Search

Cel pracyZaburzenia Lękowe Specyficzne dla Ciąży występują ze znaczną częstością i związane są z powikłaniami u matek i ich dzieci. Jest to schorzenie odrębne od innych zaburzeń lękowych, stąd stosowanie standardowych testów przesiewowych nie jest wystarczające. Brak jest polskiej wersji testu przesiewowego specyficznego dla tego zaburzenia. Naszym celem jest stworzenie polskiej adaptacji Pregnancy-Related Anxiety Questionnaire Revised 2 (PRAQ-R2), który jest szeroko stosowany za granicą.MetodaPRAQ-R2 został przetłumaczony na język polski przez niezależne osoby, mówiące biegle po polsku i angielsku. Czterdzieści osiem ciężarnych wypełniło ankietę zawierającą polską wersję PRAQ-R2, Hospital Anxiety and Depression Scale Modified (HADS-M) oraz krótki Kwestionariusz Socjodemograficzny. Po tygodniu uczestniczki badania zostały poproszone o ponowne wypełnienie kwestionariusza PRAQ-R2. Do oceny właściwości psychometrycznych wykorzystano statystyki parametryczne.WynikiNasze badanie wykazało dobrą korelację test-retest na poziomie 0,70. Współczynnik alfa Cronbacha wynosił 0,847 w t1 i 0,895 w t2. Wykazano umiarkowaną korelację pomiędzy PRAQ-R2 w obu punktach czasowych a skalą HADS-M i jej podskalami.WnioskiBadanie adaptacyjne PRAQ-R2 wykazało jego satysfakcjonującą trafność i rzetelność. Umiarkowana korelacja z HADS-M dowodzi, że lęk związany z ciążą jest zaburzeniem odrębnym od lęku uogólnionego i zaburzeń depresyjnych. Biorąc pod uwagę dużą częstotliwość i poważne powikłania PrA, uważamy, że PRAQ-R2 powinien być rutynowo stosowany wśród lekarzy pracujących z pacjentkami w ciąży.

Tło: Zdrowie psychiczne pacjentek w ciąży stało się przedmiotem zainteresowania klinicystów, jednak zaburzenia lękowe w ciąży są nadal niedostrzegane i niedodiagnozowane, pomimo ich udowodnionego związku z niekorzystnymi wynikami porodowymi. Cel: Celem niniejszego badania przeglądowego jest podsumowanie aktualnej wiedzy na temat czynników biologicznych PrA (Pregnancy-Related Anxiety, Zaburzenia Lękowe Specyficzne dla Ciąży) i najczęstszych skutków, zarówno dla matki, jak i dziecka, a tym samym wskazanie najważniejszych problemów i zasugerowanie przebiegu dalszych badań w tej dziedzinie. Metody: Dokonaliśmy przeglądu literatury, korzystając z PubMed. Wyniki: Naukowcy wykazali istotny związek pomiędzy lękiem występującym w ciąży a zmianami poziomu hormonów. Te zmiany obejmują między innymi: regulację osi HPA, funkcje tarczycy, poziom oksytocyny, prolaktyny czy progesteronu. Dyskusja: Udowodniono, że PrA jest zaburzeniem wieloczynnikowym. Z jego występowaniem korelują liczne czynniki psychologiczne, jak np. niewystarczające wsparcie społeczne, nieplanowana ciąża, brak aktywności fizycznej czy wysoki poziom stresu. Pomimo iż ciąża jest znaczącą zmianą w życiu człowieka i może być bardzo stresującym wydarzeniem, założenie, że klinicznie istotny lęk prenatalny należy tłumaczyć tylko czynnikami psychologicznymi, wydaje się niewystarczające. Wnioski: Zaburzenia lękowe specyficzne dla ciąży (PrA) są powszechnym zaburzeniem zdrowia psychicznego w ciąży i potrzebne są dalsze badania, aby zminimalizować ryzyko jego poważnych konsekwencji.

Objective: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. Methods: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. Results: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. Conclusion: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

Introduction COVID-19 pandemic may contribute to mental state worsening. Mental health disorders in pregnancy are known to have adverse outcomes both for mothers and their children. It is the first study in Poland to investigate the impact of the pandemic on stress level and general mental state in pregnant women. Methods Three hundred sixteen pregnant women completed an online survey containing four instruments. The main research questions were investigated with Bayesian regression analyses. Results We found that 37% of pregnant women presented with some mental state disorders and almost 46% with elevated emotional tension. Seventeen % had elevated stress level, 11% elevated intrapsychic stress level and 13% elevated outward stress level. Both 'being scared of lack of social support...' and 'being scared of infection...' have an impact on stress level, however the first factor is a more substantial stressor. Conclusions Multiple pregnant women during the Coronavirus SARS-CoV-2 pandemic presented with mental state disorders and elevated stress levels. As mental state disorders contribute to adverse neonatal outcomes and maternal mortality, it is imperative to focus on pregnant women's psychological and psychiatric conditions during the pandemic. It seems crucial to use screening tests to make early psychiatric diagnoses.

Na nadciśnienie tętnicze choruje około 1/4 światowej populacji dorosłych. Ze względu na szerokie rozpowszechnienie, wpływ na śmiertelność i powodowane koszty socjoekonomiczne, ważne jest poszukiwanie modyfikowalnych przyczyn rozwoju tej choroby. W pracy tej został przeprowadzony przegląd piśmiennictwa w poszukiwaniu odpowiedzi na pytanie, czy w populacji dorosłych pacjentów (≥18r.ż) chorujących na nadciśnienie tętnicze częściej występuje zaburzenie lękowe z napadami lęku, niż w populacji ogólnej? W przeglądzie literatury znaleziono 10 badań przekrojowych opisujących związek pomiędzy nadciśnieniem tętniczym, a zespołem lęku panicznego. Iloraz szans współchorobowości tych dwóch jednostek chorobowych wynosił między OR = 3,31 (2,99-3,67), a AOR 1,19 (0,87–1,62). Natomiast częstość współwystępowania wahała się od 4,2%, do 18,75%. W badaniach prospektywnych wykazano zależność między zaburzeniem lękowym z napadami lęku, a następczym rozwinięciem się nadciśnienia tętniczego w ciągu życia jako OR= 1,7 (1,4–2,0). Z drugiej strony ryzyko rozwinięcia się zaburzenia lękowego z napadami lęku u badanych z nadciśnieniem tętniczym w czasie 12-miesięcznej obserwacji wynosiło OR= 3,23 (1,51–6,93), a z 3-letnim okresem obserwacji było nieistotne statystycznie OR= 1,12 (0,80–1,57). Na podstawie przeglądu literatury, ze względu na różnice w metodologii oraz małą ilość badań prospektywnych można jedynie sugerować klinicystom, by w niektórych przypadkach poszukiwali zaburzeń lękowych z napadami lęku u pacjentów z nadciśnieniem tętniczym, szczególnie przy obserwacji niekontrolowanych i krótkotrwałych wzrostów ciśnienia tętniczego.

