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BackgroundNeuroimaging studies have demonstrated an association between lithium (Li) treatment and brain structure in human subjects. A crucial unresolved question is whether this association reflects direct neurochemical effects of Li or indirect effects secondary to treatment or prevention of episodes of bipolar disorder (BD).MethodTo address this knowledge gap, we compared manually traced hippocampal volumes in 37 BD patients with at least 2 years of Li treatment (Li group), 19 BD patients with <3 months of lifetime Li exposure over 2 years ago (non-Li group) and 50 healthy controls. All BD participants were followed prospectively and had at least 10 years of illness and a minimum of five episodes. We established illness course and long-term treatment response to Li using National Institute of Mental Health (NIMH) life charts.ResultsThe non-Li group had smaller hippocampal volumes than the controls or the Li group (F2,102 = 4.97, p = 0.009). However, the time spent in a mood episode on the current mood stabilizer was more than three times longer in the Li than in the non-Li group (t51 = 2.00, p = 0.05). Even Li-treated patients with BD episodes while on Li had hippocampal volumes comparable to healthy controls and significantly larger than non-Li patients (t43 = 2.62, corrected p = 0.02).ConclusionsOur findings support the neuroprotective effects of Li. The association between Li treatment and hippocampal volume seems to be independent of long-term treatment response and occurred even in subjects with episodes of BD while on Li. Consequently, these effects of Li on brain structure may generalize to patients with neuropsychiatric illnesses other than BD. [ABSTRACT FROM AUTHOR]

The article focuses mental health care in Poland. Traditionally, academic psychiatry in Poland, along with education and scientific research, had been strongly connected with the supervision of general psychiatric care. The major organizational event in Polish postwar psychiatry was sub-sectorization of mental hospitals in 1968, which divided the catchment area of the hospitals into smaller territories served by individual departments cooperating with the mental health outpatient clinics dedicated to those subsectors.

Objective: An undiagnosed bipolarity may be one of the reasons connected with treatment resistance in major depressive disorder. In recent years, the tools have been introduced helping to assess the bipolarity such as the Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ). The objective of the study was to compare scores of bipolarity measured with these scales between patients with treatment-resistant and treatment non-resistant depression within the framework of all-Poland multi-center study TRES-DEP. Methods: One-thousand and fifty-one patients recruited from 150 outpatient psychiatric clinics in Poland and fulfilling DSM-IV criteria for single or recurrent major depressive episode were studied. Five-hundred and sixty-nine patients were identified as having treatment-resistant depression on account of non-obtaining remission in recent depressive episode after minimum of two courses of adequate treatment with antidepressant drugs. They were compared with 482 patients with non-treatment-resistant depression. All patients were assessed using the structured demographic and clinical data interview, as well as the Polish version of HCL-32 and MDQ Results: Patients with treatment-resistant depression scored significantly higher compared with non-resistant depression both on HCL-32 and MDQ (11.9+8.3 vs 8.5±7.7 and 4.3±3.5 vs 2.7±2.9, respectively). Independent risk factors of treatment resistance were scoring of14 or higher on HCL-32, and 6 or higher on MDQ. Conclusions: Higher scoring by patients with treatment-resistant depression on both HCL-32 and MDQ may suggest a possible association between bipolarity and worse response to antidepressant drugs in patients with major depressive disorder. [Copyright &y& Elsevier]

Objective: The aim of the study was an analysis of prolactin concentration in the course of antipsychotic treatment in Polish patients participating in EUFEST study. Methods: Seventy-eight patients with the first episode of schizophrenia were studied, randomly allocated to the treatment with low dose haloperidol (n=23), amisulpride (n=21), olanzapine (n=22), quetiapine (n=11) or ziprasidone (n=1), for the period of 12 months. Prolactin concentration was assessed at baseline and after 6 and 12 months of treatment. Hyperprolactinemia was defined as prolactin concentration >18 ng/ml in males and >25 ng/ml in females. Results: At baseline, the mean prolactin concentration was 56,5 ng/ml and hyperprolactinemia was observed in 86% of patients, slightly more than in the whole EUFEST group (71%). Prolactin concentration was similar in drug-naïve as in non-drug-naïve patients. After 6 month of treatment, hyperprolactinemia was found in 67% of patients, lowest in haloperidol (29%) and highest in amisulpride group (93%). After 12 months, hyperprolactinemia was observed in 56% of patients, lowest in quetiapine (36%) and highest in amisulpride group (80%). Conclusion: Hyperprolactinemia was found in a majority of patients with the first episode of schizophrenia, including drug-naïve patients. In the course of one-year antipsychotic treatment, in patients receiving amisulpride, the hyperprolactinemia has been maintained at the initial high level while in remaining groups, a reduction by about 50% of the number of patients having hypeprolactinemia at baseline was observed. We suggest that an abnormality of stress system, could contribute to hyperprolactinemia independent of antipsychotic treatment in the first episode schizophrenic patients. [Copyright &y& Elsevier]

