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1.
Neuropsychiatr Dis Treat ; 15: 2901-2905, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31632038

RESUMO

Clozapine is an atypical antipsychotic used in treatment-resistant bipolar disorder. There is evidence for its anti-suicidal, anti-aggressive properties and efficacy in substance use comorbidities. Despite guidelines, the drug is used in 1.5% of bipolar patients only. Considering its effectiveness in treatment-resistant cases as well as its epigenetic effects it may become transformative treatment in bipolar disorder impacting the clinical course and psychosocial burden of the disease.

2.
Psychiatr Danub ; 31(Suppl 3): 252-257, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488736

RESUMO

Major depression is one of the most frequent psychiatric conditions. Despite many available treatment methods, more than 30% of patients do not achieve remission, even after trying several antidepressants and augmentation strategies. S-enantiomer of ketamine, well-known anesthetic and analgesic, has been recently approved by Food and Drug Administration in the intranasal form as a new generation antidepressant. However, the mechanism in which ketamine reduces depressive symptoms in treatment-resistant depression patients is still not completely understood. There are several theories explaining how ketamine might reduce depressive symptoms, which have been described in detail; one of them is immunomodulatory effect of ketamine, according to the inflammatory theory of depression. In the review authors present and summarize studies showing ketamine effect on human immune system ex vivo and in vitro, including changes in cytokine levels, number, ratio and activity of various immune cell population and the correlation with clinical improvement in depressive symptoms. Most of the results confirm the anti-inflammatory effect of ketamine. There are only a few studies in the population of patients suffering from depression receiving ketamine, focused on correlation between immunological changes and clinical outcome of the therapy; further studies of that area are neccesary for understanding the immunomodulatory effect of ketamine in depression.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/imunologia , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/imunologia , Ketamina/imunologia , Ketamina/uso terapêutico , Antidepressivos/imunologia , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/imunologia , Humanos , Imunomodulação/imunologia
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): 517-519, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488783

RESUMO

BACKGROUND: In the literature we can find evidence that sex hormones are involved the alterations of cognition in schizophrenic patients. Another factor, which may have an impact on cognitive domains in this clinical group inflammatory processes. The objective of this review was to explore studies, in which the role of both immunological factors and sex hormones on cognitive functions in schizophrenia are analyzed. METHODS: The search of papers covering this topic in PubMed and Google Scholar was performed. RESULTS: Endocrine factors like: testosteron, estrogen, as well as immunomodulatory are observed to play a role in cognitive functioning in schizophrenia. CONCLUSIONS: More studies are necessary to confirm these possible co-relations.


Assuntos
Transtornos Cognitivos , Cognição , Hormônios Esteroides Gonadais , Inflamação , Esquizofrenia , Psicologia do Esquizofrênico , Transtornos Cognitivos/complicações , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/patologia , Hormônios Esteroides Gonadais/metabolismo , Humanos , Inflamação/metabolismo , Esquizofrenia/complicações , Esquizofrenia/metabolismo , Esquizofrenia/patologia
5.
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
6.
Psychiatr Danub ; 31(Suppl 3): 549-553, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488789

RESUMO

Depression affects over 121 million people annually worldwide. Relatively low remission rates among depressive patients enforce the search for new therapeutic solutions and an urgent need to develop faster-acting antidepressants with a different mechanism of action occurs. The pathomechanism of depression postulated by the monoamine hypothesis is limited. The results of abnormalities in glutamate and γ-aminobutyric acid (GABA) systems in the brains of people with mood disorders allowed to develop new theories regarding pathophysiology of these disorders. Glutamatergic transmission is influenced by magnesium and ketamine through glutamatergic N-methyl-D-aspartate receptor (NMDAR) antagonistic effects. Magnesium and ketamine have a common mechanism of action in the treatment of depression: an increase in GluN2B (NMDAR subunit) expression is related to the administration of both of the agents, as well as inhibition of phosphorylation of eEF2 (eukaryotic elongation factor 2) in cell culture and increase of the expression of BDNF in the hippocampus. Combination of ketamine and magnesium in a normal magnesium level presents a superadditive effect in depression treatment. Analysed substances affect the GABAergic system and have anti-inflammatory effects, which is correlated with their antidepressant effect. The synergistic interaction between the pharmacodynamic activity of magnesium and ketamine may be of particular importance for patients with mood disorders. Further research is needed to determine the relationship between magnesium levels and ketamine treatment response mainly in the attempt to establish if the magnesium supplementation can change ketamine treatment response time or present superadditive effect.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Ketamina/uso terapêutico , Magnésio/uso terapêutico , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Humanos , Fator 2 de Elongação de Peptídeos/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo
7.
Psychiatr Danub ; 31(Suppl 3): 554-560, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488790