Background Tryptophan metabolism via the kynurenine pathway is considered the link between the immune and endocrine systems. Dysregulation of serotonergic transmission can stem from the direct influence of interferon-α on the activity of serotonergic receptors 5-HT1A and 5-HT2A, and from its indirect effect on tryptophan metabolism. Induction of the kynurenine pathway increases the concentration of neurotoxic kynurenine metabolites, and the activity of kynurenine derivatives is linked to the onset of depression. The aim of our study was to evaluate the relationships between depressive symptoms and kynurenine, tryptophan, anthranilic acid and kynurenic acid concentrations, indolamine 2,3-dioxygenase (IDO) activity and tryptophan availability to the brain. Methods The study followed a prospective longitudinal cohort design. We evaluated 101 patients with chronic hepatitis C who were treated with pegylated interferon-α2a, and 40 controls who were awaiting treatment. We evaluated the relationships between total score on the Montgomery–Asberg Depression Rating Scale and kynurenine, tryptophan, anthranilic acid and kynurenic acid concentrations, IDO activity and tryptophan availability to the brain. A logistic regression model was adapted for the diagnosis of major depressive disorder at each time point, taking into account changes in parameters of the kynurenine pathway between a given time point and the baseline measurement. Results Of the treated patients, 44% fulfilled the criteria for major depressive disorder at least once during the 24 weeks of treatment. Anthranilic acid concentrations were significantly increased compared to baseline for all time points except week 2. Tryptophan availability showed a significant decrease (β = −0.09, p = 0.01) only in week 12 of treatment. Over time, kynurenine, tryptophan and anthranilic acid concentrations, as well as IDO activity and tryptophan availability to the brain, were significantly associated with total score on the Montgomery–Asberg Depression Rating Scale. A logistic regression model revealed that participants with decreased tryptophan availability to the brain at 12 weeks of treatment and participants with increased anthranilic acid concentrations at week 24 of treatment were at increased risk for diagnosis of major depressive disorder (odds ratios 2.92 and 3.59, respectively). Limitations This study had an open-label design in a population receiving naturalistic treatment. Conclusion The present study provides the first direct evidence of the role of anthranilic acid in the pathogenesis of inflammation-induced major depressive disorder during treatment for hepatitis C with pegylated interferon-α2a.

BackgroundPatients with schizophrenia reveal changes in information processing associated with external stimuli, which is reflected in the measurements of brain evoked potentials. We discuss actual knowledge on electro- (EEG) and magnetoencephalographic (MEG) changes in schizophrenia.New methodThe commonly used averaging technique entails the loss of information regarding the generation of evoked responses. We propose a methodology to describe single-trial (non-averaged) visual evoked potentials (VEP) using spectral and statistical analyses. We analysed EEG data registered in the O1-Cz and O2-Cz leads during unattended pattern-reversal stimulation, collected from a group of adult patients with chronic schizophrenia, and compared them to those of healthy individuals. Short-time single-trial VEP were transformed to the frequency domain using the FFT algorithm. Changes of the spectral power were visualized using spectrograms which were created by stacking single-trial spectra across all trials. Measures of the absolute and the relative spectral power were calculated and compared statistically.ResultsIn schizophrenia, the energy density of VEP oscillations is shifted towards higher (gamma) frequencies, compared to healthy individuals. These differences are statistically significant in all analysed frequency bands for the relative power. This indicates distorted early processing of visual stimuli in schizophrenia.Comparison with existing methodsThe main advantage of the presented methodology is its simplicity and ease of interpretation of obtained results. The presented observations complement the knowledge on gamma oscillations acquired from computationally more complex methods of time–frequency analysis.ConclusionsHigh-frequency changes for single-trial VEPs are detected in chronic schizophrenia.

The study was performed to evaluate cerebral volume changes in HCV-infected subjects before and after interferon-free therapy with direct-acting antiviral agents (DAA). We aimed also to estimate the impact of successful DAA therapy on the neuropsychological state of patients. Eleven HCV genotype 1 (GT1) patients treated with ombitasvir/paritaprevir (boosted with ritonavir) and dasabuvir, with or without ribavirin underwent brain magnetic resonance (MR) before and 24 weeks after completion of therapy. All patients achieved sustained viral response. Precise automatic parcellation was made using the fully-available software FreeSurfer 6.0. Statistically significant volume deceleration six months after treatment was found in the subcallosal cingulate gyrus, transverse frontopolar gyri and sulci, anterior segment of the circular sulcus of the insula and horizontal ramus of the anterior segment of the lateral sulcus. After DAA therapy we found statistically significant improvement in the performance of all three tasks of the Rey Complex Figure Test that permits the evaluation of different functions (attention, planning, working,memory). Additionally, significant amelioration in Percentage Conceptual Level Responses in The Wisconsin Card Sorting Test (a neurocognitive test for assessing intellectual functioning) was also discovered. Successful interferon-free therapy may lead to transient cerebral atrophy, probably by reducing neuroinflammation and oedema. This is the first pilot study of the alterations in brain volume after successful interferon-free therapy in chronic HCV patients. Longitudinal follow-up study is needed to observe further effects of therapy on cerebral structures volume changes.

Anxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure.The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals.The study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method.Mean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control).The patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.

The purpose of this study was to assess cerebral microstructural and perfusion changes in patients with chronic hepatitis C virus (HCV) infection before and after interferon-free therapy, using advanced magnetic resonance (MR) techniques. Eleven HCV-positive patients underwent diffusion tensor imaging (DTI) and perfusion-weighted imaging (PWI) using a 1.5T MR unit, before and 24 weeks after completion of interferon-free therapy. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts. PWI values of relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed from 8 areas, including basal ganglia, and cortical and white matter locations. In HCV-positive patients therapy with ombitasvir, paritaprevir boosted with ritonavir and dasabuvir, with or without ribavirin, was scheduled. Cognitive tests were used to assess cognitive function. We found increased FA values after interferon-free therapy compared to values obtained before treatment in HCV patients in almost all white matter tracts. We also observed elevated rCBV values in basal ganglia after therapy. There were significant correlations between improvement in the score of cognitive tests and increased FA values in both inferior fronto-occipital fascicles and left posterior cingulum after treatment. Liver fibrosis regression in elastography, APRI and improvement in cognitive tests were observed. This is the first report of interferon-free therapy as the cause of white matter tracts recovery as well as cerebral perfusion improvement in HCV-infected patients, indicating better functioning of frontal lobes after interferon-free treatment.

