Showing papers in "Psychiatria Polska in 2017"

Outcome, comorbidity and prognosis in anorexia nervosa.

Abstract: Anorexia nervosa (AN) is a relatively common disorder, especially in adolescent and young adult women. The lifetime prevalence of AN in females ranges from 1.2 to 2.2%. The prevalence in males is 10-times lower. The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death. Longer follow-up periods seemed to correspond with increased improvement rates and increased mortality. Onset of the disorder during adolescence is associated with better prognosis. It is reported that as much as 70% to over 80% of patients in this age group achieve remission. Worse outcomes are observed in patients who required hospitalization and in adults. Recent studies indicate improved prognosis for cure and lower mortality rates than previously reported. However, the recovery can take several years and AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders). Studies indicate that bulimic symptoms often occur in the course of anorexia nervosa (especially within 2-3 years from the onset of AN). The authors present a review of literature on the course, comorbidity, mortality, and prognostic factors in AN. Better knowledge of the course of anorexia can contribute to more realistic expectations of the pace of symptomatic improvement, as well as to a creation of therapeutic programs which are better adapted to the needs of the patients.

Mental and behavioural disorders in the ICD-11: concepts, methodologies, and current status

Abstract: This review provides an overview of the concepts, methods and current status of the development of the Eleventh Revision of the Mental and Behavioural Disorders chapter of the International Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization (WHO). Given the global use of the current version (ICD-10) for a wide range of applications in clinical practice and health statistics, a major aim of the development process for ICD-11 has been to increase the utility of the classification system. Expert working groups with responsibility for specific disorder groupings first suggested a set of revised diagnostic guidelines. Then surveys were performed to obtain suggestions for revisions from practicing health professionals. A completely revised structure for the classification of mental and behavioural disorders was developed and major revisions were suggested, for example, for schizophrenia and other primary psychotic disorders, substance use disorders, affective disorders and personality disorders. A new category of "gaming disorder" has been proposed and conditions related to sexual health and gender identity will be classified separately from mental disorders. An ICD-11 beta draft is freely available on the internet and public comments are invited. Field studies of the revised diagnostic guidelines are in process to obtain additional information about necessary improvements. A tabulated crosswalk from previous ICD-10 to then ICD-11 criteria will be necessary to ascertain the continuity of diagnoses for epidemiological and other statistical purposes. The final version of ICD-11 is currently scheduled for release by the World Health Assembly in 2018.

Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery

Abstract: Objectives Both because of the large number of women undergoing surgery and a high cure rates, psychological rehabilitation of the consequences of breast cancer and side effects of their treatment is a major challenge of modern psychooncology. Aim. The study analyzed the quality of life in women with breast cancer, with particular emphasis on indicators of sexual satisfaction, future perspectives and body image, depending on the method of surgery. Methods The study included 42 women aged 35-70 years, 3 months after surgery due to early breast cancer, treated with adjuvant chemotherapy. The following research tools were used in the study: two EORTC questionnaires: QLQ-C30, BR23, and sexual function questionnaire: PL-FSFI. Results There was no significant difference in the overall quality of life, depending on the type of surgery. The greatest local complaints were reported by patients after breast conserving surgery (BCT) with axillary lymphadenectomy. A higher level of cognitive functioning but a greater severity of systemic side effects was found in women undergoing mastectomy compared to BCT-patients. Women who underwent surgery of the right breast reported increased problems in sexual functioning (p = 0.034). Multiple regression analysis showed a positive correlation of the emotional functioning variable with the assessment of future perspectives (p = 0.01) and body image (p = 0.007). Conclusions The type of surgical technique does not affect the overall quality of life and sexual satisfaction. Problems with memory and attention do not correlate directly with the side effects, and as such require an independent diagnostics. Women undergoing treatment of the dominant-side breast should be the candidates for sexology consultation. There is a risk of disturbances in the body image and in the assessment of future perspectives in patients with emotional disorders observed within 3 months after surgery.

The use of EEG Biofeedback/Neurofeedback in psychiatric rehabilitation.

Abstract: The aim of the systematic review was to evaluate the use of EEG Biofeedback/Neurofeedback in patients treated for mental disorders. The review covered publications analyzing influences and effects of therapy in patients receiving psychiatric treatment based on EEG Biofeedback/Neurofeedback. Selection of publications was made by searching PubMed and Scopus databases. 328 records concerning applications of the presented method were identified in total, including 84 records for patients diagnosed with mental disorders. The analysis of studies indicates that EEG Biofeedback/Neurofeedback is used for treatment of neurological, somatic and mental disorders. Its psychiatric applications for clinically diagnosed disorders include treatmentof depression, anorexia, dyslexia, dysgraphia, ADD, ADHD, schizophrenia, abuse of substances, neuroses, PTSD, and Alzheimer's disease. Research results imply that the neuromodulating effect of the therapy positively influences cognitive processes, mood, and anxiety levels. Positive effects of EEG Biofeedback confirm usefulness of this method as a main or auxiliary method in treatment of people with mental disorders. On the basis of conducted studies, it is worthwhile to consider inclusion of this method into the comprehensive neurorehabilitation activities.

