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3.
Psychiatr Danub ; 31(Suppl 3): 258-260, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488737

RESUMO

Suicidal ideations or attempts in patients with major depressive disorder (MDD) are emergent conditions that require immediate treatment. Numerous therapeutic interventions to reduce suicide risk in psychiatric disorders are effective in long-term suicide prevention, but there is necessity of sufficient, rapid pharmacological treatment of suicidal risk in MDD. Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has been reported to have rapid antidepressant effect. Depressive symptoms, anxiety, hopelessness, suicidal ideation had decreased within hours after ketamine infusion. Ketamine's rapid symptoms relief and reduction of suicide thoughts has aroused growing interests in psychiatric association.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/uso terapêutico , Suicídio/prevenção & controle , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Humanos , Ideação Suicida , Suicídio/psicologia
4.
Psychiatr Danub ; 31(Suppl 3): 520-523, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488784

RESUMO

Major depressive disorder is one of the most important psychiatric issues worldwide, with important prevalence of treatment-resistant depression (TRD). Non-monoaminergic agents are currently in the spotlight. Objective was to explore for information about mechanisms of action of ketamine, its connections with copper and possible importance for TRD treatment. There are at least few possible pathways for ketamine action in depression in which copper and other divalent ions may show a vital role. There is urgent need for more studies to gather information about correlation between ketamine, copper and antidepressive features of these agents.


Assuntos
Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Cobre/metabolismo , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/metabolismo , Ketamina/farmacologia , Ketamina/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/metabolismo , Humanos
5.
Psychiatr Danub ; 31(Suppl 3): 530-533, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488786

RESUMO

Major depressive disorder (MDD) is a recurrent, incapacitating psychiatric illness which will be the second most disabling disease worldwide by the year 2020. There is a rising promise in a N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine, which may be used in the treatment of resistant depression. Many of the studies are in favor of the drug, even in single dose application, with effects appearing in minutes to hours from administration. However, there is a need to evaluate the benefits and risks regarding psychomimetic, psychiatric, neurologic, and cognitive adverse effects of ketamine administration. The most distressing symptoms which appear most frequently during ketamine administration are dissociative symptoms, which can be quantified as a CNS adverse drug reaction. Results generally show that a single infusion of ketamine is efficacious and well-tolerated, while dissociative symptoms tend to abate within 2 hours after ketamine administration. As studies show single doses of ketamine should be definitely considered as an option in TRD patients with/without suicidal thoughts, even though it could not provide remission, or the effect could be temporary, but improving patients' quality of life by reducing depressive symptomatology should be a major asset while considering this particular procedure, particularly in inpatients.


Assuntos
Sistema Nervoso Central/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Depressão/tratamento farmacológico , Humanos , Qualidade de Vida
6.
Psychiatr Danub ; 31(Suppl 3): 574-578, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488793

RESUMO

Bipolar disorder is associated with the highest risk of completed suicide of all mental disorders. The suicide mortality of people with bipolar disorder is approximately 25 times higher than the general population. No approved pharmacological strategies for suicidality in bipolar disorder have been introduced so far. There is evidence for anti-suicidal effect of clozapine in schizophrenia. Clozapine with its unique pharmacology, anti-aggressive and anti-impulsive properties is potentially an effective strategy for suicidality in bipolar disorder.


Assuntos
Transtorno Bipolar/psicologia , Clozapina/farmacologia , Clozapina/uso terapêutico , Suicídio/prevenção & controle , Suicídio/psicologia , Transtorno Bipolar/mortalidade , Transtorno Bipolar/terapia , Humanos
7.
Psychiatr Danub ; 31(Suppl 3): 585-590, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488795

