The Impact of the CYP2D6 and CYP1A2 Gene Polymorphisms on Response to Duloxetine in Patients with Major Depression.

Depression is a global mental health concern, and personalized treatment approaches are needed to optimize its management. This study aimed to investigate the influence of the CYP2D6 and CYP1A2 gene polymorphisms on the efficacy of duloxetine in reducing depressive and anxiety symptoms. A sample of 100 outpatients with major depression, who initiated monotherapy with duloxetine, were followed up. Polymorphisms in the CYP2D6 and CYP1A2 genes were assessed. The severity of depressive and anxiety symptoms was recorded using standardized scales. Adverse drug reactions (ADRs) were analyzed. Statistical analyses, including linear regression, were conducted to examine the relationships between genetic polymorphisms, clinical variables, and treatment outcomes. Patients with higher values of the duloxetine metabolic index (DMI) for CYP2D6, indicating a faster metabolism, achieved a greater reduction in anxiety symptoms. The occurrence of ADRs was associated with a lower reduction in anxiety symptoms. However, no significant associations were found between studied gene polymorphisms and reduction in depressive symptoms. No significant effects of the DMI for CYP1A2 were found. Patients with a slower metabolism may experience less benefit from duloxetine therapy in terms of anxiety symptom reduction. Personalizing treatment based on the CYP2D6 and CYP1A2 gene polymorphisms can enhance the effectiveness of antidepressant therapy and improve patient outcomes.

Baseline depressive symptoms as predictors of efficacy and tolerability of the treatment with duloxetine: a network analysis approach.

Introduction: Depression is considered one of the most prevalent and burdensome mental disorders. Only 50-60% of patients respond to first-line treatment. Individuals with depression might benefit from personalized treatment, tailored to the individual needs of the patient. In this study, we aimed to explore the baseline characteristics of depressive symptoms associated with a good response to duloxetine treatment using a network analysis. Additionally, the relationship between baseline psychopathological symptoms and treatment tolerability was assessed. Methods: The sample of 88 drug-free patients with active depressive episode, who started monotherapy with increasing doses of duloxetine were evaluated. The Hamilton Depression Rating Scale (HAM-D) was used to assess depression severity and the UKU side effect rating scale to monitor adverse drug reactions (ADRs). A network analysis that explored interactions of specific baseline depression symptoms, treatment efficacy and tolerability was performed. Results: The node representing duloxetine treatment efficacy was directly connected to the nodes representing the first HAM-D item ("depressed mood") (edge weight = 0.191) and duloxetine dose (edge weight = 0.144). The node representing ADRs was directly connected to only one node representing the baseline score of the HAM-D anxiety (psychic) item (edge weight = 0.263). Discussion: Our findings indicate that individuals with depression presenting greater levels of depressed mood and lower levels of anxiety symptoms might better respond to the treatment with duloxetine in terms of efficacy and tolerability.

Immune-inflammatory markers and psychosis risk: A systematic review and meta-analysis.

Subclinical inflammation has been associated with psychosis; however, it remains unknown whether this phenomenon appears also in the premorbid phase. Therefore, we performed a systematic review and meta-analysis of studies comparing peripheral blood levels of C-reactive protein (CRP) and cytokines between individuals at risk of psychosis and controls. Moreover, we tested the hypothesis that the levels of these markers may be different in high-risk converters versus non-converters. Two independent reviewers searched electronic databases until Dec 16th, 2020. After reviewing publication records, 16 studies (548 high-risk individuals and 559 controls) were included. Random-effects meta-analyses with Hedges' g as the effect size estimate were performed. Individuals at clinical risk of psychosis had significantly higher levels of interleukin-6 (IL-6) compared to controls (g = 0.33, 95%CI: 0.06-0.60, p = 0.018). Heterogeneity was not significant in this subgroup analysis. Changes in the levels of IL-6 in subjects at familial risk of psychosis were not significant (g = 0.04, 95%CI: -0.24 to 0.31, p = 0.798). The use of antidepressants was associated with significantly higher levels of IL-6 in high-risk individuals (Beta = 1.56, 95%CI: 0.60-2.53, p = 0.001). No significant differences in the levels of immune-inflammatory markers were found between high-risk converters and non-converters. Our findings suggest that individuals at clinical risk of psychosis show subclinical inflammation in terms of elevated IL-6 levels. This phenomenon might be related to the use of antidepressants. The present meta-analysis does not support the usefulness of single immune-inflammatory markers in predicting transition to psychosis.

