Exploring the Link Between Attention-Deficit Hyperactivity Disorder and Cannabis Use Disorders: A Review.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adults. In the substance use disorders (SUDs) population, ADHD prevalence reaches 23.1%, leading to more severe substance abuse progression and reduced treatment effectiveness. Cannabis is the most common illicit drug used among the ADHD population. The increasing popularity of medical marijuana (MM) has raised concerns about its potential impact on neurocognitive functions, particularly in adolescents. Persistent cannabis use can cause permanent changes in brain structures and circuits. This review aims to overview the comorbidity of ADHD and SUDs, focusing on cannabis use disorders. Theoretical models of the etiologies of ADHD and SUDs were investigated to establish a framework for analyzing their underlying neurocognitive mechanisms. The reward and motivational brain circuitries involving the default-mode network and the endocannabinoid system were emphasized. The high prevalence of SUDs in the ADHD population has ramifications, including earlier age of onset, self-medication, and reduced performance in various domains. Cannabis use disorders are particularly significant due to the increasingly widespread use of cannabis and its perceived safety. The review highlights the lack of theoretical background on the therapeutic properties of medicinal cannabis, criticizing its speculated applications in the ADHD population. This article reviews the current understanding of the association between ADHD and cannabis use, emphasizing the need for further research and a cautious approach to MM's potential therapeutic applications.

Immune suppression of IgG response against dairy proteins in major depression.

BACKGROUND: Interactions between the digestive system, brain functions and immunoglobulin G (IgG) mediated immunity against food antigens became recently a topic of growing interest in psychiatry research. Psychological stress can activate hypothalamic-pituitary-adrenal axis (HPA) with subsequent hypercortisolemia. It can also influence intestinal permeability and dynamics of IgG response. Major depression can by accompanied either by activation of inflammatory response or by immune suppression (e.g. decreased antibody production) where hypercortisolemia is a significant immune modulator. The aim of our study was to assess IgG immune response against 44 food products in depressed patients and controls along with markers of psychological stress, inflammation, psychometric and dietary parameters. METHODS: Serum IgG concentrations against 44 food antigens, plasma cortisol, TNF-α, IL-6, IL-1b concentrations were measured and psychometric parameters were evaluated using Hamilton Depression Rating (HAM-D 17), Perceived Stress (PSS-10), and Symptom Checklist (SCL-90) scales in 34 depressed patients and 29 controls. Dietary parameters such as frequency of exposure to food antigens, appetite and weight change were assessed. RESULTS: There was a significantly lower IgG concentration against dairy in depressed patients compared to controls (post hoc p < 0.05) when there was a high exposure (consumption) to dairy. Our research revealed a significant interaction of IgG concentration against dairy proteins and exposure to dairy between groups (F (2.63) = 3.92, p = 0.025, η2 = 0.12). There was no significant difference in mean IgG concentration against food antigens between patients and controls. We found increased concentration of cortisol in depressed patients (t (1.61) = 2.37, p = 0.02) compared to controls. Patients with melancholic depression had significantly higher (M rank  = 21.27) concentration of cortisol (U = 41, p = 0.006), when compared with the non-melancholic group of patients (M rank  = 12.16). Cortisol concentration significantly positively correlated with HAM-D 17 (r = 0.442, p = 0.009) and with phobias in SCL-90 scale in patients' group (r = 0.531, p = 0.001). There was decreased concentration of TNF-α (t = 4.256, p < 0.001) in depressed patients compared to controls. IgG concentration of 38.63% food products positively correlated with TNF-α concentration in depressed patients compared to 9.09% of those in healthy controls. CONCLUSIONS: We observed an immune suppression of IgG response to dairy proteins in depressed patients. Hypercortisolemia with involvement of decreased concentration of TNF-α might play a significant role in suppression of IgG response in depressed patients.

An Introduction to the Model of Crisis Intervention Procedure for Borderline Patients (CIP-BP): A Case Study.