Interleukin (IL)-6 is a multifactorial cytokine known to be increased in patients with chronic hepatitis C (CHC) and to be predictive of depression incidence. The aim of the study was to explore the association between IL6 gene C-174G polymorphism and depressive symptom severity in the longitudinal study design following the course of pegylated interferon/ribavirin treatment in CHC patients. In our study, we included 62 CHC subjects. They were assessed using present state examination, Beck Depression Inventory (BDI) and Montgomery Asberg Depression Rating Scale (MADRS) at weeks 0, 3, 5, 9, 13, 24 and 24 weeks after the end of treatment. The risk of depression was associated with higher baseline MADRS score and BDI score. Interestingly, when stratified by IL6 C-174G polymorphism, higher baseline depressive symptom severity measured by MADRS and BDI predicted higher risk of depression in the course of antiviral treatment only in high IL-6 producers—G allele carriers (patients with GG and CG genotypes) (p = 0.004, p = 0.00008, respectively). There is interaction between severity of baseline depressive symptoms at the beginning of antiviral therapy and IL6 gene C-174G polymorphism leading to increased risk for the development of depressive episode in CHC patients in the course of antiviral treatment.

BACKGROUND Depressive symptoms are frequent side effects of interferon α therapy (IFN-α). Both biological and psychological processes may occur concomitantly during hepatitis C treatment. OBJECTIVES This study was carried out to determine the impact of biological (immune response) and psychological factors on formation of depressive symptoms and major depressive disorder (MDD) during hepatitis C treatment. MATERIAL AND METHODS A total of 99 patients receiving pegylated IFN-α and ribavirin for chronic C type hepatitis participated in the prospective cohort study. Symptoms of depression were assessed with the MontgomeryAsberg Depression Rating Scale (MADRS) during treatment and 24 weeks after treatment. Neuroticism was measured with the Eysenck Personality Questionnaire - Revised (EPQ-R/N). Diagnosis of MDD was made using the Present State Examination (PSE-10) and DSM-IV-TR criteria. Factor analysis was used to detect factors adding up to total severity of depressive symptoms. Predictors of MDD were investigated using logistic regression analysis. RESULTS Factor analysis returned 3 factors: 1st - MADRS scores at weeks 0-12, 2nd - MADRS and N scores before treatment, 3rd - MADRS at the 24th week of treatment and 24 weeks after treatment. The total severity of depressive symptoms consisted of 3 components: personality-related before treatment, IFN-α-related during treatment and dependent on the effect of treatment. Regression analysis showed that a history of psychiatric disorders (OR = 4.8) and MADRS scores before treatment (OR = 1.25) were predictors of MDD, as opposed to level of neuroticism. CONCLUSIONS The severity of depressive symptoms and MDD during the hepatitis C treatment was related to general depressive vulnerability, not to psychological factors related to neuroticism.

Introduction: The aim of this study was to investigate brain bioelectrical activity disturbances in HCV-positive patients before and 24 weeks after interferon-free therapy (DAA), using visual (VEP) and brainstem (BAEP) evoked potentials and advanced magnetic resonance techniques. Materials and methods: 11 HCV-infected patients (6 women, 5 men, mean age 51 years old) and 30 healthy controls, sex and age-matched, were studied. Clinical neurological examinations, VEP, BAEP, diffusion tensor imaging (DTI) and perfusion weighted imaging (PWI) were performed. Results: 11 patients achieved a sustained viral response, and liver fibrosis regression in APRI and in elastography were observed. The mean P100 latency was significantly shorter in HCV-patients after therapy compared to the values before treatment (p

Purpose: The aim of this volumetric study was to evaluate the relationship between brain atrophy quantification in multiple sclerosis (MS) patients and the progression of disability measured by neurological standardised tests. Material and methods: Seventeen patients (mean age 40.89 years) with clinically definite MS and 24 control subjects (mean age 38.45 years) were enrolled in the study. Brain examinations were performed on a 1.5T MR scanner. Automatic brain segmentation was done using FreeSurfer. Neurological disability was assessed in all patients in baseline and after a median follow-up of two years, using EDSS score evaluation. Results: In MS patients we found significantly (p < 0.05) higher atrophy rates in many brain areas compared with the control group. The white matter did not show any significant rate of volume loss in MS patients compared to healthy controls. Significant changes were found only in grey matter volume in MS subjects. At the follow-up evaluation after two years MS patients with deterioration in disability revealed significantly decreased cerebral volume in 14 grey matter areas at baseline magnetic resonance imaging (MRI) compared to MS subjects without disability progression. Conclusions: Grey matter atrophy is associated with the degree of disability in MS patients. Our results suggest that morphometric measurements of brain volume could be a promising non-invasive biomarker in assessing the volumetric changes in MS patients as related to disability progression in the course of the disease.

Objective The aim of the study was the prospective assessment of changes in depressive symptoms in relation to neuroticism and extraversion in a sample of patients with anxiety and personality disorders who underwent short-term psychodynamic psychotherapy (STPP). Method 139 people were recruited; 110 of them participated in follow-up measurements. Depressive symptoms (DS) were evaluated with the Symptoms Check List – Revised (SCL-90-R) and Present State Examination (PSE) as a part of Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.0). Personality profiles (neuroticism and extraversion) were assessed with the Polish version of the Eysenck Personality Questionnaire (EPQ). Measurements were performed in the following sequence: (1) prior to the treatment, (2) after 12 weeks of therapy, (3) 6 months after being discharged from the ward, and (4) 12 months after being discharged from the ward. Results Depressive (DS) and anxiety symptoms (AS) decreased at the subsequent 150 measurement points. DS measured by SCL-90-R related to EPQ traits of neuroticism and minimally to extraversion at the beginning of STPP. AS was also related to neuroticism and moderately to the psychoticism level. Somatization symptoms were not related to any of the EPQ traits. Conclusions 1. DS and AS, both in clinician-researcher and self-assessment, decreased during follow-up. 2. DS were interrelated to neuroticism and anxiety to psychoticism, which may hint at partly different connections between depression, anxiety and personality traits. 3. The intensity of somatization symptoms was not related to personality traits, indicating that somatization constitutes a separate psychopathological dimension, coexisting with anxiety and depression.

Background Risk of depression and suicide in patients on interferon remains also after the treatment, the pathogenesis of which is still unclear. We aimed to determine the influence of the PEG-IFN-α2a on tryptophan metabolism along the kynurenine pathway during treatment and up to 6 months after the end of treatment. Methods We evaluated 101 patients with chronic hepatitis C treated with PEG-IFN-α2a, and 40 controls, so as to determine the activation of indolamine 2,3-dioxygenase (IDO) and tryptophan (TRP) and their metabolites’ concentrations/levels: kynurenine (KYN), kynurenic acid (KYNA) and anthranilic acid (AA). The subjects were evaluated before and after weeks 2, 4, 8, 12, 24, 48, as well as 6 months after the end of the treatment. Results In the group of patients treated 24 weeks, six months after the end of treatment IDO activity was significantly higher compared to baseline (69.5 vs 57.2 β = 0.21 P = 0.000); TRP concentration was significantly lower compared to baseline (30.0 vs 35.6 β=-0.21 P = 0.001); KYNA concentration was significantly higher compared to baseline (37.2 nmol/L vs 29.4 nmol/L β = 0.22 P = 0.02), and AA concentration was significantly higher compered to baseline (51.0 nmol/L vs 38.4 nmol/L β = 0.22 P = 0.05) In the group of patients treated 48 weeks six months, after the end of treatment both the IDO activity and KYNA concentration were significantly higher compared to baseline (respective values – IDO: 78.8 vs 56.2 β = 0.14 P = 0.02; KYNA: 39.2 nmol/L vs 27.0 nmol/L β = 0.26 P = 0.000). Conclusions This is the first report of a prolonged activation of IDO six months after the end of PEG-IFN-α2a treatment. The clinical significance of the finding can be implicated in the pathophysiology of depressive episodes.

