NEUROSYPHILIS PRESENTING WITH COGNITIVE DEFICITS - A REPORT OF TWO CASES

Background: Neurosyphilis is an infection of the brain or spinal cord caused by Treponema pallidum. In the third phase of syphilis involving the central nervous system it may manifest in a widespread dysfunctions including psychiatric manifestations being often underestimated in the differential diagnosis. Case reports: Two patients demonstrating rapid cognitive decline as the primary symptom for neurosyphillis are described with particular focus on the diagnostic process complexity and adequate treatment delivery. Conclusions: Clinical manifestations as well as psychiatric symptoms of syphilis are diverse and often non-specific. The symptomatology of mood disorders in neurosyphilis is frequently atypical, intermittent, and pleomorphic and fails to meet DSM-5 diagnostic categories. Neurocognitive decline although could be one of the key symptoms domains in neurosyphilis. Those two cases emphasise the importance of specific differential diagnosis with rapid onset cognitive decline with spotlight to sexually transmitted diseases as syphilis

LITHIUM THERAPEUTIC DOSE MONITORING IN HUMAN SALIVA

Background: Lithium carbonate is valuable and effective agent in the treatment and prophylaxis of mood disorders, particularly bipolar disorder (BD). Due to its narrow therapeutic range, frequent serum lithium estimation is necessary. To avoid the discomfort of frequent venipuncture, a non-invasive method for serum lithium concentration is needed. An alternative method of determining lithium level could be saliva or urine. Literature data regarding the reliability of saliva lithium levels is not conclusive. Material and methods: The aim of this study is to provide an overview of possibility to replace blood serum with saliva look through research in that field. Results: Some authors conclude that there is constant ratio between serum and saliva lithium level and they suggest that saliva can replace serum for estimation lithium level. Other revealed that saliva/serum lithium ratio is constant individually, so saliva/serum lithium ratio should be estimated individually. Finally there are studies excluding the possibility of replacement serum with saliva. Conclusions: There is little number of studies on saliva clinical use in lithium level monitoring. Further studies should base on current data including methods of obtaining saliva and its biochemical analysis, collecting samples in a specific time frame from the last dosage of lithium, as well as inter-subject or intra-subject measurements

DECISION-MAKING IN PANIC DISORDER. PRELIMINARY REPORT

Background: The impaired decision-making with high risk-aversive behavior and elevated impulsivity are reported as a trait feature in anxiety disorders including panic disorder (PD). It is hypothesised that PD patients exhibit difficulties in executive functions which can influence patients behavioural strategies e.g. problem solving, decision making, planning, impulse control. The aim of this study was to asses decision making process, risk-taking and impulsivity in PD patients as compared to healthy controls. Material and methods: Twenty-one psychotropic drug-naïve PD outpatients and 20 healthy subjects matched by age and sex were examined. Cognitive decision-making and risk-taking behaviour was measured with CGT (Cambridge Gambling Task) from CANTAB battery. The PD severity was assessed with Panic and Agoraphobia Scale (PAS). The level of anxiety and depression was assessed with HADS (Hospital Anxiety and Depression Scale). Impulsivity was evaluated with the Barratt Impulsiveness Scale, 11th version (BIS-11). Results: There were no statistically significant differences on CGT in PD patients as compared to healthy control. However, having observed more closely, there are some differences between patients and healthy control. PD patients with higher anxiety level in HADS exhibited lower percentages of risky decisions comparing to PD with lower anxiety in HADS. PD patients with higher depression level in HADS demonstrated slowed decision-making when compared to PD patients with low level of depression in HADS. Total impulsivity and its attentional and motor dimensions were significantly higher in panic disorder patients versus healthy controls. Conclusion: There were no statistically significant differences with regard to CGT assessed decision-making between drugnaïve PD patients and healthy controls. The PD patients with higher HADS-D depression level demonstrated slowed decisionmaking as compared to PD patients with low level of depression