Amisulpride - is it as all other medicines or is it different? An update. / Amisulpryd ­ lek taki sam jak wszystkie czy inny? Aktualizacja.

Amisulpride is an antipsychotic available in Europe since 1990s, in Poland since 2000. Subsequent years brought to Polish market more second-generation compounds such as ziprasidone and aripiprazole. In 2018, the Agency for Health Technology Assessment and Tariff System issued positive recommendation for lurasidone in schizophrenia (Recommendation 30/2018) facilitating its entry to the market. Thanks to new molecules, therapeutic possibilities of medicines consequently rise, however, higher number of available substances of different properties brings also more dilemmas which one to pick. Since new publications of comparative drug trials, meta-analyses and systematic reviews are issued regularly, the authors present herein publications issued within last ten years focusing on amisulpride as opposed to other neuroleptics used in Poland. Although in many aspects it is equivalent to other atypical antipsychotics, it still has some advantages. Amisulpride seems to have better outcome than classic and atypical neuroleptics when it comes to depressive symptoms and predominant negative symptoms. It might also be superior to haloperidol in inducing symptomatic remission in first episode schizophrenia. Except for prolactin increase its side effects profile is favorable - it rarely leads to extrapyramidal symptoms (which are dose-dependent) and sedation. Therefore many patients accept treatment with amisulpride for its measurable clinical gains, such as improvement of positive symptoms and higher quality of life, compared to typical neuroleptics. Pharmacokinetics of amisulpride also encourage its wider use, especially when there is either a need for combined psychopharmacotherapy or comorbidity with general medical condition rises a need for somatic parallel treatment.

Biological and psychological components of depression in patients receiving IFN-alpha therapy for hepatitis C.

BACKGROUND: Depressive symptoms are frequent side effects of interferon α therapy (IFN-α). Both biological and psychological processes may occur concomitantly during hepatitis C treatment. OBJECTIVES: This study was carried out to determine the impact of biological (immune response) and psychological factors on formation of depressive symptoms and major depressive disorder (MDD) during hepatitis C treatment. MATERIAL AND METHODS: A total of 99 patients receiving pegylated IFN-α and ribavirin for chronic C type hepatitis participated in the prospective cohort study. Symptoms of depression were assessed with the MontgomeryÅsberg Depression Rating Scale (MADRS) during treatment and 24 weeks after treatment. Neuroticism was measured with the Eysenck Personality Questionnaire - Revised (EPQ-R/N). Diagnosis of MDD was made using the Present State Examination (PSE-10) and DSM-IV-TR criteria. Factor analysis was used to detect factors adding up to total severity of depressive symptoms. Predictors of MDD were investigated using logistic regression analysis. RESULTS: Factor analysis returned 3 factors: 1st - MADRS scores at weeks 0-12, 2nd - MADRS and N scores before treatment, 3rd - MADRS at the 24th week of treatment and 24 weeks after treatment. The total severity of depressive symptoms consisted of 3 components: personality-related before treatment, IFN-α-related during treatment and dependent on the effect of treatment. Regression analysis showed that a history of psychiatric disorders (OR = 4.8) and MADRS scores before treatment (OR = 1.25) were predictors of MDD, as opposed to level of neuroticism. CONCLUSIONS: The severity of depressive symptoms and MDD during the hepatitis C treatment was related to general depressive vulnerability, not to psychological factors related to neuroticism.

Trichotillomania Among Young Adults: Prevalence and Comorbidity.