Borderline personality disorder is highly associated with suicidal behaviors. The authors of the current case study present the introduction model of original Crisis Intervention Procedure for Borderline Patients (CIP-BP) which is a method focused on restoring emotional balance, reducing the severity of symptoms and the risk of suicidal behavior, as well as developing optimum solutions for further action. Its aim is to enable the patient to regain control of their emotional memory, increase autonomy and restore important interpersonal relations by using the original resources of this person. The procedure aims at providing nursing personnel with a practical tool to effectively avert the crisis and prevent further decompensation of BPD patients. Further pre-post study is required to determine the effectiveness of the procedure.

Cognitive impairment in schizophrenia across age groups: a case-control study.

BACKGROUND: The potential dynamics of cognitive impairment in schizophrenia is discussed in the literature of the field. Recent publications suggest modest changes in level of cognitive impairment after first psychotic episode. Present article attempts to explore cognitive differences between patients and controls across age groups and differences between age groups in clinical group. METHODS: One hundred and twenty-eight hospitalized patients with schizophrenia (64 women and 64 men) and 68 individuals from the control group (32 women and 32 men) aged 18-55 years were examined. The patients were divided into age groups (18-25, 26-35, 36-45, 46-55). Both groups were examined using Wisconsin Card Sorting Test, Rey Auditory Verbal Learning Test, Rey Osterrieth Complex Figure Test, Trail Making Test (A and B), Stroop Test, verbal fluency test and Wechsler digit span. RESULTS: Patients with schizophrenia obtained significantly lower scores versus the control group in regard to all the measured cognitive functions (Mann-Whitney U; p < 0.05. Most deficits were present in all age groups, however, statistically important impairment in executive functions (WCST) were present only in "older" groups. CONCLUSIONS: Patients with schizophrenia obtained less favourable results than the control group in all age groups. Deficits regarding executive functions do not seem to be at a significant level among the youngest group, whereas they are more noticeable in the group of 46-55-year-olds. Executive functions are significantly lowered in the group aged 36-45 in comparison to the "younger" groups. The level of cognitive functions shows a mild exacerbation in connection with age, whereas cognitive rigidity proved to be related to the number of years spent without hospital treatment.

The differences in level of trait anxiety among girls and boys aged 13-17 years with myopia and emmetropia.

BACKGROUND: A significant increase in myopia among children and teenagers can be observed all over the world. Yet at the same time, there is still an insignificant number of studies concerning this health problem. The aim of this study was to assess the level of trait anxiety among myopic group of teenagers in comparison to teenagers with emmetropia, and to confirm whether the level of trait anxiety relates to age and gender. METHODS: Two hundred thirty-nine students aged 13-17 years were included in the study. The study group comprised 114 persons with myopia (81 girls and 33 boys), while the control group comprised 125 persons without refractive error (79 girls and 46 boys). Volunteers completed a set of questionnaires including: personal data, State-Trait Anxiety Inventory for Children (STAIC) (13-14 year-olds), or State-Trait Anxiety Inventory (STAI) (15-17 year-olds). The trait anxiety subscales were thus analyzed. RESULTS: Among younger adolescents (13-14 years of age) with myopia there was a significantly higher incidence of pathological intensification of anxiety as a constant trait. After taking into account the distribution of gender, there was a higher level of trait anxiety in the group of boys with myopia than in the control group aged 13-17 years and 13-14 years. There was also a higher level of trait anxiety detected in males than in females. CONCLUSIONS: Myopia may affect the level of trait anxiety among 13-14-year-olds. In both age groups of girls, a higher percentage of patients with high level of anxiety was discovered (≥7 sten), as compared to their peers without vision defects. Our results can contribute to a more accurate analysis of young teenagers' psychological problems, especially among boys diagnosed with myopia.

[Depression and inflammation in rheumatic diseases]. / Depresja i proces zapalny w chorobach reumatologicznych.

