Postepy psychiatrii neurologii最新文献

Purpose: Neuroimaging and biological predictors of response to electroconvulsive therapy (ECT) are still being sought, so as to enable a full understanding of its therapeutic effects. The present study aims to determine the role of functional near-infrared spectroscopy (fNIRS) as a potential predictor of response to treatment with and efficacy of ECT.

Views: Each of the currently used neuroimaging methods has its limitations; however, the advantages of fNIRS provide a starting point for the widespread use of this method in the assessment of ECT. Studies using fNIRS for measurement have shown that prior to undergoing ECT depressed patients have a bilaterally lower frontal oxyhaemoglobin response to cognitive tasks compared to healthy subjects. After ECT, there is a change in oxyhaemoglobin (oxy-Hb) values compared to pre-treatment ones. However, the results regarding changes in oxy-Hb values obtained by different groups of investigators were not consistent.

Conclusions: Higher oxy-Hb values are achieved in healthy subjects than in patients. Apart from that, oxy-Hb values in patients are altered after ECT. For this reason the use of fNIRS can be an objective assessment of its therapeutic effect on patients. However, for fNIRS to become a biomarker for ECT treatment, studies need to be conducted on a larger patient population, considering the time since the last ECT and various disease entities.

Purpose: The aim of the study was to assess the association of temperamental traits and biochemical variables that determine appetitive behaviour with the health status, food intake and anthropometric parameters of alcohol-dependent individuals.

Methods: The total sample consisted of 154 adults with alcohol-dependence. The interview focused on basic socio-demographics, and the assessment of dietary preferences pertained directly to the variables studied, such as the biochemical and temperamental determinants of appetitive behaviour. The questionnaires used TCI, SADD, PACS, Y-BOCS, and the hunger scale (HS). Immunoenzymatic ELISA determined concentrations of orexin and neuropeptide Y.

Results: The Novelty Seeking subscale scores correlated with the Y-BOCS (R = 0.339), SADD (R = 0.473), HS (R = 0.234). The Harm Avoidance subscale scores correlated with PACS (R = 0.191), Y-BOCS (R = 214). The patients with more expressed Harm Avoidance traits took more doses of analgesics and had higher serum neuropeptide Y concentration, determined at week 6 of hospitalisation (1323 vs. 1064 pg/ml) and had higher Y-BOCS scores (17.00 vs. 15.00). Pre-meal hunger was higher in patients with the more expressed temperament trait of Novelty Seeking, as also shown by the higher scores of two questions in the HS, which indicate a lack of eating control associated with strong pre-meal hunger in these individuals.

Conclusions: In alcohol-dependent individuals, the more expressed Novelty Seeking temperamental trait is associated with stronger feelings of alcohol craving and increased hunger or decreased control of eating by more irritability. The more expressed Harm Avoidance temperamental trait is associated with increased alcohol craving, a greater need to relieve pain, and a higher concentration of serum neuropeptide Y.

Purpose: The purpose of this study is to discuss current applications of artificial intelligence (AI) in psychiatry and the ethical issues involved. It also aims to identify the need for further research and collaboration between researchers, clinicians, and technology developers to safely and effectively implement AI in the care of patients with mental disorders.

Views: The application of AI in the diagnosis and treatment of mental illnesses is a promising direction for modern psychiatry, but it involves many ethical challenges. AI is being used in a variety of areas, such as early disease detection, personalization of treatment and monitoring the progress of therapy. Examples include recognizing patterns in patient data, detecting the early stages of neurodegenerative diseases, and using digital games and mobile apps to treat mental disorders such as depression and anxiety disorders. Despite the growing role of AI, there are a number of controversies related to the lack of empathy its use brings to patient in patient interactions, the threat to data privacy, and the opacity of decision-making processes in AI algorithms. Ethical challenges also include the risk of over-reliance on technology and the reduced role of human specialists in psychiatry.

Conclusions: The application of AI in psychiatry comes with opportunities as well as serious ethical challenges. Ensuring the transparency of algorithms, protecting patients' privacy and clearly defining responsibility for decisions made with the support of AI remain crucial. Only a responsible approach to these issues will allow the full potential of AI to be realized without compromising basic ethical values.

