Current issue

2019, volume 35, issue 2

Special article

Long-term pharmacotherapy aimed at maintaining abstinence or reducing alcohol intake in alcohol-dependent individuals. Guidelines from the Section of Pharmacotherapy of Polish Society for Research on Addictions (PTBU) and the Section of Psychopharmacology of Polish Psychiatric Association (PTP) – 2019 update

Janusz Rybakowski, Marek Jarema, Jerzy Samochowiec, Bogusław Habrat, Marcin Wojnar, Paweł Mierzejewski, Przemysław Bieńkowski
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (2), 95–110

The article presents update of the 2013 Guidelines of the Pharmacotherapy Section of the Polish Society for Research on Addictions (PTBU) and the Psychopharmacology Section of the Polish Psychiatric Association (PTP) on long-term pharmacotherapy aimed at maintaining abstinence or reducing alcohol intake in adult alcohol-dependent patients. Apart from practical guidelines for long-term pharmacotherapy of alcohol dependence, the authors present the areas of uncertainty, which still require further studies and scientific debate.

Original article

The effect of including other psychotropic medications into a long-term bipolar disorder lithium treatment on thyroid function

Agnieszka Kraszewska, Ewa Ferensztajn-Rochowiak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (2), 111–119

Background/Aims. Long-term bipolar disorder (BD) treatment with lithium exerts a significant effect on thyroid structure and function. Compared with BD patients who do not take lithium, patients treated with lithium have higher concentrations of thyroid-stimulating hormone (TSH) and free thyroxine (FT4), lower concentrations of free triiodothyronine (FT3), higher thyroid volume and higher occurrence of goitre. The aim of the study was to compare thyroid structure and function in relation to the inclusion of other mood stabilisers and antidepressants into a lithium treatment.

Method. The studied group consisted of eighty BD patients (27 male, 53 female) aged 24–85 years, receiving a prophylactic lithium treatment for the average of 19 ± 9 years. Fifteen patients underwent lithium monotherapy; in 17, lithium was administered concurrently with carbamazepine; in 17, concurrently with quetiapine; and in 11, concurrently with valproate. In 20 subjects, lithium was administered concurrently with antidepressants.

Results. In comparison with patients on lithium monotherapy, in patients who took lithium and antidepressant drugs, the concentrations of TSH were significantly higher, while in patients who took lithium and carbamazepine the concentrations of FT4 were lower. The concentrations of thyroid peroxidase antibodies (TPOAb) were significantly higher in patients who took lithium concurrently with antidepressants and concurrently with valproate. The highest frequency of goitre (70%) was observed in patients who took lithium concurrently with antidepressants.

Conclusions. The obtained results may suggest a significant effect of including other mood stabilisers and antidepressants into a long-term lithium treatment on thyroid structure and function. A limitation of the study is the small size of the groups.

Original article

Comparison of treatment costs at the Psychiatric Ward in Gryfice between 2016 and 2017, after the introduction of olanzapine long-acting injectable in hospital treatment

Wojciech Herman, Agnieszka Popielewska-Pawłowska
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (2), 121–129

Objectives. The aim of this study was to compare the costs of treatment at the Psychiatric Ward in Gryfice between 2016 and 2017, after the introduction of olanzapine long-acting injectable in hospital treatment.

Material and methods. Analysis of numerical data of the costs of treatment at the Psychiatric Ward in Gryfice (60 inpatient beds) between 2016 and 2017, data from the central hospital pharmacy – internal expenditure of medicines (OLAI, clozapine and zuclopentixol – acetate and decanoate). In 2016, two patients were treated with olanzapine long-acting injectable; in 2017, it was 25 patients, who met the diagnosis criteria for schizophrenia according to ICD-10 and the indications for the refund of the drug (recurrence of psychotic symptoms as a result of documented persistent lack of cooperation).

Results. Compared with 2016, in 2017, there were 104 fewer patients hospitalised (–7%); the number of patient-days decreased by 254 (–1.1%) and the number of patients diagnosed as schizophrenia lowered by 32 (–18.5%). The cost of pharmacological treatment decreased both per patient (reduction by 6.7%) and per patient-day (reduction by 12, 2%). The use of other drugs also decreased.

Conclusions. Introduction of olanzapine long-acting injectable in hospital treatment is economically beneficial in the short term. In 2017, as compared to 2016, a reduction in the cost of pharmacological treatment was achieved at the Psychiatric Ward in Gryfice (both per patient and per patient-day). The consumption of other neuroleptic drugs, such as clozapine and zuclopenthixol (acetate and decanoate), decreased, too.

Review article

Application of functional near-infrared spectroscopy in psychiatry and physical activity studies

Grzegorz Kolasa, Filip Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (2), 131–145

Objectives. Functional near-infrared spectroscopy (fNIRS) is one of the fastest developing neuroimaging modalities. Features, such as non-invasiveness, simplicity of application and resistance to motion artefacts, allow to take measurements and to create scientific experiments imitating real life conditions. In this review, we want to focus on the potential of fNIRS in the fields of psychiatry, neurorehabilitation and physical exercise. Additionally, we present the advantages of fNIRS over other neuroimaging techniques like fMRI, PET and EEG/EMG. We also consider potential directions of development and challenges which emerge in front of the fNIRS society.

Literature review. The main application in the discipline of neurorehabilitation is to monitor and to observe the repair mechanism of neurons after brain traumas. The non-invasiveness of infra-red light permits to investigate patients of both adult and child psychiatry. The utility of fNIRS as a diagnostic tool and a predictor is proven. Researchers are looking for functional abnormalities within the prefrontal cortex. fNIRS creates new possibilities in terms of exploration of the physical exercise. Recent articles consider which type of effort has the best effect on the hemodynamic response in the cortex. It seems that investigating the impact of the physical activity in group of psychiatric patients is an interesting direction.

Conclusions. Currently, we are at the breakthrough in the fNIRS technology. The number of new studies, more precise methods of data analysis, and availability of good quality systems help us to better understand how to design scientific experiments properly and reliably measure the activity of the cerebral cortex.

Case report

Behavioural Disorders in the form of Hypersexuality in a Patient with Epilepsy Undergoing Therapy with Levetiracetam – a Case Study

Elżbieta Szczygieł-Pilut, Anna Zajączkowska-Dutkiewicz
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (2), 147–153

Sexual dysfunction is a frequent and overlooked problem in patients with epilepsy. Despite the importance o f this pathology, there are still only a few scientific reports regarding this issue. This is particularly significant in the event of sexual dysfunction following the implementation of anti-epileptic pharmacotherapy. In this paper, the case of a patient with this type of disorder during antiepileptic levetiracetam monotherapy is presented.