KETAMINE AS A NOVEL DRUG FOR DEPRESSION TREATMENT

Background: Depression is one of the most common mental disorders. Currently used antidepressants, acting on the monoaminergic system, are insufficient for depression treatment. In recent years, potential application of NMDA receptor modulators in the treatment of drug-resistant depression has gained attention. Administration of ketamine, being a non-competitive NMDA receptor antagonist, contributes to a faster remission of symptoms. Subjects and methods: The aim of this paper is to review current studies on the use of ketamine in the treatment of drug-resistant depression, compare results of various administration methods - intravenous, intranasal or oral, as well as compare its effectiveness with that of other antidepressants. Results: Numerous studies show the drug is effective and well tolerated, particularly in patients with increased suicidal thoughts. However, there are concerns on increasing tolerance to the drug and the possibility of implementing a long-term treatment. Conclusion: Oral and intranasal forms of the drug are particularly promising due to their non-invasiveness and ability to selfadminister. In March 2019, S-ketamine nasal spray was registered by the FDA for the treatment of drug-resistant depression

Oblicza przestępczości – wyzwania Psychologii Sądowej

W dniu 25 maja 2015 r. odbyła się w Wyższej Szkole Biznesu – National-Louis University w Nowym Sączu kolejna Ogólnopolska Konferencja Naukowa nt. „Oblicza przestępczości – wyzwania Psychologii Sądowej XXI wieku”. Konferencja ta powstała w ramach projektu: „Psychologia sądowa – wzmocnienie potencjału dydaktycznego uczelni”. Projekt był realizowany na przestrzeni ostatnich pięciu lat. Podstawowym celem tego projektu była poprawa efektywności funkcjonowania wymiaru sprawiedliwości dzięki zastosowaniu dorobku psychologii sądowej i pedagogiki. Interdyscyplinarny charakter tych nauk, powoduje to, iż są one wykorzystywane w naukach prawnych, pedagogice społecznej, psychologii penitencjarnej i in. Naczelną zasadą jest by umiejętnie łączyć niezwykle szeroką wiedzę teoretyczną ze sprawnością diagnostyczno – opiniodawczą. Nakreślone cele były realizowane w ramach dodatkowej specjalności „Psychologia sądowa”, studiów podyplomowych: „Psychologia i pedagogika sądowa”, kursów kierowanych do pracowników wymiaru sprawiedliwości: „Kursy z psychologii dla osób zawodowo związanych z wymiarem sprawiedliwości” oraz cyklu staży i wizyt studyjnych w krajowych i zagranicznych ośrodkach opiniodawstwa sądowego oraz placówkach związanych z wymiarem sprawiedliwości. Pokłosiem pięcioletniego czasu realizacji wspomnianych zadań jest zrealizowanie powyżej postawionych celów (co zostało wykonane) oraz przedstawienie wyników badań i doświadczeń w ramach konferencji naukowej, która stała się swoistym podsumowaniem tego okresu. W wyniku odbytej konferencji naukowej powstała niniejsza monografia. Zamysłem organizatorów było zainteresowanie problematyką przestępczości we współczesnym świecie. Konferencja zgromadziła przedstawicieli różnych dyscyplin naukowych reprezentujących różne ośrodki uniwersyteckie. Autorzy referatów podjęli szeroki zakres zagadnień związanych z przyczynami, przebiegiem i skutkami różnorakich przestępstw

Adverse childhood experiences and methylation of the FKBP5 gene in patients with psychotic disorders

Altered methylation of the FKBP5 gene has been observed in various mental disorders and attributed to the effects of adverse childhood experiences (ACEs). However, the level of FKBP5 methylation has not been investigated in patients with psychotic disorders. Therefore, in this study we aimed to determine the FKBP5 methylation in patients with psychosis and controls, taking into account the effects of ACEs. Participants were 85 patients with psychotic disorders, including first-episode psychosis (FEP) patients and acutely relapsed schizophrenia (SCZ-AR) patients, as well as 56 controls. The level of four CpG sites at the FKBP5 gene was determined in the peripheral blood leukocytes using pyrosequencing. After controlling for potential confounding factors, the level of FKBP5 methylation at one out of four tested CpG sites was significantly lower in FEP patients compared to other groups of participants. Significant main effects of parental antipathy and sexual abuse on the level of FKBP5 methylation were observed at the differentially methylated CpG site. Participants reporting this category of ACEs had significantly lower levels of FKBP5 methylation at this CpG site. Lower levels of FKBP5 methylation were associated with better cognitive performance and higher functional capacity in patients with psychosis. In controls, lower methylation of FKBP5 was related to worse performance of immediate memory and language skills. Our findings suggest that hypomethylation of the FKBP5 appears at early stages of psychosis and might be associated with a history of ACEs as well as less severe clinical manifestation

Is bronchoscopy always justified in diagnosis of haemoptysis? Response to the letter of Solidoro and Guerrera

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CAUSES OF MORTALITY IN SCHIZOPHRENIA: AN UPDATED REVIEW OF EUROPEAN STUDIES

