Postepy psychiatrii neurologii最新文献

Purpose: Depression is a widespread mood disorder with a high rate of relapse and chronicity that can be affected by gender, and caused by traumatic or stressful events. Transcriptome analysis measures gene expression heterogeneity in cells, tissues, organs, and the whole body. The purpose of the study was to investigate both gender-specific and tissue-specific variations in gene expression regarding depression based on transcriptomic analysis using RNA-Seq data.

Methods: The depression datasets GSE190518 and GSE214921 were downloaded from the Gene Expression Omnibus database provided by the NCBI. The GSE190518 datasets include peripheral blood samples (4 patients, 4 healthy controls), and the GSE214921 datasets contain human postmortem orbitofrontal cortex bulk tissue (20 patients, 19 healthy controls). All datasets were analyzed separately with the DESeq2 package in R. Later, GO and KEGG enrichment analyses of differentially expressed genes were performed using the clusterProfiler package in R.

Results: Our results reveal that depression stimulates genes linked to the immune system, which is a common denominator in both brain tissue and blood samples. Overall, tissue-specific factors contribute to the association between depression and the immune system via distinct genes. Furthermore, gene ontology analyses revealed that HSPA6, HSPA7, HSPA1L, HSPA1A, and HSPA1B genes are co-represented in different pathways involved in molecular function, biological processes, and cellular components.

Conclusions: Comparative transcriptomic evidence supports the immune hypothesis of depression in different tissue samples. Gender-specific depression may be triggered by protein misfolding.

Purpose: The modified Rankin scale (mRS) is the gold standard for measuring stroke-related disability in clinical trials and everyday practice. However, inter-observer variability is a source of bias that may undermine the reliability of retrospective studies. It may also depend on clinical backgrounds of different assessing physician. Our aim was to prospectively assess real-life consistency between stroke unit physicians (SUPs) and physical and rehabilitation medicine physicians (PRMPs) using mRS in patients transferred directly from a stroke unit (SU) to a rehabilitation ward (RW).

Methods: We enrolled 48 consented stroke patients transferred within the same hospital from SU to RW. Patients were scored in mRS by a SUP and a PRMP at the day of transfer as a standard of care. The reference mRS score (REF) was obtained by a single- blinded stroke physician using the Rankin Focused Assessment form to guide an interview.

Results: An mRS score was reported for all patients admitted to the RW and 33 patients discharged from the SU. The overall agreement was 75.8% between the assessments of SUPs and PRMPs (κ = 0.58), 72.7% between SUPs and the REF (κ = 0.55) and 70.0% between PRMPs and the REF (κ = 0.49). A similar agreement was observed for PRMPs and the REF in the sensitivity cohort of 48 patients (66.7%; κ = 0.46). Patients with the REF mRS of 2 (n = 6) were often scored as 3 both by SUPs (4/6) and PRMPs (5/6). In patients with the REF mRS of 3 or 4 there was no clear tendency towards overrating disability.

Conclusions: The reliability of mRS scoring in everyday practice is modest and does not seem to depend on clinical background of assessing physician.

Purpose: The purpose of this article is to assess the potential and usefulness of applying value stream mapping (VSM) in the process of treating stroke patients in the Polish healthcare system, using the Institute of Psychiatry and Neurology (IPiN) as an example.

Methods: The applied VSM method allows for a detailed identification of service delivery points (SDPs), which are the areas of potential organizational and structural changes in the stroke patient treatment process.

Results: The IPiN VSM of the stroke patients treatment process illustrates the course of the process, taking into consideration all potential opportunities for improvement, as identified during the analytical work. It was determined that improvements require addressing issues, such as excessive patient transport times caused by the distance between the most critical SDPs, i.e., the reception, imaging diagnostics, and the stroke unit and also their location on different floors of the hospital building.

Conclusions: At this stage, the VSM analysis reveals significant opportunities to improve process efficiency using lean management, without adding extra costs for the hospital. It is important to consider dividing stroke patients into two streams: standard patients (fast track, those without complications) and non-standard patients (slow track, those with complications).

Purpose: Transient global amnesia (TGA) manifests as acute short-term memory disturbances lasting up to 24 hours. The pathophysiology of the disease remains unclear. This paper presents the case of a patient with recurrent TGA, in whom a shortening of coagulation times and high blood pressure peaks were observed during each acute phase of the disease, suggesting transient increased blood coagulability and transient dysregulation of autonomic blood pressure control.

Case description: A 59-year-old patient with medical history of migraine and arterial hypertension was diagnosed with recurrent TGA (two episodes within a year). Each time, upon admission to hospital, high blood pressure peaks were recorded and activated partial thromboplastin time (aPTT) and prothrombin time (PT) were shortened with gradual normalization over the following days.

Comment: The shortening of aPTT and PT may suggest a relationship between TGA and transient blood coagulation disorders in the acute phase.

Purpose: Time pressure in the treatment of acute ischemic stroke patients generates difficult decisions for neurologists, sometimes resulting in stroke mimic patients receiving intravenous thrombolytic therapy. Proper diagnosis and appropriate treatment for these patients are crucial, yet incredibly challenging in cases of functional stroke mimics (FSM).

Views: Functional neurological disorders, including FSM, are increasingly diagnosed. However, their pathophysiology and underlying mechanisms are poorly understood, even though the diagnostic criteria for diagnosing FSM exist, and various clinical indicators support them. Functional neurological symptoms often result in serious disability for patients but the effective treatment is unknown. Neurologists need to examine the symptoms and the key clinical findings to distinguish between FSM and stroke. The intravenous thrombolytic therapy appears safe for FSM, but the potential harm of thrombolysis should be a concern. FSMdiagnosed patients require long-term treatment, starting with open and clear communication about their condition and followed by psychoeducation and physiotherapy.

