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Cel pracySkuteczność wortioksetyny w leczeniu depresji jednobiegunowej oceniano w wielu badaniach, brakuje jednak prób weryfikujących skuteczność wortioksetyny w depresji w przebiegu choroby afektywnej dwubiegunowej (ChAD).MetodaW grupie 60 pacjentów z depresją w przebiegu ChAD do wcześniej stosowanego leczenia normotymicznego (LN) dołączano wortioksetynę w dawce 10-20 mg/d w ramach 24-tygodniowej naturalistycznej próby otwartej. Do najczęściej stosowanych LN należały lamotrygina, kwetiapina, olanzapina i sole kwasu walproinowego. Skuteczność terapii oceniano podskalami Poprawy i Ciężkości Skali Ogólnego Wrażenia Klinicznego (CGI-I i CGI-S). Pacjentów klasyfikowano jako osiągających odpowiedź na leczenie wortioksetyną, jeżeli uzyskali wynik 1 lub 2 punktów w skali CGI-I. Za kryterium remisji przyjęto osiągnięcie wyniku 1 w skali CGI-S.Wyniki73% pacjentów (44/60) osiągnęło odpowiedź na leczenie wortioksetyną, a 52% (31/60) spełniło kryteria remisji klinicznej objawów depresyjnych (po czasie: 8,97±4,05 tygodni). Nie obserwowano znamiennych zależności pomiędzy odsetkami odpowiedzi na leczenie/remisji w następstwie stosowania wortioksetyny i jej dawką, typem ChAD, stopniem zaawansowania klinicznego ChAD, występowania szybkiej zmiany faz, historii występowania objawów psychotycznych, wybranych analizowanych objawów epizodu depresyjnego lub przyjmowanego równocześnie LN. 4 uczestników (6,7%) zrezygnowało z kontynuacji terapii z powodu doświadczanych działań niepożądanych (nudności), a 7 (11,7%) przerwało stosowanie wortioksetyny z powodu zmiany fazy ChAD. U 14 pacjentów (23%) doszło do utraty efektu terapeutycznego wortioksetyny po wcześniejszym osiągnięciu odpowiedzi terapeutycznej lub remisji.WnioskiWyniki wskazują na stosunkowo wysokie odsetki odpowiedzi na leczenie i remisji w toku 24-tygodniowego leczenia depresji dwubiegunowej wortioksetyną w połączeniu z LN. Powyższe dane mogą świadczyć, że leczenie kombinowane wortioksetyną i LN stanowi skuteczną i dobrze tolerowaną formę terapii depresji w przebiegu ChAD.

Nowadays there are numerous studies on the occurrence of cognitive dysfunction in late-life depression (LLD). The role of executive dysfunctions in the psychopathology of depression is particularly emphasized and needs further examination. The aim was to assess cognitive functions and their relation to depressive symptoms in elders with LLD, previously depressed, and patients without the history of depressive episodes. The study consisted of 824 older adults who underwent a neuropsychological evaluation (97 currently depressed, 114 previously depressed and 613 patients without the history of depressive episodes). LLD patients performed poorer in ACE-III and AVLT and poorer in TMT-B than those previously depressed and never depressed. The LLD group also performed significantly poorer than the previously depressed on Digit Span Forward. Results of a multiple regression analysis indicated that performance on measures of executive functioning was associated with depression severity in LLD (β =.227, P =.024). The results of this study suggest that executive functions are the most impaired in the elderly with LLD. Furthermore, there is a relationship between executive dysfunction and the severity of depression in LLD. Executive dysfunction appears to be the core neurocognitive deficit in LLD.

Cel pracyHazard patologiczny charakteryzuje się obniżoną kontrolą poznawczą i behawioralną, które prowadzi do naruszenia wartości i zobowiązań społecznych, rodzinnych, zawodowych i materialnych. Hazard patologiczny cechuje wysoka współchorobowość z chorobami afektywnymi. Liczne badania wskazały na podwyższoną impulsywność u pacjentów z zaburzeniami ze spektrum zaburzeń dwubiegunowych w stanie eutymii, jak i u osób patologicznie uprawiających hazard. Cel badania: Określenie cech dwubiegunowości oraz impulsywności u osób uprawiających hazard patologiczny, w porównaniu do osób uprawiających hazard niepatologiczny i osób nieuprawiających hazardu. Określenie interakcji pomiędzy cechami temperamentu afektywnego, impulsywnością i nasileniem zachowań hazardowych.MetodaW badaniu wzięło udział 139 uczestników (63 kobiet), średnia wieku uczestnika wyniosła 30,32 (SD = 10,69). Do pomiaru impulsywności użyto Skali Impulsywności Barratta, do pomiaru afektywnych cech temperamentalnych użyto kwestionariusz Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire. Objawy zaburzeń ze spektrum afektywnych dwubiegunowych zmierzono kwestionariuszami Mood Disorder Questionnaire i Hypomania Checklist-32. Kanadyjski Indeks Gier Hazardowych (CPGI) wykorzystano do oceny stopnia nasilenia hazardu patologicznego. Polskie wersje kwestionariuszy anonimowo wypełniono drogą internetową.WynikiOsoby uprawiające hazard patologiczny (N=36) uzyskiwały istotnie wyższe wyniki w podskalach Impulsywności ruchowej, Cyklotymiczności i Drażliwości, w porównaniu do osób uprawiających hazard niepatologiczny (N=61) i osób nieuprawiających hazardu (N=42). Cyklotymiczność i impulsywność ruchowa były predyktorami CPGI. Interakcja obu predyktorów była istotna - wyższa impulsywność ruchowa wiązała się ze zwiększonym wpływem cech cyklotymicznych temperamentu afektywnego na stopień hazardu patologicznego.WnioskiUzyskane wyniki są zgodne ze wcześniejszymi badaniami wskazującymi na podwyższoną impulsywność i cechy ze spektrum dwubiegunowości wśród osób uprawiających hazard patologicznie. Wpływ cech temperamentu afektywnego na nasilenie patologicznego hazardu jest moderowany przez impulsywność.