A Study on the relationship between orthorexia and vegetarianism using the BOT (Bratman Test for Orthorexia).

Abstract: Objectives The following article presents the relationship between vegetarianism and orthorexia nervosa (ON). Vegetarianism is an ideology and a way of life that aims at minimizing animal exploitation. A vegetarian diet excludes the consumption of meat together with other animal derived products. According to scientists, orthorexia nervosa is considered to be a new, yet unclassified eating disorder. It involves introducing dietary restrictions by individuals who feel a desire to improve their health status by healthy eating. Methods The study involved 2,611 participants, namely 1,346 vegetarians and 1,265 non-vegetarians. The research questionnaire consisted of general personal and anthropometric characteristics, the BOT(Bratman Test for Orthorexia) and questions evaluating the participants' attitude towards nutrition. Results Based on the obtained results, health food fanaticism is more specific to vegetarians than non-vegetarians. The risk for orthorexia nervosa decreases with age and diet duration. The biggest number of health food fanatics was found in the group of lacto-vegetarians, a lower number among ovo-vegetarians and lacto-ovo-vegetarians, and the smallest number was observed in the vegan group. Also, vegetarians were reported to have dietary consultations as frequently as non-vegetarians. Conclusions Very few studies can be found on the relationship between orthorexia nervosa and vegetarianism. Some scientists believe that vegetarians are particularly prone to orthorexia nervosa. In addition, it has been suggested by other researchers that vegetarianism can be used to mask eating disorders, as it allows these affected individuals to avoid certain products or situations related to food. The direction of cause and effect cannot be determined.

Therapeutic drug monitoring of atypical antipsychotics.

Abstract: The paper presents an overview and analysis of the results of research on therapeutic ranges of concentrations and receptor occupancy, mainly D2 receptors, in the treatment with some atypical antipsychotic drugs. Amisulpride, aripiprazole, clozapine, quetiapine, olanzapine, risperidone, paliperidone, sertindole, and ziprasidone were taken into account. The benefits of therapeutic drug monitoring to optimize the effectiveness of treatment and avoid side effects or toxicity were shown. The safety of patients, with the possibility to use the lowest effective dose, is an undoubted profit of TDM. This helps to avoid overdosing resulting in adverse events (with particular emphasis on extrapyramidal symptoms and seizures).The need and desirability of TDM is due to the inter -and intraindividual differences in the pharmacokinetics of drugs, because only some of them have a close correlation between dose and plasma concentration. The plasma concentration correlates well with the occupancy of D2 receptors. The efficient and safe level is determined at 60-80%. Based on the knowledge of the indications for TDM and therapeutic concentration ranges, amisulpride, clozapine and olanzapine have the highest level of recommendation to use TDM. Therapeutic ranges of plasma concentrations of the analyzed drugs were determined to be 200-320 ng/ml for amisulpride, 150-210 ng/ml for aripiprazole, over 350-500 ng/ml for clozapine, 50-500 ng/ml for quetiapine, 20-40 ng/ml for olanzapine, 20-60 ng/ml for risperidone and paliperidone, 50-100 ng/ml for sertindole and 50-130 ng/ml for ziprasidone.

A proposed new definition of mental health

Abstract: The authors propose a new approach to the definition of mental health, different than the definition proposed by the World Health Organization, which is established around issues of person's well-being and productivity. It is supposed to reflect the complexity of human life experience.

The role of the cerebellum in the regulation of language functions.

Abstract: The present paper is a review of studies on the role of the cerebellum in the regulation of language functions. This brain structure until recently associated chiefly with motor skills, visual-motor coordination and balance, proves to be significant also for cognitive functioning. With regard to language functions, studies show that the cerebellum determines verbal fluency (both semantic and formal) expressive and receptive grammar processing, the ability to identify and correct language mistakes, and writing skills. Cerebellar damage is a possible cause of aphasia or the cerebellar mutism syndrome (CMS). Decreased cerebellocortical connectivity as well as anomalies in the structure of the cerebellum are emphasized in numerous developmental dyslexia theories. The cerebellum is characterized by linguistic lateralization. From the neuroanatomical perspective, its right hemisphere and dentate nucleus, having multiple cerebellocortical connections with the cerebral cortical language areas, are particularly important for language functions. Usually, language deficits developed as a result of a cerebellar damage have subclinical intensity and require applying sensitive neuropsychological diagnostic tools designed to assess higher verbal functions.

Quality of life and social support in patients with multiple sclerosis.