Trichotillomania is an impulse control disorder characterized by repetitive pulling out of one's hair. The aim of this study was to estimate the prevalence of trichotillomania in young adults and its association with anxiety and obsessive-compulsive disorders (OCD). A total of 339 individuals completed a questionnaire to determine the presence of trichotillomania. OCD and anxiety disorders were diagnosed according to the diagnostic criteria of the International Classification of Diseases 10th Revision (ICD-10), based on the Composite International Diagnostic Interview. Twelve persons (3.5%) reported hair pulling during their lifetime, but only 8 of them met the criteria of trichotillomania according to the ICD-10. Four individuals had stopped their behaviour prior to the study participation. The lifetime anxiety disorders were diagnosed in 5 participants with trichotillomania (62.5%), while in the group without trichotillomania, 67 persons (20.2%) met the diagnostic criteria for anxiety disorders (p < 0.01). OCD were not diagnosed in individuals with trichotillomania, among participants without trichotillomania, 14 persons (4.2%) reported symptoms of OCD.

Caregivers' appraisals of patients' involuntary hospital treatment: European multicentre study.

BACKGROUND: Mental health policies emphasise that caregivers' views of involuntary psychiatric treatment should be taken into account. However, there is little evidence on how caregivers view such treatment. AIMS: To explore caregivers' satisfaction with the involuntary hospital treatment of patients and what factors are associated with caregivers' appraisals of treatment. METHOD: A multicentre prospective study was carried out in eight European countries. Involuntarily admitted patients and their caregivers rated their appraisal of treatment using the Client Assessment of Treatment Scale 1 month after admission. RESULTS: A total of 336 patients and their caregivers participated. Caregivers' appraisals of treatment were positive (mean of 8.5 on a scale from 0 to 10) and moderately correlated with patients' views. More positive caregivers' views were associated with greater patients' symptom improvement. CONCLUSIONS: Caregivers' appraisals of involuntary in-patient treatment are rather favourable. Their correlation with patients' symptom improvement may underline their relevance in clinical practice.

Mental disorder in Polish families: is diagnosis a predictor of caregiver's burden?

OBJECTIVE: To test whether a caregiver's burden is associated with the patient's psychiatric diagnosis and to find other predictors of family burden; to provide Polish data on the issue to international literature. METHOD: Of 377 eligible subjects, 141 were interviewed on admission to the mental hospital using Brief Psychiatric Rating Scale, Manchester Short Assessment of Quality of Life, Groningen Social Disability Schedule and Client's Sociodemographic and Clinical History Inventory. Their caregivers completed the Involvement Evaluation Questionnaire (IEQ). Subjects were grouped according to ICD-10 diagnoses: schizophrenia (n = 55), depression (n = 61), and anxiety and personality disorders (n = 25). Highly aggressive, suicidal and somatically unstable patients were excluded along with patients below 18 and over 65 years. Statistics included multiple regression analysis, ANOVA, Kruskal-Wallis and chi-square tests. RESULTS: Diagnostic groups differed with respect to sociodemographics, psychopathology and quality of life, but not with respect to mean level of social functioning. Despite between-group differences, the caregiver's burden did not differ according to the diagnostic group. Of the four dimensions of burden, "worrying" and "urging" scored the highest. Majority of caregivers worried about their relative's general health (82%), future (74%) and financial status (66%). Caregivers' characteristics and not patients' explained the largest proportion of the family burden variance (almost 23% for IEQ Tension). Higher burden seemed to be associated with the carer's age, being a parent and number of hours spent weekly on caring for the ill relative. Lower burden was associated with the carers' subjective feelings of being able to cope with problems and to pursue their own activities. Longer history of patient's illness led to higher IEQ Tension. Polish caregivers were affected by their role in the same way as their counterparts abroad, but more of them were worried. CONCLUSIONS: The caregiver's burden seems to be independent of the patient's diagnosis, but other factors contribute to the perceived burden, many of which are on the caregiver's part. In Poland, the overall family burden may be attributed mostly to worrying about a mentally ill relative and his future. All caregivers may benefit from psychoeducation and family interventions usually planned for those caring for relatives with schizophrenia.

[Involvement Evaluation Questionnaire--description and application]. / Kwestionariusz Oceny Zaangazowania (Involvement Evaluation Questionnaire)--charakterystyka i zastosowanie.

