Neuropsychological exponents for the driving ability in remitted bipolar patients.

BACKGROUND: Bipolar disorder (BD) is associated with cognitive deficits regardless of the phase of the disease. Medications used in treatment are an additional factor that may affect cognitive performance. Poor cognitive performance can significantly affect a patient's ability to drive. AIM OF THE STUDY: This study aims to explore cognitive functions relevant for safe driving in the group of remitted bipolar patients. METHOD: Patients with BD in remission (n = 33) and healthy volunteers (n = 32) were included. Selected psychometric tests for drivers were carried out using computer software: called Specialistic Diagnostic Platform (SPD): The Cross-over Test (COT) version with free tempo (COT-F) and tempo of 50 tasks per minute (COT-50) and the Signal Test (ST). Moreover, the following neuropsychological tests were used: Rey Auditory Verbal Learning Test (RAVLT), Stroop Color-Word Test (SCWT) part A and B, and Trail Making Test (TMT) version A and B. RESULTS: In comparison with healthy controls bipolar patients in remission had poorer outcomes for some cognitive parameters and longer reaction times in both tests for drivers and neuropsychological tests. Additionally, we found a significant correlation between the time of performance of neuropsychological tests and the time of psychometric tests for drivers. CONCLUSION: Patients with BD performed worse in several cognitive domains assessed by tests for drivers and neuropsychological tasks. These deficits can affect the speed of the patient's motor reactions while driving.

The influence of Nordic walking on the general functioning and cognitive performance of patients with Alzheimer's disease.

Purpose: Most studies show that physical activity (PA) can inhibit the progression of Alzheimer's disease (AD). This research aimed to investigate the effect of 3-month moderate PA on the general functioning and cognitive abilities of AD patients. Methods: The study included 32 patients with mild or moderate AD who scored 11-23 points in Mini-Mental State Examination (MMSE). Half of the participants were qualified to perform the exercises; the other half constituted the control group. The recommended form of activity was Nordic walking, 30 minutes, 3 days a week, for 3 months, under the supervision of the patient's carer. General functioning and the severity of cognitive deficits were assessed using the Activities of Daily Living (ADL) scale and the Montreal Cognitive Assessment scale (MoCA) before and after the 3-month study. Results: No improvement was observed in the overall functioning of the patients after 3 months of regular, moderate PA. Neither were there any differences in this respect between the active and inactive groups, both in patients with mild (MMSE 19-23) and moderate (MMSE 11-18) disease severity. Men showed a deterioration in overall functioning regardless of PA. No differences in cognitive functioning were observed between the active and inactive groups, the two genders or between mild (MMSE 19-23) and moderate (MMSE 11-18) subjects. Conclusions: The 3-month, moderate, Nordic walking PA did not improve the overall general functioning or cognitive performance in patients with mild or moderate AD.

The pattern of pharmacological treatment of bipolar patients discharged from psychiatric units in Poland.

BACKGROUND: The concomitant use of two or more mood stabilisers (MS), second-generation antipsychotics (SGA), lamotrigine as well as antidepressants, is frequently reported in the treatment of bipolar patients The aim of this study was to investigate the pattern of pharmacological treatment with special regard to polypharmacy defined as two or more psychiatric drugs taken at the same time in the same patients with bipolar disorder discharged from psychiatric units in Poland. METHOD: Pharmacotherapy of 127 consecutive patients (57 females and 70 males) with an ICD-10 diagnosis of bipolar disorder (BP) at the point of discharge from five psychiatric regional hospitals/units in Poland, was evaluated in 2015/2016 on the basis of medical files. The effect of treatment on mental status at discharge was examined using the Clinical Global Impression-Improvement scale (CGI-I). RESULTS: When only MS, SGA and lamotrigine, were taken into account, 78 (61%) of patients were prescribed two, 27 (21.3%) three and one patient four medications. The combination of MS and SGA was most commonly used (n=61, 48%). Medications preferred by Polish psychiatrists at patients' discharge were valproates (n=69, 54%), olanzapine (n=48, 37%), quetiapine (n=47, 37%) and lamotrigine (n=33, 25.9%). Thirty patients (23.6%) were prescribed lithium. No relationships were found between polypharmacy and patients' age, duration of illness and the rate of CGI-I. However, polypharmacy was significantly associated with types of bipolar disorder, particularly with the bipolar I disorder. CONCLUSION: The prevalence of polypharmacy especially with MS and SGA in the treatment of bipolar patients discharged from psychiatric units in Poland is high. The most significant factor predisposing to polypharmacy is a diagnosis of bipolar - I disorder. In general, our study confirms trends observed in other countries.

Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study.

INTRODUCTION: This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms. METHODS: Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale. RESULTS: At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61). LIMITATIONS: The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results. CONCLUSIONS: (1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients' mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.