BACKGROUND AND PURPOSE Delirium is a serious complication after stroke. It remains unclear whether different motor subtypes of delirium are associated with diverse risk factors and outcomes. The aim was to investigate if delirium subtypes differ in predisposing factors, clinical characteristics and outcomes. METHODS In all, 698 patients with ischaemic stroke or transient ischaemic attack (median age 73 years; 53.7% female) were prospectively included. Core features of delirium during the first 7 days after admission were examined. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for delirium were used. Pre-stroke characteristics were compared between different delirium subtypes and logistic regression and Cox proportional hazard models were used to explore the association between delirium, functional outcome and death. RESULTS Hyperactive, hypoactive and mixed delirium were diagnosed in 28, 75 and 66 patients, respectively. Patients with hyperactive delirium had less severe neurological deficit on admission and more often had transient ischaemic attack compared with patients with hypoactive and mixed delirium. Compared with patients with hypoactive delirium, those with hyperactive delirium more often suffered from irritability/lability prior to stroke. Hyperactive and hypoactive delirium did not differ in age, sex, comorbidities, pre-stroke dependency, cognitive decline and severity of delirium. Hyperactive, hypoactive and mixed delirium were associated with an increased risk of poor 3- and 12-month functional outcome compared with patients without delirium. Moreover, patients with hypoactive and mixed delirium had an elevated risk of death. CONCLUSIONS Hyperactive delirium is associated with less severe stroke and higher scores of pre-existing irritability/lability. All three motor subtypes of delirium are associated with poor outcome, although hyperactive delirium seems to have a less unfavourable prognosis.

Primary central nervous system lymphoma is a rare neoplasm, exceptionally responsible for developing a frontal lobe syndrome. A 71-years-old patient with primary central nervous system lymphoma had undergone frontotemporal craniotomy for tumor removal. Month later, showing syncopies, disorientation and slurred speech, he was transported to Department of Internal Medicine. Neuroimaging revealed numerous tuberous changes in frontal and parietal lobes and frontotemporal area. During hospitalization, patient exhibited inadequate affect, jocular behaviour, was disoriented in the place and time, and unaware of his health state. He took repeated, uncritical attempts to jump out the window and started to exhibit persecutory delusions and hallucinations. Immediate brain radiotherapy was recommended by the oncology specialists. However, the patient did not consent to the recommended method of treatment due to his lack of recollection of the tumor or the craniotomy. The patient was forcibly transferred to Department of Psychiatry. After five weeks of treatment, the patient's condition improved significantly, and the patient regained memory of the tumor.

The aim of the present study was to specify if cerebellar lesions cause memory impairment in children. The study sample consisted of 44 children with low-grade cerebellar astrocytoma, who underwent surgical treatment and 30 healthy controls, matched with regard to age and sex. Memory was tested using the Rey Auditory Verbal Learning Test AVLT, Corsi Block-Tapping Test, Digit Span, Digit Backwards and Information Subtests from the Wechsler Intelligence Scale for Children-Revised WISC-R (PL). Patients with cerebellar lesions demonstrated memory impairments, similar to those typical for patients with frontal lesions, with auditory and visuospatial working memory deficits, a disorganized learning process without mnemonic strategy (executive dysfunctions) and problems with recalling new material from long-term memory storage, while maintaining good recognition of previously learned material, preserved semantic knowledge and short-term auditory-verbal memory (digit span). Obtained results showed that memory deficits would vary according to the side of the cerebellar lesion, with more pronounced impairment of visuospatial memory tasks accompanying the left-sided cerebellar lesions and worse performance of verbal memory task, observed in the group of patients with right-sided cerebellar lesions. Although the presence of hydrocephalus significantly worsens the memory performance of the children studied, patients with cerebellar lesions without hydrocephalus still present significantly lower memory indicators in the profile described, compared to the control group of healthy children. It confirms the hypothesis that cerebellar lesion alone could result in memory dysfunctions in children.

