The article presents the Guidelines of the Pharmacotherapy Section of the Polish Society for Research on Addictions (PTBU) and the Psychopharmacology Section of the Polish Psychiatric Association (PTP) on long-term pharmacotherapy aimed at maintaining abstinence or reducing alcohol intake in adult, alcohol-dependent patients. Apart from practical guidelines on long-term pharmacotherapy for alcohol dependence, the authors present basic areas which require further studies and scientific debate.
The paper presents a short review of present-day drugs used in the treatment of Alzheimer’s disease and the main directions for future research in this area. An application of combined therapy directed against various targets in the pathomechanism of neurodegeneration, along with the efforts to develop drugs able to act simultaneously and improve various targets of neurodegeneration, are discussed. Data on clinical benefi ts of the simultaneous application of esterase inhibitors (donepezil) and NMDA receptor blockers (memantine) in Alzheimer’s disease is also provided. The authors discuss the importance of pharmacogenetics in individualized choice of anti-dementia drugs, with consideration given to their safety and clinical efficacy.
The research into possible causes of neurodegeneration in Parkinson’s disease is still far from being conclusive. However, it has already been confi rmed that α-synuclein protein (ASN), together with other proteins, is the principal component of the Lewy pathology. The latest α-synuclein research has revealed a new role of this protein in the pathogenesis of Parkinson’s disease (PD), related to the new physiological form of α-synuclein. The phosphorylated ASN can be detected in the blood plasma as it shows more promise for a future diagnostic marker for PD. Moreover, it has been signaled that ASN may be a prion-like protein. Finally, a new vaccine against the α- and β-synuclein is considered. All these discoveries open new, revolutionary prospects for PD diagnostics and therapy.
Oxidative stress plays an important role in the ischemic stroke pathomechanism. There has been a lot of experimental and clinical research devoted to the use of antioxidant activity compounds in the early phase of ischemic stroke. In spite of the fact that experimental studies on animals have been very successful, clinical research has fallen short of expectations. A great number of studies are still in the experimental phase. The main purpose of antioxidative treatment is to decrease oxidative stress, through inhibiting reactive oxygen species (ROS) formation and/or destroying the existing ones. Uric acid, allopurinol, oksypurinol, nimesulide, NS-398, edaravone can be included in the group of compounds whose mechanism is connected with inhibiting ROS generation, whereas glutathione, lipoic acid, N-acetylcysteine, melatonine, tirilazad, NXY-059 and STAZN belong to the group of compounds capable of removing the excessive ROS. The antioxidants which are supplemented are ascorbic acid and α-tocopherol. The compounds which act similarly to antioxidant enzymes such as ebselen, SOD:Tet451, PEG-SOD 1, PEG-CAT, EUK-8 and EUK-134 are also investigated. The attractiveness of antioxidative treatment of ischemic stroke hypothesis has inspired further research. However, in order to include antioxidant compounds in standard procedures, and make them part of the guidelines for treatment in the acute phase of ischemic stroke, we need further experimental and clinical trials, held in accordance with the STAIR (Stroke Therapy Academic Industry Roundtable) criteria.
People who suffer from bipolar affective disorder are also more commonly affl icted with chronic somatic conditions. Higher mortality is observed in this population compared to healthy subjects. In patients with bipolar disorder a more frequent occurrence of such conditions as hypertension, hyperlipidemia, hepatitis C, type II diabetes and coronary heart disease is noticed. High somatic comorbidity is due to a number of factors, depending on the patient, the disease itself and the treatment used. The presence of a somatic disease restricts the use of antidepressants, mood stabilizers and antipsychotics. Based on the research available, the author discusses some restrictions regarding the use of classic and second-generation mood stabilizers and antidepressants in the most common chronic diseases, such as cardiovascular disease, diabetes and other metabolic disorders, liver failure, kidney, epilepsy and glaucoma. The awareness of these limitations allows us to incorporate them in the treatment of bipolar disorder in somatically ill patients, which is a safeguard against therapeutic failure.
Comorbidity of alcohol dependence and bipolar disorder (BD) poses a diagnostic and therapeutic challenge. A correct diagnosis is diffi cult to arrive at because of the similarity of symptoms occurring in both illnesses. A diagnostic mistake can lead to an incorrect pharmacological treatment and, in consequence, to BD deterioration. However, proper diagnosis requires a specifi c therapy, which is complicated not only because the symptoms are complex, but also because of the difficulties of cooperating with patients, who may tend to mix medication with alcohol. The main aim of this article is to present the results of the studies conducted in order to evaluate the effectiveness of different kinds of drugs used in this group of patients. The medication recommended as the first line treatment is valproic acid. Some of the described drugs proved to be effective in both of these illnesses but only in the open-label studies (i.e. topiramate, arypiprazole), whereas the drugs usually used in alcohol dependence are recommended to reduce drinking and consequently the possible complications. Lately, attention has been paid to baclofen and nalmefene, which have shown some efficiency but data concerning the dual-diagnosis patients is still scarce.
This work examines the problem of clinical differentiation and therapeutic procedures used in children with ADHD comorbid with bipolar affective disorder. In addition to the diagnostic difficulties involved in the treatment of children and adolescents, special attention is also required as far as pharmacological treatment is concerned. It is linked, on the one hand, with the risk of worsening the symptoms of attention defi cit and hyperactivity and, on the other, with the possibility of inducing a manic or depressive episode as the first episode of BD. It is also essential for a good therapeutic effect to anticipate and correct the possible side effects, such as epileptic fits and ticks, as it is important to remember that both of these disorders may co-occur or symptoms of ADHD may precede the affective disorders. Therefore, this work focuses on the basic standards of treatment, based on data from the available literature, which should help the diagnosis and therapeutic decisions in the case of juvenile BD and ADHD patients.
Polish participants presented a summary of the lectures that where delivered during the 5th ECNP Summer School of Neuropsychopharmacology that took place in Oxford between 7 and 12 of July 2013. The most important conclusions were listed and supported with selected literature. The aim of the ECNP Summer School is to consolidate young psychiatrists’ theoretical knowledge on the subject of neuroscience, make accessible the outcomes of recent studies and encourage international exchange of experience. The report is a brief summary of the week’s intensive training.