2017, volume 33, issue 3-4

Original article

Five-year observation of chronic renal insufficiency during lithium treatment. A case study of four patients

Maria Abramowicz, Agnieszka Permoda-Osip, Barbara Nowak, Paweł Olejniczak, Janusz K. Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 169–179

Objectives. The most frequent renal side-effect of lithium is an impairment of concentrating ability and, after 10–20 years, a chronic tubular-interstitial nephropathymay occur in some patients. Discontinuation of lithium, especially in "excellent lithium responders" (ELR), is associated with a high risk of relapse and a treatment-resistant course. The purpose of the study was to assess kidney function during a five-year follow-up in the ERL with the glomerular filtration rate (GFR) < 50 ml/min/1.73 m2.

Material and methods. Three males and one female were included. At the beginning their age was 61 ± 0.8 years and duration of lithium treatment was 27 ± 9 years. Kidney parameters (serum creatinine, GFR, and urine specific gravity) were assessed at least three times during the five-year follow-up period.

Results. The patients examined had the mean change of GFR of –2.5 ± 7.7%, serum creatinine –0.5 ± 7.3%, and urine specific gravity of 0.0025 ± 0.0041 g/ml. In three patients having the initial GRF between 47–48 ml/min/1.73 m 2 , the kidney parameters did not show significant changes and the patients continued lithium treatment as previously. The patient with the lowest GFR (32 ml/min/1.73 m 2 ) had a 14% decrease in GFR and a 10% increase in serum creatinine. The dose of lithium was decreased by one-third and he was placed under strict nephrological observation.

Conclusions. Based on the results and in the ELR with the GFR not much lower than 50 ml/min/1.73 m 2 , we suggest continuing lithium with a yearly check on kidney parameters. In the ELR with a much lower GFR, a reduction of lithium dose, and nephrological observation along with more frequent monitoring would be recommended.

Original article

Uric acid concentration in bipolar disorder and schizophrenia

Magda Malewska, Agnieszka Permoda-Osip, Paweł Kasprzak, Aleksandra Niemiec, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 181–187

Objectives. Uric acid regulates metabolic processes and influences neurotransmission and neuromodulation in the central nervous system. In recent years, there has been a growing interest in the role of uric acid as part of the purinergic system in the bipolar disorder and schizophrenia. The aim of the present study was to evaluate the serum uric acid concentration in patients suffering from bipolar disorder and schizophrenia during both acute episodes and in remissions.

Material and methods. The study involved 56 patients (25 men, 31 women), aged 45 ± 15 years. There were 19 subjects with bipolar depression, 15 subjects with bipolar mania, and 22 subjects with schizophrenia. In all patients, detailed psychometric assessment was performed. Uricacid concentration was assessed both during acute episodes and in remissions.

Results. There were no differences in uric acid levels between the three groups neither during acute episodes nor in remissions. Also, among the groups there were no differences between acute episodes and in remission. However, a group of patients had an abnormally high level of uric acid both during acute episodes and in remission: in depression: 37%, in schizophrenia: 18%, and in mania: 13%.

Conclusions. Although we were not able to find differences in uric acid concentrations between bipolar mania, bipolar depression and schizophrenia and, within each group, between acute episodes and remissions, disturbances in purinergic system in these illnesses cannot be ruled out. A significance of hyperuricemia, occurring in more than 1/3 of bipolar depressed patients, for pathophysiology and treatment requires further studies.

Original article

Adipokines and metabolic consequences of atypical antipsychotic drugs in children and adolescents

Marta Tyszkiewicz-Nwafor, Małgorzata Golec, Lidia Matuszak-Wojciechowska, Agnieszka Jarząbek-Cudo, Agnieszka Słopień, Filip Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 189–202

Objectives. Atypical antipsychotics (AA) are frequently used in the pediatric population which is more predisposed to developing a metabolic disorder. It is suggested that some of the hormones produced in adipose tissue
may be involved in the pathogenesis of these problems. The aim of the study was to assess the prevalence of metabolic consequences in the pediatric population treated with AAs and their association with levels of selected adipokines.

Material and methods. 27 patients hospitalized in thec cild and adolescent psychiatric ward (patient group – PG) and 33 healthy individuals (control group – CG) were enrolled in the study. Before pharmacotherapy and prior to being discharged from the hospital anthropometric measurements were taken and laboratory tests carried out. The serum levels of selected adipokines were measured in PG.

Results. After 6.92 ± 3,62 weeks of treatment with AA there was a statistically significant increase of body weight and Body Mass Index (BMI) in PG (p = 0.013), whereas the level of leptin receptors decreased (p = 0.039). Statistical significant positive correlations were observed between the level of leptin before the treatment and BMI (R = 0.634; p = 0.049) and the level of triglycerides (TG) (R = 0.722; p = 0.012) during the treatment. There was also a positive correlation between the level of leptin receptors prior the treatment and high-density lipoprotein (HDL) (R = 0.681; p = 0.043) during the treatment.

