Advanced Biomarkers of Hepatotoxicity in Psychiatry: A Narrative Review and Recommendations for New Psychoactive Substances.

One of the factors that increase the effectiveness of the pharmacotherapy used in patients abusing various types of new psychoactive substances (NPSs) is the proper functioning of the liver. However, the articles published to date on NPS hepatotoxicity only address non-specific hepatic parameters. The aim of this manuscript was to review three advanced markers of hepatotoxicity in psychiatry, namely, osteopontin (OPN), high-mobility group box 1 protein (HMGB1) and glutathione dehydrogenase (GDH, GLDH), and, on this basis, to identify recommendations that should be included in future studies in patients abusing NPSs. This will make it possible to determine whether NPSs do indeed have a hepatotoxic effect or whether other factors, such as additional substances taken or hepatitis C virus (HCV) infection, are responsible. NPS abusers are at particular risk of HCV infection, and for this reason, it is all the more important to determine what factors actually show a hepatotoxic effect in them.

Matrix metalloproteinase-3 serum levels in schizophrenic patients.

OBJECTIVES: It has been reported that matrix metalloproteinase, MMP-3 may play a significant role in the pathophysiology of mental disorders. However, there are no data on the level of MMP-3 in people suffering from schizophrenia, or its influence on the mental state of these people. The aim of this study was to investigate the effect of an antipsychotic treatment on the blood levels of MMP-3, as well as investigating its relationship with insight into schizophrenia. METHODS: Thirty people with schizophrenia were included in the study. The concentration of MMP-3 in the blood serum was assessed using enzyme-linked immunosorbent assay. Insight into the disease was assessed using the Beck Cognitive Insight Scale. RESULTS: The antipsychotic treatment applied decreased the levels of MMP-3 in patients with schizophrenia (p = 0.005), however, the statistically significant interaction (p = 0.02) indicates that the decrease only concerned men. There was also a statistically significant correlation between the level of MMP-3 and insight into the disease (p = 0.02). CONCLUSION: MMP-3 may be associated with gender, treatment and symptoms in schizophrenic patients.KEY POINTSMMP3 could be used as a potential biomarker for schizophrenia.The level of MMP-3 decreased due to the applied antipsychotic treatment.The higher the level of MMP-3 in a group of people with schizophrenia, the better insight into their disease.

The Psychiatric Characteristics of People on a Mephedrone ("bath salts") Binge.

Background: Despite solutions presented by the European Union and national regulations introduced by many countries, the problem of mephedrone (4-MMC) is growing. Objectives: The aim of this study was to investigate the effect of regular mephedrone intake with other psychoactive substances on the clinical picture of patients, including self-harms and suicide attempts. Methods: The study involved a group of 601 patients addicted to mephedrone who were admitted to a psychiatric hospital between 2010 and 2018 due to regular mephedrone intake. Results: There was a statistically significant relationship between sleep disorders and mephedrone combined with alcohol (p < .05) or cannabinols (p < .05). However, the highest number of statistically significant correlations was reported when mephedrone was combined with opioids. There was a growing year-on-year percentage of people who attempted suicide because of regular mephedrone intake (p < .001). The more psychoactive substances were combined with mephedrone, the greater the risk of attempted suicide (p < .01). 20% of the examined group were hospitalized several times. Among those hospitalized several times, significantly more people took more than one additional psychoactive substance (p < .01). Conclusions: The more psychoactive substances combined with mephedrone, the more clinical symptoms are associated with it.

Optimisation of methadone treatment in a group of patients on a mephedrone binge and dependent on many psychoactive substances.

