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.

Stronger psychological reaction of patients in depression and remission to the first wave of the COVID-19 pandemic in Poland compared to the non-clinical group. / Silniejsza reakcja psychiczna pacjentów w depresji i remisji na pierwsza fale pandemii COVID-19 w Polsce w porównaniu z grupa niekliniczna.

OBJECTIVES: The aim of the study was to compare the subjective mental state of patients in an ongoing episode of depression and in remission (clinical group) and the group without depressive disorders and other mental disorders in their life so far (non-clinical group) in the first wave of the COVID-19 pandemic. METHODS: During the first economic shutdown in Poland (March 12, 2020-May 3, 2020), using an anonymous online survey, we assessed the subjective mental state of 2,284 people in three groups: with an ongoing depressive episode - 265 patients, in remission - 574 patients, and without mental disorders (including depression) - 1,445 people. RESULTS: The outbreak of the pandemic had a negative impact on the subjective mental state of the respondents. In the group with depression, stress of varying intensity was experienced by 98.11% of the respondents, in the group in remission by 93.9%, and in the group without depression in the past by 93.43%. Depressed mood was declared by 51.32% of depressed patients, 21.60% of patients in remission and 11.97% of patients without mental disorders. Daily anxiety attacks occurred in 46.42% of patients with depression, in 20.21% of patients in remission and 5.88% of respondents in the non-clinical group. CONCLUSIONS: The results of the survey show that patients with an ongoing episode of depression and remission subjectively felt worse than the non-clinical group in the first wave of the COVID-19 pandemic in Poland. At the same time, previously healthy people also reported unusual intensification of anxiety and depressive symptoms. For this reason it is important to continue the comprehensive treatment of people with depressive disorders and to simultaneously prevent mental disorders in the non-clinical population.

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.

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.

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.

Antipsychotic- and Anxiolytic-like Properties of a Multimodal Compound JJGW08 in Rodents.

Schizophrenia is a chronic mental illness, which remains difficult to treat. A high resistance to the available therapies, their insufficient efficacy, and numerous side effects are the reasons why there is an urgent need to develop new antipsychotics. This study aimed to assess the antipsychotic-like effects of JJGW08, a novel arylpiperazine alkyl derivative of salicylamide, in rodents. First, considering the JJGW08 receptor profile, we investigated the compound's intrinsic activity towards dopamine D2 and serotonin 5-HT1A, 5-HT2A, and 5-HT7 receptors using functional assays. Next, we assessed the effect of JJGW08 on MK-801- and amphetamine-induced hyperlocomotion, its risk of inducing catalepsy and impairing motor coordination, as well as the anxiolytic-like effects in the four-plate and marble burying tests in mice. Finally, we investigated the antipsychotic-like properties of JJGW08 in rats using MK-801-induced hyperlocomotion and prepulse inhibition tests. We found that JJGW08 showed antagonistic properties at dopamine D2 and serotonin 5-HT1A, 5-HT2A, and 5-HT7 receptors. However, the effect on the 5-HT2A and 5-HT7 receptors was very weak. Moreover, the tested compound showed an antipsychotic-like effect in MK-801- and amphetamine-induced hyperlocomotion but not in a prepulse inhibition test in rats. Notably, JJGW08 demonstrated anxiolytic-like properties in both behavioral tests. Importantly, the compound did not induce catalepsy or motor coordination impairment in mice at antipsychotic-like doses. Our study suggests it is worth searching for new potential antipsychotics among arylpiperazine alkyl derivatives of salicylamide.

Pharmacotherapy of alcohol withdrawal syndromes - Recommendations of the Polish Psychiatric Association and the Pharmacotherapy Section of the Polish Society for Addiction Research. / Farmakoterapia alkoholowych zespolów abstynencyjnych ­ zalecenia Polskiego Towarzystwa Psychiatrycznego i Sekcji Farmakoterapii Polskiego Towarzystwa Badan nad Uzaleznieniami.

