I. Krupka-Matuszczyk

Total ghrelin plasma level in patients with the restrictive type of anorexia nervosa.

Ghrelin is produced mainly in the stomach and is an essential link of the brain-gut axis. Ghrelin stimulates hunger centers in hypothalamus controlling food intake and body mass gain. The aim of the study is to analyze the total ghrelin plasma level in patients suffering from restrictive type of anorexia nervosa (AN-R). According to DSM-IV classification a group of 30 AN-R patients was investigated before and after 3 and 6 months of therapy. Therapy included normocaloric diet and cognitive-behavioral psychotherapy (CBT). The control group consisted of 20 girls without any eating disorders. Before the therapy the total ghrelin plasma level in AN-R patients was significantly higher than in the control group. After 3 and 6 months of treatment the total ghrelin plasma level in AN-R patients was significantly lower than in the control group. In AN-R patients, the total ghrelin plasma level is connected with the pathological feeding behavior.

Plasma levels of leptin and orexin A in the restrictive type of anorexia nervosa

OBJECTIVE The aim of the study was to analyze the pattern of leptin and orexin A plasma levels in patients with the restrictive type of anorexia nervosa (AN-R), during the course of treatment. Thirty females with AN-R, aged 18.0 ± 1.6 years (mean ± SD), range of 15.5-21.0 years, were investigated before and after 2, 3, and 6 months of treatment, which included a normocaloric diet and cognitive-behavioral psychotherapy. The control group consisted of 20 age-matched, healthy control females. RESULTS Before the therapy, both leptin and orexin A plasma levels were significantly lower than in the control group and were negatively correlated. During treatment, leptin levels increased and, after 6 months, showed a correlation with body mass index (BMI). Orexin A levels showed a further decrease during treatment, with no correlation with BMI. CONCLUSIONS The results corroborate those of other researchers showing a decrease of leptin levels in patients with AN-R and its increase with body mass increment. They may also suggest a possible relationship between leptin and orexin A plasma level patterns in such patients.

Bright light therapy in the treatment of childhood and adolescence depression, antepartum depression, and eating disorders

Circadian rhythm disorders represent an important component underlying the pathology of depression. One of the subtypes of depression, in which these disorders may play a crucial role, is the seasonal affective disorder (SAD). The bright light therapy (BLT) has been reported as a novel, promising treatment method for SAD since 1984, and most of the data revealing its efficacy has been referred to adult patients, without comorbid disorders. However, in the recent years, more and more reports have been presented, which confirm the usefulness of BLT in some specific subpopulations of patients, including children, adolescents and pregnant women. The present review summarizes the applications of BLT in antepartum depression, childhood and adolescence depression as well as in patients suffering from eating disorders. Although the body of evidence is still too small to recommend the use of BLT as the first line of treatment for the depression or eating disorders in these patient subpopulations; it appears that BLT may be a useful alternative or adjunctive therapy for these diseases. However, the specific clinical applications of BLT in these areas need further investigation.

Bright light treatment of depressive symptoms in patients with restrictive type of anorexia nervosa.

BACKGROUND Light therapy refers to two different categories of treatment. One of them is used in common medical practice and the other in complementary medicine. The aim of the study was to assess the effect of short time (6 weeks) bright light treatment (BLT) on depressive symptoms in female patients with the restrictive type of anorexia nervosa (AN-R). METHODS Twenty-four girls, aged 15-20 (mean 17.4±1) years, diagnosed as AN-R, with concomitant depressive symptoms ≥17 points on the 21-item Hamilton Depression Rating Scale (HDRS) were studied. All girls received cognitive behavioral therapy. Among them, twelve were randomly assigned to additional treatment with BLT for 6 weeks (10,000 lux, 30 min daily). Both groups did not differ on baseline demographic and clinical parameters. The assessments of depression by means of HDRS and measuring of body mass index (BMI) were done weekly throughout the treatment. RESULTS Improvement of depression was significantly greater in the group receiving BLT, with a significant difference between groups in depression intensity after 5 and 6 weeks. There was no difference in the increase of BMI between groups after 6 weeks, although such increase started earlier in patients treated with BLT. LIMITATIONS Six weeks of treatment may be an insufficient duration to draw the conclusion about the efficacy of BLT and a follow-up is needed to assess the maintenance of the effect. CONCLUSIONS The results obtained may suggest that BLT could be an effective non-pharmacological modality for the treatment of depression in patients with AN-R.

Delirium Screening in Cardiac Surgery (DESCARD): A Useful Tool for Nonpsychiatrists

BACKGROUND The aim of the study was to set up and validate a predictive scoring system for nonpsychiatrists to facilitate screening of postoperative delirium in cardiac surgery patients. METHODS The project was conducted as a cohort study in 5781 subjects. More than 100 pre- and perioperative somatic variables were collected to build up an algorithm. Delirium was diagnosed using Diagnostic and Statistical Manual of Mental Disorders 4th edition. The patient cohort was divided into a training and validation set to perform cross-validation. Scoring systems (Delirium Screening in Cardiac Surgery [DESCARD] tool) were developed for the set of sole preoperative and all perioperative risk factors. RESULTS Delirium was found in 236 patients (4.1%). The preoperative model comprised age, weight, total protein concentration, arterial hypertension, mode of surgery (elective/urgent/emergent), preoperative fasting glucose, and form of diabetes treatment (diet/oral agents/insulin). Taking into account all the perioperative variables, the scoring system included postoperative cerebral ischemia and the need for red blood cell transfusion, and arterial hypertension and mode of surgery were excluded. Both pre- and perioperative tools had an excellent overall diagnostic accuracy (area under receiver operator characteristics curve = 0.83 and 0.89, respectively) with higher specificity (92% and 93%, respectively) than sensitivity (60% and 69%, respectively). CONCLUSIONS The DESCARD tool might be effective in screening of patients at risk of postoperative delirium and can be easily used by all nonpsychiatrists involved in the care of cardiac surgery patients.