Objectives: In recent years, an increase in the frequency of hospitalisations of patients on a mephedrone binge has been observed. The literature lacks data on the optimisation of methadone treatment in this group of people.Methods: The study included 601 patients who took mephedrone on a regular basis between 2010 and 2018. Based on the pharmacological database created, it was verified which methadone interaction contributed to subsequent hospitalisations in the group of people studied and which of them had the best therapeutic effect.Results: During the study, 62.4% of patients received methadone (p < .001). The higher the number of drugs taken together with methadone, the higher the frequency of hospitalisations (p < .001). The highest frequency of re-hospitalisations was recorded in patients who combined mephedrone with at least two other psychoactive substances, as well as those who used methadone with chlorprothixene (p < .001). The most optimal therapeutic effect is characteristic for the intake of methadone with thiazolidine carboxylic acid, namely 95% of people using this type of treatment were hospitalised once (p < .001).Conclusions: Therapy with methadone and thiazolidine carboxylic acid seems to be the most optimal therapy for patients taking mephedrone.Key pointsThe number of hospitalisations of patients receiving mephedrone on a regular basis grows from year to year.The multiple use of poly-pharmacotherapy increased in a group of patients on a mephedrone binge.There is a statistically significant correlation between the number of hospitalisations of patients on a mephedrone binge and the total number of drugs taken together with methadone.Administration of methadone with thiazolidine carboxylic acid was the most effective therapy for patients regularly combining mephedrone with at least two other psychoactive substances.

Effectiveness of the methadone programme in the treatment of patients on a mephedrone binge and dependent on heroin: a retrospective study, 2010-19.

Objectives: The purpose of this research was to investigate the effectiveness of the methadone programme in a group of patients taking mephedrone with heroin.Methods: The research involved 230 people who took part in the methadone programme between 2010 and 2019: 101 people on a mephedrone binge and taking heroin and 129 people addicted to heroin.Results: Number of re-hospitalisations was higher in a group of patients on a mephedrone binge taking heroin in comparison to heroin dependent patients (91.9 vs 79.8%, p < 0.01). The interaction of the hepatitis C virus (HCV) infection with the dose of methadone taken explains 67.6% of the variance in the frequency of hospitalisation of the patients on a mephedrone binge (p < 0.001), and in the case of the dose of methadone alone - only 12% (p < 0.001). Regression analysis indicated that statistically significant majority of the subjects (p < 0.001) who received the optimal dose of methadone, namely 100-110 ml, were hospitalised once.Conclusions: The interaction of the methadone dose with HCV infection plays a very important role in the frequency of hospitalisation of patients taking mephedrone with heroin on a regular basis.KEY POINTSThe number of hospitalisations was higher in a group of patients on a mephedrone binge taking heroin in comparison to heroin dependent patientsThe interaction of the sex of the subjects and HCV infection with the dose of methadone taken explains 80.3 and 67.6% of variance in the frequency of hospitalisations, respectivelyThe most optimal dose of methadone in the group of people taking mephedrone with heroin ranges between 100 and 110 ml.

[Deinstitutionalization in Italian psychiatry - the course and consequences Part I. The course of deinstitutionalization - the activity of Basaglia's group]. / Deinstytucjonalizacja psychiatrii wloskiej - przebieg i skutki Czesc I. Przebieg deinstytucjonalizacji - dzialalnosc grupy Basaglii.

Psychiatric reform in Italy consisted of the implementation of legislative changes derived from anti-institutional experiments conducted by Franco Basaglia and his group in the 60's and 70's of the 20th century. The activity of Basaglia's group was an integral part of the European reform movement of that time, which profited from the economic, cultural and political prosperity for changes in psychiatry. Italian antipsychiatry has led to the most radical experiment in deinstitutionalization in history. It involved the whole public sector of psychiatry and across a quarter-century resulted in a grand social debate on the situation of the mentally ill and the need for systemic change of their treatment and care. Inspired mainly by phenomenological analysis, Basaglia opted for close emphatic contact with the mentally ill. While the British, French and American anti-psychiatrists contested the psychiatric care system as such, the Italian radicals made an approach to disassemble it from the inside and successfully gained social support for the process of deinstitutionalization. Basaglia promoted his ideas across Europe, including the World Health Organization (WHO) forum.

[Deinstitutionalization in Italian psychiatry - the course and consequences Part II. The consequences of deinstitutionalization]. / Deinstytucjonalizacja psychiatrii wloskiej - przebieg i skutki Czesc II. Skutki deinstytucjonalizacji.

