2005, volume 21, issue 4


Psychopharmacologic management with woman with affective disorders during pregnancy

Małgorzata Rzewuska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 301-314

Psychopharmacologic management decisions with newer agents represent controversial aspect of treating pregnancy women with affective disorders. Most antipsychotic drugs, mood stabilizers and antidepressants have been identified by FDA as category C (i.e. human teratogenicity cannot be ruled out) or category D (i.e. positive risk of human fetal teratogenicity has been demonstrated), most existing information about pregnancy outcomes derives from small registries, in patients with another diagnosis (epilepsya, schizophrenia).
With most psychotropics, decisions about unknown relative risks must be balanced on individual data about psychopathology, and risk associated with course and untreated illness. Major congenital malformations are in the general population in 2-3% offsprings regardless of psychotropic drug use.
Moreover, the possibility exists that some disorders, including affective, may confer elevation of risk for complications during pregnancy.
Specific pharmacologic management may vary during first, second and third trimesters, and risk of relapse is various. All these factors must be carefully consider, before decision. This review summarized current information about safety of use of psychotropic medication during pregnancy. Recommendations are presented for clinical management.


Adding reboxetine in depressed patients with inadequate response to treatment with selective serotonin reuptake inhibitors

Jan Jaracz, Maria Chłopocka-Woźniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 315-320

Reboxetine added to SSRI in depression resistant to SSRI alone. The aim of these open study was to compare the efficacy of continuation treatment with selective serotonine reuptake inhibitor (SSRI) alone and combination therapy i.e. SSRI + reboxetine (RBX) in a group of patients with major depression who did not respond to 4 weeks treatment with SSRI. Depressed patients (n = 28) who did not respond after 4 weeks of therapy with SSRI were enrolled either to a group of patients who remained on the same SSRI (n = 15) or the group (n = 13) were RBX (4-8 mg b.i.d) was administered to ongoing treatment with SSRI for two weeks. At least 50% reduction of HDRS score, when compared to the onset of treatment, was observed in 8 (61%) patients treated with SSRI + RBX and 4 patients (26%) from SSRI group. Mean HDRS score in SSRI+RBX group (9,5 SD ± 5.6) was significantly lower (p = 0,01) when compared to SSRI group (16,1; SD ± 6.7). Combination of SSRI and RBX did not cause any significant side effects. Conclusions: Addition of RBX to SSRI seems to effective in patients who did not respond to 4-weeks treatment with SSRI alone.


The treatment of „poststroke depression”

Tomasz Sobów
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 321-328

The concept of poststroke depression as a nosological entity, despite decades of research, remains controversial. Neither its biological nor psychopathological specificity has never been unambiguously confirmed. Although some correlates between clinical characteristics of poststroke depression and some patient-related (age and gender) and stroke-related (localization) variables have been proposed, it seems reasonable to treat stroke as a pathoplastic than a causative factor. Effective treatment of poststroke depression affects the outcomes of rehabilitation, in particular patients functional abilities and activities of daily living.
No standard or generally recommended treatments exist for poststroke depression and welldesigned clinical studies are sparse. Nortriptyline has been proved to be effective, though its use (the same is true for other tricyclics) is limited by side effects. Citalopram, trazodone and reboxetine have also been evaluated in controlled trials and evaluated as helpful. The results of one study suggest that citalopram might be of choice when depression is accompanied by significant anxiety while reboxetine when apathy and withdrawal are prevailing.
Psychological interventions have not been so far systematically evaluated, still behavioralcognitive therapy is often indicated.
A small number of pharmacological prevention of poststroke depression trials have been conducted showing conflicting and rather discouraging results.


