Postepy psychiatrii neurologii最新文献

Purpose: The prevalence of autism spectrum disorder (ASD) has increased tenfold over the last 40 years and the World Health Organization (WHO) has placed it alongside other globally occurring common illnesses, such as cancer, cardiovascular disorders and diabetes. As there are yet no effective methods for treating ASD, the most frequently used therapeutic interventions are psychological, psychosocial, rehabilitation and developmental support, which in combination aim to support patients and their families. Early intervention improves the prognosis, but usually a cure is impossible. Patient's lives are often burdened with social difficulties in contact with their families, peers and in education, particularly when other disorders, diseases or intellectual impairment are present, leading to undesirable behaviours, including aggression or self-aggression. Aim of the study was to review the literature available, so as to determine the effectiveness of probiotics used for treating core and accompanying symptoms of autism in patients diagnosed with ASD, with a particular focus on children and adolescents.

Views: The randomised clinical trials available on the clinicaltrials.gov register (accessed on June 27^th, 2021) and the PubMed database (search: probiotic + autism, probiotic + ASD, probiotic + Asperger syndrome, probiotic + pervasive developmental disorder, randomised controlled trial filter) have been analysed in the present study. All studies were included, without any operational time limit. The same PubMed search was also re-run for open-label trials. Out of the 140 papers found, five were open-trials. We also supplemented our study by additionally analysing the studies cited by the latest papers on probiotics in autism.

Conclusions: There are still no consistent outcomes in studies on the use of probiotics in children and adolescents with ASD, and the scope of existing studies is limited. Nevertheless, the authors considered it worthwhile to explore whether probiotic interventions can indeed reduce the severity of ASD-related symptoms and behaviours. Further studies are required on specific indications, duration of treatment and the effectiveness of interventions in the defined problem areas.

Purpose: In a public health crisis medical professionals face immense psychological tension that leads to onset of negative mental health outcomes. We aimed to estimate the self-reported level of posttraumatic, anxiety, depression, and stress-related symptoms and their association with the level of perceived social support among healthcare professionals during the coronavirus (COVID-19) pandemic in Ukraine.

Methods: A cross-sectional web-based survey conducted during the second wave of the pandemic involved 330 participants. Mental health variables were assessed via the Depression Anxiety Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5). The level of perceived social support was assessed via the Multidimensional Scale of Perceived Social Support (MSPSS).

Results: The DASS-21 median score was 42.0 (IQR = 28.0-56.0), with 50.5% of respondents reporting moderate-to-severe depressive symptoms; 55.4% had moderate-to-severe anxiety levels; 42.4% had moderate-to-severe stress levels. The PCL-5 median score was 21.0 (IQR = 12.0-32.0), with 20% of the participants meeting the full criteria for PTSD. The MSPSS median score was 5.3 (IQR = 4.3-6.1), with 61.8% of the participants reporting high, 29.4% medium, and 8.8% low levels of social support, respectively. Logistic analysis revealed that being a younger person, female, having had previous exposure to COVID-19, working in inpatient facilities with COVID patients, and experiencing a lower level of social support were significant risk factors for the onset of mental disorders. Almost 75% of participants exhibited low-to-moderate adherence to psychological/psychiatric care.

Conclusions: Health professionals working with COVID patients need to be screened for mental disorders. A campaign aimed at achieving the de-stigmatization of mental care is required.

Purpose: Bilateral thalamic ischemia can, paradoxically, manifest itself with various non-sensory clinical symptoms, thereby complicating diagnosis.

Case description: A 59-year-old woman was admitted to an Emergency Department about and hour and a half after she was found with altered mental status. Her initial symptoms were psychomotor agitation and slight confusion. No evident focal neurological deficit was observed at that time and computed tomography was negative. After acute drug intoxication was excluded, a transfer to a psychiatric unit was considered. Simultaneously, short stenosis of the left posterior cerebral artery was diagnosed with the use of computed tomography angiography. Magnetic resonance imaging revealed bilateral acute ischemia of the medial parts of the thalamus, and immediate thrombolysis and thrombectomy treatment was initiated. Both procedures were successful and the patient was discharged in good general condition.

Comment: Psychomotor agitation may be an atypical manifestation of a bilateral thalamic ischemia. This may lead to misdiagnosis and reduce the likelihood of proper treatment.

