Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia.

Introduction: In this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia. Methods: The Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome. Results: One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome. Conclusions: Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.

Assessment of Lipid Balance Parameters after Laparoscopic Sleeve Gastrectomy in 1-Year Observation.

Introduction: Currently, the increase in the percentage of obese people observed along with the development of civilization, reaching the level of a global pandemic, has forced a search for methods of effective and permanent obesity treatment. Obesity is a multifactorial disease; it coexists with many disease entities and requires multidisciplinary treatment. Obesity leads to metabolic changes in the form of metabolic syndromes, which include, among others, atherogenic dyslipidemia. The proven relationship between dyslipidemia and cardiovascular risk enforces the need to effectively improve the lipid profile of obese patients. Laparoscopic sleeve gastrectomy is a method of surgical treatment of morbid obesity which improves bariatric and metabolic parameters. The aim of the study was to assess the effectiveness of laparoscopic sleeve gastrectomy (LSG) at improving lipid profile parameters upon a 1-year follow up. Material and Methods: Bariatric parameters of 196 patients who underwent laparoscopic sleeve gastrectomy as well as the lipid profile of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-NDL, and triglycerides (TG) in a 1-year observation were analyzed. Results: Improvements in bariatric parameters were observed in patients after LSG. Total cholesterol, low-density lipoprotein (LDL), triglycerides and non-HDL level decreases were observed along with an increase in high-density lipoprotein (HDL) cholesterol levels. Conclusions: Sleeve gastrectomy is an effective method of treating obesity and improving the lipid profile in obese patients.

European Validation of the Self-Evaluation of Negative Symptoms (SNS): A Large Multinational and Multicenter Study.

BACKGROUND: Negative symptoms are usually evaluated with scales based on observer ratings and up to now self-assessments have been overlooked. The aim of this paper was to validate the Self-evaluation of Negative Symptoms (SNS) in a large European sample coming from 12 countries. We wanted to demonstrate: (1) good convergent and divergent validities; (2) relationships between SNS scores and patients' functional outcome; (3) the capacity of the SNS compared to the Brief Negative Symptom Scale (BNSS) to detect negative symptoms; and (4) a five-domain construct in relation to the 5 consensus domains (social withdrawal, anhedonia, alogia, avolition, blunted affect) as the best latent structure of SNS. METHODS: Two hundred forty-five subjects with a DSM-IV diagnosis of schizophrenia completed the SNS, the Positive and Negative Syndrome Scale (PANSS), the BNSS, the Calgary Depression Scale for Schizophrenia (CDSS), and the Personal and Social Performance (PSP) scale. Spearman's Rho correlations, confirmatory factor analysis investigating 4 models of the latent structure of SNS and stepwise multiple regression were performed. RESULTS: Significant positive correlations were observed between the total score of the SNS and the total scores of the PANSS negative subscale (r = 0.37; P < 0.0001) and the BNSS (r = 0.43; p < 0.0001). SNS scores did not correlate with the level of insight, parkinsonism, or the total score of the PANSS positive subscale. A positive correlation was found between SNS and CDSS (r = 0.35; p < 0.0001). Among the 5 SNS subscores, only avolition subscores entered the regression equation explaining a lower functional outcome. The 1-factor and 2-factor models provided poor fit, while the 5-factor model and the hierarchical model provided the best fit, with a small advantage of the 5-factor model. The frequency of each negative dimension was systematically higher using the BNSS and the SNS vs. the PANSS and was higher for alogia and avolition using SNS vs. BNSS. CONCLUSION: In a large European multicentric sample, this study demonstrated that the SNS has: (1) good psychometric properties with good convergent and divergent validities; (2) a five-factor latent structure; (3) an association with patients' functional outcome; and (4) the capacity to identify subjects with negative symptoms that is close to the BNSS and superior to the PANSS negative subscale.

Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study.

BACKGROUND: The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. METHODS: Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. RESULTS: There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. DISCUSSION: Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

METABOLIC SYNDROME. ETIOLOGY AND PATHOGENESIS.