THE ROLE OF HORMONES AND INFLAMMATORY MARKERS IN COGNITIVE FUNCTIONING OF SCHIZOPHRENIC PATIENTS

Background: In the literature we can find evidence that immunological processes are involved the alterations of cognition in schizophrenic patients. Another factor, which may have an impact on cognitive domains in this clinical group are hormones. Objective: The objective of this review was to explore studies, in which the role of both immunological and endocrine factors on cognitive functions in schizophrenia are analyzed. Methods: The search of papers covering this topic in PubMed and Google Scholar was performed. Results: The studies focusing on this co-relation are not numerous. The role such hormones like cortisol, insulin and sex hormones may be important in the immunomodulatory processes influencing cognition in schizophrenia. Conclusions: More studies are necessary to confirm these possible co-relations

THE ROLE OF HORMONES AND INFLAMMATORY MARKERS IN COGNITIVE FUNCTIONING OF SCHIZOPHRENIC PATIENTS

Background: In the literature we can find evidence that immunological processes are involved the alterations of cognition in schizophrenic patients. Another factor, which may have an impact on cognitive domains in this clinical group are hormones. Objective: The objective of this review was to explore studies, in which the role of both immunological and endocrine factors on cognitive functions in schizophrenia are analyzed. Methods: The search of papers covering this topic in PubMed and Google Scholar was performed. Results: The studies focusing on this co-relation are not numerous. The role such hormones like cortisol, insulin and sex hormones may be important in the immunomodulatory processes influencing cognition in schizophrenia. Conclusions: More studies are necessary to confirm these possible co-relations

TELEPSYCHIATRY AND VIRTUAL REALITY IN THE TEATMENT OF PATIENTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

Background: Treatment and rehabilitation of people with intellectual and developmental disabilities is a multidisciplinary challenge, which require implementing new attitudes. The use of modern technology solutions like telepsychiatry or virtual reality may be a valuable addition to the traditional methods. Objective: The objective of this review was to explore the usability of new technological solutions in this special population of patients. Methods: The search in the PubMed was conducted using the following terms: (intellectual disability (Title/Abstract) OR developmental disability OR learning disorder (Title/Abstract)) AND virtual reality (Title/Abstract) OR telepsychiatry OR telemedicine OR e-mental health AND English (lang) AND (1995/01/01(PDAT): 2017/07/31(PDAT)). Results: Telepsychiatry may be a useful tool in situations, when the direct access to professional assistance is limited, in solving particular problems like e.g. managing challenging behavior, also to support patients’ parents and for diagnostic and educational purposes. Virtual reality can be a safe and effective method of improving different skills, developing physical fitness, and enriching the ways of spending the leisure time. Conclusions: Using modern technology is a relatively new and promising field in which new ideas may develop to support the already existing services for patients with intellectual and developmental disabilities

TELEPSYCHIATRY AND VIRTUAL REALITY IN THE TEATMENT OF PATIENTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES

Background: Treatment and rehabilitation of people with intellectual and developmental disabilities is a multidisciplinary challenge, which require implementing new attitudes. The use of modern technology solutions like telepsychiatry or virtual reality may be a valuable addition to the traditional methods. Objective: The objective of this review was to explore the usability of new technological solutions in this special population of patients. Methods: The search in the PubMed was conducted using the following terms: (intellectual disability (Title/Abstract) OR developmental disability OR learning disorder (Title/Abstract)) AND virtual reality (Title/Abstract) OR telepsychiatry OR telemedicine OR e-mental health AND English (lang) AND (1995/01/01(PDAT): 2017/07/31(PDAT)). Results: Telepsychiatry may be a useful tool in situations, when the direct access to professional assistance is limited, in solving particular problems like e.g. managing challenging behavior, also to support patients’ parents and for diagnostic and educational purposes. Virtual reality can be a safe and effective method of improving different skills, developing physical fitness, and enriching the ways of spending the leisure time. Conclusions: Using modern technology is a relatively new and promising field in which new ideas may develop to support the already existing services for patients with intellectual and developmental disabilities