RESUMO

Bipolar depression (BD) is among the most severe psychiatric disorders. A significant number of patients do not achieve an entirely symptom-free state and experience residual sub-syndromal depression. Most of the treatment options approved for bipolar depression give no rapid symptom improvement. Ketamine is an anaesthetic medication that acts as an antagonist of the NMDA receptor and has antidepressant potential. Due to its unique way of action, ketamine seems to be crucial for the treatment of anhedonia. This review paper aims to provide an overview of the efficacy of ketamine infusions in bipolar depression with a focus on anhedonia Literature suggests that intravenous ketamine 0.5 mg/kg over 40 min weekly could be useful in the treatment of bipolar depression with prominent anhedonia, but there is still a small number of studies that examine the efficacy of ketamine infusions in BD. In conclusion, ketamine should be considered as a valuable treatment option for patients with BD and anhedonia.


Assuntos
Anedonia/efeitos dos fármacos , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Depressão/complicações , Depressão/tratamento farmacológico , Ketamina/farmacologia , Ketamina/uso terapêutico , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtorno Bipolar/complicações , Humanos
8.
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
9.
Neuropsychiatr Dis Treat ; 15: 1951-1956, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31371968

RESUMO

Background: Post-myocardial depression is a highly prevalent condition worsening the course and prognosis of coronary artery disease. One of the possible pathogenetic factors is dysregulation of the autonomous nervous system, resulting in heart rate variability reduction. Methods: Twenty two patients hospitalised due to a first myocardial infarction were included. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Results: Depressive symptomatology, defined as BDI ≥10, was present in 36.3% of the patients. Increase in heart rate variability (HRV) was observed in both groups during the first 6 months after the myocardial infarction. The HRV was significantly lower in the depressed group compared to patients without depression. Conclusion: Presence of depression after the myocardial infarction (MI) is associated with a significant decrease of the time domain HRV measure SDNN (standard deviation of all normal RR intervals) and with its slower increase during at least a three months period.

10.
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.

11.
Cardiol J ; 26(5): 550-554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29064538

RESUMO

BACKGROUND: Post-myocardial depression is a highly prevalent condition which worsens the course and prognosis of coronary artery disease. One possible pathogenetic factor is dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in cortisol profile disturbances. METHODS: Thirty seven patients hospitalized due to a first myocardial infarction (MI) were enrolled in this study. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Morning and afternoon serum cortisol samples were taken on the fifth day of the MI. RESULTS: Depression, defined as BDI ≥ 10, was present in 34.4% of the patients. A statistically significant difference was observed between the mean morning and the evening plasma concentrations in patients with depression compared to the no-depression group: F (1.29) = 5.0405, p = 0.0328. CONCLUSIONS: Patients with depressive symptoms directly after MI have a flattened diurnal serum cortisol profile. This is particularly expressed in patients with longer lasting symptoms.

12.
Psychiatr Pol ; 52(3): 421-435, 2018 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-30218559

RESUMO

Venous thromboembolism (VTE) is a frequent dangerous complication occurring during hospital treatment with total annual incidence of 70-200 per 100,000 citizens. Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary embolism is responsible for about 10% of hospitalization-related deaths and is the most common avoidable reason for deaths in hospitals. Psychiatric inpatients are particularly vulnerable to an increased risk of VTE due to their limited mobility, the use of restraints, catatonia, communication difficulties, and the use of antipsychotics. Patients with chronic psychiatric conditions like schizophrenia and recurrent affective disorders have significantly higher somatic comorbidity. This population of patients requires specific approach to VTE prophylaxis during hospitalization. This article offers an insight into issues related to thromboembolism, and presents validated diagnostic tools and VTE prophylaxis strategies. The paper includes the review of available research on VTE in patients hospitalized for psychiatric reasons. Considering the scarcity of specific studies in this population we highlight the necessity to follow the available general medical guidelines for psychiatric inpatients.


Assuntos
Hospitalização , Pacientes Internados/estatística & dados numéricos , Transtornos Mentais/complicações , Tromboembolia Venosa/prevenção & controle , Humanos , Embolia Pulmonar/prevenção & controle , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/etiologia , Trombose Venosa/prevenção & controle
15.
Psychiatr Pol ; 49(4): 683-96, 2015.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-26488345

