Coexistence of lower urinary tract symptoms (LUTS) with depressive symptoms in patients suffering from depressive disorders. / Wspólwystepowanie objawów z dolnego odcinka dróg moczowych z objawami depresyjnymi u pacjentów leczonych psychiatrycznie z powodu zaburzen depresyjnych.

OBJECTIVES: The aim of the present study was to investigate the correlation between lower urinary tract symptoms (LUTS) and severity of depressive symptoms in patients treated for depression. METHODS: 102 patients (43 males, 59 females) aged 20-67 (M = 46.1) treated for depression were included in this cross-sectional analysis. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). LUTS were examined with the International Prostate Symptom Score (IPSS). In order to analyze the impact of presented symptoms, both urological and psychiatric, on quality of life of analyzed individuals the 30-item General Health Questionnaire (GHQ-30) was used. RESULTS: The average IPSS score in women was significantly higher than in men (9.59 vs. 6; p = 0.04). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly higher scores in IPSS (9.76 vs. 4.1; p = 0.002). Severity of all LUTS assessed with IPSS correlated with QIDS-SR score in examined men (p < 0.05). In women, the total IPSS score correlated with the QIDS-SR score (p < 0.05) and with the total GHQ-30 score (p < 0.05). Anumber of other significant (p < 0.05) correlations were observed between the total IPSS score and certain items' scores in the GHQ-30 both in men and women. CONCLUSIONS: LUTS are common among patients with depression. There is a correlation between severity of depressive symptoms and LUTS. LUTS affect quality of life and well-being as well as cause marked distress in depressed patients. Comorbidity of LUTS and depression should draw attention of both psychiatrists and urologists and enhance interdisciplinary treatment approach. Further prospective and cohort studies are essential to reveal more details of the correlation between LUTS and depression.

Postpartum depression: bipolar or unipolar? Analysis of 434 Polish postpartum women

Objective: To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology. Methods: Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features. Results: Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics. Conclusion: Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.

Vortioxetine: A review of the pharmacology and clinical profile of the novel antidepressant.

The aim of this paper was to review the up-to-date evidence base on pharmacology and clinical properties of vortioxetine. Vortioxetine is a novel antidepressant, approved by the US Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD). Because vortioxetine exhibits both an antidepressant and anxiolytic effect, it may be effective in treating both depressive and anxiety disorders, such as generalized anxiety disorder (GAD). Based on its pharmacodynamics profile and preclinical studies, it is believe that the drug's clinical action is mediated mainly by selective blockade of serotonin reuptake (by inhibiting the serotonin transporter [SERT]) and direct modulation of 5-HT receptors activity (such as 5-HT3, 5-HT7, 5-HT1D and 5-HT1B). In patients with MDD the recommended doses range is 5-20mg/day. Vortioxetine was shown to be more effective than placebo both in MDD and GAD. In terms of side effects, nausea, vomiting, diarrhea, and dry mouth were most commonly observed in individuals receiving vortioxetine. In direct comparison to duloxetine, vortioxetine is found to have a smaller efficacy but had a lower risk of developing the common antidepressant-induced adverse effects.

Postpartum depression: bipolar or unipolar? Analysis of 434 Polish postpartum women.

Objective: To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology. Methods: Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features. Results: Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics. Conclusion: Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.

Zinc transporters protein level in postmortem brain of depressed subjects and suicide victims.