Long-term mental illnesses such as schizophrenia or affective disorders often impose a burden on the patients who suffer from it, as well as on their carers (relatives or friends). There are many instruments measuring family or caregiver burden. One of these instruments is the Involvement Evaluation Questionnaire (IEQ). The IEQ is a 31-item questionnaire which is completed by the caregiver. The IEQ contains 27 items that can be divided into four subscales (domains): tension (nine items), worrying (six items), supervision (six items) and urging (eight items). Two items appear in more than one domain. The items are scored on a 5-point Likert scale (never, sometimes, regularly, often and always). There is no full Polish adaptation of IEQ so far. The psychometric properties of the IEQ and its culture-profiled versions are satisfying and comparable. The IEQ, as a self-assessment instrument, is easy to administer and not time-consuming. The IEQ proved to be a reliable instrument for measuring caregiver consequences in mental healthcare.

[Comparison between the day-care ward and the inpatient ward in terms of treatment effectiveness based on the analysis of psychopathologic symptoms, subjective quality of life and number of rehospitalisations after discharge]. / Efektywnosc leczenia na psychiatrycznym oddziale dziennym, w porównaniu z oddzialem stacjonarnym, na podstawie analizy objawów psychopatologicznych, subiektywnej oceny jakosci zycia oraz czestosci rehospitalizacji po zakonczeniu leczenia.

AIM: To assess effectiveness of treatment in the day-care and inpatient wards within the Wroclaw branch of the international multicenter EU-funded EDEN study. The authors analysed the number of rehospitalisations after discharge from the index hospitalisation as well as psychopathologic symptoms and subjective quality of life. METHODS: Out of 1089 patients admitted to the mental hospital in Wroclaw, 238 were randomly assigned to either the day-care ward (n = 115) or the inpatient ward (n = 123). There were three interviews with patients: upon discharge, three and twelve months later. Scores of the extended version of Ventura's BPRS were used for representing the psychopathology level and for calculation of between-setting differences. Subjective quality of life was measured using the MANSA questionnaire. Statistical parameters of effectiveness (scores at given time-point, models adjusted for the scores at admission and for the duration of hospitalisation) were analysed. The frequency of rehospitalisations was also investigated. Statistical analyses after discharge were performed using the random multiple imputations method in consecutive time-points. RESULTS: There were no statistical differences between settings in the effectiveness of treatment three months after discharge. Interviews performed one year after discharged revealed a higher level of psychopathology in patients treated in an inpatient setting (p = 0.03) and it was confirmed by the model adjusted for the duration of hospitalisation (p = 0.04). Yet day-care ward patients had a higher number of rehospitalisations within one year after discharge. CONCLUSIONS: The absolute superiority of treatment in an inpatient ward over day-care setting in terms of its effectiveness was not confirmed using BPRS, MANSA scores and index of rehospitalisation.

[Is there a correlation between duration of hospitalization and SCAN diagnosis?]. / Czy istnieje zwiazek pomiedzy czasem hospitalizacji psychiatrycznej a diagnoza uzyskana za pomoca SCAN?

AIM: The authors have made an effort to find the answer to the question what are the reasons for long hospitalizations in stationary wards and in the day hospital of the Wroclaw Mental Health Care Centre? In order to achieve this goal the correlation of the SCAN questionnaire diagnoses and length of stay in the aforementioned settings was analyzed. METHODS: Analysis included 220 patients treated in the Wroclaw Mental Health Care Centre of which 111 patients were placed in day hospital and 109 in stationary wards. The correlation of length of stay in day hospital and in stationary wards with number of SCAN diagnoses in ICD-10 diagnostic groups was investigated. RESULTS: Duration of hospitalization was relatively long for both day hospital patients (150 days) and stationary ward patients (58 days). Contrary to expectations there was no correlation between the number of SCAN diagnoses and length of stay in the hospital. Patients who were diagnosed using SCAN as having affective disorders and anxiety disorder stayed in the hospital shorter despite the fact they had more comorbid disorders than patients diagnosed using SCAN as having psychotic disorders both in day hospital and in stationary wards. CONCLUSIONS: Examination using the SCAN questionnaire cannot be used as prognosis of the length of stay either in day hospital or in stationary wards. Duration of hospitalization depends mainly on the diagnostic category (anxiety and affective disorders are associated with shorter hospital stays than psychotic disorders) irrespective of the number of diagnoses a patient received. It also depends on local therapeutic traditions and preferences (dominance of long-term care and the rehabilitation model of treatment instead of active acute intervention aiming at quick discharge from the hospital).