It is known that the prevalence of depression in rheumatologic patients is higher than in the general population. Socioeconomic factors are not a sufficient explanation of mood disorder in these patients. Symptoms reported by patients with chronic inflammatory diseases resemble changes defined as "sickness behavior". Mood disorders among somatic patients could be explained by disturbances of the immune system according to the monoaminergic theory of depression. Inflammatory factors such as IL-1 (interleukin-1), IL-2 (interleukin-2), IL-6 (interleukin-6), TNF-α (tumor necrosis factor α), and IFN-γ (interferon-γ) act within the CNS (central nervous system). They get through from peripheral tissues as well as being synthesized de novo by neurons. This cytokine activity correlates positively with depression intensity as well as with genetic polymorphism of the serotonin (5-HT) transporter. The theory of glucocorticoid resistance-mediated depression (limbic-hypothalamic-pituitary-adrenal [LHPA] axis) is also connected with gained proinflammatory cytokines activity. It might assume the form of a vicious circle. Depressed mood is probably linked with depression in immune-mediated diseases. An elevated level of proinflammatory cytokines is able to activate IDO (indoleamine 2,3-dioxygenase)--an enzyme catabolizing tryptophan (5-HT precursor). Those reactions probably play the main role at the biochemical level. IDO metabolites extensively disturb neurotransmission. 3-Hydroxykynurenine (3OH-KYN), quinolinic acid (Quin) and kynurenic acid (KYNA) are neurotoxic by releasing oxidative stress mediators. Moreover, they activate MAO (monoamine oxidase), which degrades neurotransmitters responsible for stable mood. Bidirectional communication between the neuroendocrine and immune systems is significant for depression treatment, as well as CNS protection against incremental neurodegeneration among seemingly diverse diseases.

The Development and the Structure of the Verbal Suicide Scale (VSS) - Measuring Attitudes Toward Suicide in the Group of Patients Hospitalized in the Psychiatric Unit.

AIM: The assessment of suicidal risk is one of the most difficult diagnostic challenges. The aim of present article is to report the process of development and preliminary validation of the Verbal Suicide Scale. MATERIAL AND METHOD: A total of 121 psychiatric inpatients aged 19-67 anonymously completed Verbal Suicide Scale (VSS). The study took place in the Clinic of Psychiatry, Medical University of Warsaw in Mazovia Specialist Health Center in Pruszków, Poland. RESULTS: Factor analysis validated the three factor structure. Cronbach's alpha reliability for each factor was satisfactory: 0.876 for scale 1, 0.700 for scale 2 and 0.710 for scale 3. CONCLUSIONS: VSS is a short instrument for evaluating the attitude toward suicide and can be a useful tool in mental health nursing practice. Further research and analyses are required to refine the theoretical and external reliability of the method.

Differences in Assessment of Suicidal Tendencies in Men and Women: A Pilot Study.

Suicidal behaviors in psychiatric patients are one of the main challenges in current clinical practice. The aim of this study was to investigate the gender differences in suicide risk for psychiatric patients in Poland and the influence of life satisfaction in different stages of life on suicidal tendencies. A descriptive-exploratory approach to inquiry was used for this study. Sixty patients aged 16-67 (45% males and 55% females) answered the demographic-descriptive questionnaire, the Suicide Behaviors Questionnaire-Revised (SBQ-R) and the Cantril Self-Anchoring Striving Scale (CSASS). The results suggest that women turned out to show higher risk of suicidal behavior than men (p<0.001). Moreover, women displayed strong negative correlation between suicide risk and the anticipated life satisfaction in the future (rho=-0.542), while men displayed negative correlation between suicide risk and the pre-illness level of functioning (rho=-0.638). The findings suggest that different therapeutic approaches for each gender should be applied in suicide prevention process.

Serum ß-glucuronidase as a potential colon cancer marker: a preliminary study.

