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Smoking and nicotine dependence are still one of the main reasons for a number of serious and life-shortening somatic diseases. At the same time, they are more prevalent in mentally ill individuals than in the general population. This work, which constitutes the first part of recommendations of the Polish Psychiatric Association, presents the scale of the phenomenon in the general population and among people with psychiatric disorders, diagnostic criteria of nicotine dependence and nicotine withdrawal. It discusses the impact of smoking and exposure to cigarette smoke on the development and course of psychiatric disorders as well as on the treatment of psychiatric disorders, including interactions between nicotine and psychotropic medications. Many psychiatric patients can reduce smoking or achieve complete abstinence if they are offered adequate motivation and therapeutic support. Contrary to popular belief, smoking cessation and nicotine dependence treatment do not negatively affect the symptoms of psychiatric disorders; patients' mental conditions can improve following smoking cessation therapy. The best results in terms of maintaining abstinence are achieved with a treatment approach that combines pharmacotherapy with psychotherapeutic intervention integrated into routine psychiatric care.

The development of treatment methods for nicotine dependence has progressed slowly because people with psychiatric disorders are usually excluded from participating in clinical trials. There are several therapeutic options to support smoking cessation, including psychological and pharmacological interventions, which should be offered to smokers with mental disorders. The first step in helping tobacco smokers and nicotine-dependent individuals is the assessment of smoking intensity and confirmation of nicotine dependence. Currently, we have several methods of treating nicotine dependence - starting from education and psychotherapy, through pharmacotherapy and replacement therapy, and ending up with obtaining gradual progress with the application of harm reduction. Pharmacological treatment options include nicotine replacement therapy, varenicline or bupropion. The effectiveness of such interventions can be improved by providing anti-smoking therapy under psychiatric treatment and promoting harm reduction as an acceptable initial therapeutic goal. The harm reduction strategy is an approach that should be taken into account individually, particularly in the case of individuals unable to stop smoking, patients with limited insight into their illness, patients experiencing an exacerbation of their illness and persistently uncooperative patients. In this paper, recommendations of the Polish Psychiatric Association on the diagnostics and different treatment methods for nicotine dependence in patients with psychiatric disorders are presented.

A review of the literature on emotion regulation in binge eating disorder (BED) published both in English and Polish between 1990 and 2020. BED might be considered as an impulsive and compulsive disorder associated with altered reward sensitivity and food-related attentional bias. The growing body of research indicated that there were corticostriatal circuitry alterations in BED, comparable to those observed in substance abuse, including altered function of orbitofrontal, prefrontal and insular cortices with the striatum included. Negative emotions and deficits in their regulation play a significant role in BED. Processing of anger, anxiety and sadness appear to be particularly important in this disorder. Research results identified an increase in negative emotions preceding episodes of binge eating. However, there is still inconsistency when it comes to whether these episodes alleviate negative affect. Individuals with BED more often use non-adaptive emotion regulation strategies, such as rumination and suppression of negative sensations. Whereas adaptive ones, for instance, cognitive reappraisal, are used less often. Clinical implications, besides pharmacology, highlight the high effectiveness of enhanced cognitive behavioral therapy (CBT-E), dialectic-behavioral therapy (DBT) and psychodynamic therapy in the treatment of emotional dysregulation in BED. Further studies, including ecological momentary assessment (EMA), should focus on emotional changes related to the binge cycle and the identification of reinforcing factors of BED.

Contemporary approach to schizophrenia treatment assumes multidirectional therapeutic intervention aimed at achieving full remission and the patient's return to full psychosocial functioning. Properly selected and administered pharmacotherapy still plays the key role in schizophrenia treatment. In previous decades (starting from the 1950s) the use of antipsychotics aimed mostly at managing positive symptoms (aggression, agitation). In subsequent decades (starting from the 1980s) it was possible to use new generation medications with fewer side effects. Some of those medications turned out to be also helpful in alleviating negative symptoms, which gave some patients an opportunity to return to normal functioning. Nevertheless, there is still a common belief that schizophrenia patients with predominant or persistent negative symptoms are the most serious challenge from the therapeutic perspective. They are characterized by worse course of the illness, poorer prognosis and response to treatment. There is constant need for new, more effective therapeutic interventions. The following paper presents international standards and recommendations of the Polish Psychiatric Association for effective approach to treating negative symptoms in schizophrenia.