INTRODUCTION Hepatitis C virus (HCV) is the major cause of chronic liver disease in patients with hemophilia. However, since liver biopsy should not be routinely used in these patients, the accurate assessment of the stage of fibrosis has been limited so far. OBJECTIVES The aim of this study was to determine the stage of liver fibrosis in HCV‑infected patients with hemophilia by using noninvasive methods of fibrosis assessment, and to analyze the influence of risk factors on liver fibrosis. PATIENTS AND METHODS The study included 71 HCV‑infected patients with hemophilia and other congenital bleeding disorders. Patients were divided into 3 groups: HCV-RNA negative after successful treatment, HCV-RNA negative after spontaneous elimination of infection, and HCV‑RNA positive. Liver fibrosis was measured with shear wave elastography and FibroTest. The risk factors for liver fibrosis were analyzed, including demographic factors, HCV genotype, coinfections, and comorbidities. RESULTS Cirrhosis or significant fibrosis (METAVIR score >F2) was observed in 26.8% of the patients. The stage of fibrosis was associated with age and estimated duration of infection (P

Background Hepatitis C virus (HCV) infection is commonly associated with cognitive dysfunction and depression, which could be related to direct brain infection. Viral sequences and proteins were found in brain macrophage/microglia cells and these cells were reported to be activated. Since blood leukocytes cross blood–brain barrier, activation state of peripheral blood mononuclear cells (PBMC) could reflect the state of brain immune cells. Objective The aim of the study was to determine whether depression and neuroticism in chronic HCV infection correlates with the expression of key cytokines and chemokines in PBMC. Design We studied 24 HCV-positive patients undergoing treatment with interferon and ribavirin. Patients were tested for depression using Beck Depression Inventory (BDI) and Montgomery Asberg Depression Rating Scale (MADRS), while neuroticism was assessed by the Revised Eysenck Personality Inventory (N/EPO-R). Transcripts representing 28 various cytokines and chemokines were measured by real-time quantitative PCR in PBMC. Results Prior to therapy BDI and MADRS positively correlated with viral load while neuroticism correlated with IL-3, IL-8 and M-CSF transcription levels. Six months after therapy there was positive correlation between depression and/or neuroticism scores and the levels of proinflammatory cytokines TNF-α and IL-12 transcripts, as well as IL-8, IL-10, IL-16, MCP-1, MCP-2, MIP-1-alpha, MIP-1-beta, and TGF-beta, and IFN-β transcripts. Conclusion Activation of PBMC, as measured by the level of cytokine and chemokine transcripts, correlates with depression and neuroticism scores. These findings suggest a pivotal role of immune cells activation in depression and possibly neurocognitive dysfunction among chronic hepatitis C patients.

The aim of the study was to evaluate early metabolic perfusion, and microstructural cerebral changes in patients with the hepatitis C virus (HCV) infection and normal appearing brain on plain MR using advanced MR techniques, as well as to assess correlations of MR measurements with the liver histology activity index (HAI).Fifteen HCV-positive patients and 18 control subjects underwent single voxel MR spectroscopy (MRS), perfusion weighted imaging (PWI), and diffusion tensor imaging (DTI), using a 1.5T MR unit. MRS metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr) were calculated. PWI values of relative cerebral blood volume (rCBV) were assessed from 8 areas including several cortical locations, basal ganglia, and fronto-parietal white matter. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts.Compared to controls, HCV-positive patients showed significantly (p0.05) lower NAA/Cr ratios within frontal and parietal white matters, lower rCBV values within frontal and temporo-parietal cortices, decreased FA values, as well as increased ADC values in several white matter tracts. We also found elevated rCBV values in basal ganglia regions. The increase in mI/Cr and Cho/Cr ratio was correlated with a higher HAI score.The results of advanced MR techniques indicate neurotoxicity of HCV reflected by neuronal impairment within white matter, cortical hypoperfusion, and disintegrity within several white matter tracts. Hyperperfusion in basal ganglia may be an indicator of brain inflammation in HCV patients. Our findings may suggest a biologic link between HCV-related liver disease and cerebral dysfunction.

Parameters of body surface potential mapping (BSPM) in DM II patients are significantly different comparing with healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM II patients with depression was tested in the present study. For this purpose, analysis of the relationship between the Int-QRST (isointegral) maps distribution and the depressive symptoms intensification, as well interrelation between depressive and diabetic symptoms were performed.BSPM registrations were obtained from the three study groups (aged 37-52 years), namely 40 diabetic patients with clinically documented depression, 30 depressive patient without DM and 90 normal subjects. BSPM recordings were displayed in a form of the Int-QRST maps. Examination with BDI and HbA1c test were also performed in all investigated subjects.Isointegral QRST maps turned out to display abnormal, i.e. non-dipolar distribution. Moreover, extent of Int-QRST maps multipolarity increased in the examined diabetic patients along with DM II duration, BDI scores and HbA1c level.Non-dipolar distribution of Int-QRST maps, more pronounced in diabetic patients with depression, can be a specific indicator of the increased risk of severe ventricular arrhythmias occurring prior to abnormalities detectable on the standard 12-lead ECG recordings, which is of great importance especially in prevention of life-threatening arrhythmias.

INTRODUCTION Chronic kidney disease (CKD) is one of the consequences of human immunodeficiency virus-1 (HIV-1) infection. The disease increases the risk of progression to acquired immunodeficiency syndrome and death and complicates antiretroviral therapy. The prevalence of CKD in HIV-1-infected patients is difficult to estimate and depends on the diagnostic criteria for CKD. OBJECTIVES The aim of the study was to evaluate the usefulness of a single measurement of serum asymmetric dimethylarginine (ADMA) levels in the diagnosis of kidney damage in patients infected with HIV-1. PATIENTS AND METHODS The study included 119 HIV-1-infected individuals (88 males [74%]), both on antiretroviral treatment and treatment-naive, with a negative history of kidney disease, and 31 healthy volunteers. We analyzed demographic characteristics as well as data on concomitant diseases, antiretroviral regimen, serum ADMA concentrations, parameters of renal function, CD4+ cell count, and HIV-1 viral load. RESULTS No significant impairment of renal function was observed. Mean serum ADMA levels in all HIV-1-infected patients, as well as in treatment-naive patients and treated patients, were significantly higher (P