The goal of this paper is to investigate the baseline brain activity in euthymic bipolar disorder (BD) patients by comparing it to healthy controls (HC) with the use of a variety of resting state functional magnetic resonance imaging (rs-fMRI) analyses, such as amplitude of low frequency fluctuations (ALFF), fractional ALFF (f/ALFF), ALFF-based functional connectivity (FC), and r egional homogeneity (ReHo). We hypothesize that above-mentioned techniques will differentiate BD from HC indicating dissimilarities between the groups within different brain structures. Forty-two participants divided into two groups of euthymic BD patients (n = 21) and HC (n = 21) underwent rs-fMRI evaluation. Typical band ALFF, slow-4, slow-5, f/ALFF, as well as ReHo indexes were analyzed. Regions with altered ALFF were chosen as ROI for seed-to-voxel analysis of FC. As opposed to HC, BD patients revealed: increased ALFF in left insula, increased slow-5 in left middle temporal pole, increased f/ALFF in left superior frontal gyrus, left superior temporal gyrus, left middle occipital gyrus, right putamen, and bilateral thalamus. There were no significant differences between BD and HC groups in slow-4 band. Compared to HC, the BD group presented higher ReHo values in the left superior medial frontal gyrus and lower ReHo values in the right supplementary motor area. FC analysis revealed significant hyper-connectivity within the BD group between left insula and bilateral middle frontal gyrus, right superior parietal gyrus, right supramarginal gyrus, left inferior parietal gyrus, left cerebellum, and left supplementary motor area. To our best knowledge, this is the first rs-fMRI study combining ReHo, ALFF, f/ALFF, and subdivided frequency bands (slow-4 and slow-5) in euthymic BD patients. ALFF, f/ALFF, slow-5, as well as REHO analysis revealed significant differences between two studied groups. Although results obtained with the above methods enable to identify group-specific brain structures, no overlap between the brain regions was detected. This indicates that combination of foregoing rs-fMRI methods may complement each other, revealing the bigger picture of the complex resting state abnormalities in BD.

Objective The main aim of the study was to evaluate whether the available brief test of mental functions Addenbrooke’s cognitive examination III (ACE III) detects cognitive impairment in patients with cerebellar damage. The second goal was to show the ACE III cognitive impairment profile of patients with focal cerebellar lesions. Method The study sample consisted of 31 patients with focal cerebellar lesions, 78 patients with supratentorial brain damage, and 31 subjects after spine surgery or with spine degeneration considered as control group, free of organic brain damage. The ACE III was used. Results Patients with cerebellar damage obtained significantly lower results in the ACE III total score and in several subscales: attention, fluency, language, and visuospatial domains than healthy controls without brain damage. With the cut-off level of 89 points, the ACE III was characterized by the sensitivity of 71%, specificity of 72%, and accuracy of 72%. The cerebellar cognitive impairment profile was found to be “frontal-like” and similar to that observed in patients with anterior supratentorial brain damage, with decreased ability to retrieve previously learned material and its preserved recognition, impaired word fluency, and executive dysfunction. The results are consistent with cerebellar cognitive affective syndrome. Conclusions The ACE III can be used as a sensitive screening tool to detect cognitive impairments in patients with cerebellar damage.

Objective The occurrence of death by suicide in patients diagnosed with bipolar disorder is as much as 60 times greater than in the general population. Even during the state of euthymia patients are characterized by suicide risk. The aim of the study is to investigate the baseline brain activity in euthymic bipolar disorder patients in regard to suicide risk. We hypothesized that patients compared to healthy control group will demonstrate altered functional connectivity among resting state networks which will be directly related to current suicide risk. Method 41 subjects were enrolled in the study consisting control group (n = 21) and euthymic bipolar disorder patients group (n = 20). Functional magnetic resonance imaging was used to evaluate resting state brain activity and ROI-ROI functional connectivity analysis was performed. Suicidal risk was estimated using The Suicide Behaviors Questionnaire-Revised. Results A two sample t-test revealed decreased functional connectivity between regions involved in the salience network in patients compared to the control group. This decrease was negatively correlated with current suicide risk. Conclusion Obtained results suggest the association between risk of suicide and activity of regions responsible for functions such as learning from mistakes, prospective thinking, and sensory integration.