Schizophrenia is a chronic illness that in the majority of cases begins either in adolescence or early adulthood. It is often perceived as a severe, incurable condition with generally poor prognosis, while patients suffering from it tend to be agitated, aggressive and unpredictable in their behaviors. Growing awareness, along with gradual changes in the approach to the need for multifaceted schizophrenia therapy, as well as considerable progress in pharmacotherapy in recent years have allowed for improving the prognosis for many patients. Because of polymorphic character of the condition, many schizophrenia sub-types are identified by means of classifications of mental disorders, adjusting the criteria and descriptions to most frequently observed clinical scenarios. Clinical descriptions of schizophrenia are based on various psychopathological models, which are often multidimensional and multifactorial. They virtually always take account of the following two dimensions: negative (deficit) and positive (creative) symptoms. Contemporary approach to schizophrenia treatment assumes multidirectional therapeutic intervention aimed at achieving full remission and the patient's return to full psychosocial functioning. Long-term studies indicate that the severity of negative symptoms is the prognostic indicator of the deterioration of social and professional functioning and reduced quality of life. The following paper presents the review of concepts and research devoted to negative symptoms in schizophrenia and their treatment; in the second part, international standards and recommendations of the Polish Psychiatric Association concerning the approach to effective management of negative symptoms in schizophrenia are discussed.

Aim: The aim of this paper was to characterise nonspecific eating disorders (other than anorexia nervosa and bulimia nervosa)., Method: The Medline database was searched for articles on nonspecific eating disorders. The following disorders were described: binge eating disorder (BED), pica, rumination disorder, avoidant/restrictive food intake disorder, night eating syndrome (NES), sleep-related eating disorder (SRED), bigorexia, orthorexia, focusing on diagnosis, symptoms, assessment, comorbidities, clinical implications and treatment., Results: All of the included disorders may have dangerous consequences, both somatic and psychological. They are often comorbid with other psychiatric disorders. Approximately a few percent of general population can be diagnosed with each disorder, from 0.5-4.7% (SRED) to about 7% (orthorexia). With the growing literature on the subject and changes in DSM-5, clinicians recognise and treat those disorders more often., Conclusions: More studies have to be conducted in order to differentiate disorders and treat or prevent them appropriately.

Co-occurrence of alcohol dependence with other mental disorders is very common, being important cause of diagnostic and therapeutic difficulties. There is a lack of systemic solutions in mental health care dedicated to the patients with dual diagnosis. The literature on the topic of treatment of patients with dual diagnosis is limited. While comorbidity of alcohol dependence with mental disorders is prevalent, there is rising interest among researchers on that issue. In this paper we present current hypotheses on pathogenesis of dual diagnosis as well as recommendations for its treatment. The role of disturbances in functioning of hypothalamic-pituitary-adrenal axis in pathogenesis of co-occurrence of alcohol dependence with anxiety and affective disorders is presented. Researchers studying dual diagnosis underline the fact that simultaneous treatment of alcohol dependence and co-occurring psychiatric disorders increases the chance to improve patients` functioning. Inappropriate treatment without complete management of all existing problems may make full recovery impossible.

The paper is a review of the literature on the comorbidity of alcohol dependence with other psychiatric disorders. A condition when alcohol dependence is accompanied by another mental disorder is much more common than it is commonly believed. It is estimated that more than one third of people diagnosed with mental disorders, abuses or is dependent on psychoactive substances, especially alcohol; among alcohol-dependent patients 37% suffer from other mental disorders. Alcohol dependence is associated with increased risk of mood disorders - more than three times higher, depression - almost four times higher, bipolar disorder - more than six times higher, anxiety disorders in general - more than twice, generalized anxiety disorder - more than four times higher, panic disorders - almost double, posttraumatic stress disorder - more than twice. Underestimating of comorbidity is an important problem during treatment of such population of patients. Social skills training can improve a stress management and decrease alcohol and drug use among dual diagnosed patients.