Abstract: Objectives Quality of life and needforsocial support in persons diagnosed with multiple sclerosis (MS) are to a large extent determined by the degree of their disability. The aim of the study was to analyze an association between specific forms of MS, subjectively perceived quality of life and social support. Methods The study included subjects with established diagnosis of MS, treated at rehabilitation centers, hospitals and in a home setting, as well as the members of patient organizations. After being informed about objectives of the study, type of included tasks and way to complete them, each participant was handed out a set of questionnaires: Berlin Social Support Scales (Łuszczynska, Kowalska, Schwarzer, Schulz), Quality of Life Questionnaire (WHOQOLBREF), as well as a survey developed specifically for the purposes of this project. The results were subjected to statistical analysis with STATA 12 package. Results The study included a total of 110 persons (67 women and 43 men). Quality of life overall, as well in physical, psychological, social relationships and environmental health domains, turned out to be particularly important in patients with primary-progressive MS. Irrespective of MS type, social support overall did not play a significant role on univariate analysis. However, subgroup analysis according to sex demonstrated that men with MS received social support four times less often than women. Conclusions Quality of life in individuals with primary-progressive MS is significantly lower than in patients presenting with other types of this disease. Men with MS are more likely to present with worse scores for social support overall. They are less likely both to acknowledge the need for support and to realize the availability of support they actually need.

Stigmatization feelings and depression symptoms in psoriasis patients.

Abstract: OBJECTIVES The objective of the study was to show the correlation between the feelings of stigmatization and depressive symptoms in psoriasis patients. The study has considered severity of feelings of stigmatization and depressive symptoms, as well as factors such as gender and skin lesions visibility. METHODS The study involved 54 adult subjects suffering from psoriasis - 26 women and 28 men. The patients filled in the 33-item Feelings of Stigmatization Questionnaire and the Beck Depression Inventory. Moreover, the subjects were asked to mark the location of their psoriatic lesions on a schematic drawing. RESULTS A correlation was found between feelings of stigmatization and depressive symptoms in the psoriasis patients. No differences between women and men were found with regard to depressive symptoms and feelings of stigmatization (except for the secretiveness aspect). It was found that location of skin lesions did not have an effect on occurrence of depressive symptoms and feelings of stigmatization (except for the shame and guilt aspect). CONCLUSIONS It is still necessary to change the public attitude to patients with psoriasis. It is also very important to provide the patients with psychotherapeutic support aimed at enhancing their self-acceptance in order to overcome any feelings of stigmatization and to prevent them from depression.

Schizophrenia and anorexia nervosa - reciprocal relationships. A literature review.

Abstract: Although schizophrenia and anorexia nervosa are seemingly very distinct psychiatric disorders, their symptoms are connected by various types of relationships. The present article reviews the literature and recapitulates the views of various authors on the links between these two disorders. Symptoms of anorexia may 1) precede the onset of psychosis; 2) evolve in its active phase or more rarely manifest in remission; and, conversely, 3) psychotic symptoms may occur transiently in the course of anorexia nervosa. When anorexia precedes the manifestation of psychosis, symptoms of anorexia can be treated as a component of the prodromal phase of schizophrenia. Another possibility of co-existence of a psychosis (e.g., schizophrenia) with anorexia is when the eating disorder syndrome manifests at the same time as the full-blown psychotic syndrome. In such cases, when the symptoms of the two disorders occur simultaneously, it is often difficult to say whether the patient is suffering from schizophrenia, in the course of which anorexia has arisen secondary to psychotic symptoms or whether he/she is suffering from anorexia during which he/she has developed psychotic symptoms, usually thematically associated with eating. Studies published so far, mainly case reports, point to the complex nature of the interrelationships between schizophrenia and anorexia nervosa. Further research is needed to conclusively explain the relationships between psychotic disorders and anorexia nervosa, which would allow physicians to use more effective methods of treatment in this group of patients.

Treatment guidelines for Circadian Rhythm Sleep-Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association. Part I. Physiology, assessment and therapeutic methods.

Abstract: Majority of the physiological processes in the human organism are rhythmic. The most common are the diurnal changes that repeat roughly every 24 hours, called circadian rhythms. Circadian rhythms disorders have negative influence on human functioning. The aim of this article is to present the current understanding of the circadian rhythms physiological role, with particular emphasis on the circadian rhythm sleep-wake disorders (CRSWD), principles of their diagnosis and chronobiological therapy. The guidelines are based on the review of recommendations from the scientific societies involved in sleep medicine and the clinical experiences of the authors. Researchers participating in the preparation of guidelines were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association, based on their significant contributions in circadian rhythm research and/or clinical experience in the treatment of such disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies. CRSWD have a significant negative impact on human health and functioning. Standard methods used to assess CRSWD are sleep diaries and sleep logs, while the actigraphy, when available, should be also used. The most effective methods of CRSWD treatment are melatonin administration and light therapy. Behavioral interventions are also recommended. Afourteen-day period of sleep-wake rhythm assessment in CRSWD enables accurate diagnosis, adequate selection of chronobiological interventions, and planning adequate diurnal timing of their application. This type of assessment is quite easy, low-cost, and provides valuable indications how to adjust the therapeutic approach to the circadian phase of the particular patient.