AIM: Colorectal cancer is characterized by high morbidity and mortality in developed countries. The lack of low-cost, easy-to-use screening diagnostic methods is one of the causes of late diagnosis of colorectal cancer. Beta-glucuronidase (GLU) is a lysosomal exoglycosidase involved in degradation of glycosaminoglycans of the cell membranes and extracellular matrix of normal and cancerous colon tissues. The aim of our research was to evaluate the activity of GLU in the serum of colorectal cancer and estimate its potential value in the diagnosis of colorectal cancer. MATERIAL AND METHODS: Blood samples were collected from 21 patients with colorectal adenocarcinoma and 17 healthy subjects. GLU activity was determined by the colorimetric method of Marciniak et al. by measuring the amount of p-nitrophenol released from 4-nitrophenyl-beta-D-glucuronide, at λ = 405 nm. RESULTS: We found significantly greater activity of GLU (p<0.0001) in the serum of patients with colorectal cancer, as compared to the healthy subjects. The serum GLU activity significantly differentiates patients with colorectal cancer from healthy individuals. CONCLUSIONS: Serum GLU activity has diagnostic value and may be used in the diagnosis of colon adenocarcinoma.

[The Montreal Cognitive Assessment 7.2--Polish adaptation and research on equivalency]. / Montrealska Skala Oceny Funkcji Poznawczych MoCA 7.2.- polska adaptacja metody i badania nad równowaznoscia.

AIM: The Montreal Cognitive Assessment is a screening test for diagnosis of Mild Cognitive Impairment- MCI. Only one version of the method was available in Poland so far. In order to assess progression of cognitive impairment, or to diagnose effectiveness of therapy, two equivalent version of method are needed. English additional version 7.2. was translated and culturally adapted to sustain reliability of the assessment. Then equivalency of both Polish versions was investigated. This paper examines whether both Polish versions of MoCA are equivalent, and describes the process of its cultural adaptation. METHODS: 66 psychiatric patients (37 men, 29 women) with different levels of cognitive impairment were examined using both Polish versions of MoCA. Both versions were administered randomly to patients with no time interval in between. RESULTS: No significant differences (p=0,601) for total MoCA scores were found between first version of Polish MoCA, and alternate version. Equivalency measured by correlation coefficient Spearman's rho correlation coefficient (rho=0,926) proved to be high. CONCLUSIONS: Both Polish versions of MoCA are equivalent, and can be useful in repeated measurement of progress in cognitive impairment or in testing of the effectiveness of treatment.

Visceral obesity in normal-weight patients suffering from chronic schizophrenia.

BACKGROUND: BMI (body mass index) can be misleading regarding the level of adiposity in a normal-weight individual. Recently, a bioelectrical impedance analysis (BIA) method was developed that can measure body composition variables. The main objectives of this study were to use BIA to compare the body composition variables between chronic non-diabetic schizophrenic patients with normal weight and healthy individuals. The secondary objective was to compare the nutritional pattern of schizophrenia patients with that of matched healthy subjects, and to identify possible relationships between the content of different components of their diet and visceral adiposity. METHODS: The subjects were 52 normal-weight patients (33 males and 19 females) diagnosed with schizophrenia based on the DSM-IV and 45 (23 males and 22 females) BMI- matched controls. The patients had been receiving atypical or typical antipsychotic agents for at least one year before enrollment into the study but continuously for 3 months preceding the study and were psychiatrically stable. Body fat (kg), percent (%) body fat, fat-free mass, VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) were measured using the bioelectrical impedance analysis (BIA) method. Daily food rations (DFR) were quantitatively evaluated by a 24-h dietary recall method covering 3 days preceding the examination. RESULTS: In normal-weight patients schizophrenia was significantly linked with higher VAT, VAT/SAT ratio and lower fat- free mass. Men had over 5 times and women over 2 times as much VAT as BMI matched groups. In women with schizophrenia and in their controls, the amount of magnesium, niacin and vitamin B6 in their diet inversely correlated with VAT, while in men lower zinc and vitamin C intake was related to higher visceral adiposity. CONCLUSIONS: Our study has shown that normal-weight patients with chronic schizophrenia have higher levels of visceral fat (VAT) than controls but similar volume of subcutaneous adipose tissue (SAT). Although no clear conclusion can be made regarding cause-and-effect relationships between the dietary content of food served to our patients and visceral obesity, we suggest that schizophrenia diet should be further investigated as a possible factor related to this type of obesity.

