2020, volume 36, issue 3

Review article

High dose aripiprazole – clinical use

Andrzej Juryk, Dominika Dudek
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (3), 177-185

Aripiprazole is a second-generation antipsychotic medication, with a dual mechanism of antagonist and agonist on the receptors D2. Despite the fact that it has been present on the Polish market for over a dozen years, and for several years in the form of the long-acting injections, for many doctors, it is not the drug of the first choice in the first episode of psychosis or mania, especially with accompanying psychomotor agitation. It also has an unjust opinion that it can exacerbate psychotic symptoms or increase agitation and the risk of aggression. However, it is more often used as a second-line drug in the presence of metabolic disorders or hyperprolactinaemia, as well as in the case of persistent negative symptoms. Multiple studies and meta-analyses suggest no benefit from aripi­prazole doses above 20 mg/day, but registered dosages are as high as 30 mg/day. This article aims to provide an overview of the available data and clinical cases with higher doses, i.e. above 15 aripiprazole per day, which may be useful in the treatment of manic episodes and some cases of schizophrenia, among others.

Review article

MDMA – hopes and fears associated with therapeutic use in mental disorders

Kamil Kozera, Lena Cichoń, Krzysztof M. Wilczyński, Małgorzata Janas-Kozik
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (3), 187-204

MDMA (3,4-methylenedioxymethamphetamine) is a psychoactive substance classified as a hallucinogen.

MDMA acts in the brain through a variety of neurochemical mechanisms, reducing anxiety, giving a sense of oneness with other people, expanding empathy, sharpening the senses and intensifying the experience of emotions. Therefore, the use of the MDMA assisted psychotherapy is being considered in selected disorders, such as Posttraumatic Stress Disorder (PTSD), Social Anxiety Disorder (SAD) in people with Autism Spectrum Disorder (ASD), and in treatment of alcoholic addition. Although the recreational use of ecstasy may lead to numerous life-threatening side effects, data available in the literature suggest that psychoactive substances may be safely administered in clinical settings.

This article aims to review current research on the MDMA assisted psychotherapy. The first part of the article concludes data on MDMA assisted psychotherapy from available clinical trials. The second one sums up hopes and fears associated with the administration of MDMA in clinical settings that were discussed in the current clinical discourse.

It seems that further studies are needed to determine the long-term safety and effectiveness of MDMA assisted psychotherapy.

Review article

Current state of knowledge on the use of medical marijuana in some neurological diseases

Katarzyna Ziętal, Ilona Joniec-Maciejak, Dagmara Mirowska-Guzel
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (3), 205-225

Cannabinoids are a group of compounds found naturally in animal and plant organisms, and in the human body. Cannabinoids can be extracted from cannabis varieties, differing in morphological structure. In addition to cannabinoids, cannabis contains a number of active compounds, including terpenes, flavonoids, phenanthrenes, spiroindanes, and dihydrostilbens.

Epilepsy, Parkinson’s disease and multiple sclerosis are neurological diseases the symptoms of which dramatically impair patients’ quality of life. If standard pharmacotherapy does not bring the expected results, attempts are made to introduce alternative methods of therapy. One of them is the use of cannabis-based preparations containing two main active substances, i.e. THC and CBD. Preliminary results of clinical trials with cannabis-based preparations indicate a potential therapeutic effect in reducing the frequency of seizures in drug-resistant epilepsy among children. However, this needs to be proven in further properly planned studies. In patients with MS, their use may reduce pain and spasticity. In Parkinson’s disease, most of the data on the potential benefits of cannabis-based preparations comes from preclinical studies.

The purpose of the studies was to confirm the effectiveness of the use of “medical cannabis.” However, the results of the studies are not clear. On this account, cannabis use is still not a legalised method of therapy in most countries. However, cannabis is more and more often used in severe cases of resistance to treatment.

The aim of this paper is to critically analyse contemporary scientific data on the possible use of medical cannabis.

Review article

Hypersexuality and pharmacological treatment options

Beata Kocyan, Anna Knapik, Martyna Kozłowska, Ewa Martyniak, Grzegorz Brożek, Marek Krzystanek
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (3), 227-237

Objectives. There are no standardised guidelines regarding the pharmacotherapy of compulsive sexual beha­viour. The paper aims to review the available literature concerning the treatment of excessive sexual activity disorders. Specific mechanisms underlying hypersexu­ality and the consequent potential differences in its treatment were considered.

Literature review. The classification of sexual dis­orders related to excessive sexual activity is rather problematic. Both DSM-5 and ICD-11 lack in a homogenous classification of this disorder. Currently, the safest and most beneficial drugs for patients with non-paraphilic disorders seem to be SSRI medications. Drugs presenting an antiandrogenic action (LHRH) are not recommen­ded due to their side effects, apart from cases proceeding with severe symptoms. Promising results were obtained in a trial with naltrexone; yet, the study did not fulfil methodological norms. Other medications used in the treatment of hypersexuality are of minor importance; however, they may be used especially when psychiatric comorbidities are present.

Conclusions. The best effects in the treatment of compulsive sexual behaviour are obtained with the combination of psychotherapy and SSRI drugs. Few methodologically correct studies have been performed. Most studies are carried out on small groups and fail to use methods which would enable to compare various thera­peutic options. Research on the pharmacotherapy of non-paraphilic hypersexuality should be continued, especially regarding drugs which may act on the obsessi­ve-compulsive mechanism.

Review article

Genetic and pharmacogenetic counselling in psychiatric practice

Joanna M. Pawlak, Joanna W. Twarowska-Hauser
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (3), 239-249

Genetic research in psychiatry has been developing intensively for over 30 years. The social knowledge on the role of genes in the predisposition to diseases and their importance for treatment effects increases. Psychiatric genetic counselling is a service provided under healthcare around the world. The aim of this paper is to present psychiatric genetic counselling, its role for patients and its application in the clinical practice at the current state of knowledge. We discuss these aspects of genetic consultation which relate to mental health. Psychiatric genetic counselling is rarely available in the Polish psychiatric care system and access to specialist training is limited. We indicate that the patient’s adaptation to the genetic burden can bring potential benefits, e.g. better compliance with doctor’s prescriptions. Based on current expert recommendations, we discuss pharmacogenetic tests which are useful in clinical practice. In particular, we analyse the polymorphisms of CYP2D6, CYP2C19 and histocompatibility complex genes HLA.

Case report

Chronic leukopenia associated with taking lamotrigine. Case report

Ewa Marciniszyn, Zuzanna Sitarska, Łukasz Święcicki
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (3), 251-257

This article presents the case of a patient who developed significant leukopenia after lamotrigine intake (with lower limit of the norm of neutrophils; granulocytes count was about 1,500 per mm3 but did not fall to lower values). The disease worsened over a period of about 4 years. During this time, the patient did not discontinue the drug. She continued to take lamotrigine without consulting a psychiatrist because she was convinced of its beneficial effect on her mood. After discontinuation of lamotrigine, the blood picture returned to normal within two weeks. At the same time, the patient’s mental state deteriorated significantly.