Intestinal microbiota - a key to understanding the pathophysiology of anorexia nervosa?

Abstract: Anorexia nervosa (AN) is a psychiatric disorder related to very serious consequences for physical and mental health of patients. Due to a complex clinical picture, which consists of anumber of somatic and mental symptoms, AN remains a serious problem of modern medicine and encourages the search for possible causes of the illness and new, more effective therapies. The recent reports emphasize the role of the intestinal microbiota in regulation of body weight. In this light, the hypothesis that in AN patients there is a significant imbalance of the intestinal microbiota, which contributes to the pathogenesis of the illness, seems interesting. The results of the latest research suggest that abnormal composition of the intestinal microbiota may be an important factor supporting cachexia of AN patients. Detailed analyzes of the composition of the microbiota characteristic for anorexia nervosa could be useful in developing new methods for monitoring and treatment of this illness. This paper aims to present the current state of the art about the role of the intestinal microbiota in the pathogenesis, course and treatment of AN.

Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa

Abstract: Anorexia nervosa (AN) is the third most common disorder, after obesity and asthma, in the population of adolescents between 13-18 years of age. Food intake reduction is associated with whole body dysfunction, affecting its physical, psychological and social spheres. As a result of starvation, dysfunction develops in virtually all systems and organs. However, most frequently patients with AN complain of digestive symptoms, such as a feeling of fullness after meals, pain in the upper abdomen, dysphagia, nausea, bloating and constipation. They can have mild functional character, but may also reflect serious complications, including diseases requiring urgent surgical intervention. In addition, gastric complaints may hinder nutritional management of AN. Care of AN patients requires cooperation of many specialists in the field of psychiatry, psychology, paediatrics, internal medicine and nutrition. However, it is often difficult to organize such a team. Therefore, we decided to approach the issues of gastrointestinal symptoms and complications in the course of AN, and the rules of nutritional therapy.

The serum concentration of copper in bipolar disorder

Abstract: OBJECTIVES Some scientific reports indicate the changes in the concentration of serum copper in patients with bipolar disorder (BD), however the data are inconclusive. The aim of this study was to assess the concentration of copper in the blood serum of patients in various phases of BD compared to healthy volunteers, taking into consideration the specific clinical features, and the stage of illness. METHODS The study enrolled 133 patients with a diagnosis of BD (type I, II and NOS), including 61 people in depressive episode, 23 in mania or hypomania and 49 in remission. The control group consisted of 50 people. Atomic absorption spectrometry was used to measure the concentration of copper. RESULTS There were no statistically significant differences in the serum copper concentration between patients in various phases of BD (mania/hypomania, depression, remission), sub-types (Type I, Type II + NOS) or stages and healthy volunteers. However, serum copper concentrations in patients in stage 1 was significantly higher than in advanced stages (2+3+4), (s = 0.22; p = 0.02). Serum copper concentration was also the higher, the later the age of onset was (s = 0.33; p < 0.001), and the lower, the greater the number of illness episodes (s = - 0.23; p = 0.02) (multiple regression model, adj R2 = 0.19, p = 0.0001). CONCLUSIONS The dependencies demonstrated above may reflect pathophysiological processes that occur in the course of BD (e.g., inflammatory response and oxidative stress) with a different intensity depending on its stage.

Polish adaptation of Sexual Addiction Screening Test - Revised.

Abstract: OBJECTIVES Addictive sexual behaviours are gaining more and more attention from researchers. There are actually 25 different questionnaires for assessing the level of loss of control over sexual. The main aim of this work was to make such an adaptation of the Sexual Addiction Screening Test-Revised (SAST-R; the most popular and questionnaire). behaviours (LoCoSB). None of them have been adapted and validated in a Polish language version. METHODS For the purpose of psychometric features examination and validation of the Polish version of SAST-R (SAST-PL-M), we recruited 116 heterosexual men receiving psychological treatment due to LoCoSB and meeting the criteria for hypersexual disorder. The control group consisted of 442 heterosexual males having never looked for any psychological or psychiatric help due to LoCoSB. RESULTS SAST-PL-M has high reliability (Cronbach's alpha = 0.904) and good filtering characteristics for identification of people who are potentially experiencing difficulty with control over sexual behaviours (the ROC curve for a threshold of 5 out of a maximum 20 points is characterised by a sensitivity of 99.1% and a specificity of 78.3%). CONCLUSIONS SAST-PL-M can be used as an efficient screening test for symptoms of LoCoSB in clinical and research setups. Results below 5 points indicate a high probability of no problems, while more than 5 points can indicate the need for additional clinical interviews. SAST-PL-M results may be successfully referred to the results of SAST-R when used with heterosexual male populations for research purposes.