Many studies, suggest an association between the use of antipsychotics (APs) and occurrence of venous thromboembolism (VTE). Thromboembolism is often related to a significant r'iisk of disability or death. Despite many years of investigating the interrelationsbetween use of APs and VTE, they have not been specified yet. This paper aims to summarize reports on the VTE risk factors in patients using APs. Based on the analyzed clinical studies, meta-analyses and.data published by European Medicines Agency, it has been determined, that the main risk factors for VTE are duration of treatment and patient-related factors, such as gender, age, body mass, and physical activity. Current data do not allow to identify the prothrombotic potential for individual APs or indicate a higher risk for developing VTE in patients treated ' with newer atypical APs. Due to the complex pathogenesis of VTE it would benecessaryto perform large, comparative studies, allowing to identify precisely differences in prothrombotic potential of individual APs. It is necessary to specify products with the lowest VTE risk, what would be useful in the treatment of high-risk patients. All patients treated with APs should be assessed with the risk ofVTE and, if needed, appropriate prevention methods (including most of all the elimination of modifiable risk factors) should be implemented. Moreover, patients should be educated in scope of VTE prodromal symptoms. All patients with the higher VTE risk should be diagnosed as soon as possible and adequate treatment should be implemented.

Despite the fact that the group of sexual offenders remains a population which is still difficult to study, the results of current research are considered novel and interesting. Surprisingly, the very old descriptions applying to paraphilia, which is considered to be one of the reasons of sexual offences, appear to be accurate, especially in the context of similarities between impulsivity and pathologic sexual behaviors. Notably, the nomenclature concerning impulsivity enables a specific and reasonable description of behaviors associated with sexual offences. Moreover, the results of research studies show that it is the lack of inhibition, not pathologic arousal, which is the most important factor in the pathogenesis of forbidden sexual behaviors. In addition, it has been shown that behavioral manifestations of impulsivity (substance abuse, suicide attempts) appear commonly in sexual offenders. Mutual relationships between alcohol drinking, suicide attempts, history of child sexual abuse and sexual offences, both in symptomatologic and etiologic aspect, raise a suggestion that all these phenomena may share a common background of poor inhibitory control.

Alcohol use is considered to be one of the major factors contributing to global health burden as well as social and economic harm. Only about 16% of alcohol dependent individuals enter addiction treatment programs in Poland, with only a few more in Western Europe. The aim of the paper was to present two main treatment strategies of alcohol dependence: total abstinence and harm reduction. The advantages and disadvantages of both treatment goals are presented, pointing to a possibility of treating them as complementary strategies. A need to choose a proper, personalised patient-oriented aim of a treatment program is emphasised, with an option to revise the objective during long-term therapy. The paper describes implications from investigating the problem of alcohol dependence from a population health perspective. The surprisingly high amount of individuals remitting spontaneously from alcohol dependence without treatment is also discussed, and a possible bias resulting from analysing data on alcoholic subjects coming only from addiction centres, not from general population is taken into consideration. In the second part of the paper, American as well as British alcohol treatment guidelines are presented.

Unlabelled: Depression is one of the most severe health issues of the modern medicine. One of the most troublesome symptoms of depression is pain. On the other hand, patients suffering from chronic pain problems are also often subjects of mood or anxiety disorders. There are still very little studies in the field of co-occurrence of these two symptoms and therefore there are no universal standards to deal with such cases., Aim: The aim of this study was to evaluate the relationship between symptoms of depression and pain., Method: The study consisted of 3726 female and 2116 male participants, all patients of Mental Health and Neurological clinics. The mean age of the patients was 47 years. A structured questionnaire was used including data about demographics, Depression, Anxiety, and Pain Severity Scales., Results: The data analysis revealed statistically significant relationship between severity of pain and depression, anxiety as well as suicidal thoughts. The study also revealed a high correlation between severity of mood disorders and the severity of pain., Conclusions: The patients with a long history of pain disorders have also an increase of depression and anxiety symptoms, and suicidal thoughts. Patients with more severe depression and anxiety symptoms have also an increase of pain problems. There is significant relationship between depression and pain symptoms, as well as between pain and suicidal thoughts.