Cel pracyW odniesieniu do choroby afektywnej dwubiegunowej (ChAD), dotychczasowe prace wskazują na zaburzenia ruchów sakadycznych, głównie pod postacią wydłużenia czasu reakcji (latencji) w testach prosakad i antysakad. Dotychczas nie przeprowadzono oceny ruchów wergencyjnych gałek ocznych u osób z ChAD. Głównym celem naszego badania jest ocena parametrów konwergencji (zbieżne ruchy gałek ocznych) w tej grupie klinicznej.MetodaDo badania włączono 30 pacjentów z ChAD w stanie remisji objawowej i 23 zdrowych ochotników. Uczestników poddano badaniu optometrycznemu oceniającemu punkt bliski konwergencji przy użyciu pręta fiksacyjnego. Badanie okulometryczne przeprowadzono przy pomocy okulografu wykorzystującego promieniowanie podczerwone z dedykowanym stymulatorem wergencji.WynikiPacjenci z ChAD wykazali istotnie większy średni błąd pozycji konwergencji do celu oraz większą liczbę wtrąceń sakadycznych w porównaniu do grupy kontrolnej. Analiza składowych głównych przeprowadzona na zmiennych okulometrycznych pokazała istotne różnice między pacjentami z ChAD a zdrowymi ochotnikami. Wykazano obecność istotnych korelacji między zaburzeniami ruchów wergencyjnych a liczbą wtrąceń sakadycznych.WnioskiPacjenci z ChAD ujawnili zaburzenia ruchów wergencyjnych gałek ocznych podobne do zaburzeń opisywanych w trakcie śledzenia bodźców poruszających się w płaszczyźnie czołowej. Podczas gdy zaburzenia wergencji były opisywane w innych zaburzeniach psychicznych, nasza praca po raz pierwszy obiektywnie zmierzyła to zjawisko w ChAD.

Introduction Neurological soft signs (NSS) are described as subtle, non-localizable neurological abnormalities that cannot be related to impairment of a specific brain region or are not believed to be typical for any specific neurological disease. Crucial issue concerning research on NSS are the instruments with which they are assessed, since the results and the conclusions of the studies are mediated by the characteristics of such instruments. There is common, silent and unverified assumption that NSS rating scales may be used as interchangeable measure of the same phenomenon. Aim To investigate the differences in item content and the interchangeability of commonly used NSS scales. Methods A content analysis was carried out to determine symptom overlap among the chosen seven most often used scales using the Jaccard index (0 = no overlap, 1 = full overlap) according to the methodology of Fried 2017. Results 71 NSSs were distinguished from 167 items used in 7 above mentioned instruments. Mean overlap among all scales is low (0.27), overlap among specific scales ranges from 0.1 to 0.5. Conclusions The diversity of NSS in analyzed tools causes the low overlap between scales, leading to uncertainty as to whether they measure the same phenomena. This limits the reproducibility of studies and impedes the possibility of unifying the knowledge stemming from existing data. We argue that the non-localizable nature of NSS is yet to be examined.

Growing number of studies suggests link between circadian rhythms and inflammatory bowel diseases (IBD) manifestation. We hypothesize that: 1) IBD are associated with increased eveningness and sleep disturbances; 2) eveningness and sleep disturbances are related to more severe IBD symptoms. In total, 129 participants were enrolled to this study, divided into three groups: 34 Crohn's disease (CD) patients, 38 ulcerative colitis (UC) patients and 57 healthy controls (HC) group. They all fulfilled a questionnaire, consisting of the Composite Scale of Morningness (CSM), Seasonal Pattern Assessment Questionnaire (SPAQ), Pittsburgh Sleep Quality Index, Inflammatory Bowel Disease Questionnaire (IBDQ) and Multidimensional Fatigue Inventory (MFI). Multiple regression models controlled for age and sex revealed that in CD group higher eveningness measured with CSM was associated with higher general fatigue, physical fatigue, mental fatigue and reduced motivation measured by MFI. Lower CSM morning affect is associated with greater general fatigue, physical fatigue and more reduced activity. Greater seasonality scores are associated with increased physical fatigue and more reduced activity and motivation. Lower sleep quality measured with PSQI is associated with higher physical fatigue and more reduced activity. Correlational analysis revealed that higher seasonality and lower sleep quality are associated with increased systemic and bowel symptoms and decreased emotional and social functions measured with IBDQ. In UC group, eveningness is associated with greater general fatigue, physical fatigue and more reduced activity. Higher CSM morning affect is associated with decreased general fatigue, physical fatigue and less reduced activity. Higher CSM circadian preference scores are associated with decreased general and physical fatigue, and less reduced activity. Increased seasonality is associated with more physical fatigue. Lower sleep quality is associated with greater general and physical fatigue. To our best knowledge this is the first study evaluating associations between chronotype and sleep disturbances with IBD symptoms. We have found that chronotype preferences, whose role in IBD has been until now overlooked, may be one of the important factors contributing to fatigue in this clinical group.

