Łukasz Mokros

Board game versus lecture-based seminar in the teaching of pharmacology of antimicrobial drugs—a randomized controlled trial

The effectiveness of an educational board game developed to teach the pharmacology of antimicrobial drugs to medical students was compared with the lecture-based seminar as a supplemental tool to improve short- and long-term knowledge retention and the perception of the learning method by students. A group of 124 students was randomized to board game and control groups. Short-term knowledge retention was assessed by comparing differences in post- and pre-tests scores, and long-term knowledge retention by comparing final examination scores. Both didactic methods seem to improve short-term knowledge retention to similar extent. Long-term knowledge retention of board game seminar participants was higher than those who attended the lecture-based seminar (ANCOVA, P = 0.035). The effect was most pronounced within 14 days after the intervention (ANOVA, P = 0.007). The board game was well perceived by the students. The board game seems to be a promising didactic tool, however, it should be further tested to assess its full educational utility.

The relationship between chronotype and personality among patients with alcohol dependence syndrome: Pilot study

ABSTRACT The study investigates the distribution of chronotypes among alcohol-dependent subjects and the relationship between personality and chronotype. Fifty-eight alcohol-dependent patients and 29 age-matched healthy controls were studied using Ogińska’s Chronotype Questionnaire (ChQ), Eysenck’s Personality Questionnaire – Revised (EPQ-R), Selzer’s Michigan Alcoholism Screening Test (MAST) and a sociodemographic status questionnaire designed by the authors. The alcohol-dependent patients tended to be morning type, based on the morningness–eveningness ChQ scale, with a weakly marked rhythm, based on the distinctness ChQ scale. Preference towards morningness was associated with older age, but no relation between chronotype and severity of alcohol dependence was found. A high amplitude of the rhythm was associated with higher neuroticism. Therefore, despite being in the minority, patients with a distinct circadian rhythm (i.e. with a high amplitude) are at greater risk of mood and anxiety disorders and hence should be given special consideration.

Differences in the verbal fluency, working memory and executive functions in alcoholics: Short-term vs. long-term abstainers

The aim of the study was to assess differences in verbal fluency, working memory and executive functions in two subgroups of alcohol-dependent patients, those undergoing short-term abstinence (STA) and those undergoing long-term abstinence (LTA), and to compare the level of cognitive functions in patients after long-term abstinence with healthy subjects. The study group consisted of 106 alcohol-dependent patients (53 immediately after drinking at least 3 days and 53 after at least one-year abstinence). The control group comprised 53 subjects, whose age, sex and education levels matched those of the patients in the experimental group. The dependence intensity was assessed using SADD and MAST scales. The neuropsychological assessment was based on the FAS Test, Stroop Test and TMT A&B Test. The results obtained for alcohol-dependent patients revealed significant disturbances of cognitive functions. Such results indicate the presence of severe frontal cerebral cortex dysfunctions. Frontal cortex dysfunctions affecting the verbal fluency and working memory subsystems and the executive functions also persisted during long-term abstinence periods. No significant correlations between the duration of dependence, quantity of alcohol consumed and efficiency of the working memory and executive functions were observed in alcohol-dependent subjects after short-term or long-term abstinence.

The epidemiology of asthma and its comorbidities in Poland – Health problems of patients with severe asthma as evidenced in the Province of Lodz

INTRODUCTION Population studies supply interesting data regarding the epidemiology, comorbidity and risk factors of asthma, which have direct clinical implications for patients. OBJECTIVES The aim of the work was to evaluate the degree of severity of asthma in the studied group, the levels of anti-asthma treatment, the prevalence of asthma comorbidities and their influence on the clinical course of the illness. PATIENTS AND METHODS The study encompassed 451 participants: 52.11% were asthma patients (study group) and 47.89% were healthy subjects (controls). Respiratory function tests, ACT™ test and skin prick tests were performed. RESULTS Asthma severity was mild in 14.89%, moderate in 49.36% and severe in 35.74%. Oral GCS were used by 29%, inhalers 44%, LABA 68%, SABA 67%, LAMA 6%, SAMA 14% and MX 16%. Rhinitis and allergy were significantly more common in patients. GERD and neurological diseases were risk factors for asthma, and GERD significantly intensified the risk of severe asthma. GERD, atherosclerosis, hypertension, ischaemic heart disease and other cardiac diseases, lipid disorders, COPD, and the presence of any neoplastic disease significantly worsened the degree of asthma control. DISCUSSION Severe asthma was a significant clinical issue in over 35% of cases. The most commonly-used group of drugs were LABAs, while inhaled GCS and LAMA were uncommon, especially among severe cases. A significant problem was the high percentage of systemic GCS used by severe cases. The most important risk factor for asthma, including its severe form, is GERD. Numerous comorbid conditions significantly worsen the degree of asthma control.

