2013, volume 29, issue 2

Review article

Influence of intestinal microbiota on the central nervous system and its potential in the treatment of psychiatric disorders

Leszek Rudzki, Agata Szulc
Farmakoterapia w Psychiatrii i Neurologii, 2013, 2, 69–77

Comorbidity of intestinal diseases such as irritable bowel syndrome (IBS) or inflammatory bowel diseases, e.g. colitis ulcerosa or Crohn’s disease, along with psychiatric diseases, primarily depression and anxiety disorders, indicate the existence of important relations and interactions within the gut-brain axis or, more precisely, the brain-gut-intestinal microbiota axis, a bidirectional communication tract connecting intestines and intestinal microbiota with the central nervous system (CNS), which includes neuronal, endocrinological and immunological mechanisms. Intestinal microbiota are one of the key elements of the gut-brain axis. A growing amount of evidence confirms the influence of intestinal microbiota on brain function, mood and behaviour and also their antidepressant and anxiolytic potential. Microbiota have an influence on the CNS through the modulation of levels of cytokines, and the tryptophan metabolism and its kynurenic pathway metabolites, through the production of neurotransmitters and their influence on the expression of their brain receptors, and through their interactions with the enteric and autonomic nervous system, mostly with the vagus nerve. Microbiota have an influence on the stress response of hypothalamus-pituitary-adrenal axis (HPA) and are a key factor in the prevention of increased intestinal permeability in response to psychological stress and pro-inflammatory cytokines. A powerful body of evidence indicates a key role of the inflammatory response in the pathogenesis of depression. There is also an increasingly strong indication of the significance of increased intestinal permeability (leaky gut syndrome) in the pathogenesis of depression. The aim of this review is to present a number of interactions between intestinal microbiota and the CNS and to demonstrate their potential involvement in the treatment of psychiatric diseases, mostly depression and anxiety disorders, and also to discuss the role of microbiota in the prophylaxis of psychological stress, through the retightening of the intestinal barrier and reduction of intestinal permeability.

Review article

Treatment of rapid-cycling bipolar disorder

Łukasz Święcicki, Marlena Sokół-Szawłowska
Farmakoterapia w Psychiatrii i Neurologii, 2013, 2, 79–88

The article focuses on a review of data, derived from the professional literature, concerning the treatment of rapid- -cycling bipolar disorder. The definition of the discussed problem has been presented in the introduction. The authors, who are practicing psychiatrists, also present a critical review of data, based on specialist literature, from the perspective of its usefulness in everyday clinical practice. The results of a study regarding the pharmacological and non-pharmacological treatment methods of rapid-cycling bipolar disorder have been also included. The pharmacological method involves the use of antidepressants in the treatment of rapid-cycling bipolar disorder, although there are a number of controversies related to their use; these are also discussed. Next, the authors present the results of a study regarding the use of the new generation antipsychotic drugs and mood stabilizers, following which they have present the study results, involving standard medication such as calcium channel blockers and thyroid hormones applied in the treatment of somatic disorders. At present, an alternative to the pharmacotherapy of rapid-cycling bipolar disorder is electroconvulsive therapy, and also perhaps transcranial magnetic stimulation. However, our knowledge of effective treatment methods of rapid-cycling bipolar disorder, based on the results of the very few studies available – which are often undertaken in the remission periods – is still insufficient. Therefore, there is an urgent need to carry out long-term research on more diagnostically homogenous groups, the results of which would be unquestionably useful in the course of making therapeutic decisions.

