PSYCHIATRIC DISORDERS ASSOCIATED WITH CUSHING’S SYNDROME

Background: Cushing\u27s syndrome is the term used to describe a set of symptoms associated with hypercortisolism, which in most cases is caused by hypophysial microadenoma over-secreting adrenocorticotropic hormone. This endocrine disorder is often associated with psychiatric comorbidities. The most important include mood disorders, psychotic disorders, cognitive dysfunctions and anxiety disorders. Subject and methods: The aim of this article was to review the prevalence, symptoms and consequences of psychiatric disorders in the course of Cushing’s syndrome. We therefore performed a literature search using the following keywords: Cushing’s syndrome and psychosis, Cushing’s syndrome and mental disorders, Cushing’s syndrome and depression, Cushing’s syndrome and anxiety. Results: The most prevalent psychiatric comorbidity of Cushing’s syndrome is depression. Psychiatric manifestations can precede the onset of full-blown Cushing’s syndrome and therefore be misdiagnosed. Despite the fact that treatment of the underlying endocrine disease in most cases alleviates psychiatric symptoms, the loss of brain volume persists. Conclusions: It is important to be alert to the symptoms of hypercortisolism in psychiatric patients to avoid misdiagnosis and enable them receiving adequate treatment

PSYCHIATRIC COMORBIDITY IN OLDER ADULTS WITH INTELLECTUAL DISABILITY

Background: The population of older adults with intellectual disability (ID) is large and growing due to a significant increase of life expectancy caused by improvements in health and social care. Multimorbidity is highly prevalent in this population and comorbid psychiatric disorders are especially frequent. Subject and methods: The aim of this article is to review the prevalence and consequences of psychiatric comorbidity in the population of older adults with ID. We therefore performed a literature search of studies relevant to adults with ID, published since January 2006, using the following keywords: intellectual disability and comorbidity, intellectual disability and mental disorders, intellectual disability and polypharmacy. Results: Psychiatric comorbidity is frequent among patients with ID and correlates with older age. Mental disorders are present in up to 40% of older adults with ID and the most prevalent are challenging behaviour, depression, anxiety and dementia. Patients with ID and at least one co-morbid mental disorder are at a high risk of polypharmacy. Importantly, psychiatric comorbidity was found to significantly increase service use and costs of care. Conclusions: Further investigation of the population of older adults with ID is needed, with special attention to development of clear treatment guidelines in order to effectively manage co-morbid mental illnesses and physical health problems

PSYCHOLOGICAL DISTRESS AND SOCIAL FACTORS IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE LUNG DISEASE

Chronic respiratory diseases which embrace asthma and chronic obstructive pulmonary disease (COPD) are common in the population. In a large number of cases they are diagnosed very late. Statistics of deaths, especially in the case of COPD, are underestimated because morbidity and mortality can be affected by other comorbid conditions, for example cardiovascular disease. Asthma and COPD impair not only physical functioning of patients but also affect their psychological state. Mood disorders and cognitive function impairment are more often observed in this group than in the general population. It has been proven that the coexistence of psychological dysfunction significantly worsens the functioning of patients (affects, among others, their work, family and social lives) and has an impact on the course of the treatment of the somatic illness. First of all, patients with cognitive deficits have greater problems in applying treatment recommendations. Accordingly, it seems to be important to pay more attention to the problem of mental disorders in patients with obstructive lung diseases. There is a clear need for a multidisciplinary approach that will enable prevention, early detection and effective treatment of the psychological disorders in that group of patients

PSYCHIATRIC COMORBIDITY IN OLDER ADULTS WITH INTELLECTUAL DISABILITY

Background: The population of older adults with intellectual disability (ID) is large and growing due to a significant increase of life expectancy caused by improvements in health and social care. Multimorbidity is highly prevalent in this population and comorbid psychiatric disorders are especially frequent. Subject and methods: The aim of this article is to review the prevalence and consequences of psychiatric comorbidity in the population of older adults with ID. We therefore performed a literature search of studies relevant to adults with ID, published since January 2006, using the following keywords: intellectual disability and comorbidity, intellectual disability and mental disorders, intellectual disability and polypharmacy. Results: Psychiatric comorbidity is frequent among patients with ID and correlates with older age. Mental disorders are present in up to 40% of older adults with ID and the most prevalent are challenging behaviour, depression, anxiety and dementia. Patients with ID and at least one co-morbid mental disorder are at a high risk of polypharmacy. Importantly, psychiatric comorbidity was found to significantly increase service use and costs of care. Conclusions: Further investigation of the population of older adults with ID is needed, with special attention to development of clear treatment guidelines in order to effectively manage co-morbid mental illnesses and physical health problems