Is Venlafaxine More Effective than Escitalopram and Nortriptyline in the Management of Painful Symptoms in Patients with Major Depression?

BACKGROUND: Conflicting data regarding the efficacy of antidepressants of different mechanism of action on unexplained painful physical symptoms (UPPS) in depression have been published so far. OBJECTIVE: The aim of this study was to compare the impact of escitalopram (ESC), nortriptyline (NOR), and venlafaxine (VEN) on UPPS in patients with major depression. MATERIALS AND METHODS: Sixty patients, participants in the GENDEP study, with a diagnosis of depression according to the ICD-10 criteria were randomly assigned to treatment with ESC (10-30 mg, mean dose 15.2, standard deviation [SD]±9.2) or NOR (50-150 mg, mean dose 106.2, SD±8.2). Additionally, 30 patients who were treated with VEN (75-225 mg, mean dose 181.3, SD±8.8) were included. Before inclusion (day 0) and throughout the study (days 14, 28, 42, 56), the severity of pain was monitored using the visual analog scale. RESULTS: The patients treated with ESC, NOR, and VEN did not differ in the intensity of pain at days 0, 14, 28, 42, and 56. CONCLUSION: Our results do not support the hypothesis suggesting the superiority of VEN over ESC and NOR in the management of UPPS in major depression.

Clinical recovery and health-related quality of life in ischaemic stroke survivors receiving thrombolytic treatment: a 1-year follow-up study.

The aims of this study were to examine prospectively the course of neurological and functional recovery and health related quality of life (HRQoL) in ischaemic stroke patients after intravenous thrombolysis, to assess the 1-year outcome and to determine the early predictors. A group of 53 consecutive patients were assessed at admission to the acute stroke unit (T0), before their discharge (T1), and at 3 (T2) and 12 (T3) months after hospital discharge. The National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI) and the Stroke Specific Quality of Life Scale (SSQoL) were used to evaluate stroke severity, functional disability and health related quality of life (HRQoL). A good outcome was defined as simultaneous improvement in all three scales. At T0, 83 % of the patients had severe or moderate neurological impairment. Additionally, 77 % demonstrated very severe or severe disability when assessed by the BI. 74 and 79 % of the patients reported an acceptable HRQoL at 3 and 12 months following discharge, respectively. Neurological and functional status improved significantly over time with most changes occurring during hospitalization and the subsequent 3 months. At T3, 75.5 % of the patients had the good outcome which had been independently predicted by the level of stroke related disability at T0. A majority of the stroke survivors treated with thrombolysis achieved a good outcome. The measurement of stroke specific HRQoL, as a tool for gathering information from the patient, should be incorporated in the assessment of post-stroke recovery and outcome.

The Biological Rhythms Interview of Assessment in Neuropsychiatry in patients with bipolar disorder: correlation with affective temperaments and schizotypy

Objective: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. Methods: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. Results: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. Conclusion: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

The Biological Rhythms Interview of Assessment in Neuropsychiatry in patients with bipolar disorder: correlation with affective temperaments and schizotypy.

OBJECTIVE:: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. METHODS:: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. RESULTS:: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. CONCLUSION:: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management.

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

A Study of Biological Rhythm Disturbances in Polish Remitted Bipolar Patients using the BRIAN, CSM, and SWPAQ Scales.

BACKGROUND/AIMS: The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) is a novel tool allowing for a complex assessment of biological rhythms. We compared patients with bipolar disorder (BD) and healthy control subjects (HC) using the Polish version of the BRIAN scale. METHOD: Fifty-four remitted BD patients (17 males and 37 females aged 52 ± 13 years) and 54 healthy control subjects (25 males and 29 females aged 42 ± 14 years) were studied. In addition to the BRIAN scale, the Composite Scale of Morningness (CSM) and the Sleep-Wake Pattern Assessment Questionnaire (SWPAQ) were employed. RESULTS: The Polish version of the BRIAN scale displayed high feasibility and consistency, showing that the patients had greater biological rhythm disturbances than the controls. After regression analysis, significant differences were obtained for the BRIAN subscales activity and predominant chronotype, and for the SWPAQ items quality of night-time sleep and ability to stay awake. We obtained positive correlations between higher BRIAN scores and morningness and eveningness, but the correlations with vigilance and the ability to stay awake (on the SWPAQ) were negative. CONCLUSIONS: Using the BRIAN scale, we confirmed the greater disturbances of biological rhythm in Polish remitted bipolar patients, compared with healthy controls. The differences between these 2 groups in sleep-awake patterns were also demonstrated by the SWPAQ scores. In contrast to other studies, we were unable to confirm an evening chronotype as a discriminating factor between remitted bipolar patients and healthy subjects. This can be explained by the older age and the use of lithium by a significant proportion of the patients.

Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke.

