2010, volume 26, issue 3-4

Original article

Complex poisonings with phenothiazine-derivatives in the forensic toxicology practice and their clinical implications

Rafał Skowronek, Rafał Celiński, Marek Krzystanek, Małgorzata Korczyńska, Joanna Kulikowska, Joanna Nowicka, Czesław Chowaniec
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 121–126

Nowadays, complex poisonings with mixtures dominate among causes of fatal xenobiotic intoxications. Low consciousness of interactions between drugs, drugs and alcohol and drugs and narcotics has significant participation in this adverse occurrence. Especially dangerous drugs are neuroleptics, including phenothiazine-derivatives (PHD). The aim of this study was to analyze fatal complex poisonings with PHD in the practice of the Chair and Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice in the years 1999-2008. The results of chemico-toxicological investigations of biological material, collected during autopsies from corpses of persons poisoned by mixtures, were analyzed, including a kind of phenothiazine, the presence of alcohol and narcotics and sex of casualties. In our material the complex poisonings with phenothiazines were the most often cause of fatal intoxications with these drugs. People liable to poisonings: the patients, drug addicts, alcoholics have to be educated about proper use of phenothiazines and possible interactions all the time. New, worrying phenomenon is the practice of prometazin' addition to home-made poppy straw extracts ('compote').

Review article

Ziprasidone in the treatment of cognitive dysfunctions in schizophrenia

Alina Borkowska
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 127–132

Cognitive dysfunctions in schizophrenia are core and enduring deficit connected with neurodevelopmental changes in the brain. Currently they are one of most important of psychopathological dimensions of the illness. The results of contemporary researches indicate, that atypical antipsychotic drugs show positive influence on different cognitive domains in schizophrenia. Ziprasidone is one of atypical neuroleptics with positive clinical effect and may be recommended as a drug for improvement cognitive abilities in schizophrenia, which is connected with its receprors profile. The ziprasidone mechanism of action is probably different in relation to cognitive functions and clinical symptoms of the illness. This may be used in schizophrenia patients, also with chronic schizophrenia with greater cognitive dysfunctions and in patients with intolerance of other drugs or without positive effect of previous treatment.

Review article

Suicidality in Bipolar Disorder

Rafał Jaeschke, Marcin Siwek, Dominika Dudek
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 133–140

Large suicide risk in course of BD is one of psychiatry's serious problems. Suicidal behaviors take place mainly during depressive or mixed dysphoric episodes. Suicidal risk seems to be similar in patients with BD type I or II.
Proper pharmacotherapy is the most effective way of reducing suicidal risk in BD. Lithium carbonate is the drug of established effectiveness in preventing suicides among the BD patients. Lithium's antisuicidal properties are independent from its mood stabilizing effects. Comparisons of antisuicidal effectiveness of lithium and other mood stabilizers (valproate or carmabazepine) bring mixed results. Indirect data suggest that clozapine, olanzapine and quetiapine might be effective in dealing with suicidal risk among the BD patients. On the contrary, results of longitudinal studies say that antipsychotic drugs might increase suicidal risk in this group of patients. Data concerning the relationship between antidepressants intake and suicidal tendencies in BD are scarce.

Review article

The influence of SSRI antidepressant on emotional processing in depression treatment – cognitive and neuroimaging research

Magdalena Linke, Sławomir Murawiec
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 141–147

The paper presents the latest cognitive and neuroimaging data for SSRI (selective serotonin reuptake inhibitor) antidepressant drug treatment (eg. citalopram and escitalopram). Effects of antidepressant on central nervous system and depression symptoms in presented research refer to cognitive model of depression. Results suggest that SSRI antidepressant drugs have influence on emotional processing (emotional bias) which is strongly connected to depression. Even acute SSRI administration increase positive bias due to specific brain area activation (eg. amygdala).

Review article

Pharmacotherapy of personality disorders- review of the pharmacological trials and experts’ guidelines

Justyna Holka-Pokorska
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 149–164

There is a substantial growth of the amount of data showing the possibility of the recovery during the personality disorder therapy. Other research shows that severness of disorder symptoms change with patient's age. It is also known that psychotherapy as a main therapeutic tool has a strong unprecedented position in the clinical psychiatry. In clinical treatment however patients with personality disorders are treated with pharmacotherapy very often. The majority of clinical models concerning the personality disorders pharmacotherapy are based on the assumption that for patients with abnormal personality structure the pharmacotherapy plays the protective role in case of the decompensation towards the mental disorder symptoms.
The purpose of the article is the description of the most common opinions and recommendations concerning pharmacological treatment of personality disorders with the crucial role of the recommendations of the World Federation of Societies of Biological Psychiatry. The most important placebo controlled research on the effectiveness of various medications during the personality disorder treatments has also been reviewed.

Review article

Current methods of treatment of pedophilia

Dominika Berent, Andrzej Depko, Monika Talarowska, Antoni Florkowski, Tomasz Śliwiński
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 165–172

This is to summarize knowledge about currently used methods of treatment of pedophilia. It comes mainly from studies enrolling groups of sex offenders, non-comparable according to the structure of paraphilia across the studies. Moreover, the assessment of treatment efficacy predominantly relies on selfreporting of changes in intensity of deviant sexual fantasies and behaviours, which seems to make the reliability of such a method questionable. Here shown methods of treatment are: surgical castration, pharmacological treatment and psychotherapy. Presented hormonal pharmacological treatment contains: medroxyprogesterone acetate, cyproterone acetate, gonadorelin analogues; non-hormonal: selective serotonin reuptake inhibitors, antipsychotics, topiramate, naltrexone.

Review article

Admission Day and Prognosis in Acute Stroke

Agnieszka Jezierska-Ostapczuk, Maciej Niewada, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2010, 3-4, 173–179

Weekend admissions can be associated with poor outcome and increased mortality. This phenomenon is associated particularly with acute diseases and was defined as the "weekend effect". Stroke is a condition that requires immediate intervention. Our aim was to evaluate the impact of weekend admissions on stroke outcome and mortality in medical literature. It has been suggested that increased mortality in weekend stroke patients may be due to availability of quality pre-hospital and hospital stroke service. Comprehensive stroke centres with 24/7 availability of stroke specialists, advanced neuroimaging, surveillance of specialized nursing care can ameliorate the "weekend effect" in stroke patients. Identification of disparities in resources, expertise and healthcare provider working during the weekend may ameliorate differences in outcomes. Efficient and effective emergency healthcare should be available, irrespective of the day or time of admission.