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

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

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

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

Zaburzenia psychotyczne związane z używaniem „dopalaczy”

  INTRODUCTION: The use of psychoactive substances has become an increasing social and medical problem. The problem is both their availability and variable composition together with hard to predict health effects. MATERIAL AND METHODS: The materials used in the publication were obtained by searching the PubMed database for the following keywords: „novel psychoactive substances”, „new psychoactive substances”, „NPS”, „legal highs”, „smart drugs”, „bath salts”, „psychoactive drugs” „designer drugs”, „internet drugs”, „synthetic catinones”, „synthetic cannabinoids”, „novel psychoactive substances AND psychosis”, „new psychoactive substances AND psychosis”, „legal highs AND psychosis”, „legal highs AND psychosis”. Materials published until the January 2017 were taken for the analysis. RESULTS: The article describes classification of the new psychoactive substances based on type of chemicals. There were described their working mechanisms and related psychophysical effects. Present research and case studies were also presented. In addition to the symptoms of the nervous system or cardiovascular system, a number of symptoms of psychiatric disorders such as hallucinations, delusions, agitation, aggressive behavior, sleep and wakefulness disorders, anxiety and affective disorders have been described. Frequency and severity of symptoms were often dependent on the type of substance and the dose taken. Some of the cases described required hospitalization. CONCLUSIONS: Issues related to the novel psychoactive substances are related to the availability of these substances, the amount of the substances belonging to this group, the ease of synthesizing new agents and to the limited possibilities of labeling these substances. The use of this group of substances can cause various symptoms of psychiatric disorders, not specific for chemical substance.    WSTĘP: Używanie substancji psychoaktywnych z grupy „dopalaczy” staje się coraz większym problemem zarówno społecznym, jak i medycznym. Kłopotliwa jest zarówno ich dostępność, jak i zmienny skład oraz nie zawsze możliwe do przewidzenia skutki zdrowotne. MATERIAŁ I METODY: Materiały wykorzystane w publikacji uzyskano przeszukując bazę PubMed w kierunku fraz: ”novel psychoactive substances”, „new psychoactive substances”, „NPS”, „legal highs”, „smart drugs”, „bath salts”, „psychoactive drugs”, „designer drugs”, „internet drugs”, „synthetic catinones”, „synthetic cannabinoids”, ”novel psychoactive substances AND psychosis”, „new psychoactive substances AND psychosis”, „NPS AND psychosis”, „legal highs AND psychosis”. Analizowano materiały pojawiające się do stycznia 2017 roku. Przeanalizowano streszczenia otrzymanych pozycji. WYNIKI: W artykule opisano podział nowych substancji psychoaktywnych na podstawie klasy substancji chemicznych. Opisano ich mechanizmy działania i związane z nimi efekty psychofizyczne. Zaprezentowano także dotychczasowe badania i opisy konkretnych przypadków. Oprócz objawów ze strony układu nerwowego czy sercowo-naczyniowego opisano wiele objawów zaburzeń psychicznych, takich jak: halucynacje, urojenia, pobudzenie, zachowania agresywne, zaburzenia rytmu snu i czuwania, a także niepokój czy zaburzenia afektywne. Częstość oraz stopień nasilenia objawów zależały często od rodzaju przyjętej substancji, a także jej dawki. Część opisanych przypadków wiązała się z koniecznością hospitalizacji. WNIOSKI: Problematyka związana z tematem „dopalaczy” wiąże się zarówno z dostępnością tych substancji, ilością substancji należącej do tej grupy, łatwością syntetyzowania nowych środków oraz ograniczonymi możliwościami oznaczania tych substancji. Przyjmowanie tej grupy substancji może wywoływać różne objawy ze strony zaburzeń psychicznych, niespecyficzne dla danych środków.

Physical activity, psychological and functional outcomes in non-ambulatory stroke patients during Rehabilitation : a pilot study

Despite the extensive literature on stroke rehabilitation, there are few studies that comprehensively show non-ambulatory stroke patients. The aim of the study was to explore the dynamics of the change in physical activity (PA), psychological and functional outcomes, and the correlation between them in non-ambulatory patients during early in-patient post-stroke rehabilitation. Measurements were taken on 21 participants at the beginning of and 6 weeks post-conventional rehabilitation with the Barthel Index (BI), Berg Balance Scale (BBS), Trunk Control Test (TCT), Stroke Impact Scale (SIS), General Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire (SSEQ), the original scale of belief in own impact on recovery (BiOIoR), Hospital Anxiety and Depression Scale, Acceptance of Illness Scale and when the patient could walk—Time Up & Go and 6 Minute Walk Test. Daily PA was assessed over 6 weeks using a Caltrac accelerometer. Only outcomes for BI, BBS, TCT, SIS, and SSEQ significantly improved 6 weeks post-rehabilitation. PA energy expenditure per day significantly increased over time (p < 0.001; effect size = 0.494), but PA only increased significantly up to the third week. PA change was correlated with BiOIoR post-treatment. Self-efficacy in self-management mediated improvement in SIS. The BiOIoR and confidence in self-management could be important factors in the rehabilitation process

Nlrp3 Inflammasome Signaling Regulates the Homing and Engraftment of Hematopoietic Stem Cells (HSPCs) by Enhancing Incorporation of CXCR4 Receptor into Membrane Lipid Rafts

Fast and efficient homing and engraftment of hematopoietic stem progenitor cells (HSPCs) is crucial for positive clinical outcomes from transplantation. We found that this process depends on activation of the Nlrp3 inflammasome, both in the HSPCs to be transplanted and in the cells in the recipient bone marrow (BM) microenvironment. For the first time we provide evidence that functional deficiency in the Nlrp3 inflammasome in transplanted cells or in the host microenvironment leads to defective homing and engraftment. At the molecular level, functional deficiency of the Nlrp3 inflammasome in HSPCs leads to their defective migration in response to the major BM homing chemoattractant stromal-derived factor 1 (SDF-1) and to other supportive chemoattractants, including sphingosine-1-phosphate (S1P) and extracellular adenosine triphosphate (eATP). We report that activation of the Nlrp3 inflammasome increases autocrine release of eATP, which promotes incorporation of the CXCR4 receptor into membrane lipid rafts at the leading surface of migrating cells. On the other hand, a lack of Nlrp3 inflammasome expression in BM conditioned for transplantation leads to a decrease in expression of SDF-1 and danger-associated molecular pattern molecules (DAMPs), which are responsible for activation of the complement cascade (ComC), which in turn facilitates the homing and engraftment of HSPCs