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Melatonin (MELA) is a nocturnal hormone involved in the regulation of the circadian rhythm. MELA can be detected in plasma and saliva, and its salivary concentration strongly correlates with its plasma concentration. Dim light melatonin onset (DLMO) is considered to be the most accurate objective marker for assessing the circadian phase. The purpose of the study was to establish a method for the determination of MELA in plasma and saliva based on the liquid chromatography with tandem mass spectrometry (LC-MS/MS) and compare DLMO using both plasma and saliva matrices. The validation of the LC-MS/MS methods was performed in accordance with the European Medicines Agency (EMA) guideline. The study was conducted on a group of 21 volunteers, male and females, aged 26-54 years. Plasma and saliva were collected at five time points: between 20:00 and 00:00 hours. The MELA concentration was determined by the LC-MS/MS. The DLMO was considered as the point in time when MELA concentration exceeds 20 pg/mL in plasma and 7 pg/mL in saliva. The correlation coefficient between the plasma and salivary MELA concentration was r = 0.764 (

Sedatywne leki przeciwdepresyjne są często stosowanymi lekami w leczeniu bezsenności. Cześć z zaleceń jako leki o udowodnionej skuteczności w leczeniu zaburzeń zasypiania i utrzymania snu wskazuje jednak głównie leki nasenne. Celem artykułu było porównanie wpływu na sen leków nasennych i trazodonu oraz analiza wskazań do stosowania trazodonu w leczeniu chorych zgłaszających się do lekarza z powodu bezsenności. Zidentyfikowano trzy badania oceniające wpływ trazodonu na sen w bezsenności, 5 badań w bezsenności w przebiegu zaburzeń afektywnych i 6 badań w innych wskazaniach (PTSD, choroba Alzheimera, uzależnienie od alkoholu i opiatów, zaburzenia pod postacią somatyczną, bezsenność w ciąży). W leczeniu bezsenności trazodon ustępuje lekom nasennym w sile i szybkości indukowania snu (zasypiania). W tym wskazaniu musi być podawany wcześniej niż leki nasenne, co najmniej 1 godzinę przed planowaną porą snu. Jest natomiast skuteczny w leczeniu zaburzeń utrzymania snu, szczególnie u chorych z współistniejącymi zaburzeniami psychicznymi lub leczonych aktywizującymi lekami przeciwdepresyjnymi. Leki nasenne i trazodon mają przeciwny efekt na sen głęboki. Trazodon zwiększa długość snu głębokiego, co powiązane jest z odczuwaniem przez pacjentów poprawy jakości snu. Natomiast leki nasenne zmniejszają aktywność fal wolnych w EEG snu, która jest biologicznym markerem głębokości snu. Głównym mechanizmem, w którym trazodon promuje sen jest silne antagonistyczne działanie na receptory serotoninowe 5-HT2, podczas gdy dla leków nasennych jest nim agonistyczne działanie na receptory kwasu gama-aminomasłowego GABAA, a innych sedatywnych leków przeciwdepresyjnych blokowanie receptorów histaminowych H1. Ten mechanizm działania związany jest z niskim ryzykiem przyrostu masy ciała, który rzadko jest obserwowany w trakcie leczenia trazodonem.

A high risk of obstructive sleep apnea (OSA) has been reported in patients with schizophrenia. However, existing screening questionnaires for OSA haven't been validated in this population and the impact of OSA on schizophrenia symptoms has rarely been studied. This study aimed to investigate the prevalence and impact of OSA in patients with schizophrenia and validate the existing OSA screening scales.Patients with schizophrenia consecutively admitted to hospital (n = 51) and patients with schizophrenia and obesity (n = 31) were compared to healthy controls (n = 51). Apnea risk was measured with STOP-BANG, NoSAS, No-Apnea, and the Berlin Questionnaire; psychiatric symptoms were measured with the PANSS and Calgary scales and B-CATS battery. Daytime sleepiness was measured with the Epworth sleepiness scale. OSA was diagnosed using the Embletta system.OSA was found more frequently in obese schizophrenia patients than in those consecutively admitted to hospital (45% vs. 22%, p 0.05). Significant differences between patients with and without OSA were found on the PANSS negative symptoms subscale, B-CATS digit symbol test, and in daytime sleepiness. None of the used screening scales showed satisfactory sensitivity and specificity. Obesity with coexisting neck circumference ≥41 cm in women or ≥43 cm in men (BMI-NECK model) predicted OSA in 57% of cases.OSA should be screened in patients with schizophrenia as it has a negative influence on psychiatric symptoms and may contribute to the higher mortality of these patients. Assessment of BMI and neck circumference proves a good screening test in ambulatory contexts.

Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression. Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic. Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity. Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key points Depression in the working population and depression-related sick leave have a profound economic impact on society Depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions A wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to work In terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapy Although depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measures Depression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.

Sleep reactivity to stress is a predisposition to experience sleep disturbances in response to stress. The present study aimed to examine the potential moderating role of sleep reactivity to stress in the relationship between the number of night shifts per month as a stressor and insomnia symptoms. A total of 188 shift-working physicians completed a short questionnaire about work schedule, the Ford Insomnia Response to Stress and the Insomnia Severity Index. Sleep reactivity to stress was a significant moderator of the effect of number of nights worked in the last month on insomnia symptoms. At low and medium sleep reactivity to stress the relationship between the number of night shifts per month and insomnia symptoms was positive and significant. At high sleep reactivity to stress the relationship was no longer significant. The results show that with low and medium sleep reactivity to stress, the more night shifts a person works per month, the more severe insomnia symptoms they will report. With high sleep reactivity to stress even a low number of night shifts per month will lead to a deterioration of sleep. This is important for identifying those who are more vulnerable to adverse consequences of working in the shift system, and the knowledge of workers' sleep reactivity to stress may help in providing targeted interventions.

Numerous studies have shown dysfunctional mechanism of interaction between bottom-up emotional and top-down cognitive processes in persons with schizophrenia (SCZ). During the emotional directed forgetting (DF) paradigm participants have to apply volitional mechanisms to resist automatic emotional enhancement of the memory. Here we sought to compare mechanisms underlying emotional DF in SCZ and in healthy persons (HC). Eighteen SCZ and eighteen HC completed a DF paradigm with neutral and negative pictures. EEG was recorded during study and test phase of the task. We analyzed both the behavioral outcomes and event-related potential components, indicating emotional enhancement of memory (Late Positive Potential elicited by pictures) and DF strategies (N2/P3 elicited by forget/remember cues during study-phase; “old/new” and “reversed old/new” effects during test-phase of the task). Directed forgetting effects and emotional enhancement of memory were observed in both groups, even despite overall lower recognition rates in SCZ. Furthermore, cue presentation elicited similar pattern of N2/P3s in SCZ and in HC. However, “reversed old/new” effect was observed only in HC for negative stimuli. Patients may show similar reaction to affective stimuli as healthy controls during the emotional DF task. However, further investigation is needed to elicit the specific mechanisms underlying the DF strategies in SCZ.

Melatonin is registered to treat circadian rhythm sleep–wake disorders and insomnia in patients aged 55 years and over. The essential role of the circadian sleep rhythm in the deterioration of sleep quality during COVID-19 confinement and the lack of an adverse effect of melatonin on respiratory drive indicate that melatonin has the potential to be a recommended treatment for sleep disturbances related to COVID-19. This review article describes the effects of melatonin additional to its sleep-related effects, which make this drug an attractive therapeutic option for treating patients with COVID-19. The preclinical data suggest that melatonin may inhibit COVID-19 progression. It may lower the risk of the entrance of the SARS-CoV-2 virus into cells, reduce uncontrolled hyper-inflammation and the activation of immune cells, limit the damage of tissues and multiorgan failure due to the action of free radicals, and reduce ventilator-induced lung injury and the risk of disability resulting from fibrotic changes within the lungs. Melatonin may also increase the efficacy of COVID-19 vaccination. The high safety profile of melatonin and its potential anti-SARS-CoV-2 effects make this molecule a preferable drug for treating sleep disturbances in COVID-19 patients. However, randomized clinical trials are needed to verify the clinical usefulness of melatonin in the treatment of COVID-19.