Salivary exoglycosidases as markers of alcohol dependence.

BACKGROUND: Some salivary markers of alcohol abuse/dependence have been proposed so far: aminotransferases, gamma-glutamyltransferase, ethanol, ethyl glucuronide, ethyl sulfate, sialic acid, ß-hexosaminidase A, oral peroxidase, methanol, diethylene/ethylene glycol, α-amylase, clusterin, haptoglobin, heavy/light chains of immunoglobulins and transferrin. AIM: To investigate the effect of chronic alcohol drinking and smoking on the activity (pKat/ml) and output (pKat/min) of salivary lysosomal exoglycosidases: α-fucosidase (FUC), α-mannosidase (MAN), ß-galactosidase (GAL), and ß-glucuronidase (GLU), and their applicability as markers of alcohol dependence. METHODS: The activity of FUC, MAN, GAL and GLU was measured colorimetrically in the saliva of healthy social drinkers, alcohol-dependent non-smokers and alcohol-dependent smokers. RESULTS: We observed an increased salivary activity of FUC, GAL, GLU and MAN, as well as an increased output of GAL and GLU, in comparison with controls. The highest increase in the activity/output was found in salivary GLU and MAN (GLU, even 7- to 18-fold), and the least in GAL. We found an excellent sensitivity and specificity and a high accuracy (measured by the area under the ROC curve) for salivary FUC, GLU and MAN activities. The salivary GLU activity positively correlated with the number of days of last alcohol intoxication. Salivary activity of FUC, GAL and MAN, but not GLU, positively correlated with the periodontal parameters such as gingival index and papilla bleeding index. CONCLUSIONS: Although we found an excellent sensitivity and specificity as well as a high accuracy for the salivary activity of FUC, GLU and MAN, the GLU activity seems to be mostly applicable as a marker of chronic alcohol drinking (alcohol dependence).

Glycosylation changes in the salivary glycoproteins of alcohol-dependent patients: a pilot study.

AIM: Glycosylation of serum proteins is affected with prolonged heavy drinking, and carbohydrate deficient transferrin (CDT) is well established and highly specific biomarker of sustained alcohol consumption. However, total amount of sialic acid is not the only glycoepitope that may be altered as a result of the disease. This work is focused on glycan structures altered in salivary glycoproteins of alcoholics, indicating the most efficient carriers of such marker glycoepitopes. METHODS: Salivary glycoproteins of 31 alcohol-dependent patients and 21 healthy controls were studied by means of lectin ELISA and lectin blotting with the lectins specific for core and antennary fucose, α2,3-bound sialic acid as well as T and Tn antigens in O-glycans. RESULTS: In direct lectin ELISA, core fucosylation, α2,3 sialylation and expression of T-antigen were significantly lowered in the saliva of alcohol-dependent patients. In lectin blotting ten glycoprotein bands were analyzed. The profile of disease-related alterations was found to be complex, but all six lectins studied here were able to detect altered glycan structures. In some glycoproteins the tendency to correct the glycosylation profile was observed after 7 weeks of abstinence. CONCLUSION: Alterations in the glycosylation profiles in the salivary glycoproteins of alcohol-dependent people were found. Some of salivary glycoproteins, such as α-amylase, clusterin, haptoglobin, heavy and light chains of immunoglobulins, and transferrin, seem to be worthy of detailed glycosylation analysis in the detection of alcohol dependence. Further studies may allow one to estimate if such glycomarkers may also reflect the amount of alcohol intake or the duration of alcohol intake.

