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

ASSOCIATION BETWEEN DEPRESSION AND HEMODIALYSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Depression is the most common and serious psychiatric disorder that affects patients with chronic kidney disease and end-stage renal disease, and, has a significant impact on their quality of life. The aim of this study was to investigate and compare prevalence rates of depression among hemodialyzed patients, and non-dialyzed patients with a glomerular filtration rate <30 ml/min/1.73m2 receiving conservative treatment or following kidney transplantation. A total of 50 hemodialyzed and 50 non-dialyzed patients with stage 4/5 of CKD was assessed using the following questionnaires: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), The Satisfaction with Life Scale (SWLS), The Acceptance of Illness Scale (AIS), and The Life Orientation Test-Revised (LOT-R). The use of steroids and immunosuppressant drugs was also investigated. Symptoms of depression and anxiety were present in both groups, however the proportion of persons with mild or severe depression was higher among dialyzed patients. The AIS, LOT-R and SWLS scores were very similar in both the groups. The patients using steroids and/or immunosuppressant drugs were more prone to develop mild or severe depression according to the HAM-D scores. The results indicated a high prevalence of depression and anxiety among patients with CKD. Furthermore, the fraction of patients with depression is greater among hemodialyzed patients. This indicates the importance of monitoring the mental state of the patients as well as the necessity of providing timely psychological care for patients with CKD

THE PREVALENCE OF SEASONAL AFFECTIVE DISORDER AMONG THE BLIND AND PATIENTS WITH SERIOUS VISUAL IMPAIRMENT

Background: Seasonal affective disorder (SAD) is an interesting disorder in which depression should occur at a particular time of a year, each year and it should disappear at a specific time of the year. While the prevalence of SAD among generally healthy individuals is well known, the information about the prevalence of this disorder among the blind and visually impaired patients is very limited. The aim of the study was to investigate the prevalence of SAD among the blind and people with serious visual impairment in polish population. Subjects and methods: 250 blind or seriously visually impaired individuals and 258 healthy controls were assessed with the usage of Seasonal Pattern Assessment Questionnaire (SPAQ). In research group survey was conducted with the Computer Assisted Telephone Interview (CATI) technique. In control group the questionnaire was distributed via Internet. The results were analysed with the usage statistical package - Statistica 13.1. Results: The results revealed that among people suffering from SAD there is statistically significant difference in SPAQ scores between completely blind and seriously visually impaired people. The study shows that is the control group age is negatively correlated with score in SPAQ score, while in the study group age is positively correlated with SPAQ score. The data show that there is a difference in occurrence of SAD between men and women. Conclusion: The study has shown a significant difference in occurrence of SAD between study and control groups. What is more the analysis has indicated major difference in the occurrence of SAD between men and women from the study group. Taking into consideration the fact that this is the second analysis of this type in Europe further investigations are needed

Święta czy chora – trudności orzecznicze w przypadku pacjentki z zaburzeniami schizotypowymi i osobowością borderline

Autorzy prezentują przypadek pacjentki, która zwróciła się do poradni w celu otrzymania zaświadczenia o zdrowiu psychicznym. Prośbę motywowała koniecznością przedstawienia tego dokumentu w procedurze ubiegania się o przyjęcie do zakonu. Deklarowała brak dotychczasowego leczenia psychiatrycznego. Towarzysząca jej kobieta potwierdziła fakty podane przez pacjentkę. Jednak treści przekazywane przez pacjentkę, tok jej wypowiedzi, ekscentryczny wygląd i determinacja do uzyskania zaświadczenia sugerowały, że lekarz powinien zachować ostrożność. Kobieta zgodziła się na hospitalizację w celu obserwacji stanu psychicznego. W trakcie pobytu pacjentki na oddziale zobiektywizowano wywiad – poszerzono go o informacje uzyskane od jej rodziców i wypisy z przebytych hospitalizacji. Przeprowadzono badanie psychologiczne i neuroobrazowe. Zgromadzone dane i obserwacja w oddziale wskazały na obecność zarówno choroby psychicznej, jak i głębokich deficytów osobowościowych. Opis przypadku potwierdza konieczność zachowania rozwagi przy wystawianiu zaświadczeń o zdrowiu psychicznym. Autorzy podkreślają, że jednostronny wywiad może nie ujawnić prawdziwego obrazu funkcjonowania pacjenta