Autism spectrum disorder in adults, especially high-functioning ones, is often difficult to differentiate from other mental disorders. Therefore, many adults with ASD are misdiagnosed, and their social difficulties are not adequately addressed. Moreover, frequent comorbid issues make diagnosis a challenging prospect. Most of the available screening and diagnostic tools rely on self-reporting, which can be a biased method. Weak Central Coherence is one of the main cognitive theories of ASD. According to research, individuals with ASD are slower in comparison to typically developed control on the uptake of context. The study goal was to see if the central coherence tasks could be used as a reliable screening marker that differentiates between high-functioning ASD and typically developed controls.Thirty males with ASD (as in DSM-5) and 30 demographically matched controls were investigated with Central Coherence Inferences Tests. Tests' scores and reaction times needed to complete the tasks in both groups were compared.High-functioning participants with ASD achieved a similar score in central coherence tests as the typically developed control group, but they needed significantly more time to solve them. The ROC analysis for both central coherence tests revealed AUC values of 0.73 in differentiating ASD from typically developed controls.The results are discussed in reference to the clinical application of central coherence as a possible screening marker. Further research directions are proposed in terms of differential diagnosis of adults with ASD.

Physicians belong to the risk group for sleep disorders as a result of work related stress, excessive working time, large amount of on-call duties and shift work. Poor sleep quality of healthcare providers threatens not only their safety, but also the safety of their patients. This study examines if there are any differences in how working either long hours or at night duties relates to self-reported sleep time, sleep quality and daytime sleepiness in primary care physicians. We analyzed data from a survey research of 807 participants. Respondents were divided into four groups based on their reported work hours per week and number of nights on duty per month. Overtime was associated with shorter sleep time and worse subjective sleep quality even when compared with that of participants who work on night duties. All investigated groups of participants reported short sleep latencies which suggests that sleep debt is a common problem in this population. Surprisingly in the case of poor sleep quality participants rarely used recommended methods like regular physical activity or specialist advice. The most frequently reported answer was that they do nothing to improve sleep and every third participants uses hypnotics to do that. These results suggest that primary care physicians despite being at high risk for sleep disorders due to working overtime and at night, pay less attention to their sleep quality and do not use recommended strategies to improve it.

The neurophysiological components that have been proposed as biomarkers or as endophenotypes for schizophrenia can be measured through electroencephalography (EEG) and magnetoencephalography (MEG), transcranial magnetic stimulation (TMS), polysomnography (PSG), registration of event-related potentials (ERPs), assessment of smooth pursuit eye movements (SPEM) and antisaccade paradigms. Most of them demonstrate deficits in schizophrenia, show at least moderate stability over time and do not depend on clinical status, which means that they fulfil the criteria as valid endophenotypes for genetic studies. Deficits in cortical inhibition and plasticity measured using non-invasive brain stimulation techniques seem promising markers of outcome and prognosis. However the utility of these markers as biomarkers for predicting conversion to psychosis, response to treatments, or for tracking disease progression needs to be further studied.

Cel: Zaburzenia rytmu okołodobowego snu i czuwania (CRSWD) to grupa zaburzeń, w których pory snu istotnie odbiegają od oczekiwań pacjentów lub od akceptowanych społecznie pór snu i czuwania. Celem artykułu jest przedstawienie zasad rozpoznawania i leczenia CRSWD u dorosłych i u dzieci. Metoda: Zalecenia proponowane jako standard leczenia CRSWD powstały w oparciu o analizę zaleceń towarzystw naukowych związanych z badaniami nad snem i medycyną snu. Do udziału w przygotowaniu zaleceń zostały zaproszone, przez Zarządy Polskiego Towarzystwa Badań nad Snem i Sekcji Psychiatrii Biologicznej Polskiego Towarzystwa Psychiatrycznego, osoby posiadające znaczący dorobek naukowy dotyczący badań nad rytmem okołodobowym i/lub wieloletnie doświadczenie kliniczne w leczeniu jego zaburzeń. Na ostateczną formę zaleceń istotny wpływ miały też uwagi nadesłane przez członków Towarzystwa i Sekcji. Wyniki: Pacjenci z endogennymi CRSWD są często leczeni z rozpoznaniem bezsenności lub nadmiernej senności i nie otrzymują właściwego leczenia. W ramach diagnostyki każdemu pacjentowi zgłaszającemu zaburzenia snu i czuwania , konieczne jest zadanie pytań o jakość oraz pory snu w dni wolne od zajęć obowiązkowych (praca, nauka). Diagnozę CRSWD umożliwia także użycie dzienników/rejestrów snu oraz aktygrafii. Leczeniem z wyboru jest chronoterapia polegająca na stosowaniu melatoniny, fototerapii i oddziaływań behawioralnych. Zaburzenia związane z pracą zmianową i zmianą strefy czasu są narastającym problemem zdrowotnym. Interwencje w tych zaburzeniach powinny koncentrować się przede wszystkim na zapobieganiu ich powstawania. Wnioski: Najważniejszym problemem w leczeniu CRSWD jest brak ich właściwego rozpoznawania przez lekarzy. Zamiast interwencji chronoterapeutycznych często stosowane są leki nasenne i/lub psychostymulujące, które mogą łagodzić objawy, ale nie są skuteczną formą leczenia.

Cel pracyPrzezczaszkowa stymulacja magnetyczna serią bodźców (ang. repetitive transcranial magnetic stiumlation – rTMS) poprawia nastrój u chorych na depresję. Obecne badanie miało odpowiedzieć na pytanie czy rTMS wpływa także na bezsenność towarzyszącą depresji.MetodaZbadano 13 chorych (średni wiek 50,6 ±13,9; 11 kobiet) z rozpoznaniem zaburzeń depresyjnych nawracających i zaburzeń afektywnych dwubiegunowych. Chorzy zostali poddani dwudziestu, codziennym sesjom rTMS nad okolicą kory przedczołowej grzbietowo-bocznej po stronie lewej (ang. dorsolateral prefrontal cortex – DLPFC) o częstotliwości 10Hz. Efekt stymulacji mierzono za pomocą Skali Ogólnej Oceny Klinicznej (ang. Clinical Global Impression – CGI), 21-punktowej Skali Depresji Hamiltona (ang. 21-item Hamilton Depression Rating Scale - HDRS), Ateńskiej Skali Bezsenności (ang. Athens Insomnia Scale AIS) oraz za pomocą dzienniczka snu i badania aktygraficznego.WynikiPo rTMS obserwowano istotny spadek punktacji w CGI, w generalnej punktacji HDRS oraz w punktach HDRS dotyczących jakości snu. AIS wykazała trend w kierunku redukcji liczby punktów. Nie obserwowano zmian w zakresie dzienniczka snu i aktygrafii.WnioskiBadanie potwierdziło korzystny wpływ rTMS na nastrój w depresji. Pozostałe wyniki sugerują, że rTMS o wysokiej częstotliwości nad lewą DLPFC nie wykazuje znacznego wpływu na jakość snu u chorych na depresję. Dodatkowe metody terapeutyczne lub modyfikacja protokołu rTMS powinny zostać rozważone celem poprawy bezsenności u chorych z depresją.