Antidepressants in the treatment of pain syndromes

Adam Miller, Jolanta Rabe-Jabłońska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 329-342

Antidepressant drugs have been used for many years to treat various pain syndromes. The mechanism of analgesic action is still unclear. The following factors most likely contribute to this effect: interfering with noradrenergic, serotoninergic, dopaminergic, GABA-ergic and opioid systems, adenosine reuptake inhibition, blocking of the NMDA receptor and ion channels. Analgesic action of tricyclic antidepressants (TcA) have been proven. In spite of their improved tolerance, selective serotonin reuptake inhibitors do not appear to be particularly effective in the treatment of pain. Recently, a number of controlled trials with selective serotonin and noradrenaline reuptake inhibitors, such as venlafaxine, milnacipran and duloxetine, suggest that these drugs are as effective in relieving pain as TcA and better tolerated. The analgesic effect of antidepressants seems to be independent of their antidepressant effect.


Discontinuation of selective serotonin re-uptake inhibitors (SSRI)

Emilia Kołodziej-Kowalska, Jolanta Rabe-Jabłońska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 343-354

Although SSRI's are widely used and generally considered safe, an abrupt cessation of SSRI may result in a discontinuation syndrom that can mimic serious illness and be distressing and uncomfortable. The authors present a review of up-to-date knowledge concerning the incidence, clinical symptoms, pathomechanizm, risk factors and principles of prevention and treatment of SSRI's discontinuation syndrome. Authors discuss problems associated with differentiation of SSRI discontinuation symptoms from recurrence of depression or coexisting diseases and any potential consequences of failure to correctly recognize this syndrome.


Norepinephrine transporter gene polymorphism and prophylactic lithium treatment in bipolar affective disorder

Agnieszka Permoda-Osip, Janusz Rybakowski, Aleksandra Suwalska, Monika Dmitrzak-Węglarz, Piotr Czerski, Anna Leszczyńska-Rodziewicz, Joanna Hauser
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 355-361

Disturbances of noradrenaline neurotransmission probably play a role in the pathogenesis of bipolar affective disorder. The purpose of the present study was searching for an association between 1287 A/G polymorphism of noradrenaline transporter gene (nroepinephine transporter - NET) and a prophylactic effect of lithium carbonate in patients with bipolar affective illness. The study included 90 subjects (52 women and 38 men) with bipolar affective illness. The mean age of the patients was 52 ± 12 years and the duration of lithium therapy was 14,6 ± 7,3 years. Serum lithium concentration in those patients was in the range of 0,5 to 0,8 mmol/l. Patients were divided into three groups, depending on the efficacy of lithium carbonate prophylaxis: excellent lithium responders, partial lithium responders and lithium non-responders. In the group of investigated patients, no relationship between the quality of lithium prophylactic effect and the studied polymorphism of NET gene was found.


Effects of new antiepileptic drugs on cognitive functions

Iwona Halczuk
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 363-379

People with epilepsy are at increased risk of cognitive deficits as a result of various factors: structural brain lesions, genetic background, the effect of seizures themselves, psychosocial factors and adverse effects of antiepileptic drugs. The major cognitive effects of antiepileptic drugs are impaired attention, memory, vigilance, and psychomotor speed, but secondary effects on other cognitive functions can be seen. The adverse cognitive effects of antiepileptic drugs are offset in part by reduced seizures. Antiepileptic drugs-induced cognitive side effects are increased with rapid initiation, higher dosages, and polytherapy. Some patient groups may be at particular risk of adverse cognitive effects of antiepileptic drugs (e.g. elderly, children, fetus). The ultimate therapeutic goal is to control seizures with no or minimal side effects. Multiple studies have demonstrated that antiepileptic drug therapy may have consequences on cognitive function. Most of new antiepileptic drugs are at least as effective as the “old” antiepileptic drugs and, in general, they seem to be better tolerated than the old drugs. The new antiepileptic drugs might have less influence on cognitive functions but the aspect has not been systematically studied.