The Polish standard of treatment with racemic ketamine for patients with depressive disorders was developed by a Working Group appointed by the National Consultant in the field of psychiatry. Despite the wide range of available medications, as many as one-third of depressed patients do not respond to standard antidepressant treatment, raising the need for an ongoing search for new effective and safe therapies. In recent years, the possible role of overactivity of the glutamatergic system in the etiopathogenesis of depression has again attracted the attention of many experts. The possibility of using substances with a modulating effect on the glutamatergic system in the treatment of depressive disorders has been postulated, among others, the long-known anesthetic ketamine, which is a noncompetitive NMDA receptor antagonist. This paper summarizes the results of studies on the efficacy and safety of racemic ketamine (administered intravenously) in the treatment of patients with depressive symptoms in the course of both unipolar and bipolar affective disorder, and, meeting the expectations of many practicing psychiatrists wishing to broaden the range of therapies offered to their patients, presents recommendations on indications, contraindications, precautions and the treatment regimen itself with intravenous ketamine for patients with mood disorders.

This year, we observe sixty's anniversary of the article by a British psychiatrist, Geoffrey Hartigan, demonstrating, for the first time, the possibility of preventing of the recurrence of mood disorders by using lithium salts. Herein, a history of prevention of recurrences of mood disorders both worldwide and in Poland will be presented concerning both lithium and other mood-stabilizing drugs. The merit for verifying the prophylactic lithium effect in the 1960-1970s should be given to Danish researchers, Mogens Schou and Poul Baastrup. In Poland, the first paper on prophylactic lithium appeared already in 1971. In the 1970s, French researchers showed prophylactic activity of valproic acid amide, and Japanese researchers - carbamazepine. In the 1980th, studies on valproic acid amide were performed in the 2nd Psychiatric Clinic of the Institute of Psychiatry and Neurology led by Prof. Pużyński. Since the mid-1990s, 2nd generation of mood-stabilizing drugs has been introduced, including some atypical antipsychotics (clozapine, olanzapine, quetiapine, aripiprazole, risperidone) and anticonvulsant drug, lamotrigine, showing prophylactic activity in bipolar mood disorder. The studies on lithium resulted in the identification of factors connected with its prophylactic efficacy as well as the antisuicidal, antiviral, and neuroprotective effects of this drug. From a sixty-year perspective following Hartigan's article, it seems that his pioneering concept on the possibility of pharmacological influence on the course of mood disorders was fully confirmed. Current Polish recommendations on pharmacological prophylaxis of mood disorders were presented in the books "Standardy leczenia niektórych zaburzeń psychicznych" and "Psychofarmakologia kliniczna", both published in 2022.

Background: Although the efficacy of electroconvulsive therapy (ECT) has been well established, the utilization rate of ECT has decreased in Poland in recent years. One of the main reasons could be the negative attitude towards ECT in the community and by mental health professionals. The aim of this study was to assess the knowledge about and attitudes toward ECT in Polish mental health professionals including psychiatrists and non-physicians: nurses, psychologists, social workers., Subjects and Methods: Psychiatrists and other mental health professionals in two large Polish hospitals were approached to participate in the survey by completing a 28-item questionnaire. The specific hospitals have been selected due to the fact that they were located in the same province of Poland (Mazowsze), had similar catchment area and profile, provided similar mental health services with only one exception; one offered ECT while the other did not. Of the 185 questionnaires that had been distributed, 165 were completed yielding a response rate of 89.19%. The study population consists of 85 psychiatrists and trainees and 80 non-physicians., Results: Psychiatrists did not differ from other mental health professionals with respect to the knowledge and attitudes toward ECT. However, there were significant differences in the attitude (9.1±3.8 vs 7.1±3.3; p<0.001) and knowledge (5.9±3.8 vs 2.8±4.1; p<0.001) scores between those professionals, who have ever worked in a psychiatric ward where they could observe ECT sessions and those who have not had such an opportunity., Conclusions: Frequent witnessing of ECT sessions seems to be the most effective educational intervention to change negative attitudes towards ECT.

The last half-century, thanks to the efforts of outstanding researchers, brought about great progress in the pathogenesis and clinics of affective illnesses. The catecholamine and serotonin hypothesis delineated in the 1960s have retained significant merit. Since the 1990s, the theories have pointed on excessive immune activation and impairment of neuroplasticity under stress. Since the 1970s, asystematic subclassification of unipolar and bipolar affective disorder has proceeded. Epidemiological studies of the last half-century indicated a significantly higher prevalence of depression compared with previous decades. The 21st century brought evidence for agreater frequency of various forms of bipolar affective disorder. During the last 50years, the etiopathogenesis, diagnosis and treatment of affective disorders were my favorite and fascinating clinical and research topics. This initiated in 1970 when I began my work in the Department of Psychiatry, Medical Academy in Poznan, on account of the introduction of lithium salts for the treatment of these disorders. In 1976-1977, I received afellowship of the National Institutes of Health at the University of Pennsylvania in Philadelphia and participated in research that elucidated the mechanism of lithium transport across cell membranes. I carried out the studies on the pathogenesis of affective disorders for more than 40 years afterward. They concerned abnormalitiesof transport across cell membranes, the activity of stress system, excessive pro-inflammatory activation, molecular genetics, dysfunctions of cognition and neurotrophins, especially the brain-derived neurotrophic factor (BDNF). Atthe beginning of the 21st century, I coordinated two Polish epidemiological projects DEP-BI and TRES-DEP. For my research on bipolar disorders, I received many international awards. I am also the author of the book The faces of manic-depressive illness which had three Polish editions as well as English and Russian versions.