Background: The excess mortality in schizophrenia is still a phenomenon insufficiently studied on the cross-national level. It is important to analyse current studies on morality in schizophrenia since significant changes have recently taken place in psychiatric health care systems and guidelines of pharmacological treatment have been developed in European countries. Subjects and methods: This article reviews studies addressing mortality in schizophrenia in Europe that were published in English in the Pubmed database in 2009-2014. It aimed at determining countries where studies were conducted, methodologies and tools used, and current main mortality rates, as well as direction of causality in this group of patients. Results: The recently published studies were conducted only in few European countries. The majority of data was obtained from general medical records and death records. The studies indicate that schizophrenia patients are characterized by higher mortality rate than the general population, with natural causes (cardiovascular diseases and cancers) and suicides predominating. The increasing mortality gap with significantly shorter life expectancy of patients with schizophrenia in comparison with the general population is considerable. Conclusions: Death records are a crucial tool in studies on mortality in schizophrenia patients; however they are insufficiently employed. Recent European reports do not show positive tendencies, indicating that standardized mortality rates in schizophrenia remain on the same level or even increase, particularly for deaths resulting from natural causes. Due to various methodologies used in studies, their direct comparison is difficult. This limitation warrants further discussion on methods used in future studies on schizophrenia mortality in Europe

Is bronchoscopy always justified in diagnosis of haemoptysis?

Introduction: Fiber-optic bronchoscopy (FOB) is commonly performed in the first line in diagnostic process of haemoptysis.However, lots of evidences suggest that in haemoptysis FOB do not always provide additional, useful information to radiologicaldiagnostics. Therefore, this study aimed to evaluate the validity of performing FOB as a method of choice in first line diagnosticsof haemoptysis. Material and methods: Data comprised consecutively collected results from patients referred for FOB assessment for clinicalpurposes were retrospectively analysed. We included all examinations, which were performed due to haemoptysis as the onlyindication, excluding any other lung-related conditions. Results: 114 patients were finally included to the study. The median age was 59 (IQR: 46–64.75). Active bleeding was visualizedduring examination of 13 (11.4%) patients. Patients with active bleeding did not differ significantly according to age: 59 (54–69)vs 59 (45–64) years; W = 532.5, p-value = 0.27, and gender: c2 = 1.68, p-value = 0.2. On the other hand, in 29 (25.44%)patients, FOB revealed no visible abnormalities. This subgroup of patients was significantly younger — 46 (34–62) years vs 60(53–67) years; W = 782, p-value = 0.003. Conclusion: Low number of visualized active bleeding sites suggest overuse of bronchoscopy in diagnosis of haemoptysis. Indicationsfor this examination should be reconsidered especially in young patients with non-massive haemoptysis

Various neuromodulation methods including Deep Brain Stimulation of the medial forebrain bundle combined with psychopharmacotherapy of treatment-resistant depression—Case report

BackgroundTreatment-resistant depression remains one of the main concerns of modern psychiatry. Novel methods such as Transcranial Magnetic Stimulation (including deep and theta burst protocols, iTBS) and Deep Brain Stimulation (DBS) can be considered as alternative treatment options.Case presentationTwenty-nine-year-old Caucasian female, single, higher-educated was treated with major depressive disorder initially with standard pharmaco- and psychotherapy. Due to diagnosed treatment resistance additional therapeutic approaches were introduced sequentially: Electroconvulsive therapy (efficient only 4 months) and Transcranial Magnetic Stimulation (intermittent Theta Burst Stimulation, iTBS improved just insomnia). Finally the patient was enrolled to the Deep Brain Stimulation (DBS) study with the medial forebrain bundle target. After 20 months of active DBS a reduction of over 80% of depressive symptom severity was observed (Montgomery-Asberg and Hamilton Depression Rating Scales), together with an 87% reduction of anxiety symptoms intensity (Hamilton Anxiety Rating Scale) and a 90% increase in social and occupational functioning. Subjective assessment of the patient performed with questionnaires and visual analog scales showed less pronounced improvement in terms of depressive and anxiety symptoms, and high reduction of anhedonia. Some mild, transient side effects of neurostimulation were eliminated with an adjustment in stimulation parameters.ConclusionsThe presented clinical case confirms the possibility of achieving remission after the use of MFB DBS in treatment-resistant depression, but postponed for many months. Nevertheless, personalization of every combined therapy with DBS is necessary with exploration of individual factors as past traumas and personality traits. More reports on long-term observations in DBS treatment in TRD trials (especially focused on MFB target) are needed

Effectiveness of screening for atrial fibrillation and its determinants. A meta-analysis