Background: Schizophrenia (SZ) and bipolar disorder (BD) patients share deficits in motor functions in the form of neurological (NSS) and cerebellar soft signs (CSS), and implicit motor learning disturbances. Here, we use cluster analysis method to assess (1) the relationship between those abnormalities in SZ and BD and (2) the differences between those groups. Methods: 33 SZ patients, 33 BD patients as well as 31 healthy controls (HC) took part in the study. We assessed CSS with the International Cooperative Ataxia Rating Scale (ICARS) and NSS with the Neurological Evaluation Scale (NES). Implicit motor learning was evaluated with the Serial Reaction Time Task (SRTT). Participants were divided into clusters (Ward's method) based on the mean response time and mean error rate in SRTT. The difference in ICARS and NES scores, and SRTT variables between clusters were evaluated. We have measured associations between SRTT parameters and both ICARS and NES total scores and subscores. Results: Cluster analysis based on the SRTT parameters allowed to extract three clusters. Those were characterized by the increasing disruption of motor functioning (psychomotor retardation, the severity of NSS and CSS) regardless of the diagnosis. Cluster 1 covered almost all of HC and was characterized by faster reaction times and small number of errors. BD and SZ patients represented in cluster 1, although fully functional in performing the SRTT, showed higher rates of NSS and CSS. Patients with BD and SZ were set apart in clusters 2 and 3 in a similar proportion. Cluster 2 presented significantly slower reaction times but with the comparable number of errors to cluster 1. Cluster 3 consisted of participants with normal or decreased reaction time and significantly increased number of errors. None of the clusters were predominantly composed of the patients representing one psychiatric diagnosis. Conclusions: To our best knowledge, we are presenting the first data indicating the relationship between implicit motor learning and NSS and CSS in SZ and BD patients' groups. Lack of clusters predominantly represented by patients with the diagnosis of SZ or BD may refer to the model of schizophrenia-bipolar disorder boundary, pointing out the similarities between those two disorders.

Background Impairment of implicit motor sequence learning was shown in schizophrenia (SZ) and, most recently, in bipolar disorder (BD), and was connected to cerebellar abnormalities. The goal of this study was to compare implicit motor sequence learning in BD and SZ. Methods We examined 33 patients with BD, 33 patients with SZ and 31 healthy controls with a use of ambidextrous Serial Reaction Time Task (SRTT), which allows exploring asymmetries in performance depending on the hand used. Results BD and SZ patients presented impaired implicit motor sequence learning, although the pattern of their impairments was different. While BD patients showed no signs of implicit motor sequence learning for both hands, the SZ group presented some features of motor learning when performing with the right, but not with the left hand. Conclusions To our best knowledge this is the first study comparing implicit motor sequence learning in BD and SZ. We show that both diseases share impairments in this domain, however in the case of SZ this impairment differs dependently on the hand performing SRTT. We propose that implicit motor sequence learning impairments constitute an overlapping symptom in BD and SZ and suggest further neuroimaging studies to verify cerebellar underpinnings as its cause.

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

Awake craniotomy (AC) for brain tumors, when the patient is conscious during the operation, allows to reduce the risk of motor disability and aphasia, however, it may be a source of extreme stress. The aim of our study was to examine the patients' subjective experience of the surgery including the level of psychological trauma and cognitive functioning.Eighteen patients operated due to brain tumor were enrolled in this study. The Essener Trauma-Inventory Questionnaire and the Addenbrooke's Cognitive Examination (ACE III) were administrated. The patients' experience with awake craniotomy was evaluated with a qualitative descriptive survey.All patients remembered the intraoperative neuropsychological examination and several sensations like: drilling, cold, head clamp fixation or having eyes covered. In most of the patients the postoperative psychological trauma experience did not reach the clinical level. The ACE III postoperative scores revealed partial cognitive deficits with the lowest scores in memory and word fluency domains. Slight amnestic aphasia was observed postoperatively only in two patients.Awake craniotomy for resection of brain tumors is well-tolerated by patients and does not cause significant psychological trauma. Nonetheless, anxiety about the procedure warrants further study and individualized neuropsychological care is needed for the emotional preparation of the patient.

Objective: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. Methods: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. Results: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. Conclusion: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

The microbiome co-evolved with its human host over a long time and became essential for many processes. Bacteria play a role in maintaining human health as they digest food, produce vitamins and participate in the regulation of metabolism. By influencing the cytokine balance along with the composition and activity of leukocytes, they constantly interact with the immune system, affecting innate and adaptive immune homeostasis. A growing number of studies indicate that the microbiome in the human intestine may have an impact on the functions of the central nervous system (CNS), through identified pathways called the gut–brain axis. Recent data show that the human microbiome ecosystem interferes with the brain’s development, central signaling systems and behavior. It has been proposed that disruption in the human microbiome may affect the course of psychiatric disorders. The aim of this review is to summarize the recognized pathways of the gut–brain axis that have been thoroughly studied in animal models and to evaluate the role of the dialogue between the microbiota and the central nervous system in schizophrenia, bipolar disorder and depression.

Bergmann glia (BG), a specific type of radial astrocytes in the cerebellum, play a variety of vital functions in the development of this structure. However, the possible role of BG in the development of abnormalities observed in individuals with autism spectrum disorder (ASD) seems to be underestimated. One of the most consistent findings observed in ASD patients is loss of Purkinje cells (PCs). Such a defect may be caused by dysregulation of glutamate homeostasis, which is maintained mainly by BG. Moreover, these glial cells are involved in long-term depression (LTD), a form of plasticity which can additionally subserve neuroprotective functions. The aim of presented review is to summarize the current knowledge about interactions which occur between PC and BG, with special emphasis on those which are relevant to the survival and proper functioning of cerebellar neurons.