BACKGROUND: Major depressive disorder (MDD) is a serious psychiatric illness, associated with an increasing rate of suicide. The pathogenesis of depression may be associated with the disruption of zinc (Zn) homeostasis. In the brain, several proteins that regulate Zn homeostasis are present, including Zn transporters (ZnTs) which remove Zn from the cytosol. The present study was designed to investigate whether depression and suicide are associated with alterations in the expression of the ZnTs protein. METHODS: Protein levels of ZnT1, ZnT3, ZnT4, ZnT5 and ZnT6 were measured in postmortem brain tissue from two different cohorts. Cohort A contained 10 subjects diagnosed with MDD (7 were suicide victims) and 10 psychiatrically-normal control subjects and cohort B contained 11 non-diagnosed suicide victims and 8 sudden-death control subjects. Moreover, in cohort A we measured protein level of NMDA (GluN2A subunit), AMPA (GluA1 subunit) and 5-HT1A receptors and PSD-95. Proteins were measured in the prefrontal cortex (PFC) using Western blotting. In addition, Zn concentration was measured using a voltammetric method. RESULTS: There was a significant increase in protein levels of ZnT1, ZnT4, ZnT5 in the PFC in MDD, relative to control subjects, while ZnT3 protein level was decreased in MDD. There was no significant difference in the Zn concentration in the PFC between control and MDD subjects. Similarly, in the PFC of suicide victims (non-diagnosed), an increase in protein levels of ZnT1, ZnT4, ZnT5 and ZnT6 was observed. Conversely, protein levels of ZnT3 were decreased in both suicide victims and subjects with MDD, in comparison with control subjects. There was also a significant decrease in the protein level of GluA1, GluN2A, PSD-95 and 5-HT1A in MDD. CONCLUSIONS: Our studies suggest that alterations in Zn transport proteins are associated with the pathophysiology of MDD and suicide.

[Others physical methods in psychiatric treatment based on electromagnetic stimulation]. / Inne fizykalne metody leczenia w psychiatrii oparte o stymulacje elektromagnetyczna.

In the last decades a few new physical methods based on the electromagnetic head stimulation were subjected to the clinical research. To them belong:--vagus nerve stimulation (VNS),--magnetic seizure therapy/magnetoconvulsive therapy (MST/MCT),--deep stimulation of the brain (DBS) and--transcranial direct current stimulation (tDCS). The paper presents a description of mentioned techniques (nature, advantages, defects, restrictions), which were compared to the applied electroconvulsive treatment ECT, earlier described transcranial magnetic stimulation TMS and the pharmacotherapy (the basis of the psychiatric treatment).

Lurasidone: The 2016 update on the pharmacology, efficacy and safety profile.

The aim of this paper was to review the up-to-date evidence base on pharmacology and clinical properties of lurasidone. Lurasidone is an atypical antipsychotic, approved by the US Food and Drug Administration (FDA) for the treatment of schizophrenia and bipolar depression. Lurasidone exhibits both an antipsychotic and antidepressant action. Based on its pharmacodynamics profile, it is believed that the drug's clinical action is mediated mainly through the D2, 5-HT2A and 5-HT7 receptors inhibition. In patients with schizophrenia the recommended dose range is 40-80mg/day. In bipolar depression broader dosage ranges (20-120mg/day) were found to be effective. In terms of side effects, higher rates of akathisia, parkinsonism and hyperprolactinemia were observed in individuals receiving lurasidone (as compared to patients treated with other atypical antipsychotics). On the other hand, treatment with lurasidone yields relatively lower risk for developing sedation or overweight/obesity.

[Contemporary place of the electroconvulsive therapy. Part 2. Clinical aspect]. / Obecne miejsce terapil elektrowstrzasowej Czesc 2. Aspekt kliniczny.

Electroconvulsive therapy (ECT) is an important method of biological treatment in serious psychic disturbances. Similarly to drug therapy it is marked by a determined schematics of applying including the list of indications, contraindications, procedures of the performance, as well as the list of adverse invents. Applying defined schemas allows for minimizing the risk and influences the final effectiveness of therapy.

[The place of quetiapine extended release in the treatment of mental disorders]. / Miejsce kwetiapiny o przedluzonym uwalnianiu w terapii osób z zaburzeniami psychicznymi.

This article presents a summary of available data on the use of quetiapine extended release (QUE-XR). QUE-XR is an example of an atypical antipsychotic drug that can be used in a single dose, thereby simplifying the treatment regimen. From the therapeutic standpoint, this issue is of paramount importance, since approximately 50% of patients have adherence issues. Therefore, availability of the drug which is comfortable in administration can significantly improve treatment outcomes. Due to its antipsychotic, antidepressive, mood stabilizing and anxiolytic efficacy, QUE-XR seems to be a promising drug with potentially broad spectrum of indications (in patients with schizophrenia, bipolar disorder, major depression and some anxiety disorders - both in the acute phase of treatment, and the maintenance treatment). Notably, QUE-XR seems to ameliorate sleep disturbances, and it may also improve patients' quality of life (as suggested by some studies). Due to the simple dosing regimen of QUE-XR, conducting therapy with this drug may contribute to the improvement of compliance. Yet, the primary clinical criterion for selection of the type of formulation of quetiapine should be the individual preferences of the patient, and the knowledge and experience of the treating physician.

