total, low-, and high-density lipoprotein cholesterol (L/HDL-C) and triglycerides derived from blood samples. CYP2C19 and CYP2D6 metabolic phenotypes were assigned from genetic data. Linear regression investigated aims, adjusted for key covariates. RESULTS: Of 469,739 participants, 36,043 took antidepressants (53% female, median age 58, 17% taking cholesterol-lowering medications) and 3255 took antipsychotics (58% female, median age 57, 27% taking cholesterol-lowering medications). Significant associations were found between use of each amitriptyline, fluoxetine, citalopram/escitalopram, sertraline, paroxetine and venlafaxine with higher total cholesterol, LDL-C, and triglycerides and lower HDL-C, compared to participants not taking each medication. Venlafaxine was associated with the worst lipid profile (total cholesterol, adjusted mean difference: 0.21 mmol/L, 95% confidence interval (CI): 0.17 to 0.26, p < 0.001). Antipsychotic use was significantly associated with lower HDL-C and higher triglycerides. In participants taking sertraline, CYP2C19 intermediate metabolisers had higher HDL-C (0.05 mmol/L, 95% CI: 0.01 to 0.09, p = 0.007) and lower triglycerides (-0.17 mmol/L, 95% CI: -0.29 to -0.05, p = 0.007), compared to normal metabolisers. CONCLUSIONS: Antidepressants were significantly associated with adverse lipid profiles, potentially warranting baseline and regular monitoring. Further research should investigate the mechanistic pathways underlying the protective effects of the CYP2C19 intermediate metaboliser phenotype on HDL-C and triglycerides in people taking sertraline.

Endorsing: closing the loop on diagnostic tests in electronic health care records.

The Oxford University Hospital NHS Trust (OUH) had introduced a policy to improve the timely endorsement of diagnostic tests. However, performance in the Oxford Kidney Unit (OKU) has been consistently below the OUH target of 85%. This project was undertaken to improve endorsement within the OKU. Weekly percentages of all diagnostic test results that were endorsed within 7 days of reporting were monitored as our main outcome measurement. During the intervention period, four plan-do-study-act (PDSA) cycles were undertaken each lasting 6 weeks. Introduced changes included interventions to develop a team-based approach and practical tools to enhance compliance, such as creating clinical worklists, a guidance document on endorsement and an endorsement newsletter. Data was monitored for a further 6 months beyond the intervention period to ensure improvement was sustained. There was a significant improvement in endorsement to above 85% by the end of the second PDSA cycle. This was maintained throughout the project and for a further 6 months beyond the intervention period. Our systematic approach to improving the endorsement of results is potentially transferable to other healthcare organisations using electronic healthcare records for clinical care.

The Influence of CYP2D6 and CYP2C19 Genetic Variation on Diabetes Mellitus Risk in People Taking Antidepressants and Antipsychotics.

CYP2D6 and CYP2C19 enzymes are essential in the metabolism of antidepressants and antipsychotics. Genetic variation in these genes may increase risk of adverse drug reactions. Antidepressants and antipsychotics have previously been associated with risk of diabetes. We examined whether individual genetic differences in CYP2D6 and CYP2C19 contribute to these effects. We identified 31,579 individuals taking antidepressants and 2699 taking antipsychotics within UK Biobank. Participants were classified as poor, intermediate, or normal metabolizers of CYP2D6, and as poor, intermediate, normal, rapid, or ultra-rapid metabolizers of CYP2C19. Risk of diabetes mellitus represented by HbA1c level was examined in relation to the metabolic phenotypes. CYP2D6 poor metabolizers taking paroxetine had higher Hb1Ac than normal metabolizers (mean difference: 2.29 mmol/mol; p < 0.001). Among participants with diabetes who were taking venlafaxine, CYP2D6 poor metabolizers had higher HbA1c levels compared to normal metabolizers (mean differences: 10.15 mmol/mol; p < 0.001. Among participants with diabetes who were taking fluoxetine, CYP2D6 intermediate metabolizers and decreased HbA1c, compared to normal metabolizers (mean difference -7.74 mmol/mol; p = 0.017). We did not observe any relationship between CYP2D6 or CYP2C19 metabolic status and HbA1c levels in participants taking antipsychotic medication. Our results indicate that the impact of genetic variation in CYP2D6 differs depending on diabetes status. Although our findings support existing clinical guidelines, further research is essential to inform pharmacogenetic testing for people taking antidepressants and antipsychotics.