Preliminary study of the expression of genes connected with the orexigenic and anorexigenic system using microarray technique in anorexia nervosa.

The pathogenesis of anorexia nervosa (AN) is still poorly understood. The Diagnostic and Statistical Manual of Mental Disorders (4th edition) classification differentiates 2 AN types: the restricting type (AN-R) and the binge eating/purging type (AN-BP). We investigated 4 young women suffering from AN (2 with AN-R and 2 with AN-BP). Four women, age matched, with other psychiatric disorders (paranoid schizophrenia, adjustment disorder, mental retardation) served as the reference group. The oligonucleotide microarray method (HG-U133A, Affymetrix) was used to determine the expression profile of 13 genes connected with the orexigenic and anorexigenic system: leptin, leptin receptor-coding gene, hypocretin (orexin) receptor-coding gene, hypocretin (orexin) neuropeptide precursor-coding gene and growth hormone secretagogue receptor. A hierarchical analysis of the results showed that AN-BP and AN-R patients were grouped into different clusters. Also, expression levels of leptin receptor-coding gene showed significant differences between AN-BP and AN-R patients and between AN-R and control subjects. This preliminary study suggests that the microarray technique may contribute to elucidating molecular genetics of the pathogenesis of both types of AN.

Sleep and inflammatory markers in different psychiatric disorders

Many psychiatric disorders, like schizophrenia, affective disorders, addictions and different forms of dementia are associated with sleep disturbances. In the etiology and course of those diseases inflammatory processes are regarded to be an increasingly important factor. They are also a frequently discussed element of the pathology of sleep. In this literature review reports on correlations between poor sleep and inflammatory responses in various psychiatric conditions are discussed. The link between schizophrenia, affective disorders and inflammatory cytokines is a complex phenomenon, which has been already confirmed in a number of studies. However, the presence of sleep deficits in those conditions, being a common symptom of depression and psychoses, can be an additional factor having a considerable impact on the immunological processes in mental illnesses. In the analyzed data, a number of studies are presented describing the role of inflammatory markers in sleep disturbances and psychopathological symptoms of affective, psychotic, neurogenerative and other disorders. Also attention is drawn to possible implications for their treatment. Efforts to use, e.g., anti-inflammatory agents in psychiatry in the context of their impact on sleep are reported. The aspect of inflammatory markers in the role of sleep deprivation as the treatment method in major depressive disorder is also discussed. A general conclusion is drawn that the improvement of sleep quality plays a crucial role in the care for psychiatric patients.

Impact of pharmacological and psychological treatment methods of depressive and anxiety disorders on cognitive functioning.

Anxiety and depressive disorders are characterized by a number of clinical symptoms like decreased mood, apathy, anhedonia and anxiety. An important element of the clinical picture is also neurocognitive impairment. The most common treatment methods for depression and anxiety are pharmacology, psychotherapy or a combination of both methods. The data from literature show that those treatment methods lead to an improvement of clinical symptoms, but they exert a possible impact on cognitive functions. However the study results referring both to the role of pharmacological treatment and psychotherapy in this domain are still inconsistent. There is an increasing number of accessible data confirming the positive effects of those clinical interventions on cognitive functioning of anxiety and depressive patients, but the interpretation is complicated because of differences in methodology as well as examined sample size and their characteristics. More studies are then needed to describe this phenomenon.

Inferior performance on selected neuropsychological tests in abstinent schizophrenia patients who have used cannabis

Summary Background A substantial proportion of patients with schizophrenia have co-morbid psychoactive substance use, which can influence their cognitive functions. The aim of this study was to assess cognitive functioning in abstinent schizophrenia patients with various previous patterns of psychoactive substance use. Material/Methods The study was performed on a group of 80 schizophrenia patients (74 men, 6 women), aged 18–40 (mean 25) years, of whom in 40 a co-morbid psychoactive substance abuse was diagnosed. The latter group was subdivided, based on their predominant type of substance (opioid, amphetamine, or cannabis). All patients were examined during clinical improvement, and patients with comorbid substance use were also examined after a 6-week period of detoxification in a therapeutic community. A battery of neuropsychiatric tests was used, which included subtests of Trail Making test, Stroop test and Verbal Fluency test. Results No significant differences in clinical factors and cognitive functioning between the 2 examined groups were found. However, when the patients were divided according to their pattern of substance use, it turned out that the group of patients who used cannabis, despite the shortest duration of disease and that of addiction, and highest percentage of using atypical antipsychotics, performed worse on all cognitive tests, significantly so on Stroop and Fluency tests, compared to the groups with predominant opioid or amphetamine use. Conclusions Abstinent schizophrenic patients who previously used cannabis have worse cognitive functioning compared to other schizophrenic patients with comorbid substance use. The possible role of previous cannabis use or cannabis withdrawal in this phenomenon is discussed.

An open, large, 6-month naturalistic study of outcome in schizophrenic outpatients, treated with olanzapine

In many countries of the industrialised world second generation (“atypical”) antipsychotics have become the first line drug treatment for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examined how the efficacy and tolerability of olanzapine differs from that of other second generation antipsychotics.