Głęboka stymulacja mózgu jako metoda leczenia depresji lekoopornej w przebiegu choroby afektywnej dwubiegunowej — przegląd badań neuroobrazowych i eksperymentalnych

  Bipolar disorder (BD) — psychiatric disorder characterized by at least one manic or hypomanic state and recurrent episodes of depression, is one of the main causes of disability among young adults. Depression — dominant in the course of BD is particularly prone to be treatment resistant. A new experimental treatment for refractory depression in the course of bipolar disorder is deep brain stimulation (DBS), associated with a single neurosurgical low – risk procedure, causes immediate antidepressant effect. Neuroimaging studies have shown sIMFB (supero-lateral branch of the medial forebrain bundle) as the most reactive for deep brain stimulation. Further studies on stimulating sIMFB carried out in the selected groups of treatment-resistant depressive patients with BD are needed.      Choroba afektywna dwubiegunowa (ChAD) jest przewlekłym zaburzeniem psychicznym będącym jedną z głównych przyczyn niepełnosprawności wśród młodych dorosłych. Depresja w przebiegu ChAD stanowi dominującą fazą choroby, a jednocześnie główny czynnik obniżający jakość życia pacjentów, odpowiedzialny za największą śmiertelność w tej grupie klinicznej. Epizody depresji są również szczególnie narażone na lekooporność. Nową eksperymentalną metodą leczenia depresji lekoopornej w przebiegu ChAD jest głęboka stymulacja mózgową (DBS) związana z jednorazowym zabiegiem neurochirurgicznym obarczonym niewielkim ryzykiem niepowodzenia. Powoduje ona długotrwały antydepresyjny efekt u większości zbadanych do tej pory pacjentów z ChAD. Wyniki badań neuroobrazowych wskazują obszar grzbietowo-bocznej gałęzi pęczka przyśrodkowego przodomózgowia (slMFB) jako najbardziej reaktywny na głęboką stymulację mózgową. Łączy on pozostałe miejsca stymulacji wykorzystywane do tej pory w terapii DBS depresji lekoopornej. Dalsze badania nad stymulacją sIMFB, przeprowadzane w wyselekcjonowanych grupach, mogą stać się podstawą wprowadzenia nowej metody leczenia depresji lekoopornej w przebiegu ChAD.

Psychiatric disorders and the cerebellar structure and functions — an overview of the latest research

W artykule przedstawiono przegląd najnowszych badań dotyczących roli móżdżku w niektórych zaburzeniach psychicznych. Szczegółowej analizie poddane zostały: schizofrenia, zaburzenia afektywne jedno- i dwubiegunowe, autyzm oraz zaburzenia lękowe, ze szczególnym uwzględnieniem zespołu stresu pourazowego (PTSD). Móżdżek, dzięki swoim licznym połączeniom ze strukturami korowymi i podkorowymi, w zróżnicowany sposób uczestniczy w opisanych zaburzeniach, zarówno pod względem strukturalnym (zmiany w strukturach móżdżku wykazano we wszystkich analizowanych chorobach), jak i funkcjonalnym (liczne dane neuroobrazowe ujawniają specyficzne wzorce aktywacji móżdżku w analizowanych zaburzeniach). Nadal jednak wnioski z analizowanych badań nie są konkluzywne i określenie dokładnej relacji pomiędzy móżdżkiem a zaburzeniami psychicznymi na ten moment jest niemożliwe. Przeprowadzanie większej liczby badań na temat móżdżkowych korelatów zaburzeń psychicznych jest konieczne dla dogłębnego poznania tego zagadnienia.The article provides an overview of the latest studies concerning the role of the cerebellum in certain psychiatric diseases. We analyzed in detail the following disorders: schizophrenia, depression, bipolar disorder, autism and anxiety disorders with a main focus on PTSD. Thanks to its numerous connections with cortical and subcortical structures, the cerebellum participates in psychiatric disorders in various ways, both in the terms of structure: changes in cerebellar structures were noted in all analyzed diseases; and function: numerous neuroimaging data indicates a abnormal activation patterns in analyzed disorders. Still the results of the studies are hardly conclusive and the clear description of the relationship between the cerebellum and psychiatric disorders is at this moment impossible. More research is needed to provide unequivocal conclusions concerning this subject