Cel: W organizmie człowieka większość procesów przebiega w sposób rytmiczny. Wśród rytmów biologicznych istotną grupę stanowią rytmy o okresie zbliżonym do 24 godzin czyli rytmy okołodobowe, których zaburzenia wywołują szereg negatywnych skutków w funkcjonowaniu człowieka. Celem artykułu jest przedstawienie aktualnego stanu wiedzy na temat fizjologii rytmów okołodobowych, zaburzeń rytmu okołodobowego snu i czuwania (CRSWD), zasad ich oceny oraz stosowania chronobiologicznych oddziaływań terapeutycznych. Metoda: Zalecenia proponowane jako standard leczenia CRSWD powstały w oparciu o analizę zaleceń towarzystw naukowych, związanych z badaniami nad snem i medycyną snu oraz opinie autorów. Do udziału w przygotowaniu zaleceń zostały zaproszone przez Zarządy Polskiego Towarzystwa Badań nad Snem i Sekcji Psychiatrii Biologicznej Polskiego Towarzystwa Psychiatrycznego osoby posiadające znaczący dorobek naukowy dotyczący badań nad rytmem okołodobowym i/lub wieloletnie doświadczenie kliniczne w leczeniu jego zaburzeń. Dodatkowo na ostateczną formę opublikowanych zaleceń istotny wpływ miały uwagi nadesłane przez członków Towarzystwa i Sekcji. Wyniki: Rytm okołodobowy snu i czuwania ma kluczowe znaczenie dla zdrowia i funkcjonowania człowieka. Podstawową formą oceny CRSWD są rejestry i dzienniki snu, zalecane jest również stosowanie aktygrafii. Dostępne są skuteczne metody leczenia CRSWD, z których najlepiej udokumentowane działanie ma stosowanie melatoniny i fototerapii. Istotne są również oddziaływania behawioralne. Wnioski: Ocena rytmu snu i czuwania w CRSWD przez okres co najmniej 14 dni umożliwia właściwą diagnozę CRSWD, dobór odpowiednich oddziaływań chronobiologicznych oraz zaplanowanie pory ich stosowania. Przeprowadzenie takiej oceny jest stosunkowo łatwe i mało kosztowne a dostarcza cennych informacji, pozwalających zaplanować postępowanie terapeutyczne we właściwej fazie rytmu danego pacjenta.

Objective:This study aimed to screen young adults for sleep-disordered breathing, and compare those with high and low risk for sleep-disordered breathing.Methods:A survey based on the Berlin questionnaire was completed by 330 university students, and the results were used to divide them into sleep-disordered breathing positive and sleep-disordered breathing negative groups. A representative group was selected from each cohort (positive group,n= 16; negative group,n= 21), and assessed with sleep study, ENT examination, the Nose Obstruction Symptom Evaluation scale, and the Epworth Sleepiness Scale.Results:Sleep-disordered breathing prevalence was 11.2 per cent in the questionnaire and 24 per cent according to the sleep study. The sleep-disordered breathing positive and negative groups significantly differed in terms of coexisting sleep-disordered breathing symptoms. There were no significant differences between the positive and negative groups with regard to sleep study parameters (apnoea/hypopnoea index, respiratory disturbance index, oxygen desaturation index, snoring intensity) and the Epworth Sleepiness Scale.Conclusion:Subjective and objective diagnostic tools revealed that sleep-disordered breathing is a common problem among young adults.

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT‐I) should be the first‐line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT‐I Academy that would enable a Europe‐wide system of standardized CBT‐I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT‐I, preconditions for health professionals to teach CBT‐I, the way in which CBT‐I should be taught, who should be taught CBT‐I and to whom CBT‐I should be administered. Furthermore, diverse aspects of CBT‐I care and delivery were discussed and incorporated into a stepped‐care model for insomnia. publishedVersion

Objective The aim of the study was to investigate the prevalence of difficulty with initiation or maintenance of sleep (DIMS) and excessive daytime sleepiness (EDS) in a general pediatric population, and to evaluate the relationship between these conditions and sleep-disordered breathing (SDB) symptom intensity. Methods This population-based cross-sectional study from 27 primary schools in a medium-sized city in Poland was based on use of a questionnaire regarding demographic data, symptoms of SDB, DIMS, and EDS. Data were collected between September and December 2014. In all, 2940 caregivers were recruited and were asked to fill-out questionnaires and written consent. Results A total of 68% of the questionnaires (n = 1987) were returned and analyzed. Habitual snoring (HS) was reported in 104 (5.3%) children. DIMS and EDS were seen in 137 children (6.9%) and 117 children (5.9%), respectively. The prevalence of DIMS increased from 3.5% in children who never snored to 28.6% in children who snored very often or always. Similarly, the prevalence of EDS was 2.7% in children who did not snore and increased to 19% in children who snored very often or always. No correlation was seen between increasing DIMS (r = 0.006, p > 0.05) or EDS (r = −0.031, p > 0.05) scores and body mass index. Conclusions This study is the first to measure the symptoms of both DIMS and EDS in a general pediatric population and to assess the relationship between both DIMS and EDS and SDB in children. We found that children with more frequent snoring had a higher prevalence of DIMS as well as EDS; however, there was no correlation between body mass index and either DIMS or EDS symptom severity.

Quantitative electroencephalogram analysis (e.g. spectral analysis) has become an important tool in sleep research and sleep medicine. However, reliable results are only obtained if artefacts are removed or excluded. Artefact detection is often performed manually during sleep stage scoring, which is time consuming and prevents application to large datasets. We aimed to test the performance of mostly simple algorithms of artefact detection in polysomnographic recordings, derive optimal parameters and test their generalization capacity. We implemented 14 different artefact detection methods, optimized parameters for derivation C3A2 using receiver operator characteristic curves of 32 recordings, and validated them on 21 recordings of healthy participants and 10 recordings of patients (different laboratory) and considered the methods as generalizable. We also compared average power density spectra with artefacts excluded based on algorithms and expert scoring. Analyses were performed retrospectively. We could reliably identify artefact contaminated epochs in sleep electroencephalogram recordings of two laboratories (healthy participants and patients) reaching good sensitivity (specificity 0.9) with most algorithms. The best performance was obtained using fixed thresholds of the electroencephalogram slope, high-frequency power (25-90 Hz or 45-90 Hz) and residuals of adaptive autoregressive models. Artefacts in electroencephalogram data can be reliably excluded by simple algorithms with good performance, and average electroencephalogram power density spectra with artefact exclusion based on algorithms and manual scoring are very similar in the frequency range relevant for most applications in sleep research and sleep medicine, allowing application to large datasets as needed to address questions related to genetics, epidemiology or precision medicine.

Restless legs syndrome (RLS) is one of the most common sleep disorders. The purpose of this paper is a case description of the patient suffering from RLS, concurrent with numerous clinical problems. In our patient, during long-term therapy with a dopamine agonist (ropinirole), the phenomenon of the augmentation, defined as an increase in the severity of the RLS symptoms, was observed. The quality of life of the patient was significantly deteriorated. Due to the augmentation of RLS symptoms the dopaminergic drug was gradually withdrawn, and the gabapentin as a second-line drug for the treatment of RLS was introduced. Because of the large increase of both insomnia and RLS symptoms during the reduction of ropinirole dose, clonazepam was temporarily introduced. In addition, in the neurological assessment of the distal parts of the lower limb sensory disturbances of vibration were found. The neurographic study confirmed axonal neuropathy of the sural nerves, which explained an incomplete response to dopaminergic medications. However, gabapentin treatment in the dose recommended in neuropathies was impossible due to bothersome side effects. Another important issue in the treatment of the patient were depressive symptoms and the fact that the majority of used antidepressants (mirtazapine, mianserin, tricyclic antidepressants) increase the severity of RLS. Among antidepressants recommended for the treatment of depression in patients with RLS (such as bupropion, moclobemide, reboxetine, tianeptine and agomelatine) only agomelatine exhibits promoting sleep properties. Because of the concomitant insomnia, this drug was applied in our patient.