RESUMO

Ketamine is an anaesthetic and analgesic agent that demonstrates the antidepressive effect in major depression. Several administrations routes, dosing schemas and esketamine are investigated in basic and clinical research with particular focus on treatment-resistant depression (TRD) where drug demonstrates its efficacy where very limited alternatives are available. The majority of ketamine studies in TRD treatment reported no serious adverse events regardless the administration route or regimen. However, the most commonly observed adverse events following ketamine administration in antidepressive doses include general, psychotomimetic, dissociative and hemodynamic ones. The side effects are mild or moderate, well-tolerated and transient. This paper discusses the risks regarding cardiovascular safety in MDD patients in short-term ketamine administration with particular focus on the effect on blood pressure and adverse drug reactions mitigation measures. The increase in systolic (SBP) and diastolic (DBP) blood pressure is dose-dependent and begins shortly after administration peaking at around 30 to 50 minutes with SBP and DBP rise from 10% to 50% above predose values and resolving at approximately 2 to 4 hours after the dose administration. These changes generally are primarily asymptomatic. The elevations in SBP and DBP are observed on each dosing day with multiple administration schema. The treatment with ketamine and esketamine is contradicted in subjects at risk of an increase in blood pressure or intracranial pressure. The current evidence indicates the blood pressure should be assessed prior to dosing with ketamine and hypertensive individuals shall receive effective lifestyle/pharmacologic management prior to treatment. Blood pressure should be monitored after dose administration until blood pressure returns to acceptable levels. If blood pressure remains elevated acute blood pressure management shall be delivered. In patients experiencing symptoms of hypertensive crisis immediate emergency care must be provided. The unmet need for improved pharmacotherapies for TRD means the use of ketamine and esketamine is warranted therapeutic option in patients who fail to achieve a sustained remission of depressive symptoms with drugs with monoamine-based mechanisms of action. Adequate safety measures must be applied when using ketamine/esketamine in TRD subjects with particular focus on somatic comorbidities as the transient drug effect on cardiovascular system is demonstrated and of clinical significance.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Sistema Cardiovascular/efeitos dos fármacos , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/administração & dosagem , Ketamina/uso terapêutico , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Depressão/tratamento farmacológico , Humanos , Ketamina/efeitos adversos
8.
Front Psychiatry ; 10: 520, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31379632

RESUMO

Bipolar disorder is associated with a high risk of suicide attempts and suicide deaths. The suicide mortality of people with bipolar disorder is approximately 25 times higher than the general population. No approved pharmacological strategies for suicidal thoughts and attempts in bipolar disorder have been introduced so far, and lithium remains as the first-line treatment for suicidal subjects. Clozapine is also a potentially good candidate for this indication. This case series represents three treatment-resistant bipolar patients with severe suicidal ideation who responded to low-dose clozapine treatment.

9.
Epilepsy Behav ; 95: 34-38, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31022662

RESUMO

OBJECTIVE: The interictal dysphoric disorder (IDD) is a proposed epilepsy-specific mood disorder characterized by a cluster of symptoms such as depressed mood, irritability, euphoria, and anxiety. Since its introduction, the concept of IDD has been a matter of debate. This study aimed to evaluate the frequency of the IDD and the association between psychiatric disorders and IDD. We also analyzed potential associations between IDD symptoms and epilepsy-related variables. METHODS: A consecutive group of 118 outpatients with epilepsy were screened. Ninety-six patients met inclusion criteria and examined by a trained psychiatrist using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition Text Revision (DSM-IV-TR) (SCID-I). In order to diagnose IDD, all participants completed the self-rating questionnaire consisting of a set of questions aimed to assess the eight key symptoms of IDD. On completion of the questionnaire, the psychiatrist reviewed all the data for completeness and accuracy with the patient. RESULTS: In our group with epilepsy, we observed IDD in 49.0% (47 of 96) of people with epilepsy (PWE) with substantial overlap (85%) of IDD with depressive and anxiety disorders. The frequency of depressive mood, anergia, and irritability was significantly higher in patients with IDD diagnosis. Older age at epilepsy onset was associated with IDD. STUDY LIMITATIONS: The cross-sectional study design, a consecutive sample of patients presenting to a tertiary referral center, a small sample size of the population, and applied methodology could have affected the results. CONCLUSIONS: The present study indicates that IDD occurs in high frequency in PWE with a substantial overlap of IDD with depressive and anxiety disorders. The study highlights the importance of the observer-based systematic approach for diagnosing IDD and the usage of operationalized diagnostic criteria for psychiatric comorbidities in PWE. Future research should be directed at validating whether IDD is nosologically independent of other psychiatric conditions.

10.
Epilepsy Behav ; 94: 9-13, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30884410

RESUMO

OBJECTIVE: Anxiety disorders (ADs) are frequent comorbid disorder in patients with epilepsy (PWE). The availability of validated screening instruments to detect AD in PWE is limited. The aim of the present study was to validate the Polish version of the Hamilton Anxiety Rating Scale (HARS) in adult PWE for the detection of AD. METHODS: A total of 96 outpatient PWE completed the self-report symptom scale, the HARS, and were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HARS. RESULTS: Receiver operating characteristic analyses showed areas under the curve at 81.2%. For diagnoses of AD, the HARS demonstrated the best psychometric properties for a cutoff score ≥17 with sensitivity of 68.8%, specificity of 87.5%, positive predictive value of 52.4%, and negative predictive value of 93.3%. CONCLUSIONS: The Polish version of the HARS performed moderately well as a screening instrument for ADs in PWE. In the epilepsy setting, the HARS maintains moderate sensitivity, high specificity, and excellent Negative perdictive value (NPV) but low Positive perdictive value (PPV) for diagnosing ADs with an optimum cutoff score ≥17. These results suggest that the HARS performed better to rule out anxiety, however, because of moderate sensitivity, some cases of anxiety might be missed.

