Current issue

2023, volume 39, issue 2



Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (1), 91–94
Original article

Retrospective analysis of electroconvulsive therapy in treatment-resistant schizophrenia

Maciej Malewski, Magda K. Malewska-Kasprzak, Maria Chłopocka-Woźniak, Filip Rybakowski, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 95–102

Objectives. This study aims to analyse the effectiveness of electroconvulsive therapy (ECT) for treatment-res­istant schizophrenia, based on the experience of the Department of Adult Psychiatry, Poznan University of Medical Sciences.

Material and methods. The study included 39 patients with treatment-resistant schizophrenia who were treated with ECT at the Department of Adult Psychiatry, Poznan University of Medical Sciences between 2000 and 2022. The group included 30 women and 9 men aged 19–74 years (mean 39±11) who received at least 7 ECT sessions. The efficacy of electroconvulsive therapy was assessed using the Clinical Global Impression (CGI) scale – clinical status before treatment and improvement after treatment.

Results. In the whole group, the median value in the CGI score before treatment was 6 points, which corresponds to a heavy intensification of clinical symptoms. This value was observed in 34 of 39 patients (87%). The median value in CGI improvement score – that is, the effectiveness of treatment – in all the patients treated for schizophrenia with ECT was 2 points, which may indicate the high effectiveness of the method. The most observed value in the CGI improvement scale was 1 point. This value was observed in 19 of 39 patients (46%). The effectiveness of ECT is negatively correlated with a larger number of hospitalisations. The effectiveness of ECT was not correlated with the type of antipsychotic treatment.

Conclusions. These results confirm data from the literature indicating that ECT therapy is effective for treatment-resistant schizophrenia.

Review article

Lithium in mood disorders – an update

Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 103–113

Objectives. The paper aims to present the most important clinical research on lithium in mood disorders, published between 2019 and 2023.

Literature review. The bibliography was selected and discussed across such topics as prophylactic and therapeutic lithium efficacy in mood disorders, therapeutic lithium concentrations and preparations, advantages and adverse side effects of long-term lithium administration, clinical factors connected with the efficacy of long-term lithium administration, the use of lithium in pregnancy and the postpartum period, the prevalence of lithium use and attitudes of psychiatrists towards it, and the incentives for broader lithium administration.

Conclusions. The studies published between 2019 and 2023 confirmed the significant role of lithium in preventing the recurrences of mood disorders and as a therapeutic drug in acute episodes of the illness. The potentiation of antidepressants in treatment-resistant depression may constitute the second indication for lithium administration after the prevention of bipolar disorder. The optimal lithium concentration for prophylactic purposes is 0.6–0.8 mmol/l. The most important among the advantages of long-term use of the drug are suicide prevention and a possible anti-dementia effect, but also a favourable effect on the functioning of many body systems. Adverse side effects of long-term lithium administration, including its influence on kidneys, can be minimised by appropriate application and drug monitoring. The use of lithium in pregnancy and the postpartum period seems relatively safe and therapeutically efficient. Despite the many advantages of the use of lithium in affective disorders, lithium is still underutilised, so that the therapeutic potential of the drug is not fully exploited.

Review article

Therapeutic potential of N,N-dimethyltryptamine in the treatment of psychiatric and neurodegenerative disorders

Jakub Schimmelpfennig, Kamila Jankowiak-Siuda
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 115–130

Objectives. Outlining the therapeutic potential of dimethyltryptamine (DMT) from the perspective of its unique properties, mainly neuroplasticity and neuroprotection.

Literature review. The first information on the therapeutic potential of DMT, commonly found in plants, humans and animals, appeared in the 1960s. This led researchers to consider the potential role of DMT as a neurotransmitter crucial for the survival of the organism under hypoxic conditions. The discovery of its immunomodulatory, neuroplastic, and body-protective properties against the effects of oxidative stress or damage sparked the scientific community’s interest in DMT’s therapeutic potential. In the first part of this paper, we show how DMT, as a psychoplastogen, i.e. a substance significantly stimulating mechanisms of structural and functional neuroplasticity in cortical areas, can be used in the treatment of Alzheimer’s disease, brain damage, or frontotemporal dementia. Next, we show how neuroplastic changes occur through activation of sigma-1 and 5-HT2A receptors. We also focus on its anti-inflammatory effects, protecting nerve and glial cells from oxidative stress, which shows therapeutic potential, especially in the treatment of depression, anxiety, or addiction. Finally, we outline the important effects of DMT on the biogenesis and proper functioning of mitochondria, whose dysfunction underlies many psychiatric, metabolic, neurodegenerative, and immunological disorders.

Conclusions. The effects of DMT show therapeutic potential in the treatment of post-stroke, post-traumatic brain injury, transplantation or neurological and mitochondrial diseases, such as Alzheimer’s and Parkinson’s, frontotemporal dementia, amyotrophic lateral sclerosis, or multiple sclerosis. DMT shows therapeutic potential also in the treatment of PTSD, and neurological and psychiatric disorders like depression, anxiety disorders, or addictions.

Review article

MDMA-assisted psychotherapy in the treatment of PTSD in adults – literature review

Monika Nowak, Julia Górczyńska, Michał Gebuza
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 131–142

Objectives. This paper aims to review the literature on the potential use of 3,4-methylenedioxymethamphetamine (MDMA) therapy in the treatment of post-traumatic stress disorder. The paper also includes a description of the mechanism of action of MDMA and its effects on the human body.