[Transcranial magnetic stimulation in psychiatric therapy]. / Przezczaszkowa stymulacja magnetyczna w terapii psychiatrycznej.

Transcranial magnetic stimulation (TMS) is one of new techniques of the physical treatment in psychiatry. Its advantage is painlessness, so as lack of invasiveness and evoking a convulsive effect. The technique of TMS was introduced into the clinical practice in 1985--originally as a diagnostic method in neurology. Later TMS became a valuable tool in the basic research in neurophysiology and neuropsychology, so as in clinical examinations. In 1994 the first papers on TMS application in therapy of depression and schizophrenia were published. The research on the therapeutic TMS effectiveness encounters certain problems and restrictions: difficulties in determining a place of the stimulation, lack of the possibility of the selection of optimal parameters for the stimulation, problem in guarantying optimal conditions for the double-blind study, etc. During the last two decades TMS was applied in therapy of mood disorders and psychoses more on the principle of consuetude, than confirmations of the evident effectiveness. However recently a group of European experts presented the study, in which they regarded TMS as the effective method in therapy of depression and schizophrenia--presenting conditions to the optimal stimulation.

[The influence of long-term care on the health of caregivers of Alzheimer's disease patients]. / Wplyw sprawowania dlugotrwalej opieki na stan zdrowia opiekunów pacjentów z otepieniem w chorobie Alzheimera.

The literature indicates that caregivers of patients with Alzheimer's disease experience a significant degree of burden that impacts on their health-related quality of life (HRQOL). AD caregivers experience significant changes in a social, family and professional life depending on diverse factors. Caring for a patient with dementia directly links to significant psychological stress. It also affects the caregivers' physical and mental health. The psychiatric morbidity is higher among the caregivers population. Depression, anxiety disorder and insomnia have been found to be the most common. The burden and the negative changes experienced by the caregivers predispose the lower quality of care and premature institutionalisation of AD patients. Excessive burden experienced by carers increases their rate of patients neglect and abuse. Life quality improvement becomes the main target of the proper care giving system.

[Contemporary place of the electroconvulsive therapy Part 1. The historical context arnd the biological basis]. / Obecne miejsce terapii elektrowstrzasowej Czesc 1. Kontekst historyczny i podstawy biologiczne.

Electroconvulsive therapy (ECT) is a former physical therapy method in psychiatry which is applicable up till today in relation to its high effectiveness and the safety. Centuries of applying nonconvulsive methods of the electric stimulation preceded introducing this method into the clinical practice. ECT is arousing a lot of controversies; populous myths are connected with its applying--that demands explanations. Numerous biological mechanisms explaining the clinical efficacy of ECT action are well-known.

[The efficacy of transcranial magnetic stimulation in the treatment of depression]. / Skutecznosc przezczaszkowej stymulacji magnetycznej w leczeniu depresji.

BACKGROUND: Transcranial magnetic stimulation (TMS) is known as method of depression therapy. RESULTS: The paper presents the results of clinical 2nd phase investigation or safety and efficacy of TMS as compared to electroconvulsive therapy and standalone pharmacotherapy. RESULTS: It was shown that in all three groups of patients a significant improvement of clinical state (decrease of depressive symptoms) was achieved. The strongest effect was observed in the group of patients treated with electroconvulsive therapy (as well as drugs). However, trans-cranial magnetic stimulation combined with pharmacotherapy did not prove to be more effective than standalons pharmacological treatment. The authors discuss possible explanations of inefficacy of transcranial magnetic stimulation therapy. CONCLUSIONS: None antidepressive efficacy of TMS was observed. Forthcoming examinations of TMS are necessary for optimalization of stimulation parameters and conditions.

[Working memory disturbances in patients with major depression after ECT treatment]. / Zaburzenia pamieci operacyjnej u pacjentów z glvboka depresja leczonych wstrzasami elektrycznymi.

