Ketamine in Substance Use Disorder Treatment: A Narrative Review.

Substance use disorder (SUD) continues to pose a significant global health challenge, necessitating innovative and effective therapeutic interventions. Ketamine, traditionally recognized for its anesthetic properties, has emerged as a novel and promising avenue for the treatment of SUD. This narrative review critically examines the current body of literature surrounding the use of ketamine in various forms and settings for individuals grappling with substance abuse. The review explores the neurobiological underpinnings of ketamine's potential therapeutic effects in SUD, shedding light on its impact on glutamatergic neurotransmission, neuroplasticity, and reward pathways. Special attention is given to the psychotropic and dissociative properties of ketamine, exploring their implications for both therapeutic outcomes and patient experience. Ultimately, this review aims to provide a comprehensive overview of the current state of knowledge regarding ketamine's role in the treatment of SUD, emphasizing the need for further research and clinical exploration. As we navigate the complex terrain of addiction medicine, understanding the nuances of ketamine's potential in SUD holds promise for the development of more effective and personalized therapeutic strategies.

The effect of aripiprazole on leptin levels of patients with chronic schizophrenia and a comparison of leptin, acute phase protein, and cytokine levels with regard to body mass and body composition indexes.

INTRODUCTION: The aim of this study was to test the effect of aripiprazole on leptin, insulin, acute phase proteins, and selected cytokines levels in patients with chronic schizophrenia. Additionally, levels of leptin, insulin, acute phase proteins, and cytokines were compared with body mass and body composition indexes. MATERIAL AND METHODS: Levels of leptin, insulin, serum amyloid A (SAA), tumour necrosis factor alpha (TNF-α), and interleukins 17A (IL-17A) and 18 (IL-18) in blood serum were measured for 17 patients before and after 28 days of administering aripiprazole by means of enzyme-linked immunosorbent assay (ELISA). Before and after the study, body mass and waist circumference (WC) were also measured, and body mass index (BMI) and body fat percentage (BF%) were estimated. The sex of each patient was taken into account. RESULTS: After administration of aripiprazole the reduction of levels of leptin, insulin, SAA, and TNF-a were statistically significant, similarly to body mass reduction and decrease in WC, BMI, and BF%, which were also statistically significant. A positive correlation between leptin and BF% and negative correlation between insulin and body mass and body composition indexes were observed before and after the study. High sensitivity C-reactive protein (hsCRP) and hsCRP/albumin positively correlated with BMI before the treatment. In the group of women a statistically significant positive correlation between TNF-α and IL-17A and body mass and body composition indexes was observed, and in the group of men a negative correlation between IL-18 and BMI, WC, and BF% was noted. CONCLUSIONS: The effect of aripiprazole is connected to its anti-inflammatory activity. A 28-day treatment resulted in reduction of adipose tissue, and in the group of women it returned their leptin sensitivity to normal levels. A change of psychotropic treatment and administration of aripiprazole reduces cardiometabolic risks.

Depressive and anxiety disorders in patients with primary hyperparathyroidism. / Zaburzenia depresyjne i lekowe u chorych z pierwotna nadczynnoscia przytarczyc.

OBJECTIVES: The objective of the study was to evaluate the prevalence and severity of anxiety and depression in patients with primary hyperparathyroidism (PHPT), and to determine a relationship between the severity of these disorders and the serum calcium ion and parathyroid hormone level, as well as to evaluate the usefulness of self-rating scales in screening for depressive disorders in PHPT patients. METHODS: Using the 17-item Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II) and Hospital Anxiety and Depression Scale (HADS), study was performed on a group of 101 patients with PHPT. A control group included 50 patients diagnosed with non-toxic thyroid goiter. RESULTS: The HAM-D indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The BDI-II indicated higher prevalence and severity of depressive symptoms in the whole population of patients and in women with PHPT. Such a relationship was not observed in men. The HADS did not show significant differences in the prevalence of depressive and anxiety symptoms between the study and control groups in the whole population and after taking into account the gender division. CONCLUSIONS: A relationship between PHPT and depression was confirmed. Such a relationship was not confirmed for anxiety. A relationship between the severity of depression and the serum calcium ion and parathyroid hormone level was also not confirmed. A statistically significant negative correlation between the severity of anxiety and the serum calcium ion level in the whole population of patients, and an additional positive correlation between the serum parathyroid hormone level and the severity of anxiety in women were confirmed. Self-rating tests are not sufficient for screening for depressive disorders in PHPT patients.