11.
Epilepsy Behav ; 92: 221-225, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30690323

RESUMO

OBJECTIVE: Anxiety disorders are frequent comorbid disorder in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate State-Trait Anxiety Inventory (STAI) in adult PWEs for the detection of anxiety disorders. METHODS: A total of 96 outpatients with epilepsy completed the self-report symptom scale and were diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the State-Trait Anxiety Inventory State (STAI-S) and State-Trait Anxiety Inventory Trait (STAI-T) anxiety subscales. RESULTS: Receiver operating characteristic analyses for STAI-T showed area under the curve at 84.7%. For diagnoses of anxiety disorders, the STAI-T demonstrated the best psychometric properties for a cutoff score ≥ 52 with sensitivity of 81.3%, specificity of 77.5%, positive predictive value (PPV) of 41.9%, and negative predictive value (NPV) of 95.4%. CONCLUSIONS: The STAI-T proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in PWEs. In the epilepsy setting, STAI-T maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥ 52.

12.
Epileptic Disord ; 20(6): 562, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30530406

Assuntos
Neurossífilis , Humanos
15.
Med Hypotheses ; 118: 74-77, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30037619

RESUMO

Schizophrenia is a mental disorder that mostly appears in the second or third decade of life with no consistent appearance. The first-line pharmacological treatment are antipsychotic drugs, which mainly act by suppressing the activity of dopamine. Unfortunately many of schizophrenic patients suffer from persistent positive or negative symptoms that cannot be fully treated with available medication. With exploration on the possible causes of the disease there is evidence on dopaminergic transmission defects, there is a need to find more holistic way in treating the disease and a diet regimen could be one of them. Ketogenic diet, which is a popular diet regimen that consists in low-carbohydrate (about 30-50 g/day), medium-protein (up to 1 g/kg daily) and high-fat intake (around 80% of daily calories) mainly known for its helpful role in weight-loss. The key mechanism is to generate ketosis. A state in which ketones bodies in the blood provides energy part of the body's energy comes from ketone bodies in the blood. Possible hypothesis can be that ketogenic diet changes the ratio of GABA:glutamate in favor of GABA, by suppressing the catabolism and increasing the synthesis of GABA as well as glutamate metabolism, which could help to compensate the disrupted GABA levels in schizophrenic brain, leading to possible better outcome of the disease regarding symptomatology and preventing the weight-gain regarding some medications used and the correlating diseases responsible for weight gain.


Assuntos
Dieta Cetogênica , Gorduras na Dieta/administração & dosagem , Ingestão de Energia , Metabolismo Energético , Corpos Cetônicos/metabolismo , Esquizofrenia/dietoterapia , Antipsicóticos/uso terapêutico , Encéfalo/metabolismo , Dieta , Jejum , Ácido Glutâmico/metabolismo , Humanos , Cetose , Modelos Teóricos
16.
Epilepsy Behav ; 84: 162-165, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29803946

RESUMO

OBJECTIVE: Anxiety disorders are frequent comorbid disorders in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate the Polish version of the Hospital Anxiety and Depression Scale (HADS) in adult PWEs for the detection of anxiety disorders. METHODS: A total of 96 outpatients with epilepsy completed the self-reported symptom scale, the HADS, and were diagnosed using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HADS anxiety subscale (HADS-A). RESULTS: Receiver operating characteristic analyses showed areas under the curve at 80.8%. For diagnoses of anxiety disorder, the HADS-A demonstrated the best psychometric properties for a cutoff score ≥10 with sensitivity of 81.3%, specificity of 70.0%, PPV of 31.5%, and NPV of 94.9%. CONCLUSIONS: The HADS-A proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in our sample of PWEs. In the epilepsy setting, the HADS-A maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥10.


Assuntos
Transtornos de Ansiedade/diagnóstico , Epilepsia/complicações , Adolescente , Adulto , Transtornos de Ansiedade/complicações , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Escalas de Graduação Psiquiátrica , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
17.
Epilepsy Behav ; 79: 1-3, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29223931

RESUMO

OBJECTIVE: Anxiety disorders (ADs) are common in patients with epilepsy (PWE). The aim of this study was to estimate the prevalence of specific ADs in outpatients with epilepsy. METHODS: A group of 118 consecutive outpatients with epilepsy were screened, and 96 patients meeting inclusion criteria were examined by a trained psychiatrist using Structured Clinical Interview (SICD-I) for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision) (DSM-IV-TR). RESULTS: A diagnosis of any current AD was established in 16 (16.7%) out of 96 participants. Furthermore, panic disorder (PD) was the most frequent AD; it was observed in 13.5% of PWE and constituted 81.2% of the identified ADs in the study group. Older age and later age of seizure onset were associated with increased odds of AD diagnosis. STUDY LIMITATIONS: The cross-sectional study design, a consecutive sample of patients presenting to a tertiary referral center, and small sample size of the population could have affected the results. CONCLUSIONS: Panic disorder and other forms of AD are common among PWE. Age and age of seizure onset are important factors associated with AD among PWE.


