2017, volume 33, issue 1

Original article

Lithium influence on circadian rhythm assessed by the Composite Scale of Morningness in remitted bipolar patients

Ewa Dopierała, Adrian Chrobak, Anna Tereszko, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (1), 9–20

Objectives. Biological rhythm disturbances make an etiological factor and a feature of bipolar disorder (BD). Bipolar patients are more likely to represent an evening chronotype. Lithium, hich is used in the treatment and prophylaxis of BD, favorably influences biologicalrhythms. In this study, we evaluated the lithium therapy effects on circadian rhythm in remitted bipolar patients
compared to healthy controls. 

Material and methods. Fifty-four remitted BD patients (37 female and 17 male), aged 52 ± 13 years and 54 healthy control subjects (29 female and 25 male) aged 42 ± 14 years were studied. Half of the patients were treated with lithium. We assessed each of the subjects using the Composite Scale of Morningness (CSM). 

Results. Bipolar patients taking mood-stabilizing drugs other than lithium – BP Li (–) achieved 29.78 ± 9.81 points in the Composite Scale of Morningness, patients treated with lithium carbonate – BP Li (+) gained 35.67 ± 7.67 and average score of the control group was 35.04 ± 8.40. The greatest difference was obtained for "the time of best performance" (8th item of CSM), where BP Li (–) indicated significantly later hours during the day compared to BP Li (+) and healthy controls. 

Conclusions. The conducted study has many limitations, however, allowed to observe a significant effect of lithium on the circadian rhythm in euthymic bipolar patients. Lithium-treated patients showed more tendency to morningness compared from BP Li (–). Biological rhythm disturbances and worse quality of life are more common in people with an evening chronotype. The effect of lithium on biological rhythms can make a significant element of its mood-stabilizing action in BD.

Original article

Self-assessment of mood, cognitive status and chronic fatigue in conjunction with intensification of sleep apnoea

Marek Daniłosio, Jarosław Wysocki, Marcin Lepak, Edyta Staroń, Adam Broncel, Piotr Gałecki
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (1), 21–40

Objectives. Obstructive sleep apnoea (OSA) is a disease manifesting itself primarily with recurrent episodes of stopping breathing (apnoea) or significant shortness of breath (hypopnea) during sleep. OSA is also potentially related to a number of psychological problems generally not associated with impaired breathing during sleep. The objective of the study was to assess the relationship between the routinely measured sleep parameters and the patient's psychical condition assessed with the use of psychometric tests. 

Material and methods. Based on the results of polysomnography (PSG) tests, a study group was formed, consisting of 96 patients diagnosed with OSA, and a control group was formed, consisting of 24 patients, excluding OSA whose sleep disorders and excessive daytime sleepiness had other causes. The following self-assessment questionnaires were used in the study: Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Toronto Alertness Scale (TAS), Fatigue Assessment Scale (FAS), hypomania symptoms questionnaire (HCL-32), Beck Depression Inventory (BDI), Snaith-Hamilton Pleasure Scale (SHAPS). 

Results. The results in the TAS, FAS, HCL'32, BDI, and SHAPS were significantly correlated with the severity of obstructive sleep apnoea. Patients with severe and moderate sleep apnoea obtained significantly worse results in psychometric tests measuring the risk of affective disorders and the degree of attention than subjects with mild apnoea and subjects with sleep disorders with OSA excluded. 

Conclusions. A patient diagnosed with obstructive sleep apnoea should undergo routine psychiatric evaluation in order to assess the urgency of planned treatment, given the significant risk of affective disorders.

Review article

“All about grass”? Effects of cannabis on cognition

Alicja Anna Bińkowska
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (1), 41–52

Marijuana is one of the most popular and most frequently taken psychoactive substances in the world. Therefore, it seems particularly important to know the influence of this plant on the human thought and behaviour. This paper reviews the impact of cannabis use on cognitive functioning. In cannabis, there are over 100 different active compounds known as cannabinoids. The ones known best include Δ9-tetrahydrocannabinol (THC) and cannabidiol (CDB). These two compounds workdifferently, i.e. THC impairs the learning process, increases anxiety and causes effects similar to psychosis, while CBD supports the learning process, working in antipsychotic and anxiolytic way. Furthermore, CBD may diminish the negative effects of THC, hence the influence of marijuana is largely dependent on the mutual proportions of these two compounds. It is believed that the cognitive deficits caused by the use of THC are operably linked to the areas of highest density of CB1 receptors in the brain. The research results are relatively compliant with regard to the negative effect of THC on learning and memory. Majority of research suggests
a slight deficit in executive functions associated with the use of marijuana in regular smokers. The results of longitudinal studies suggest no effect of marijuana on intelligence, when other relevant factors, such as use of nicotine and alcohol, are taken into account.

Review article

Drugs used for premedication and anesthesia during electroconvulsive therapy in psychiatry

Katarzyna Osten-Sacken, Agnieszka Permoda-Osip, Alicja Bartkowska-Śniatkowska
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (1), 53–65

Electroconvulsive therapy (ECT) is the most important and the most effective biological method of treatment in psychiatry. Currently, ECT treatment is performedwith premedication, muscle relaxation and anaesthesia. For premedication, the drug most commonly used is midazolam, which has rapid sedative effect and allows to decrease the dosage of drugs used for induction of anaesthesia. Recently, a possibility of premedication with dexmedetomidine, which may have beneficial effects on post-ECT anxiety, agitation, and delirium, has been indicated. In contrast to midazolam, the drug does not possess anticonvulsant properties neither exerts negative effects on memory. Succinylcholine is currently the only muscle relaxant used. Drugs for anaesthesia during ECT treatment include thiopental, propofol and ketamine. A number of researches have been performed on these anaesthetics concerning their influence on the ECT effectiveness, the ECT procedure and possible adverse effects. Comparison between thiopental and propofol showed significantly better therapeutic effect in patients receiving propofol in spite of shorter duration of seizures. The use of propofol has been associated with fewer cardiovascular side-effects. The findings on antidepressant effect of ketamine infusions have prompted the use of this drug during anaesthesia for ECT. Patient receiving ketamine showed slightly faster time of clinical improvement compared to those given thiopental or propofol; however, the final results were similar. Some research analyses pointed to a higher frequency of cardiovascular side-effects and cognitive dysfunction during ketamine anaesthesia.

Case report

Use of three antipsychotics in long-acting injections in a patient with psychotic symptoms, in the course of Huntington’s disease – case report

Marta Malinowska-Kubiak, Agnieszka Permoda-Osip
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (1), 67–75

Huntington's disease (HD) is a progressive neurodegenerative disease. Although the symptoms have been known for 150 years, there is still no effective treatment. Frequently, patients with HD experience co-occurring symptoms, such as mood swings, psychotic disturbances or aggression, thus many pharmacological interventions are undertaken with the aim of eliminating these
symptoms. This paper presents the case of a 50-year-old patient with Huntington's disease, repeatedly hospitalized in the Oskar Bielawski Regional Neuropsychiatry Hospital in Koscian. Owing to recurrent aggressive behaviour and to the appearance of positive symptoms, such as persistent persecutory delusions, and also because of lack of cooperation in outpatient care, it was particularly difficult to select appropriate neuroleptic treatment for this patient. The co-occurring symptoms were eventually reduced through the simultaneous use of three antipsychotics in the depot form.