Conclusions: FSM should be diagnosed using the diagnostic criteria. Electronic health information exchange among healthcare providers is necessary to avoid unnecessary thrombolytic treatments in this group of patients.

Purpose: Abused child syndrome remains a significant public health concern with profound physical and psychological implications.

Case description: We present a case report of a 12-year-old child who was admitted to the child inpatient psychiatric unit of a paediatric hospital with signs and symptoms of abuse. The child was malnourished but did not exhibit physical injuries. A detailed medical history revealed inconsistent explanations regarding the diets used by the mother, allegedly recommended by a neurologist. Diagnostic evaluation, including medical examination, laboratory tests, and imaging studies supported the suspicion of child maltreatment. The case was reported to the police and the court. Appropriate interventions were initiated, including treatment, social work involvement, and psychosocial support.

Comment: This case highlights the importance of early recognition, comprehensive assessment, and multidisciplinary cooperation in addressing child abuse. Medical professionals play a critical role in child safety and should be vigilant in identifying and reporting suspected cases of child abuse and neglect. How they respond and whether they notify the justice authorities may determine the child's future fate and even his or her life.

Purpose: This article attempts to outline the dilemma regarding the use of pharmacotherapy and psychotherapy in the treatment of mental disorders with particular emphasis on depression. Depressive disorder is one of the most common mental disorders suffered by society; it affects from 5% to over 12% of the population [1]. It is also a growing problem as the number of diagnoses has increased over the last decades.

Views: The numerous organisations working to improve mental health have constructed guidelines focused on shaping preventive intervention and therapeutic procedures. However, the method of selecting a procedure remains unclear, with the choice between pharmacotherapy and psychotherapy being particularly troublesome. This begs the question of whether these forms of interaction are complementary or exclusive. The article provides an overview of the current discussion on the legitimacy of using multiple forms of interactions when treating depression. Currently, the treatment of depression is based primarily on pharmacotherapy using antidepressants and psychotherapy as well as combined treatment.

Conclusions: Although a diverse range of psychotherapeutic approaches are used to treat depression, research indicates that all leading approaches are similarly effective. Pharmacotherapy and psychotherapy offer comparable effectiveness in reducing depressive symptoms and demonstrate similar effects on neuronal activity. Combined treatment may offer optimal effectiveness, especially with moderate and severe symptoms of depression.

Purpose: Young adults experience high stress levels, leading to mood disorders. This study investigates the associations between specific fatty acid levels, lipid profiles, inflammatory markers, and emotional well-being among young adults.

Methods: Seventy-two young adults aged 18-35 participated in this study. Participants completed self-assessments of depression severity (PHQ-9), stress (PSS-10), insomnia (ISI), and anxiety (GAD-7). Blood samples were collected and analyzed for plasma fatty acid profiles, lipid profiles, C-reactive protein (CRP) and kynurenine pathway metabolites. Classification and Regression Tree (C&RT) and multivariate stepwise regression analyses were employed to identify potential predictors of mental health outcomes.

Results: The analyses revealed significant associations between certain fatty acids, lipid markers, and mental health conditions. Lauric acid, myristic acid, and eicosatrienoic acid were identified as potential indicators of mental health issues. Higher levels of palmitoleic acid were linked to increased depressive symptoms, while higher oleic acid levels were associated with reduced depression. Anxiety was influenced by myristoleic acid and docosahexaenoic acid. Stress and sleep disturbances correlated with specific fatty acids. The models explained a significant percentage of variability in mental health outcomes, accounting for 25% in both depressive symptoms and anxiety, 23% in stress, and 43% in sleep disturbances.

Conclusions: Specific fatty acids, associated with lipid profiles, kynurenic acid, and CRP, significantly impact the mental health of young adults. Monitoring biomarkers may assist in managing mental health disorders. Personalized dietary interventions could improve well-being and sleep quality. Further research is needed to confirm these findings and establish causal relationships.

Purpose: The objective of this study was to assess the efficacy of manual therapy, specifically using the Maitland concept, in treating carpal tunnel syndrome (CTS), and to compare its effectiveness with surgical decompression of the median nerve.

Methods: A total of 69 patients were enrolled and divided into two groups: a control group (undergoing surgery) and treatment group (receiving manual therapy). Subgroups were formed based on gender, considering factors such as grip strength. Inclusion criteria comprised active symptoms of CTS and electrophysiological evidence of nerve lesion. Exclusion criteria included diabetes, thyroid diseases, trauma to the upper limb, and pregnancy. Baseline and 10-12 month post-intervention assessments encompassed EQ-5D-5L, CTS6, DASH, grip strength and electrophysiological studies. The treatment group (43 patients) underwent five weekly manual therapy sessions. A physiotherapist individually assessed and treated patients, emphasizing passive techniques and prescribing home self-neuromobilization. The control group (26 patients) underwent carpal tunnel release surgery.

Results: Both surgical and manual therapy interventions significantly reduced symptom severity (p < 0.001). Manual therapy improved hand function in females (p < 0.001) and showed positive trends in the control group. The treatment group demonstrated higher grip strength, with significant improvements in females (p < 0.001). Quality of life also improved in females (p < 0.001). No significant differences in distal motor latency though sensory latency showed positive trends in females.

Conclusions: This research offers a comprehensive understanding of the effectiveness of manual therapy and surgical release in treating CTS. The findings suggest that both interventions can result in improvements in grip strength and quality of life with variations in based on gender and specific outcome measures.