Pharmacological treatment of a very early and early onset bipolar disorder

Diagnosing and treatment of children’s bipolar illness is often challenging and difficult because of the lack of homogeneous diagnostic and therapeutic criteria. Not all of pharmacological agents applied in treatment of adults bipolar illness may be used to treat children and adolescent because of different tolerance, bioavailability and side effects. In this article authors reviewed current approaches of the safety and the effectiveness of pharmacotherapy in pediatric bipolar disorder.Rozpoznawanie i leczenie dziecięcej choroby dwubiegunowej jest często trudne ze względu na brak jednorodnych kryteriów diagnostycznych i terapeutycznych. Nie wszystkie leki psychotropowe stosowane w leczeniu choroby dwubiegunowej dorosłych mogą być poddawane dzieciom i młodzieży ze względu na odmienną tolerancję, biodostępność oraz działania niepożądane. W niniejszym artykule autorzy dokonali przeglądu aktualnego piśmiennictwa dotyczącego bezpieczeństwa i skuteczności leczenia farmakologicznego dziecięcej choroby dwubiegunowej

Evaluation of C-reactive protein (CRP) plasma concentration among women during labour and in early puerperium

Objectives: Calculation and analysis of CRP plasma concentration among women during labour and in the second day of puerperium in various clinical situations Material and methods: 317 participants about estimated due date (EDD) were included to the study and then divided into four groups: 1. Women with labour onset after previous rupture of membranes and spontaneous vaginal delivery – PROM (n= 97) 2. Women with labour onset at intact membranes and spontaneous vaginal delivery – non -PROM (n= 133) 3. Women who delivered by caesarean section for elective indications – ELCS (n= 58) 4. Women who delivered by caesarean section for emergency indications – EMCS (n= 29) Venous blood sampling for CRP plasma concentration evaluation was done in the course of labour or strictly before elective caesarean section and then, subsequently, on the second day of puerperium. Results: In all groups postdelivery CRP plasma level was significantly higher than in the course of labour (p < 0,001). CRP plasma concentration during labour among women who finally delivered vaginally was significantly higher in case of amniotic fluid leakage before the onset of labour, in comparison with this found in women with intact membranes (PROM = 6,30 mg/L vs non-PROM = 2,50 mg/L, p < 0,05). There was a significant difference between groups who gave birth by caesarean section. CRP level was lower among women who had elective caesarean section (EMCS 6,30 mg/L vs ELCS 4,15 mg/L, p < 0,05). In our study we found significantly higher puerperal CRP plasma level among women after caesarean section, as well for emergency as for elective indications, than among women after vaginal delivery, independently from ruptured or intact foetal membranes (p < 0.001). There was no difference in the CRP concentration on the 2nd of puerperium between two groups of women who gave birth vaginally, with or without membranes rupture before labour onset (PROM vs non-PROM, NS), same as between those who had caesarean delivery (ELCS vs EMCS, NS). Conclusions: 1. The increase of CRP plasma concentration follows the parturition and it is significantly higher after caesarean than after vaginal delivery 2. Intrapartum CRP level is higher among women with amniotic fluid leakage before the onset of labour, than in those with intact foetal membranes, what can suggest the participation of inflammatory response in the labour beginning with membranes rupture 3. CRP concentration on the second day of puerperium is similar in women after elective and emergency caesarean section 4. The assessment of CRP concentration as the only test in early puerperium is not useful for the decision making about antibiotic therapy 5. Because of early discharge of women from the hospital, as well after vaginal as caesarean delivery, the usefulness of CRP concentration assessment in early puerperium decreases progressivel

Child and adolescent schizophrenia - biological background for diagnosis and treatment

Rozpoznawanie i leczenie schizofrenii o wczesnym początku (EOS) oraz o początku w wieku dziecięcym (COS) są trudne ze względu na brak jednorodnych kryteriów diagnostycznych i terapeutycznych oraz występującą w tym okresie dużą współchorobowość. Rosnąca liczba przeprowadzanych badań neuroobrazowych w tej grupie chorych wykazuje wiele strukturalnych nieprawidłowości, które mogą potwierdzać neurorozwojową koncepcję schizofrenii. Nadal nie ma ściśle określonych markerów pozwalających określić podatność zachorowania na schizofrenię w wieku dziecięcym i adolescencji, a wskazywane czynniki należą do szerokiej grupy zaburzeń neurofizjologicznych, neuropsychologicznych neurochemicznych oraz funkcjonalnych mózgu. Dane kliniczne dotyczące bezpieczeństwa stosowania leków psychotropowych u dzieci i młodzieży są również ograniczone. Leczenie pacjentów z EOS opiera się głównie na zasadach poznanych i stosowanych u osób dorosłych, a za najbezpieczniejsze leki uważa się atypowe neuroleptyki. Psychiatria 2010; 7, 4: 161-167Diagnosing and treatment of children&#8217;s schizophrenia (COS) and early onset schizophrenia (EOS) is often challenging due to lack of diagnostical and therapeutical criteria and considerable comorbidity. The growing number of neuroimaging data indicate a presence of many structural brain abnormalities that may confirm neurodevelopmental hypothesis of schizophrenia. We still couldn&#8217;t find any of biological markers which would allow to determine vulnerability for schizophrenia in child and adolescancy period. The markers that are considered, belong to the wide group of neuropsychological, neurophisiological and other functional brain disturbances. The treatment of COS and EOS is based on the same rules as these used in the adult schizophrenia treatment. Atypical neuroleptics are considered as the most safe treatment for children and adolescent suffering from schizophrenia. Psychiatry 2010; 7, 4: 161-16