The amino acid profile in blood plasma of young boys with autism.

Abstract: OBJECTIVES It has been suggested that some amino acids are involved in the pathogenesis of autistic disorders. The aim of the study was to evaluate the plasma amino acids profile in young males with autism. METHODS Total of 27 autistic boys (aged 2-10 years, the study group) without any metabolic disorders and 13 healthy boys (aged 2-9 years, control group) were included in the study. In all subjects fasting blood plasma free amino acids (both exogenous and endogenous) were quantitatively measured by high performance liquid chromatography with UV-VIS detection. RESULTS The mean plasma concentration values of citrulline, .-aminobutyric acid, isoleucine, leucine, phenylalanine, tryptophan and ornithine were significantly lower in boys with autism as compared to the control group (p < 0.03, p < 0.04, p < 0.02, p < 0.02, p < 0.05, p < 0.02, p < 0.05, respectively). The areas under the Receiver Operating Characteristic curves for these amino acids ranged from 0.637 to 0.726. None of the amino acids measured differentiate autistic children from healthy children. The sum of exogenous amino acids was lower in the study group than in the control group but this difference was not statistically significant. CONCLUSIONS Lower levels of exogenous amino acids confirm the possible role of these amino acids in autism. Determination of exogenous amino acids in plasma, however, cannot be used as a diagnostic test but it can still support autistic patients care.

Can brain-derived neurotrophic factor (BDNF) be an indicator of effective rehabilitation interventions in schizophrenia?

Abstract: The increasing body of evidence implies that brain-derived neurotrophic factor (BDNF) is the most common neurotrophin in the nervous system, playing an important role as an effectiveness indicator for rehabilitation interventions in schizophrenia patients. Currently, with the modern laboratory and instrumental diagnostic methods it is possible to diagnose deficits influencing the level of patient's functioning and use them as a basis for establishing individual re-adaptation programs for schizophrenia patients considering various forms of the therapy in different environments. Based on the PubMed and Scopus search tools a review of the available literature was performed and the paper presents current results of studies analyzing a relationship between selected rehabilitation interventions used in schizophrenia patients and changes in BDNF levels (a correlation between BDNF levels and physical activity and EEG Biofeedback therapy). Out of 240 records identified in total, the ones concerning the subject matter of the paper were taken into account. Studies concerning use of the presented method appear to indicate usefulness of BDNF factor in evaluation of effectiveness of implemented rehabilitation interventions in this group of patients. Changes in neurotrophin levels may indicate a synergy of the central and the peripheral nervous system, and high BDNF levels depending on physical activity and a neuromodulating effect of the EEG Biofeedback therapy may indicate their effectiveness. Use of various neurorehabilitation methods may improve the social functioning in schizophrenia patients. Treating BDNF as a biological indicator of those processes may represent an interesting hypothesis.

Screening for maternal postpartum depression and associationswith personality traits and social support. A Polish follow-upstudy 4 weeks and 3 months after delivery.

Abstract: Objectives To investigate the likelihood of postpartum depression and to explore maternal characteristics in terms of personality, social support and other medical and psychological data. Methods A sample of 548 patients was investigated 4 weeks and 3 months after delivery. They responded to questionnaires containing sociodemographic questions: the EPDS (Edinburgh Postnatal Depression Scale), the PHQ-9 (Patient Health Questionnaire-9), theNEO-FFI (Personality Inventory), and the BSSS (Berlin Social Support Scales). Results Probable depression any time during first 3 months postpartum was prevalent among 6.38% of women, based on the following criteria: EPDS > 12 points and PHQ-9 > 9 points. A score of EPDS > 9 in the first week after delivery (ORa = 4.16; CI 1.59-10.86), a history of hospitalisation during pregnancy (ORa = 3.51; CI 1.32-9.20), a high level of neuroticism (ORa = 1.37; CI 1.05-1.77), and high buffering-protective social support (ORa =2.56; 1.25-5.23) were significantly associated with depressive symptoms. Potential protective factors were initial breastfeeding (ORa = 0.31; CI 0.11-0.90) and high satisfaction with currently received social support (ORa=0.41;CI 0.22-0.79). The total dropout rate was 23%. Conclusions New mothers who are neurotic and who suffered from physical or mental problems during pregnancy and puerperium might experience depressive symptoms more easily. They would also protect those close to them from negative information about themselves. A lack of initial breastfeeding and unsatisfactory social support played a similar role.

Application of phase angle for evaluation of the nutrition status of patients with anorexia nervosa.