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

Blood Antibody Titers and Adverse Reactions after BNT162b2 mRNA Vaccination

This study aimed to measure, considering a prior history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (SCV-negative/positive), antibodies titer using Elecsys Anti-SARS-CoV-2 S immunoassay (Roche Diagnostics, Mannheim, Germany), in a serum of healthcare workers (HCW) who received two doses of BNT162b2 vaccines. The local and systemic adverse reactions occurrence was checked with a self-reported questionnaire. A total of 60 SCV-negative HCW showed lower antibody titers than those presented by SCV-positive subjects (n = 7). The highest antibody level was detected 8 days after the second dose of vaccine administration. At the same time, the titer was higher in the SCV2 -positive than the SCV2-negative group and comparable after the first dose in those who became infected to the level after the second dose of those who did not. The local and systemic effects in the SCV2-negative and SCV2-positive groups appeared independent of the vaccine dose. After the second dose, systemic reactions were reported more often than the local adverse effects. Whether no effect was observed or whether the response was local or systemic, the antibody level in a specific group remains constant. These results can be helpful in the improvement of vaccination programs, controlling the occurrence of adverse and long-term effects of the vaccination

A saint or ill – difficulties in issuing a medical certificate for a patient with schizotypal disorders and borderline personality

The authors present a case of a patient who turned to a mental health clinic in order to receive a certificate of mental health. She motivated the request to be a necessary step in the procedure of applying for admission to a religious order. She declared no previous psychiatric treatment and was accompanied by another woman who confirmed the facts stated by the patient. However, the content provided by the patient, the manner of talking, eccentricity in appearance and determination to obtain the certificate called for caution in issuing such an opinion. The patient agreed to proposed hospitalisation for observation of her mental health. During her stay on the ward, the patient was interviewed and the information collected was cross-referenced with information obtained from the patient’s parents and from previous hospitalisation reports. Psychological tests and CT scans were carried out. The obtained data and observation of the patient on the ward indicated both the presence of a mental illness and deep deficits in personality. This case confirms the need for exercising prudence in issuing opinions on mental health. It highlights the fact that one-sided objective interview may not reveal the real picture of the patient’s mental health.Autorzy prezentują przypadek pacjentki, która zwróciła się do poradni w celu otrzymania zaświadczenia o zdrowiu psychicznym. Prośbę motywowała koniecznością przedstawienia tego dokumentu w procedurze ubiegania się o przyjęcie do zakonu. Deklarowała brak dotychczasowego leczenia psychiatrycznego. Towarzysząca jej kobieta potwierdziła fakty podane przez pacjentkę. Jednak treści przekazywane przez pacjentkę, tok jej wypowiedzi, ekscentryczny wygląd i determinacja do uzyskania zaświadczenia sugerowały, że lekarz powinien zachować ostrożność. Kobieta zgodziła się na hospitalizację w celu obserwacji stanu psychicznego. W trakcie pobytu pacjentki na oddziale zobiektywizowano wywiad – poszerzono go o informacje uzyskane od jej rodziców i wypisy z przebytych hospitalizacji. Przeprowadzono badanie psychologiczne i neuroobrazowe. Zgromadzone dane i obserwacja w oddziale wskazały na obecność zarówno choroby psychicznej, jak i głębokich deficytów osobowościowych. Opis przypadku potwierdza konieczność zachowania rozwagi przy wystawianiu zaświadczeń o zdrowiu psychicznym. Autorzy podkreślają, że jednostronny wywiad może nie ujawnić prawdziwego obrazu funkcjonowania pacjenta

ASSOCIATION BETWEEN DEPRESSION AND HEMODIALYSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Depression is the most common and serious psychiatric disorder that affects patients with chronic kidney disease and end-stage renal disease, and, has a significant impact on their quality of life. The aim of this study was to investigate and compare prevalence rates of depression among hemodialyzed patients, and non-dialyzed patients with a glomerular filtration rate <30 ml/min/1.73m2 receiving conservative treatment or following kidney transplantation. A total of 50 hemodialyzed and 50 non-dialyzed patients with stage 4/5 of CKD was assessed using the following questionnaires: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), The Satisfaction with Life Scale (SWLS), The Acceptance of Illness Scale (AIS), and The Life Orientation Test-Revised (LOT-R). The use of steroids and immunosuppressant drugs was also investigated. Symptoms of depression and anxiety were present in both groups, however the proportion of persons with mild or severe depression was higher among dialyzed patients. The AIS, LOT-R and SWLS scores were very similar in both the groups. The patients using steroids and/or immunosuppressant drugs were more prone to develop mild or severe depression according to the HAM-D scores. The results indicated a high prevalence of depression and anxiety among patients with CKD. Furthermore, the fraction of patients with depression is greater among hemodialyzed patients. This indicates the importance of monitoring the mental state of the patients as well as the necessity of providing timely psychological care for patients with CKD