PSYCHOGENIC SPEECH DISORDER – A CASE REPORT

Background: Conversion (dissociative) disorder is a psychiatric disorder in which somatic symptoms or deficits are present in the absence of a definable organic cause. The etiology of this disorder is not yet fully understood. The most characteristic presentations are: pseudosensory syndromes, pseudoseizures, psychogenic movement disorders and pseudoparalysis. Psychogenic speech disorder is a rare form of conversion (dissociative) disorder. The aim of present case study is to complete the knowledge on this subject. Subject and methods: The article presents a case of a fifty year old woman who developed psychogenic disorder of speech after being degraded to a lower position at work. After excluding organic background of observed symptoms, the diagnosis of conversion (dissociative) disorder was stated and adequate therapy was implemented, within the capabilities of the Ward. Results: Partial remission of presented symptoms was achieved as a result of psychopharmacotherapy and psychotherapy. Conclusions: Before stating the diagnosis of conversion (dissociative) disorder, possible somatic causes of the observed symptoms should be excluded. Special attention should be drawn to the importance of studying the psychological and family context of this case and the patient’s difficulty to understand and accept that produced symptoms might be triggered by a psychogenic factor

EFFECTS OF HORMONES ON COGNITION IN SCHIZOPHRENIC MALE PATIENTS – PRELIMINARY RESULTS

Background: Schizophrenia is a prevalent neurodevelopmental disorder of an unknown etiology and a variable phenotypic expression. In the recent years, the impact of hormones on the course of schizophrenia has been investigated. This study is aimed at assessing the level of correlating serum levels of hormones in schizophrenic male patients with their cognitive functioning measured with neuropsychological tests. Subjects and methods: In the index group there were 15 medicated male schizophrenic patients. In the control group there were 15 age and education matched healthy men. All subjects underwent analysis of serum hormones level (TSH, testosterone, estradiol, FSH, LH, progesterone and prolactin) and a battery of tests (Trail Making Test A and B, Stroop Test, Verbal and Semantic Fluency Test). Results: The mean serum levels of the following hormones were higher in the index group than in the control group: TSH (1.76 mIU/L vs 1.58 mIU/L; p=0.66), progesterone (0.85 ng/ml vs 0.69 ng/ml; p=0.22) and prolactin (558.71 uIU/ml vs 181 uIU/ml; p=0.025). The mean levels of estradiol (24.36 pg/ml vs 25.40 ng/ml; p=0.64), FSH (3.17 mIU/ml vs 5.72 mIU/ml; p=0.019), LH (3.85 mIU/ml vs 5.77 mIU/ml; p=0.056) and testosterone (2.90 ng/ml vs 5.38 ng/ml; p=0.003) were higher in the control group. In the index group there were significant negative correlations between FSH and semantic fluency (ρ=-0.678606), progesterone and: TMT B (ρ=-0.586763), Stroop 1 (ρ=-0.701880) and Stroop 2 (ρ=-0.601074) and prolactin and TMT A (ρ=-0.579607). Conclusions: The preliminary results of our study show that serum levels of FSH and testosterone are significantly lower, whereas the level of prolactin is markedly higher, in schizophrenic male patients than in healthy men. There is an inverse correlation between serum levels of progesterone, FSH and prolactin and the results of certain cognitive functioning tests in schizophrenic men

EMPATHY AMONG PHYSICIANS, MEDICAL STUDENTS AND CANDIDATES

Background: Empathy is one of the crucial personality traits for all medical professionals, including physicians. The importance of empathy in doctor-patient relationship cannot be overestimated, as it is beneficial for both sides. Regrettably, there is evidence for the decline in this trait over the course of medical studies. Subjects and methods: The participants were 509 voluntary respondents: medical school candidates (16,1%), medical students (65%), medical trainees (9.8%), residents (6.3%) and specialists (2.8%). The Interpersonal Reactivity Index (IRI) was administered to them, which is a self-report tool measuring empathy. Results: Gender difference in the IRI score was especially prominent – the mean score for female respondents was 59.83 points, while in men it was 51.16 point (p<0.001). The level of empathy did not differ significantly in the sub-groups divided with regards to the stage of their medical career. However, the total IRI score in women was the highest in the group of doctors, while in postgraduated males it was the lowest. Age of the respondents correlated positively with the perspective taking sub-scale and negatively with the fantasy and personal distress sub-scales. Conclusions: Empathy is a trait that is rarely being enhanced in medical students during their education. While empathy is crucial for the development of a satisfactory doctor-patient relationship, there is an urgent need to adopt educational programs aimed at reinforcing empathy in medical students