[Patients' opinions on psychiatric hospital treatment]. / Leczenie szpitalne w opinii pacjentów z ostrymi zaburzeniami psychicznymi.

AIM: Qualitative analysis of acute psychiatric patients' subjective opinions on the conditions and effects of their hospital treatment. Presentation of patients' expectations in this respect and the follow up of the opinion changes taking place during hospital stay. METHOD: Patients' opinions were obtained in open questions which were part of the Clients' Scale for Assessment of Treatment (CAT) performed twice during the study: one week after admission and at discharge. Answers were analyzed using a qualitative approach and odds ratio. RESULTS: An overwhelming part of the respondents pointed to the positive aspects of psychiatric hospitalization (92% of those interviewed) and less than a half (42%) pointed to its negative aspects. The most important sources of positive cognitions about hospital stay were: a relationship with the ward staff, the forms of treatment introduced, relationship with other patients, overall atmosphere and sense of security and empathy. Almost 3/4 of the interviewed patients were convinced about a favourable outcome of treatment and care. Amongst elements of treatment that were helpful to the patients, pharmacotherapy was named most frequently. Patients' activity understood as occupational therapy and interpersonal contacts was an important component of the stay in the hospital and treatment. Most patients felt that no changes in the ward routine were necessary. CONCLUSION: It is important to take into consideration the patients' opinions and expectations towards therapy, ward conditions and work organization while planning mental health care. The presented results are a part of a complex investigation and might inspire to expanded research in this field.

[SCAN system--semi-structured interview based on diagnostic criteria]. / System SCAN--czesciowo strukturalizowany wywiad oparty na kryteriach diagnostycznych.

This paper presents the main features of contemporary diagnostic systems which are implemented into the SCAN--modern and semi-structured diagnostic interview. The concepts of further development of the classifications, rationale for operationalized diagnostic criteria and for the divisional approach to mental diagnoses will be in focus. The structure and components of SCAN ver. 2.1 (WHO), i.e. Present State Examination--10th edition, Item Group Checklist, Clinical History Schedule, Glossary of Definitions and computer software with the diagnostic algorithm: I-Shell, as well as rules for a reliable use of diagnostic rating scales, will be discussed within the scope of this paper. The materials and training sets necessary for the learning of proper use of the SCAN, especially training sets for SCAN Training Centers and the Reference Manual--a form of guidebook for SCAN shall be introduced. Finally the paper will present evidence that SCAN is an instrument feasible in different cultural settings. Reliability and validity data of SCAN will also be dealt with indicating that SCAN could be widely used in research studies as well as in everyday clinical practice facilitating more detailed diagnostic approach to a patient.

[Study of compatibility of psychiatric diagnoses with ICD-10 diagnostic criteria using the SCAN questionnaire]. / Badanie zgodnosci rozpoznan psychiatrycznych z kryteriami diagnostycznymi klasyfikacji ICD-10 za pomoca kwestionariusza SCAN.

AIM: Authors aimed at testing whether psychiatrists in their diagnostic process obeyed strict ICD-10 diagnostic criteria. Diagnoses made by psychiatrists at discharge were compared with those of SCAN ver.2.1 on admission. METHODS: Diagnoses obtained by SCAN I-Shell program were compared with clinical diagnoses obtained by psychiatrists in the psychiatric wards according to ICD-10 criteria on 3 levels: diagnostic group (Fc), diagnostic class (Fcc), and diagnostic category (Fcc.c). Validity assessment was obtained with Cohen's Kappa coefficient, sensitivity, specificity and Yule's Y coefficient. RESULTS: On the diagnostic group level, Cohen's kappa was 0.14-0.65, Yule's Y 0.57-0.71. Sensitivity 0.69-0.95 and specificity 0.41-0.94. In psychotic disorders group F2 kappa was 0.65, Yule's Y 0.71, sensitivity 0.69, specificity 0.94. In affective disorders group F3 kappa was 0.31, Yule's Y 0.57, sensitivity 0.95, specificity 0.41. In neurotic disorders group F4 kappa was low 0.14, Yule's Y 0.62, sensitivity 0.95, specificity 0.50. CONCLUSIONS: The study showed a higher level of agreement between SCAN and clinical diagnoses in the group of psychotic disorders with exception of schizoaffective disorders, and lower agreement rates in the group of affective and neurotic disorders where the number of SCAN diagnoses outweighed that of the clinical ones. It could be the result of systematic faults in the coding of diagnoses.