Abstract: The evaluation of the nutrition status of patients has been the subject of interest of many scientific disciplines. Any deviation from normal values is a serious clinical problem. There are multiple nutrition status evaluation methods used including diet history, scales and questionnaires, physical examination, anthropometric measurements, biochemical measurements, function tests, as well as bioelectric impedance analysis or adipometry. Phase angle, obtained by means of bioelectric impedance analysis, is another parameter that is being more and more frequently applied in nutrition status monitoring. It is proportional to body cell mass. Its direct correlation with the cellular nutrition status has been documented. High phase angle values signify well-being, while low phase angle values indicate poor condition of cells. The purpose of this paper was to review the current state of knowledge about the application of phase angle in evaluation and monitoring of the nutrition status of patients with anorexia nervosa on the basis of available literature. It was proven that the phase angle values in patients with anorexia nervosa are much lower compared to healthy people. Detailed observations showed phase angle value increase in the course of treatment. The relevance of the commonly used body mass index (BMI) has been questioned due to significant degree of generalization in the nutrition status evaluation. Thus, there is a need for new, objective parameters for nutrition status evaluation, which will assist in the treatment and monitoring of patients in a more meaningful and reliable way. The existing independent studies equivocally confirm the usefulness of phase angle in the evaluation of nutrition status of patients with anorexia nervosa and its broader application in clinical practice is only a matter of time. However, these are merely attempts and they have not yet found wider application in clinical practice in the treatment of anorexia nervosa.

The effect of vitamin D3 deficiency on the severity of depressive symptoms. Overview of current research.

Abstract: Traditional methods of depression treatment with the use of pharmacotherapy with antidepressants have limited effectiveness. Biological, psychological and environmental causes of depressive disorders are known, but pathophysiology of depression has not been fully explained. Many factors and mechanisms play role in the pathophysiology of depression, one of which may be vitamin D3 deficiency. Deficiency or border level of vitamin D3 is fairly common in the general population and may occur even in one billion people globally. Epidemiological studies show that vitamin D3 or its metabolites do not reach an optimal level in most adults. Even lower than the optimal level may cause clinical symptoms and be one of the risk factors for depression. In the population of patients suffering from depressive disorders deficiency or insufficiency of vitamin D3 occur more frequently than in the general population. The use of vitamin D3in patients with depression may have antidepressant effect. Continuous supplementation may also reduce the risk of recurrence. This article is a review of literature on the possible impact of vitamin D3 deficiency on the prevalence of depression and antidepressant effect of the supplementation. Selection of articles was made by searching the Medline and PubMed databases using specific keywords: depression, vitamin D3 deficiency. Previous studies on the use of vitamin D3 and its role in prevention and treatment of depressive disorders included too small number of people to clearly assess the effectiveness and safety of supplementation used as adjunctive therapy to antidepressants, as well as and dose range which should be used.

Differential criteria for binge eating disorder and food addiction in the context of causes and treatment of obesity.

Abstract: Objectives To establish the differential criteria for Binge Eating Disorder (BED) and Food Addiction (FA). Methods We performed a detailed analysis of comparative diagnostic criteria for BED and Substance use disorder contained in the Diagnostic and Statistical Manual of Mental Disorders DSM-V. We applied the diagnostic criteria for both disorders to scientific publications on the issue of excessive eating in obese people, during the years 2005-2016, available on PubMed. We isolated specific similarities and differences between Binge Eating Disorder and Food Addiction. We formulated differential criteria for BED and FA. Results In BED as well as FA the following characteristics are apparent: preoccupation with food, excessive eating, loss of control over the amount of food and manner of eating, inability to change behavior, continuing behavior despite negative consequences, increased impulsiveness and emotional imbalance. Differences between BED and FA relate to the function of food, reaction to omitted food, psychological mechanisms of coping with excessive eating and body image, the issue of tolerance, withdrawal syndrome and the correlation between excessive eating and other areas of life. Conclusions The criteria of differentiation between BED and FA concern the following: function of food, eating circumstances, reaction to the unavailability of food, awareness of the problem. Appropriate diagnosis of these disorders and their differentiation increases the chances of adequate treatment of obese patients.

Polish adaptation of the Young Schema Questionnaire 3 Short Form (YSQ-S3-PL).

Abstract: Objectives The aim of the study was to prepare the Polish adaptation of the Young Schema Questionnaire S3-PL. The scale is a self-assessment tool designed to measure 18 early maladaptive schemas. Methods The sample consists of 1,529 adults (927 women and 585 men), aged 18-85 years (mean age was 32 years), from non-clinical groups. Results After language validation the internal consistency was assessed. The Cronbach's alpha ranged from 0.62 (Entitlement/grandiosity) to 0.81 (Failure), and it was 0.96 for total score. The best solution obtained in exploratory factor analysis was an eight-factor model, instead of the assumed 18-factor structure. Confirmatory factor analysis also did not fully supported Young's theoretical model. From all the tested models, bi-factor model (i.e., one generic factor and correlated specific factors - schemas) fitted the data best. In accordance with this model schema variance is explained concurrently by generic and specific factors; generic factor explains most of the Defectiveness variance, while only slightly - Self-sacrifice variance. Convergent validity analysis confirmes positive medium correlations with scales measuring psychopathology. Similarly, negative correlations with self-efficacy and optimism indicate good divergent validity. Conclusions The psychometric characteristics of the Polish adaptation of the YSQ-S3PL is similar to those reported for other language versions. The results allow to recommend the method for scientific research. However, using it in therapeutic practice needs caution - especially in the case of clinical diagnosis. Further analyses are necessary to assess criterion validity and discriminative power in clinical settings.