OBJECTIVES: To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden. METHODS: Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors. RESULTS: Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers' sense of coherence and amount of time spent caregiving at Time 1, and with caregivers' anxiety at Time 2. CONCLUSIONS: A significant proportion of the caregivers experienced considerable burden in the post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers. PRACTICE IMPLICATIONS: Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving.

Comparison of the effects of escitalopram and nortriptyline on painful symptoms in patients with major depression.

OBJECTIVE: Unexplained painful physical symptoms are commonly reported by depressed patients. The evidence suggests that dual-action antidepressants are potent in relieving pain in depression. However, a direct comparison of the effects of selective serotonergic and selective noradrenergic antidepressants on painful symptoms has not been investigated so far. METHOD: Sixty patients who participated in the Genome-based Therapeutic Drugs for Depression study with a diagnosis of moderate or severe episodes of depression according to the International Classification of Diseases, 10th Revision, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were involved. All the participants were randomly allocated to receive nortriptyline or escitalopram. The severity of depression was measured using the Montgomery-Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale and the Beck Depression Inventory at weeks 0, 2, 4, 6 and 8. The intensity of pain was measured on the Visual Analog Scale at the same points of the study. RESULTS: At "week 0," 83.3% of the patients later randomized to treatment with escitalopram and 86.7% of those treated with nortriptyline reported at least one painful symptom. A significant decrease of pain intensity was observed after 2 weeks of treatment. The two groups did not differ in degree of pain reduction at weeks 2, 4, 6 and 8 in comparison to baseline values. A 50% reduction in pain intensity preceded the 50% reduction of depression severity. The intensity of pain at "week 0" did not differ in remitted or nonremitted patients at week 8. CONCLUSION: Both selective serotonergic and selective noradrenergic antidepressants are equally effective in alleviations of painful physical symptoms of depression. The presence of painful symptoms before the onset of treatment did not determine the final response.

[Social functioning and quality of life in schizophrenia patients --relationship with symptomatic remission and duration of illness]. / Funkcjonowanie spoleczne i jakosc zycia u chorych na schizofrenie--zaleznosc z remisja objawowa i czasem trwania choroby.

AIM: The assessment of social functioning and subjective quality of life in relation to symptomatic remission in schizophrenia patients after a first psychiatric hospitalization, as well as the analysis of connection between intensity of psychopathological symptoms and the level of functioning and quality of life, taking into account the status of remission and duration of illness. METHODS: Sixty-four patients were assessed, at 13 months (1st examination) and at mean 8 years (2nd examination) after the first hospitalization, and compared with two control groups of healthy persons. The following scales were used: Positive and Negative Syndrome Scale (PANSS), Social Functioning Scale (SFS), WHO Quality of Life (WHOQoL--Bref) scale and Global Assessment Scale (GAS). RESULTS: At first examination, the score of SFS domains was not significantly different between patients in remission and without remission while the score of most domains of WHOQoL was significantly higher in patients with remission. At second examination, the scores of both SFS and WHOQoL were significantly higher in patients with remission and did not differ significantly from healthy persons. In both examinations, significant correlations between PANSS and SFS and WHOQoL scores were found, especially in patients without remission. CONCLUSIONS: At mean 8 years after first psychiatric hospitalization, 2/3 of the patients with schizophrenia did not get a symptomatic remission and had worse social functioning and quality of life compared to patients with remission and to healthy controls. Psychopathological symptoms correlated significantly with social functioning and quality of life, especially among patients without remission.

The prevalence of antipsychotic polypharmacy in schizophrenic patients discharged from psychiatric units in Poland.

BACKGROUND: The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. METHODS: Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. RESULTS: At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. CONCLUSIONS: The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.

[Polish version of Comprehensive Assessment of At Risk Mental States (CAARMS)--the description of the method]. / Polska wersja Kompleksowej Oceny Zagrazajacych Stanów Psychicznych (CAARMS)--opis metody.

The first psychotic episode is usually preceded by the decline in functioning as well as the occurrence of symptoms, which due to low intensity or short duration do not fulfil the criteria allowing for the recognition of delusions or hallucinations. Early intervention at this stage may prevent the development of psychosis or its onset. It is thus necessary to implement clearly established criteria, which will allow for the identification of patients with a high risk for developing psychosis. One of the diagnostic tools used to identify this stage is the Comprehensive Assessment of at Risk Mental States (CAARMS) developed by Alison Young et al. in the PACE Clinic in Melbourne. This is a method which seems to be a useful tool in everyday medical practice.

Creative thinking deficits in patients with schizophrenia: neurocognitive correlates.

