2015, volume 31, issue 3-4

Original article

Impulsivity in drug-naïve panic disorder as related to therapeutic intervention

Katarzyna Jakuszkowiak-Wojten, Jerzy Landowski, Mariusz Wiglusz, Wiesław J. Cubała, Maria Gałuszko-Węgielnik, Karol Grabowski
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3–4), 201–206

Objectives. Impulsivity is a key feature of several psychiatric disorders. However, the relationship between impulsivity and anxiety disorders is controversial and not well explored. The aim of this study was to compare impulsivity in healthy control and drug-naïve panic disorder patients before and after 8 weeks of therapeutic intervention.

Materials and methods. We examined 21 healthy volunteers and 15 psychotropic drug-naïve outpatients with panic disorder without agoraphobia before and after 8 weeks of treatment with escitalopram or Cognitive Beha­vioural Therapy (CBT). The severity of Panic Disorder was assessed based on the Panic and Agoraphobia Scale (PAS), CGI (Clinical Global Impression Scale), HADS (Hospital Anxiety and Depression Scale). Impulsivity was evaluated based on the Barratt Impulsiveness Scale, 11th version (BIS-11).

Results. The clinically significant improvement was observed with PAS, CGI and HADS-A in both treatment groups after the therapeutic intervention. That improvement was similar in both groups and both methods had equal efficacy in PD treatment. No statistically significant change in the score of total impulsivity before and after treatment was found regardless of the treatment applied (i.e. escitalopram or CBT).

Conclusions. Future research should be performed to examine the impact of impulsivity on panic disorders outcome. Higher impulsivity seems to be an independent and persistent trait in patients with panic disorder not linked with PD severity.

Original article

Total sleep deprivation with sleep phase advance in treatment-resistant depression

Ewa Dopierała, Ewa Ferensztajn-Rochowiak, Maria Chłopocka-Woźniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3–4), 207–219

Objectives. Treatment-resistant depression (TRD) is defined as a lack of adequate improvement after at least two appropriate courses of antidepressant drugs. Total sleep deprivation (TSD), just as sleep phase advance (SPA), is one of the methods of chronotherapy and their combination in the TRD could lead to a significant improvement. In this study, we examined the use of TSD with SPA in the TRD during pharmacotherapy.

Material and methods. The study was comprised of 12 patients with TRD in the course of bipolar or uni­polar mood disorder. Single TSD followed by three nights with SPA were used during ongoing drug the­rapy. Efficacy was evaluated using the 17-item Hamilton Depression Rating Scale (HAM-D) on the day before the TSD and on 1st, 2nd, 3rd, 4th, 5th, 6th and 14th day after the TSD.

Results. The mean HAM-D scoring before treatment was 22.7 ± 6.3. On the first day after the TSD, scoring decreased to 9.6 ± 3.9, six patients obtained remission (50%) and two of them (17%) showed improvement. Finally, on the 14th day of the research, the mean scoring was 9.5 ± 10.5, eight patients (67%) met the criteria for remission and the remaining 4 patients (33%) still presented depressive symptoms.

Conclusions. During the study of the integrated chrono­therapy, we observed a significant antidepressant effect in the form of rapid improvement and remission in a substantial proportion of patients with treatment-resistant depression. The effect maintained in the following days.

Original article

Cytokiny IL-2, IL-4, IL-6, IL-8 i IL-10 u młodzieży i młodych dorosłych ze spektrum choroby afektywnej dwubiegunowej – badania wstępne / Cytokines IL-2, IL-4, IL-6, IL-8 and IL-10 in adolescents and young adults with bipolar spectrum – preliminary results

Aleksandra Rajewska-Rager, Monika Dmitrzak-Węglarz, Maria Skibińska, Natalia Lepczyńska, Jacek Sikora
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3–4), 221–227

Objectives. In recent years, growing interest in neuroimmunology of affective disorders is observed. Changes in concentrations of cytokines may be a potential biomarker in mood disorders. However, despite the numerous studies in adults, there have been few studies of assessment cytokines levels in young patients with bipolar disorder. The purpose of this study was to assess selected cytokines in serum of adolescents and young adults diagnosed with mood disorders in various episodes of the disease.

Material and methods. The study included 33 young people aged 14–24 with a diagnosis of mood disorders on the spectrum of bipolar disorder. The diagnosis was carried out in accordance with the diagnostic criteria of ICD-10 and DSM-IV by two independent psychiatrists, using structured interviews (KSADS-PL, SCID). Clinical evaluation (Beck, HAMD, YADRS, HCL-32) and biochemical analysis was conducted during control subsequent visits (visit 0, week 12, month 6).

Results. The results showed a statistically significant correlation between the lack of depression symptoms and higher concentrations of interleukin-8 in the 12th week of the study (p = 0,017). However, the 6th month of the study revealed a higher concentration of Interleukin-6 in the subset of young adults (18 > years) compared to teenagers (p = 0.030). In the 6th month of the study, significant relationship was present between the change of diagnosis (into the direction of bipolar disorder) and the occurrence of higher concentrations of interleukin-8 in blood serum (p = 0.033).

Conclusions. Preliminary results suggest that cytokines levels may be a promising indicator for bipolar disorder in youth, although replication studies with a control group are required.