Objectives: The aim of the study was to create a Polish version of the Self-evaluation of NegativeSymptoms (SNS) scale, to assess its internal consistency, and to make correlations between the SNS scores and the Brief Negative Symptom Scale (BNSS) scores in the group of patients with schizophrenia., Material and Methods: The procedure of Polish adaptation of the French-language version of the SNS scale, comprising 20 items organized in 5 subscales: asociality, blunted affect, alogia, avolition and anhedonia, was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women) with severity of symptoms on the Positive and Negative Syndrome Scale (PANSS) 56±16 points, receiving unchanged pharmacological treatment in the last 3 months., Results: The Polish version of the SNS scale was accepted by the author of the scale, Professor Sonia Dollfus. The reliability analysis showed high values of the Cronbach's alpha coefficient for the whole scale (0.91) and for the subscales (0.61-0.85). The SNS and its subscales showed significant correlations with the total BNSS score and with the scores of the BNSS subscales, which confirms the validity of the scale., Conclusions: A statistically significant level of consistency of the whole scale and its individual domains with the results of the clinical assessment with the BNSS, speaks for the adequacy of the self - assessment of negative symptoms by a patient with schizophrenia. Good psychometric properties of the Polish version of the SNS obtained in the study can indicate its usefulness in the research on negative symptoms conducted in Poland.

Objectives: Electroconvulsive therapy (ECT) is the most effective treatment for drugresistant depression. In most studies, cognitive functions including working and semantic memory showed only transient impairment after ECT. However, the deficits of episodic (autobiographical) memory were demonstrated to be long-lasting., Methods: We investigated autobiographical memory in 20 patients (8 male, 12 female), aged 21-64 years, with drug-resistant depression, treated with ECT, using the Polish adaptation of the Autobiographical Memory Interview-Short Form (AMI-SF). The assessments were performed before, immediately after 10-12 ECT sessions, and 3 months thereafter., Results: Before the ECT, the mean severity of depression was 30 ± 6 points on the 17-item Hamilton Depression Rating Scale and the treatment produced a significant clinical improvement in all patients. The indices of autobiographical memory, as assessed by the AMI-SF, were significantly lower immediately after ECT and 3 months thereafter. The impairment in autobiographical memory did not show correlation with clinical improvement and with any other clinical factors., Conclusions: The results obtained in patients with drug-resistant depression confirm that ECT treatment produces a significant impairment of autobiographical memory persisting also three months after the procedure, suggesting that it may be the most important adverse cognitive effect of the ECT.

Objectives: To create a Polish adaptation of the Brief Negative Symptom Scale (BNSS), to assess the internal consistency of the Polish version of the BNSS, and to make correlations between the BNSS scores and the Positive and Negative Syndrome Scale (PANSS) in the group of patients with schizophrenia., Methods: The procedure of Polish adaptation of the assessment form (Scoresheet) of the BNSS, comprising 13 items organized in 6 subscales (anhedonia, lack of proper distress, asociality, avolition, blunted affect, and alogia), as well as the Manual and the Workbook of the scale was carried out. Psychometric tests were performed in 40 patients with paranoid schizophrenia (20 men and 20 women), aged 44±13 years, with illness duration of 17±10 years, and severity of symptoms on the PANSS 56±16 points, receiving unchanged pharmacological treatment in the last three months., Results: The Polish version was accepted by the authors of the scale. The reliability analysis showed high values of the Cronbach's alpha coefficient both for the whole scale (0.97) and for individual subscales (0.74-0.93). The BNSS and its subscales showed a high significant correlation with the total PANSS score and with the PANSS negative symptom subscale, both original and modified., Conclusions: The obtained results indicate good psychometric properties of the Polish version of the BNSS and its possible usefulness in the study of negative symptoms of schizophrenia conducted in Poland.

