2021, volume 37, issue 3

Original article

Suicides in Poland in the context of depression pharmacotherapy

Joanna M. Pawlak, Monika Dmitrzak-Węglarz
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (3-4): 187-203

Objectives. The aim of the article is to present data on the number of suicides in Poland in the period from 2000 to 2020 and to analyse changes in the number of suicides in the context of treatment with antidepressants.

Material and methods. The source of the data was the Police reports on deaths in suicide and the report of the National Health Fund. This report emphasises the increase in expenditure on services related to the diagnosis and treatment of depression and the reimbursement of antidepressants used in outpatient treatment. The calculations were performed using the Statistica 13 software.

Results. A very high or high (r < -0.6) negative correlations between the number of suicides and the following variables were found: the number of patients receiving prescriptions for reimbursed antidepressants, also in relation to the subgroup of patients under 18 years of age; the number of suicides and the number of patients at this age who were diagnosed with depression; the number of daily doses of the drug in reimbursed antidepressants; the number of sick days issued to the patient due to depression. However, in the 65–74 age group, the correlation between the number of suicides and the number of patients with prescriptions for reimbursed antidepressants was positive.

Conclusions. Bearing in mind the limitations of the presented analysis, emphasis should be placed on the study of cause-effect relationships in relation to suicidal behaviour in various age groups. In order to prevent suicide, a deeper analysis of the effectiveness of the available antidepressant treatment is necessary.

Original article

The influence of moderate physical activity on the concentration of particular fractions of brain-derived neurotrophic factor in the blood serum of patients with Alzheimer’s disease

Marcin Górniak, Maria Skibińska, Filip Rybakowski, Jan Jaracz, Monika Dmitrzak-Węglarz, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (3-4): 205-219

Objectives. To determine the influence of moderate physical activity (PA) on the changes in the BDNF (brain-derived neurotrophic factor) and mBDNF (mature BDNF) concentrations in the plasma of patients with Alzheimer’s disease (AD).

Material and methods. The study included 32 people diagnosed with AD of mild or moderate severity, previously not physically active, 16 of whom started training Nordic walking. The BDNF and mBDNF levels were determined before and after the 3-month study. Psychometric measurements were also carried out using the MoCA (Montreal Cognitive Assessment) and ADL (Activities of Daily Living) scales.

Results. During the observation period in the entire study group (32 people) and in the group with MMSE (Mini-Mental State Examination) with scores of 19–23 points (15 people), a significant increase in the serum BDNF concentration was found. In the group of people with the late-onset disease (N = 27), a significant increase in the serum BDNF concentration was found, regardless of PA and a significant increase in the mBDNF concentration only in the active group. There were no significant correlations between changes in the BDNF and mBDNF levels and the general functioning and cognitive performance measured on the MoCA and ADL scales.

Conclusions. The obtained results indicate the possibility of an increase in the BDNF concentration in the serum of patients with Alzheimer’s disease, which is not always related to physical activity and does not correlate with general functioning and cognitive performance. On the other hand, mBDNF may be a more sensitive indicator of the influence of AF on changes in the concentration of neurotrophins than BDNF.

Original article

Influence of binaural beats on the state of relaxation and mood

Julia Jurczyk
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (3-4): 221-233

Objectives. Alpha brain waves have a frequency of 8 to 12 Hz and in humans are most often associated with a state of relaxation, stress relief, and peace. The results of many studies show that brainwaves can be stimulated by the binaural beats with a frequency corresponding to the given waves. The following study was conducted in order to answer the question of whether binaural beats at alpha wave frequency (10 Hz) will affect subjective mood, executive functions, and decrease pulse rate under the influence of emotional stimuli. In the described study, it was assumed that these changes may be accompanied by an increase in the EEG signal strength in the alpha band.

Material and methods. A total of 30 people were subjected to a manipulation experiment involving listening to binaural beats, 15 in the experimental group, and 15 in the control group. The participants of the experimental group listened to binaural beats with a frequency of 10 Hz twice for 3 minutes, while the participants of the control group spent the same time in silence. Pulse measurements were taken in both groups, Emotional Stroop Test was carried out, and the UMACL questionnaire was completed. Afterwards, it was checked whether the mean values ​​of these variables were significantly different between the groups.

Results. The results of the analysis indicated that the subjects who listened to binaural beats at a frequency of 10 Hz had a higher hedonic tone, i.e. they declared more pleasure than those who did not undergo this stimulation. At the same time, the study showed no significant changes in the measurement of heart rate, executive functions, tension, or energy arousal between the groups.