RESUMO

OBJECTIVES: The aim of the study was to identify possible interrelation between the presence of post-stroke depression (PSD) and chosen clinical and demographic parameters. METHODS: Initially 116 patients (61.4 ± 12.6 years, women N = 42) hospitalized in Neurology Department, Medical University of Gdansk (April 2003 - December 2005) due to first ischemic stroke, were included in the study. We analysed demographic data, the lesion's side and location according to neuroimaging and global neurological deficit estimated on the first day after the stroke and at discharge using NIHSS (National Institutes of Health Stroke Scale) and Barthel Index of Activity of Daily Living. Psychiatric evaluation was done:6 (42 ± 3 days) and 12 weeks (84 ± 7 days), as well as 6 (±14 days) and 12 months (±14 days) after stroke based on ICD-10 and functional assessment scale (Rankin Scale). RESULTS: Depression was diagnosed in 29 patients (27.6%). No correlation was found between PSD and sex or age. On the first day and at discharge patients without PSD were functioning slightly better but the difference was not statistically significant. We found association between the presence of PSD and the results of Rankin scale with the exception of degree of improvement during whole observation. In the group of patients with PSD left hemisphere strokes were slightly more common, but the difference did not reach statistical significance. The location of lesions in frontal lobes and basal ganglia was associated with presence of depression. CONCLUSIONS: We found the association between the presence of PSD and location of lesions (frontal lobes or basal ganglia), as well as with the degree of functional improvement during 12 months after stroke.


Assuntos
Depressão/diagnóstico , Depressão/etiologia , Lobo Frontal/patologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Depressão/patologia , Depressão/psicologia , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/etiologia , Polônia , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/psicologia
16.
Psychiatr Pol ; 49(3): 455-64, 2015.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-26276914

RESUMO

OBJECTIVES: The aim of this study was to investigate plasma concentrations of four pro-inflammatory cytokines (IL17a, IL6, TNFα and IL12p70) in patients with myocardial infarction and to analyse them according to presence of depression observed during first 6 months after myocardial infarction. METHODS: In 44 patients with the first acute STEMI (ST segment elevation myocardial infarction) plasma levels of IL17a, IL6, TNFα and IL12p70 were measured on the 3rd and 5th day after the MI. Cytokine concentrations were analyzed according to the presence of depression during 6 months of observation. RESULTS: Two groups of patients distinguished according to presence of depression during 6 months of observation differed in their inflammatory reaction to MI. In the depression group all four cytokines on the 3rd day after the MI were elevated compared to control and on the 5th day two of them: IL17a and IL6 were still elevated. In the group without depression on the 3rd day only two of four investigated cytokines were elevated and on the 5th day only IL6 concentration remained higher. CONCLUSIONS: It can be assumed that more pronounced inflammatory response as an element of stress reaction after MI can predispose to depression. IL17a increase can play particularly important role in this process.


Assuntos
Citocinas/sangue , Depressão/sangue , Depressão/etiologia , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Biomarcadores/sangue , Depressão/diagnóstico , Feminino , Humanos , Interleucina-12/sangue , Interleucina-17/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/sangue
17.
Psychiatr Pol ; 47(4): 599-607, 2013.
Artigo em Polonês | MEDLINE | ID: mdl-24946467

RESUMO

Formations described as intracranial calcifications can appear in the course of diseases of the central nervous system, other systems and organs (e.g. endocrine), but also as a disorder of idiopathic character. They are frequently located in subcortical nuclei and usually constitute an incidental finding. This report presents the case of a patient suffering from paranoid schizophrenia for approximately 40 years, who did not agree to any treatment and was hospitalized against her will because she was the threat to the lives of others. She was treated with zuklopentixol resulting in positive symptoms reduction and considerable improvement in social functioning. Unfortunately neurological symptoms appeared: bradykinesis, rigidity--of the type of the lead pipe, balance, posture and gait abnormalities, disturbances in precise hands movements, double-sided Rossolimo's sign, plantar reflex without the participation of the big toe on the left. Neuroimaging studies have demonstrated changes in the form of lenticular nuclei calcification and reduction of signal intensity in posterior parts of both putamens. Neurological symptoms decreased significantly after switching to atypical neuroleptic (olanzapine), and the patient did not require any additional treatment. Mineralization of the basal ganglia can often be associated with psychiatric disorders and it shouldn't be neglected because it can require modification of pharmacotherapy or additional neurological treatment.


Assuntos
Antipsicóticos/uso terapêutico , Doenças dos Gânglios da Base/complicações , Doenças dos Gânglios da Base/diagnóstico , Calcinose/complicações , Calcinose/diagnóstico , Esquizofrenia Paranoide/complicações , Esquizofrenia Paranoide/tratamento farmacológico , Idoso , Benzodiazepinas/uso terapêutico , Clopentixol/uso terapêutico , Diagnóstico Tardio , Feminino , Humanos , Olanzapina , Recidiva , Esquizofrenia Paranoide/diagnóstico , Resultado do Tratamento , Recusa do Paciente ao Tratamento
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