Psychotic disorders as a complication of interferon-a treatment of hepatitis C

Summary Low-dose long-term interferon-a is a standard therapy for hepatitis C and is often associated with neuropsychiatric side effects, most frequently depression, mild cognitive impairment and fatigue which disappear with cessation of such treatment. Psychotic disorders are a rare complication of the treatment and usually resolve with its termination. In this paper, a review of the literature on interferon-a-induced psychotic disorders in hepatitis C patients has been performed. Epidemiology, predisposing factors, clinical picture, treatment and mechanisms of this serious neuropsychiatric complication have been discussed. Also, an own case of chronic schizophreniform psychosis and dementia following such treatment is described. interferon-a / psychotic disorders / clinical factors / treatment / mechanism

Mixed states — nosological position and clinical implications

Stany mieszane w przebiegu zaburzeń afektywnych są pojęciem, które nadal wzbudza wiele kontrowersji wśród psychiatrów. Wraz ze zmieniającą się koncepcją podziału zaburzeń nastroju równolegle zmieniają się podejścia do leczenie tej jednostki chorobowej. Pomimo powszechnego stosowania międzynarodowych systemów klasyfikacyjnych zaburzeń psychicznych ICD-10 oraz DSM-5 psychiatrzy nadal miewają trudności nie tylko z leczeniem epizodów mieszanych, ale także z prawidłowym ich rozpoznawaniem. Niniejsza praca jest próbą przybliżenia stanowisk ekspertów zajmujących się problematyką szeroko rozumianych zaburzeń nastroju — dotyczących definicji samego pojęcia, jego miejsca w kontinuum chorób afektywnych oraz wiążących się z tym implikacji farmakoterapeutycznych.Mixed states in the course of affective disorders are still a controversial topic among psychiatrists. Approaches to treatment of mixed episodes are constantly changing in parallel with changes in the whole concept of mood disorders and their classification. Even though international classifications of diseases like ICD-10 and DSM-5 are in widespread use, psychiatrists still tend to have difficulties with not only treating mixed states but also with their proper recognition. The following article is an attempt to familiarize the Reader with opinions from experts in the topic of affective disorders — concerning the definition of the concept of mixed states, their status in the continuum of mood disorders and associated with it pharmacotherapeutic implications

Kryteria diagnostyczne zaburzeń psychicznych dla dorosłych osób z niepełnosprawnością intelektualną w klasyfikacji DC–LD

Diagnosing people with intellectual disability and additional mental health difficulties can be challenging. This paperlooks at the current classifications of mental health disorders in the population with intellectual disability. Specificallydesigned for this population, the DC-LD (Diagnostic Criteria for Psychiatric Disorder for use with adults with LearningDisabilities/Mental Retardation) classification system is almost unknown in Poland. Therefore, our aim is to focus on thisclassification system in order to help physicians and psychologists who work with adult patients with intellectual disability.Diagnozowanie pacjentów z niepełnosprawnością intelektualną oraz współist-niejącymi zaburzeniami psychicznymi może przysparzać trudności. W artykule omó-wiono zasady klasyfikacji zaburzeń psychicznych u dorosłych osób z niepełnospraw-nością intelektualną w różnych systemach diagnostycznych. Specjalnie przeznaczo-ny dla takich osób system DC-LD (Diagnostic Criteria for Psychiatric Disorder for use with adults with Learning Disabilities/Mental Retardation- Kryteria diagnostyczne za-burzeń psychicznych dla dorosłych osób z niepełnosprawnością intelektualną) prak-tycznie nie jest w Polsce znany, dlatego poświęcono mu najwięcej uwagi, w celu przybliżenia tego systemu lekarzom i psychologom, którzy zajmują się dorosłymi pa-cjentami z niepełnosprawnością intelektualną

Neuropsychological assessment of cognitive dysfunctions in poststroke depression

Introduction. The purpose of his study was to assess the cognitive dysfunctions and their associations with depression and clinical picture of the illness in patients after stroke with depression. Material and methods. The 46 patients, 27 female and 19 male, aged 51-74 years, with diagnosis of depression after stroke participated in this study. The control group consisted with 25 healthy subjects, gender, age and education level matched to patients group. The severity of depression were assessed using 17-items Hamilton Depression Scale, and neuropsychological assessment was made with two screening tests for dementia: MMSE and Clock Drawing Test. Selected neuropsychological methods for assessment different aspects of cognition were also applied. Results and conclusions. The results show significant level of cognitive impairment connected with localization of the brain lesions, intensity of depression, and time duration after stroke, and also with duration of untreated depression.Wstęp. Celem pracy było określenie zaburzeń funkcji poznawczych oraz ocena zależności między depresją, zaburzeniami funkcji poznawczych a czynnikami klinicznymi choroby u osób po przebytym udarze mózgu ze współistniejącą depresją. Materiał i metody. Przebadano 46 chorych z depresją po udarze mózgu (27 kobiet i 19 mężczyzn) w wieku 51-74 lat. Grupę kontrolną stanowiło 25 osób zdrowych, dobranych pod względem płci, wieku i wykształcenia do osób chorych. Nasilenie depresji oceniono za pomocą 17-punktowej Skali Depresji Hamiltona, natomiast badanie neuropsychologiczne wykonano za pomocą testów przesiewowych dla otępienia: MMSE i Rysowania Zegara oraz wybranych metod badających różne aspekty funkcji poznawczych. Wyniki i wnioski. Stwierdzono, że u badanych chorych z depresją po udarze mózgu wystąpiły nasilone zaburzenia w zakresie wielu obszarów poznawczych, natomiast nasilenie tych zmian wiązało się z lokalizacją zmian strukturalnych w mózgu (lewa-prawa półkula), nasileniem objawów depresyjnych oraz czasem, jaki upłynął od udaru, oraz z czasem nieleczonej depresji