Background The prevalence of HCV infection in people with hemophilia is substantially higher than that in the general population (63% - 98%). Multiple transfusions and substitutive therapy have also been linked to a high risk of HBV and HIV transmission. However, the prevalence of other blood-borne viral infections in this population is less well known. Objectives This study aimed to assess the prevalence of co-infection with HBV and other blood-borne viruses in Polish HCV-infected hemophiliacs. Methods Seventy-one individuals, the majority of whom were male (94.36%), who had congenital bleeding disorders (60 had hemophilia A, five had hemophilia B, and six had other factor deficiencies) and HCV infection, which was defined as the presence of positive anti-HCV antibodies, were included in this study. The study group was divided into two subgroups according to the year in which blood donors were first tested for HBsAg in Poland. The serological markers were screened using commercially available enzyme immunoassays according to the manufacturer's instructions. The molecular tests were performed using real-time PCR technology with commercial assays according to the manufacturer's instructions. Results The spontaneous elimination rate of HCV RNA was 29.6%. The HCV genotype 1 was detected in 28 patients (65.1%), genotype 2 in one patient (2.3%), genotype 3 in 11 patients (25.6%), genotype 4 in two patients (4.7%), and a mixed infection with genotypes 1 and 4 was detected in one person (2.3%). Fifty-three patients (74.6%) were anti-HBc positive. Among the seven HBsAg(+) patients, three individuals were HBV-DNA positive. No occult hepatitis B was detected. In six HBsAg positive patients, the HCV RNA was positive, while one patient was also infected with HIV. The prevalence rate of past infection with HAV in the study group was 30.9%, with a tendency for a higher prevalence in older patients. The prevalence of CMV and EBV infection was high and similar to that seen in the general population. All the patients were HGV and HTLV-1 negative. Conclusions The diagnostics and management of infections with hepatotropic viruses, particularly HBV, are neglected in hemophilic patients. All patients with coagulation disorders and a history of exposure to non-inactivated blood products should be screened for blood-borne infections. The prevalence of other potentially blood-borne viral infections exhibited a pattern similar to that observed in the general population.

BACKGROUND AND PURPOSE: Asymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data. MATERIALS AND METHODS: Fifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed. RESULTS: Significantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p

Objective. The aim of our study was to observe the outcome of MADD in comparison with depressive (DD) and anxiety (AD) disorders. Method. Patients treated with 12 weeks of group psychodynamic psychotherapy in a psychiatric day care ward were examined using SCAN 2.1 at admission and 1 year after admission. Treatment was indicated on the basis of diagnosis of ICD-10 - F4-F6. A total of 139 patients were included, 110 (79.1%) of whom were examined at the follow-up point. Results. The prevalence of MADD increased from 22.7% at the baseline to 33.6% at the end. The outcome of MADD was statistically different from the outcome of DD (χ(2)=18.4, P=0.0025), but not different from the outcome of comorbid DD and AD (χ(2)=1.8, P=0.84), nor generalized anxiety disorder (χ(2)=8.1, P=0.15), nor other AD (χ(2)=5.3, P=0.38). Conclusion. MADD is a useful diagnosis of a transitional or residual form of comorbid DD and AD in some specific population groups. A diagnosis of personality disorder can sustain long-term diagnosis of MADD.

Introduction Hepatitis C virus (HCV) is a primarily hepatotropic virus, but hepatocytes are not the only localization of its replication. It is still unclear if extrahepatic HCV replication, measured as the detection of HCV RNA negative strand in peripheral blood mononuclear cells (PBMCs) before initiation of treatment, has an influence on therapy response. Detection of HCV RNA in extrahepatic sites for assessment of therapy efficacy is not routinely used in clinical practice. The aim of the study was to evaluate whether the replication of HCV in PBMCs affects the rate of sustained virological response (SVR). Materials and methods The study group comprised 55 patients with chronic hepatitis C, originally treatment naive. They were treated with pegylated interferon (PEG-IFN) alpha 2a and ribavirin, with the standard dosing schedule. Parallel serum samples for HCV RNA and PBMC samples for HCV RNA negative strand were obtained at baseline, at the end of treatment and 24 weeks after finishing therapy. Results Undetectable HCV RNA in serum at the end of therapy was found in 48 patients (87.3%), while 33 patients (60.0%) achieved sustained virological response (SVR) (51% for HCV genotype 1 and 78% for genotype 3, respectively). Fifteen individuals (31.3%) were relapsers. Factors associated with significantly higher rate of SVR were young age, mild or no fibrosis and infection with HCV genotype 3. HCV RNA negative strand in PBMCs before treatment was found in 21.8% (12 out of 55 patients). HCV RNA negative strand was detected at baseline more frequently in patients who later achieved SVR. Relapse appeared significantly more often in patients with negative strand at the end of therapy: in 2 out of 15 individuals compared to 0 out of 33 patients (p=0.03). Conclusions Presence of negative HCV RNA strand in PBMCs before treatment may be suggested as a potential marker of good treatment response. Detection of negative strand at the end of therapy is a predictor of relapse.

At the beginning of the XXIst century the Internet became one of the most important sources of information. Medicine and health are the main topics of discussion on numerous forums and portals. Authors of the following article took the trouble to investigate Polish forums concerning Lyme disease. A typical Googlesearch of the Polish Internet reveals 77 forums with boreliosis threads. The largest (ca. 700 threads) and mostly quoted (26/77, which states for 34% all forums contained references to it) of all the forums is entitled 'borelioza' and it is hosted by Gazeta.pl (http:// forum.gazeta.pl/forum/71,1.html?f = 26140). It was founded and it is still run by the Boreliosis Patients Association. The Association disseminates ideas of ILADS, which presents boreliosis as a chronic, serious disease and also supports diagnostic and treating recommendations, contradictory to the standards of renowned medical authorities. People searching the Internet for the information on boreliosis are very likely to come across the webpages referring to the forum of the Association. As a result they might encounter faulty recommendations of ILADS. Members of the Association induce one another with hypochondriac fantasies of a disease, sometimes exceeding the limits of a delusion. The Association promotes faulty convictions about the internal "enemy"--boreliosis, incompetent and unfeeling doctors protecting it, and propose to unite in common defence. Such actions are a perfect encouragement for all somatization prone patients to undertake activities destructive to their health. It also leads to irrational social behaviour, which can be described as an induced hypochondria.The Internet has become a source of many unreliable information on boreliosis, which may potentially impose a serious threat to patients' health. While counselling the patients who affiliate their chronic symptoms with boreliosis, do not forget the possibility of induced anxiety disorder, hypochondria, or a propagated distrust to the doctors and pay more attention to the patients.

Background and Objectives: An interaction between neuroticism and burden of illness supports depressive symptoms even at subclinical level. We have assessed its effect in groups of patients with different kind of somatic illness. Methods: Depressive symptoms (SCAN 2.1) and a level of neuroticism (EPQ-R) were assessed in inpatients from 3 different hospital wards, namely the general internal, hematological and infectious wards, and in controls from the general population. Results: A total of 184 adult subjects were examined (45 with haematological malignancies, 46 treated for other, non-malignant internal diseases, 48 with HCV infection before treatment and 45 healthy persons as control). Differences in mean neuroticism scores were not statistically significant (ANOVA, F = 1.44, p = 0.23) whereas differences in mean depression scores were statistically significant (ANOVA, F = 6.34, p < 0.001). Results of ANCOVA for separate-slopes model analysis revealed a statistically significant level of interaction between groups and neuroticism in their influence on depression mean scores (F = 22.9, p < 0.001). The residual effect of the group variable was weak (F = 0.54, p = 0.21). Conclusions: The interaction is a significant factor related to depressive symptoms and can be used in estimating the extent of the psychological impact of a burden of illness.