The aim of the study was to assess the impact of individual components of the metabolic syndrome on the human body, taking into account their etiology and pathogenesis. This article is analytical analysis of scientific and medical literature basing on aspects of the etiology and pathogenesis of the metabolic syndrome. The key role in the pathogenesis of the metabolic syndrome is played by insulin resistance, which may be a result of lifestyle conditions (low physical activity, overweight or obesity) or genetic background. A certain role in the pathogenesis of the metabolic syndrome is also attributed to disorders of the hypothalamic-pituitary-adrenal axis in the form of increased cortisol control, which may initiate the development of abdominal obesity, insulin resistance, hypertension and dyslipidemia. Aforementioned factors (environmental, hormonal and genetic) lead to excessive fat tissue gathering. The excess of abdominal fat tissue - abdominal obesity - leads to insulin resistance, the concentration of which causes body mass gain. Such mechanism is dangerous for our health and may lead to the occurrence of type 2 diabetes and premature development of atherosclerosis with all its consequences such as atherosclerotic cardiovascular diseases including coronary artery disease.

Association of Negative Symptoms of Schizophrenia Assessed by the BNSS and SNS Scales With Neuropsychological Performance: A Gender Effect.

Objective: The relationship between negative symptoms and neurocognitive performance in schizophrenia is well documented, but the mechanism of these connections remains unclear. The study aims to measure the relationship between the results on the new scales for the assessment of negative symptoms such as Brief Negative Symptom Scale (BNSS) and Self-evaluation of Negative Symptoms (SNS), and the results of some neurocognition tests. The second aim is to assess a possible gender effect on these associations. Methods: The study included 80 patients (40 men, 40 women) with schizophrenia, aged 19-63 (mean 38 years), during the improvement period (total PANSS score <80, unchanged pharmacological treatment in the last 3 weeks). They were assessed using the BNSS, SNS, Personal and Social Performance (PSP) scales, and the tests for neuropsychological performance such as the Trail Making Test (TMT-A, TMT-B), Stroop Color-Word Interference Test, Verbal fluency tests (VFT), Category fluency test (CFT), and Digit Symbol Substitution Test (DSST). Results: Male patients obtained higher scores than females on some PANSS and BNSS items. No gender differences were observed for the SNS scale. Female patients scored better in the PSP and CFT. In male patients, a significant positive correlation between the intensity of negative symptoms measured by the BNSS and the results of PSP with the Trail Making Test was observed. In female patients, we found a positive correlation between the results of BNSS and PSP with the Stroop Color-Word Interference Test. Conclusion: The obtained results confirm the relationship between negative symptoms and neurocognition in schizophrenia patients. However, in male and female patients such association was observed for different cognitive domains. Further research is needed to explain the nature of these differences.

Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study.

BACKGROUND: The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. METHODS: Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. RESULTS: The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. CONCLUSIONS: The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct "cores" of schizophrenia, the "Positive" and the "Negative," while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

Negative symptoms in schizophrenia, assessed by the brief negative symptom scale, self-evaluation of negative symptom scale, and social cognition: a gender effect.

OBJECTIVE: Negative symptoms of schizophrenia can be related to social cognition. The aim was to measure a relationship between the results on the new scales for the assessment of negative symptoms such as the Brief Negative Symptom Scale (BNSS) and Self-evaluation of Negative Symptoms (SNS), and the measures of social cognition. METHODS: The study included 80 patients (40 men, 40 women) with schizophrenia, aged 19-63 (mean 38 years), during the improvement period. They were assessed using the BNSS, SNS, Personal and Social Performance (PSP) scales, and the tests for social cognition such as the Facial Emotion Identification Test, Reading the Mind in Eyes Test, Strange Stories and Faux Pas Test. RESULTS: Male patients obtained higher scores than females when assessed by the BNSS. No gender differences were observed for the SNS scale. Female patients scored better in the PSP and both parts of the Faux Pas test and obtained a significant correlation between the results of the SNS scale, BNSS, PSP, and the affective part of the Faux-Pas test what was not the case in males. CONCLUSIONS: Gender differences were found in the assessment of negative symptoms by a clinical scale and the relationship between negative symptoms and social cognition.KEY POINTSFemale patients scored better in the BNSS, PSP and both parts of the Faux-Pas testGender differences were present in the assessment of negative symptoms by clinical (BNSS) but not the self-assessment (SNS) scale.Female patients obtained a significant correlation between the results of the SNS scale, BNSS, PSP, and the affective part of the Faux-Pas test what was not the case in male subjects.