EEG changes in patients with eating disorders

Wojciech Jernajczyk, Irena Namysłowska, Cezary Żechowski, Aleksandra Wierzbicka, Antoni Jakubczyk, Adam Wichniak, Krystyna Czasak, Iwona Musińska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 381-388

In present study we analyzed visually EEG recordings of females with anorexia nervosa. 126 patients had not taken any medication for at least 2 weeks prior to the EEG examination and 52 females were treated with psychotropic drugs. Similarly, there were collected EEG recordings of females with bulimia nervosa, among them 82 EEG recordings of non-medicated patients and 36 of treated ones with psychotropic drugs. All recordings were estimated with regard to presence of abnormalities, their type, localization and intensity.
In the group of patients with anorexia nervosa there were observed significantly more abnormal EEG examinations than within the group with bulimia nervosa. Moreover, in females with anorexia the abnormalities in EEG were more pronounced, with epileptiform discharges and right hemisphere lateralization.


The effect of olanzapine (zolafren) on cognitive functions in schizophrenia

Alina Borkowska, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 389-395

 In this study, the effect of treatment with the generic form of olanzapine (Zolafren, produced by ADAMED company) on different aspects of working memory and verbal fluency in schizophrenic patients was investigated. Thirty-three schizophrenic patients (18 male and 15 female), aged 20-48 (mean 32 ± 9) years, participated in this research. Psychopathological symptoms were evaluated using Positive and Negative Syndrome Scale (PANSS), and for cognitive assessment Trail Making Test (TMT), Stroop Test, Verbal Fluency Test and Wisconsin Card Sorting Test (WCST) were used. The clinical and neuropsychological evaluation was done before, and after 1, and 3 months of Zolafren administration. The daily dose of Zolafren was 10-20 (mean 14,2 ± 3,6) mg/day after 1 month of treatment, and 5-20 (mean 13,0 ± 3,6) mg/day after 3 months.

The positive effect of Zolafren treatment was found on psychopathological symptoms and on cognitive functions, such as psychomotor speed (TMT A), visuospatial working memory (TMT B), verbal functions (Stroop Test and Verbal Fluency) and on working memory and executive functions (WCST). Favorable effect of the drug on cognitive functions was especially evident after 3 months of treatment.


PIP-syndrome caused by carbamazepine and oxcarbazepine - case raport

Agnieszka Piróg Balcerzak, Małgorzata Luks
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 397-401

Syndrome of psychosis,intermittent hyponatremia and polydipsia is a water-electrolyte disturbance observed in some psychotic patients, mainly with schizophrenia or schizoaffective disorder. Hyponatremia may be the first symptom of that syndrome and in some cases it leads into neurological syndrome named water intoxication. Some medicines in different mechanism may cause PIP-syndrome, including antipsychotics and anticonvulsant drugs. The treatment is based on waterelectrolyte disturbances’ correction, applying synthetic vasopressin and steroids. This report describes the case of schizoaffective disorders inpatient, with PIP-syndrome caused by thioridazine and carbamazepine. Treating with synthetic vasopressin exacerbated the disturbance, likewise the trial of changing CBZ into OCBZ. The other anticonvulsant drugs used in this patient caused withdrawal of PIP-syndrome, what suggest that the reason of it was CBZ and OCBZ.


Extrapyramidal symptoms connected with a sudden discontinuation of risperidone treatment

Małgorzata Luks, Agnieszka Piróg-Balcerzak
Farmakoterapia w Psychiatrii i Neurologii, 2005, 4, 403-408

Extrapyramidal symptoms are the main group of side-effects connected with antipsychotic’s treatment. At this case report I describe a patient with all kinds of EPS - acathisia, dyskinesia, parkinsonism and dystomia. 25 year old patient JK diagnosed with schizophrenia for 5 years suffered intense dystonia connected with nape's muscles, oral and upper limbs dyskinesis after rapid risperidon withdrawal. Also, in different intensity, other EPS apper.
The reduction of dyskinesis, and the improvement of patient’s mental health has been reached by amisulpride and klonidyne treatment.