INTRODUCTION: Electroconvulsive therapy (ECT) is the most effective treatment in a variety of psychiatric syndromes (especially mood disorders). However one of its adverse effects is neurocognitive dysfunction. Declarative memory impairment after ECT is unquestionable and well investigated. There are only few ambiguous studies focused on nondeclarative and immediate memory changes during ECT. METHOD: A study of immediate (working) memory changes in depressed patients treated with ECT (n=10; bitemporal ECT 3 times a week) or imipramine or desipramine (150-250 mg/day; n=10) was conducted in patients who fulfilled DSM-IV criteria for major unipolar depression. Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI) were used to assess the efficacy of antidepressant therapy. Cognitive functions were assessed with neuropsychological tests: Stroop A and B, TMT (Trial Making) A and B. The patients' status was evaluated 1 day before the treatment and 1 day, 2 weeks, 1 month and 6 months after the first ECT procedure. RESULTS: 1 day after first ECT treatment, patient's working memory was slightly impaired, but this was not statistically significant. Both groups showed statistically significant improvement in working memory I month after start of treatment. However there were statistically significant differences between ECT and pharmacologically treated groups at the first month of therapy. CONCLUSION: ECT treatment only temporally affects working memory function. The improvement of function may be a result of clinical recovery from depressant symptomatology.

[The evolution of depressive symptoms in coronary artery disease patients after successful coronary angioplasty]. / Dynamika objawów depresyjnych u pacjentów z choroba niedokrwienna serca, poddanych zabiegom przezskórnej angioplastyki wiencowej.

AIM: The aim of the study was to investigate the spectrum and course of depressive symptoms in cardiac ischemic disease (CAD) patients before and after successful coronary angioplasty (PCI) in one year follow-up. METHOD: 227 patients with CAD selected for PTCA were enrolled. 156 patients with full clinical and angiographic success and without restenosis within 4 weeks after the intervention were included in further analysis. Patients' status was assessed four times (one day before and at 1, 6 and 12 months after the intervention), with Beck's Depression Inventory (BDI), Rosenberg's Self-Esteem Scale (RS), Beck's Hopelessness Scale (HS), Automatic Thoughts Questionnaire (ATQ). RESULTS: Mild and moderate depressive disorders with the prevalence of non-specific somatic symptoms were observed one day before PTCA in 75 (48%) patients. One month after the PCI, depressive symptoms persisted in 33 subjects. Moreover in the group of patients who were free of depressive symptoms a day before PTCA, twelve patients (15%) developed depressive symptomatology. Depressive symptoms and depressive disorders of thinking (especially hopelessness) recognized 4 weeks after PTCA had a tendency to persist at 6 and 12 months. The tendency was associated with more severe affective-cognitive and somatic symptoms of the depressive syndrome, more frequent negative automatic thoughts and stronger hopelessness detected at the beginning of the study. CONCLUSIONS: The results of the study suggest that successful PCI is not a sufficient determinant for the improvement of depressive symptoms. Diagnosis of depression in CAD patients needs special attention, because of a tendency to persist.

[The quality of life related to depressive symptoms in coronary artery disease patients after successful coronary angioplasty: one-year follow up]. / Jakosc zycia a objawy depresyjne u pacjentów z choroba niedokrwienna serca po zabiegach przezskórnej angioplastyki wiencowej w ciagu rocznej obserwacji.

AIM: The aim of the study was to assess how the comorbidity of depressive symptoms and cardiac ischemic disease (CAD) influences the quality of life (QoL) in patients after the successful coronary angioplasty (PCI). METHOD: 227 patients with CAD selected for PTCA were enrolled. 156 patients with full clinical and angiographic success and without restenosis within 4 weeks after the intervention were included in one year follow-up. Patients' status was assessed four times (one day before and at 1, 6 and 12 months after the intervention), with the Polish version of SF-36, Beck's Depression Inventory (BDI), Rosenberg's Self-Esteem Scale (RS), Beck's Hopelessness Scale (HS) and the Automatic Thoughts Questionnaire (ATQ). RESULTS: In the whole study group (n=156) the quality of life at 1 month after PTCA was significantly improved. This tendency persisted in further examinations. There was a significant correlation between the quality of life (SF-36), severity of depressive symptoms (BDI) and parameters describing depressive changes in thinking (HS, RS, ATQ). On each occasion during the one-year follow-up' the presence of depressive symptoms was associated with the poorer quality of life, both with respect to the total SF-36 points and individual components of QoL measured by 8 subscales of the SF-36. CONCLUSIONS: Present findings indicate that depressive disorders in patients with CAD--even after successful intervention--significantly affect the quality of life. Optimized comprehensive approach to CAD patients with concomitant depressive disorders may require the inclusion of psychological interventions, and in severe cases even psychiatric treatment.