Leki przeciwpsychotyczne o przedłużonym działaniu (LAI) są cenną alternatywą w leczeniu zaburzeń psychotycznych, głównie schizofrenii. Zapewniają bardziej stabilny poziom leku, poprawiają współpracę w leczeniu, zwiększają szanse na dobra i trwałą poprawę. Ich stosowanie zmniejsza także niepokój otoczenia chorego o to czy pacjent stosuje się do zaleceń lekarskich. Uważa się, że wahania poziomu leku nie sprzyjają utrzymaniu długotrwałej poprawy klinicznej, a więc zwiększają ryzyko pogorszenia stanu zdrowia pacjenta, w tym nawrotu psychozy lub ryzyka hospitalizacji, zwiększają ryzyko występowania uciążliwych dla chorego objawów ubocznych. Mylne jest dość powszechne przekonanie, że LAI stosuje się jedynie dlatego, aby uniknąć złej współpracy chorego przy leczeniu przeciwpsychotycznym. Stosowanie LAI nie jest tylko i wyłącznie inną formą podawania leku przeciwpsychotycznego. Leki przeciwpsychotyczne drugiej generacji i przedłużonym działaniu łączą korzyści wynikające z atypowości leku z korzyściami leków długodziałających. Omówiono cztery leki przeciwpsychotyczne II generacji stosowane w formie o przedłużonym działaniu: risperidon, olanzapinę, aripiprazol i paliperidon. Omówiono wskazania, zasady leczenia w tym praktyczne wskazówki stosowania tych leków, tolerancję oraz potencjalne interakcje tych leków.

Introduction One of the common side effects of antipsychotic drugs is excessive sedation. The treatment with antipsychotics often manifests as an increase in slow wave activity in electroencephalography (EEG). The aim of this study was to analyze EEG recordings of patients treated with a non-sedative antipsychotic drug sertindole with regard to its adverse effects and clinical efficacy. Patients and methods EEG recordings of 45 patients (27 females, mean age 30.1±8.7 years) with schizophrenia were analyzed. EEG recordings were categorized based on abnormalities severity. The clinical efficacy was rated on the Clinical Global Impression Scale. Results Abnormalities from mild to moderate were found in 29% of the group. Clinical improvement was observed in 80% of patients. Sedation/daytime sleepiness was present in 7% of patients. Other side effects were prolongation of QTc (11%, severe 4%), insomnia (9%), extrapyramidal symptoms (7%), and heart palpitations (2%). Conclusions Patients treated with sertindole do not show side effects similar to those found during treatment with other antipsychotic drugs. Increased slow wave activity in EEG and sedation were absent in the majority of the investigated patients.

Work and social functioning in schizophrenia are strongly influenced by cognitive impairment so improving cognition is a priority in the treatment of schizophrenia. Until recently the lack of a widely accepted index of cognitive change for use in schizophrenia was a major obstacle to the development of cognition enhancing treatments. The MATRICS (measurement and treatment research to improve cognition in schizophrenia) consensus cognitive battery (MCCB) was developed as a standard cognitive battery for use in clinical trials of cognition enhancing treatments for schizophrenia and has attracted worldwide interest. To analyze the reliability and validity of a translated and adapted Polish approved academic version of the MCCB. Sixty one patients were assessed at baseline and again after 30 days. The study protocol approximated the MATRICS psychometric and standardization study; the 10 tests that comprise the MCCB were administered to participants. Functioning and psychopathological symptoms were also assessed. Patients and test administrators also assessed the tolerability and practicality of all the cognitive tests. All tests in the battery were found to have high test-retest reliability. All the tests were rated as tolerable and practical by patients and administrators. However practice effects were generally higher in the Polish version of the MCCB than in the original version. Our analysis corroborates previous evidence that the MCCB represents a good tool for assessing cognitive deficits in research studies of schizophrenia also in non-English speaking countries.

Introduction: Sleep-promoting antidepressants are of interest because they are used not only as antidepressants, but also to promote sleep. Methods: We reviewed case reports describing the switch to mania during treatment with trazodone, mirtazapine, or agomelatine. Results: Trazodone, mirtazapine, and agomelatine may induce manic symptoms. However, the risk of switching is related, first of all, to doses recommended for antidepressant treatment, administered without mood-stabilizer co-therapy. Low doses of these antidepressants, used for their hypnotic or sedative effects, were observed to cause mania only in patients with other risk factors for switching. There is no evidence for trazodone or mirtazapine and only sparse evidence for agomelatine, claiming that treatment with these antidepressants is related to an increased risk of switching to mania when administered in combination with a mood stabilizer. Discussion: These findings suggest that low doses of trazodone and mirtazapine are safe in bipolar disorder, and should still be considered important alternatives to hypnotics when long-term pharmacological treatment of insomnia is necessary. It seems that these antidepressants and agomelatine can also be used safely in antidepressant doses when combined with a mood stabilizer.

Purpose of Review The aim of this review article was to summarize recent publications on effects of antidepressants on sleep and to show that these effects not only depend on the kind of antidepressant drugs but are also related to the dose, the time of drug administration, and the duration of the treatment. Recent Findings Complaints of disrupted sleep are very common in patients suffering from depression, and they are listed among diagnostic criteria for this disorder. Moreover, midnocturnal insomnia is the most frequent residual symptom of depression. Thus, all antidepressants should normalize sleep. However, at least in short-term treatment, many antidepressants with so-called activating effects (e.g. fluoxetine, venlafaxine) may disrupt sleep, while others with sedative properties (e.g., doxepin, mirtazapine, trazodone) rapidly improve sleep, but may cause problems in long-term treatment due to oversedation.For sleep-promoting action, the best effects can frequently be achieved with a very low dose, administered early enough before bedtime and importantly, always as a part of more complex interventions based on the cognitive-behavioral protocol to treat insomnia (CBT-I). Summary For successful treatment of depression, it is necessary to understand the effects of antidepressants on sleep. Each physician should also be aware that some antidepressants may worsen or induce primary sleep disorders like restless legs syndrome, sleep bruxism, REM sleep behavior disorder, nightmares, and sleep apnea, which may result from an antidepressant-induced weight gain.

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate-to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (

Computerised cognitive remediation therapy (CCRT) has been shown to improve cognitive function in individuals with schizophrenia beyond effects of other forms of therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether or not this is a suitable site to start the therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in a psychiatric ward. A randomised controlled trial of CCRT versus an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The intervention lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in cognitive function and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This result shows that providing a drill and practice cognitive remediation to inpatients does not produce benefits for cognitive functioning substantially greater than other forms of therapy provided in a ward, but it is more efficient in reduction of negative symptoms. Our results suggest that CRT might be considered as a promising intervention for reducing negative symptoms in schizophrenia individuals.

CelOcena funkcjonowania poznawczego chorych na schizofrenię okazuje się pomocna przy rozpoznawaniu choroby, identyfikacji osób obarczonych ryzykiem niepomyślnego rokowania i doborze odpowiedniego rodzaju leczenia. Jest również ważnym uzupełnieniem diagnozy psychiatrycznej. Z tego powodu istnieje potrzeba dostępu do narzędzi pomiaru funkcji poznawczych o sprawdzonych właściwościach psychometrycznych, które zarazem są łatwe do stosowania w pracy klinicznej. Przedmiotem analiz i opisu był pomiar rzetelności i trafności psychometrycznej oraz ocena praktyczności zastosowania krótkiej baterii testów do oceny funkcjonowania poznawczego pacjentów z rozpoznaniem schizofrenii B-CATS (Brief Cognitive Assessment Tool for Schizophrenia) w warunkach praktyki całodobowego oddziału psychiatrycznego.Metoda68 pacjentów psychotycznych hospitalizowanych na oddziale psychiatrycznym przebadano dwukrotnie wykorzystując testy wchodzące w skład badanej baterii. W pierwszym pomiarze dokonano oceny stanu psychicznego i funkcjonowania pacjenta wykorzystując skale: PANSS, GAF, GARF, SOFAS, SLOF.WynikiBaterię B-CATS charakteryzuje zadowalająca stabilność względna. Stabilność bezwzględną należy uznać za satysfakcjonującą w przypadku jednego z testów: próby Fluencji. Bateria posiada satysfakcjonującą trafność diagnostyczną. Jest łatwa w zastosowaniu, „przyjazna” dla pacjenta.WnioskiOpisywana bateria testów jest szybkim i praktycznym narzędziem pozwalającym na trafną ocenę ogólnego poziomu funkcjonowania poznawczego pacjentów psychotycznych.