The assessment of postpartum mood disorders and its risk factors

Wstęp: Celem pracy jest ocena rozpowszechnienia zaburzeń nastroju z uwzględnieniem występowania depresji poporodowej oraz analiza czynników predysponujących do ich występowania. Materiał i metody: Grupą badaną były pacjentki Ginekologiczno-Położniczego Szpitala Klinicznego Uniwersytetu Medycznego w Poznaniu, przebywające na oddziałach poporodowych. Badanie miało charakter kwestionariuszowy. W pracy wykorzystano skalę depresji Becka, Edynburską Skalę Depresji Poporodowej (EPDS) i kwestionariusz własny. Pacjentki wypełniły anonimowy kwestionariusz i skalę depresji Becka w 1.−7. dni po porodzie (n = 184), a następnie przesłano im skalę depresji Becka oraz EPDS po 30 dniach od porodu w celu ponownej oceny nastroju. Uzyskano 41 odpowiedzi zwrotnych. Badanie uzyskało zgodę Lokalnej Komisji Bioetycznej. Wyniki: Wśród badanych pacjentek będących w 1.−7. dniu po porodzie: 11,96% uzyskało wynik świadczący o łagodnej depresji, a 0,54% o umiarkowanej według skali Becka. Po około 30 dniach od porodu wynik ten zwiększył się do 19,51% dla łagodnej i odpowiednio 2,44% dla umiarkowanej depresji. Wnioski: Na podstawie uzyskanych wyników czynnikami predysponującymi do wystąpienia zaburzeń nastroju w 1.−7. dni po porodzie były: nieplanowana ciąża, komplikacje zdrowotne podczas trwania ciąży, pobyt w szpitalu z powodu zagrożenia ciąży, epizody depresji w przeszłości oraz wystąpienie myśli rezygnacyjnych lub samobójczych w przeszłości. Wystąpienie w przeszłości stresującego wydarzenia w postaci poronienia, martwego porodu lub śmierci dziecka wiązało się z uzyskiwaniem niższych wyników w skali Becka przez badane pacjentki. W pracy nie wykazano istotnej statystycznie zależności pomiędzy uzyskanymi wynikami w skali Becka a badanymi czynnikami ocenianymi miesiąc od porodu, analizowana grupa była istotnie mniejsza (n = 41).Introduction: The aim of our study was to estimate the prevalence of mood disorders including postpartum depression and to analyze its potential risk factors. Material and methods: The patients staying in maternity wards at the Gynecological Clinical Hospital of PUMS were examined during their postpartum period. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI) and our own questionnaire. The anonymous questionnaire and BDI were filled by the patients between 1st and 7th day after the delivery (n = 184), then they were asked to fill the BDI and EPDS after 30 days of the childbed (n = 41 patients refilled the survey). The research has obtained permission of the Local Bioethical Commission. Results: During the first week of the childbed, 11.96% of the patients achieved score, which might imply they suffer from mild depression and 0.54% from major depression according to BDI. After the second examination the score increased to 19.51% and 2.44%, respectively. Conclusions: The unplanned pregnancy, health issues during the gestation, hospitalization due to pregnancy complications, no stressful factors in the past like: history of miscarriage, stillbirth or death of the child, episodes of depression in the past, suicidal ideation in the history can be bracketing the risk factors of mood disorders after 1 to 7 days of the childbed. The significant correlation between score of the BDI and the answers in the questionnaire wasn’t demonstrated after 30 days of the postpartum period, however the analyzed group was significantly lower (n = 41)

Association between polymorphisms of 1287 A/G noradrenaline transporter gene and drug response for escitalopram and nortriptyline in depressed patients