Carbapenemase-producing Enterobacteriaceae in a group of Polish travelers returning from South and South-East Asia, June 2017 - June 2018. Environment- or healthcare-associated?

INTRODUCTION: Carbapenemase-producing Enterobacteriaceae have spread rapidly through the countries and continents to become a global concern. One of the main reservoirs of NDM-1 positive strains from the Enterobacteriaceae family is the Indian subcontinent (Bangladesh, Pakistan, India). MATERIAL AND METHODS: During June 2017 - June 2018, rectal swab samples were collected routinely in all patients returning to Poland from South and South-East Asia. During molecular examinations gene blaNDM-1 encoding NDM-1 carbapenemase was detected. RESULTS: 31 patients were examined after returning to Poland from a trip to South and South-East Asia. The presence of New Delhi Metallo-ß-lactamase-1 producing Escherichia coli and Klebsiella pneumoniae was confirmed in three patients (9.7%) returning to Poland from travels to India. All the positive patients were hospitalized during the trip in a New Delhi hospital. CONCLUSIONS: Digestive tract carriage of NDM in a group of Polish travelers is a significant health and epidemiological problem. The study confirms the necessity for screening for carbapenemase-producing Enterobacteriaceae (CPE), particularly among travellers. Rectal swabs should be collected in every case of patients returning from international trips, and the possibility of environment-associated infections should be emphasized.

Engaging in Creativity Broadens Attentional Scope.

Previous studies have shown that creativity is enhanced by a broad attentional scope, defined as an ability to utilize peripheral stimuli and process information globally. We propose that the reverse relationship also holds, and that breadth of attention also is a consequence of engaging in a creative activity. In Study 1, participants showed increased breadth of attention in a visual scanning task after performing a divergent thinking task as opposed to an analytic thinking task. In Study 2, participants recognized peripheral stimuli displayed during the task better after performing a divergent thinking task as compared to an analytic task, whereas recognition performance of participants performing a task that involves a mix of divergent and analytic thinking (the Remote Associates Test) fell in between. Additionally, in Study 2 (but not in Study 1), breadth of attention was positively correlated with performance in a divergent thinking task, but not with performance in an analytic thinking task. Our findings suggest that the adjustment of the cognitive system to task demands manifests at a very basic, perceptual level, through changes in the breadth of visual attention. This paper contributes a new, motivational perspective on attentional breadth and discusses it as a result of adjusting cognitive processing to the task requirements, which contributes to effective self-regulation.

The prevalence of intestinal parasites in children in preschools and orphanages in the Warmia-Masuria province (North-Eastern Poland).

OBJECTIVE: A comparison of the prevalence of intestinal parasites (IP) in preschoolers and orphans in the Warmia-Masuria province (Poland). MATERIAL AND METHODS: Between 2003-2006 fecal samples and perianal swabs from 1052 preschoolers and 859 orphans were tested on the basis of direct saline and iodine mount, decantation test and the adhesive cellophane tape method. RESULTS: 10.8% of preschoolers and 46,3% of orphans were infected with IP. Among the six detected IP species the E. vermicularis was the most common. Infections of E. vermicularis were diagnosed in 9.5% of preschoolers and 36,7% of orphans. There were statistically significant differences in the distribution of IP between males and females in preschools. IP infections were the most frequent among 7-year-old children, 19.1% in preschools and 65.7% in orphanages, respectively. In preschools, the prevalence of IP was higher among preschoolers from the rural area (17.3%) than from the urban area (10.3%). CONCLUSION: Orphans and children from rural areas, especially at the age of 7, should be covered by systematic screening with parasitic tests throughout all of Poland. In this group of children, enterobiasis is the main health problem. The promotion of the awareness of IP infections and their prevention among parents and educational staff is required.