NEUROSYPHILIS PRESENTING WITH COGNITIVE DEFICITS - A REPORT OF TWO CASES

Background: Neurosyphilis is an infection of the brain or spinal cord caused by Treponema pallidum. In the third phase of syphilis involving the central nervous system it may manifest in a widespread dysfunctions including psychiatric manifestations being often underestimated in the differential diagnosis. Case reports: Two patients demonstrating rapid cognitive decline as the primary symptom for neurosyphillis are described with particular focus on the diagnostic process complexity and adequate treatment delivery. Conclusions: Clinical manifestations as well as psychiatric symptoms of syphilis are diverse and often non-specific. The symptomatology of mood disorders in neurosyphilis is frequently atypical, intermittent, and pleomorphic and fails to meet DSM-5 diagnostic categories. Neurocognitive decline although could be one of the key symptoms domains in neurosyphilis. Those two cases emphasise the importance of specific differential diagnosis with rapid onset cognitive decline with spotlight to sexually transmitted diseases as syphilis

DECISION-MAKING IN PANIC DISORDER. PRELIMINARY REPORT

Background: The impaired decision-making with high risk-aversive behavior and elevated impulsivity are reported as a trait feature in anxiety disorders including panic disorder (PD). It is hypothesised that PD patients exhibit difficulties in executive functions which can influence patients behavioural strategies e.g. problem solving, decision making, planning, impulse control. The aim of this study was to asses decision making process, risk-taking and impulsivity in PD patients as compared to healthy controls. Material and methods: Twenty-one psychotropic drug-naïve PD outpatients and 20 healthy subjects matched by age and sex were examined. Cognitive decision-making and risk-taking behaviour was measured with CGT (Cambridge Gambling Task) from CANTAB battery. The PD severity was assessed with Panic and Agoraphobia Scale (PAS). The level of anxiety and depression was assessed with HADS (Hospital Anxiety and Depression Scale). Impulsivity was evaluated with the Barratt Impulsiveness Scale, 11th version (BIS-11). Results: There were no statistically significant differences on CGT in PD patients as compared to healthy control. However, having observed more closely, there are some differences between patients and healthy control. PD patients with higher anxiety level in HADS exhibited lower percentages of risky decisions comparing to PD with lower anxiety in HADS. PD patients with higher depression level in HADS demonstrated slowed decision-making when compared to PD patients with low level of depression in HADS. Total impulsivity and its attentional and motor dimensions were significantly higher in panic disorder patients versus healthy controls. Conclusion: There were no statistically significant differences with regard to CGT assessed decision-making between drugnaïve PD patients and healthy controls. The PD patients with higher HADS-D depression level demonstrated slowed decisionmaking as compared to PD patients with low level of depression

LITHIUM THERAPEUTIC DOSE MONITORING IN HUMAN SALIVA

Background: Lithium carbonate is valuable and effective agent in the treatment and prophylaxis of mood disorders, particularly bipolar disorder (BD). Due to its narrow therapeutic range, frequent serum lithium estimation is necessary. To avoid the discomfort of frequent venipuncture, a non-invasive method for serum lithium concentration is needed. An alternative method of determining lithium level could be saliva or urine. Literature data regarding the reliability of saliva lithium levels is not conclusive. Material and methods: The aim of this study is to provide an overview of possibility to replace blood serum with saliva look through research in that field. Results: Some authors conclude that there is constant ratio between serum and saliva lithium level and they suggest that saliva can replace serum for estimation lithium level. Other revealed that saliva/serum lithium ratio is constant individually, so saliva/serum lithium ratio should be estimated individually. Finally there are studies excluding the possibility of replacement serum with saliva. Conclusions: There is little number of studies on saliva clinical use in lithium level monitoring. Further studies should base on current data including methods of obtaining saliva and its biochemical analysis, collecting samples in a specific time frame from the last dosage of lithium, as well as inter-subject or intra-subject measurements