Wstęp. Celem pracy była analiza możliwej asocjacji genu kandydującego związanego z układem noradrenergicznym - transportera noradrenaliny (NET) - z efektywnością leczenia przeciwdepresyjnego. Materiał i metody. W badaniu uczestniczyło 90 niespokrewnionych pacjentów (21 mężczyzn i 69 kobiet), ze średnią wieku 38 lat, z rozpoznaniem epizodu depresji niepsychotycznej, co najmniej umiarkowanego stopnia, którzy spełniali kryteria diagnostyczne DSM-IV i ICD-10. Pacjentów podzielono losowo na dwie grupy: 1) osoby leczone lekiem serotoninergicznym - escitalopramem (n = 51) w terapeutycznych dawkach 10-20 mg/d.; 2) osoby leczone lekiem noradrenergicznym - nortryptyliną (n = 39) w dawkach 75-100 mg/d. Skutecznością leczenia określano redukcję o &#8805; 50% punktów w skali Hamiltona w 8. tygodniu leczenia w porównaniu z tygodniem 0. Oznaczenia genotypowe badanych polimorfizmów przeprowadzono na podstawie metody PCR-RFLP. Analizy statystyczne wykonano za pomocą programu Statistica versja 7.1. Wyniki. W niniejszej pracy nie wykazano asocjacji genotypowych i allelowych polimorfizmu 1287 A/G genu NET a efektem terapii, zarówno w grupie osób leczonych escitalopramem (genotypy: p = 0,767; allele: p = 0,651), jak i w grupie osób leczonych nortryptyliną (genotypy: p = 0,471; allele: p = 0,484). Wnioski. U osób chorujących na depresję nie wykazano związku badanego polimorfizmu genu NET z dobrą odpowiedzią zarówno na escitalopram, jak i nortryptylinę.Introduction. The aim of this study was to analyze the possible association of the candidate gene of noradrenergic system - noradrenaline transporter with efficacy of antidepressant treatment. Material and methods. In the study we analyzed 90 patients with major depression (21 males and 69 females) with a mean age of 38 years, suffering from depressive disorder of at least moderate severity, meeting the research criteria of ICD-10 and DSM-IV for major depression. Patients were randomized into two groups: 1) patients received the serotoninergic drug - escitalopram (n = 51) with specified dose range 10-20 mg/day. 2) Patients treated by noradrenergic drug - nortriptyline (n = 49) with dose range 75-150 mg/day. The response to the drug was defined by a reduction &#8805; 50% of total score of Hamilton scale in the 8 week of treatment in comparison to the week 0. Genotypes for 1287A/G NET gene polymorphisms were established by PCR-RFLP method. Statistical analysis was performed with Statistica version 7.1. Results. We have not found an association of 1287A/G polymorphism of NET gene with treatment response neither to escitalopram (p = 0.767 for genotypes, p = 0.651 for alleles) nor to nortriptyline (p = 0.471 for genotypes, p = 0.484 for alleles) when comparing the group of patients with response to the group of patients without response to the drugs. Conclusions. The polymorphisms of NET gene analyzed in this study are not likely to be associated with treatment response to antidepressants, neither escitalopram nor nortriptyline in our group of patients with depression

Improvement of antioxidative activity of broiler muscles after dietary modulation with selenium and methionine

The objective of the study was to compare the antioxidative capacity of broiler chicken breast and leg muscles after dietary modulation with selenium (Se) and methionine (Met). Free radical scavenging (ABTS, DPPH) and iron reduction (FRAP) activities were determined as the total antioxidative potential (TEAC), as well the enzyme activity of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx), in relation to concentrations of lipid peroxidation end products (TBARS). Analyses were performed on breast m. pectoralis superfi cialis and profundus individually and together. The studied leg muscles included biceps femoris, gastrocnemicus, iliotiobialis, peroneus longus, sartorius, semimembranosus, semitendinosus and all leg muscles together. Flex broiler chickens were fed diets supplemented with 6.7, 8.2, 9.7 and 11.2 g DL-methionine/kg feed and Se as sodium selenite and selenized yeast at 0.26, 0.38 and 0.50 mg Se/kg. Greater TEAC and enzyme activities were observed in leg than in breast muscles. Selenium did not change TEAC in muscles sets, but improved antiradical capacity in the pectoralis major and minor, sartorius and biceps femoris. The highest level of methionine increased TEAC in individual leg muscles. Selenium and methionine at the highest concentrations increased SOD activity in the entire group and individual muscles, while Se raised GPx activity. In conclusion, the diet supplementation with selenium and high concentrations of methionine had a greater impact on the antioxidative potential of individual than the whole set of chicken breast and leg muscles. The positive effect of the studied diet modulation could raise the quality and extend the shelf-life of fresh chicken meat