Conclusions. The results do not clearly indicate whether and how binaural beats can affect mood, but they are the basis for further, in-depth research on the effect of binaural beats.

Review article

Lithium treatment and stress response in bipolar disorder

Ewa Ferensztajn-Rochowiak, Aleksandra Szczepankiewicz, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (3-4): 235-243

Objectives. This article aims to present the mechanisms of stress response in bipolar affective disorder (BPAD), in the context of the efficacy of lithium treatment. The biological concept of stress by Hans Selye is presented, including environmental stressors in the pathogenesis of BPAD. Genetic, epigenetic, and psychological factors are discussed in accordance with the predisposition-stress model. The relationship between the genetic and molecular basis of BPAD and the prophylactic efficacy of lithium are presented, including the negative influence of psychosocial stressors.

Literature review. The literature review was carried out in terms of the genetic basis of bipolar disorder in the context of the stress response, taking into account research on the glucocorticoid receptor (GR) gene and circadian clock genes, as well as on epigenetic mechanisms, i.e. DNA and histone methylation processes. The over 40-year history of research on psychosocial stress in the pathogenesis and the course of BPAD is presented, including a factor of early childhood trauma. The research on the influence of lithium on the biological components of the stress response (i.e. the GSK-3 enzyme, Bcl protein or glutamate concentrations) and the factors of the effectiveness of prophylactic lithium treatment were discussed.

Conclusions. In the pathogenesis of bipolar disorder, genetic and environmental factors interact with each other according to the predisposition-stress model. Psychosocial stress factors, such as early childhood trauma or insufficient social support, significantly reduce the long-term effectiveness of lithium prophylaxis. The most important genetic and molecular components mediating the stress response to lithium prophylactic efficacy concern the polymorphisms of the GR receptor – NR3C1 and the FKBP5 genes.

Review article

Complications of general anaesthesia in electroconvulsive therapy

Rafał Wojdacz, Anna Z. Antosik-Wójcińska, Łukasz Święcicki
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (3-4): 245-257

Objectives. Electroconvulsive therapy (ECT) is con­sidered an effective and relatively safe method of treatment in selected mental disorders. The electroconvulsive therapy-related mortality rate is very low and has been estimated at 2.1 per 100 000 treatments. However, like every medical procedure, electroconvulsive therapy might involve life-threatening complications. They are usually related to intravenous infusion of anaesthetics in general anaesthesia, epileptic seizures intrinsic to electroconvulsive therapy treatment as well as interactions with other medicinal products.

Literature review. The most common causes of death during electroconvulsive therapy are cardiac arrhythmia and acute coronary syndrome. The most frequent complication related to electroconvulsive therapy treatment is craniofacial trauma, especially dental and tongue injuries. Additionally, it is possible to observe complications within the respiratory system (prolonged apnoea, aspiration pneumonia, bronchospasm), nervous system (subarachnoid haemorrhage, subdural hematoma), or cardiovascular system (takotsubo cardiomyopathy).

Conclusions. The American Psychiatric Association (APA) does not point to absolute contraindications to electroconvulsive therapy; nevertheless, there are medical conditions that involve an increased risk of adverse events. However, when analysing the position of electroconvulsive therapy in the treatment of mental disorders, one should not only take into account the high effectiveness of the method, the transient nature of most side effects, and the relatively rare occurrence of serious and life-threatening somatic complications, but it should also be remembered that electroconvulsive procedures are often the treatment of choice and a rescue procedure saving the sick person’s life.

Case report

Obsessive compulsive syndrome in a patient treated by cariprazine in the course of schizophrenia with predominantly negative symptoms

Agnieszka Koźmin-Burzyńska, Maciej Matuszczyk, Marek Krzystanek
Farmakoterapia w Psychiatrii i Neurologii 2021, 37 (3-4): 259-266

Objectives. The negative symptoms of schizophrenia pose a significant problem for both the patients and their surroundings, leading to impaired daily functioning. It is also a diagnostic and therapeutic challenge. A co-occurrence of obsessive-compulsive symptoms in the course of schizophrenia is a challenge in the selection of appropriate pharmacotherapy.

Case report. The following case study presents a gradual metamorphosis of symptoms and a way of functioning in a patient with a predominance of negative symptoms in schizophrenia under the influence of cariprazine, and the disclosure of previously unobserved thoughts and obsessive activities after modification of pharmacotherapy. The presented clinical case indicates that cariprazine is effective in the treatment of negative symptoms of schizophrenia and may cause secondary obsessive-compulsive symptoms.

Conclusions. In the case discussion, the authors point out that the possibility of obsessive-compulsive symptoms may relate to a group of antipsychotic drugs with antiserotonin activity.