Narcolepsy in the light of modern diagnostic, clinical and therapeutic concepts

Narcolepsy is a chronic neurological disease classified as hypersomnia of central origin. Core symptoms of the disease (hypersomnia and cataplexy) are particularly burdensome for patients. The etiology of the disease is not fully understood. There are several theories explaining the essence of the disease. One of the possible causes is the disruption of the autoimmune system leading to the disappearance of hypocretin-releasing neurons. Currently, multicenter studies on synthesizing hypocretin-like proteins that may be the basis of causal narcolepsy treatment are conducted. As yet pharmacotherapy contributes only to reduce the symptoms of the disease. Commonly used medications are amphetamine derivatives, modafinil, pitolisant and γ-hydroxybutyric acid sodium salt (GHB)

Uzależnienie od ekstremalnie dużych dawek zolpidemu — opis przypadku i przegląd piśmiennictwa

The case of a physician addicted to extremely high dose of zolpidem is reported. She was admitted to psychiatric ward alsodue to codeine and caffeine abuse. As a result of complicated abstinence syndrome she was hospitalised for long time. Specificclinical and treatment problems associated with abandonment of high-dose zolpidem were discussed. Additionally, currentdata on many potentially serious consequences of zolpidem abuse were presented of which physicians who prescribe thismedication should be aware.W pracy przedstawiono przypadek lekarki uzależnionej od ekstremalnie dużej dawki zolpidemu, nadużywającej także kodeiny i kofeiny, która z powodu tych problemów oraz powikłań leczenia zespołu abstynencyjnego była długotrwale hospitalizowana psychiatrycznie. Omówiono szczególne problemy kliniczne i terapeutyczne wiążące się uzależnieniem od wysokich dawek zolpidemu występujące w trakcie odstawiania leku. Ponadto zaprezentowane współczesne dane wskazujące na wiele możliwych poważnych skutków nadużywania tego leku, których lekarze przepisujący go powinni być świadomi

Concentration of Selected Adipokines and Factors Regulating Carbohydrate Metabolism in Patients with Head and Neck Cancer in Respect to Their Body Mass Index

Head and neck cancers (HNCs) are a group of tumors not common in European populations. So far, not much is known about the role of obesity, adipokines, glucose metabolism, and inflammation in the pathogenesis of HNC. The aim of the study was to determine the concentrations of ghrelin, omentin-1, adipsin, adiponectin, leptin, resistin, visfatin, glucagon, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), plasminogen activator inhibitor-1 (PAI-1), and gastric inhibitory peptide (GIP) in the blood serum of HNC patients depending on their body mass index (BMI). The study included 46 patients divided into two groups according to their BMI values: the normal BMI group (nBMI) included 23 patients with BMI < 25 kg/m2 and the increased BMI group (iBMI) included patients with BMI ≥ 25 kg/m2. A control group (CG) included 23 healthy people (BMI < 25 kg/m2). Statistically significant differences in the levels of adipsin, ghrelin, glucagon, PAI-1, and visfatin were shown between nBMI and CG. In the case of nBMI and iBMI, statistically significant differences were observed in the concentrations of adiponectin, C-peptide, ghrelin, GLP-1, insulin, leptin, omentin-1, PAI-1, resistin, and visfatin. The obtained results indicate a disruption of endocrine function of adipose tissue and impaired glucose metabolism in HNC. Obesity, which is not a typical risk factor for HNC, may aggravate the negative metabolic changes associated with this type of neoplasm. Ghrelin, visfatin, PAI-1, adipsin, and glucagon might be related to head and neck carcinogenesis. They seem to be promising directions for further research

Concentration of Selected Adipokines and Factors Regulating Carbohydrate Metabolism in Patients with Head and Neck Cancer in Respect to Their Body Mass Index

Head and neck cancers (HNCs) are a group of tumors not common in European populations. So far, not much is known about the role of obesity, adipokines, glucose metabolism, and inflammation in the pathogenesis of HNC. The aim of the study was to determine the concentrations of ghrelin, omentin-1, adipsin, adiponectin, leptin, resistin, visfatin, glucagon, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), plasminogen activator inhibitor-1 (PAI-1), and gastric inhibitory peptide (GIP) in the blood serum of HNC patients depending on their body mass index (BMI). The study included 46 patients divided into two groups according to their BMI values: the normal BMI group (nBMI) included 23 patients with BMI 2 and the increased BMI group (iBMI) included patients with BMI ≥ 25 kg/m2. A control group (CG) included 23 healthy people (BMI 2). Statistically significant differences in the levels of adipsin, ghrelin, glucagon, PAI-1, and visfatin were shown between nBMI and CG. In the case of nBMI and iBMI, statistically significant differences were observed in the concentrations of adiponectin, C-peptide, ghrelin, GLP-1, insulin, leptin, omentin-1, PAI-1, resistin, and visfatin. The obtained results indicate a disruption of endocrine function of adipose tissue and impaired glucose metabolism in HNC. Obesity, which is not a typical risk factor for HNC, may aggravate the negative metabolic changes associated with this type of neoplasm. Ghrelin, visfatin, PAI-1, adipsin, and glucagon might be related to head and neck carcinogenesis. They seem to be promising directions for further research