The General Health Questionnaire (GHQ) was designed by Goldberg in the 1970's as a screening instrument to provide information on the mental wellbeing. Although it is widely used as a unidimensional instrument, factor analyses tend to suggest that it contains more than one dimension.The purpose of this paper is to review the factor-analytic research that has been carried out with regard to the 30-item General Health Questionnaire (GHQ-30) and to present the results of the analysis of our research.A total of 623 patients suffering from neurotic disorders and somatic illnesses were included into the study, 130 men and 493 women at the age ranged from 17 to 85 years old. A total score was calculated with Likert's method. The principal factor analysis with orthogonal varimax normalised rotation was used. Results. The GHQ-30 was found to have high internal consistency as a scale and high item-total correlations for most of the items. The factorial analysis showed that three factors labelled as the followed can be abstracted from the scale: depression and anxiety, interpersonal relations, general functioning. These factors jointly account for 58% of the variance.Results showed both multifactorial (at the level of a lower order) and unifactorial (at the level of an upper order) structure of the GHQ-30.

The most important factors in the pathogenesis of cognitive disorders in diabetes mellitus (DM) are metabolic changes directly caused by hyperglycemia. Impairment of cognitive function is accompanied by a decrease in cerebral insulin. Insulin improves cognitive processes, including somatosensoric cognitive functions. Cognitive disorders are especially pronounced if diabetic patients suffer also from depression.The evaluation of cognitive functions, especially sensomotoric skills were obtained from three study groups (aged 37-52 years): 30 healthy subjects, 40 diabetic patients with clinically documented depression and 30 depressive patients without DM. The sensomotoric skills were carried out using a SPS-2001E apparatus - a computer working stress simulator. The examination with Beck Depression Inventory (BDI) were also performed in all the investigated persons.Sensomotoric skills investigation revealed slight cognitive disorders in the early stages DM (subgroup IA) and its intensification according to increasing BDI scores and HbA1c blood concentration (from subgroup IA to IC). Intensification of sensomotoric cognitive disorders was significantly higher (p0.001) in the depressive patients with DM (group I), than in these without DM (group III).The obtained results suggest that coincidence of aggravating factors, such as depression and metabolic disorders in DM, may cause mutual interactions leading to premature and more intense cognitive impairment. The method proposed by the authors may serve as a screening examination in early diagnosis of CNS disorders reflected by somatosensoric cognitive disorders. The presented work indicates importance of sensomotoric skills investigation for the early diagnosis of the nervous system damage related to DM.

The aim of this research is to present the severity of the generalized anxiety disorder (GAD) symptoms and its correlation with neuroticism among patients suffering from somatic diseases.184 subjects participated in the study: 45 inpatients undergoing haematological treatment (group 1), 46 inpatients from the internal ward (group 2), 48 patients infected with HCV prior to treatment (group 3) and 45 healthy persons from the control group (group 4). The patients' level of generalized anxiety was measured by means of the Present State Examination Questionnaire (PSE), whereas the level of neuroticism was measured by means of Eysenck's Personality Questionnaire (EPQ-R).The GAD was found to affect more patients with somatic diseases than people from the control group (group 1: 11%, 2: 8.7%, 3: 8.7% and 4: 6.7%). 14 out of 16 persons with GAD had the neuroticism value above median. Median scores of neuroticism were similar in all groups except for the control group in which the median value was slightly lower. The correlation between the level of neuroticism and the increase of generalized anxiety symptoms did not depend on the gravity of the somatic diseases. The value of correlation was found to be the highest among patients infected with HCV (0.73) and lower in the remaining two groups (0.54 and 0.58). The increase of generalized anxiety symptoms was proportional to the level of neuroticism, the regression line slope depended on subjective evaluation of gravity of the diseases. The regression line slope was found to be the highest amongst haematologically treated patients (1.54), smaller among patients from the general practice ward (0.84) and those infected with HCV (1.04), and the smallest among patients from the control group (0.15).Patients suffering from internal illnesses are much more vulnerable to GAD and have a higher level of GAD symptoms, especially ones with an elevated level of neuroticism. The regression line slope between GAD scores and neuroticism scores can be understood as an indicator of psychological stress.

The present study was undertaken in order to verify the hypothesis stating that patients with depression exhibit some abnormalities concerning a cerebral symmetry. For this purpose, an analysis of the relationship between the VEPs (Visual Evoked Potentials) results and the depressive symptoms intensification, as well interrelation between depressive and diabetic symptoms were performed.VEPs recordings were obtained from the two study groups (both aged 20-45 years), 20 healthy subjects and 32 diabetic patients with clinically documented depression. The VEPs examination was carried out using a computer system called STELLA (Stimulated Electroencephalogram on Line Analyzer).VEPs examinations revealed a cerebral symmetry in the all control subjects and in 10 out of 32 diabetic patients with depressive disorders. It is noteworthy that 22 of 32 diabetic patients (68.8%) showed a hemispheric asymmetry in the VEPs recordings. Of 12 patients with a moderate depression, 10 showed the left cerebral laterality, and 2--the right laterality. In turn, all 10 patients with major depressive disorder (MDD) demonstrated in the VEPs recordings a significant cerebral laterality with the right hemisphere dominance.The obtained results suggest that interhemispheric cerebral asymmetry might be considered a specific feature of depression, and, if this is a case, it could justify a conclusion that right hemisphere dominance could be a neurophysiological marker of MDD. It should be emphasized that intensification of the depressive symptoms has an unfavorable influence on course of diabetes mellitus, its self-control and severity of following complications.

analysis of data characterizing HCV infection in patients infected with HIV.37 persons (29 male and 8 female) aged 23-49 years (mediana 34), with HIV/HCV coinfection, treated (n=25) and untreated (n=12) with antiretroviral therapy. HAART was effective in treated patients; CD4+ count350 cells/microl. Viral load of HIV and HCV, HCV genotypes, CD4/CD8, biochemical tests, histopathological examination were measured. Results were analyzed statistically.the majority of patients were former IVDUs (n=31.84%), 3 persons (8%)--MSM, 3 (8%)--route of infection unknown. Duration of HCV infection 1-10 years, mediana 5. All patients were in A1 or A2 stage of HIV infection. Among patients treated with HAART (n=25) mediana of CD4+ count before treatment was 263 (69-595) cells/micro, mediana of HIV viral load 75000 copies/ml (n=7); 2040-263414 copies/ml. 17 patients were currently treated with PI, 17 with NNRTI, and 2 patients with NRTI only. HCV genotype was determined in 32 patients: 3a--n=19 (59%), 1--n= 9 (28%) 4--n=4 (13%). HCV viral load: 2.4 x 10(5)-7.73 x 10(6) IU/ml, mediana 1.6 x 10(6). Levels of ALT: 21-358 IU/ml, mediana 102, AST: 20-195 IU/ml, mediana 62, GGTP--9-463 IU/ml, mediana 58. ALT level was significantly higher in HCV genotype 3a infection (p=0.0214). Fibrosis stage above 2 was revealed in 3 patients and in majority (62%) was below 2. None patient had liver cirrhosis. Fibrosis was significantly higher in patients with low CD4+ nadir (p=0.03).Progression of liver fibrosis is slow in patients coinfected with HIV/HCV with high CD4+ count. High percentage of HCV genotype 3 and mild fibrosis are good prognostic factors for effectiveness of HCV infection treatment in HIV infected persons.