Review article

The pharmacological treatment of anxiety disorders co-occurring with bipolar disorder

Wiesław Jerzy Cubała
Farmakoterapia w Psychiatrii i Neurologii, 2013, 2, 89–96

Bipolar disorder (BD) is characterised by the high complexity of its symptomatology and frequent co-occurrence of psychiatric disorders. Anxiety disorders are among the most commonly co-occurring psychiatric conditions, and have a negative impact on the course of the disease and its prognosis. The treatment of anxiety disorders comorbid to BD employs a wide array of non-pharmacological interventions, including psychoeducation and cognitive-behavioural psychotherapy. The choice of an adequate pharmacological approach is crucial in the planning and management of the treatment, as specific concerns regarding its efficacy and safety arise in this subpopulation of patients. The first line of pharmacological intervention should be focused on the assessment of the adequacy of mood stabilizing treatment. Pseudoresistance to pharmacological agents and their dosing needs to be excluded at the outset. In patients with BD and any other comorbid anxiety disorder, there is evidence of the effective use of valproate, quetiapine, olanzapine, and lamotrigine. There is also mounting evidence for specific lithium resistance in BD patients, with regard to its mood stabilizing properties and the lack of therapeutic impact as such on the accompanying anxiety disorders. The use of antidepressants, particularly selective serotonin reuptake inhibitors, may pose the risk of an induction into a more severe course of bipolar disorder, and has shown poor therapeutic efficacy. Therefore in patients with comorbid bipolar and anxiety disorders, the initial goals of treatment should aim, above all, at mood stabilization and the selection of thymoleptic agents, which are efficient in the treatment of the co-occurring anxiety disorder.

Review article

The herbal preparation Sedatif PC and its possible use in the treatment of anxiety and sleep disorders

Marek Jarema
Farmakoterapia w Psychiatrii i Neurologii, 2013, 2, 97–103

The treatment of both anxiety and sleep disorders requires the use of thorough pharmacological and non-pharmacological therapies. Anxiolytic drugs are recommended with caution because of the risk of substance dependence, and in more advanced disorders antidepressants are usually the drugs of choice. Alternative therapy may consist of herbal medicines (natural drugs). One of such preparation is Sedatif PC, which is a composite drug with several active herbal substances. This medication is particularly recommended in the case of nervousness, adverse response to stress, and in the treatment of vegetative symptoms which accompany anxiety and sleep disorders.

Case report

Therapeutic difficulties in neuroleptic malignant syndrome: a case report

Władysław Sterna
Farmakoterapia w Psychiatrii i Neurologii, 2013, 2, 105–110

The paper presents the case of a 46-year-old male patient, in long-term treatment for schizophrenia, whose mental state deteriorated after a month-long discontinuation of clozapine due to the symptoms of neuroleptic malignant syndrome, which appeared in the course of clozapine treatment. As the patient’s life was in danger, he was hospitalized in the Intensive Treatment Ward, and treated for pneumonia as an additional complication. At this stage electroconvulsive therapy (ECT) was initiated but, in spite of the ECT stimulus being increased, the clinical effect was insufficient. It was only the application of the maximum ECT, combined with the changing of the anaesthetic (thiopental for propofol and later etomidate) and the augmentation with small doses of clozapine that brought the desired clinical effect. It has been 8 months now since the patient has been discharged from the hospital. He has continued successful out-patient treatment, taking 150 mg of clozapine a day. What must be emphasized here is the very good cooperation between physicians of various specialisms in this case, which is not always the case in the treatment of psychiatric patients.

Scientific conference report

A report from the 1st ECNP School of Old Age Neuropsychopharmacology, 28 April – 3 May, Venice, Italy

Patryk Piotrowski, Jakub Michał Kaźmierski, Radosław Stepańczak
Farmakoterapia w Psychiatrii i Neurologii, 2013, 2, 111–118

In this paper the Polish participants of the 1st European College of Neuropsychopharmacology (ECNP) School of Old Age Neuropsychopharmacology, which took place between April 28th and 3rd of May 2013 in Venice, present a summary of the most important issues discussed at the event. The content of lectures is reviewed along with the key conclusions of the theoretical and practical courses. The learning process was supported by a reading list provided by the lecturers. The workshops held during the school were interactive in character, aiming at consolidating the knowledge gained and an in-depth analysis of clinical cases as well as a discussion between the international guests, during which the lecturers acted as moderators The report summarises a week of intensive training in psychogeriatry.