[Manfred Cierpka Questionnaire usefulness in the analysis of perception of familiar support in patients with acute leukaemia]. / Wykorzystanie kwestionariusza Manfreda Cierpki w analizie wsparcia rodzinnego u pacjentów z ostra bialaczka.

AIM: The mechanisms of the impact of family support on somatic diseases are still unclear and they are subject of research. Especially little is known about the role of family relations. This study discusses the meaning of social support in somatic disorders, particularly acute leukaemia in the context of family functioning. The aim of the study is the evaluation of usefulness of the Manfred Cierpka questionnaire as the assessment tool examining social support for leukaemic patients. METHOD: The study included 36 subjects, 21 men and 15 women, with diagnosis of acute leukaemia. The level of depression symptoms was Manfred Cierpka questionnaire usefulness in the analysis of perception of familiar support in patients with acute leukaemia by the set of questionnaires. The level of disease symptoms was estabilished on the basis of several clinical variables and procedures, during a one year course of the disease. Family functioning and functioning of the patient within the family were evaluated by family assessment questionnaire of Cierpka. RESULTS: The result of the overall family functioning assessment in the subgroup with depressive symptoms was significantly worse than in the group without depression. There was no such difference in self assessment of the patients' functioning in the family. The scores of the family assessment questionnaire does not differentiate the group according to severity of the illness and one year mortality. CONCLUSION. The Manfred Cierpka questionnaire is helpful as an assessment method of subjective perception of family support for leukaemic patients. The results of the family functioning questionnaire are related to the sustaining of depressive symptoms in the course of the disease. It may indicate the usefulness of early family intervention in the specific group of patients.

[The completed and attempted suicide in Krakow: similarities and differences]. / Samobójstwa dokonane i usilowane w Krakowie--podobienstwa i róznice.

The study presents the results of the interdisciplinary research conducted on the basis of cooperation between the Institute of Forensic Medicine, the Department of Clinical Toxicology, and the Clinic of Psychiatry in Kraków. The aim of the research was to determine similarities and differences between attempted and completed suicide from the point of view of socio-demographic and clinical traits. The authors analysed 220 cases of completed suicide committed in Kraków and its environs in the year 2000. The material presented in the study was based on the archive data from post mortem examinations conducted in the Institute of Forensic Medicine in Kraków. The sample consisted of 177 males and 43 females ranging in age from 13 to 89 years. The mean age was 43.6 years for the entire group, 42 years for males and 50 years for females. The majority of subjects were males, either unemployed, or pensioners. A similar tendency was observed in the group of female subjects. Mental disorders and alcoholic addiction in anamnesis were discovered in a significant number of cases, both in the group of males and in the group of females. Subjects, in whom serious somatic diseases had been detected, constituted a separate group of cases. According to the archive data, in the last century, suicide was most frequently committed by hanging. Similarly, in the sample examined, in 133 cases, suicide was committed by hanging. In 37% of cases, the level of alcohol in the suicides' blood was between 0.5 and 3 or more g/L. In 2000/2001, within the analogical period of 12 months, the group of 200 patients after a suicide attempt by drug intoxication was examined in the Department of Clinical of Toxicology Jagiellonian University College of Medicine. This group included 49 males and 150 females, ranging in age from 18 to 79 years (mean age 35). The examination was conducted by means of structured investigation and medical documentation. Contrary to completed suicide, in the group of suicide attempters, females outnumbered males. Young people under thirty, living in a large city, possessing elementary or secondary education, and either unemployed, or pensioners, constituted the majority of the examined group. A significant percentage of females was divorced and lived with their children only. The majority of the examined population of suicide attempters had used alcohol during the attempt, had suffered from depression, personality or behavioural disorders, had undergone psychiatric treatment, or had had cases of suicide among their friends or relatives.