Review article

Psychobiotics: new possibilities for treatment of affective disorders?

Hanna Karakuła-Juchnowicz, Hanna Pankowicz, Dariusz Juchnowicz, Patrycja Szachta, Teresa Małecka-Massalska
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3–4), 229–242

Recent years have brought growing interest in potential connections between vintestinal microbiota and mental health.

Results from numerous studies indicate a modulatory role of microbiota in brain development and functioning via a complex of neural, endocrine and immune mechanisms related to normal functioning of the brain-gut axis. These findings, in turn, give rise to research into new treatment strategies for psychiatric disorders through modifications of the gut microbiota with the use of a new therapeutic group, i.e. psychobiotics. These are probiotic bacteria which, if consumed in adequate doses, influence the gut-brain axis functioning and consequently the state of patients suffering from mental illness.

The purpose of this paper was to define the current state of knowledge on the potential use of psychobiotics in the treatment of affective disorders. In order to present the analysed issues in a clear and comprehensive manner, the article is divided into the following subsections: (I) Intestinal microbiota: definitions, composition and functions; (II) From probiotics to psychobiotics: a historical perspective; (III) Mechanisms of action of psychobiotics in preclinical studies; (IV) Preclinical studies on the effect of microbiota on behaviour in animal models; (V) Clinical studies on the effect of microbiota on mental state in a group of healthy volunteers; (VI) Possibilities and future prospects for the psycho­-biotic-based treatment of affective disorders.

Preliminary study results raise hope that psychobiotics may be an important addition to the psychiatrist’s armamentarium as a therapeutic improving the efficacy of the treatment for affective disorders.

Review article

Stres oksydacyjny oraz uszkodzenia i naprawa DNA w zaburzeniach depresyjnych / Oxidative stress, DNA damage and repair in depression disorders

Piotr Czarny, Piotr Gałecki, Tomasz Śliwiński
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3–4), 243–249

Objectives. The aim of this paper is to elucidate the role of oxidative stress as well as DNA damage and repair in pathogenesis of depression, using the available literature.

Literature review. Depression is accompanied by activation of proinflammatory pathways, dysfunction of mitochondria, increase of oxidative stress markers and decrease of antioxidative defense. Last two factors can cause damage to biomolecules, including nucleic acids. Research carried out by our team and others confirmed that hypothesis. Higher oxidative DNA damage was found in depressed patients. Our results also indicate the presence of impairments in efficiency of such DNA damage repair in nuclei. Additionally, single nucleotide polymorphisms of genes encoding proteins involved in base excision repair (BER) – the main pathway removing oxidative DNA damage – can modulate the risk of depression and influence efficiency of DNA damage repair. These results may reflect the state of mitochondrial DNA.

Conclusion. Available literature confirms that oxidative stress and impaired efficiency of DNA damage repair together are responsible for elevated levels of nuclear DNA damage observed in depression. Similar processes can occur in mitochondria and may lead to mitochondrial DNA damage and dysfunction of these organelles. This, in turn, increases production of reactive oxidative species and may trigger vicious cycle. There is a need for further studies concerning the role of nuclear and mitochondrial DNA damage and repair in pathogenesis of depressive disorders, which could lead to the development of more efficient and personalized therapies.

Review article

Polipragmazja jako czynnik ryzyka zaburzeń neuropsychiatrycznych u pacjentów w wieku starszym / Polypharmacy as a risk factor of neuropsychological disorders in elderly patients

Leszek Spandel, Jadwiga Jośko-Ochojska, Agnieszka Batko-Szwaczka
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3–4), 251–260

This article discusses the importance of polypharmacy as a growing problem in modern medicine. This issue is most prominent in elderly population, which due to changes in the structure of society, is becoming one of the most common group of patients in a GP’s office. Statistically, every patient over 65 years of age uses between 4 and 8 medications simultaneously. Adverse effects of medicinal products are responsible for over 20% of instances of hospitalization in elderly patients, out of which up to 7% lead directly or indirectly to death. The paper discusses the adverse effects and interactions between multiple drugs which pose an increasing challenge when creating an individual therapy plan for elderly patients. Though guidelines for healthcare professionals such as Beers, STOPP/START criteria or Priscus list have been created in order to facilitate drug treatment and to help improve the safety of prescribing medications for older adults, they do not exhaust all the possible difficulties encountered when dealing with elderly patients. This article presents the most important rules, specificity and challenges of polypharmacotherapy in elderly patients, including physiological metabolism changes in elderly patients, multispecialist healthcare system, lower compliance in senior patient population, easy access to OTC drugs and supplements, and common adverse effects.


Sprawozdanie z VII Szkoły Neuropsychofarmakologii (ECNP), 5–10 lipca 2015, Oksford / Report on the 7th ECNP School of Neuropsychopharmacology, 5–10 July 2015, Oxford

Anna Antosik-Wójcińska, Michał Lew-Starowicz
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (3), 261–265

The aim of this report is to summarize the training for psychiatrists, which took place in Oxford between 5 and 10 July 2015. It presents briefly the topics of lectures and workshops and the events that accompanied this international meeting of scientists and clinicians. The most important conclusions from the lectures are concisely described. The list of publications is attached to enable broadening the knowledge on the topics discussed by the lecturers.