2020, volume 36, issue 4

Review article

Lithium therapy in literature and art

Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (4), 271–284

Introduction. In 1949, Australian psychiatrist John Cade described a therapeutic action of lithium carbonate in mania. This date is regarded as an introduction of lithium into contemporary psychiatric therapeutics and the beginning of modern psychopharmacology. In the early 1960s, a prophylactic activity of lithium was observed, preventing recurrences of affective episodes in mood disorders. Lithium has become a prototype of the mood-stabilising drugs and remains a drug of the first choice for the prophylaxis of recurrences in bipolar mood disorder.

Literature review. Both the introduction of lithium into psychiatric therapy and its therapeutic action has been reflected in literature and art. This article presents the connections of lithium therapy with literature and art. They pertain to such characters as John Cade, Salvador Luria, Patty Duke, Kay Jamison, Jerzy Broszkiewicz, Ota Pavel, Robert Lowell, Jaime Lowe, Nicole Lyons, Kurt Cobain, Sting, and the band Evanescence.

Conclusions. Special attention was given to the book Unquiet mind, written in 1996 by Kay Jamison, professor of psychology. In the book, her personal bipolar disorder and lithium treatment were described from the viewpoint of the eminent professional. Polish translation of the book titled Niespokojny umysł already has two editions: in 2000 and 2018.

Review article

Neurological symptoms of COVID-19

Adriana Wawer, Agnieszka Piechal
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (4), 285–296

Objective. Some viral infections can have a harmful effect on the functioning of the nervous system and can even cause serious neurological damage. This work aims to review the results of studies published so far concerning neurological complications in people infected with coronaviruses, especially SARS-CoV-2, and possible mechanisms responsible for nervous system damage.

Literature review. Recently, there have been reports that coronaviruses, including SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), cause acute respiratory disease, exhibit neurotropic properties and can also cause neurological symptoms. There are studies published showing that these viruses may penetrate to the brain and cerebrospinal fluid.

Conclusions. Coronaviruses are still poorly understood, so it seems important to study the potential impact of SARS-CoV-2 infections on the nervous system. It seems appropriate that patients infected with SARS-CoV-2 should be early evaluated for neurological symptoms, including headache and impaired consciousness.

Review article

Inflammatory process as an etiological and prognostic factor of stroke and the goal of potential treatment strategies

Agnieszka Kraśniej-Dębkowska, Maciej Śnieżyński, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (4), 297–311

Objective. Inflammation is the body’s natural defence mechanism against factors that damage its tissues. However, if it lasts chronically, it may adversely affect the body’s homeostasis. Inflammation is not only a long-known risk factor for the development of atherosclerosis and its complications, but also develops brain tissue damage in the course of ischemic stroke or intracerebral haemorrhage, leading to even greater damage. In addition, the immune system functions are impaired, which increases the risk of infection.

Literature review. Drugs that can reduce the risk of stroke by inhibiting vascular damage and modifying the inflammatory process in the central nervous system, including counteracting the risk of infection, have become the subject of many experimental and clinical studies on strokes. Such drugs include canakinumab, human recombinant interleukin-1 receptor antagonist, colchicine, fingolimod, siponimod or natalizumab.

Conclusions. Considering all available research results, the therapeutic pathway using anti-inflammatory drugs has a high potential; however, the complications associated with evoked immunosuppression in patients should be kept in mind. The paper presents a review of the literature on the role of the inflammatory process in the pathogenesis of stroke as well as related therapeutic options.

Review article

Non-pharmacological treatment of epilepsy

Bartosz Osuch, Piotr Maciejak
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (4), 313–326

Objectives. This paper aims to summarise the existing knowledge regarding the available non-pharmacological methods of epilepsy treatment. The accurate diagnosis of patients with drug-resistant epilepsy is vital for optimising further treatment.

Literature review. In case of failure to achieve permanent seizure control with two appropriately selected and applied antiepileptic pharmacological regimens, it is recommended to consider surgical treatment. The possibility of removing the epileptic focus without causing functional deficits is evaluated (resection surgery). If the resection operation is not possible, alternative methods of treatment are palliative surgery (disconnection procedures) and neurostimulation systems. Some patients may also benefit from a ketogenic diet.

Conclusions. While a satisfactory therapeutic effect with only one of the aforementioned methods is difficult to achieve, the combined therapy is to be taken into consideration.

Case report

COVID-19 in two patients with multiple sclerosis treated with beta interferons

Karolina Kania, Elżbieta Tokarz-Kupczyk, Alicja Kalinowska-Łyszczarz
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (4), 327–334

Objectives. Treatment of multiple sclerosis (MS) in the era of the COVID-19 (coronavirus disease 2019) pandemic raises many questions for doctors.

Case reports. We are presenting two cases of patients suffering from multiple sclerosis (MS) treated with interferon beta-1b and interferon beta-1a, who suffered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with a benign course in one case and an asymptomatic one in another. None of the patients required hospitalisation.

Conclusions. MS treatment during coronavirus disease 2019 (COVID-19) pandemics poses several questions. Considering our own clinical experiences, we present a brief review of medical literature on the safety of MS immunotherapy. So far, the published data on MS and COVID-19 do not show increased risk associated with MS diagnosis or disease modifying therapy, even when associated with immunosuppression.

Case report

The coexistence of pituitary macroadenoma and schizophrenia – practical therapeutic implications based on the case report and the literature review

Piotr Hałajko, Justyna Morylowska-Topolska, Elżbieta Sitarz, Kaja Karakuła, Alicja Forma, Hanna Karakuła-Juchnowicz
Farmakoterapia w Psychiatrii i Neurologii 2020, 36 (4), 335–346

Introduction. Antipsychotic drugs may increase serum prolactin levels. This effect is the strongest in patients treated with risperidone and amisulpride.

Aim. This paper (1) presents a case report of an active pituitary macroadenoma diagnosed in a patient receiving a long-term olanzapine treatment; and (2) discusses its practical therapeutic implications based on the literature review.

Case report. A 28-year-old male patient had been treated with olanzapine for paranoid schizophrenia since 2008. In December 2016, an unsuccessful attempt to discontinue the drug was made as the patient had been in remission for the past few years. The attempt ended in March 2017 with psychiatric hospitalisation. MRI of the head and a prolactin test revealed a pituitary macroadenoma. The medication was changed from olanzapine to aripiprazole, but the patient’s mental status deteriorated. Ziprasidone was initiated, which resulted in symptomatic remission. The MRI scans of the head that were made in the following months showed no tumour progression. As prolactin levels were stably high, the patient received quinagolide therapy. In addition, small doses of clozapine and psychotherapy were added to the ongoing treatment.

Conclusions. The present case report shows that (1) routine imaging tests should be performed as part of the diagnostic procedure in first-episode psychosis; (2) prolactin levels should be measured both before and during therapy; and (3) early and close interdisciplinary cooperation is needed to develop common therapeutic recommendations that could be applied in difficult and non-typical clinical cases, such as the one described herein.