Background Growing number of studies indicates a link between eveningness chronotype, affective temperaments and bipolarity, both in patients with mood disorders and in general population. Given these tripartite associations, we hypothesized that the effect of circadian preferences on the bipolarity may be mediated by the temperamental traits. Methods The study included 1449 subjects (402 men and 1047 women). They all fulfilled a web-based questionnaire, consisting of the Composite Scale of Morningness (CSM), Mood Disorder Questionnaire (MDQ), Hypomania Checklist-32 (HCL-32) and the Temperament Evaluation of the Memphis, Pisa and San Diego-Autoquestionnaire (TEMPS-A). The role of temperamental traits in the relationship between morningness-eveningness and bipolarity was assessed using mediation analysis. Results Morningness is correlated with lower bipolarity measured by the MDQ and HCL-32, and to lower scores of depressive, cyclothymic, irritable and anxious temperaments of the TEMPS-A. There is no significant association between morningness and hyperthymic traits. Cyclothymic and irritable traits are full mediators of the association between chronotype and bipolarity, influencing bipolarity independently from circadian preferences. Depressive and anxious traits are partial mediators of this association, increasing the effect of eveningness on bipolarity. Limitations The indirectness of the findings in the web-based study and disproportion of participants’ gender. Conclusions Our study confirmed that eveningness is associated with bipolarity. In case of depressive and anxious temperaments, bipolarity is associated stronger with eveningness than with the TEMPS-A scores. On the other hand, cyclothymic and irritable temperaments were associated with bipolarity independently from circadian preferences.

OBJECTIVES Fried () quantified the overlap of items among seven widely used depression rating scales. The analysis revealed substantial heterogeneity of the depressive syndromes and a low overlap among the scales. To our best knowledge, there are no studies evaluating the content overlap of (hypo)mania scales. The goal of our study, therefore, is to quantify the overlap of items among seven widely used (hypo)manic scales, implementing the methodology developed by Fried (). METHODS Seven commonly used (hypo)manic scales underwent content analysis. Symptom overlap was evaluated with the use of the Jaccard index (0 = no overlap, 1 = full overlap). In case of every scale, rates of idiosyncratic symptoms and rates of specific versus compound symptoms were calculated. RESULTS The seven scales gathered 64 hypo(manic) symptoms. The mean overlap among all of the instruments was low (0.35), the mean overlap of each scale with all others ranged from 0.29 to 0.48, and the overlap among individual scales ranged from 0.20 to 0.65. Thirty-six percent of symptoms appeared only on one scale. Only 6% of the symptoms appeared on all of the instruments. CONCLUSIONS We have shown that using (hypo)manic scales as interchangeable measurements may be problematic.

Cel pracyChoroba Afektywna Dwubiegunowa (ChAD) istotnie wpływa na poziom dysfunkcji poznawczych i motorycznych. Badania nad funkcjami poznawczymi w Chorobie Afektywnej Dwubiegunowej wskazują między innymi na występowanie deficytów w zakresie przetwarzania wzrokowo – przestrzennego i pamięci wzrokowo – przestrzennej. Dotychczas w badaniach z udziałem pacjentów z ChAD nie wykorzystywano jednak Testu Rotacji Mentalnych (Mental Rotation Task) do oceny tych funkcji. Naszym celem było wprowadzenie tej metody i ocena wspomnianych zaburzeń w grupie pacjentów z ChAD w eutymii.MetodaW badaniu wzięło udział 31 pacjentów z ChAD w fazie eutymii oraz 27 zdrowych ochotników dobranych pod względem wieku i lat edukacji. Każdy z uczestników wykonywał komputerową wersję Testu Rotacji Mentalnych. Badani mieli za zadanie porównywać dwie zrotowane względem siebie figury i ocenić ich podobieństwo, wskazując czy figury są identyczne, czy też stanowią swoje lustrzane odbicie.WynikiTest wykazał istotnie dłuższy czas reakcji w grupie pacjentów z ChAD w warunkach zrotowania figur pod kątem -90, -45, 45, 90 stopni oraz w przypadku braku rotacji. Dla kątów -135, 135 i 180 stopni nie odnotowano istotnej różnicy między grupami. Poziom poprawności wykonania był istotnie niższy w grupie pacjentów niż w grupie kontrolnej zarówno w wyniku ogólnym jak i w poszczególnych warunkach zadania. Korelacja między średnim czasem reakcji a poprawnością okazała się nieistotna.WnioskiNasze wyniki są zgodne z literaturą opisującą deficyty wzrokowo-przestrzenne w ChAD. Badanie to jako pierwsze prezentuje deficyty rotacji umysłowych u pacjentów z ChAD w fazie eutymii.