Purpose: Myelin oligodendrocyte glycoprotein-associated disease (MOGAD) is an autoimmune demyelinating disorder of the central nervous system, presenting as optic neuritis, transverse myelitis, or acute disseminated encephalomyelitis. In 2023, international diagnostic criteria were established, integrating clinical, laboratory, and magnetic resonance imaging (MRI) findings. This narrative review summarizes current knowledge on late-onset MOGAD (LO-MOGAD), emphasizing its distinct clinical features, diagnostic difficulties, and treatment aspects compared to earlier-onset cases.

Case description: A 60-year-old man developed bilateral optic neuritis, tested positive for MOG immunoglobulin G antibodies, and exhibited a demyelinating lesion in the cervical spinal cord. Five years earlier, he experienced progressive binocular vision loss. Brain MRI revealed non-enhancing supratentorial white matter lesions, and spinal MRI showed a lesion from C3-C5. Anti-aquaporin-4 antibodies and oligoclonal bands were absent.

Comment: LO-MOGAD often presents with subacute onset, bilateral optic neuritis, and short-segment myelitis. Age-related comorbidities and inconsistent study protocols complicate diagnosis and management, highlighting the need for age-specific research.

Purpose: The article presents a case of invasively treated stroke in a patient with heart failure (HF) and implanted left ventricle assist device (LVAD), and risk factors suspected as the reasons behind the stroke.

Case description: A 58-year-old patient with HF supported with LVAD, with atrial fibrillation (AF) and rapid heart rate, was admitted to intensive cardiac care unit due to episodes of AF falsely detected by implantable cardiac defibrillator as ventricular fibrillation (VF), provoking unnecessary defibrillator discharges and episodes of real VF in consequence. Twelve hours after admission, the patient displayed symptoms of stroke and was treated with mechanical thrombectomy of the occluded right middle cerebral artery, with good results.

Comment: The treatment for stroke in a patient with multiple risk factors, who needed antithrombotic therapy due to LVAD, presented a significant challenge. Fortunately, timely diagnosis of stroke enabled quick invasive treatment with good results.

Purpose: This study aimed to compare clinical and demographic characteristics, treatment approaches, and comorbidities among multiple sclerosis (MS) patients with pediatric-onset (POMS), adult-onset (AOMS), and late-onset multiple sclerosis (LOMS).

Methods: We analyzed the medical records of 439 patients diagnosed with MS, hospitalized between 2018 and 2023 in the University Clinical Center, Medical University of Silesia. The patients were divided into categories based on their age at onset: POMS - < 18 years, AOMS - 18-49 years, and LOMS - ≥ 50 years. Age of onset, symptoms, age at diagnosis, diagnostic delay, Expanded Disability Status Scale (EDSS) scores, course of the disease, relapse characteristics, comorbidities, and use of disease-modifying therapy were compared between the groups.

Results: The LOMS group was characterized by a higher proportion of males, had the longest diagnostic delay and disease duration, highest comorbidity rates, and a greater level of disability. Median EDSS score was highest in the LOMS group (3.16) and lowest in the POMS (0.73) (p < 0.001). Relapsing-remitting MS was most prevalent in the POMS and AOMS groups, while progressive MS was more prevalent in LOMS (p < 0.001). The longest first-line therapy durations and the lowest rate of switching to second-line therapies were observed in the LOMS group.

Conclusions: Characteristics of MS vary, based on the age of onset, hence every patient requires a personalized approach. The higher prevalence of the progressive form, more frequent comorbidities and higher degree of disability observed in the LOMS group makes treatment of this group more challenging and treatment switching is more frequent.

Purpose: The aim of this study was to analyze the relationship between religiosity and health-related attitudes during the COVID-19 pandemic, including views on sanitary restrictions and vaccination. The study also examined the impact of anxiety levels on these attitudes, as well as preferred coping strategies among religious and non-religious individuals.

Methods: The study was conducted online on a non-representative sample of 700 individuals, of whom 289 provided complete responses. A proprietary questionnaire, the Fear of COVID-19 Scale (FCV-19S), and the Mini-COPE inventory were used. Statistical analyses were performed using the χ² test and Student's t-test (p < 0.05).

