Postepy psychiatrii neurologii最新文献

Purpose: Along with the aging process, we can observe a deterioration of cognitive functions with the simultaneous occurrence of behavioural and psychological symptoms in the elderly population. Dementia with accompanying psychosis is becoming a growing problem, not only in medical but also in social terms. This article focuses on the issues related to the occurrence of psychosis in dementia, and the need to develop new treatment.

Views: Psychosis in the elderly is different from that occurring with schizophrenia, as it is characterized by a different course and frequent resistance to treatment. In case of elderly patients, psychosis is probably associated with dysregulation of the serotonergic system. Due to the difficulties in using pharmacology in this age group, it is very important to individualize treatment. Antipsychotics are the main treatment used but they have many side effects, so in fact there is a lack of effective and safe solutions. Although pimavanserin is considered to be an effective alternative in the treatment of psychosis, it also carries a higher risk of mortality in this age group.

Conclusions: The search for new, effective and safer drugs in the treatment of dementia-related psychosis works in many directions. New animal models are emerging that allow the screening of various drug "candidates". The available research suggests that the serotoninergic system is a good direction for the search for new therapeutic solutions. As the number of elderly people with dementia increases, there is a great medical need to make it easier for them and their caregivers to function.

Purpose: This study aimed to assess the influence of somatic diseases and patient characteristics (age, gender) in relation to delirium tremens (DT) episodes in alcohol withdrawal syndrome (AWS). We also analysed the influence of age, gender and specific somatic diseases on the duration of hospital stay and the frequency of comorbid somatic diseases among AWS and DT patients.

Methods: The medical records of patients admitted to an AWS treatment ward in a Polish psychiatric hospital in 2019 were analysed. In total, 800 hospitalisations of 656 patients (625 hospitalisations for AWS and 175 for DT) were evaluated.

Results: The most frequent group of somatic diseases among AWS and DT patients was cardiovascular diseases, with essential hyper tension as the main medical condition. Patients suffering from DT were diagnosed with respiratory system diseases (p < 0.001) and pneumonia (p < 0.000) more often than AWS patients. Hospital stays were longer for patients with pneumonia, chronic obstructive pulmonary disease and duodenal ulcers. Patients with acute pancreatitis were hospitalised for a significantly shorter period of time than other patients. Patient gender and age did not significantly affect the development of DT. However, age was positively correlated with duration of hospitalisation (p < 0.001).

Conclusions: The presence of respiratory system diseases, especially pneumonia, was found to influence the incidence of DT in AWS patients. Increased clinical vigilance for the prevention of lower airway infections in AWS patients is essential.

Purpose: Deep brain stimulation (DBS) is a relatively new and still experimental treatment modality for treatment-resistant depression (TRD). There is preliminary evidence that stimulation of brain reward circuit structures or their connecting white matter bundles may exert an antidepressant effect. The main nucleus of the reward circuit is the nucleus accumbens (NAc), which plays a critical role in reward-seeking behavior, motivation, and addiction. Also, white matter bundles connecting different structures of the reward circuit have been studied clinically as targets for DBS, including the medial forebrain bundle (MFB) - a central component of the mesolimbic dopaminergic reward circuit. This review aims to present the clinical outcomes of MFB DBS for TRD.

Views: The scientific literature was reviewed using the following keywords: 'DBS', 'major depressive disorders', 'TRD', and 'MFB'. The identified studies were assessed on the basis of patient characteristics, clinical outcomes, and adverse events related to DBS. The search revealed five open-label clinical case studies and four case reports reporting the cumulative number of 35 patients treated by MFB DBS for TRD.

Conclusions: The current clinical data of MFB DBS are limited by small sample size and the small number of clinical open-label trials. There is an urgent need for more clinical trials targeting the MFB for TRD. The results obtained in these studies showed a very rapid antidepressant effect observed within one week after the start of stimulation. MFB DBS for TRD should be considered as a last resort treatment due to its invasive character. However, this treatment may be a promising alternative for TRD patients.

Purpose: The aim of the present study was to assess attitudes of Polish neurologists towards cigarette smoking and their real-life anti-smoking practices.

Methods: A study questionnaire was constructed, and distributed among Polish neurologists (n = 101; 73% females). More than two thirds (70%) of the study group worked in in-patient neurological wards with separate stroke units.

Results: Seventy five percent of the study group documented the smoking status of their patients in medical files. Two thirds of the study group collected data on patient's cigarette smoking during each visit. Only 54% and 22% of study participants routinely assessed the severity of tobacco dependence and diagnosed tobacco dependence according to the ICD-10 criteria, respectively. Two thirds of physicians declared routinely using any anti-smoking intervention, but only 12% used the recommended 5'A (Ask, Advice, Assess, Assist, Arrange) model of behavioral intervention and only 11% introduced Evidence Based Medicine (EBM)-supported pharmacotherapy. The vast majority of study participants (80%) did not try to increase their professional skills in anti-smoking interventions.

Conclusions: Real-life anti-smoking practices among Polish neurologists are generally unsatisfactory and do not follow EBM-based guidelines. The low percentage of neurologists who diagnose and treat nicotine dependence may negatively impact the efficacy of secondary stroke prevention in Poland.

Purpose: Cerebral palsy (CP) is one of the leading causes of child disability, which profoundly affects the lives of whole families and contributes to the burden of health care. Despite the extensive rehabilitative, surgical and other therapeutic efforts of an array of specialists, a significant proportion of patients remain severely disabled. Transcranial magnetic stimulation (TMS) is a non-invasive diagnostic tool in various diseases of the cerebral cortex and cortico-spinal tract (CST). Repetitive TMS (rTMS) is able to induce a long-lasting cerebral plasticity, which is associated with a therapeutic effect in a number of psychiatric and neurological diseases. This article reviews the diagnostic findings gained with TMS in CP as well as therapeutic trials performed with rTMS.