This article presents recommendations of the Polish Psychiatric Association regarding approach to pregnancy loss and unsuccessful in vitro treatment of infertility. From the psychological perspective pregnancy loss and perinatal death are amongst the most stressful events in human life - carrying increased risk of developing affective, anxiety or post-traumatic stress disorders. Psychologists, physicians and the rest of the medical staff should provide integrated and individualized care which should be based on respect, empathy and expertise. The necessary phases of support for women experiencing pregnancy loss are: (1) physician providing exhaustive informational support regarding state of health, potential causes of fetal death, further approach and phases of induced labor of the fetus/pregnancy termination/procedure, (2) facilitating psychological consultation at any time and (3) providing exhaustive information on current legal standing (health insurance and labor law). Experiencing recurrent in vitro fertilization failures may result in the emotional consequences similar to those observed in miscarriages. The prolonged frustration may favor developing depressive symptoms and escalate pathological anxiety. We present basic recommendations for psychotherapy and pharmacotherapy in pregnancy loss and unsuccessful in vitro infertility treatment.

Treatment of depressive disorders in women of childbearing age requires special attention due to the possibility of planned or unplanned pregnancy and the specificity of mood disorders associated with the perinatal period. A doctor who treats depression in a woman of childbearing age should openly discuss with the patient her sexuality and the possibility of becoming pregnant. A psychiatrist may encounter various problems, such as: a therapeutic decision regarding a woman suffering from recurrent depression who receives preventive or maintenance antidepressant medication and becomes pregnant or plans to conceive; proceedings in the case of a depressive episode in a woman who is already pregnant; proceedings in the case of postpartum depression; antidepressant treatment in the context of breastfeeding. The recommendations were prepared by the working group of the Polish Psychiatric Association based on the latest worldwide standards as well as opinions and consensus of experts. The recommendations provide general principles of therapeutic approach and include data on the safety of antidepressants.

In the article, the recommendations of the Polish Psychiatric Association regarding pharmacological treatment of women with bipolar disorder during pregnancy and postpartum period were presented. The issue pertains to every twentieth woman wanting to get pregnant. Before planned pregnancy, it is advisable to obtain a several-month stabilization of psychiatric state, to establish treatment with one mood-stabilizing drug (except for valproate and carbamazepine) or gradual discontinuation of drugs in case of mild course of illness and lack of recurrences in recent two years. In the first trimester of pregnancy, the dose of the mood-stabilizing drug should be reduced (lithium carbonate to 500 mg/day). Depression during pregnancy can be treated with quetiapine or lamotrigine or with antidepressant drug added to a mood-stabilizing drug. Atypical antipsychotics drugs with mood-stabilizing properties can be used in case of (hypo) manic or mixed states. Following the delivery, it is advisable to introduce a moodstabilizing drug as soon as possible to prevent postpartum psychiatric disturbances. In the treatment of postpartum depression, quetiapine can be used or an antidepressant drug added to a mood-stabilizer. Considering breastfeeding, it should be remembered that the infant/maternal ratio of serum drug concentration is low for valproate, olanzapine, quetiapine, sertraline and paroxetine, and high for lithium and lamotrigine. In the case of postpartum psychosis, a hospitalization and antipsychotic treatment are needed.

Objectives: The aim of this paper is a quantitative assessment of FASD facial phenotype in the Polish population using the Polish version of the 4-Digit Diagnostic Code., Methods: The study covered 2 groups of children: 30 children aged 4-7 and 30 children aged 8-11 with a facial phenotype characteristic for the Fetal Alcohol Syndrome (FAS). The control group consisted of 60 children (4-11 years old) developing normally. We compared 3 facial features (small palpebral fissure lengths, smooth philtrum and thin upper lip). The repeatability, conformity and diagnostic accuracy of particular dysmorphic features of the study were assessed., Results: Obtained values for palpebral fissure were "poor", "good" and "very good", for philtrum "good" and "very good" and for upper lip "good" and "very good". As for conformity, values for palpebral fissure were "moderate" and 'good", for philtrum - "good" and for upper lip also "good". In the experimental group, the FAS diagnostic criteria were met by 13 subjects, partial FAS criteria were met by 37 subjects and the criteria of static encephalopathy with no FAS phenotype were met by 2 subjects. None of the subjects in the control group met these criteria., Conclusions: The pictorial scale for the assessment of the facial dysmorphic features proved to be a useful tool in the clinical diagnostics of FAS in the Polish conditions. Due to the problems associated with the measurement of the palpebral fissure, it is necessary to verify the normal growth charts for the Polish population.

Objective: To measure the intensity of depressive symptoms in the populations residing in rural areas of western Poland, and to delineate the putative association between the intensity of depression and selected socio-demographic and clinical factors., Materials and Method: The study covered 445 adults recruited from one family physician practice in the rural area of Wielkopolska region. The following tools were applied: Beck Depression Inventory (BDI), the WHO WHOQoL-Bref quality of life assessment scale, and a socio-demographic and clinical questionnaire elaborated by the authors., Results: Depressive symptoms were observed in approx. 30% of the patients. The intensity of symptoms correlated with age, female gender, and inversely correlated with the quality of life. There was no association between depressive symptoms and level of education (counted as years of education), number of somatic illnesses, and family burden of psychiatric disorders., Conclusion: Symptoms of depression were noted in approx. 30% of patients who consulted their family physician. The Beck questionnaire is a simple tool whose application could decidedly improve the recognition of depression. It is worth taking note of factors that may be connected with the intensity of depressive symptoms - gender, the number of diagnosed somatic illnesses, and the quantity of drugs administered.