Relationships between various temperament dimensions, levels of selected cytokines and Posttraumatic Stress Disorder (PTSD) in males, incurred as a result of mechanical injuries of lower extremities.

OBJECTIVES: This analysis addresses the relationships between various temperament dimensions, levels of selected cytokines and PTSD in males, incurred as a result of mechanical injuries of lower extremities. METHODS: PTSD was assessed with a PTSD Factorial Version Inventory. Temperamental traits were evaluated by means of Formal Characteristics of Behaviour - Temperament Inventory (FCB-TI). Cytokine levels were determined using ELISA kits. The study population was selected from among a larger population of 80 persons. 15 persons with signs of inflammation were excluded. PTSD group included 33 persons, 32 subjects were included in the control group. RESULTS: Positive statistical correlation with PTSD was observed for: perseverance and emotional reactivity. On the other hand, negative relationship was shown between PTSD and: briskness, endurance and activity. No statistically significant correlations were revealed between the levels of selected cytokines (sIL-2, IL-6, IL-10, TNF-alpha & IFN-gamma) and temperamental traits. Moreover, this study investigates the relationships between temperamental traits, PTSD and various personality dimensions. CONCLUSIONS: 1. Patients with temperamental traits such as high perseverance and emotional reactivity had a greater risk of PTSD. 2. Patients with temperamental traits such as high briskness, endurance and activity had lower risk of PTSD. 3. The level of cytokines (sIL-2, IL-6, IL-10, TNF-alpha, IFN-gamma) was not dependent on the temperamental traits.

Therapeutic effect of aripiprazole in chronic schizophrenia is accompanied by anti-inflammatory activity.

BACKGROUND: Weight gain and metabolic abnormalities occur in chronic schizophrenia patients treated with atypical antipsychotics. The purpose of the study was to evaluate changes in serum levels of C-reactive protein (CRP), insulin and cytokines (IL-6, TNF-α, IL-1ß, IFN-γ, sTNF-R1, IL-12, IL-23, IL-1Ra, TGF-ß1, IL-4, and IL-10) after switching to aripiprazole. METHODS: Cytokine, hsCRP and insulin measurements were performed in patients (n=17) on day 0 and day 28 of the study using standard ELISA assays. The psychopathological status was assessed using PANSS. WC and BMI were measured and calculated, respectively. RESULTS: We observed high clinical efficacy in aripiprazole linked to a 2.7% weight loss. There were statistically significant reductions in PANSS scores and body parameters (p<0.001). After 28 days we detected a significant reduction in hsCRP (p<0.001), insulin (p<0.001), IL-1ß, IL-6, TNF-α, sTNF-R1, IL-12, IL-23, IL-1Ra, TGF-ß1, IL-4 (p<0.001), IFN-γ (p<0.05) and a significant elevation of IL-10 (p<0.001). There was a significant negative correlation between IL-10 levels and PANSS positive, negative and total scores after the study (p=0.022, p=0.003, p=0.008, respectively). CONCLUSIONS: Aripiprazole limits inflammatory processes by enhancing anti-inflammatory signaling. Aripiprazole also reduces the risk of metabolic abnormalities.

[The sense of coherence in women undergoing coronary arteriography]. / Poczucie koherencji w grupie kobiet poddanych koronarografii.