Nocturnal paroxysmal dystonia describes a syndrome consisting of recurrent motor episodes of dystonic-dyskinetic features arising from non-rapid eye movement (NREM) sleep. In the article, the authors present female case of nocturnal paroxysmal dystonia. The patient has had attacks since her childhood and was eventually diagnosed at the age of 48. Therapy with carbamazepine considerably reduced the frequency and entent of seizures. The present case evidences that nocturnal paroxysmal dystonia still is a diagnostic challenge for clinicians. Especially, we emphasize the importance of polysomnography in the verification of the diagnosis.

Metabolic disturbances are a growing concern for the treatment of schizophrenia. As decreased activity and poor sleep quality are risk factors for metabolic disturbances, we investigated the activity and sleep patterns of schizophrenic patients using actigraphy. Seventy-three patients with schizophrenia spectrum disorder (mean age 29.2 ± 10.2 years, 27 females) treated with olanzapine (n = 54) or risperidone (n = 19) and 36 age- and sex-matched healthy controls were examined. Actigraphic recordings were obtained throughout seven consecutive days. The Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS) were used to assess sleep and daytime sleepiness. Drug side effects were evaluated with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Barnes Akathisia Rating Scale (BARS). Mental status was rated with the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS). The patients had lower mean 24 h-activity (p 0.001) and mean 10 h-daytime-activity (p 0.001), and longer time in bed (p 0.001). Higher PANSS scores, especially in the negative symptoms scale, were related to lower activity (r(s) = -0.508, p 0.001). Higher depressive symptoms were related to lower mean 24 h-activity (r(s) = -0.233, p = 0.049), longer time in bed (r(s) = 0.315, p = 0.007) and higher AIS (r(s) = 0.377, p = 0.001) and ESS scores (r(s) = 0.321, p = 0.006). Healthy females presented higher activity than healthy males (p 0.001). Similar but not significant gender differences were observed in the patients. These findings show that patients with schizophrenia treated with olanzapine or risperidone exhibit low physical activity and altered sleep pattern which may promote metabolic side effects. These changes are linked to negative and depressive symptoms.

Objective To investigate whether the outcome of treatment with trazodone CR in primary insomnia differs between patients with and without subthreshold depression. Methods 14 patients (9 females, mean age 57.3 ± 13.3) with primary insomnia and increased Beck Depression Inventory (BDI) scores (> 10) and 15 sex- and age-matched patients with primary insomnia and low BDI scores (≤ 10) were treated with trazodone CR 25–150 mg/d for 3 months and followed for 1 month after discontinuation of the medication. The Athens Insomnia Scale (AIS), Sheehan Disability Scale (SDS), and Clinical Global Impression scale (CGI) were completed at baseline, after each month of treatment and after the first week of run-out phase. Additional assessment tools comprised sleep diaries, the Leeds Sleep Evaluation Questionnaire (LSEQ) and actigraphic recordings. Results Subjective sleep time increased by 61.5 ± 72.3 min in the group with low BDI and 60.0 ± 59.4 min in the group with increased BDI at the end of the treatment phase. The significant improvements were also observed in the AIS, CGI, LSEQ and SDS. During the run-out phase the improvement was sustained in patients with low BDI, while AIS scores, sleep latency and total sleep time deteriorated in patients with increased BDI. Conclusions Patients with subthreshold depression, even if the depressive symptoms do not fulfill the time criteria for depressive episode, show marked worsening of insomnia after discontinuation of sleep promoting medication.

Background Understanding the basis of sleep-related endophenotypes might help to pinpoint factors modulating susceptibility to psychiatric disorders. However, the genetic underpinnings of sleep microarchitecture in humans remain largely unknown. Here we report on the results of a classical twin study in monozygotic (MZ) and dizygotic (DZ) twin pairs examining the genetic effect on sleep electroencephalogram (EEG) composition. Methods Polysomnographic recordings were obtained in 35 pairs of MZ (26.4 ± 5.4 years, 17–43 years, 17 male pairs, 18 female pairs) and 14 same-gender pairs of DZ twins (22.1 ± 2.7 years, 18–26 years, 7 male pairs, 7 female pairs). The EEG power spectra were generated on the basis of Fast Fourier transformations combined with conventional sleep parameters, according to standardized criteria. Results We tested the genetic variance contributing to the observed overall variance of the sleep measures and found that the relative contributions of the δ, θ, α, and σ frequency bands at central derivations were significantly correlated to the genetic background. In these frequency bands, MZ twins also showed within-pair concordance in spectral power that was significantly higher than that of DZ twins. Conclusions The broad overlap of EEG frequencies during non-REM sleep and wakefulness, which shows a significant genetic variance, supports the hypothesis of common neuronal mechanisms generating EEG oscillations in humans. Our findings strongly support the suitability of the spectral composition of non-REM sleep for defining endophenotypes.

OBJECTIVE: Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD).METHODS: Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network.RESULTS: The present article (Part II) summarises findings on potential biomarkers in neurochemistry (neurotransmitters such as serotonin, norepinephrine, dopamine or GABA, neuropeptides such as cholecystokinin, neurokinins, atrial natriuretic peptide, or oxytocin, the HPA axis, neurotrophic factors such as NGF and BDNF, immunology and CO2 hypersensitivity), neurophysiology (EEG, heart rate variability) and neurocognition. The accompanying paper (Part I) focuses on neuroimaging and genetics.CONCLUSIONS: Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.

Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network.The present article (Part I) summarises findings on potential biomarkers in neuroimaging studies, including structural brain morphology, functional magnetic resonance imaging and techniques for measuring metabolic changes, including positron emission tomography and others. Furthermore, this review reports on the clinical and molecular genetic findings of family, twin, linkage, association and genome-wide association studies. Part II of the review focuses on neurochemistry, neurophysiology and neurocognition.Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high-quality research has accumulated that will improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.

Współcześnie niepłodność stanowi coraz bardziej rozpowszechniony problem medyczny i społeczny. Terapia niepłodności została zrewolucjonizowana poprzez wprowadzenie oraz ciągłe doskonalenie technologii rozrodu wspomaganego (ART). W większości krajów notuje się także stały wzrost częstości stosowania procedur z zakresu ART. Niepłodność, terapia niepłodności oraz zaburzenia psychiczne są ze sobą powiązane w bardzo złożony sposób. Większość badań wskazuje, że obecność zaburzeń psychicznych (a w tym najczęstszych pośród nich zaburzeń depresyjnych) u osób leczonych z powodu niepłodności, może wpływać na zmniejszenie skuteczności terapii ginekologicznej. Inne badania wskazują, że nieskuteczna terapia niepłodności, stanowi niezależny czynnik ryzyka rozwoju zaburzeń psychicznych (zwłaszcza zaburzeń psychotycznych oraz uzależnień). Mimo coraz większego rozpowszechnienia procedur rozrodu wspomaganego brak jest jednolitych standardów dotyczących psychologiczno-psychiatrycznego postępowania wspierającego terapię niepłodności oraz procedur postępowania w przypadku psychiatrycznych powikłań diagnozy i terapii niepłodności. Celem niniejszego opracowania było dokonanie analizy prac dotyczących psychiatrycznych aspektów terapii niepłodności pod kątem ich znaczenia dla postępowania klinicznego w zakresie pomocy psychiatryczno-psychologicznej wobec chorych leczonych z powodu niepłodności.