Background: The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates., Methods: Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale., Results: At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%., Conclusions: The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary., (Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Purpose: To use the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ), for detecting bipolarity in depressed patients., Patients: One thousand and fifty-one patients fulfilling ICD-10 criteria for unipolar major depressive episode, single or recurrent, were studied. Patients were assessed using a structured demographic and clinical data interview, and by the Polish versions of the HCL-32 and MDQ questionnaires., Results: Hypomanic symptoms exceeding cut-off criteria for bipolarity by HCL-32 were found in 37.5% of patients and, by MDQ, in 20% of patients. Patients with HCL-32 (+) or MDQ (+) differed significantly from patients with HCl-32 (-) and MDQ (-) respectively, by being less frequently married, having more family history of depression, bipolar disorder, alcoholism and suicide, earlier onset of illness, and more depressive episodes and psychiatric hospitalizations. The percentage of patients resistant to treatment with antidepressant drugs was significantly higher in HCL-32 (+) vs. HCL-32 (-) and in MDQ (+) vs. MDQ (-): 43.9% vs. 30.0%, and 26.4% vs. 12.4%, respectively., Conclusions: The results confirm a substantial percentage of bipolarity in major depressive disorder. Such patients have a number of clinical characteristics pointing on a more severe form of the illness and their depression is more resistant to treatment with antidepressants., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Long-term mood instability and fluctuations in mood are quintessential features of bipolar disorder; however a great majority of of mood rating scales are cross-sectional and focused on acute symptoms. NIMH Life Chart Methodology (NIMH-LCM) and ChronoRecord program on the contrary record the severity, duration and frequency of mood swings. Many bipolar patients need combined treatment and take multiple medications, which is associated with better treatment outcome but also with the increased risk of side effects. Treatment with drug combination negatively impacts the compliance of the patients. Simultaneous assessment of daily mood fluctuations and monitoring of life events and medications may help to optimize treatment and to better detect nuances of partial response. TacyJakJa.pl an Internet site, in which patients keep on-line diaries concerning their course of disease and treatment, makes this tool available to a large number of patients. Not only does it enable the patients to learn about mood disorders, but also it increases their involvement in their treatment.

Aim: The aim of the study was to examine the activity of selected cytokines in bipolar patients during manic and depressive episodes and in remission., Method: The cytokine status was assessed in 76 bipolar patients, 35 with mania- and 41 with depression. For cytokine measurements blood samples were drawn from each patient twice-- while in an acute episode and in remission. 78 healthy individuals were examined once. Serum samples were tested for concentrations of: IL-6, IL-10, IL-1beta, TNF-alpha, IFN-gamma using the cytometric method. The patients' mental status was assessed with Young Mania Rating Scale and Hamilton Depression Rating Scale., Results: Concentration of IL-6 was higher during the manic state as compared to control group. Additionally, IL-6 level was higher in mania than in remission. Concentration of IL-10 was higher in patients in remission after manic episodes than in healthy controls. In manic patients raising of IFN-gamma level was accompanied by more severe symptoms evaluated with YMRS. In remission after mania there was a correlation between IL-6 concentration and the intensity of the manic state. IFN-gamma level was higher in depressed patients comparing to remission, as well as manic patients and subjects from control group. IFN-gamma in remission after depression was still higher than in the healthy controls. Concentration of IL-1beta was higher in depressed patients comparing to healthy subjects., Conclusion: The results obtained in this study show disturbances of the immune system in bipolar patients. These disturbances have features of either decrease or pathological increase of the immune response. Cytokines' profiles were different for mania and depression. Clinical improvement seems to be connected with immunomodulation process that results in changes of cytokine levels in bipolar patients in remission.

The pharmacological properties and possible clinical use of trazodon in the treatment of depression are presented. Trazodon is the only antidepressant from the SARI (Serotonin Antagonists and Reuptake Inhibitors) group available in Poland. It has a wide pharmacodynamic profile (being an antagonist of 5-HT2A and 5-HT2C serotoninergic receptors, alpha1 and alpha2 adrenergic receptors as well as H1 histaminergic receptors, and in higher doses it blocks the SERT serotonine transporter) which explains its wide therapeutic spectrum ranging from symptomatic treatment, through the potentialization of other drugs activity, all the way to monotherapy of depressive syndromes. An especially complex action on the serotoninergic system results in the lack of unwanted side-effects during treatment with trazodon (e.g. sexual dysfunction, significant body weight gain), which may be present during the treatment with other drugs (selective serotonin reuptake inhibitors). It is metabolised by the CYP450 isoenzyme: mainly the 2D6 and 3A4. This requires its dose to be adjusted when administered simultaneously with other drugs influencing the activity of those isoenzymes. Trazodon CR is an orally administered controlled release form, which simplifies its dosage and reduces the risk of adverse effects. Usually doses of 75 to 600mg daily are used; in the elderly those doses should be lower. Trazodon turned out to be effective in the treatment of various depressive syndromes, amongst them depression with insomnia, with anxiety and unrest, as well as depression in the elderly. In the recommended dose spectrum, trazodon is well tolerated. Unwanted adverse effects of the drug appear rarely and they are: somnolence, dizziness, gastrointestinal dysfunctions, and dry mouth.