Aim of the studyInvestigation of relationship between cerebellar motor dysfunctions and language impairments connected with cerebellum during phonological and semantic fluency tasks and verb generation task in schizophrenic patients and healthy control group.Subject or material and methods14 schizophrenic patients on olanzapine, clozapine or quetiapine treatment and 13 healthy volunteers were examined. Motor signs were assessed by using the International Co-operative Ataxia Rating Scale (ICARS). Phonological and semantic fluency tasks were performed. All of the words were recorded and counted.ResultsPatients with schizophrenia revealed significantly higher ICARS mean score (12.21) than control group (3.92), and lower number of proper generated words in semantic fluency and verb generation tasks. Strong negative correlation (rs(13) = -0.71, pDiscussionHigher number of total ICARS score in schizophrenia patients in comparison to control group may suggest cerebellar impairments. There is disproportion between semantic and phonological fluency. Significant correlation between verb generation and cerebellar signs supports a hypothesis of cerebellum dysfunction during this task in schizophrenia patients.ConclusionsSchizophrenic patients reveal impairments which may be connected with the cerebellum.

The aim of this study was to specify whether cerebellar lesions cause visuospatial impairments in children. The study sample consisted of 40 children with low-grade cerebellar astrocytoma, who underwent surgical treatment and 40 healthy controls matched with regard to age and sex. Visuospatial abilities were tested using the spatial WISC-R subtests (Block Design and Object Assembly), Rey-Osterrieth Complex Figure, Benton Judgment of Line Orientation Test, PEBL Mental Rotation Task, and Benton Visual Retention Test. To exclude general diffuse intellectual dysfunction, the WISC-R Verbal Intelligence IQ, Performance IQ, and Full-Scale IQ scores were analysed. Post-surgical medical consequences were measured with the International Cooperative Ataxia Rating Scale. Compared to controls, the cerebellar group manifested problems with mental rotation of objects, visuospatial organization, planning, and spatial construction processes which could not be explained by medical complications or general intellectual retardation. The intensity of visuospatial syndrome highly depends on cerebellar lesion side. Patients with left-sided cerebellar lesions display more severe spatial problems than those with right-sided cerebellar lesions. In conclusion, focal cerebellar lesions in children affect their visuospatial ability. The impairments profile is characterized by deficits in complex spatial processes such as visuospatial organization and mental rotation, requiring reconstruction of visual stimuli using the imagination, while elementary sensory analysis and perception as well as spatial processes requiring direct manipulation of objects are relatively better preserved. This pattern is analogous to the one previously observed in adult population and appears to be typical for cerebellar pathology in general, regardless of age.

Objective The aim of the paper was to assess the risk factors of febrile seizures in children. Methods The paper presents an analysis of a group of 176 children aged 6 months to 5 years who were admitted to A&E because of febrile seizures. Results The analysed group of 176 children comprised 61.96% boys and 38.07% girls, and the average age equalled 23 months. Family history was significant in 9.66% of patients. A statistically significant difference was noticed between insignificant family history and the incidence of febrile seizures. In all the studied groups of children the factor that determined the incidence of febrile seizures was a sudden increase in the body temperature with an infection of the upper respiratory tract of several day's duration as another cause. Febrile seizure incident was most frequently associated with a sudden increase in the body temperature in 53.40% children. A statistically significant difference was observed between persisting fever and an increase thereof during the day. Yet another factor predisposing for febrile seizures incidence was an infection of the upper respiratory system that could be observed in 32.95% patients. The mean body temperature when the seizures occurred was 38.9 °C. Conclusions A sudden increase in the body temperature within the first day of pyrexia predisposes for the incidence of febrile seizures and it was proved that it depends on how long fever persists during the day. The other factor triggering the seizures was an infection of the upper respiratory tract of several days’ duration.

Chronotype is defined as individual circadian preference, most often represented on the continuum between two extremes: morningness and eveningness. Growing number of studies show associations between circadian preference and various psychopathological symptoms. Eveningness has been shown to be related with depressiveness in non-clinical population, while mornigness has been presented as protective factor. Schizotypy is a schizophrenic-spectrum personality trait linked with a tendency to eccentricity, magical thinking and unusual experiences. Features of schizotypy has been identified in patients with mood disorders i.e bipolar disorder. While there is growing number of studies evaluating associations between chronotype and affective symptons, to our best knowledge there are no studies adressing the issue of association between schizotypy and circadian preferences. A total of 887 healthy individuals took part in the web-based study. Chronotype has been assessed with the use of Composite Scale of Morningness. Schizotypy has been measured with the use of the enlarged version of The Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Analysis revealed significant positive correlations between cognitive disorganization, introvertive/anhedonia, implusiveness/nonconformity and eveningness. To our best knowledge, results indicate for the first time relationship between eveningness and schizotypy, measured by O-LIFE.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Nieswoiste zapalenia jelit, do których zaliczają się choroba Leśniowskiego-Crohna i wrzodziejące zapalenie jelita grubego, są przewlekłymi chorobami wiążącymi się ze zwiększoną częstością współistnienia zaburzeń psychicznych. Spośród nich do najczęstszych należą zaburzenia depresyjne oraz lękowe, jakkolwiek istnieją przesłanki epidemiologiczne i biologiczne sugerujące zwiększoną częstość innych zaburzeń, jak np. choroby afektywnej dwubiegunowej. Szczególną podatność pacjentów z nieswoistym zapaleniem jelit na pojawienie się tych zaburzeń psychicznych tłumaczą mechanizmy biologiczne, leżące u podłoża zarówno nieswoistych zapaleń jelit, jak i depresji oraz lęku. Szczególną rolę odgrywają interakcje osi jelitowo-mózgowej, zaburzenia immunologiczne, stres oksydacyjny i dysfunkcja nerwu błędnego – znaczenie tych czynników, stanowiących pomost pomiędzy patofizjologią nieswoistych zapaleń jelit i zaburzeń depresyjnych oraz lękowych, omówiono szczegółowo w niniejszej pracy. Współwystępowanie zaburzeń depresyjnych oraz lękowych może negatywnie wpływać na przebieg nieswoistych zapaleń jelit, zwiększać częstość i ciężkość zaostrzeń oraz utrudniać ich leczenie, toteż poznanie powiązań między zaburzeniami psychicznymi a nieswoistymi zapaleniami jelit okazuje się niezbędne w pełnieniu skutecznej opieki nad pacjentem.