Views: The absence of responses in the motor cortex in the first months of life, as revealed by TMS, may predict the development of CP in children at risk. In a proportion of children with the unilateral form of CP, TMS documents the pathological preservation of ipsilateral, cortico-spinal connections from the non-lesioned hemisphere, which is associated with poor outcome. rTMS seems to be a safe method with significant therapeutic potential in CP. The data published so far reveals an almost unanimously significant therapeutic benefit in motor performance over placebo. However, the studies conducted to date have almost without exception involved children with unilateral palsy, and have focused nearly exclusively on therapy for motor symptoms.

Conclusions: Magnetic stimulation brings significant diagnostic and therapeutic effects in CP. However, more studies that go beyond the limits specified above are still awaited.

Purpose: Most studies show that physical activity (PA) can inhibit the progression of Alzheimer's disease (AD). This research aimed to investigate the effect of 3-month moderate PA on the general functioning and cognitive abilities of AD patients.

Methods: The study included 32 patients with mild or moderate AD who scored 11-23 points in Mini-Mental State Examination (MMSE). Half of the participants were qualified to perform the exercises; the other half constituted the control group. The recommended form of activity was Nordic walking, 30 minutes, 3 days a week, for 3 months, under the supervision of the patient's carer. General functioning and the severity of cognitive deficits were assessed using the Activities of Daily Living (ADL) scale and the Montreal Cognitive Assessment scale (MoCA) before and after the 3-month study.

Results: No improvement was observed in the overall functioning of the patients after 3 months of regular, moderate PA. Neither were there any differences in this respect between the active and inactive groups, both in patients with mild (MMSE 19-23) and moderate (MMSE 11-18) disease severity. Men showed a deterioration in overall functioning regardless of PA. No differences in cognitive functioning were observed between the active and inactive groups, the two genders or between mild (MMSE 19-23) and moderate (MMSE 11-18) subjects.

Conclusions: The 3-month, moderate, Nordic walking PA did not improve the overall general functioning or cognitive performance in patients with mild or moderate AD.

Purpose: The goal of this study is a review of the literature on the role of alexithymia among stroke patients, especially assessing its impact on the process of convalescence, psychiatric comorbidity and clinical outcomes.

Views: Organic alexithymia is a common post-stroke complication, which interferes with many aspects of health among stroke survivors, with interleukin-18 having an important role in the appearance and depth of alexithymia. Post-stroke patients suffering from alexithymia are more prone to depression, manifestations of which may differ from the symptoms of this shown by the non-alexithymic post-stroke population. Alexithymia is also the cause of more severe symptoms of stroke itself, as well as more severe symptoms of post-stroke post-traumatic stress disorder. It is often associated with right-hemisphere lesions, but there are findings which show that left brain insult may also be the cause; the explanation is that information transfer from right to left hemisphere causes disturbances in emotional awareness.

Conclusions: Alexithymia plays an important role in the health of post-stroke patients. Assessment of the trait should be considered in their population, since it plays an important role in terms of predicting psychiatric comorbidity and severity of stroke complications, which transfers to treatment choice. Further research is required to examine other post-stroke psychiatric comorbidities associated with alexithymia and to closely determine the response of rehabilitation, including pharmacological treatment and psychological therapy.

Purpose: Dissociative identity disorder (DID) is characterized by the presence of a minimum of two identities. Each identity has different fixed patterns of perception, establishing relationships, and thinking about itself and the environment in which it lives. The etiology of dissociative identity disorder is still not fully understood. The aim of the study is to review the literature on the psychopathology and diagnostics of DID and to describe the clinical case of a patient with co-existing DID and paranoid schizophrenia.

Case description: The male patient discussed in the article is characterized by the presence of three separate identities (the dominant male personality, and two additional personalities, male and female). The main personality informing about the existence of the others is the female personality, with a female name.

Comment: Psychiatrists and psychologists, as well as doctors of other specialties, should have knowledge about the symptomatology of dissociative identity disorder in order to have a holistic approach to patient care.

Purpose: Obstructive sleep apnea syndrome (OSAS) is suggested to have a strong association with peripheral neuropathy (PNP). However, knowledge about this relationship is still very limited. The aim of this prospective case series was to investigate the peripheral nerves in OSAS patients, along with related clinical symptoms, and to assess the effect of continuous positive airway pressure (CPAP) therapy.

Methods: The nerves of upper and lower extremities of 25 patients with moderate to severe OSAS who complained of symptoms suggestive of peripheral neuropathy (PNP) were investigated electrophysiologically. The cross-sectional area (CSA) of the median nerve at the wrist and of the ulnar nerve in the epicondylar groove were assessed with ultrasound. Fifteen patients who showed abnormalities were then reassessed after 3 months of CPAP therapy, and again after an additional 6 months.

Results: The most common findings were carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow (UNE). Surprisingly, CTS was seen in ultrasound twice as frequently as in electrophysiology. The main symptom was numbness in the upper and lower extremities. CPAP therapy reduced the CSA, improved the conduction at entrapment sites and alleviated the symptoms in some of the patients.

Conclusions: CTS and UNE are the most frequent neuropathies in patients with OSAS. However, the clinical symptoms tend to be more generalized. CPAP therapy seems to be beneficial for both objective measurements and subjective symptoms.