Metabolic indices in schizophrenia: Association of negative symptoms with higher HDL cholesterol in female patients.

OBJECTIVES: Negative symptoms of schizophrenia can be related to metabolic abnormalities. The study aimed to assess negative symptoms using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptoms Scale (BNSS), and their relationship with body mass index (BMI) and lipid indices, in male and female schizophrenic patients. METHODS: Fifty chronic schizophrenia patients (29 males, 21 females) were included. They have mild to moderate severity of the illness (total PANSS score <80), and received unchanged pharmacological treatment in the last three weeks. Psychopathology symptoms were assessed using the PANSS and BNSS. The measurements of BMI and serum lipids were done in all patients. RESULTS: In female patients, a significant positive correlation between the intensity of negative symptoms measured by the PANSS and BNSS scales and the concentration of high-density lipoprotein (HDL) cholesterol, and a trend for negative correlation with BMI was observed. Such correlations were not found in male patients. CONCLUSIONS: Assessing the negative symptoms of schizophrenia, and investigating the relationship of these symptoms with metabolic indices, we showed distinctive features in male and female schizophrenia patients. The positive correlation between negative symptoms and HDL cholesterol in female patients needs to be confirmed in further studies.

Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

INTRODUCTION: The worldwide outbreak of morbid obesity forced contemporary medicine to adopt a multidisciplinary approach, which led to the description of metabolic syndrome (MS): a disease with self-aggravating components and one of the most important causes of morbidity and mortality. The need for therapeutic methods provoked development of metabolic surgery, which nowadays give possibilities for safe and effective treatment of all MS aspects simultaneously and improves many obesity-related comorbidities. AIM: To assess the laparoscopic sleeve gastrectomy (LSG) procedure's efficiency in resolving MS components, treating comorbidities and to analyze the influence on certain biochemical markers in 1-year follow-up. MATERIAL AND METHODS: The retrospective cohort study of 211 patients after an LSG operation relied on statistical analysis of clinical data collected prospectively in follow-up visits. All applicable guidelines and bioethical recommendations were respected in this study. RESULTS: Assessment of bariatric efficiency proved the LSG operation to be effective in inducing significant weight loss and treating obesity. Analysis on the influence on MS components, such as non-insulin dependent diabetes (NIDDM), arterial hypertension (AH) and dyslipidemia, showed substantial improvement in all observed cases of these diseases. In the present study, follow-up also proved a partial remission inducing effect of this bariatric operation in many comorbidities, especially in chronic obstructive pulmonary disease, obstructive sleep apnea, peptic ulcer disease and depression. A desirable reduction in creatinine, C-reactive protein, uric acid, alanine aminotransferase, asparagine aminotransferase, γ-glutamyltransferase serum levels has also been observed during the follow-up. CONCLUSIONS: The LSG is an effective method of treatment in all areas of metabolic syndrome, provides a significant positive clinical outcome in obesity-related comorbidities and induces desirable changes in inflammatory, kidney and liver related biomarkers.

Dysfunctions of the retina and other elements of the visual system in schizophrenia. / Zaburzenia funkcji siatkówki i innych elementów ukladu wzrokowego w schizofrenii.