The aim of this study was to investigate selected measures of creativity in schizophrenic patients and their relationship with neurocognitive executive functions Forty-three inpatients with paranoid schizophrenia who were in symptomatic remission (a total of 60) and 45 healthy control participants were included. Creativity was assessed using the Barron-Welsh Art Scale (BWAS) and the inventiveness part of the Berlin Intelligence Structure Test (BIS). Executive functions were measured by means of the Wisconsin Card Sorting Test (WCST). Schizophrenic patients gave responses on the BWAS, had lower total score on the BIS and in the figural test, and performed worse on all domains of the WCST compared with control subjects. Their lower scores on the BIS correlated with lower scores on the WCST. Our results indicate that remitted schizophrenic patients perform worse on selected measures of creativity than healthy subjects and that executive dysfunctions may partially explain these deficits.

[Facial emotion perception in schizophrenia: relationships with cognitive and social functioning]. / Rozpoznawanie emocji twarzy w schizofrenii: zwiazek z funkcjonowaniem poznawczym i spolecznym.

UNLABELLED: Evidence suggests that facial emotion recognition is disturbed in schizophrenic patients however its nature has not been elucidated. Affect recognition is an important aspect of psychosocial functioning. AIM: In this study we assessed recognition of facial emotional expression in schizophrenic patients and its relationship with selected clinical and neuropsychological variables as well as with social functioning. METHOD: We used Penn Emotional Facial Recognition (ER40) task, Wisconsin Card Sorting Test WCST, Social Functioning Scale. Twenty-three patients who met the DSM-IV criteria for schizophrenia -paranoid type, hospitalised at the Department of Adult Psychiatry University of Medical Sciences in Poznan, Poland were involved in the study. The control group of healthy volunteers matched for gender and age was included. RESULTS: Schizophrenic patients performed worse on emotion recognition test than the control group. The relationship between results of ER-40 and WCST and severity of negative symptoms was found. CONCLUSION: Cognitive dysfunctions and disturbances of facial emotion recognition are closely linked in patients with schizophrenia, however casual relationships and relation to symptomatology remains unclear and further studies are necessary.

[The anatomy of depression in light of evidence from neuroimaging studies]. / Anatomia depresji w swietle wyników badan neuroobrazowych.

The introduction of structural and functional neuroimaging methods has significantly improved our knowledge ofneurobiological basis of psychiatric disorders. The aim of this review is to present the results of studies using magnetic resonance imagining and positron emission tomography in affective disorders. The most consistently reported structural abnormalities in major depressive disorder include a reduced volume of the prefrontal lobe, (orbitofrontal, dorsolateral and anterior cingulate cortex) hippopocampus and amygdala. In bipolar disorder, smaller prefrontal lobes, subgenual prefrontal cortex as well as enlarged amygdala and striatum volume were found. Several mechanisms explaining the structural abnormalities including the neurotoxic effect of hipercortisolemia, and disturbances ofneurogenesis have been postulated. Results of studies using functional imaging showed a common pattern of decreased activation in the dorsolateral prefrontal cortex (part of the dorsal system) and increased regional cerebral blood flow and metabolism in the subgenual cingulate, amygdala, anterior insula and ventral striatum (parts of ventral system) during the depressive episode. In bipolar depression, a reduced metabolism in the dorsolateral prefrontal cortex and increased metabolism in amygdala and thalamus were reported. Successful therapy normalized these abnormalities. According to the proposed models, structural and functional abnormalities in the ventral and dorsal systems, responsible for emotion regulation, are associated with symptoms of depression.

[Psychopathology and creativity]. / Psychopatologia a kreatywnosc.

In this paper, a concept has been presented stating that the process of creativity may be connected with psychopathological features such as mood disorders, mainly bipolar, and psychosis-like thought abnormalities. Biographic studies point to a more frequent occurrence of affective disorders in creative subjects and members of their families. There is also data concerning the occurrence of schizophrenia in the families of prominent persons. A number of studies have demonstrated a similarity of patients with bipolar affective illness and members of their families to creative persons, as to increased indexes of creativity as well as such temperamental features as cyclothymia, neuroticism and openness. An association has been also found between the dimension of"psychoticism", schizotypal features and the measures of creativity. A reduction of the so called "latent inhibition" mechanism, resulting in perception of seemingly irrelevant external stimuli is connected with a predisposition to both increased creativity and schizophrenia-like disturbances. A neurobiological model of generating ideas and creative drive assumes a dominant role of three brain structures: frontal lobes, temporal lobes and the mesolimbic system. The neurotransmission system mostly connected with elevated mood and psychotic thinking is the dopaminergic system, especially its mesolimbic and cortical pathways. Both neurobiological and pharmacological evidence has been accumulated for an association of these pathways with motivational, emotional and cognitive processes, and indirectly, with the processes of creativity. In recent years, a number of interesting results has also been obtained from molecular-genetic studies about genetic determinants of creativity processes in association with bipolar mood changes and psychotic conditions.