2021, volume 37, issue 1

Review article

Pharmacotherapy of pandemic and post-pandemic stress-related mental disorders

Janusz Heitzman
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (1), 9–32

Objectives. The outbreak of the COVID-19 pandemic at the end of 2019, caused by the SARS-CoV-2 virus, manifested in the form of severe acute respiratory failure, also results in a reduced mental condition and resilience on an unprecedented scale and with consequences that are difficult to assess.

Literature review. It has been observed that the clinical picture of mental disorders manifested in reaction to confrontation with the pandemic trauma does not strictly coincide with the diagnostic criteria of commonly used diagnoses, i.e. acute stress reaction (ASR), acute stress disorder (ASD), and post-traumatic stress disorder (PTSD). In the case of PTSD in particular, it is difficult to adopt unambiguous criteria for a precise diagnosis during the ongoing pandemic. The occurrence of mental disorders in response to pandemic trauma depends on individual risk factors, the nature of traumatic stress, and environmental factors.

Conclusions. The phenomenon of a widespread population confrontation with the pandemic, more than the intensity of the stressor itself, prompts us to recall the possibility of effective pharmacological support in already existing pandemic mental disorders and to prepare for pharmacological intervention against mental disorders that will manifest themselves after the pandemic has expired.

Review article

Second generation antidepressants and the risk of arrhythmia

Julia Suwalska, Maria Napierała, Marek Proch, Iwona Szymańska, Magdalena Szydłowska, Bartosz Szablewski, Dorota Łojko
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (1), 33–44

Objectives. Second generation antidepressants belong to the most commonly prescribed medications; they are used in the treatment of depression, anxiety disorder, and pain. The aim of the study is to evaluate their risk of QT prolongation, which can lead to potentially life-threatening ventricular arrhythmias.

Literature review. Based on the Summary of Product Characteristics and CredibleMeds database, we present current knowledge about the risk of QT prolongation caused by second generation antidepressants. Recommendations concerning planning and conducting treatment using second generation antidepressants are discussed.

Conclusions. As scientific research shows, newer antidepressants cause fewer side effects than tricyclic antidepressants, but they are not devoid of them. For some of them, there is a proven risk of QT prolongation and torsade de pointes, which can, very rarely, lead to patient’s death. Before prescribing new antidepressants, clinicians should evaluate the patient’s risk of QT prolongation and, in case of high risk, they should apply the lowest effective dose, regularly monitor the patient’s condition, and inform the patient to consult a cardiologist if any alarming symptoms, such as syncope or palpitations, occur.

Review article

Two in one: simultaneous use of two long-acting antipsychotics in schizophrenia

Marek Jarema
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (1), 45–51

Objectives. This paper aims to review the literature regarding the possible simultaneous use of two long-acting antipsychotics in the treatment of schizophrenia.

Selected literature review. Despite using the appropriate dose in antipsychotic treatment and continuing it for the necessary period, it happens that such treatment may be considered ineffective. In such a case, to supplement the clinical effect of antipsychotics, the addition of a second antipsychotic medication, mood stabiliser, or an antidepressant may be considered. If the inadequate response to the treatment results from poor medication adherence, the use of long-acting antipsychotic is re­commended. Some clinicians, however, try to use two long-acting antipsychotics simultaneously.

Conclusions. Sparse available data did not allow us to conclude that the simultaneous use of two long-acting antipsychotic agents significantly improves the outcome of pharmacological treatment of schizophrenia.

Review article

Can the use of benzodiazepines increase the risk of dementia?

Jan Jaracz, Natalia A. Rakowska
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (1), 53–62

Objective. This study aims to provide up-to-date data on the possible relationship between the use of benzodiazepines and the subsequent occurrence of dementia.

Literature review. Benzodiazepines (BDA) have been used in medicine for over half a century. Initially, they were considered very safe, especially when compared to older generation drugs. Over time, more and more information about possible side effects became available and the problem of abuse and addiction was growing. One of the side effects of BDA is possible deterioration of cognitive functions, particularly relevant in elderly population. In recent years, numerous studies have been published, the results of which indicate the possible impact of using this group of drugs on the risk of developing dementia. The possibility of reverse causality, i.e. when BDA is included in the prodromal phase of dementia to alleviate such symptoms as anxiety or insomnia, is also discussed.

Conclusions. Although numerous studies confirm a higher incidence of dementia in BDA users, this relationship has not been clearly confirmed due to methodological problems and possible influence of many additional factors.

Review article

Influence of selected drugs used in the treatment of type 2 diabetes and cardiovascular diseases on depressive disorders in elderly patients

Daria Słomińska, Katarzyna Manikowska, Marta Hoszman, Przemysław Łukasz Mikołajczak, Hanna Winiarska
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (1), 63–74

Objectives. In geriatric patients, cardiovascular diseases and type 2 diabetes are considered the most common chronic health problems. Moreover, increasing the pre­valence of depression, which significantly reduces the quality of life and increases disability in this group, has also been observed. This paper aims to review the literature on the relationship between drugs from selected pharmacological groups used in the treatment of diabetes and cardiovascular diseases and depression, both with respect to their depressive and antidepressant effects.

Literature review. The increased risk of the prevalence and the severity of depression is associated with strongly lipophilic beta-blockers and insulin therapy. In contrast, drugs that block the RAA system reduce the risk of developing and worsening symptoms of depression and improve cognitive function in elderly patients. Literature reports indicate the antidepressant effect of commonly used antidiabetic drugs such as metformin and incretin drugs (GLP-1 analogues and DPP-4 inhibitors). The potential anti-depressive effect of intranasal insulin administration requires further research.

Conclusions. Based on the review, it should be stated that due to the frequent occurrence of mood disorders in elderly patients, the selection of drugs used in the therapy of somatic diseases should allow for the risk of causing or worsening symptoms of depression. However, the possibility of their beneficial effect on mood disorders should also be considered.

Review article

Why do patients not follow therapeutic recommendations?

Anna Jopowicz, Agnieszka Piechal, Agnieszka Piechal, Iwona Kurkowska-Jastrzębska
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (1), 75–93

Objectives. Adherence to medical prescriptions is a basic determinant of treatment success. Failure to comply with this rule is a serious problem that affects not only the patient but also the health care system. Non-adherence to medical treatment changes the course of the disease, can lead to deterioration of health or even death; also, it contributes to the increase in healthcare costs.

Literature review. Compliance with medical recommendations is influenced by many factors, which can be divided into factors dependent on the patient, healthcare provider and healthcare system, socioeconomic situation, and certain interactions between them.

Conclusions. In order to improve the compliance with medical recommendations, it is important to identify specific barriers for each patient and to adopt appropriate techniques to overcome them. Compliance with medical recommendations is improved with good cooperation between the doctor and the patient.