AIM: The examination referred to two groups of female patients: with and without significant coronary stenoses in coronarography. There were two stages of the examination: before and 6-9 months after coronarography. The factor dividing patients into two groups: without significant atheromatosis and with coronary atheromatosis, was the result of invasive diagnostics of coronary heart disease. METHODS: The sense of coherence scale (SOC-29) and sociodemographic questionnaires were used to evaluate the condition of the two groups. RESULTS: In group of patients with irrelevant coronary stenoses statistically lower values of sense of comprehension were noticed in the first and the second examination and also sta- tistically lower values of sense of manage were observed, comparing to the group of patients with significant stenoses. The initial value of general coherence was comparable in both groups and did not significantly change in 6-9 months after coronarography. The characteristic parameters: lack of social support, intensity of depressiveness and anxiety before getting information about necessity of coronarography and worse education were connected with lower sense of coherence. CONCLUSIONS: The baseline strength of the total sense of coherence was not different between groups. Patients with no significant stenosis of coronary arteries demonstrate a lower sense of comprehensibility before and after the coronary arteriography and lower sense of manageability after the procedure compared to the group of patients with significant atherosclerotic lesions. No social support, tendency for depression and anxiety and lower level of education were associated with lower sense of coherence in both groups.

Therapeutic efficacy assessment of weak variable magnetic fields with low value of induction in patients with drug-resistant depression.

BACKGROUND: The aim of this prospective study was to verify whether magnetostimulation with weak variable magnetic fields with low value of induction could enhance the effects of pharmacological therapy in drug-resistant depression. MATERIALS AND METHODS: Thirty patients, 26 women and 4 men, with drug-resistant depression were enrolled in the study. The subjects from Group No. I (14 patients) were given fluvoxamine and treated with weak variable magnetic field using the VIOFOR JPS device; the subjects from Group No. II (16 patients) were also given fluvoxamine but they were treated with the VIOFOR JPS device in placebo mode. Changes in depressive symptoms were estimated with the 21-point Hamilton Depression Scale (HDRS), Montgomery-Asberg Depression Scale (MADRS) and Beck Depression Inventory (BDI) questionnaire. RESULTS: After 15 days of treatment highly significant differences were revealed between the patients treated with magnetic field and the patients treated with placebo: the final HDRS score was 53% of the initial value for the group receiving combined treatment, and 86% in the placebo group (p<0.001); for MADRS score the values were 51% and 88% (p<0.001), respectively, and for BDI 60% and 87% (p<0.001). Thus, the average effect of placebo applied with fluvoxamine was a ca. 15% reduction of symptoms, while the concurrent application of magnetic field and SSRI treatment resulted in a 40-50% improvement. CONCLUSION: Our study indicates that adding a two-week low-induction variable magnetic field stimulation to a classical pharmacologic therapy reduces the intensity of symptoms in patients with drug-resistant depressive disorders.

[Estimation of therapeutical efficacy of weak variable magnetic fields with low value of induction in patients with depression]. / Ocena skutecznosci terapeutycznej slabych zmiennych pól magnetycznych o niskiej wartosci indukcji u chorych z zaburzeniami depresyjnymi.

AIM: Preliminary results of research on the therapeutical efficacy of weak variable magnetic fields with low value of induction used as magnetostimulation in patients with depression not reacting to two consecutive, correctly applied anti-depressant pharmacological treatment are presented in the paper. METHOD: The examined patients (24 persons aged 18-65 years) treated with anti-depressants accessible in Poland were randomly divided into 2 groups. In 1 group (11 persons--9 women and 2 men) magnetostimulation with the use of a weak variable magnetic field with a low value of induction of 15 microT generated by the VIOFOR JPS device (Poland) lasting 12 minutes daily for 15 days was added to pharmacological therapy. Patients from 2 groups (13 persons--11 women and 2 men) were exposed to exposure with the same device. The intensity of depression was estimated with Beck's, Montgomery-Asberg's and Hamilton's scales. RESULTS: As a result of a cycle of active magnetostimulation a distinct, statistically significant decrease of intensification of depression, both in the 7th and 15th day exposure was obtained, while in the sham-exposed group only slight, transient decrease of intensification of depression in the 7th day of sham-exposure was observed. CONCLUSIONS: It was concluded that adding magnetostimulation to pharmacological therapy results in a progressive, significant reduction of intensification of depression symptoms.