The Italian mental health care is based on Law 180 (it. Legge 180), also called Legge Basaglia, from the name of the author of the reform, Franco Basaglia. It was adopted on May 13th 1978. The new legislation resulted from the actions of a strong anti-psychiatric movement and it brought about a major change in the organization of psychiatric care. The reform and its consequences were widely studied by the researchers, especially in the United Kingdom and the United States of America. The authors point out many successes of the reform, especially in its beginning. They seek the sources of its failure in a faulty and incomplete implementation. Legge Basaglia completely changed the structure of mental health care in Italy, finally bringing psychiatry back to medicine and the general hospitals, as well as promoting community-based psychiatry. Deinstitutionalization in Italy was not related to an increase in compulsory psychiatric hospitalizations, suicide attempts by the mentally ill, nor did it raise the number of crimes committed by them. It also did not cause common trans-institutionalization, with the transfer of patients to the private sector, as predicted by its opponents.

Magnetic Resonance Imaging and Manganism: A Narrative Review and Laboratory Recommendations.

In recent years, a series of articles has been published concerning magnetic resonance imaging (MRI) studies in a group of patients exposed to manganism, specifically factory workers, welders, and individuals with liver diseases, as well as those abusing home-produced ephedrone. Some potential symptoms of manganese toxicity include motor disturbances, neurocognitive problems, sleep disorders, and psychosocial changes. Despite various publications on MRI research in individuals with an elevated risk of manganism, there is a noticeable absence of a comprehensive review in this field. The detection of the accumulation of manganese in the brain through MRI can confirm the diagnosis and guide appropriate treatment. Due to the high cost of determining manganese ion levels in biological material, an additional aim of the manuscript was to identify simple medical laboratory parameters that, when performed concurrently with MRI, could assist in the diagnosis of manganism. Among these types of parameters are the levels of bilirubin, magnesium, liver enzymes, creatinine, hemoglobin, and hematocrit.

[The importance of hope in coping with schizophrenia]. / Rola nadziei w zmaganiach ze schizofrenia.

Hope is an important dimension of psychological functioning, the source of strength in existential challenges both in health and illness. It is already known that hope is connected with the subjective well-being in people suffering from schizophrenia. Therefore, increasing hope is a promising goal of therapeutic interventions. On the other hand, multiple definitions of hope and methodological differences in the approach to the subject do not lead to determining therapeutic indications, useful in clinical practice. Most scientific projects about hope in people with schizophrenia concentrate on description of mechanisms influencing the patients welfare or determining the relationships between hope intensification and other factors. The paper reviews the concepts of hope and related psychometric techniques and presents the results of research on hope in people with schizophrenia. The presented studies are focused mainly on relationships between hope and psychopathology, the recovery and well-being of the patients. Continuing the research in this topic and analysis of current data may contribute to beneficial changes in the treatment of schizophrenia

[Impulsivity in sexual offenders--new ideas or back to basics?]. / Impulsywnosc sprawców przestepstw seksualnych--nowe koncepcje czy powrót do zródel?

Despite the fact that the group of sexual offenders remains a population which is still difficult to study, the results of current research are considered novel and interesting. Surprisingly, the very old descriptions applying to paraphilia, which is considered to be one of the reasons of sexual offences, appear to be accurate, especially in the context of similarities between impulsivity and pathologic sexual behaviors. Notably, the nomenclature concerning impulsivity enables a specific and reasonable description of behaviors associated with sexual offences. Moreover, the results of research studies show that it is the lack of inhibition, not pathologic arousal, which is the most important factor in the pathogenesis of forbidden sexual behaviors. In addition, it has been shown that behavioral manifestations of impulsivity (substance abuse, suicide attempts) appear commonly in sexual offenders. Mutual relationships between alcohol drinking, suicide attempts, history of child sexual abuse and sexual offences, both in symptomatologic and etiologic aspect, raise a suggestion that all these phenomena may share a common background of poor inhibitory control.

