NEUROBIOLOGICAL ASPECTS OF PSYCHOSIS AND GENDER

In comparison to female schizophrenia patients male patients have more impaired premorbid functioning, earlier onset of disorder, more severe symptomatology, less favourable outcome, different structural brain abnormalities and cognitive deficits. It has been hypothesized that estrogen, with effects on both neurodevelopment and neurotransmission, could play a protective role in women with schizophrenia and account for some of the gender differences observed in the disorder. On the other hand, it is known that altered promoter DNA methylation could play a critical role in mediating differential regulation of genes and in facilitating short-term adaptation in response to the environment. This data could indicate that environmental factors have gender specific influence on DNA methylation changes in schizophrenia. Recent data support the epigenetic theory of major psychosis and suggest that DNA-methylation changes are important to the etiology of psychosis in a gender specific pattern. Clinically observed gender differences in schizophrenia are probably influenced by genetic and environmental factors. The interplay between those two sets of factors is mediated by estrogen and epigenetic mechanisms

PSYCHOSIS AND DEPRESSION – A NEUROBIOLOGICAL VIEW

Psychosis and depression are syndromes that affect the most basic human processes of perception and judgment. Traditional dichotomous classification of psychotic and affective disorders resolved in strict separation between schizophrenia on one hand and bipolar disorder and recurrent depressive disorder on the other hand. However, it is not uncommon that depression and psychosis as syndromes are expressed together in the course of the same mental disorder. According to recent knowledge on the molecular level there are probably many multiple susceptibility genes involved in the pathogenesis of both psychotic and affective disorders, each of small effect, which act in conjunction with environmental factors. Research data indicates a significant overlap in genetic susceptibility across the traditional classification categories of psychotic disorders and affective disorders. It seems that a new classification and research approach will provide better understanding of severe mental disorders and explain the usefulness of some medications in different groups of these disorders

PSYCHOSIS AND DEPRESSION – A NEUROBIOLOGICAL VIEW

Psychosis and depression are syndromes that affect the most basic human processes of perception and judgment. Traditional dichotomous classification of psychotic and affective disorders resolved in strict separation between schizophrenia on one hand and bipolar disorder and recurrent depressive disorder on the other hand. However, it is not uncommon that depression and psychosis as syndromes are expressed together in the course of the same mental disorder. According to recent knowledge on the molecular level there are probably many multiple susceptibility genes involved in the pathogenesis of both psychotic and affective disorders, each of small effect, which act in conjunction with environmental factors. Research data indicates a significant overlap in genetic susceptibility across the traditional classification categories of psychotic disorders and affective disorders. It seems that a new classification and research approach will provide better understanding of severe mental disorders and explain the usefulness of some medications in different groups of these disorders

GENE ENVIRONMENT INTERACTIONS IN BIPOLAR DISORDER

It has been estimated that the heritable component of bipolar disorder ranges between 80 and 90%. However, even genome-wide association studies explain only a fraction of phenotypic variability not resolving the problem of »lost heritability«. Although direct evidence for epigenetic dysfunction in bipolar disorder is still limited, methodological technologies in epigenomic profiling have advanced, offering even single cell analysing and resolving the problem of cell heterogeneity in epigenetics research. Gene overlapping with other mental disorders represents another problem in identifying potential susceptibility genes in bipolar disorder. Better understanding of the interplay between multiple environmental and genetic factors involved in the patogenesis of bipolar disorder could provide relevant information for treatment of patients with this complex disorder. Future studies on the role of these factors in psychopathological conditions, subphenotypes and endophenotypes may greatly benefit by using more precise clinical data and a combined approach with multiple research tools incorporated into a single study

FACTORS ASSOCIATED WITH THE OUTCOME OF DRUG ADDICTION TREATMENT

Despite different treatment approaches many patients with drug addiction continue to use drugs during and after treatment. Approximately 50 percent of the patients in substance abuse treatment do not complete the first month of treatment ,and this is associated with poor outcome. Attempts have been made to improve outcomes of addiction treatment by addressing patient characteristics that predict continued drug use. Appropriate instruments have been developed in order to facilitate assessment and outcome research. It could be concluded that different psychosocial factors could serve as a predictor of drug addiction treatment outcome. However the interplay of these factors is still poorly understood and further research is neede

FACTORS ASSOCIATED WITH THE OUTCOME OF DRUG ADDICTION TREATMENT

Despite different treatment approaches many patients with drug addiction continue to use drugs during and after treatment. Approximately 50 percent of the patients in substance abuse treatment do not complete the first month of treatment ,and this is associated with poor outcome. Attempts have been made to improve outcomes of addiction treatment by addressing patient characteristics that predict continued drug use. Appropriate instruments have been developed in order to facilitate assessment and outcome research. It could be concluded that different psychosocial factors could serve as a predictor of drug addiction treatment outcome. However the interplay of these factors is still poorly understood and further research is neede

ASSOCIATION OF THE FIVE-FACTOR MODEL PERSONALITY TRAITS AND OPIOID ADDICTION TREATMENT OUTCOME

Many patients with opioid addiction continue to use opioids during and after treatment, and their career of drug taking is usually punctuated by repeated treatment admissions and relapses. Personality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals\u27 traits. The most widely used system of traits is called the Five-Factor Model (FFM). Studies have shown that persons who use heroin are consistently depicted as high on Neuroticism and higher Extroversion, also they are described as more impulsive and less sociable. Those who maintain abstinence are characterized by a higher Agreeableness and Conscientiousness. Treatment programs for opioid addiction vary substantially in treatment processes, and an early identification of patients traits that address their strengths and weaknesses within specific treatment settings could be useful in decreasing the possibility of relapse

PSYCHOPHARMACOTHERAPY PRESCRIPTION AND SUICIDAL BEHAVIOUR

Suicidal behaviour has multiple causes. Psychiatric disorder is a major contributing factor. Consecutively, diagnosis and treatment of mental disorders has an impact on suicide rate. The studies that investigated the possible impact of psychopharmacotherapy prescription practise on suicide rate have been gathered in the present article. Ongoing discussion of potential benefits and risks of antidepressant treatment with respect to suicidal behaviours includes many ecological, or population- based, correlational studies of temporal or regional trends in suicide rates and rates of usage of modern antidepressants including SSRIs. A number of studies have found a relationship between increase in national antidepressant prescribing and declining suicide rates, with general agreement but some exceptions. In general, studies showed that increased prescribing of antidepressants may indicate improved diagnosis and treatment of depression. On the other hand, studies that investigated the impact of prescription of anxyolitics on suicide rate were scarce, although the ratio of anxiolytics to antidepressants has been described as a quality indicator regarding treatment of depression, which is in most cases combined with anxiety and increased suicide risk. Importantly, sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance, but studies demonstrated that sedatives and hypnotics were both associated with increased risk for suicide in the elderly. Finally, studies on antipsychotic prescription demonstrated that particularly treatment with clozapine decreased suicide mortality among individuals with schizophrenia and schizoaffective disorders and on the other hand lithium reduced suicide rate among individuals with mood disorders