Association between serum testosterone levels, body mass index (BMI) and insulin in male patients with schizophrenia treated with atypical antipsychotics--olanzapine or risperidone.

OBJECTIVE: A sufficient amount of testosterone (T) is essential for adequate sexual functioning but also for cognitive and psychological well-being. Most recent studies have demonstrated that higher BMI and other symptoms of metabolic syndrome are associated with alterations in sex steroid hormone concentrations. Although, neuroleptics are known to cause a significant and sustained weight excess, the relationships between body mass index and the level of testosterone in psychiatric patients have not been thoroughly studied. The main purpose of the present study was to examine the correlations between testosterone, estradiol BMI, and insulin in male patients diagnosed with schizophrenia and treated with olanzapine or risperidone. METHODS: The study included 78 males diagnosed with schizophrenia according to the DSM-IV diagnostic classification hospitalized in psychiatric inpatient units (42 on risperidone and 36 on olanzapine). The initial and final evaluation of testosterone (T), estradiol, prolactin (PRL) and insulin serum levels were performed at week 3 and 8 after the onset of the new treatment, respectively. RESULTS: At week 3, the mean serum prolactin was markedly higher, whereas testosterone level was lower in risperidone patients compared to those treated with olanzapine. T level was negatively affected by the studied medication (risperidone), increased prolactin and a higher BMI. At week 8, the mean serum prolactin level was markedly higher in risperidone patients. Higher values of BMI and serum insulin were the most prominent factors independently associated with decreased plasma testosterone levels at that measurement point. Individual changes of T level between week 3 and 8 were positively correlated with the corresponding changes in estradiol levels. CONCLUSIONS: T serum levels appear to be independently linked with BMI, insulin and prolactin in both investigated neuroleptics. Further research is needed to elucidate the relationship between reproductive hormones and metabolic parameters in patients with schizophrenia under neuroleptic treatment.

[Does the usual dietary intake of patients with depression require vitamin-mineral supplementation?]. / Czy zwyczajowy sposób zywienia pacjentów z depresja wymaga suplementacji witaminami i skladnikami mineralnymi?

INTRODUCTION: Research on diet and nutrition of patients with depression show that their eating habits are frequently irrational and result in the inconsistent supply of nutrients, especially vitamins and minerals, the deficiency of which leads to nervous system dysfunction. AIM: The aim of the study was to evaluate the content of selected vitamins and minerals in daily food rations of patients suffering from recurrent depressive disorders. METHODS: The study involved a group of 69 people (54 women and 15 men, aged 18-65 years, mean age of women 45.7 +/- 12.2 years, men 46.0 +/- 12.2 years), treated for recurrent depressive disorders. A questionnaire designed in the Department of Dietetics and Clinical Nutrition, Medical University of Bialystok was used to collect dietary data. The quantitative assessment of eating habits used a 24-hour diet recall including 3 weekdays and 1 weekend day. RESULTS: The study showed that the supply of most nutrients assessed was inconsistent with recommendations. CONCLUSIONS: The results indicate that the need for vitamin-mineral supplementation should be considered individually. Nutritional education related to the proper choice of groups of food products is indicated at the time of clinical improvement to ensure the optimum supply of vitamins and minerals.

Nutritional values of diets consumed by women suffering unipolar depression.