In current diagnostic classifications such as the International Classification of Diseases (ICD-10) and the American Diagnostic and Statistical Manual (DSM-IV), unipolar and bipolar mood disorders are mentioned, where the differentiating factor is occurrence of mania or hypomania. In DSM-IV, bipolar mood disorder type I (bipolar I), with the episodes of mania, and bipolar mood disorder type II (bipolar II) with hypomania, have been separated. Clinical and epidemiological studies performed in recent decades using more sensitive measures of the assessment of hypomania suggest a marked prevalence of bipolar disorders of not-bipolar I type, amounting to about 3-5% of population. In 2005, Angst and collaborators introduced the Hypomania Check List-32 scale (HCL-32) aimed at a better identification of the occurrence of hypomania symptoms in patients with affective disorders. The studies carried out in many countries have demonstrated a significant sensitivity and specificity of the scale and its usefulness for the assessment of bipolar affective disorders. In the present paper, the Polish version of HCL-32 scale is presented. This version has been already employed in the all-country Polish project TRES-DEP where the features of bipolarity were assessed in depressive patients in whom treatment with antidepressant drugs was unsuccessful.

We investigated three polymorphisms in the NMDA receptor 2B subunit gene (GRIN2B), involved in glutamatergic neurotransmission, as a candidate gene for bipolar disorder. In the study we included 419 patients with bipolar disorder. Consensus diagnosis by at least two psychiatrists was made, according to DSM-IV criteria, using SCID. The control group consisted of 487 healthy subjects. Genotypes for -200G/T, 366C/G and rs890G/T of GRIN2B polymorphisms were established by PCR-RFLP method. Linkage disequilibrium analysis was done with Haploview. Genotype distributions were in Hardy-Weinberg equilibrium for the three polymorphisms in the group of patients and control subjects. No association was found between the three polymorphisms and bipolar disorder. In linkage disequilibrium analysis we did not find linkage between the three polymorphisms of GRIN2B gene. The polymorphisms of GRIN2B gene analysed in this study are not likely to be associated with bipolar disorder.

Surgical intervention to the brain has a long history, but contemporary psychosurgery started in the mid-1930s. The first psychosurgical operation was a prefrontal leucotomy. In this chapter, a history of psychosurgery is described with a special focus on so-called "ablation" procedures such as anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leucotomy. The expectations that psychiatrists linked to the surgical intervention have grown along with the progress of diagnostic neuroimaging procedures used in brain research. In recent years, the introduction of neuromodulation techniques seemed to produce a qualitative progress in modern psychosurgery. However, the controversies about these surgical interventions to the brain among psychiatrists still restrict the indications for psychosurgery to highly selected cases.

Objectives: This study involved a naturalistic, prospective project assessing objective and subjective dimensions of quality of life (QoL) and the range of its putative determinants in first-episode schizophrenia., Methods: Seventy-four patients, mean age 24.7 years, participated in the study. The patients were assessed 1 month following the first hospitalisation (Time 1), 12 months later (Time 2), and 4-6 years after Time 1 (Time 3). The Social Functioning Scale and World Health Organisation Quality of Life-BREF (WHOQOL-BREF) were applied to evaluate objective and subjective QoL, respectively. The Positive and Negative Syndrome Scale was used to examine psychopathological status, and the Global Assessment Scale was applied to evaluate social adjustment prior to hospitalisation., Results: The objective and subjective QoL was relatively low at Time 1. Over time, the objective QoL improved in three domains, decreased in one domain, and remained stable in three domains. The subjective QoL did not change. The most important predictors of both dimensions of QoL were psychopathology and duration of untreated psychosis., Conclusions: Because psychopathology seems to have the greatest impact on the QoL, there is a need to develop community psychosocial treatment to reduce these symptoms and to support patients in the early phase of the disease.