Purpose: Adult human brain neurogenesis is the process of cell division, differentiation, and integration of the new neurons in the brain. The neurons that arise in subventricular zone migrate to the olfactory bulb, while the newly formed neurons in the dentate gyrus migrate locally. In adult neurogenesis starting from neural stem cells, in addition to glial neurons astrocytes and oligodendrocytes are also formed. Neurogenesis is regulated by endogenous and exogenous factors influencing the proliferation potential of progeni tor cells and accelerating the rate of development of the dendritic connections of newly formed neurons.

Views: The slow, initial process of a developing neurodegenerative disease may have a stimulating effect on neurogenesis. Increased levels of pro-inflammatory factors may contribute to the formation of new neurons. A similar hypothesis seems to be confirmed by data in the literature. The importance of proneurogenic effects during inflammation is shown by proteins secreted by active microglia, mainly CD 47 and CD 55 and interleukin 4 and 10. On the other hand, the unfavorable effect of the inflammatory process in the brain is usually associated with chronic disease in it, when stimulated microglia increase the concentration of cytokines that have a negative effect on neurogenesis.

Conclusions: Restoring the balance between dying and emerging neurons is important and offers hope for new therapy directions in the treatment of neurodegenerative diseases. We note common points that could become the target of further research. Attention should be paid to disorders of the calcium metabolism, so important in signal transduction, the state of mitochondria with enzymes involved in the formation of ATP, and the reduction of inflammation in neurogenic regions.

Purpose: Bipolar disorder (BD) is a mental disorder that affects approximately 2-3% of the population. The mainstay of treatment in bipolar disorder is lithium, which has also found an important application in the potentiation of antidepressants in drug-resistant depression, in the course of both bipolar disorder and recurrent depressive disorders.

Views: The narrow therapeutic range of lithium and the frequent side effects it causes necessitates the monitoring of its concentration in the blood, which requires the periodic presence of the patient in a clinical laboratory. This is costly and inconvenient for patients, and is a common obstacle for psychiatrists who are reluctant to prescribe this effective drug precisely because of the inconvenience of having to monitor blood levels. If regular monitoring of lithium levels could be carried out without the need to puncture the vein and visit a clinic it would save time for both patients and healthcare professionals, avoid discomfort, and make difficult-to-reach patients easier to manage.

Conclusions: Saliva in the monitoring of the lithium level is a promising biological material and offers the possibility to quickly estimate the individual lithium dosage for a specific patient which will provide the required therapeutic level. Saliva can be collected at home without the involvement of qualified personnel. Providing a more convenient and effective means of monitoring lithium therapy (e.g. the proposed non-invasive saliva level test) would enable safer, more effective therapy (more likely to maintain therapeutic blood levels) and an individualized therapeutic approach to a patient.

Purpose: Psychotic-like experiences (PLEs) are subclinical symptoms of psychosis that can be observed in general population. They share many characteristics with psychosis and may, but do not have to, precede the development of psychotic disorders. Sense of coherence (SOC) is a global orientation which helps a person successfully cope with the demands of life, and stay healthy. A SOC level expresses how much a person believes that the world is predictable and coherent, and has been shown to be related to psychological functioning. It consists of the three components: comprehensibility, manageability, and meaningfulness. The aim of the study was to test the relationship between SOC and PLEs, which has not been tested before.

Methods: The research comprised the pilot and the main study. The study samples consisted of 82 and 215 adults respectively. Psychiatric disorders or the use of psychoactive substances 3 months prior to the study were the exclusion criteria. SOC and PLEs were measured with self-report questionnaires. Correlation and regression analyses were performed to examine the relationship between the study variables.

Results: SOC was found to be strongly and negatively correlated with PLEs. Also, SOC was determined to be a non-redundant, negative predictor of psychotic-like experiences. When SOC components (comprehensibility, manageability, and meaningfulness) were tested separately as predictors, meaningfulness was found to be a negative predictor of negative PLEs and a positive predictor of positive PLEs.

Conclusion: The results suggest that SOC is an important factor negatively related to PLEs. Further studies are required to verify whether high-level SOC may be a factor preventing the development of PLEs.

Purpose: The outbreak of COVID-19 has caused fear and anxiety around the world. Health care workers are particularly exposed to stress. Fear of COVID-19 and stress can negatively affect job satisfaction. The aim of the study was to determine the relationship between fear of COVID-19, stress and job satisfaction among Polish doctors during the pandemic.

Methods: 97 doctors participated in the study. The Perceived Stress Scale (PSS-10), Fear of COVID-19 Scale (FOC-6), and Job Satisfaction Scale (BJSS) were used.