Polish adaptation of the Dimensional Anhedonia Rating Scale (DARS) - validation in the clinical sample

BackgroundAnhedonia is the core symptom of depression. Its presence has been linked to worsened prognosis. The Dimensional Anhedonia Rating Scale (DARS) is a scale measuring desire, motivation, effort and consummatory pleasure across different domains. The aim of this paper was to confirm factor structure, assess reliability and validity of the Polish adaptation of the DARS in a clinical sample of patients with mood disorders and healthy controls (HC).MethodsThe study sample included 161 participants aged 18–65 years - 34 HC, 72 patients with bipolar disorder and 55 with major depressive disorder (in depressive episode or remission). Reliability of the Polish adaptation of the DARS was assessed using Cronbach’s α and the average inter-item correlation (AIC). Convergent and divergent validity was established by Pearson’s correlations between the DARS and the Snaith-Hamilton Pleasure Scale (SHAPS), the Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), the Hospital Anxiety and Depression Scale (HADS). The structure of the scale was examined by factor analysis.ResultsThe factor structure was consistent with the original scale. Strong internal consistency for the DARS total score (Cronbach’s α = 0.95) and all subscales (0.86–0.93) was observed. The DARS demonstrated good convergent (moderate to strong correlations with measures of anhedonia and depression) and divergent validity (weak correlations with anxiety level).ConclusionThe Polish DARS demonstrated excellent internal consistency and very good validity. The scale is a valuable contribution to the psychometrics of anhedonia measures in patients with mood disorders

TED—Trazodone Efficacy in Depression: A Naturalistic Study on the Efficacy of Trazodone in an Extended-Release Formulation Compared to SSRIs in Patients with a Depressive Episode—Preliminary Report

These are the preliminary results of a 12-week non-randomized, open-label, non-inferiority study comparing the effectiveness of trazodone in an extended-release formulation (XR) versus SSRIs in the treatment of major depressive disorder (MDD). Participants (n = 76) were recruited, and 42 were assigned to the trazodone XR group and 34 to the SSRIs group. The choice of drug was based on clinical presentation and relied upon the attending physician. Assessments were made at five observation time points, at the following weeks: 0, and after 2, 4, 8, and 12 weeks. The evaluations included: symptoms of depression (MADRS, QIDS-clinician, and self-rated versions-primary study endpoints), anhedonia (SHAPS), anxiety (HAM-A), insomnia (AIS), psychosocial functioning (SDS), and therapeutic efficacy (CGI). At baseline, the trazodone group had significantly more severe depressive, anxiety, and insomnia symptoms and worse psychosocial functioning compared to the SSRIs group. After 12 weeks, trazodone XR was more effective than SSRIs in reducing the severity of insomnia and depression. There were no differences between the groups in the frequencies of therapeutic response and remission, which indicated the non-inferiority of the trazodone XR treatment. In conclusion, our results showed that in a “real world” setting, trazodone XR is effective in the treatment of patients with MDD

TED—trazodone effectiveness in depression: a naturalistic study of the effeciveness of trazodone in extended release formulation compared to SSRIs in patients with a major depressive disorder

Introduction: Selective serotonin reuptake inhibitors (SSRIs) are the most often used medications to treat major depressive disorder (MDD). Despite their effectiveness in reducing depressive symptoms, several issues are associated with their use in MDD, such as limited improvement of anhedonia, emergence of emotional blunting, induction or exacerbation of insomnia, and sexual dysfunction. Due to its also devoid of the issues related to treatment noted with SSRIs. The aim of this 12-week non-inferiority naturalistic observation was to compare the effectiveness and tolerability of SSRIs and trazodone in extended release (XR) in MDD.Methods: A total of 186 subjects were recruited, of which 92 received trazodone XR and 94 received SSRIs. Patients were allocated to trazodone XR or SSRIs, according to the attending physician based on clinical evaluation. Assessments at baseline and weeks 2, 4, 8, and 12 were conducted to evaluate the severity of depression (Montgomery–Åsberg Depression Rating Scale, clinician- and patient-rated Quick Inventory of Depressive Symptomatology—the primary endpoints of the study), anhedonia (the Snaith–Hamilton Pleasure Scale), anxiety (the Hamilton Anxiety Rating Scale), insomnia (the Athens Insomnia Scale), and therapeutic effectiveness (the Clinical Global Impression Scale).Results: After 12 weeks, trazodone XR was more effective than SSRIs in reducing the severity of depression, anxiety, and insomnia. There was a trend for higher effectiveness of in reduction of anhedonia, which became insignificant after controlling the results for the duration of previous psychiatric treatment as a covariate. The proportion of treatment-responsive subjects in the trazodone XR group compared to SSRIs was comparable or higher. The proportion of patients achieving remission was higher in the trazodone XR arm vs. the SSRI arm.Discussion: In summary, the results indicate that trazodone XR is effective in MDD in the “real-world” setting. Its potential superiority over SSRIs in addressing particular symptomatic dimensions should be verified in future studies

