2020, volume 36, issue 2

Original article

A randomized, double-blind, placebo-controlled study of polyunsaturated fatty acids efficacy in adolescents with anorexia nervosa

Agnieszka M. Piróg-Balcerzak, Anna K. Bażyńska, Katarzyna Biernacka, Joanna Brągoszewska, Lidia Popek, Barbara Remberk, Natalia Orlecka, Filip Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 95–106

Objective. Omega–3 polyunsaturated fatty acids (PUFAs) were tested in adolescent depression and in several neurodevelopmental disorders with partial success. Anorexia nervosa (AN) is characterised by deficiencies in fatty food intake and frequent comorbidity, including depressive and cognitive symptoms. Thus supplementation with PUFAs may be beneficial in this group of patients. The aim of the study was to assess whether PUFAs as an add-on treatment is associated with better improvement of body mass index (BMI) and psychopathological symptoms than placebo in patients with AN.

Method. 61 female adolescent inpatients with AN were randomly allocated to omega–3 PUFAs supplementation or placebo for 10 weeks. Patients also participated in the behavioural programme and eclectic psychotherapy (treatment as usual, TAU). At baseline and follow-up visits, patients’ BMI and psychopathology were assessed with Clinical Global Impression Scale (CGI), Patient Global Impression Scale (PGI), and Eating Attitude Test (EAT-26).

Results. After 10 weeks, both groups showed improvement in all parameters. Improvement in CGI scores was observed greater in placebo vs. PUFA-s group (p = 0.015) while other differences were not statistically significant. Omega–3 PUFAs supplementation appears not to be effective as an add-on treatment in inpatient adolescent girls with anorexia nervosa.

Conclusions. The results should be analysed with caution due to small sample size and heterogeneity in TAU. As the TAU turned out to be highly effective, additional therapeutic effect of PUFA might not be visible. Nevertheless, that does not explain the tendency for better improvement in the placebo group.

Original article

The assessment of psychopathological symptoms and the course of schizophrenia depending on gender, duration of the disease, somatic comorbidity and suicide attempts

Marta Broniarczyk-Czarniak, Agata Orzechowska, Piotr Gałecki
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 107–115

Objectives. Schizophrenia is a chronic mental disorder with periods of exacerbation and remission. The prevalence during life is estimated at 0.5–1%. The study aims to prove that there are differences in the prevalence of positive and negative symptoms of schizophrenia depending on the gender and duration of the disease, and to confirm that there is a relationship between the factors such as the occurrence of somatic diseases and the risk of suicide attempts, and a specific clinical picture and course of the disease.

Material and methods. The study included 76 patients with schizophrenia treated with standard antipsychotic pharmacotherapy. The severity of psychopathological symptoms was assessed after admission to hospital using the scale of positive and negative symptoms and the sociodemographic survey created for the purposes of this study.

Results. The first episode of schizophrenia in men occurs earlier than in women. There are no statistically significant differences in the psychopathological picture of the disease in men and women. The severity of negative symptoms increases with the duration of the illness for the entire population of the study. Patients with schizo­phrenia without co-occurring somatic diseases have more severe positive symptoms of illness. There are no statistically significant differences in the group of patients who attempted suicide and who did not.

Conclusions. Positive symptoms of the disease are more common in younger patients without somatic diseases while negative symptoms increase with age. Men develop first symptoms of schizophrenia earlier than women. It is not possible to distinguish the dominant group of psychopathological symptoms for women and men in patients who suffer somatic diseases and attempt suicide more often.

Review article

Lurasidone – pharmacodynamic and pharmacokinetic properties, clinical potential and interaction risk

Marcin Siwek, Anna J. Krupa, Anna Wasik
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 117–134

Lurasidone is a novel second-generation antipsychotic approved for the treatment of schizophrenia and bipolar depression in adults. It displays high affinity for D2 and 5-HT2A and 5-HT7 receptors, moderate affinity for 5-HT1A and α2C-noradrenergic receptors, and negligible affinity for histamine H1 and muscarinic M1 receptors. It acts as potent D2, 5-HT2A and 5-HT7 antagonist and partial 5-HT1A agonist. Lurasidone taken orally is rapidly absorbed with the time to maximum concentration of 1-3 hours. Lurasidone should be taken with food (at least 350 kcal) due to limited absorption. The mean elimination half-life of lurasidone is 18.1–25.5 hours for doses 20–80 mg/day and 28.8–37.4 hours for doses of 120–160 mg/day. Steady-state is reached within 7 days. The drug is metabolised via CYP 3A4 and excreted mainly in faeces (67–80%) and with urine (about 8–19%). The use of lurasidone with strong inhibitors or inducers of CYP 3A4 (e.g. ketoconazole, erythromycin, or carbamazepine, respectively) is contraindicated. In the case of combined treatment of lurasidone and moderate inhibitors of CYP 3A4, the dose of lurasidone should be decreased to 40 mg/day. Lurasidone is an inhibitor of P-glycoprotein and could increase the level of digoxin and potentate the side effects risk of this drug. Pomelo, grapefruit, or a large amount of oranges should be avoided in the diet during treatment with lurasidone. Pharmacodynamic properties of lurasidone underlie its antipsychotic, antidepressant, precognitive, and sleep-awake rhythm normalising activity.