Morning Diastolic Blood Pressure May Be Independently Associated With Severity of Obstructive Sleep Apnea in Non-Hypertensive Patients: A Cross-Sectional Study.

STUDY OBJECTIVES The aim of the study is to verify a possible association between arterial blood pressure and obstructive sleep apnea (OSA) severity in a group of non-hypertensive patients. METHODS This is a retrospective study of 1,171 consecutive patients referred to the sleep laboratory with complaints suggestive of OSA who underwent standard diagnostic polysomnography. In total, 454 patients with no History of arterial hypertension nor had received any such treatment were selected from this group. RESULTS Patients with severe OSA (apnea-hypopnea index [AHI] ≥ 30 events/h) presented with higher diastolic blood pressure (DBP) in the morning than healthy subjects (AHI < 5 events/h) or those suffering from mild (15 < AHI ≥ 5 events/h) or moderate OSA (30 < AHI ≥ 15 events/h): 86.2 ± 11.3 versus 79.2 ± 8.5, 80.3 ± 10.2 and 81.4 ± 9.6 mmHg, P < .01, respectively. In a linear regression model, a rise in morning DBP was predicted by AHI (ß = 0.14, P < .001) and body mass index (BMI) (ß = 0.22, P < .01), but not by age (ß = 0.01, P = .92), male sex (ß = -0.06, P = .19), or smoking (ß = 0.01, P = .86). In contrast, no association existed between morning systolic blood pressure (SBP) and AHI independently of BMI, sex, age, or smoking. High blood pressure (ie, SBP ≥ 140 mmHg or DBP ≥ 90 mmHg on each of three measurements on different occasions) was predicted by age of 42 years or older, BMI of at least 29 kg/m2, and severe OSA. CONCLUSIONS High AHI, independent of obesity, age and sex, was associated with elevated DBP in the morning. Thus, elevated morning DBP may be one of the symptoms related to OSA that warrants specific diagnostics. COMMENTARY A commentary on this article appears in this issue on page 861.

High Negative Predictive Value of Normal Body Mass Index for Obstructive Sleep Apnea in the Lateral Sleeping Position

STUDY OBJECTIVES Obesity is a major risk factor for obstructive sleep apnea (OSA). Patients who are not obese and who have OSA usually present with a low apnea-hypopnea index (AHI) in the lateral sleeping position. Hence, sleep-disordered breathing (SDB) seems more dependent on body mass index (BMI) in the lateral sleeping position than the supine sleep position. This makes obesity a better predictor of SDB in the lateral sleeping position. The objective of this study was to find a negative predictive value of normal BMI for SDB in relation to sleep positions, thus defining a group of patients who could be treated by positional intervention, and prioritizing the use of polysomnography diagnostics. METHODS This study comprises a retrospective and prospective part run on groups of 1,181 and 821 consecutive patients, respectively. All had been referred to the university-based sleep laboratory because of suspected OSA and underwent polysomnography. RESULTS In the retrospective study, areas under the receiver operating characteristic curves for normal BMI at AHI ≥ 5 and AHI ≥ 15 events/h were found to be larger in the lateral sleeping positing than supine: 0.79 versus 0.69 and 0.80 versus 0.68, respectively (P < .05). Comparable results were obtained in the prospective study. For normal BMI, the negative predictive value for AHI < 15 events/h in the lateral sleep position was 97.5% and 97.1% in the retrospective and prospective study, respectively. CONCLUSIONS Normal BMI offers a high negative predictive value for moderate or severe OSA in the lateral sleeping position.

Sleep quality, chronotype, temperament and bipolar features as predictors of depressive symptoms among medical students

ABSTRACT The assessment of risk factors is a crucial step in the prevention and treatment of affective disorders and should encompass personal dispositions. The aim of this study was to assess the value of chronotype and temperament as independent predictors of depressive symptoms among medical students. The study surveyed 140 students of the Faculty of Medicine with a battery of questionnaires: the Beck Depression Index (BDI), Hypomania Checklist 32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), Chronotype Questionnaire and Eysenck Personality Questionnaire Revised. The results were tested using Pearson’s correlation quotient and general linear model. Ten percent of the participants demonstrated a BDI score suggestive of clinically significant depressive symptoms. BDI score correlated positively with HCL-32 score. A rise in BDI was independently predicted by elevated Neuroticism and PSQI scores and morningness. Those effects were independent from each other and from other parameters of the model. The presence of depressive symptoms might be associated with bipolar features among medical students. Poor sleep quality predicted depressive symptoms, similarly to Neuroticism and independently of temperament and chronotype. Future studies on the associations between personal dispositions and mood disorders among medical students are required to help identify those at greater risk of developing affective illness. Effective prophylaxis and early intervention are warranted to ensure better treatment results.

