Objectives. Management of anorexia nervosa (AN) should be multidirectional and the co-occurring symptoms may require pharmacotherapy. The aim of our study was to retrospectively analyze factors, which may affect selection of pharmacological treatment of AN and its impact on BMI as well as the severity of the symptoms of eating disorders, depression, obsessions and compulsions.
Material and methods. The study included 80 adolescent patients, in whom differences in the degree of malnutrition and severity of the symptoms were evaluated both at the beginning as well as at the end of the hospitalization. Retrospective analyses of the pharmacological treatment were conducted – 33 patients were not taking any medication, 22 were treated with NaSSA, 13 with SSRI and 12 with olanzapine.
Results. Depending on the applied pharmacological treatment, the patients showed different values of BMI at the beginning and at the end of the hospitalization, but they did not show differences in BMI increase or in the rate of BMI increase. Furthermore, in the analyzed subgroups, the severity of the symptoms of eating disorders and depression were significantly different before the pharmacological treatment, however, not at the end.
Conclusions. Pharmacologically untreated patients had less severe course of the disease than those who were treated. Using medications in patients with more severe course of the disease resulted in the improvement of psychopathological symptoms and their severity was comparable to that presented by patients with a less severe course of the disease. These results may indicate the effectiveness of pharmacotherapy in more severe cases of AN.
Background. Selective serotonin reuptake inhibitors (SSRI) are widely used in the treatment of depression and anxiety disorders. Escitalopram is considered the most selective serotonin transporter inhibitor, demonstrating a good efficacy and tolerability. The aim of this study was to assess the usefulness of Aciprex (escitalopram) in the treatment of outpatients with episodes of depression and in anxiety disorders.
Material and method. Two hundred and thirty three psychiatrists decided to participate in the study. In the case of indications for application of escitalopram due to depressive episodes or anxiety disorders, they started pharmacotherapy in doses of 10–20 mg. The severity of the symptoms was assessed using the Clinical Global Impression Severity scale (CGI-S), while the impact of symptoms on different aspects of patients functioning was measured with a self-report Numeric Rating Scale (NRS). The assessment was performed before the initiation of treatment and during control visits after week 4 and 8, when Clinical Global Impression improvement scale – CGI-I) was used additionally.
Results. 3986 patients, 43% with recurrent depression, 25% with first episodes of depression and the remaining with anxiety disorders (panic disorder, obsessive-compulsive disorders, social phobia) were involved in the study. A significant reduction in the severity of symptoms according to CGI-S and CGI-I was found. Both patients with depressive episodes and anxiety disorders treated with Aciprex reported a significant reduction of the negative impact of symptoms on activity, sleep, relations with others and general quality of life. Side effects from their gastrointestinal systems and central nervous systems appeared in 5% of patients and were usually of mild intensity (61.6%). Only 13 patients with side effects led to the discontinuation of treatment.
Conclusions. The eight-weeks of treatment with Acirex showed a significant improvement in their symptoms of depressive episodes and anxiety disorders as well as the reduction in the negative impact of symptoms on different aspects of patients functioning was found. Aciprex was well tolerated, side effects typical for SSRI’s were reported by less than 5% of patients.
Ceruloplasmin is the main protein involved in copper metabolism. Ceruloplasmin plays a significant role in iron metabolism; it facilitates oxidation ferrous ion to ferric ion and encourages binding ferric ion to transferrin and ferritin. Taking into account its iron oxidase activity, ceruloplasmin belongs to a ferroxidases subclass.
Ceruloplasmin activity is decreased in many neurodegenerative disorders: aceruloplasminemia, Alzheimer’s disease and Parkinson’s disease. This observation coexists with iron (ferric ion) deposits in many organs. In Alzheimer’s disease, Parkinson’s disease and aceruloplasminemia ferric ion accumulation results in apoptosis on free radicals damage pathway. In Wilson’s disease, impaired intracellular copper transport results in low serum ceruloplasmin and tissue copper accumulation. All periods of mechanisms of damages of cells have not been explained so far. Further research is essential concerning the damage to free radicals neurons in neurodegenerative diseases and possible ways of treatment.
Over the last few years psychiatrists have been increasingly concerned about obesity, dyslipidemia and raised glucose levels in patients taking antipsychotics. The problem of metabolic syndrome is significantly more frequent (up to 2‒3 times) in this group of patients. In this paper, we have presented a summary of the mechanisms responsible for increased appetite and weight gain induced by antipsychotics. These two phenomena underlie further metabolic abnormalities. Due to high prevalence of metabolic disorders and their effect on increased cardiovascular risk, the systemic evaluation of basic risk factors (abdominal obesity, cholesterol, triglycerides and glucose, blood pressure) is necessary in all patients taking antipsychotics (the same applies to antidepressants and mood stabilizers).
The cytochromes P450, a family of heme proteins, play an important role in the oxidation of drugs, toxins, as well as endogenous substrates, e.g. neurotransmitters. Quantitatively, the liver is the major drug metabolizing organ; however, the metabolism of drugs in the brain could modulate the pharmacological and pharmacodynamic effects of psychoactive drugs at their site of action.
Interestingly, CYP2D6 levels are higher in many brain regions of human smokers and alcoholics. CYP2D6 is expressed in brain regions and that enzyme activities correlate with protein and mRNA levels.
Constitutive expression of CYP2D6 in CNS may create a local environment of drug metabolism, which – along with the potential neurotransmitter modulation – may contribute to altered sensitivity and inter-individual variability in psychotropic drug response.
Objective. Valproic acid (VPA) is used in epilepsy treatment and as a stabilizer in bipolar disorder for over 40 years. Extremely rarely it can cause symptoms of Parkinsonism of unknown mechanism.
Case. We present the 76-year old male with symptomatic epilepsy treated with VPA, who developed severe extrapyramidal syndrome in a form of bradykinesia and hypertonia of upper and lower extremities within 2 days after an increase of a dose of VPA. CT scan excluded acute ischemic and haemorrhagic lesions. The level of VPA in plasma was in the reference range. Decreasing a dose of VPA caused improvement in motor functions and better gait. The symptoms withdrew completely within the following 3 months.
Discussion. It is important to consider side effects of VPA, when patients develop Parkinsonian syndrome during therapy. Discontinuation of the drug usually results in reduction in the Parkinsonian symptoms or its complete remission.
The aim of the report is to describe training for psychiatrists, which took place in Oxford from June 29th to July 4th, 2014. We present an overview of the topics of lectures and workshops, and the atmosphere of the international meeting. The attached list of publications helps to foster a closer acquaintance with the conclusions of the lecturers, who led this year’s School of Neuropsychopharmacology.