Schizophrenia is an illness with a large variety of symptoms, significant variability of the individual course, and still not fully explained etiology. It is suggested that genetic, infectious and immunological factors may be involved, and neurodevelopmental, neurodegenerative and neurotransmitter hypotheses have been proposed. Detection of the measurable and reproducible biological indicators of the clinical picture and the course, referred to as biomarkers, may be essential to elucidate the etiopathogenic mechanism of the illness. For schizophrenia, this function may be performed by the retina of the eye and other elements of the visual pathway. The observed abnormalities are of a structural and functional nature. They concern virtually the entire visual system, and, in accordance with the neurodevelopmental theory of schizophrenia, arise at the early stages of brain formation. What is essential - the specific structure of the human eye, its translucency, lack of myelin and low concentration of glial cells provide excellent opportunities for non-invasive assessment of the microstructure and function of the central nervous system. The following paper discusses the most important changes in the visual apparatus observed in patients with schizophrenia. Particular attention was paid to retinal vascular changes, anomalies in the electroretinogram and optical coherence tomography, structural and functional disorders of cortical centers and neurochemical disorders in the cells of the visual pathway.

Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study.

INTRODUCTION: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method. METHODS: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed. RESULTS: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients. DISCUSSION: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

Polish version of the Brief Negative Symptom Scale (BNSS). / Polska wersja Krótkiej Skali Objawów Negatywnych (Brief Negative Symptom Scale ­ BNSS).

OBJECTIVES: To create a Polish adaptation of the Brief Negative Symptom Scale (BNSS), to assess the internal consistency of the Polish version of the BNSS, and to make correlations between the BNSS scores and the Positive and Negative Syndrome Scale (PANSS) in the group of patients with schizophrenia. METHODS: The procedure of Polish adaptation of the assessment form (Scoresheet) of the BNSS, comprising 13 items organized in 6 subscales (anhedonia, lack of proper distress, asociality, avolition, blunted affect, and alogia), as well as the Manual and the Workbook of the scale was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women), aged 44±13 years, with illness duration of 17±10 years, and severity of symptoms on the PANSS 56±16 points, receiving unchanged pharmacological treatment in the last three months. RESULTS: The Polish version was accepted by the authors of the scale. The reliability analysis showed high values of the Cronbach's alpha coefficient both for the whole scale (0.97) and for individual subscales (0.74-0.93). The BNSS and its subscales showed a high significant correlation with the total PANSS score and with the PANSS negative symptom subscale, both original and modified. CONCLUSIONS: The obtained results indicate good psychometric properties of the Polish version of the BNSS and its possible usefulness in the study of negative symptoms of schizophrenia conducted in Poland.

Polish version of the Self-evaluation of Negative Symptoms (SNS). / Polska wersja Skali Samooceny Objawów Negatywnych (Self-evaluation of Negative Symptoms ­ SNS).

OBJECTIVES: The aim of the study was to create a Polish version of the Self-evaluation of NegativeSymptoms (SNS) scale, to assess its internal consistency, and to make correlations between the SNS scores and the Brief Negative Symptom Scale (BNSS) scores in the group of patients with schizophrenia. MATERIAL AND METHODS: The procedure of Polish adaptation of the French-language version of the SNS scale, comprising 20 items organized in 5 subscales: asociality, blunted affect, alogia, avolition and anhedonia, was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women) with severity of symptoms on the Positive and Negative Syndrome Scale (PANSS) 56±16 points, receiving unchanged pharmacological treatment in the last 3 months. RESULTS: The Polish version of the SNS scale was accepted by the author of the scale, Professor Sonia Dollfus. The reliability analysis showed high values of the Cronbach's alpha coefficient for the whole scale (0.91) and for the subscales (0.61-0.85). The SNS and its subscales showed significant correlations with the total BNSS score and with the scores of the BNSS subscales, which confirms the validity of the scale. CONCLUSIONS: A statistically significant level of consistency of the whole scale and its individual domains with the results of the clinical assessment with the BNSS, speaks for the adequacy of the self - assessment of negative symptoms by a patient with schizophrenia. Good psychometric properties of the Polish version of the SNS obtained in the study can indicate its usefulness in the research on negative symptoms conducted in Poland.

A large European, multicenter, multinational validation study of the Brief Negative Symptom Scale.