Medical students and stigma of depression. Part 2. Self-stigma.

Abstract: Up to 30% of medical students suffer from depression. They have better access to healthcare, but still receive appropriate treatment less frequently than people with depression in the general population. Most of them do not seek medical help as depression is perceived as a stigmatizing disorder, which leads to self-stigma and hampers early diagnosis and treatment. Thus, self-stigma means less effective therapy, unfavorable prognosis and relapses. According to the literature, self-stigma results in lowered self-esteem and is a major obstacle in the performance of social roles at work and in personal life. Stigmatization and self-stigma of depression among medical students are also associated with effects in their later professional life: they can lead to long-term consequences in the process of treating their patients in the future. Currently there are no unequivocal research results indicating the most effective ways of reducing stigmatization and self-stigma. It is necessary to educate about the symptoms and treatment of depression and to implement diverse intervention techniques to change behaviors and attitudes as early as possible.

Executive dysfunction in late-life depression.

Abstract: Objectives Nowadays there are numerous reports stressing the occurrence of cognitive functions disorders in late-life depression (LLD). More and more frequently the studies stress the role of executive dysfunctions in LLD. The purpose of the study was an evaluation of the components of executive functions in non-demented LLD patients, as well as an evaluation of the relation between the individual components of executive functions and the level of depressiveness. Methods The study included 87 persons with depression and 100 persons in the control group. For the purpose of a screening evaluation of cognitive functions the Mini-MentalState Examination (MMSE) was applied. For the evaluation of the level of executive functions efficiency the following were chosen: a) Trail Making Test (TMT), b) Verbal Fluency Tests (VFT) and c) go/no-go task (GNG). Results A significant difference was found in the levels of efficiency of all the components of executive functions in patients with late-life depression. The patients with depression demonstrated the slowest psychomotor speed and worse results in the tests evaluating cognitive flexibility, semantic fluency and inhibition. Statistically significant relation was observed between the higher result in GDS-SF (Geriatric Depression Scale-Short Form) and the worse performance in the GNG test. Conclusions The patients with depression demonstrated a significant impairment of executive functions. A relation was found between the cognitive control disorder and the level of depressiveness. Executive dysfunctions can play an important role in the persistence of depressive symptoms. Identification of patients with depression and executive dysfunctions has significant therapeutic implications.

Large animals as potential models of human mental and behavioral disorders.

Abstract: Many animal models in different species have been developed for mental and behavioral disorders. This review presents large animals (dog, ovine, swine, horse) as potential models of this disorders. The article was based on the researches that were published in the peer-reviewed journals. Aliterature research was carried out using the PubMed database. The above issues were discussed in the several problem groups in accordance with the WHO International Statistical Classification of Diseases and Related Health Problems 10thRevision (ICD-10), in particular regarding: organic, including symptomatic, disorders; mental disorders (Alzheimer's disease and Huntington's disease, pernicious anemia and hepatic encephalopathy, epilepsy, Parkinson's disease, Creutzfeldt-Jakob disease); behavioral disorders due to psychoactive substance use (alcoholic intoxication, abuse of morphine); schizophrenia and other schizotypal disorders (puerperal psychosis); mood (affective) disorders (depressive episode); neurotic, stress-related and somatoform disorders (posttraumatic stress disorder, obsessive-compulsive disorder); behavioral syndromes associated with physiological disturbances and physical factors (anxiety disorders, anorexia nervosa, narcolepsy); mental retardation (Cohen syndrome, Down syndrome, Hunter syndrome); behavioral and emotional disorders (attention deficit hyperactivity disorder). This data indicates many large animal disorders which can be models to examine the above human mental and behavioral disorders.

Self-injury - placement in mental disorders classifications, risk factors and primary mechanisms. Review of the literature.