Delusions are amongst the main symptoms of schizophrenia. Delusional states may be caused by stress, somatic illness, or may be idiopathic, such as the persistent delusional disorder. Determination of a cause is usually difficult, but it is really important for the treatment. A case report of acute delusional disorder complicated by dissociative symptoms, suggesting an organic cause of the disorder is presented. Delirium caused by neuroleptic intoxication was an additional complication. Detailed informations gathered from relatives and psychological examinations made it possible to determine personality disorder as a ground, and stress as a precipitating factor of acute delusional disorder. Hospitalisation and psychological support helped in getting rid of the psychotic symptoms.

Neuropsychiatric symptoms are commonly related to interferon alpha treatment. The paper summarises the current knowledge about their aetiology, course, and treatment. Interferon alpha is a cytokine with antiviral and antineoplasmatic activity. It is commonly used in the treatment of chronic hepatitis C and B, malignant melanoma, Kaposi sarcoma, renal cancers, and some haematological malignancies. Treatment with interferon alpha is associated with depressive symptoms, cognitive disturbances, chronic fatigue syndrome, dysphoria, anxiety symptoms, anorexia, mania and psychotic states. Up to a half of the patients need psychiatric consultations, 10-25% of them need psychiatric treatment. Neuropsychiatric symptoms are the results of direct affection of CNS by interferon and induced cytokines. They increase hypothalamic-pituitary-adrenal (HPA) activity, alter thyroid function and lead to a behavioural syndrome called 'sickness behaviour'. Moreover interferon induces the activity of 2, 3 indoloamine dioxygenase, the enzyme which converts tryptophan into kynurenine, leads to a reduced level of tryptophan, and thus to a reduced level of central serotonin and to an increased level of neurotoxic kynurenine metabolites. Interferon also affects central opioid receptors and changes dopaminergic and noradrenergic neurotransmission. Serotonin selective reuptake inhibitors (SSRI), other antidepressants i.e. nortriptyline, benzodiazepines, naltrexone, and neuroleptics (for maniac and psychotic states) are used to treat interferon associated psychiatric symptoms. Psychological therapy may also be useful, as well as psychoeducation and behavioural interventions.

Interferon alpha, used in hepatitis C virus (HCV) infection causes many neuropsychiatric side effects: emotional disturbances, chronic fatigue, cognitive impairment, and psychotic states. They overlap with emotional disturbances and cognitive impairment caused by chronic HCV infection.To assess prevalence and severity of depressive symptoms in patients treated with interferon alpha due to HCV infection.A total of 44 persons (27 men, 17 women) aged from 21 to 61 years old (median 45 years) treated due to chronic hepatitis were examined. They were treated with pegylated interferon alfa 2a and ribavirin. All of them underwent liver biopsy to assess liver inflammation, fibrosis, and steatosis as well as completed Eysenck's neuroticism questionnaire. Then, before treatment and after 12 weeks, they underwent biochemical and psychiatric examination. Biochemical examination included aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (G-GT), and HCV RNA. Psychiatric examination included Beck Depression Inventory (BDI), Hamilton Depressive Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS), and the SF-36 questionnaire. Diagnoses of depression were made basing on PSE questionnaire from Schedules of Clinical Assessment in Neuropsychiatry (SCAN version 2.0).Depressive disorders were diagnosed in 3 (6.8%) subjects before treatment and in 5 (11.4%) subjects after 12 weeks of treatment. A statistically significant increase of depressive rates was observed (medians: HDRS 6/11.5; MADRS 4/10; BDI 8/10.5). Quality of life dropped significantly in some SF - 36 scales: physical functioning, general health, vitality, and social functioning. Depressive ratings were independent of biochemical parameters (AST, ALT, G-GT), HCV RNA, liver inflammation, fibrosis, steatosis level, and HCV genotype. Ratings of neuroticism highly influenced all depressive ratings. Rise of depressive ratings was independent of neither any initial biochemical parameters nor the neuroticism level.Interferon alpha increases the severity of depressive symptoms. The rise is probably caused by biological activity of interferon and independent of initial ratings of depression.

Data on the serum level of advanced glycation end products (AGEs) in Alzheimer’s disease (AD) patients are scarce, although a specific biochemical marker easy to detect in body fluids is desired for an early diagnosis of disease and to monitor the effects of therapeutic treatment. In the current study, the content of AGEs was examined with an immunochemical assay in the sera of AD patients, in the frame of a search for a biochemical marker of disease. Subjects with AD and vascular dementia (VaD) were included in the study (n = 30; age range, 68-70 years). The results were compared to the healthy control groups. The enzyme-linked immunosorbent assay (ELISA) inhibition test for the determination of AGEs is based on a rabbit anti-AGE, affinity-purified antibody and a model AGE-myoglobin antigen, in which a serum sample treated with proteinase K is used as an inhibitor. For the measurement of immune complexes and anti-AGE antibodies, the corresponding ELISA tests have been applied. The AGE level in the VaD group (49.5 UAGE) was higher than in AD patients (46.1 UAGE). The level of total AGEs in the sera of AD patients was significantly lower than in the control group (50/51.6 UAGE). These relations were not observed with regard to the immune complexes and anti-AGE antibody levels in AD (70.2 UIC/0.027 UIgG) and VaD (83 UIC/0.034 UIgG) patients because the levels of these parameters were similar to the controls (76.2 UIC/0.042 UIgG). The work revealed the lower level of circulating serum AGEs in patients with AD in relation to healthy controls.

The aim of the study was to define the correlation between anxiety/depressive symptoms, distress and functioning.The research is based on the analysis of 104 persons (65 women, 39 men), who were patients of psychiatrists (42 persons), or general physician attenders (62 persons) complaining of anxiety or depressive symptoms. Distress was estimated with the General Health Questionnaire (GHQ-30), psychopathological symptoms and diagnoses were evaluated with the Present State Examination (PSE) and the level of functioning with Global Assessment of Functioning (GAF). The intensity of ICD-10 symptoms was calculated for: generalized anxiety disorder, agoraphobia, social phobia, panic disorder, depressive disorder and dysthymia.The lowest score of distress was found in the group with sub-clinical, sole anxiety or depressive symptoms. An intermediate level was present in the group with anxiety and mixed anxiety-depressive disorders, and the highest in the group with depression. The functioning scores were in an inverse order.The differences in scores of distress and functioning between groups of patients with anxiety disorders, mixed anxiety-depressive disorders and depression are dependent on the intensity of depressive symptoms and are independent of the intensity of anxiety symptoms.