Alcohol addiction is one of the most common health problems. Long-term consumption of high doses of ethanol leads to numerous adaptive changes in the central and peripheral nervous systems, most notably a decrease in the activity of inhibitory GABAergic pathways and an increase in the activity of excitatory glutamatergic pathways. Up to half of patients may develop alcohol withdrawal syndrome (AWS) when they stop drinking alcohol. This article contains the recommendations of the Polish Psychiatric Association and the Pharmacotherapy Section of the Polish Society for Addiction Research for the pharmaco�therapy of AWS. This paper presents the aetiopathogenesis, neurotransmitter and receptor mechanisms, symptoms and diagnostic criteria of AWS, medications used in the treatment of alcohol withdrawal syndromes, management of uncomplicated and complicated alcohol withdrawal syndromes, and discusses the management of special populations. First­line drugs in the management of AWS are benzodiazepines (BDZ). Most studies have not shown a su�periority of any BDZ in the treatment of AWS. The decision to choose a formulation should be based on its pharmacokinetic properties, comorbidities, and the patient's current condi�tion. The most commonly used BDZs are diazepam, lorazepam, oxazepam, and clorazepate.

Spontaneous head twitches in aged rats: behavioral and molecular study.

RATIONALE: We have discovered that rats at the age of 18 months begin to twitch their heads spontaneously (spontaneous head twitching, SHT). To date, no one has described this phenomenon. OBJECTIVES: The purpose of this study was to characterize SHT pharmacologically and to assess some possible mechanisms underlying SHT. METHODS: Wistar male rats were used in the study. Animals at the age of 18 months were qualified as HSHT (SHT ≥ 7/10 min observations) or LSHT (SHT < 7/10 min observations). Quantitative real-time PCR with TaqMan low-density array (TLDA) approach was adopted to assess the mRNA expression of selected genes in rat's hippocampus. RESULTS: HSHT rats did not differ from LSHT rats in terms of survival time, general health and behavior, water intake, and spontaneous locomotor activity. 2,5-dimethoxy-4-iodoamphetamine (DOI) at a dose of 2.5 mg/kg increased the SHT in HSHT and LSHT rats, while ketanserin dose-dependently abolished the SHT in the HSHT rats. The SHT was reduced or abolished by olanzapine, clozapine, risperidone, and pimavanserin. All these drugs have strong 5-HT2A receptor-inhibiting properties. Haloperidol and amisulpride, as antipsychotic drugs with a mostly dopaminergic mechanism of action, did not influence SHT. Similarly, escitalopram did not affect SHT. An in-depth gene expression analysis did not reveal significant differences between the HSHT and the LSHT rats. CONCLUSIONS: SHT appears in some aging rats (about 50%) and is permanent over time and specific to individuals. The 5-HT2A receptor strongly controls SHT. HSHT animals can be a useful animal model for studying 5-HT2A receptor ligands.

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.

Assessment of dim light melatonin onset based on plasma and saliva samples.

Melatonin (MELA) is a nocturnal hormone involved in the regulation of the circadian rhythm. MELA can be detected in plasma and saliva, and its salivary concentration strongly correlates with its plasma concentration. Dim light melatonin onset (DLMO) is considered to be the most accurate objective marker for assessing the circadian phase. The purpose of the study was to establish a method for the determination of MELA in plasma and saliva based on the liquid chromatography with tandem mass spectrometry (LC-MS/MS) and compare DLMO using both plasma and saliva matrices. The validation of the LC-MS/MS methods was performed in accordance with the European Medicines Agency (EMA) guideline. The study was conducted on a group of 21 volunteers, male and females, aged 26-54 years. Plasma and saliva were collected at five time points: between 20:00 and 00:00 hours. The MELA concentration was determined by the LC-MS/MS. The DLMO was considered as the point in time when MELA concentration exceeds 20 pg/mL in plasma and 7 pg/mL in saliva. The correlation coefficient between the plasma and salivary MELA concentration was r = 0.764 (p < .001). The ratio of the plasma/saliva MELA concentrations was 2.87. The mean time of the DLMO in the plasma was 21:30 ± 0:45 hours, and in the saliva was as follows: 21:34 ± 1:00 hours. The correlation between the DLMO, calculated based on the plasma and saliva MELA profiles, was r = 0.679 (p < .05). The determination of salivary MELA concentration using LC-MS/MS allows for the determination of the DLMO. Our method may be applied in clinical practice for the diagnosis and monitoring of circadian rhythm disorders.Abbreviations: CE: Collision Energy; CID: Collision-Induced Dissociation; DL: Desolvation Module; DLMO: Dim Light Melatonin Onset; EFSA: European Food Safety Authority; EMA: European Medicines Agency; ESI: electrospray ionization; HB: heat block; HPLC: high performance liquid chromatography; IS: internal standard; K3EDTA: ethylenediaminetetraacetic acid tripotassium salt; LC-MS/MS: liquid chromatography with tandem mass spectrometry; LLE: liquid-liquid extraction; LLOQ: lower limit of quantification; MELA: melatonin; MELA-D4: melatonin-d4; MRM: multiple reaction monitoring; Q1: quadrupole 1; Q3: quadrupole 3; RE: relative error; RIA: radioimmunoassay; RSD: relative standard deviation; SD: standard deviation; ULOQ: upper limit of quantification.