Assuntos
Transtornos de Ansiedade/epidemiologia , Epilepsia/diagnóstico , Convulsões/epidemiologia , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Epilepsia/epidemiologia , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Transtorno de Pânico , Prevalência , Convulsões/diagnóstico , Convulsões/psicologia , Centros de Atenção Terciária , Adulto Jovem
18.
Epilepsy Behav ; 77: 58-61, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29111504

RESUMO

BACKGROUND: Despite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWE), such disorders often go unrecognized and untreated. In addition, the availability of validated screening instruments to detect depression in PWE is limited. The aim of the present study was thus to validate the Polish version of the Beck Depression Inventory (BDI) in adult PWE. METHODS: A group of 118 outpatient PWE were invited to participate in the study. Ninety-six patients meeting the inclusion criteria completed the Polish Version of Beck Depression Inventory-I (BDI-I) and were examined by a trained psychiatrist using the Structured Clinical Interview (SICD-I) for Diagnostic and statistical manual of mental disorders - fourth edition (Text revision) (DSM-IV-TR). Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for BDI. RESULTS: Receiver operating characteristic analysis showed the area under the curve to be approximately 84%. For major depressive disorder (MDD) diagnosis, the BDI demonstrated the best psychometric properties for a cut-off score to be 18, with a sensitivity of 90.5%, specificity of 70.7%, positive predictive value (PPV) of 46.3%, and negative predictive value (NPV) of 96.4%. For the 'any depressive disorder' group, the BDI optimum cut-off score was 11, with a sensitivity of 82.5%, specificity of 73.2%, PPV of 68.8%, and NPV of 85.4%. CONCLUSIONS: The BDI score is a valid psychometric indicator for depressive disorders in PWE maintaining adequate sensitivity and specificity, high NPV, and acceptable PPV with an optimum cut-off score of 18 for MDD diagnosis.


Assuntos
Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Epilepsia/complicações , Escalas de Graduação Psiquiátrica , Adulto , Depressão/complicações , Transtorno Depressivo Maior/complicações , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Psicometria , Sensibilidade e Especificidade , Adulto Jovem
19.
Psychiatr Danub ; 29(Suppl 3): 341-344, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953787

RESUMO

BACKGROUND: Neurosyphilis is an infection of the brain or spinal cord caused by Treponema pallidum. In the third phase of syphilis involving the central nervous system it may manifest in a widespread dysfunctions including psychiatric manifestations being often underestimated in the differential diagnosis. CASE REPORTS: Two patients demonstrating rapid cognitive decline as the primary symptom for neurosyphillis are described with particular focus on the diagnostic process complexity and adequate treatment delivery. CONCLUSIONS: Clinical manifestations as well as psychiatric symptoms of syphilis are diverse and often non-specific. The symptomatology of mood disorders in neurosyphilis is frequently atypical, intermittent, and pleomorphic and fails to meet DSM-5 diagnostic categories. Neurocognitive decline although could be one of the key symptoms domains in neurosyphilis. Those two cases emphasise the importance of specific differential diagnosis with rapid onset cognitive decline with spotlight to sexually transmitted diseases as syphilis.


Assuntos
Disfunção Cognitiva , Neurossífilis , Disfunção Cognitiva/etiologia , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Treponema pallidum
20.
Psychiatr Danub ; 29(Suppl 3): 357-360, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953791

RESUMO

BACKGROUND: There is evidence for neurosyphilis being associated with the central nervous system vasculitis involving medium and small vessels. As the hemispheric white matter is the major target of these vascular alterations the white matter axonal and myelination disruption may be observed employing measure for the rate of water molecule diffusion. High apparent diffusion coefficient (ADC) correspond to unimpeded water diffusion and indicating white matter disintegration. CASE REPORTS: In a retrospective study exploringcentral nervous system magnetic resonance (MR) images of two subjects presenting with neurosyphilis the ADC values were found to be increased as related to normal values being accompanied with normal appearing white matter of hemispheres. CONCLUSIONS: Applying ADC analysis to evaluate the brain in patients with neurosyphilis may reveal undetectable changes and explain the scale of abnormalities that occur in CNS. The increased mean ADC valuesin the normal appearing white matter of the hemispheres may correlate with neuropsychoatric symptomatology in syphilis.


Assuntos
Neurossífilis , Substância Branca , Imagem de Difusão por Ressonância Magnética , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico por imagem , Estudos Retrospectivos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
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