Obstructive sleep apnea syndrome and hypothyroidism - merely concurrence or causal association?

The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) ranges from 4 to 7% in men and from 2 to 5% in women. Its deleterious consequences such as traffic accidents, cardiovascular complications increasing morbidity and mortality, make it a major health problem. Apart from obesity (a major risk factor for OSAHS), hypothyroid patients are prone to reveal this phenotype. Although hypothyroidism seems an acknowledged risk factor for OSAHS, some authors report the lack of clinically relevant association. The argument partly depends on the increased prevalence of hypothyroidism in OSAHS patients, but the epidemiological data is limited and somehow inconsistent; even less is known about sub-clinical hypothyroidism in OSAHS patients. Even if frequency of overt and sub-clinical hypothyroidism in OSAHS patients is comparable to the general population, screening for it seems beneficial, as hormone replacement therapy may improve sleep disordered breathing. Unfortunately, this favorable outcome was found only in a few studies with limited number of patients with hypothyroidism. Yet, despite the lack of international guidelines and no large multicentre studies on the topic available, we think that TSH screening might prove beneficial in vast majority of OSAHS patients.

Haloperidol, but not olanzapine, may affect expression of PER1 and CRY1 genes in human glioblastoma cell line

Abstract Background: There is barely any evidence of antipsychotic drugs affecting the molecular clockwork in human, yet it is suggested that clock genes are associated with dopaminergic transmission, i.e. the main target of this therapeutics. We decided to verify if haloperidol and olanzapine affect expression of CLOCK, BMAL1, PER1 and CRY1 in a human central nervous system cell line model. Methods: U-87MG human glioblastoma cell line was used as an experimental model. The cells were incubated with or without haloperidol and olanzapine in the concentration of 5 and 20 μM for 24 h. Real-time quantitative polymerase chain reaction with the ΔCT analysis was used to examine the effect of haloperidol and olanzapine on the mRNA expression of the genes. Results: At 5 μM, haloperidol decreased expression of CRY1 almost 20-fold. There was nearly a 1.5-fold increase in expression of PER1. Considering the 20 μM haloperidol concentration and both olanzapine concentrations, no other statistically significant effect was observed. Conclusions: At certain concentration, haloperidol seems to affect expression of particular clock genes in a human central nervous system cell line model, yet mechanism underlying this phenomenon remains elusive.

Psychopathological profile and antipsychotic treatment may be linked to internalised stigma in schizophrenia – a cross-sectional study

Purpose: The aim of this study was to assess the relationship between the internalised stigma of mental illness associated with the use of antipsychotic treatment and psychopathological profile among patients diagnosed with schizophrenia. Method: The study group comprised 64 patients diagnosed with schizophrenia. The Internalised Stigma of Mental Illness Inventory was used to assess the degree of self-stigmatisation in five aspects: Alienation, Stereotype Endorsement, Discrimination experience, Social withdrawal and Stigma resistance. The symptoms were assessed by a psychiatrist using the Clinical Assessment of Schizophrenic Syndromes Scale. Other variables of interest included data on current pharmacotherapy, body-mass index (BMI) and general functioning. Multivariate linear regression models were created to assess the association between variables of interest and ISMI subscale scores. Results were considered statistically significant when p < 0.05. Results: Zuclopenthixol, a long-acting injectable (LAI), was linked to greater Alienation, Stereotype endorsement and Discrimination experience, while risperidone LAI was associated with higher indices of Stereotype endorsement. Oral risperidone was linked to lower severity of Alienation and a greater level of Stigma resistance. A rise in the Lack of insight score predicted falls in Alienation, Stereotype endorsement, Discrimination experience and Social withdrawal scores. A rise in the Disturbances of Sense of Self score predicted rises in Alienation, Stereotype endorsement and Discrimination experience. ISSN: 1230-2813 volume 26 / Issue 1 2017 ADVANCES IN PSYCHIATRY & NEUROLOGY