Results: Religiosity was not significantly associated with adherence to preventive measures but was associated with greater skepticism toward restrictions in places of worship and vaccinations. Higher anxiety levels were associated with more frequent compliance with sanitary guidelines, regardless of degree of religiosity. Religious individuals were more likely to use coping strategies based on faith and social support, while non-religious ones more often relied on avoidance and helplessness strategies.

Conclusions: Religiosity may serve a protective role in coping with pandemic-related stress but can also be associated with a lower acceptance of preventive measures. Anxiety emerged as a significant motivator for following recommendations, regardless of religious beliefs. These findings underscore the importance of addressing both emotional and spiritual factors in health communication strategies during epidemiological crises.

Purpose: Adolescent drug abuse is a growing global public health concern, with early onset linked to a variety of harmful effects. This study examines the long-term mental, physical, social, and legal implications of adolescents' illicit drug usage, with an emphasis on psychiatric illnesses and risks associated with demographic factors such as cultural background and socioeconomic status.

Methods: A retrospective descriptive study was conducted at the "Ali Mihali" Psychiatric Hospital in Vlora, Albania, using clinical data spanning 10 years (2014-2024). The study comprised 312 individuals with a history substance use that began during adolescence (12-18 years). Patients were assessed using structured psychiatric interviews and standardized evaluation tools, including the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI-II), and Young Mania Rating Scale (YMRS). Data on mental, medical, and legal histories were obtained from the hospital.

Results: The study found a significant rise in early-onset substance use, with cannabis being most commonly used, followed by cocaine and heroin. The average age at the initiation of use ranged from 12 to 18 years, with 34.5% starting at 18. Psychiatric problems, including psychotic disorders (56.4%), bipolar disorder (21.8%), and personality disorders (17.9%) were observed. Physical health concerns were present in 39.7% of patients, including liver disease, respiratory issues, and infectious diseases (hepatitis, HIV). Moreover, 14.4% of patients had experienced legal issues, including drug trafficking and domestic violence.

Conclusions: Early drug misuse has long-lasting impacts on mental health, physical health, and social integration, according to this study. It highlights the necessity of all-encompassing, multisectoral approaches to prevention, early intervention, and rehabilitation.

Purpose: As some addictive behaviors increased during the COVID-19 pandemic, we have attempted to identify their risks and protective factors against them. In this research, we have investigated the relationship between the fear of COVID-19 and addictive behaviors and the role of general and COVID-19-specific sense of control, attitude to vaccination, and earlier recovery from COVID-19.

Methods: A total of 511 individuals aged 18-79 participated in the online survey. Women comprised 71.29% of the sample, men 27.93%, and 0.79% (n = 3) declined to provide information on their gender. Participants completed questionnaires assessing substance-related and substance-dependent behaviors, general and COVID-19-specific locus of control, fear of COVID-19, and attitudes toward vaccination. Moderation and mediation analyses were conducted.

Results: Fear of COVID-19 was associated with increased internet, social media, and marijuana use. Lower sense of control (both general and COVID-19-specific) was associated with an increased severity of various addictions. A COVID-19-specific sense of control mediated the relationship between fear and addictive behaviors, particularly for women.

Conclusions: This study highlights the impact of fear and sense of control on addictive behaviors during the COVID-19 pandemic. Promoting a sense of control may mitigate the risk of addiction in the face of pandemic-related stress. Public health efforts should address the potential for long-term consequences of addictive behaviors exacerbated by such global health crises, as similar challenges may arise with future outbreaks.

Purpose: Progressive multifocal leukoencephalopathy (PML) is a lethal demyelinating disease of the central nervous system caused by John Cunningham virus (JCV). PML develops due to the reactivation of latent JCV infection in individuals with cellular immunodeficiency. Since the beginning of acquired immunodeficiency syndrome (AIDS) epidemic, human immunodeficiency virus (HIV) infection has remained a leading cause of PML with the condition recognized as an AIDS-defining illness. The clinical manifestations of PML may vary depending on the underlying condition. In AIDS-associated PML, the symptoms include motor weakness, speech or language disturbances, cognitive and behavioral changes and gait abnormalities and incoordination.

Case description: We present the case of a male patient who developed PML as the first clinical manifestation of a newly diagnosed HIV infection.

Comment: The introduction of antiretroviral therapy has led to a significant decrease in the morbidity and mortality due to the opportunistic infections in HIV-positive patients. However, the improvement is least pronounced in case of PML.