Clinical and demographic features of acutely hospitalised schizophrenia patients according to Toxoplasma gondii serostatus

Background: Few data exist concerning the clinical correlates of Toxoplasma gondii infection in persons with schizophrenia. The aim of this study was to investigate the correlation between toxoplasmosis and schizophrenia regarding the quality of life, symptoms and course of hospitalisation in patients with schizophrenia. Methods: Acutely hospitalised patients (n = 67) were examined twice during their hospital stay. Schizophrenia psychopathology, quality of life, extrapyramidal symptoms and T. gondii antibody titres were assessed upon admission and at discharge. Results: Toxo-IgG (+) patients (59.7%) were older, less educated, more obese and less eager to undertake psychotherapy. Female gender and higher fertility were dominant in this group with abnormal involuntary movements more commonly observed. Lower antipsychotic drug doses and monotherapy were used more frequently for Toxo-IgG (+) patients. Lower education (OR 2.41, 95% CI 1.21-4.79) was the most important factor associated with higher likelihood of IgG seropositivity. High levels of Toxo-IgM antibodies correlated with lower quality of life (r = -0.37; p = 0.02) and more severe positive (r = 0.40; p = 0.01) and focal (r = 0.32; p = 0.04) schizophrenia symptoms. Conclusions: Toxoplasmosis is more common in older, obese women with lower education. Recent infection is linked to more severe schizophrenia symptoms. Patients with toxoplasmosis history were given less medication

Farmakoterapia depresji u pacjentów z zaawansowanymi chorobami

Sadness and anxiety are natural reactions to approaching death. However, sometimes these symptoms reach the significant intensity and are associated with the development of a depressive episode in people at the end of life. Diagnosis of depression may mean that somatic symptoms of advanced disease are subject to exacerbation due to the mental condition (reduced pain threshold, fatigue, sleep disorders, reduced appetite). Depressive patients will be less likely to cooperate in treatment, which may lead to deterioration of overall health, worse prognosis and higher mortality. It seems, therefore, that pharmacotherapy of depression in end-of-life patients should not be marginalized. However, due to antidepressants’ delayed onset of action most patients probably fail to achieve satisfactory improvement on time. We propose as the first target for the treatment of depression in palliative care a fast and safe reduction of symptoms. Without giving up the basic antidepressant treatment, expected risk and benefits should be carefully and individually considered before the inclusion of standard medications, especially in terms of remaining life expectancy. We also believe that, if started, such pharmacotherapy should often be accompanied by medications that can quickly alleviate at least some depression symptoms making it easier for the patient to wait for the beneficial effect of the drug. Focusing on the rapid improvement of mental state, mianserin, mirtazapine, pregabalin, quetiapine, trazodone and vortioxetine seem to be beneficial for use in palliative care.Smutek i lęk są naturalnymi reakcjami na zbliżającą się śmierć, czasami jednak objawy te osiągają znacznenasilenie i wiążą się z rozwojem epizodu depresyjnego u chorego u kresu życia. Potwierdzenie rozpoznaniadepresji u pacjenta wymagającego opieki paliatywnej może oznaczać, że duża część objawów somatycznychzaawansowanej choroby podlega zaostrzeniu ze względu na stan psychiczny (obniżony próg bólu, zmęczenie,zaburzenia snu, obniżone łaknienie). Chorzy depresyjni będą gorzej współpracować w leczeniu, cobędzie się przekładać na ich mniejszą ogólną sprawność, gorsze rokowanie i większą śmiertelność. Wydajesię więc, że podjęcie farmakoterapii depresji u chorych u kresu życia nie powinno być marginalizowane.Z powodu opóźnionego początku działania leków przeciwdepresyjnych większość pacjentów prawdopodobnienie osiągnie zadowalającej poprawy na czas. Wobec tego jako pierwszy cel leczenia depresji w opiecepaliatywnej proponuje się koncentrację na szybkiej i bezpiecznej redukcji objawów. Oczekiwane ryzykoi korzyści podstawowego leczenia przeciwdepresyjnego należy starannie i indywidualnie rozważyć przedwłączeniem leków, zwłaszcza biorąc pod uwagę oczekiwany czas życia pacjenta. Nie zaniechując takiejterapii, autorzy uważają, że ewentualnemu jej rozpoczęciu często powinny towarzyszyć leki, które mogąszybko złagodzić przynajmniej niektóre objawy depresji, ułatwiając pacjentowi oczekiwanie na korzystnedziałanie terapii podstawowej. W odniesieniu do szybkiej poprawy stanu psychicznego, kwetiapina, mianseryna,mirtazapina, pregabalina, trazodon i wortioksetyna wydają się być najkorzystniejszym wyborem

Relation of cigarette smoking and mood disorders to cognitive impairment progression

Background: Both depressive disorders and nicotine use are proven and important risk factors of dementia. The purpose of this study was to verify if cigarette smoking and depression symptoms together are disadvantageous for the prognosis in mild cognitive impairment. Material and methods: A total of 43 patients with a diagnosis of mild cognitive impairment were included in the study. ADAS-Cog was performed upon inclusion in the study and again at least 2 years later. Additionally, patients with ≥18 points in MADRS were qualified as depressive. The Fagerström scale for nicotine dependence was administered to smokers. Results: Our study shows a relation between severity of depressive symptoms and further deterioration of cognitive functions according to ADAS-cog scale. Regression analysis revealed that smoking associated with severity of depressive disorders is also correlated with the progression of cognitive impairment. Conclusions: The results of our study are based on a small number of subjects and should be regarded as early findings. Moreover, nicotine dependency should not be regarded as an isolated factor affecting mood disorders and cognitive impairment progression. Further studies on larger groups of patients and using more sensitive methods of cognitive function assessment are needed

Clinical and demographic features of acutely hospitalised schizophrenia patients according to Toxoplasma gondii serostatus

Background: Few data exist concerning the clinical correlates of Toxoplasma gondii infecotin in persons with schizophrenia. The aim of this study was to invesgtiate the correlaotin between toxoplasmosis and schizophrenia regarding the quality of life, symptoms and course of hospitalisaotin in paetints with schizophrenia. Methods: Acutely hospitalised paetints (n = 67) were examined twice during their hospital stay. Schizophrenia psychopathology, quality of life, extrapyramidal symptoms and T. gondii anbtiody ttires were assessed upon admission and at discharge. Results: Toxo-IgG (+) paetints (59.7%) were older, less educated, more obese and less eager to undertake psychotherapy. Female gender and higher ferltiity were dominant in this group with abnormal involuntary movements more commonly observed. Lower anptisychocti drug doses and monotherapy were used more frequently for Toxo-IgG (+) paetints. Lower educaotin (OR 2.41, 95% CI 1.21-4.79) was the most important factor associated with higher likelihood of IgG seroposivtiity. High levels of Toxo-IgM anbtiodies correlated with lower quality of life (r = -0.37; p = 0.02) and more severe posivtie (r = 0.40; p = 0.01) and focal (r = 0.32; p = 0.04) schizophrenia symptoms. Conclusions: Toxoplasmosis is more common in older, obese women with lower educaotin. Recent infecotin is linked to more severe schizophrenia symptoms. Patients with toxoplasmosis history were given less medication. Grabowski J, Waszak P, Przybylak M, Bidzan L. Clinical and demographic features of acutely hospitalised schizophrenia patients according to Toxoplasma gondii serostatus. Eur J Transl Clin Med. 2023;6(1):14-24

Use of Sertraline in Hemodialysis Patients

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control