Aim: To evaluate prospectively the course of schizophrenia in men and women after a first psychiatric hospitalization in terms of socio-vocational situation, social functioning and psychopathological status., Methods: A study sample consisted of 74 patients (46 males, 28 females), examined 1 month (T. 1), 13 months (T. 2) after a discharge, and 4-6 years after T. 1 (T.3). The research instruments were: a questionnaire for socio-demographic data and information about the illness course, Social Functioning Scale (SFS) and PANSS., Results: During the follow-up period, the socio-vocational situation and psychopathological status has worsened. The percentage of patients unemployed or not studying increased by 26%, whilst those receiving a disability pension by 50%. Despite of the pharmacological treatment, symptoms severity increased, particularly in the group of negative symptoms and general psychopathology (p < 0.01). Social functioning showed a significant trend to improve but only in some domains. Between T. 1 and the last follow-up, there was an increase in total SFS and in 3 out of the 7 domains. This improvement was particularly noticeable in the group of female patients hospitalized before the age of 20 years (p < 0.05). Female patients, regardless of age of their first hospitalization, scored higher in the Independence performance domain., Conclusions: (1) The early course of schizophrenia appears to be heterogeneous. This was reflected by the deterioration of socio-vocational situation and psychopathological status, and by a variability of the changes in social functioning. (2) This heterogeneity and non-parallel changes should be taken into account when planning and evaluating therapeutic interventions. (3) The early course of schizophrenia seems to be more beneficial for female patients.

Unlabelled: Studies performed in recent years in different countries suggest a considerable prevalence of depressive disorders in primary care patients. The aim of our study was the assessment of depressive disorders among primary care patients in Poland., Material and Methods: Three-hundred thirty-three randomly chosen private and public primary care clinics from the whole country took part in the study. In each centre, 20 or 25 patients aged 18-65 years coming for a regular visit were asked to participate in the study. All patients filled in the Beck Depression Inventory (BDI). Additionally, basic demographic data and information on the presence of chronic somatic diseases were collected. Those patients who scored 12 or more points on BDI (cut-offpoint for depression in Poland) were evaluated by a primary care physician for presence of a depressive disorder upon the ICD-10 criteria and subsequently referred for a psychiatric consultation to the nearest psychiatric outpatient clinic for establishing plausible diagnosis of depression., Results: Out of 7360 patients approached, 7289 (95.5%) agreed to participate. The mean age of the sample was 43.3 +/- 13.2 and 71% were females. Forty one percent of patients (2985) had 12 or more points on the BDI and were referred for a psychiatric evaluation. Only half of them came for a psychiatric consultation. Depressive disorder was recognised in 906 patients. Estimated prevalence of depressive disorders in the whole sample was 23.3%. The patients in whom depressive disorders were confirmed by psychiatric assessment had significantly more often hypertension, ischaemic heart disease, anaemia, stroke and hypothyroidism., Conclusions: The results obtained show that depressive disorders' prevalence in primary care patients in Poland is significant. The patients who had depressive disorders significantly more often than patients without depression suffered from some somatic diseases. In light of the results, both recognition and adequate treatment of depressive disorders in primary care patients should be regarded as equally important as the recognition and treatment of cardiovascular diseases or other common somatic illnesses.

Objective: To review the current status of psychiatry in selected countries of Central and Eastern Europe: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Russia, Slovakia, and Slovenia., Method: A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages., Results: There is a shift from traditional in-patient facilities towards out-patient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West., Conclusion: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

Aim: To assess the frequency of bipolar disorders among outpatients with affective illness treated by 96 Polish psychiatrists, representing all regions of Poland., Methods: The study was performed on 880 patients (237 male, 643 female). They were identified, according to the criteria used, into the following diagnostic categories: 1. Bipolar affective illness, type I (Bipolar I); 2. Bipolar affective illness, type II (Bipolar II); 3. Bipolar spectrum disorder; 4. Unipolar affective illness., Results: Affective disorders having bipolar features were found in 61.2% of the patients studied, bipolar I more frequent in men (27.4% vs 17.6%) and bipolar II more frequent in women (31.7% vs 21.5%). Bipolar spectrum was identified in 12% of the studied patients. Patients with bipolar affective illness compared with unipolar affective illness had a family history of bipolar disorder significantly more frequently, premorbid features of hyper- or cyclothymic personality, early onset of depression (before 25 years), symptoms of atypical depression (hypersomnia and hyperphagia), episodes of psychotic depression, postpartum depression, and treatment-resistant depression. The group of bipolar spectrum had most clinical features similar to classic types of bipolar affective illness and showed significant differences with unipolar affective illness., Conclusions: In outpatients, who had a depressive episode in the past and were treated by psychiatrists in Poland, bipolar disorders may amount to 60% of them. Patients with bipolar affective illness significantly differ from patients with unipolar affective illness as to the numerous clinical features, not connected with manic, hypomanic or mixed states. The results of the study may also indicate a legitimacy to delineate a bipolar spectrum disorder.