Pulmonary embolism masked by symptoms of mental disorders.

Purpose: The objective of this article is to draw attention to an unusual clinical manifestation of pulmonary embolism (PE) as symptoms suggesting an underlying mental disorder. This seems all the more important since PE is one of the most common causes of potentially preventable hospital deaths and delayed diagnosis of PE in patients consulted at emergency departments has been shown to be most common in elderly patients and the ones presenting with significantly altered mental status. Views: PE is a life-threatening condition that requires prompt diagnosis and appropriate management. There is no symptom that can be found characteristic for PE. Clinical picture of this condition is varied and may resemble many other disorders. The article emphasises that PE may also manifest with psychopathological symptoms that mimic psychiatric emergencies. Three most common groups of psychopathological symptoms that can mask a developing PE, such as panic attacks, symptoms of psychosis, and catatonia, are discussed here based on the literature review. Conclusions: Particular care must be exercised while evaluating such a patient because initial misdiagnosis results in the patient being referred to a mental health care unit instead of a unit treating somatic disorders. There are no diagnostic or treatment facilities in large psychiatric hospitals to assist such a patient. This, in turn, leads to a significant delay in management and, consequently, to major complications or death.

The risk of pulmonary embolism in the context of various clinical situations and management in psychiatric patients. / Ryzyko zatorowosci plucnej w kontekscie róznych sytuacji klinicznych oraz postepowania leczniczego w psychiatrii.

Pulmonary embolism (PE) and deep vein thrombosis are components of venous thromboembolism (VTE), being the third most common cardiovascular disease. PE is the most common life-threatening cardiovascular disorder, which is associated with mortality of 30% when managed incorrectly. Patients with mental disorders are at higher risk of thromboembolism as compared to general population and PE is commonly noted in this group. This mainly results from additional thromboembolic risk factors associated with symptoms and treatment of mental disorders. The scores recommended to estimate the VTE risk do not include factors typical of this group of patients. This article discusses how components of Virchow's triad are activated by symptoms of mental disorders, i.e. psychosis, anxiety, depression and catatonia. The current state of knowledge on the thromboembolic risk associated with coercive measures that involve physical restraint of four limbs is presented. Current data on potentially thrombotic effect of antipsychotics, antidepressants and electroconvulsive therapy are summarised. Recommendations for the prevention of PE in patients with mental disorders are discussed.

Reasons, Form of Ingestion and Side Effects Associated with Consumption of Amanita muscaria.

In recent months, there has been a new trend involving the consumption of Amanita muscaria. The aim of this article was to investigate the reasons for consumption, the form taken and the adverse symptoms that were indicated by those consuming Amanita muscaria. After analysing 5600 comments, 684 people were included in the study, who, in social media groups such as Facebook, stated the purpose of consuming the mushroom (n = 250), the form of mushroom they were taking (n = 198) or the adverse symptoms they experienced (n = 236). The gender of the subjects differentiated the parameters analysed. In the study group of women, the main purpose of consuming Amanita muscaria was to reduce pain, as well as to reduce skin problems, while in men it was mainly to relieve stress, reduce the severity of depressive symptoms and reduce insomnia (p < 0.001). With regard to the form of mushroom ingested, tincture was predominant in the women's study group, while dried was predominant in the men (p < 0.001). In terms of side effects, women reported primarily headaches, while men reported nausea, vomiting, abdominal pain and drowsiness (p < 0.001). Advanced research on Amanita muscaria should be carried out to make the community aware of the toxicity of this fungus.

[Intensification of interpersonal sense of guilt in patients with schizophrenia]. / Nasilenie interpersonalnego poczucia winy w schizofrenii paranoidalnej.