Bipolar or unipolar? - the question for clinicians and researchers.

BACKGROUND: Correct diagnosis and criteria of affective disorders is always a subject of interest to researchers and practitioners. METHODS: The study aimed at assessing frequency of various traits and symptoms of bipolar affective disorders (BP-I, BP-II, BP-S spectrum) in patients (n=246) treated for recurrent affective disorders (unipolar-UP). The analysis was based on criteria of affective disorders of Ghaemi et al. and Hirschfeld's Mood Disorders Questionnaire. RESULTS: UP was confirmed in 32.9% of individuals, whereas 19.5% were BP-I, 35% BP-II and 12.6% BP-S. UP patients were significantly more often professionally active than those with BP (37.2% vs. 22.7%). Duration of a disorder was significantly shorter and the number of depressive episodes lower in the UP group. In comparison with UP, BP-I were associated with the previous occurrence of unusual and/or risky behaviour (OR=24.5), excessive, irrational expenditure (OR=21.1), lack of a critical attitude with respect to social behaviour (OR=20.3), increased sex drive (OR=17.7), and excessive self-confidence (OR=12). BP-II were associated with a lack of criticism with regard to social behaviour (OR=12.7) and unusual and/or risky behaviour (OR=10). Spectrum BP were most strongly associated with short term hypomanic episodes, including drug induced episodes (OR=15.8) and lack of criticism (OR=11.8). Early onset of depression (before 25 years of age) increased the risk of all three types of BP (by a factor of 3 to 5). LIMITATIONS: This was a naturalistic study, in which treatment was uncontrolled. CONCLUSIONS: Results of the study are a voice in the discussion on too narrow criteria defining bipolar affective disorders.

[Bipolarity among unipolar affective disorder patients--uniDEP-BI national multi-site study]. / Wystepowanie cech dwubiegunowosci u osób z zaburzeniem depresyjnym nawracajacym--ogólnopolskie, wieloosrodkowe badanie uniDEP-BI.

UNLABELLED: The main objective of the study was to evaluate the occurrence of bipolarity among outpatients with a recurrent major depressive disorder. METHOD: The uniDEP-BI study was conducted throughout Poland by 96 psychiatrists from 16 sites, who were trained in the study instruments. The sample was selected from the population of outpatients with at least one depressive episode (n = 880). The final study group included 246 working age adults (75.2% of females) treated for recurrent unipolar disorder. The study questionnaire consisted in the DSM-IV criteria of major depressive episode, (hypo)manic episode, criteria for bipolar spectrum disorder by Ghaemi et al. RESULTS: Unipolar mood disorder was confirmed in 32.9% cases, bipolar I disorder was found in 19.5%, bipolar II in 35% and bipolar spectrum disorder in 12.6% of the assessed patients. Patients with bipolar compared to the unipolar mood disorder had significantly more frequently a family history of bipolar disorder, short (hypo)manic episodes after antidepressive treatment, premorbid cyclo-, hyperthymic or impulsive (borderline type) personality, recurrent depressive episodes, atypical depressive symptoms, early onset of depression (< 25 yrs), distracted attention and panic attacks. Subjects with confirmed recurrent depressive disorder were significantly more often working (37.2% vs. 22.7%). Duration of the illness was significantly shorter and the number of previous depressive episodes was significantly lower in this group. CONCLUSIONS: The findings showed that the bipolarity features are more common among patients with unipolar mood disorders. It also points to a need of proper and deeper diagnostics of affective disorders and verification of rules and period of antidepressive and normothymic treatment.

[Does contemporary pharmacotherapy limit coercion in psychiatry? Preliminary results]. / Czy wspólczesna farmakoterapia ogranicza stosowanie przymusu w psychiatrii? Wyniki badania pilotazowego.