THE ROLE OF SELECTIVE ESTROGEN RECEPTOR MODULATORS IN THE TREATMENT OF SCHIZOPHRENIA

Background: Gender differences in schizophrenia have been recognized for a long time and it has been widely accepted that sex steroid hormones, especially estradiol, are strongly attributed to this fact. Two hypotheses regarding estradiol action in psychoses gained special research attention – the estrogen protection hypothesis and hypoestrogenism hypothesis. A growing number of studies have shown benefits in augmenting antipsychotic treatment with estrogens or selective estrogen receptor modulators (SERM). Methods: This review is focused on the role of selective estrogen receptor modulators in the treatment of schizophrenic patients. In order to achieve this result PubMed was searched using the following terms: schizophrenia, raloxifene, humans. We reviewed only randomized, placebo-controlled studies. Results: Raloxifene, a selective estrogen receptor modulator was identified as useful to improve negative, positive, and general psychopathological symptoms, and also cognitive functions. All reviewed studies indicated improvement in at least one studied domain. Augmentation with raloxifene was found to be a beneficial treatment strategy for chronic schizophrenia both in female and male patients, however potential side effects (a small increase in the risk of venous thromboembolism and endometrial cancer) should be carefully considered. Conclusions: SERMs could be an effective augmentation strategy in the treatment of both men women with schizophrenia, although further research efforts are needed to study potential long-term side effects

ANALYSIS OF PSYCHOEMOTIONAL STATE AND INTELLECTUAL ABILITIES IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE - PRELIMINARY RESULTS

Background: In the literature we can find examples of comorbidity of the diseases of the respiratory tract and mental disorders. Among them a particularly significant position is occupied by chronic obstructive pulmonary disease (COPD) and asthma, which may be accompanied by anxiety, depressive and cognitive symptoms. The present research project was aimed to establish a connection between psycho-intellectual functioning and suffering from the aforementioned diseases. Subjects and methods: The patients were divided into 3 groups. In the asthma group there were 11 people, mean age 54, who met the GINA criteria for asthma. The group of patients with COPD was formed by 12 people, mean age 67. The control group included 13 people, mean age 48. Patients from all the groups underwent spirometry, sputum induction and the following tests: Mini- Mental State Examination (MSSE), Trail Making Test (TMT A and B), Beck Depression Inventory – BDI (Beck et al. 1961) and State- Trait Anxiety Inventory for Adults - STAI 1 and 2. Results: In the TMT tests results were the following: We can presume some deficiency when the time required by a patient to complete the task is longer than 78 seconds for Part A and 273 seconds for Part B. In our research the best mean time was obtained in control group (Part A - 30.04 s, Part B – 67.37 s), then in the asthma group (Part A - 35.54 s, Part B – 98.81 s) and in the COPD group (Part A - 42.80 s, Part B – 107.79 s). In our research study the lowest score for the Beck Depression Inventory was obtained in the control group (mean 6.15), then in asthma (mean 9.63) and in COPD (mean 13.61). Results for State-Train Anxiety Inventory were distributed as follows: mean score in the asthma group was 36.48 in Part 1 and 43.27 in Part 2, in the COPD group 36.41 in Part 1 and 42.66 in Part 2 and in the control group 32.61 in Part 1 and 36.75 in Part 2. Conclusions: In our research the level of anxiety and depression measured by self-assessment questionnaires was higher in the study groups than in the control group. Also cognitive functions were worse than in the healthy controls, especially among COPD patients

ANALYSIS OF PSYCHOEMOTIONAL STATE AND INTELLECTUAL ABILITIES IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE - PRELIMINARY RESULTS

Background: In the literature we can find examples of comorbidity of the diseases of the respiratory tract and mental disorders. Among them a particularly significant position is occupied by chronic obstructive pulmonary disease (COPD) and asthma, which may be accompanied by anxiety, depressive and cognitive symptoms. The present research project was aimed to establish a connection between psycho-intellectual functioning and suffering from the aforementioned diseases. Subjects and methods: The patients were divided into 3 groups. In the asthma group there were 11 people, mean age 54, who met the GINA criteria for asthma. The group of patients with COPD was formed by 12 people, mean age 67. The control group included 13 people, mean age 48. Patients from all the groups underwent spirometry, sputum induction and the following tests: Mini- Mental State Examination (MSSE), Trail Making Test (TMT A and B), Beck Depression Inventory – BDI (Beck et al. 1961) and State- Trait Anxiety Inventory for Adults - STAI 1 and 2. Results: In the TMT tests results were the following: We can presume some deficiency when the time required by a patient to complete the task is longer than 78 seconds for Part A and 273 seconds for Part B. In our research the best mean time was obtained in control group (Part A - 30.04 s, Part B – 67.37 s), then in the asthma group (Part A - 35.54 s, Part B – 98.81 s) and in the COPD group (Part A - 42.80 s, Part B – 107.79 s). In our research study the lowest score for the Beck Depression Inventory was obtained in the control group (mean 6.15), then in asthma (mean 9.63) and in COPD (mean 13.61). Results for State-Train Anxiety Inventory were distributed as follows: mean score in the asthma group was 36.48 in Part 1 and 43.27 in Part 2, in the COPD group 36.41 in Part 1 and 42.66 in Part 2 and in the control group 32.61 in Part 1 and 36.75 in Part 2. Conclusions: In our research the level of anxiety and depression measured by self-assessment questionnaires was higher in the study groups than in the control group. Also cognitive functions were worse than in the healthy controls, especially among COPD patients