Streszczenie Częstość występowania obturacyjnego bezdechu sennego (OBS) ocenia się na 3-7,5% u mężczyzn i 2-3% u kobiet. U osób chorujących psychicznie jest ona jeszcze wyższa, ponieważ pacjenci ci stanowią grupę z wysokim ryzykiem występowania OBS. Celem opracowania jest przegląd piśmiennictwa na temat występowania bezdechu sennego u chorych na schizofrenię, chorobę afektywną dwubiegunową (CHAD) oraz zaburzenia depresyjne nawracające. Dostępne dane wskazują, że OBS występuje u 15-48% chorych na schizofrenię, 21-43% chorych na chorobę afektywną dwubiegunową i 11-18% pacjentów z zaburzeniami depresyjnymi nawracającymi. Brak rozpoznania OBS u osób chorujących psychicznie ma liczne negatywne konsekwencje. Objawy bezdechu sennego mogą imitować objawy zaburzeń psychicznych np. objawy depresji lub negatywne objawy schizofrenii, a także przyczyniać się do pogłębienia zaburzeń poznawczych. Część z leków stosowanych w leczeniu zaburzeń psychicznych może nasilać objawy OBS. OBS jest również czynnikiem ryzyka schorzeń sercowo-naczyniowych oraz zaburzeń metabolicznych, które są istotnym problem u osób chorujących psychicznie i przyczyniają się do skrócenia ich oczekiwanego czasu życia. Z punktu widzenia lekarzy zajmujących się leczeniem OBS, ważne jest zwrócenie uwagi na to, że objawy depresyjne są najczęstszą przyczyną tłumaczącą brak ustępowania nadmiernej senność u pacjentów skutecznie leczonych stałym dodatnim ciśnieniem oddechowym (CPAP). Terapia CPAP prowadzi do istotnej poprawy samopoczucia psychicznego, u chorych na schizofrenię i CHAD w nielicznych przypadkach może jednak prowadzić do nagłego pogorszenia stanu psychicznego, do zaostrzenia objawów psychotycznych w przebiegu schizofrenii lub zmiany fazy z depresyjnej na maniakalną w przebiegu CHAD.

Background Despite social cognitive dysfunction that may be observed in patients with schizophrenia, the knowledge about social and nonsocial affective processing in schizophrenia is scant. The aim of this study was to examine neurophysiological and behavioural responses to neutral and negative stimuli with (faces, people) and without (animals, objects) social content in schizophrenia. Methods Twenty-six patients with schizophrenia (SCZ) and 21 healthy controls (HC) completed a visual oddball paradigm with either negative or neutral pictures from the Nencki Affective Picture System (NAPS) as targets while EEG was recorded. Half of the stimuli within each category presented social content (faces, people). Results Negative stimuli with social content produced lower N2 amplitude and higher mean LPP than any other type of stimuli in both groups. Despite differences in behavioural ratings and alterations in ERP processing of affective stimuli (lack of EPN differentiation, decreased P3 to neutral stimuli) SCZ were still able to respond to specific categories of stimuli similarly to HC. Conclusions The pattern of results suggests that with no additional emotion-related task demands patients with schizophrenia may present similar attentional engagement with negative social stimuli as healthy controls.

CelOcena częstości występowania zaburzeń ciągłości snu u kobiet w okresie przekwitania, ocena zależności pomiędzy występowaniem zaburzeń ciągłości snu a stopniem nasilenia zespołu klimakterycznego i występowaniem poszczególnych objawów zespołu klimakterycznego, jak również ocena zależności pomiędzy występowaniem problemów ze snem a stężeniem gonadotropin, prolaktyny i hormonów płciowych w surowicy.MetodaZbadanych zostało 140 kobiet (średni wiek 54,4 ± 4,7 lat), które kolejno zgłosiły się do Kliniki Endokrynologii Ginekologicznej z powodu objawów zespołu klimakterycznego. Do oceny typu i nasilenia zaburzeń ciągłości snu użyto pytań o jakość snu ze Skali Depresji Hamiltona. Nasilenie objawów zespołu klimakterycznego oceniano przy użyciu indeksu Kuppermana. U wszystkich badanych oznaczono stężenia hormonów: follikulotropiny (FSH), lutropiny (LH), 17β-estradiolu, prolaktyny (PRL), testosteronu całkowitego, siarczanu dehydroepiandrosteronu (DHEAS) oraz globuliny wiążącej hormony płciowe (SHBG).WynikiSkargi na zaburzony sen były częste w zbadanej grupie kobiet. Zaburzenia zasypiania zgłosiło 57,8% kobiet, zaburzenia utrzymania snu 70% kobiet, zbyt wczesne wybudzenie poranne 60,7% kobiet. Nasilenie wszystkich trzech typów zaburzeń ciągłości snu powiązane było z nasileniem objawów zespołu klimakterycznego mierzonych indeksem Kuppermana (współczynniki korelacji Spearmana odpowiednio r=0,63, r=0,61, r=0,52). Zaburzenia utrzymania snu negatywnie korelowały ze stężeniem FSH, 17β-estradiolu oraz SHBG w surowicy krwi. Zaburzenia zasypiania negatywnie korelowały ze stężeniem 17β-estradiolu w surowicy krwi.WnioskiZaburzenia ciągłości snu są częstym i istotnym problemem zdrowotnym u kobiet w okresie przekwitania. Interwencje mające na celu zmniejszenie nasilenia zespołu klimakterycznego powinny być traktowane jako ważna część leczenia problemów ze snem u kobiet w tym okresie życia.

CelBadania epidemiologiczne wykazały, że niski poziom dehydroepiandrosteronu łączy się ze zwiększonym ryzykiem rozwoju zespołu metabolicznego. Celem badania była ocena, czy suplementacja dehydroepiandrosteronu w dawce 100mg/dobę u chorych na schizofrenię leczonych olanzapiną wpływa na antropometryczne oraz biochemiczne parametry zespołu metabolicznego.MetodaW dwunastotygodniowym badaniu, podwójnie ślepym, z randomizacją i kontrolą placebo uczestniczyło 55 chorych płci męskiej, z rozpoznaniem schizofrenii paranoidalnej, w wieku 21-59 lat. Otrzymywali oni dehydroepiandrosteron (DHEA) lub placebo w dawce 100mg, jako terapię dodaną do stabilnej dawki olanzapiny (średnio 15 mg/dobę). Oceniano efekty wpływu DHEA lub placebo na wartości lipidogramu, poziomu glikemii na czczo, BMI oraz obwodu pasa.WynikiBadanie ukończyło 45 chorych. Nie wykazano istotnych zmian w zakresie wartości cholesterolu całkowitego, cholesterolu HDL, cholesterolu LDL oraz trójglicerydów w obu podgrupach pacjentów, którzy ukończyli badanie. Wyniki analizy z powtarzalnymi pomiarami w układzie: poziom glikemii na czczo 2x tj. pomiar na początku i na końcu badania x 2 (grupa badawcza i kontrolna), wykazały znaczący efekt interakcji (F =5,7, df= 1,000 p= 0,021). Poziom glikemii znacząco zmalał w podgrupie DHEA. Dodatkowo obserwowano wzrost wartości obwodu pasa w cm (delta= -1,11, t=-2,87; df=20; p=0,01) oraz wartości BMI (delta= -0,48, t=-2,38; df=19; p=0,028) dla podgrupy placebo, przy braku zmian powyższych parametrów dla podgrupy DHEA.WnioskiSuplementacja dehydroepiandrosteronu może wywierać efekt stabilizujący wartości BMI, obwodu pasa oraz glikemii na czczo u chorych na schizofrenię leczonych olanzapiną. Potwierdzenie insulinopodobnego działania dehydroepiandorsteronu w grupie pacjentów ze schizofrenią wymaga jednak przeprowadzenia dalszych badań długoterminowych z zastosowaniem bardziej szczegółowych narzędzi z zakresu oceny biochemicznej metabolizmu glukozy.