AIM: The goal of the present study was to examine whether contemporary psychopharmacotherapy (atypic neuroleptics) can have an impact on the patient's compliance and limit coercion (involuntary admission to hospital, coercive measures). METHOD: 71 adult inpatients with diagnoses of the schizophrenia spectrum (F20 group according to ICD-10) admitted to psychiatric hospital were observed. 41 of them were treated with atypic neuroleptics before hospitalization and 30 with typical ones. Data about their pharmacotherapy before hospitalization, compliance, history of disease and coercion used during hospitalization were gathered and analysed by means of chi square Pearson's and Mann-Whitney's tests. RESULTS: There were no significant differences in non-compliance, the type of admission to hospital and frequency of coercion measures used during hospitalization between groups of patients receiving atypic and typical antipsychotics. However, the group with atypic neurolepitics was nearly significantly more adherent to therapy than the typical ones. CONCLUSIONS: Results of the study did not confirm the impact of atypic neuroleptics on compliance and coercion connected with admission to hospital. A long-term study with an increased number of patients is needed to confirm the results of this study.

[Effectiveness of treatment in day hospital versus inpatient ward evaluated by patients' psychopathological symptoms and subjective quality of life (QoL) analysis]. / Porównanie efektywnosci leczenia na psychiatrycznym oddziale dziennym i oddziale stacjonarnym na podstawie analizy objawów psychopatologicznych oraz subiektywnej oceny jakosci zycia pacjentów.

AIM: The authors analyzed patients' psychopathological symptoms and subjective quality of life (QoL) for evaluating the effectiveness of treatment in day hospital versus inpatient wards. Analyses concerned patients from Wroclaw and recruited within the framework of an EU funded multi-centre study EDEN. METHOD: 238 patients admitted to the Psychiatric Hospital in Wroclaw were randomly assigned to treatment in either day hospital (n=l15) or inpatient ward (n=123). Patients were interviewed at 4 time-points comprising their stay in hospital. Differences between settings in terms of dynamics of psychopathological symptoms and subjective QoL were expressed in mean scores of BPRS subscales and MANSA. Two parameters of effectiveness were considered: the static--the score on the scale at a given time-point and average score level, and the dynamic--describing dynamics of changes (gradients). Statistical methods included ANOVA and ANCOVA with co-variables. RESULTS: In terms of manic and excitement symptoms inpatient wards proved to be more effective as measured at discharge, no differences in dynamics between settings were found. Day hospital was superior in alleviating negative symptoms during treatment but improvement in that respect was quicker in the inpatient ward. In terms of alleviating positive symptoms, the inpatient ward was more effective only at the beginning of the treatment. Day hospital was more effective in handling symptoms of depression and anxiety but only at the beginning of treatment. Dynamics of subsiding of the symptoms at the beginning of hospitalization was better for the inpatient ward. No differences in QoL in both settings were found. CONCLUSIONS: Taking into consideration the static and the dynamic parameters of effectiveness of treatment, the superiority of inpatient treatment over day hospital has not been, therefore, definitely proven.

[Course of the EDEN study by using participants' flow sheets]. / Przebieg badania EDEN wedlug schematu opisu badan z doborem losowym.

UNLABELLED: The development of science allows us to take up new investigative challenges. Interpretations of results can be difficult if there is no adequate and complete information about investigative methods applied, course of trial and statistical analyses. The CONSORT group proposed a standardized diagram facilitating an accurate presentation of the randomised trial. The EDEN study is an example of the application of this method, where the studied groups, number of participants, and all procedures can be presented. It is helpful to prepare reports and find necessary data. The first part of the diagram describes the course of recruitment, the second part presents data necessary to estimate the course of the study and data about numbers of patients in each timepoint whilst the third part shows the assessment of caregivers. CONCLUSIONS: The analysis of the course and correctness of the study is legible if the flow diagram is used. It is useful to find the necessary data for statistical analyses at every stage of study. Permanent control of the study allow to avoid bias upsetting the course of the study and influencing its quality. It introduces comprehensible and straight forward presentation of the results.

Depression and anxiety in coronary artery bypass grafting patients.

PURPOSE: Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients. SUBJECT AND METHODS: After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory. RESULTS: Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed. CONCLUSIONS: High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.