Negative symptoms represent an unmet need of treatment in schizophrenia. Although a consensus exists on negative symptom construct, and second generation assessment instruments reflecting the consensus are available, studies still rely upon old assessment instruments, that do not reflect recent conceptualizations and might limit progress in the search for effective treatments. This is often the case in the European context, where one of the challenges encountered in designing large studies is the availability of validated instruments in the many languages of the continent. To address this challenge and promote sound research on negative symptoms in Europe, the ECNP Schizophrenia Network coordinated a large multicenter, multinational validation study of the Brief Negative Symptom Scale (BNSS). Clinically-stable subjects with schizophrenia (SCZ, N = 249) were recruited from 10 European Countries. Apart from BNSS, subjects were administered the Positive and Negative Syndrome Scale (PANSS) and standardized instruments for depression, extrapyramidal symptoms and psychosocial functioning. Results showed an excellent internal consistency, convergent and discriminant validity of BNSS and replicated a 5 factor-model. A larger number of subjects with predominant negative symptoms, i.e. the target population for clinical trials, was identified by using the BNSS compared to the PANSS. Regression analysis showed that BNSS-avolition, a key negative symptom poorly assessed by PANSS, explained 23.9% of psychosocial functioning, while no combination of the PANSS core negative symptoms showed the same impact on functioning. The study demonstrated that BNSS has substantial advantages with respect to PANSS for the identification of the avolition domain and subjects with predominant negative symptoms.

Clinical picture, pathogenesis and psychometric assessment of negative symptoms of schizophrenia. / Obraz kliniczny, patogeneza i ocena psychometryczna objawów negatywnych schizofrenii.

Negative symptoms of schizophrenia constitute a serious diagnostic and therapeutic problem. They substantially account for the impairment of health, social functioning and quality of life whereas treatment is difficult. In this paper the development of the concept of schizophrenia and negative symptoms is presented. The models of positive and negative symptoms, introduced in the 1980's by Timothy Crow and Nancy Andreasen, and William Carpenter's concept of so-called deficit syndrome with the criteria of the division of negative symptoms into the primary and secondary, are discussed. Current views on the pathogenesis of negative symptoms are shown with reference to neuroimaging studies, neurotransmitter alterations, neuropsychological deficits, genetic, immunological and epidemiological studies. A subsection is devoted to the diagnostics tools for negative symptoms. Chronologically, they are divided into scales of the 1st and 2nd generation. The first generation includes: the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS), the Schedule for the Deficit Syndrome (SDS), and the Proxy for Deficit Syndrome. The second generation scales, developed as a result of the recommendation by American experts in 2006, include: the Brief Negative Syndrome Scale (BNSS) and the Clinical Assessment Interview for Negative Symptoms (CAINS), also the self-assessment scales: the Motivation and Pleasure Scale - Self Report (MAP-SR) and the Self-assessment of Negative Symptoms (SNS). The BNSS and the SNS scales, whose Polish versions were elaborated in the Department of Adult Psychiatry of Poznan University of Medical Sciences, are discussed in-depth.

Stages of the clinical course of schizophrenia - staging concept. / Etapy przebiegu schizofrenii - koncepcja stagingu.

Clinical staging is a tool useful in medical sciences. It assumes the presence of three key elements. Firstly, pathologic indices are progressing in subsequent stages. Secondly, the patients in the individual stages present similar pathological changes. Thirdly, treatment should be most effective in the earlier stages. Such model is particularly well established in the treatment of malignancies. Staging is useful here to define prognosis, to evaluate the results of treatment, facilitate the exchange and comparison of information among treatment centres. There is much data describing a similar model for mental illnesses including schizophrenia. There are two theories supporting the staging model for schizophrenia: the neurodevelopmental hypothesis and allostatic load concept. Both theories make a theoretical premise for creating the staging model for schizophrenia. We can describe at least three stages in the development of a schizophrenic illness: the prodrome, the first episode and chronic phase. Each stage is reflected by anatomical and functional changes in the brain. Therefore, a clinical staging model can describe a development of schizophrenia over time, to help selecting adequate treatments that are particularly relevant to a given stage and to show the relations between known biological markers and psychosocial risk factors and the stage of the illness.

[Activity of selected cytokines in bipolar patients during manic and depressive episodes]. / Ocena aktywnosci wybranych cytokin w epizodzie maniakalnym i depresyjnym choroby afektywnej dwubiegunowej.