Aim: The aim of the study was to identify risk factors of relapse by investigating relationships among suicidality, impulsivity, genetic markers of serotonin activity, and relapse in alcohol-dependent patients., Methods: 90 alcohol dependent patients were followed for 12 months after the baseline assessment, which entailed evaluation of suicidality and impulsivity as well as collection of DNA samples. Polymorphisms of genes involved in the synthesis and activity of the serotonin system were analyzed. After 12 months from the first visit, the patients were re-contacted and interviewed for relapse., Results: Relapse rates were significantly higher among patients with the history of suicidal attempts recorded at the baseline assessment. The genetic analysis showed that patients with the G/G genotype in the 5HTR1A gene were more likely to relapse, whereas patients with the C/C genotype were more likely to abstain. Moreover, there was a strong trend for an association between the G/G genotype and a history of suicide attempts., Conclusions: High level of suicidality may predict relapse in alcoholic patients. Altered serotonergic function increases the risk of a suicide attempt and may contribute to higher risk of relapse in alcohol dependent patients.

Aim: The aim of the study was to evaluate the prevalence of depressive disorders in perimenopausal women reporting to gynecologists and to assess a possibility of screening and diagnosing depression in gynecological practice., Method: The study entailed 2262 female patients of the age of 45-55 attending 120 gynecologists in Poland. Patients were first asked to fill in the Beck's Depression Inventory and next examined by their gynecologists to verify the presence of the basic symptoms of depressive episode according to ICD-10 diagnostic criteria. Patients who obtained 12 points or more in BDI total score were referred for a psychiatric consultation, including the MINI questionnaire. The study was monitored by 'Servier Polska'., Results: 32.5% of women aged 45-55 years visiting gynecologists scored 12 points or more on the BDI scale. Patients with high BDI scores reported long-lasting somatic and emotional symptoms associated with menopause more frequently than patients with low BDI scores. Women with high BDI scores also more frequently experienced gynecological surgery in the past, more frequently attended gynecological clinics, and reported more peri- and postmatal mood disorders. 57% of patients did not visit psychiatrists. Depressive disorders were diagnosed in 76% of patients who came for the psychiatric evaluation., Conclusions: The study suggests that more than 19% of perimenopausal women attending their gynecologists suffer from depressive disorders. Gynecologists in Poland can diagnose depression accurately and start pharmacological treatment of the disorder in half of the patients.

The development of the social network and social support assessment method designed by Bizoń is concisely outlined. The final version of the measurement method is described and all its components are presented in the appendix. It consists of the Interview Questionnaire, including Social Support Inventory, the Map of Social Network, the List of Social Network, Table of the data coding and Questionnaire of Demographic Data. The main studies with this instrument are reviewed. They indicate that Bizoń's method is a helpful diagnostic tool and has some advantages in comparison with similar methods applied in the studies of social support.

The paper describes an instrument for presentation of content of delusions, which thanks to its synthetic graphic form, leads to improved systematization and understanding of delusional beliefs.

The authors present a review of literature on the initial rationale and efficacy in clinical trials of carbamazepine (CBZ) in the treatment of alcohol withdrawal, and the pharmacokinetics of carbamazepine in alcoholics as well. Neurophysiological and clinical studies support the kindling hypothesis in the pathophysiology of alcohol withdrawal. The exact physiological action mechanism of CBZ has not been entirely examined. However, the "antikindling effects" are of particular importance in epilepsy and other neurological and psychiatric conditions. Numerous controlled studies were able to demonstrate the effectiveness of carbamazepine in the treatment of alcohol withdrawal symptoms and have compared its properties to other drugs such as clomethiazole and benzodiazepines. Carbamazepine could be a useful alternative to conventional therapeutic approaches, especially in the treatment of mild and moderate alcohol withdrawal symptoms, and alcohol withdrawal with generalized tonic-clonic seizures.

Among the present pathogenetic hypotheses of delusions the cognitive model based on the attribution theory presents interesting assumptions. The attribution theory describes the ways in which we explain causes of events and human behaviour from the point of view of common sense psychology, as well as biases found in explaining everyday events, known as attribution errors. One of them is self-serving bias, which protects self-esteem and distorts attribution processes. Kaney, Bentall and co-workers revealed the defensive attributional style in the patients with persecutory delusions and after empirical research they suggested that delusions are the extreme forms of self-serving bias. After presenting the studies of Kaney-Bentall the authors of the article express their doubts regarding attributional hypothesis of persecutory delusions.

The article presents a psychotherapeutic and spiritual approach to psychotic patients. Theoretical assumptions and a practical application (implementation and results) are described on the basis of ten years' experience with an open religious group at the Psychiatric Department of Warsaw Medical School.