Literature review. MDMA was first used for treatment in the late 1970s. Its anti-anxiety and pro-social properties were used to help patients cope with emotional difficulties and improve interpersonal relationship building. Unfortunately, MDMA was banned worldwide between 1985 and 1986 due to its neurotoxic effects. However, since the beginning of the 21st century, researchers have shown renewed interest in the controlled use of MDMA in therapy. Clinical trials conducted since 2010 have shown promising effects of MDMA-assisted therapy for the treatment of social anxiety in adults with PTSD. The study showed that patients receiving MDMA-assisted therapy experienced a reduction in their responses to anxiety-provoking stimuli. This allowed them to work more effectively with traumatic memories and reduce PTSD symptoms.

Conclusions. MDMA is a semisynthetic substance with a structure similar to serotonin and norepinephrine. Its mechanism of action is based on acting as an activator on certain receptors, resulting in stimulation of the secretion of norepinephrine, serotonin and dopamine. Moreover, MDMA is a substrate for transporters of these neurotransmitters and it inhibits their breakdown as a monoamine oxidase inhibitor. MDMA in therapy may help patients understand and accept traumatic experiences and may help reduce PTSD symptoms, but further research is needed to confirm the efficacy and safety of this therapeutic approach.

Review article

Importance of genotyping and phenotyping of CYP450 isoenzymes in the treatment of psychiatric disorders

Julita Socha, Julita Kuczyńska, Paweł Mierzejewski
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 143–168

Objectives. Discussion on the clinical significance of genotyping and phenotyping variants of the cytochrome P450 (CYP) enzyme system in the pharmacotherapy of mental disorders.

Literature review. Drug resistance is one of the biggest challenges in the pharmacotherapy of mental disorders; however, hypersensitivity to drugs is also a major problem. Doses of drugs in such cases are selected individually based on clinical response. This usually takes a long time and adversely affects the effects of treatment. Despite this, knowledge of individual cytochrome P450 enzyme activity is still not used. In clinical practice, CYP2D6, CYP2C19, CYP3A4, CYP1A2, and CYP2C9 isoenzymes are particularly important. Neither genotyping nor phenotyping are used as a standard of therapeutic management whereas a pharmacogenetic test once in a lifetime is sufficient to determine one’s genotype. Knowing this can be useful not only in the field of psychiatry but also in all other fields, including oncology. Human population shows great variability in the CYP enzyme activity. In the case of the CYP2D6 isoenzyme, about 6.5% of the Caucasian population are so-called poor metabolisers (PM), about 90% of the population are intermediate and normal metabolisers (IM+NM) who generally tolerate drugs well, while ultrafast metabolisers (UM) make up 3% of the population. It’s also worth knowing that concomitant drug intake can change the EM (extensive metaboliser) genotype to a PM phenotype, which means that non-genetic factors can influence the change in the enzyme activity, a phenomenon known as phenoconversion.

Conclusions. Determining both the patient’s CYP genotype and phenotype is advisable in order to optimise the safety and efficacy of treatment — this should certainly be done in patients who are resistant or hypersensitive to a number of drugs.

Review article

Postpartum psychosis with particular emphasis on its treatment

Anna Konopka, Jagoda Kaczmarek, Sylwia Serbin, Weronika Kulma, Wiktoria Bossy, Ewa Kurczewska
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 169–185

Objectives. Pregnancy and puerperium are a time of intense changes in a woman’s life and her functioning at the social, psychological, and biological levels. Perinatal disorders are common; they are mainly manifested by baby blues and postpartum depression. Postpartum psychosis, although rare, is a disease that can cause danger to the health of the mother and child. The aim of the study was to present the current information on postpartum psychosis, to emphasise the need to take prompt therapeutic measures, and thoroughly discuss all stages of treatment.

Literature review. The article reviews current publications related to the issue of postpartum psychosis. The literature was compiled using the PubMed research database. The paper presents basic information on the aetiology, symptoms, and diagnosis of this disease. The treatment and prevention of postpartum psychosis was discussed in detail. We have also focused on studies exploring the link between postpartum psychosis and the diagnosis of bipolar disorder.

Conclusions. Postpartum psychosis usually develops in a much shorter time than other mental disorders associated with childbirth and, unquestionably, it requires hospitalisation. Therapy is based on the use of medications from the mood stabilisers group, benzodiazepines, and antipsychotics. It is also possible to use electroconvulsive therapy. In addition, it is recommended to continue lithium therapy for about 9 months after the symptoms have resolved. Patients who are in a risk group should be informed about the course of postpartum psychosis and available treatment options. Education of mothers and their families, careful observation, and pharmacotherapy are most important in preventing the onset of adverse effects.

Review article

Nutrition and cognitive function in the elderly population

Monika Bidzan-Wiącek, Leszek Bidzan
Farmakoterapia w Psychiatrii i Neurologii 2023, 39 (2), 187–201

Objectives. Cognitive problems, including dementia, which affects a significant part of the elderly population, are becoming a major public health concern. The biolo­gical changes leading to brain damage begin years before the onset of clinical symptoms. The severity of biological changes is determined by many factors. Some of those factors, including diet, can be modified. Studies have shown that the type of diet affects the severity of cognitive impairment and/or the prevalence of dementia.

Literature review. This paper outlines the suggested effect of comprehensive dietary strategies on cognitive function. There is some evidence that the Mediterranean diet as well as some types of dietary restrictions can have protective effects against cognitive decline and dementia. Some animal-based models suggest that lower calorie intake is associated with increased life expectancy and reduced risk of cognitive decline. A low intake of saturated fatty acids (SFA) is one of the factors in the Mediterranean diet that is beneficial to health. Replacing SFA with PUFA improves glucose and cholesterol regulation and increases BDNF levels in the hippocampus. The Medi­terranean diet is also rich in dietary polyphenols, which have antioxidant and anti-inflammatory properties.

Conclusions. Protective effects of diet are determined by adherence to diet before ageing. There is currently no evidence of the therapeutic effectiveness of interventional dietary changes in patients with clinical manifest­ations of dementia.