2012, volume 28, issue 1

Original article

Niacin test in schizophrenia: literature’s review and preliminary results of own research

Marcin Górniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2012, 1, 7–16

Introduction: Niacin test for the diagnosis of schizophrenia was proposed by David Horrobin in 1980. The results of the test show a weakened response of patients with schizophrenia to a niacin applied orally or topically, what may prove the presence of lipid disorders in this disorder. A purpose of the article was to perform a review of the research with the use of niacin test in schizophrenia and to present the preliminary results of own research.
Material and methods: The study included 29 patients with schizophrenia (12 men, 17 women) aged 20 to 53 years. The control group consisted of 30 healthy people (15 men, 15 women) aged from 23 to 48 years. Eighteen patients were first episode ones, among them 11 drug naïve and 11 of patients were chronic ones.
A tissue paper with 0,001 M solution of methyl nicotinate was applied topically for 90 seconds. The intensity of reaction was determined by computer analysis of picture of an exposed area.
Results: Schizophrenia patients obtained significantly lower values of the intensity of reaction compared to the control group. There were no differences related to gender, duration of illness and taking antipsychotic medications.
Conclusions: Our preliminary results indicate a reduction of skin reaction to niacin in schizophrenia, are consistent with those obtained by other researchers and confirm the disturbances of lipid metabolism in schizophrenia. Niacin test may be helpful both in diagnosis of schizophrenia and in assessment of treatment on lipid status. It is possible to use the test as an enophenotypic marker in schizophrenia, e.g. for deficit symptoms or functional impairment.

Original article

The prevalence of polypharmacy in treatment of schizophrenic patients discharged from psychiatric units in Poland

Jan Jaracz, Edyta Tetera-Rudnicka, Dominika Kujath, Agnieszka Raczyńska, Sebastian Stoszek, Wojciech Czernaś, Piotr Wierzbiński, Adam Moniakowski, Krystyna Jaracz
Farmakoterapia w Psychiatrii i Neurologii, 2012, 1, 17–24

Surveys of prescribing antipsychotics (AP) in different countries have identified relatively widespread use of polypharmacy in treatment of schizophrenia. It is a common practice, despite guidelines recommendations of antipsychotic monotherapy.
The aim of the study was to determine the pattern of psychotropic prescribing including polipharmacy with antipsychotics (AP) in a group of patients with schizophrenia discharged from psychiatric unit. Pharmacological therapy of 131 patients from 6 psychiatric units in Poland was examined.
Monotherapy received 69 (52,7%) patients, 56 (42,8%) were discharged on two and 6 (4,6%) on three AP’s. Second generation AP were prescribed more frequently (84%) than first generation AP (16%). Olanzapine was most widely used AP. Combination of two second generation AP was as common as concomitant use of second and first generation AP. Patients who were on two AP had more previous hospitalizations. When all psychotropics were taken into account 55 patients (42%) received one, 48 (36,5%) two, 27 (20,5%) three, and 1 patient four psychotropic drugs. Relatively small proportion of patients were receiving benzodiazepins/hypnotics (n = 11,8%) and anticholinergic drugs (n = 12,9%).
Data collected from 6 psychiatric hospitals/departments in Poland revealed the rate of polipharmacy similar to observed in other European countries. Reasons for and the impact of the predominant use of polypharmacy require further study.

Review article

Selective serotonin-reuptake inhibitors in alcohol dependence therapy: review of randomized controlled trials

Dariusz Kaczmarek, Jadwiga Zalewska-Kaszubska
Farmakoterapia w Psychiatrii i Neurologii, 2012, 1, 25–31

Objective: To assess the efficacy of Selective Serotonin Reuptake Inhibitors (SSRI) in the treatment of alcoholism.
Material and methods: A systematic review of electronic medical databases (Medline/Pubmed, Embase) was performed to find relevant clinical publication (all up to November 2011). Only randomized double-blind controlled trials comparing a SSRI with placebo in the treatment of alcohol dependence were considered for study inclusion. We used the following key words: alcohol, alcoholics, fluoxetine, sertraline, fluvoxamine, paroxetine, citalopram i escitalopram.
Results: Eight randomized controlled studies (1105 participants, aged between 18 and 75 years) were included in the analysis.
Conclusions: There is no evidence that SSRIs are therapeutically effective to a heterogeneous population. A significant interaction between efficacy of SSRIs and co-occurring depressive disorder or alcoholic subtypes and alcohol dependence was found. Subtyping alcohol-dependent subjects may help to explain mixed results in the literature on the efficacy of SSRIs treatment in alcohol dependence and allows address these medicines to the appropriate group of patients.

Review article

Adeno-associated virus vectors in gene therapies of neurodegenerative diseases

Adriana Wawer, Anna Sznejder-Pachołek, Ilona Joniec-Maciejak, Joanna Schwenkgrub, Andrzej Członkowski
Farmakoterapia w Psychiatrii i Neurologii, 2012, 1, 33–40

The search for effective therapy of neurodegenerative diseases is an important issue and an important challenge. Nowadays, there are high hopes for the gene therapy based treatment. This involves using a noninfectious virus administered directly into the brain. AAV vectors are increasingly being used as tools for delivery of therapeutic agents to the CNS. The present paper aims to review clinical trials carried out so far with the use of the AAV vectors in treatment of neurodegenerative disorders: Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis, Canavan disease and late infantile neuronal ceroid lipofuscinosis. Results obtained from these trials show good tolerance of AAV vectors in the CNS and safety of therapies.

Review article

Registered indications for antipsychotic drugs in Poland

Marek Krzystanek, Paweł Krzywda, Magdalena Marszałek, Irena Krupka-Matuszczyk, Tomasz Szafrański
Farmakoterapia w Psychiatrii i Neurologii, 2012, 1, 41–49

Antipsychotics (APPs) are one of the basic drug groups in psychiatry. APPs are used in the treatment of schizophrenia, psychotic disorders, as well as in the treatment of bipolar affective disorder, mainly its manic phase.
The aim of the study was to present the actual situation, regarding the registered therapeutic indications of APPs, admitted for turn in Poland.
The registered indications of different APPs’ market forms available in Poland, in the aspect of specific indications for the treatment of psychiatric disorders, as well as the differences in the description of specific indications of different market forms of the given drug were analyzed.
The analysis indicated the significant differences in registered therapeutic indications. The differences are also present within registrations of different market forms of the same neuroleptic. The registered indications of neuroleptics may significantly vary from the indications listed in psychiatry and pharmacotherapy textbooks. The differences reduce the possibility of use of LPPs in the treatment of psychiatric disorders, and force physicians to prescribe the concrete market form of a drug.
Authors suggest that a uniformed interpretation of the therapeutic indications of APPs, referred not to a market name but an international name of a drug, might improve the financial safety of psychiatrist’s work. Legislative changes, introducing possibilities of use of drugs on the basis of scientific evidence apart of the registered indication are obligatory. The changes ought to assure the legal safety both to the treating person and the treated one.