Respiratory and phonation disorders in adolescent girls suffering from anorexia nervosa

Wstęp. Powstawanie głosu wymaga prawidłowej morfologii i funkcji krtani, sprawnego układu nerwowego i hormonalnego, jak też właściwego sposobu oddychania, fonacji i artykulacji. W przebiegu jadłowstrętu psychicznego obserwuje się zaburzenia większości układów i narządów wewnętrznych wraz z towarzyszącymi zaburzeniami emocjonalnymi. Cel pracy. Ocena wybranych parametrów oddechowo-fonacyjnych u dziewcząt z anoreksją. Materiał i metody. Badanie przeprowadzono w grupie dziewcząt w wieku 12–19 lat, 41 z anoreksją i 25 w grupie kontrolnej. Ocena toru oddechowego, maksymalnego czasu fonacji, percepcyjna ocena głosu (GRBAS), ocena krtani w laryngostroboskopii. Wyniki. Zaobserwowano nieprawidłowości strukturalno-funkcjonalne: nieprawidłowy żebrowo-obojczykowy tor oddychania (91%), istotnie skrócony maksymalny czas fonacji (83%), zaburzenia głosu o charakterze czynnościowym (54%), nieodpowiednią do wieku budowę krtani (36%) oraz zawężenie zakresu głosu. Wnioski. 1. Jadłowstręt psychiczny prowadzi do zmian strukturalnych i czynnościowych narządu głosu. 2. Na podstawie przeprowadzonych badań wydaje się wskazane objęcie również opieką foniatryczną pacjentek z zaburzeniami odżywiania o podłożu psychicznym.Introduction. Good voice quality requires normal anatomical structure of the larynx, its proper function as well as normal hormonal and nervous systems and good way of breathening, phonation and articulation. Anorexia nervosa (AN) impairs most of systems and lead to emotional problems. Aim of the study. To evaluate the voice organ and voice quality in girls suffering from anorexia nervosa. Material and methods. Girls (aged 12–19) 41 with AN and 25 as a control group; an assessment of breathing habits and structure and function of vocal organ was performed. Results. The following abnormalities were observed: breathing irregularities (93%), significantly shortened maximum phonation time in 83%, voice disorders of functional character in 54% in laryngostroboscopy. Most of anorectic girls were abnormal laryngeal configuration (36%), narrow voice range. Conclusions. 1. Anorexia nervosa leads to voice abnormalities observed in anatomical and functional larynx assessment. 2. Observed structural and functional changes of vocal organ in AN indicate involvement in phoniatric care of a group of patients with eating disorders of psychological background

On the Significance of New Biochemical Markers for the Diagnosis of Premature Labour

Preterm labour is defined as a birth taking place between 22nd and 37th weeks of gestation. Despite numerous studies on the aetiology and pathogenesis of preterm labour, its very cause still remains unclear. The importance of the cytokines and acute inflammation in preterm labour aetiology is nowadays well-proven. However, chronic inflammation as an element of the pathogenesis of premature labour is still unclear. This paper presents a literature review on the damage-associated molecular patterns (DAMPs), receptors for advanced glycation end products (RAGE), negative soluble isoforms of RAGE, chemokine-stromal cell-derived factor-1 (SDF-1) and one of the adipokines, resistin, in the pathogenesis of preterm labour. We conclude that the chronic inflammatory response can play a much more important role in the pathogenesis of preterm delivery than the acute one

Scenario for adequate cutaneous vitamin D 3 synthesis due to solar radiation in Poland for people with phototype II and III

Introduction. The limited outdoor activity of contemporary people results in deficiency of vitamin D. An adequate vitamin D level cannot be achieved due to random insolation. A scenario of pro-healthy outdoor behavior is needed that takes into account climatic conditions in Poland. Objective . To present the outdoor activity scenario in Poland for people with phototype II and III to get an adequate vitamin D 3 dose without the risk of erythema. Material and methods. The paper presents the results of mathematical simulations of UV doses received by persons with phototype II and III in the spring/summer season in Poland (Jastrzębia Góra, Zakopane). The following scenarios are examined: using all the time a sunscreen with SPF30, short sunbathing without photo-protection and application of a sunscreen with SPF30 for the rest of the day. Results. During late spring and summer in Poland it is possible to get a vitamin D 3 dose of 2000 IU due to solar radiation without the risk of erythema. For persons with phototype II and III short (20–30 min) near-noon exposure without photo-protection then application of sunscreen with SPF30 for the rest of the time spent outdoors is recommended. Clothing should allow insolation of at least 1/4 of the whole skin area. Conclusions . Avoiding near-noon solar radiation or using sunscreens with high SPF always while staying on the sun does not allow one to obtain a proper vitamin D status