Conclusions. The increased body weight and BMI in pediatric population may occur after a few weeks of treatment with AA. It may be associated with changes in the levels of some adipokines. Furthermore, high initial level of leptin may be connected with changes in BMI and TG while initial level of leptin receptors can be associated with HDL.

Review article

Psilocybin: the possibility of therapeutic use in selected mental and neurological disorders

Karolina Dydak, Mariola Śliwińska-Mossoń, Marzenna Bartoszewicz, Halina Milnerowicz
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 203–223

Psilocybin is a psychoactive, low toxicity substance. It can be found in Psilocibe mushrooms. This substance is an agonist of serotonin receptors and affects the activity of the central nervous system. Moreover, psilocybin demonstrates regulatory activity of certain brain areas responsible for emotions, mood, memory and learning. The aim of this paper is to present the latest research studies on the use of psilocybin in treatment of depression, addictions and cluster headaches coming from different independent research centres. The scientific articles selected present only a fraction of all the published results, yet they show that psilocybin is a substance with  untapped therapeutic potential. The study focused on specific afflictions, such as drug-resistant depression and depressive symptoms in terminal diseases, nicotine and alcohol addiction, and cluster headaches. Most recent results from various independent research centres were chosen. Psilocybin is a substance that requires much research on bigger groups of patients in order to be able to fully confirm its therapeutic effects, evaluate its safety of use, and determine its long-term effects. However, it is a substance worth paying more attention to, despite the controversy it may raise as a psychedelic drug.

Review article

Adjuvant anti-inflammatory therapy in schizophrenia – current evidence

Filip Stramecki, Błażej Misiak, Dorota Frydecka
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 225–238

Schizophrenia is a mental disorder with overlapping biological, genetic and environmental factors. During the last years, extensive scientific studies have been carried out, demonstrating a close relationship between the immune system, inflammation and psychopathology of schizophrenia. The relationship between dysregulation of the immune system and the severity of psychotic symptoms and cognitive impairment in schizophrenia has  been demonstrated. In the last two decades, the use of anti-inflammatory drugs in the schizophrenia pharmacotherapy has been studied. The aim of this study is to review the latest scientific reports, focusing on adjuvant anti-inflammatory therapy in schizophrenia. Studies using cyclooxygenase inhibitors, involving mainly celecoxib, have shown they can be effective in reducing psychotic symptoms in patients during the first episodes of  schizophrenia and during an active phase of chronic disease. Despite many reports supporting efficacy of simvastatin in controlling positive and negative symptoms, its use is still a contentious issue due to the side effects. It has been reported that phosphodiesterase inhibitors can also be a group of drugs with a positive effect on the functioning of the patients suffering from schizophrenia. Pregnenolone, as a representative of neurosteroids, is effective in reducing the severity of negative symptoms of schizophrenia. Despite numerous studies, it is still not possible to create specific pharmacotherapeutic recommendations due to methodological limitations of the conducted research.

Review article

Vortioxetine or duloxetine – patient’s profile and individualization of therapy based on case reports

Piotr Baranowski, Dorota Kuczborska-Majda
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 239–250

Vortioxetine is a modern antidepressant with a broad receptor profile. In the US (Food and Drug Administration, FDA) and in Europe (European Medicines Agency, EMA) vortioxetine has been registered for the treatment of major depressive episodes in adults. Currently, however, trials are underway to extend the therapeutic indications for this drug. Duloxetine is a drug from the group of serotonin and noradrenaline reuptake inhibitors. Its registered indications include: major depressive disorders, diabetic neuropathic pain and generalized anxiety disorder. Both duloxetine and vortioxetine are registered for the treatment of adults.

Scientific conference report

Report of the 5 th ECNP School of Child and Adolescent Neuropsychopharmacology (Venice, Italy, 2–7 April 2017)

Anna Zielińska, Piotr Niwiński
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 251–261

The aim of the publication is to present the topics covered during the ECNP School of Children and Adolescent Neuropsychopharmacology which took place in Venice (2–7 April 2017). International experts provided high-level and up-to-date training in child and adolescent neuropsychopharmacology.

Scientific conference report

Report on the 9 th ECNP School of Neuropsychopharmacology, 25–30 June 2017, Oxford

Paweł Gosek, Michał Jarkiewicz
Farmakoterapia w Psychiatrii i Neurologii 2017, 33 (3–4), 263–271

The article presents the report of the 9 th ECNP School of Neuropsychopharmacology held on 25–30 June, Oxford. The authors discuss the structure and content of the course and also summarize a number of topics iscussed during the course, concerning the various aspects of etiopathogenesis, clinical imaging and pharmacotherapy of mental disorders.