Results: Fear of COVID-19 and perceived stress are related to job satisfaction. The stronger the perceived stress and the greater the fear, the lower the job satisfaction. Perceived stress and fear of COVID-19 as predictors of work satisfaction turned out to be statistically significant and explained 15.7% of job satisfaction variance. Fear of COVID-19 was a mediator between perceived stress and job satisfaction. It increases the negative impact of perceived stress on job satisfaction.

Conclusion: During the COVID-19 pandemic, health care workers experience severe stress and perceive SARS-CoV-2 as a significant threat to their health and safety, which affects their job satisfaction and can lead to burnout. Doctors should not only be protected from infection but should also be provided with psychological help and support, which could prevent the negative impact of COVID-19 on their professional functioning.

Purpose: This article discusses the modulatory effects of the serotonergic system on the behavioral and neurochemical effects exerted by psychostimulants, mainly cocaine.

Views: The mesocorticolimbic dopaminergic system plays an important role in the rewarding effects of psychostimulants and the long-lasting neuroadaptive changes underlying the development of addiction. Dopaminergic brain regions such as the ventral tegmental area (VTA) and substantia nigra (SN) and their projection fields (prefrontal cortex - PFC, nucleus accumbens - Acb, dorsal striatum) are innervated by serotonergic neurons that can modulate this system. Pharmacological manipulation of the activity of the serotonergic system in rats has shown that lowering or elevating its activity increases and decreases, respectively, most behavioral responses to cocaine. Studies on the role of serotonin receptors have shown that the serotonin 5-HT_1B receptor agonists administered to the Acb during self-administration increase the reinforcing effects of cocaine, whereas when administered during abstinence they decrease cocaine seeking. Distinct populations of 5-HT_2AR and 5-HT_2CR in the PFC, Acb, and VTA differentially affect the output of the mesocorticolimbic dopaminergic pathway. 5-HT_2B receptors exert independent control over the activity of the three ascending dopamine (DA) pathways through specific tonic excitatory and inhibitory control of DA efflux from the Acb and PFC and do not affect striatal activity.

Conclusions: The serotonergic system exerts modulatory effects on the behavioral and neurochemical effects of psychostimulants. The pharmacological manipulation of serotonergic system activity makes it possible to attenuate the effects of psychostimulants, which gives hope for the development of effective pharmacotherapy. Currently, the main obstacle to this is the excessive side effects shown by potential drugs.

Purpose: Pulmonary embolism (PE) is the most serious clinical manifestation of venous thromboembolism (VTE) and a common cause of death in psychiatric patients. Patients diagnosed with mental illness have additional thromboembolic risk factors. These factors are not included in scores used to assess VTE risk. The goal of this elaboration is to take notice of the increased thrombo- embolic risk in psychiatric patients, with a particular focus on patients with catatonic symptoms.

Case description: Two cases of young men with catatonic symptoms who suffered from cardiac arrest during psychiatric hospitali- zation are reported on. Autopsy showed pulmonary embolism as the main cause of death. Based on the Padua Prediction Score the two patients had no indications for thromboprophylaxis. Both men were mostly treated with olanzapine.

Comment: PE should be always taken into account in differential diagnosis, even if patients do not present with its typical risk factors.

Purpose: This article emphasizes the characteristics of the application of bibliotherapy in psychiatric rehabilitation of people suffering from chronic schizophrenia. The role of the bibliotherapist and methodology for conducting bibliotherapy for people with chronic schizophrenia are also described.

Views: The characteristic symptoms are connected to a patient's perception of the surrounding reality differing from the norm. This may be due to the symptoms of schizophrenia and its course, in which psychoticism can become a regulative part of a patient's personality. The academic definition of bibliotherapy proposed by Ewa Tomasik says that "bibliotherapy is an intentional activity that uses books or non-printed materials to fulfil rehabilitative, re-socializing, prophylactic and developmental aims for people from varying social backgrounds, in different age and with diverse needs". This article focuses on and discusses the structure and course of bibliotherapy sessions embedded in individual and group rehabilitation process. An additional goal is to explain bibliotherapy as an element of the entire system of rehabilitation and therapeutic interactions which has a therapeutic effect for this system, not only in terms of individual classes. Attention is paid to the narrative nature of bibliotherapy, in combination with behavioral-cognitive, humanistic and psychodynamic interactions.

Conclusions: Bibliotherapy can help people suffering from chronic schizophrenia to organize their self-narrative and narratives about other people, to make them real and to organize their statements, so that the content and manner of thinking can be regulated.