<div><p>Background</p><p>Many atrial fibrillation patients eligible for oral anticoagulants are unaware of the presence of AF, and improved detection is necessary to facilitate thromboprophylaxis against stroke.</p><p>Objective</p><p>To assess the effectiveness of screening for AF compared to no screening and to compare efficacy outcomes of different screening strategies.</p><p>Materials and methods</p><p>Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE from Jan 1, 2000 –Dec 31, 2015 were searched. Studies employing systematic or opportunistic screening and using ECG or pulse palpation in populations age ≥40 years were included. Data describing study and patient characteristics and number of patients with new AF were extracted. The outcome was the incidence of previously undiagnosed AF.</p><p>Results</p><p>We identified 25 unique (3 RCTs and 22 observational) studies (n = 88 786) from 14 countries. The incidence of newly detected AF due to screening was 1.5% (95% CI 1.1 to 1.8%). Systematic screening was more effective than opportunistic: 1.8% (95% CI 1.4 to 2.3%) vs. 1.1% (95% CI 0.6 to 1.6%), p<0.05, GP-led screening than community based: 1.9% (95% CI 1.4 to 2.4%) vs. 1.1% (95% CI 0.7 to 1.6%), p<0.05, and repeated heart rhythm measurements than isolated assessments of rhythm: 2.1% (95% CI 1.5–2.8) vs. 1.2% (95% CI 0.8–1.6), p<0.05. Only heart rhythm measurement frequency had statistical significance in a multivariate meta-regression model (p<0.05).</p><p>Conclusions</p><p>Active screening for AF, whether systematic or opportunistic, is effective beginning from 40 years of age. The organisation of screening process may be more important than technical solutions used for heart rhythm assessment.</p></div

Czy bronchoskopia jest zawsze niezbędna w diagnostyce krwioplucia?

WSTĘP: Bronchofiberoskopia jest często wykonywanym badaniem we wstępnej diagnostyce krwioplucia. Wiele danych wskazuje jednak na to, że badanie to nie zawsze dostarcza dodatkowych istotnych informacji, ponad te uzyskane z badań obrazowych. Z tego powodu przeprowadzono analizę, której celem było określenie przydatności bronchofiberoskopii w pierwszoplanowej diagnostyce krwioplucia. MATERIAŁ I METODY: Przedmiotem retrospektywnej analizy były wyniki badań bronchoskopowych wykonanych u pacjentów kierowanych do pracowni bronchoskopowej. Zawarto w niej jedynie te badania, w których wyłącznym wskazaniem było krwioplucie, wyłączając inne przyczyny z zakresu układu oddechowego. WYNIKI: Do ostatecznej analizy włączono 114 pacjentów. Mediana wieku wynosiła 59 lat (IQR: 46–64,75). Aktywne krwawienie stwierdzono w badaniu u 13 pacjentów (11,4%). Nie różnili się oni od pozostałych pod względem wieku: 59 (54–69) v. 59 (45–64) lat; W = 532,5, p = 0,27, oraz płci: c2 = 1,68, p = 0,2. Natomiast u 29 pacjentów (25,44%) w bronchofiberoskopii nie ujawniono żadnych nieprawidłowości. Pacjenci należący do tej grupy byli istotnie młodsi — 46 (34–62) v. 60 (53–67) lat; W = 782, p = 0,003. WNIOSKI: Mały odsetek wyników wskazujących na aktywne krwawienie sugeruje nadużywanie bronchofiberoskopii w diagnostyce krwioplucia. Wskazania do tego badania powinny być zrewidowane, w szczególności w grupie młodych pacjentów z niemasywnym krwiopluciem.WSTĘP: Bronchofiberoskopia jest często wykonywanym badaniem we wstępnej diagnostyce krwioplucia. Wiele danych wskazuje jednak na to, że badanie to nie zawsze dostarcza dodatkowych istotnych informacji, ponad te uzyskane z badań obrazowych. Z tego powodu przeprowadzono analizę, której celem było określenie przydatności bronchofiberoskopii w pierwszoplanowej diagnostyce krwioplucia. MATERIAŁ I METODY: Przedmiotem retrospektywnej analizy były wyniki badań bronchoskopowych wykonanych u pacjentów kierowanych do pracowni bronchoskopowej. Zawarto w niej jedynie te badania, w których wyłącznym wskazaniem było krwioplucie, wyłączając inne przyczyny z zakresu układu oddechowego. WYNIKI: Do ostatecznej analizy włączono 114 pacjentów. Mediana wieku wynosiła 59 lat (IQR: 46–64,75). Aktywne krwawienie stwierdzono w badaniu u 13 pacjentów (11,4%). Nie różnili się oni od pozostałych pod względem wieku: 59 (54–69) v. 59 (45–64) lat; W = 532,5, p = 0,27, oraz płci: c2 = 1,68, p = 0,2. Natomiast u 29 pacjentów (25,44%) w bronchofiberoskopii nie ujawniono żadnych nieprawidłowości. Pacjenci należący do tej grupy byli istotnie młodsi — 46 (34–62) v. 60 (53–67) lat; W = 782, p = 0,003. WNIOSKI: Mały odsetek wyników wskazujących na aktywne krwawienie sugeruje nadużywanie bronchofiberoskopii w diagnostyce krwioplucia. Wskazania do tego badania powinny być zrewidowane, w szczególności w grupie młodych pacjentów z niemasywnym krwiopluciem