AIM: The article presented results of a research designed to compare the feeling of guilt in healthy adults and in persons diagnosed with paranoid schizophrenia. METHOD: One hundred people diagnosed with paranoid schizophrenia participated in the research and 100 people without diagnosed psychopathology (control group). RESULTS: The findings of the research showed that the persons from the clinical group obtained much higher results in all the tests measuring a sense of guilt and that interpersonal guilt in persons suffering from paranoid schizophrenia in a majority of cases significantly is not correlated with clinical symptoms - thus it can be assessed in a relatively independent manner from a patient's behaviour and cognitive state. However, it has been proved that the strongest indications of positive symptoms of schizophrenia are: Sense of guilt related to helplessness (IGQ), Sense of guilt related to induced self-hate (IGQ), Guilt as a state (GI) and Guilt as a feature (GI), whereas indicators of negative symptoms and a general result--Guilt as a state (GI). CONCLUSION: One might suppose that such a pattern of results indicates the primacy of a characteristic (guilt as a characteristic according to the Inventory of a Sense of Guilt), which is proved by a lack of correlation between schizophrenia symptoms (being more of a state nature) and the most important dimensions of the sense of guilt (being more of a characteristic nature). Moreover, the research results give grounds to confirm the existence of significant differences in the intensity of the experienced sense of guilt (Guilt as a state and Sense of guilt related to induced self-hate guilt) among outpatients and all-day treatment patients.

Ganser syndrome - a dissociative disorder or a factitious disorder? A case report. / Zespól Gansera ­ zaburzenie dysocjacyjne czy zaburzenie pozorowane? Opis przypadku.

Ganser syndrome (GS) is one of afew eponyms that have survived in psychiatry until the present day. GS is a little-known and rare disorder. It is most often described as a response to a stressor (e.g. incarceration), that is why it is an important issue in forensic psychiatry. Organic causes are taken into consideration. The basic symptoms of the syndrome are: approximate answers, visual and auditory hallucinations, clouding of consciousness and conversion symptoms. Additionally, patients may perform activities in an awry manner and suffer from insensitivity to painful stimuli.GS is usually acute and subsides spontaneously. Usually patients do not remember they had an episode of the disease. Diagnostic criteria of GS are imprecise and its classification has been changed over the years. GS was not listed in the DSM-5 classification, although in the DSM-IV it was classified as a dissociative disorder. Currently some authors tend to classify it rather as a factitious disorder. WHO (ICD-10 and ICD-11) classifies GS as a dissociative and conversion disorder, which seems to be appropriate in the light of current knowledge. The presented case report describes apatient with a nearly identical pattern of full-blown GS, which occurred twice. The symptoms appeared shortly after the patient was incarcerated. The course of the disorder was chronic and recurrent. The patient was insensitive to pain stimuli. Somatic causes were excluded in the diagnostic process.

Manganese concentration in patients with encephalopathy following ephedrone use: a narrative review and analysis of case reports.

BACKGROUND: Numerous case reports describe manganese encephalopathy in patients using ephedrone (methcathinone). The aim of this narrative review of case reports was to relate manganese ion concentrations in peripheral blood to the reported neurological deficits. METHODS: International databases, including Thomson (Web of Knowledge), PubMed/Medline, Science Direct, Scopus and Google Scholar were searched for literature items published between 2007 and 2020, in which the authors measured the manganese concentration in patients taking ephedrone. RESULTS: We identified 39 patients in two case series comprising of twenty-three and twelve patients, respectively, and four case reports meeting inclusion criteria. The study showed that 93% of them had elevated blood manganese concentration in relation to the accepted norm (>219 nmol/L), and the median was 364 nmol/L. The median duration of ephedrone use in individual groups of patients was approximately 48 months, and it did not show a relationship with the manganese concentration in the blood. A greater percentage of the people with manganese concentration higher than 250 nmol/L exhibited more severe gait, speech and handwriting disorders. The median duration of ephedrone withdrawal was a month in the group of people with the highest level of manganese ions (>500 nmol/L). CONCLUSION: Manganese concentrations did not vary with the duration of ephedrone use.

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists.

In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents' opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients' hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor's recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry.

Pulmonary embolism - a considerable clinical challenge in psychiatry. Case reports.