Sexual activity in a large representative cohort of polish men: Frequency, number of partners, correlates, and quality of life.

IntroductionSexual activity of men has been evaluated at the population-level in different regions of the world. However, reliable data are lacking for Eastern Europe. Therefore, the aim of this study was to analyze the frequency of sexual activity and the number of sexual partners in a large representative cohort of Polish men.MethodsWe performed a cross-sectional investigation with computer-assisted web interviews. Participants were stratified by age (≥18 years) and place of residence. The most recent population census was used to produce a population-representative sample of respondents. Men's sexual activity was then correlated with multiple variables.ResultsWe enrolled 3001 men, representative for age and place of residence, including adequate proportions of respondents from urban and rural areas. Most Polish men were sexually active, predominantly having had sex at least weekly with one partner. Almost 18% of respondents declined sexual intercourse and/or sexual partner in the prior year. The highest sexual activity was observed for men 35-44-years-old (for sex frequency) and 18-24-years-old (for partner number), living in medium-sized cities, employed, and married (for sex frequency) or divorced (for partner number). Erectile dysfunction negatively affected the frequency of sexual activity and lowered the number of sexual partners, although premature ejaculation did not have any effect. Frequency of sexual activity and number of sexual partners correlated well with psychological distress, quality of sex life, and overall life quality. Whereas lifestyle habits including smoking and alcohol intake decreased the likelihood of sexual activity, all analyzed comorbidities did not affect sex life.ConclusionsThis study of men's sexual activity was the first population-representative and nationwide investigation performed in Poland. Most Polish men were sexually active and sexual activity correlated with multiple variables including sociodemographic factors, erectile functioning, mental distress, overall and sex-specific quality of life, and lifestyle habits

Data_Sheet_1_Polish adaptation of the Dimensional Anhedonia Rating Scale (DARS) - validation in the clinical sample.docx

BackgroundAnhedonia is the core symptom of depression. Its presence has been linked to worsened prognosis. The Dimensional Anhedonia Rating Scale (DARS) is a scale measuring desire, motivation, effort and consummatory pleasure across different domains. The aim of this paper was to confirm factor structure, assess reliability and validity of the Polish adaptation of the DARS in a clinical sample of patients with mood disorders and healthy controls (HC).MethodsThe study sample included 161 participants aged 18–65 years - 34 HC, 72 patients with bipolar disorder and 55 with major depressive disorder (in depressive episode or remission). Reliability of the Polish adaptation of the DARS was assessed using Cronbach’s α and the average inter-item correlation (AIC). Convergent and divergent validity was established by Pearson’s correlations between the DARS and the Snaith-Hamilton Pleasure Scale (SHAPS), the Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), the Hospital Anxiety and Depression Scale (HADS). The structure of the scale was examined by factor analysis.ResultsThe factor structure was consistent with the original scale. Strong internal consistency for the DARS total score (Cronbach’s α = 0.95) and all subscales (0.86–0.93) was observed. The DARS demonstrated good convergent (moderate to strong correlations with measures of anhedonia and depression) and divergent validity (weak correlations with anxiety level).ConclusionThe Polish DARS demonstrated excellent internal consistency and very good validity. The scale is a valuable contribution to the psychometrics of anhedonia measures in patients with mood disorders.</p