The aim of the present study was to evaluate the validity of mixed anxiety and depressive disorder (MADD) with reference to functional characteristics and symptomatic characteristics in comparison with anxiety disorders, depressive disorders, and groups showing subthreshold symptoms (exclusively depressive or anxiety related). The present study was carried out in the following three medical settings: two psychiatric and one primary care. Patients seeking care in psychiatric institutions due to anxiety and depressive symptoms and attending primary medical settings for any reason were taken into account. A total of 104 patients (65 women and 39 men, mean age 41.1 years) were given a General Health Questionnaire (GHQ-30), Global Assessment of Functioning (GAF) and Present State Examination questionnaire, a part of Schedules for Clinical Assessment in Neuropsychiatry, Version 2.0. There were no statistically relevant differences between MADD and anxiety disorders in median GHQ score (19 vs 16) and median GAF score (median 68.5 vs 65). When considering depressive disorders the median GHQ score (28) was higher, and median GAF score (59) was lower than that in MADD. In groups with separated subthreshold anxiety or depressive symptoms, median GHQ scores (12) were lower and median GAF scores (75) were higher than that in MADD. The most frequent symptoms of MADD are symptoms of generalized anxiety disorder (GAD) and depression. Mixed anxiety and depressive disorder differs significantly from GAD only in higher rates of depressed mood and lower rates of somatic anxiety symptoms. Distinction from depression was clearer; six of 10 depressive symptoms are more minor in severity in MADD than in the case of depression. Distress and interference with personal functions in MADD are similar to that of other anxiety disorders. A pattern of MADD symptoms locates this disorder between depression and GAD.

Neuropsychiatric symptoms are commonly associated with chronic hepatitis C virus infection and its treatment. There are no Polish studies concerned this problem in patients during combination therapy (interferon and ribavirin).to examine the mood disorders an quality of life during the first 12 weeks of therapy.The following research instruments were used: the Present State Examination (PSE), The Beck Depression Inventory, The Montgomery Asberg Depression Rating Scale, SF-36, Hamilton Depression Rating Scale. ALT, AST, GGT activity, HCV viral load and genotype, histological activity index of the liver was also measured.A group of 94 untreated patients (M=, K=) with hepatitis C was examined. 44 of them was examined secondly after 12 week of combination therapy. Depression disorders was observed in 4% pts before treatment and in 11% after 12 weeks therapy. In the group untreated patients there was two statistically significant correlations: between examined neuropsychiatric disorders and HCV viral load and necroinflammatory activity in the liver.The mood disorders are not so common in the patients with hepatitis C and could have biological etiology. The interferon based therapy increase the frequency and intensity of them.

The development of science allows us to take up new investigative challenges. Interpretations of results can be difficult if there is no adequate and complete information about investigative methods applied, course of trial and statistical analyses. The CONSORT group proposed a standardized diagram facilitating an accurate presentation of the randomised trial. The EDEN study is an example of the application of this method, where the studied groups, number of participants, and all procedures can be presented. It is helpful to prepare reports and find necessary data. The first part of the diagram describes the course of recruitment, the second part presents data necessary to estimate the course of the study and data about numbers of patients in each timepoint whilst the third part shows the assessment of caregivers.The analysis of the course and correctness of the study is legible if the flow diagram is used. It is useful to find the necessary data for statistical analyses at every stage of study. Permanent control of the study allow to avoid bias upsetting the course of the study and influencing its quality. It introduces comprehensible and straight forward presentation of the results.

Haematological treatment is associated with excessive distress due to side effects of cytostatics and due to severe life consequences of the illness. It could be a cause of anxiety or depressive states in vulnerable persons.The purpose of the study was to assess prevalence of depression, anxiety disorders, and distress among patients treated due to haematologic malignancies.45 patients with leukaemia or lymphoma, 29 treated due to other internal diseases and 28 healthy persons were assessed. The following research instruments were used: the Present State Examination (PSE), the General Health Questionnaire (GHQ-30), criteria scales (ICD-10) for depression and anxiety.Depression was diagnosed in 29% of the patients with hematological illnesses and in 11% of patients with other internal illnesses. Prevalence of GAD was appropriately 11% and 9%. Generally, psychiatric disorders were present in a half of the patients in every group. About 1/4 th of the haematologic patients had much more severe depressive symptoms than others.The groups of patients have much higher, depressive and distress scores than controls. Psychiatric or psychotherapeutic treatment could be considered as part of the treatment of malignant haematologic cancers.

The aim of this study was to analyse the treatment methods at the different stages of the pathway to psychiatric care.In a period of two months all patients age 15 and over who applied to the Psychiatric Service in the Zabkowice catchment area and Psie-Pole catchment area were assessed by psychiatrists for their eligibility to enter the study. Those who had fulfilled the entry criteria were interviewed using a Polish version of WHO's encounter form (EF) by the mental health professionals during their initial interview.A total of 228 patients (105 men and 123 women) were seen. Encounter forms were completed on 200 people. 28 patients refused to answer some of the questions. There were significant differences in treatments offered to patients by hospital doctors and medical specialists, general practitioners (GP's) and psychiatrists. Our data show that sedative/hypnotics are the main psychotropic drugs prescribed by GP's. The small percentage of antidepressant (10% of all psychotropic drugs) used by GP's and medical specialists was noteworthy. They didn't decide to prescribe neuroleptics to their patients.The study revealed that GP's, hospital doctormedical specialists prescribed antidepressant and neuroleptics far too rarely and GP's far too often prescribed sedative/hypnotics. This can indicate that they have difficulties in diagnosing of mental disorders as well as poor knowledge concerning indications relating the use of psychotropic drugs.

Comorbidity of some anxiety disorders and depression were examined in order to compare their statistical closeness.Patients treated in an out-patient care center for psychiatric disorders and/or family medicine were recruited. Persons that have anxiety and depressive symptoms as a consequence of somatic illnesses or consequence of other psychiatric disorders were excluded. Disorders were diagnosed a with diagnostic questionnaire based on Schedule for Assessment in Neuropsychiatry (SCAN), version 2.0, according to ICD-10 criteria. Analyses include selected disorders: generalized anxiety disorder, panic disorder, agoraphobia, specific phobias, social phobia and depression.104 patients were included. 35 of them (33.7%) had anxiety disorders, 13 persons (12.5%) have depression. Analyses show that in patients with generalized anxiety disorder, depression occurred at least twice as often as in the remaining patients (odds ratio = 7.1), while in patients with agoraphobia the occurrence of panic disorder increased at least by 2.88 times (odds ratio = 11.9). In other disorders the odds ratios was greater than 1, but the differences were not statistically significant.Depression/generalized anxiety disorder and agoraphobia/panic disorder were shown to be statistically closer than other disorders.