Objective : This study addressed the relationship between daytime sleepiness and spectral composition of the preceding NREM sleep. Methods : Nineteen healthy volunteers (mean age: 36.5 years; SD: 10.1) underwent polysomnography during two consecutive nights and the multiple sleep latency test (MSLT) on the following day. Daytime sleepiness was also assessed by the Epworth sleepiness scale (ESS). The sleep recordings were visually scored according to standard criteria. The quantitative sleep EEG analysis was performed using a fast Fourier transform routine. The sleep parameters were compared between subjects with short and long MSLT sleep latencies (cut-off=10 min) and between subjects with low and high ESS scores (cut-off=6 points). Results : Subjects with short MSLT sleep latencies showed a reduced theta EEG activity. There was no evidence of reduced synchronization of sleep EEG in subjects with high ESS scores. Conclusions : Moderately increased daytime sleepiness as indicated by MSLT sleep latency less than 10 min is accompanied by decreased power of theta activity during NREM sleep indicating a deficit of sleep EEG synchronization.

The trait-like nature of electroencephalogram (EEG) is well established. Furthermore, EEG of wake and non-rapid eye movement (non-REM) sleep has been shown to be highly heritable. However, the genetic effects on REM sleep EEG microstructure are as yet unknown. REM sleep is of special interest since animal and human data suggest a connection between REM sleep abnormalities and the pathophysiology of psychiatric and neurological diseases. Here we report the results of a study in monozygotic (MZ) and dizygotic (DZ) twins examining the heritability of REM sleep EEG. We studied the architecture, spectral composition and phasic parameters of REM sleep and identified genetic effects on whole investigated EEG frequency spectrum as well as phasic REM parameters (REM density, REM activity and organization of REMs in bursts). In addition, cluster analysis based on the morphology of the EEG frequency spectrum revealed that the similarity among MZ twins is close to intra-individual stability. The observed strong genetic effects on REM sleep characteristics establish REM sleep as an important source of endophenotypes for psychiatric and neurological diseases.

MATRICS Consensus Cognitive Battery (MCCB) is a contemporary standard for assessment of cognitive functions in schizophrenia. The aim of the study was to examine the association between electroencephalographic spectral power and a wide range of cognitive functions measured with MCCB.Thirty-nine patients with schizophrenia (27 male, mean age 28.2 ± 5.2 years) underwent EEG recordings and were assessed with MCCB. The EEG recordings were visually inspected and manually cleaned from artifacts and subjected to spectral analysis with EEGlab. Absolute and relative power as percentage of total spectral power were computed for frequency ranges from 0.5 to 30 Hz. To compare spectral power in patients with various cognitive functioning, patients from best and worst MCCB quartiles were selected.Superior cognitive performance was associated with less power of theta waves. Six MCCB cognitive tests showed significant correlations with absolute theta power and three tests with relative theta power. The correlation coefficients between MCCB composite score and theta power were rp = -0.45 for absolute and rp = -0.36 for relative values. Increased theta power was linked especially to memory deficits.These preliminary results suggest that electroencephalographic resting state theta power is an indicator of cognitive deficit in patients with schizophrenia.

The relationship between sleep disturbances and sexual dysfunctions still remains unclear. The links which indicate the importance of central nervous system and sleep mechanisms in regulations of the endocrine system seem to have bilateral character; the nature of such associations is not fully understood. The aim of the paper is to describe the influence of androgens on the relations between sexual functioning and sleep functions in patients of both sexes. The physiological role of the androgens is described with the emphasis put on the specific action of these hormones in sleep regulation, as well as the mutual relations between the regulatory role of sleep on the sexual apparatus. The newest data suggest that the androgenic hormonal profile is linked to the sleep rhythm, but not to the chronobiological diurnal rhythm in male patients. This may constitute the purpose for further research on the role of androgens in the connections between sexual and sleep disturbances. Up to date there is little known about androgens' role in sleep regulation in women. The influence of sexual activity disturbances as behavioral factors influencing the severity and the persistence of insomnia as well as their position among other factors important for the triggering of insomnia requires further scientific exploration.

In schizophrenia patients, both an older age and earlier age at onset of the disease are related to worse cognitive functioning. As patients with later schizophrenia onset are also older, analysing the two effects separately can be misleading, as they can either be spurious or cancel one another out. The purpose of the present study was to elucidate the effects of age and onset-age on cognition in schizophrenia patients. Individuals with schizophrenia ( N =151), aged 18–59 years, were examined with a MATRICS Consensus Cognitive Battery (MCCB) to get a full picture of their cognitive performance. Results showed age and age at onset indeed interrelated. Regression analyses revealed later onset of schizophrenia related to better social cognition. Patients׳ older age was related to a slower performance in symbol coding task, less effective executive functions, worse visual learning, lower attention, and lower total score in the MCCB. In the above regression analyses we controlled doses of antipsychotic medications. The results suggest that a previously found relationship between older age and social cognition might be spurious, and strengthen observations that it is specifically later onset-age which fosters better social cognition in schizophrenia patients.

Alterations of sleep can be observed polysomnographically in approximately 90 percent of depressed patients. Most of the registered sleep abnormalities in depression also occur in other psychiatric disorders. Only some types of REM sleep alterations – short REM latency, increase of REM density and shortening of mean latency of eye movements – were reported as more specific for affective disorders. In the present study polysomnograms of 21 medication free patients with major depressive disorder (assessed with a structured interview for DSM-III-R and Hamilton Scale) and 21 healthy controls were analysed. REM latency (LREM), REM density (RD), latencies of eye movements (LEM) and mean latency of eye movements (M-LEM) were calculated for both groups. Depressed patients (compared with healthy controls) showed increased RD (38.2% vs. 28.2%, p < 0.0001), shortened M-LEM (35.7 s vs. 48.3 s, p < 0.04) and shortening of LEM in the 1st (28.9 s vs. 48.9 s, p < 0.007) and 4th (27.0 s vs. 59.1 s, p < 0.043) REM sleep periods. LREM was not shortened significantly in depressives (78.5 min vs. 91.3 min, ns). In healthy subjects a negative correlation between M-LEM and RD was found (rho = − 0.47, p < 0.03). Since in the current study depressed patients differed from healthy controls, especially concerning phasic activity during REM sleep, presented data support the essential role of REM density for the assessment of sleep in depression. As a quick and easy manner to compute measurement, M-LEM is suggested as additional parameter for the assessment of phasic activity during REM sleep.

Background The aim of this study was to verify whether or not an increased prevalence of excessive daytime sleepiness (EDS) or EEG abnormalities is observed in patients with schizophrenia spectrum disorders (SSD), and to compare the effects of second generation antipsychotics (SGA) on patients’ daytime sleepiness level and EEG recordings. Methods EEG recordings and self-reports of EDS, assessed with Epworth (ESS) and Stanford (SSS) Sleepiness Scales, were compared between 244 patients with SSD and 82 patients with anxiety, personality or behavioral disorders (non-psychotic disorders, NPD). To examine the effects of various SGA, patients treated in monotherapy with aripiprazole, olanzapine, clozapine, risperidone and sertindole were compared. Results A higher prevalence of abnormal EEG recordings was observed in SSD patients. No significant differences in average daytime sleepiness were found between patients with SSD and NPD; however, patients with SSD had longer sleep duration. Aripiprazole treatment was associated with significantly smaller and less frequent EEG abnormalities than treatment with any other SGA, while treatment with clozapine and olanzapine was related to an increased prevalence of severe EEG abnormalities. Patients with SSD treated with SGA in monotherapy were less sleepy than unmedicated patients with NPD. Conclusions Although antipsychotics may have profound effects on EEG patients with schizophrenia do not have higher daytime sleepiness than patients with anxiety/personality disorders. Patients with schizophrenia may compensate sedative effects of antipsychotic treatment with sleep duration prolongation and report even less sleepiness than non-psychotic patients.