BACKGROUND: Previous studies have shown that patients suffering from depression are more likely to adversely change their eating habits (eg. through increases in appetite, comfort eating and compulsive eating), which may result in an abnormal nutritional status. OBJECTIVES: To evaluate selected dietary habits, such as the number and type of meals consumed during a normal day and comparing dietary calorific values and nutritional content between women suffering unipolar depression to those without this condition. MATERIAL AND METHODS: Subjects were a group of 110 women aged 18-65 years consisting of a test group of 55 women undergoing treatment for unipolar depression at the Department of Psychiatry, Medical University of Bialystok and a control group of 55 women, without depression, attending an Obesity and Diet Related Treatment Centre. A study questionnaire was used to determine their eating habits along with other relevant data. The 24-hour diet recall method was used to obtain quantitative data collected on 3 weekdays and 1 weekend day; results being averaged. The calorific values and nutrient content of selected components, according to mealtimes, were evaluated using the Diet 5.0 computer programme. RESULTS: Those patients with depression showed that the 3 meals/day model dominated whilst the 4 meals/day model was predominant in the control group. The most frequently missed meals for both groups were afternoon tea and the mid-morning meal. Abnormalities in the calorific intake and nutritional contents from various meals were observed in women suffering depression. CONCLUSIONS: It seems appropriate to recommend that those women especially suffering from depression should consult with dieticians about their changing dietary habits, particularly for achieving the proper calorific and nutritional values/ balance from their meals.

Depression with comorbid borderline personality disorder - could ketamine be a treatment catalyst?

Borderline personality disorder (BPD) is diagnosed in 10-30% of patients with major depressive disorder (MDD), and the frequency of MDD among individuals with BPD reaches over 80%. The comorbidity of MDD and BPD is associated with more severe depressive symptoms and functional impairment, higher risk of treatment resistance and increased suicidality. The effectiveness of ketamine usage in treatment resistant depression (TRD) has been demonstrated in numerous studies. In most of these studies, individuals with BPD were not excluded, thus given the high co-occurrence of these disorders, it is possible that the beneficial effects of ketamine also extend to the subpopulation with comorbid TRD and BPD. However, no protocols were developed that would account for comorbidity. Moreover, psychotherapeutic interventions, which may be crucial for achieving a lasting therapeutic effect in TRD and BPD comorbidity, were not included. In the article, we discuss the results of a small number of existing studies and case reports on the use of ketamine in depressive disorders with comorbid BPD. We elucidate how, at the molecular and brain network levels, ketamine can impact the neurobiology and symptoms of BPD. Furthermore, we explore whether ketamine-induced neuroplasticity, augmented by psychotherapy, could be of use in alleviating core BPD-related symptoms such as emotional dysregulation, self-identity disturbances and self-harming behaviors. We also discuss the potential of ketamine-assisted psychotherapy (KAP) in BPD treatment. As there is no standard approach to the application of ketamine or KAP in individuals with comorbid TRD and BPD, we consider further research in the field as imperative. The priorities should include development of dedicated protocols, distinguishing subpopulations that may benefit most from such treatment and investigating factors that may influence its effectiveness and safety.

Binge drinking-induced subtle myocardial injury.

BACKGROUND: Most of the clinical, histopathological, and biochemical studies consider the effect of chronic alcohol intoxication on myocardial injury. Much less attention has been paid to acute alcohol (binge drinking)-induced cardiotoxicity, even though alcohol binging is much more common than alcohol dependence. METHODS: We briefly present some of the binge drinking-induced "holiday heart" effects. The literature was searched to find effects of alcohol on heart. RESULTS: In binge drinking, the literature has demonstrated transient myocardial subtle changes in cardiac magnetic resonance, increased serological markers of myocardial injury and inflammation, abnormal cardiac rhythm, changes in other biochemical and ultrastructural indices of myocardial dysfunction, as well as changes in metabolism, blood pressure, heart rate, thrombosis/fibrinolysis processes, and coronary vasoconstriction. CONCLUSIONS: Although acute low alcohol exposure has widely proven positive effect on myocardial function, heavy acute drinking frequent events are related to adverse cardiovascular effects.

Fasting insulin serum levels and psychopathology profiles in male schizophrenic inpatients treated with olanzapine or risperidone.