AIM: The aim of the study was to examine the activity of selected cytokines in bipolar patients during manic and depressive episodes and in remission. METHOD: The cytokine status was assessed in 76 bipolar patients, 35 with mania- and 41 with depression. For cytokine measurements blood samples were drawn from each patient twice-- while in an acute episode and in remission. 78 healthy individuals were examined once. Serum samples were tested for concentrations of: IL-6, IL-10, IL-1beta, TNF-alpha, IFN-gamma using the cytometric method. The patients' mental status was assessed with Young Mania Rating Scale and Hamilton Depression Rating Scale. RESULTS: Concentration of IL-6 was higher during the manic state as compared to control group. Additionally, IL-6 level was higher in mania than in remission. Concentration of IL-10 was higher in patients in remission after manic episodes than in healthy controls. In manic patients raising of IFN-gamma level was accompanied by more severe symptoms evaluated with YMRS. In remission after mania there was a correlation between IL-6 concentration and the intensity of the manic state. IFN-gamma level was higher in depressed patients comparing to remission, as well as manic patients and subjects from control group. IFN-gamma in remission after depression was still higher than in the healthy controls. Concentration of IL-1beta was higher in depressed patients comparing to healthy subjects. CONCLUSION: The results obtained in this study show disturbances of the immune system in bipolar patients. These disturbances have features of either decrease or pathological increase of the immune response. Cytokines' profiles were different for mania and depression. Clinical improvement seems to be connected with immunomodulation process that results in changes of cytokine levels in bipolar patients in remission.

Selected cytokine profiles during remission in bipolar patients.

OBJECTIVES: The aim of the study was to examine the cytokine status in bipolar patients during immediate remission after acute episodes of mania or depression and in patients with sustained (≥6 months) remission, compared with healthy controls. METHODS: The study was performed on 121 bipolar patients, of whom 35 were in immediate remission after mania, 41 were in immediate remission after depression, and 45 were in >6-month remission on lithium monotherapy or lithium combined with other drugs. The control group consisted of 78 healthy individuals without any history of psychiatric or immunological illnesses. Serum concentrations of IL-1ß, IL-2, IL-6, IL-10, TNF-α and IFN-γ were determined using the Human Th1/Th2 Cytometric Bead Array method. RESULTS: The concentration of IL-10 was higher in patients in remission after mania and the concentration of IFN-γ was higher in those in remission after depression than in healthy controls. On the other hand, cytokine concentrations in patients with sustained remission were not different from those of healthy subjects. CONCLUSIONS: The results obtained in this study show that sustained remission in bipolar patients achieved mostly by lithium maintenance brings the cytokine status to a level similar to healthy control subjects.

[The role of oxytocin and vasopressin in central nervous system activity and mental disorders]. / Rola oksytocyny i wazopresyny w czynnosci osrodkowego ukladu nerwowego i w zaburzeniach psychicznych.

Oxytocin and vasopressin, "peptides of love and fear", except for their classic role in control of labor and breastfeeding and blood pressure regulation, are also implicated in various processes like sexual behaviours, social recognition and stress response. These hormones seems to be essential for appropriate and beneficial social interactions, play a very important role in maternal care and closeness, promote general trust and cooperation and prolong social memory. They also play a very important role in modulating fear and anxiety response, especially by regulating the hypothalamic-pituitary-adrenal axis and amygdala activity by its projections to the brain stem and hypothalamic structures. Both hormones, particularly oxytocin, appears to be activating sexual behaviour or is responsible for increased sexual arousal. Evidence from clinical trials suggests their potential role in pathogenesis of schizophrenia, depression, autism and addiction together with possible therapeutic use in the above conditions. In schizophrenia, patients with higher peripheral oxytocin levels showed less severe positive, general and social symptoms and better prosocial behaviours. Literature suggests that exogenous oxytocin may be effective as an adjunctive therapy for that illness. Some data suggest that naturally occurring autoantibodies reacting with oxytocin and vasopressin are involved in depression, eating disorders and conduct disorder genesis.