2021, volume 37, issue 2

Original article

COVID-19 infection in 50 patients receiving lithium

Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (2), 113–121

Objectives. The aim of the study was a naturalistic observation of the occurrence and course of COVID-19 infection in fifty patients treated with lithium from March 2020 to March 2021 and not receiving the vaccination against COVID-19 during this period.

Materials and methods. The study group included 23 men and 27 women aged 23–71 (mean 45) receiving lithium for 1–45 (mean 7) years. Bipolar disorder (BD) was diagnosed in 46 patients, including BD type 1 in 19 patients and BD type 2 in 26 patients, and recurrent depression in one patient. The patients were treated with lithium to prevent manic and depressive recurrences, of which six underwent lithium monotherapy. Four patients with schizophrenia receiving clozapine were administered with lithium to treat and prevent neutropenia.

Results. In the study group, 37 patients (74%), including five patients receiving lithium monotherapy, did not develop the infection. The infection was mild in 8 patients and moderately severe in two. Two patients developed lithium intoxication. One patient died of COVID-19 related pneumonia.

Conclusions. The observations made on the study group show that COVID-19 infection occurred in one-fourth of lithium-treated patients. In the majority of the subjects, the infection was benign. The results also suggest that COVID-19 infection and related circumstances may be a risk factor for lithium intoxication.

Review article

Relapse prevention in schizophrenia: expectations and reality

Marek Jarema
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (2), 123–135

Aim. The aim of the paper was to evaluate the practical prospects for preventing from relapsing or worsening in schizophrenia patients.

Selected literature review. Some of the recent publications deal with the prospects for preventing from relapsing or worsening symptoms in patients suffering from schizophrenia. This paper reviews publications highlighting the effectiveness of such prevention measures.

Conclusions. The review revealed that both pharmacological and non-pharmacological methods of treatment may be useful in the clinical improvement of schizophrenia.

Review article

Review of the literature on the use of MRI in psychiatry with a focus on schizophrenia and bipolar and unipolar affective disorder

Jakub Majchrzycki, Agnieszka Permoda-Pachuta, Martyna Wachowiak
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (2), 137–149

Objectives. Broad neuroimaging studies currently play an important role in the understanding of the principles of the functioning of the central nervous system (CNS). This applies not only to the healthy nervous system, but also to many pathological processes responsible for neurological and psychiatric disease entities. Magnetic resonance imaging (MRI) as a diagnostic imaging method has been used in medicine since the 1970s. Currently, the diagnosis of mental disorders and the choice of treatment methods are based primarily on the patient’s history, a structured interview and ancillary psychological tests. However, there is still a lack of more objective methods that can solve many diagnostic problems.

Literature review. The aim of this paper is to present the methods of diagnosis by means of magnetic resonance imaging, helpful in many aspects of work with a patient diagnosed with a mental disorder. The paper reviews the literature on specific MRI techniques, such as volumetry, proton magnetic resonance spectroscopy, diffusion-weighted MR (DMR), fMRI (functional magnetic resonance imaging), MRI with magnetisation transfer coefficient, and tractography, which may open up new possibilities, also for psychiatry. Because of the large number of papers in this field, the focus was on three psychiatric disorders, i.e. schizophrenia and unipolar and bipolar affective disorder.

Conclusions. It seems likely that in future magnetic resonance imaging of the central nervous system may make it possible not only to differentiate between mental disorders or to forecast their course, but also to determine the effectiveness of treatment of mental disorders and to predict possible side effects of the applied pharmacotherapy or electrotherapy.

Review article

Perspectives of Wilson’s disease treatment

Agnieszka Antos, Tomasz Litwin, Marta Skowrońska, Iwona Kurkowska-Jastrzębska, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (2), 151–163

Objectives. Wilson’s disease (WD) is a genetic, neurodegenerative disorder caused by copper metabolism disturbances with subsequent pathological copper accumulation in organs and tissues (mainly liver and brain) with their secondary damage and clinical symptoms related to affected organs. The treatment of the disease is based on medications leading to negative body copper balance, i.e. (1) decreasing absorption of copper from the digestive tract (zinc salts); (2) increasing the copper excretion with urine (chelators: d-penicillamine, trientine, dimercaprol); and (3) liver transplant in specific clinical situations (acute liver failure, liver cirrhosis decompensation despite treatment). The article aims to review the available literature concerning the current research directions in WD treatment.

Literature review. During the space of last years, intensive research into the new treatment of WD has started, including: (1) new pharmacological agents (modified thermostable trientine, trientine with delivery system to central nervous system, molybdenum salts, methanobactin, and others); (2) gene therapy; and (3) cells therapy (hepatocytes transplant). We conducted a targeted literature review of PubMed articles written in English, using the following search terms: “Wilson’s disease,” “treatment perspectives,” and “gene therapy.” Reviews, original articles, randomised controlled trials, meta-analyses, book chapters, and abstracts published up to April 2021 were included. Below, we present a narrative synthesis of the extracted data.

Conclusions. Currently, chelators, medications decreasing absorption of copper from the digestive tract, and liver transplant are the treatment methods recommended by international societies as a WD treatment. Among the studies on new therapies for WD, the research with tetrathiomolybdate bis-choline is the most advanced and promising. Great hope can be associated with gene therapy.

Case report

Beneficial effect of lithium in female patient with bipolar affective illness and psoriasis

Przemysław Filipiak, Anna Jaskóła, Karolina Gattner
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (2), 165–171

Objectives. Psoriasis makes a relative contraindication for lithium treatment which can exacerbate its symptoms or induce it itself. On the other hand, lithium exerts immuno-modulatory activity.

Case study. In this paper, a case of a female patient is presented. The patient has been treated since 2012 for bipolar affective illness (bipolar disorder – BD) and psori­asis, which occurred for the first time during a depress­ive episode. Despite intensive pharmacological treatment, both as inpatient and outpatient, a satisfactory improvement of affective illness has not been obtained. After the introduction of lithium, a remission of BD was achieved as well as a reduction of psoriatic changes, which have been maintained until now (2021).

Conclusion. The remission of Bipolar Disorder (BD) on lithium can suggest that the patient belongs to the group of the so-called excellent lithium responders. In the presen­ted case remission of psoriasis was observed during lithium treatment. This case report must be treated with caution because remission could be spontaneous and the patient needs further observation.