Disturbed sleep is a core symptom of depression and is among diagnostic criteria for depressive episode. Effects of an antidepressant drug on sleep are important for its clinical profile. Rapid improvement of sleep quality is particularly indicated in depressed patients with insomnia, anxiety, agitation and suicidal thoughts. The aim of the study was to evaluate the effects of trazodone on sleep in depressed patients in comparison to other sleep promoting antidepressants: agomelatine, amitriptyline, doxepin, mianserine and mirtazapine according to analysis of scientific publications. Sedative antidepressants including trazodone are regarded as treatment of choice in depression with agitation, anxiety or insomnia. They are also frequently used in low dose to promote sleep, as an alternative to hypnotics. Such approach to treatment of insomnia in depressed patients protects them against dependence on hypnotic drugs. Additionally, the antagonistic action of antidepressants on serotonergic 5-HT2 receptors improves not only the sleep continuity, but promotes also slow wave sleep. Trazodone and mirtazapine in comparison to many other antidepressants do not suppress REM sleep. Antidepressants have different effects on sleep. In treatment of depression sedative antidepressants should be administered in the full, recommended dose. However, if they are administered as concomitant treatment only to promote sleep, low doses are indicated. Too late administration time and too high dose are the most common factors related to failure of insomnia treatment with these drugs.

In this study we investigated sleep and circadian rhythm, functioning and psychopathological symptoms in patients with schizophrenia. We looked for answers to the following questions: What percentage of patients with schizophrenia after a therapeutic process in the daily psychiatric ward suffers from insomnia and excessive daytime sleepiness? What factors influence the functioning of patients with schizophrenia.23 patients and 23 healthy controls matched for age and sex (14 women, 9 men; mean age 40.5 +/- 13.66) were examined. All subjects filled out sleep diaries, underwent actigraphy for 7 days, and ratings with scales for the assessment of sleep quality, daytime sleepiness, general clinical state and the degree of improvement, presence and severity of psychopathological symptoms and depression, drug side effects.Moderate insomnia was found in 6 (26%), severe insomnia in 2 (8%) patients. Four patients (17%) suffered from severe daytime sleepiness. Actigraphy showed a low activity level that had influence on the functioning of patients. The functioning of the patients was most negatively influenced by negative symptoms of schizophrenia and drug side effects. Older patients and those who were ill for a longer time presented more drug side effects and they were more depressive. The patients spent more time in bed and had longer sleep time than healthy controls. The patients presented highest activity at the time of therapeutic activities.Despite improvement of psychopathological symptoms, many patients with schizophrenia still present low daytime activity and clinically significant insomnia and/or daytime sleepiness, which deteriorates their functioning.

Narcolepsy is a chronic hypersomnia of central origin, linked with dysfunction of hypocretin-containing neurons, localized in the lateral hypothalamus. Main symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. Establishing the proper diagnosis is very important, because of the negative impact of narcolepsy on patients' functioning in social-life and the possibility of improvement of quality of life with adequate treatment.Present review describes clinical characteristics of narcolepsy, usefulness of neurophysiological tests in differential diagnosis of narcolepsy and assessing the efficacy of the treatment, as well as the application of novel biological methods in diagnosis of narcolepsy.According to diagnostic criteria of ICSD-2 the diagnosis of narcolepsy is based on the clinical features and diagnostic examinations and tests. Among them neurophysiological procedures, such as polysomnography (PSG) and Multiple Sleep Latency Test (MSLT) are still recommended as most useful in differential diagnosis of narcolepsy and other hypersomnias. In recent decades novel biochemical and genetic tools have been developed as diagnostic measures in narcolepsy, including the levels of hypocretin in cerebral spinal fluid and HLA DQB1*0602 typing. These both biological markers are strongly associated with the occurrence of cataplexy, therefore do not present considerable diagnostic value in narcolepsy without cataplexy.Neurophysiological procedures (MSLT) and biological markers are necessary in the diagnosis of narcolepsy with cataplexy and hypersomnia without cataplexy. Neurophysiological procedures are useful in monitoring of the treatment of hypersomnia also.

Event related potentials (ERPs) originate predominantly from cortical structures in response to information processing. In contrast to evoked potentials of short latency (100 ms), long latency cognitive ERPs are not directly related to the physical characteristics of the stimulus, but rather to the information and meaning that the stimulus has for the investigated person.The aim of this review article was to present selected research questions in psychiatry that can be addressed with ERP studies. As examples we used studies performed in patients with schizophrenia and posttraumatic stress disorder (PTSD).ERPs can be recorded during well established cognitive tests in psychiatry: go-no go, n-back, continuous performance test (CPT), Wisconsin card sorting test, Stroop test, verbal learning test and many others. Several ERP components are used as endophenotypes in genetic psychiatric research.ERPs can be also useful in clinic related questions: identification of subject at high-risk of psychosis, assessment of attention deficits or selective attention problems in anxiety disorders, evaluation of early response to psychopharmacological treatment and efficacy of psychotherapeutic interventions.

Over the last few decades, numerous attempts have been made to identify electroencephalographic (EEG) manifestations of schizophrenia. However, clinical applicability of these studies has not been demonstrated.A novel approach to EEG analysis which is based on combination of two methods of time series analysis was presented. Empirical mode decomposition is used to decompose a signal into several independent mode functions (IMF). Then, Lempel-Ziv complexity is used to quantify variability of such modes. We dub this approach EMD-LZC analysis. We carry out EMD-LZC analysis of EEG (performed according to 10-20 standard) of 21 healthy volunteers and 19 schizophrenic patients who were not medicated for at least a week.We find that variability of the third IMF mode is lower in the patients. The statistically significant differences were observed in 14 channels. Interestingly enough, the Fourier power spectra of both cohorts were not statistically different in any of 19 EEG channels.Unlike traditional spectral analysis, the combination of empirical mode decomposition and Lempel-Ziv complexity enabled us to identify the properties of EEG that are affected by schizophrenia. The future, more extensive, studies should verify the applicability of the proposed algorithm to diagnostics of schizophrenia. Moreover, we would like to link the observed differences in EEG variability to the pathogenesis of this disease.

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. The aim of the study was to evaluate the incidence of REM sleep behaviour disorder (RBD) in consecutive patients with narcolepsy referred to our sleep disorders centre.Among patients examined because of hypersomnia, a diagnosis of narcolepsy was established in 30 patients (mean age 34.1 +/-13.6; 13 females, 17 males) on the basis of clinical features, polysomnography (PSG) and Multiple Sleep Latency Test. Polysomnographic analysis included assessment of muscle activity during REM sleep, recorded from chin and anterior tibialis muscles. Video recordings were reviewed for intense motor activity during REM periods, manifested as excessive, violent body movements (especially legs) and vocalization, reflecting dream-enacting behaviour. Questions about RBD symptoms were asked as a standard in all newly diagnosed patients and those reporting for follow-up visits.Symptomatic, polysomnographically documented RBD was found in three patients. In one of them RBD symptoms appeared during anticataplectic treatment with antidepressive medications. Disturbances of muscle tone regulation during REM sleep without clinical symptoms were found in polysomnography in a further four patients. Among patients reporting for follow-up visits, three subjects confirmed clinical symptoms corresponding to RBD of various severity.RBD occurs in narcolepsy more frequently than it was previously considered. Questions about symptoms of this disorder that may be injurious for the patient or patient's bed partner should be routinely asked during the clinical interview.