Abstract: Self-injury is a common phenomenon among adolescents and young adults, however its prevalence in clinical population is estimated at 40-80%, especially in regard to patients during puberty. Symptoms usually appear between 12th and 14th year of age, and their average duration is approx. 2 years. According to accepted sociocultural norms self-injury can be regarded as a normal behavior. Nevertheless, the prevalence of body art phenomenon in Western culture including professional tattooing, piercing, scarification, burning tattoos and other body modification typical for tribal cultures, has forced the need to redefine the boundaries for normative behavior. Introduction of a separate nosological unit of Non-Suicidal Self Injury in the fifth edition of DSM classification proves the validity of discussion, being hold for many years, regarding classification and understanding of the underlying mechanisms of self-harm. The aim of our study was to present the current state of knowledge regarding self-harm, with an emphasis on issues devoted to their placement in newest mental disorders classifications and mechanisms responsible for their development and maintenance. Databases such as: PubMed, EBSCO (medical and psychological resources) and WEB OF SCIENCE (years 1990-2016) have been screened for the following key words: self-injury, self-harm, self-mutilation, suicide, deliberate self-harm, affect regulation, NSSI, DSH, personality disorders, suicide attempt, neurobiology self-harm, DSM-5, adolescent, adults, stress coping styles, self-mutilation - children, adolescents and adults-prevalence. The analysis indicated 110 articles and 3 textbooks. We have used the following criteria: (1) for the articles presenting the latest research on risk factors for self-harm we have used the criterion of the study group number (>30 people) and meta-analyses have been included, (2) for theories explaining the mechanisms of self-harm criterion of empirical review of the assumptions and the number of the published studies that verify the theory has been applied.

Cariprazine - a novel antipsychotic drug and its place in the treatment of schizophrenia.

Abstract: Although the development of second-generation antipsychotics was a cornerstone in the treatment of schizophrenia, several unmet treatment needs in the field still exist. It is particularly important to note that available antipsychotics have limited efficacy in the treatment of negative symptoms and cognitive impairment. At this point, it should be noted that primary negative symptoms, i.e., those that are not due to depression, extrapyramidal symptoms or psychotic withdrawal, might affect even one-fourth of patients with schizophrenia and are associated with poor clinical and functional outcomes. Cariprazine, is an emerging antipsychotic drug, D3/D2 receptor partial agonist, with affinity to several serotonin receptors. In this article, we provide an overview of pharmacokinetic and pharmacodynamic properties of cariprazine, showing its unique receptor profile. Next, we discuss results of double-blind, placebo-controlled, randomized clinical trials and post hoc analyses of cariprazine that have been published to date. These studies have provided evidence for efficacy of cariprazine in the treatment of schizophrenia exacerbations compared to placebo, with safety and good tolerability. In addition, one clinical trial published to date revealed superior efficacy of cariprazine compared to risperidone in the treatment of predominant negative symptoms that had been also associated with concomitant improvement of functional performance. Overall, current evidence in the field supports the use of cariprazine in exacerbation of schizophrenia and suggests promising efficacy in the treatment of predominant negative symptoms.

Resilience as a predicator of mental health of incarcerated women.

Abstract: Objectives Serving a prison sentence is an experience that bears the hallmarks of a trauma. Scientific findings on how people handle traumatic The aim of the following research was to analyze the way in which psychological resilience differentiates mental states of incarcerated women and to identify the predicator of mental well-being in this group.experiences show that there are numerous personal and social resources that allow for better adaptation. One of the concepts used to describe the process reflecting relatively good adaptation is psychological resilience. Methods The study included women incarcerated in the External Department of Czersk Penitentiary for juvenile female offenders who serve a prison sentence for the first time and penitentiary recidivists. The following scales were used in the research: the Resilience Measurement Scale - RMS-25 and the HADS-M scale, which allows to conduct a test for symptoms of depression. Results The results revealed crucial statistical correlations between the results of the resilience scale and results of the HADS-M. It was also found that the predicators of anxiety and depression in the study group are the level of personal coping skills and tolerance of negative emotions (RMS-25). Additionally, a crucial factor in predicting the state of anxiety is the number of years of imprisonment. The conducted regression analysis also showed that the level of personal coping skills and tolerance of negative emotions (RMS-25) as well as openness to new experiences and sense of humor (RMS-25) are essential predicators of the level of aggression. Conclusions The concept of psychological resilience is significant in analyzing the differences in mental health of incarcerated women and may help to create conditions that are conducive to reducing negative effects of prisoners staying in conditions of institutional constraint.

Persistent genital arousal disorder - a case report

Abstract: The persistent genital arousal disorder (PGAD) may coexist with restless legs syndrome and overactive bladder syndrome and share some similarities with these conditions. Thus, the new term: restless genital syndrome (RGS) is proposed. The purpose of this paper is to present a case of PGAD, including the description of the etiology, the diagnostics and the treatment of the disorder. The described patient meets the criteria for PGAD. Organic lesions within nervous and urogenital system were excluded and the psychogenic background of the syndrome was assumed in this case. The patient was diagnosed with personality disorder with a predominance of dependent personality traits and emotional lability. After the failure of pharmacological treatment, systemic psychotherapy with cognitive-behavioral elements was initiated with moderate effect.