Aim: A comparison of the clinical picture and treatment results of the first depressive episode with the second and the third and further depressive recurrence., Methods: The study was designed as a one-year, prospective, naturalistic observation of the clinical course of depression. One hundred and sixty-six psychiatrists participated in the study, performed in the years 1999-2000. Data of 179 patients with the first depressive episode, 170 patients with the second episode and 183 patients with third or further episode were included in the analysis., Results: At the beginning of the observation, the groups of patients did not differ as to age, proportion of gender and intensity of depression, both global and particular symptoms. Patients with the first depressive episode were included into the study after longer duration of symptom occurrence and were more often treated with new generation antidepressants. Comparison of the course of disease revealed higher intensity of depressive symptoms, both global and particular clusters after 6 months and 12 months of treatment, and lower percentage of remission in patients with multiple episodes compared to the first episode group. The type of antidepressant was not significantly related to the efficacy of treatment. Ten patients (2%) had suicidal attempts, one (0.2%) with fatal outcome: in first episode group they were made during initial period of treatment, in multiple episodes--later in the course., Conclusions: The results obtained indicate that the course and the treatment outcome of subsequent depressive episodes are less favourable compared to the first depressive episode. Treatment recommendations for depression may be verified based on the results of the study.

Background: It has been proposed that the Borna Disease Virus (BDV) plays a role in the etiopathogenesis of psychiatric disorders. We assessed BDV seropositivity in Polish psychiatric patients and healthy controls, and the relationship between seropositivity and selected diagnostic and clinical variables., Material/methods: Serum samples from 946 psychiatric patients with different diagnoses (ICD-10) and 407 psychiatrically healthy controls were assayed. The ECLIA method was used, which enables the assessment of two anti-BDV antibodies: anti-p24 and anti p-40. Data were also collected on diagnosis, age, age at onset, and place of residence., Results: Only anti-p24 antibodies were found. The seropositivity rates were: 2.4% and 1.0%, respectively, in patients and controls (p=0.1). A significant difference between patients and controls was observed in mental retardation and affective-anxiety spectrum disorders. Seropositivity did not show any association with demographic variables, but it was elevated in patients with recent onset of disease vs. remote onset of disease (10.2% vs. 1.6%; p=0.0003)., Conclusions: Significantly higher anti-BDV seropositivity was found in Polish psychiatric patients with affective-anxiety spectrum disorders and mental retardation than in controls. The association between recent onset disorders and higher anti-BDV response, in the light of recent reports on circulating immune complexes of BDV antigens and antibodies, warrants further studies on the longitudinal course of humoral response to BDV.

Borna Disease Virus (BDV) is single stranded RNA virus, which may infect a wide range of animal species. Manifestations of the experimental BDV infection show some resemblance to psychopathological symptoms of mental disorders in humans. Several reports suggest the higher prevalence of anti-BDV antibodies in psychiatric patients than in healthy controls. However, the seroprevalence of anti-BDV antibodies varied due to the different serological methods used in the previous studies. Electrochemiluminescence Immunoassay (ECLIA) is a recently developed, highly specific method of detecting antibodies directed toward two BDV proteins: p24 and p40. We used the ECLIA method for the assessment of seropositivity in 946 psychiatric patients hospitalized in the psychiatric hospitals in the western part of Poland. All patients were clinically diagnosed with ICD-10 criteria. Anti-p40 antibodies have not been found in the studied sample. We found anti p-24 antibodies in 23 cases, which give the seroprevalence rate of 2.4%. This result is consistent with the outcome of Japanese population assessment, done with the same methodology. The seropositive cases did not show diagnostic specificity. We did not find statistically significant gender differences in rate of seropositivity. The seroprevalence of anti-BDV antibodies was not significantly different in patients of urban and rural residence, and in patients of different age groups. This is the first demonstration of anti-BDV antibodies in the Polish population of patients hospitalized in psychiatric hospitals.

In recent years a number of drinking-related assessment instruments have undergone extensive developmental work and are in widespread use. These include measures that are designed to assess: 1) patterns of alcohol consumption. Timeline Followback Method (TLFB); and 2) antecedents to alcohol use, Inventory of Drinking Situations (IDS)-two constructs that would be expected to be sensitive to cross-cultural variability in drinking practices. These assessment tools present opportunities for the study of cross-cultural differences in drinking patterns and the circumstances under which drinking occurs. A World Health Organization project utilizing these assessment tools is currently underway in five countries (Australia, Canada, Mexico, Poland, and Sweden). This project focuses on the identification of profile differ.

The effect of disulfiram ("Anticol") treatment lasting from 7 to 12 months of 57 alcohol dependent out-patients was evaluated. The satisfactory results (i.e. patients remained abstinent and took the medication regularly) were observed in 30 patients. Those patients did not differ from others in regard to age, length of alcohol abuse, the severity of dependence, the genetic encumbrance , the features of alexithymia , and the membership of AA-clubs. The percentage of patients with positive treatment results was significantly higher among subjects with high self-motivation to treatment, among married subjects, and among those professionally active. The findings are similar to the recent American results where about a half of alcoholics showed positive effects of disulfiram treatment, especially those with high motivation to the treatment and with the stabile social position.