Purpose: Pulmonary embolism (PE) is the most serious clinical manifestation of venous thromboembolism (VTE) and a common cause of death in psychiatric patients. Patients diagnosed with mental illness have additional thromboembolic risk factors. These factors are not included in scores used to assess VTE risk. The goal of this elaboration is to take notice of the increased thrombo- embolic risk in psychiatric patients, with a particular focus on patients with catatonic symptoms. Case description: Two cases of young men with catatonic symptoms who suffered from cardiac arrest during psychiatric hospitali- zation are reported on. Autopsy showed pulmonary embolism as the main cause of death. Based on the Padua Prediction Score the two patients had no indications for thromboprophylaxis. Both men were mostly treated with olanzapine. Comment: PE should be always taken into account in differential diagnosis, even if patients do not present with its typical risk factors.

The scientific path of Jakub Frostig in the light of his correspondence with the leading representatives of world psychiatry - from psychoanalysis and phenomenological approach to biological psychiatry. Part 1. Towards psychoanalysis and phenomenological approach. / Droga naukowa Jakuba Frostiga w swietle jego korespondencji z czolowymi przedstawicielami psychiatrii swiatowej ­ od psychoanalizy i podejscia fenomenologicznego do psychiatrii biologicznej. Czesc 1. Ku psychoanalizie i podejsciu fenomenologicznemu.

Jakub Frostig (1896-1959) was one of the most active Polish psychiatrists of the interwar period, with broad scientific interests, maintaining close scientific contacts with the leading specialists of world psychiatry, from the German -and English-language areas. This aspect of his activity is presented in the two-part publication based on new sources, which have never been used before, especially on the correspondence with Ludwig Binswanger (1881-1966), Max Müller (1894-1980) and Adolf Meyer (1866-1955), spanning several years. In addition, the German-language work of the psychiatrist and its reception in this language area are described in more detail for the first time. The first part of the article discusses the little known participation of Frostig in the Polish psychoanalytic movement and his attempts to popularize psychoanalysis in Lviv in the 1920s, as well as the philosophical inspirations of his work from the early period of his scientific activity. Frostig's ambitions and chances for a scientific career did not always go hand in hand. The work presents the causes of these discrepancies, which limited his career in the period before and after his emigration to the United States in 1938.

The scientific path of Jakub Frostig in the light of his correspondence with the leading representatives of world psychiatry - from psychoanalysis and phenomenological approach to biological psychiatry. Part 2. Towards biological psychiatry. / Droga naukowa Jakuba Frostiga w swietle jego korespondencji z czolowymi przedstawicielami psychiatrii swiatowej ­ od psychoanalizy i podejscia fenomenologicznego do psychiatrii biologicznej. Czesc 2. W strone psychiatrii biologicznej.

In the second part of the article devoted to Jakub Frostig (1896-1959), his research from the 1930s on insulin coma treatment is presented in a broader context. Frostig began his research in the psychiatric hospital Zofiówka in Otwock and continued after his emigration to the United States. Thanks to new sources, we managed to determine the reasons underlying Frostig's departure from Poland. At the end of the 1930s, the issue of emigration became a necessity for him, saving his life and his family. Frostig was well aware of the political atmosphere at the time and the threats that followed. The inability to make a scientific career in Poland was the first impulse to look for a job abroad. After taking over the post of director of Zofiówka in 1933, this factor ceased to be decisive. The feeling of danger born on the wave of European anti-Semitism, especially in Germany, after Hitler came to power, came to the fore. Efforts to obtain awork permit in Switzerland and Australia proved unsuccessful. Eventually, just before the outbreak of World War II, Frostig managed to emigrate to the USA, where he concentrated on popularizing the treatment of psychiatric disorders with insulin comas in the local psychiatric environment. He did not accomplish a scientific career in the USA as he intended. His life story came full circle, and just as in the first years of his professional career in Lviv, he was forced to switch to a private practice. Despite the difficulties mentioned above, Frostig played a significant role in Polish psychiatry and greatly contributed to its development.