Review article

The role of blocking serotonin 2C receptor by fluoxetine in the treatment of bulimia

Marek Krzystanek, Artur Pałasz
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 135–141

Fluoxetine serves as a primary drug for the pharmacological treatment of binge eating. Its activity usually consists in blocking 2C serotonin receptors. This may be considered to be controversial since agonists of this receptor are effective in pharmacological treatment of bulimia. Bulimia episodes occur as a result of a decrease in serotonergic activity in the central nervous system. The mechanism is clinically confirmed. Drugs which increase the activity of the serotonin system in suppressing binge eating proved effective. The anorexigenic effect of drugs which increase the activity of the serotonin system results from the stimulation of serotonin receptors and not from their blocking. Appetite regulation and binge eating are associated with the activity of the dopaminergic and serotonergic systems. Experimental studies conducted so far prove that the increase in dopaminergic activity in the structures of the reward system is caused by stimulation, and not blocking, of serotonin 2C receptors. The anorexigenic effect of proserotonin drugs may also result from the stimulation of type 3 serotonin receptors and possibly 2C on neurons located in the nucleus of solitary tract. The psychopharmacological investigation conducted in this paper revealed the role of 5-HT2C receptors in the pathogenesis of bulimia nervosa and the mechanism of action of fluoxetine in the treatment of binge eating. Based on existing knowledge, the fact that fluoxetine blocks these receptors does not appear to play a significant role in appetite suppression. Due to few experimental works, the problem requires further research.

Case report

A severe course of the COVID-19 in a patient receiving prophylactically lithium

Karolina Gattner, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 143–148

Introduction. The SARS-CoV2 pandemic makes a challenge for patients with bipolar disorder receiving prophylactically lithium. There have been findings pointing to the antiviral effect of lithium which arouse suppositions that using the drug may prevent or attenuate the illness.

Case report. A 58-year old male patient, inhabitant of Lombardy, with bipolar disorder for more than 20 years, who have been receiving prophylactically lithium and valproate since 2010. In February 2020, became infected with COVID-19 disease, with a temperature of 40°C; chest pain, dyspnoea, and dry cough developed. SARS-CoV2 infection was confirmed by PCR test; chest imaging showed characteristic changes for the infection. He was treated with antibiotics, oxygen, fluids, and antipyretic drugs. Hyperpyrexia and respiratory problems persisted for 40 day; full recovery occurred after 7 weeks.

Comments. This case shows that also in patients on long-term lithium therapy, COVID-19 may run a severe course.

Case report

New psychopharmacotherapy dilemmas associated with COVID-19 – case report

Jolanta Kucharska-Mazur, Jędrzej Stańczak, Jerzy Samochowiec
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 149–153

Introduction. Due to the current pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is necessary to take therapeutic decisions concerning the simultaneous use of psychopharmacology and drugs supporting the elimination of the virus, especially chloroquine.

Case study. A 36-year-old female patient, with a diagnosis of paranoid schizophrenia, treated with clozapine, zuclopenthixol and lamotrigine, was diagnosed with SARS-CoV-2 infection. Following the recommendations of a specialist of infectious diseases, azithromycin and chloroquine were introduced to the treatment. Due to potential drug interactions, morphology, AST, ALT and ECG were monitored. No abnormalities of monitored parameters were observed. The virus was effectively eliminated.

Comments. With appropriate patient monitoring and care, antipsychotics were successfully combined with chloroquine and azithromycin in short-term therapy of lung inflammatory changes associated with SARS-CoV-2 infection.

Case report

Psychotic disorders as an adverse effect of levetiracetam or discontinuation of mood stabilising drugs

Katarzyna Kurczych, Agnieszka Makulska, Iwona Kurkowska-Jastrzębska
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (2), 155–163

Patients using antiepileptic drugs (AEDs) suffer from relatively common adverse effects manifested by psychotic and behavioural disorders. This is particularly true in patients with a history of psychiatric disorders and using levetiracetam. This has important therapeutic implications because very often discontinuation of AED is the only available option. Simultaneous use of mood-stabilising AEDs reduces this risk; however, too rapid withdrawal of such AEDs can also induce psychotic symptoms.

We present four cases of epilepsy patients who experienced psychiatric disorders induced by LEV. In one of them, they occurred after adding LEV to the treatment; in two – after discontinuation of a mood-stabiliser; and in one both modifications were made simultaneously. Our cases show that LEV-induced behavioural disorders are dose-dependent and do not always require discontinuation of the drug. This seems to be justified by good seizure control ensured by the use of LEV, and using mood-stabiliser reduces LEV adverse effects.