OBJECTIVE: Recent studies have suggested that higher insulin levels are associated with better psychopathology profiles in cross-sectional samples of patients with schizophrenia. This study examines whether drug-induced fasting insulin changes between third and eight week of treatment are related to clinical improvement in non-diabetic patients receiving the atypical neuroleptics: risperidone or olanzapine. METHODS: non-diabetic men with a diagnosis of schizophrenia according to the DSM-IV diagnostic classification were recruited from psychiatric inpatient units. Following a drug-free period, neuroleptic treatment was initiated (risperidone n=36, olanzapine n=35) and doses were adjusted to achieve maximal clinical efficacy. All patients were hospitalized throughout the study. Initial and final evaluations of serum insulin levels and psychopathology (assessed with the Positive and Negative Syndrome Scale, PANSS), were carried out at weeks 3 and 8 after the onset of treatment, respectively. RESULTS: There were no differences between and within the risperidone and olanzapine groups in changes of serum insulin level between the third and eighth week of treatment. In the olanzapine group, Pearson correlation analysis revealed a significant negative correlation between changes in fasting serum insulin levels and the PANSS-Total, Positive and General Psychopathology subscale scores. Only improvement in the PANSS-Negative Symptom subscale score was not correlated with insulin level change between the third and eighth week of treatment. In the risperidone group, correlations between PANSS subscales scores and the corresponding serum insulin levels change were positive, albeit statistically non-significant. In both groups the improvement in PANSS-Total scores was not correlated with changes in BMI. CONCLUSION: Olanzapine-related changes in endogenous fasting insulin levels were correlated with clinical improvement in acutely ill non-diabetic schizophrenic patients. Because the interesting linkage between insulin and positive and negative symptoms could be an epiphenomenon, randomized studies are needed to further explore the role of insulin in therapeutic responses in patients with schizophrenia.

Plasma carnitine concentrations after chronic alcohol intoxication.

BACKGROUND: Carnitine transports fatty acids from the cytoplasm to the mitochondrial matrix, where the fatty acids are oxidized. Chronic alcohol consumption reduces the concentration of carnitine and interferes with oxidative processes occurring in the cell. AIM: The assessment of carnitine concentrations in plasma of chronically intoxicated alcohol dependent persons in a 49-day abstinence period. MATERIAL/METHODS: The study included 31 patients (5 women and 27 men) aged from 26 to 60 years (44.6 ± 8.9) and 32 healthy subjects (15 women and 17 men) aged 22-60 years (39.8 ± 9.4). The patients' alcohol dependence ranged from 2 to 30 years (13.6 ± 7.5). Examined subjects consumed 75-700 g of ethanol/day (226.9 ± 151.5). Plasma concentrations of free and total carnitine were measured three times: at the first (T0), 30th (T30) and 49th (T49) day of hospital detoxification. Free (FC) and total (TC) carnitine were determined by the spectrophotometric method. Plasma acylcarnitine (AC) concentration was calculated from the difference between TC and FC; then the AC/FC ratio was calculated. To determine statistically significant differences for related variables, Student's t-test was used. RESULTS: At T0, alcoholics had significantly lower concentration of FC and TC (p < 0.05) in plasma, as compared to the control group. In comparison to controls, at T30, plasma TC and FC (p < 0.01) as well as AC (p < 0.001) were reduced. The lowest concentration of TC, FC and AC (p < 0.001)was found at T49. The ratio of AC/FC at T0 had a tendency to be higher in alcoholics than in the control group (p = 0.05), whereas at T49 it was significantly lower in alcoholics as compared to the control subjects (p < 0.05). CONCLUSIONS: Chronic alcohol intoxication causes a plasma deficiency of carnitine. Forty-nine days of abstinence showed a significant decrease in the concentration of TC, FC and AC. Further research is necessary to clarify whether a low level of plasma carnitine after chronic alcohol intoxication is caused by the uptake of blood carnitine by tissues such as liver or muscles. In alcoholics the supplementation of carnitine is recommended in the case of a low level of plasma carnitine.