Subjective mental deterioration of healthcare workers during the first wave of the COVID-19 pandemic in Poland. / Subiektywne pogorszenie stanu psychicznego pracowników sektora opieki medycznej w czasie pierwszej fali pandemii COVID-19 w Polsce.

OBJECTIVES: The presented study is aimed at determining the subjective psychological reaction to the outbreak of pandemic in healthcare workers and is part of a wider research project covering successive waves of increasing number of SARS-CoV-2 infections during the COVID-19 pandemic in Poland. METHODS: 664 respondents completed the anonymous online questionnaire in the period from March 12, 2020 to May 3, 2020. This is the period of the first lockdown in Poland. Data were collected using the snowball method (employees passed the questionnaire over the Internet to subsequent groups of employees in subsequent healthcare units). RESULTS: The outbreak of pandemic had varying impact on the well-being of 96.7% of respondents. Subjectively perceived stress of varying intensity was reported by 97.3% of them, low mood was reported in 19.0%, and anxiety in 14.1% of the respondents. These results and other features of the psychological reaction (including sleep problems) to overload in healthcare workers may indicate mental deterioration in the first weeks of pandemic. CONCLUSIONS: The results obtained in the study group may encourage further analyzes of healthcare workers' mental state and contribute to discussion on the COVID-19 pandemic.

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.

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.

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.

Nucleus accumbens as a stereotactic target for the treatment of addictions in humans: a literature review.

INTRODUCTION: Deep brain stimulation (DBS) has achieved substantial success as a treatment for movement disorders such as Parkinson's Disease (PD), essential tremor (ET), and dystonia. More recently, a limited number of basic and clinical studies have indicated that DBS of the nucleus accumbens (NAc) and other neighbouring structures of the reward circuit may be an effective intervention for patients with treatment-refractory addiction. MATERIAL AND METHODS: We performed a structured literature review of human studies of DBS for addiction outlining the clinical efficacy and adverse events. We found 14 human studies targeting mostly the NAc with neighbouring structures such as anterior limb of the internal capsule (ALIC). Five studies including 12 patients reported the outcomes for alcohol dependence. Nine studies including 18 patients reported the outcomes for addictions to various psychoactive substances. The most common indication was addiction to heroin, found in 13 patients, followed by methamphetamine, 3 patients, cocaine, one patient, and polysubstance drug abuse in one patient. CONCLUSIONS: The limited clinical data available indicates that DBS may be a promising therapeutic modality for the treatment of intractable addiction. In general, the safety profile of DBS in patients with addiction is good. Based on the data published in the literature, the NAc is the most often targeted, and is probably the most effective, structure of the reward circuit in the treatment of addiction in humans. Given the ever-expanding understanding of the psychosurgery of addiction, DBS could in the future be a treatment option for patients suffering from intractable addictive disorders.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients.

INTRODUCTION AND HYPOTHESIS: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. METHODS: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. RESULTS: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.

Multifunctional Arylsulfone and Arylsulfonamide-Based Ligands with Prominent Mood-Modulating Activity and Benign Safety Profile, Targeting Neuropsychiatric Symptoms of Dementia.

The current pharmaceutical market lacks therapeutic agents designed to modulate behavioral disturbances associated with dementia. To address this unmet medical need, we designed multifunctional ligands characterized by a nanomolar affinity for clinically relevant targets that are associated with the disease pathology, namely, the 5-HT2A/6/7 and D2 receptors. Compounds that exhibited favorable functional efficacy, water solubility, and metabolic stability were selected for more detailed study. Pharmacological profiling revealed that compound 11 exerted pronounced antidepressant activity (MED 0.1 mg/kg), outperforming commonly available antidepressant drugs, while compound 16 elicited a robust anxiolytic activity (MED 1 mg/kg), exceeding comparator anxiolytics. In contrast to the existing psychotropic agents tested, the novel chemotypes did not negatively impact cognition. At a chronic dose regimen (25 days), 11 did not induce significant metabolic or adverse blood pressure disturbances. These promising therapeutic-like activities and benign safety profiles make the novel chemotypes potential treatment options for dementia patients.

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.