Creutzfeldt-Jakob disease (CJD) is a neurodegenerative disorder belonging to the group of transmissible spongiform encephalopathies. The transition of physiological, soluble, neuroprotective prion protein PrPc into its insoluble, misfolded isoform PrPSc remains its central pathogenic event. The progressive accumulation of isoform PrPSc within the brain tissue results in spongiform degeneration and a plethora of clinical symptoms. Typically, CJD manifests as progressive dementia with myoclonus, visual or cerebellar dysfunction, pyramidal/ extrapyramidal signs or akinetic mutism. However, a growing number of studies indicate that CJD may present with prodromal psychiatric manifestations including anhedonia, anxiety, irritability, depression, insomnia, psychosis and catatonic behavior. We present a case of CJD with a history of prodromal psychiatric symptoms and catatonic behavior diagnosed by brain biopsy.

Background/Aims: The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) is a novel tool allowing for a complex assessment of biological rhythms. We compared patients with bipolar disorder (BD) and healthy control subjects (HC) using the Polish version of the BRIAN scale. Method: Fifty-four remitted BD patients (17 males and 37 females aged 52 ± 13 years) and 54 healthy control subjects (25 males and 29 females aged 42 ± 14 years) were studied. In addition to the BRIAN scale, the Composite Scale of Morningness (CSM) and the Sleep-Wake Pattern Assessment Questionnaire (SWPAQ) were employed. Results: The Polish version of the BRIAN scale displayed high feasibility and consistency, showing that the patients had greater biological rhythm disturbances than the controls. After regression analysis, significant differences were obtained for the BRIAN subscales activity and predominant chronotype, and for the SWPAQ items quality of night-time sleep and ability to stay awake. We obtained positive correlations between higher BRIAN scores and morningness and eveningness, but the correlations with vigilance and the ability to stay awake (on the SWPAQ) were negative. Conclusions: Using the BRIAN scale, we confirmed the greater disturbances of biological rhythm in Polish remitted bipolar patients, compared with healthy controls. The differences between these 2 groups in sleep-awake patterns were also demonstrated by the SWPAQ scores. In contrast to other studies, we were unable to confirm an evening chronotype as a discriminating factor between remitted bipolar patients and healthy subjects. This can be explained by the older age and the use of lithium by a significant proportion of the patients.

BackgroundWe hypothesised that men and women who engage in extreme or high-risk sports would score higher on standardised measures of bipolarity and impulsivity compared to age and gender matched controls.MethodsFour-hundred and eighty extreme or high-risk athletes (255 males and 225 females) and 235 age-matched control persons (107 males and 128 females) were enrolled into the web-based case-control study. The Mood Disorder Questionnaire (MDQ) and Barratt Impulsiveness Scale (BIS-11) were administered to screen for bipolarity and impulsive behaviours, respectively.ResultsResults indicated that extreme or high-risk athletes had significantly higher scores of bipolarity and impulsivity, and lower scores on cognitive complexity of the BIS-11, compared to controls. Further, there were positive correlations between the MDQ and BIS-11 scores.ConclusionThese results showed greater rates of bipolarity and impulsivity, in the extreme or high-risk athletes, suggesting these measures are sensitive to high-risk behaviours.

IntroductionSchizophrenia (SZ) patients present subtle motor deficits known as Neurological Soft Signs (NSS). Those deficits encompass impairments of motor coordination, sequencing of complex motor acts and sensory integration. It has been shown that SZ patients present also deficits of higher motor functions as implicit motor learning. Growing number of studies indicate that both NSS and implicit motor learning deficits are associated with impairments of common cortico-cerebellar pathways, however relationship between these two deficits has not been evaluated yet.ObjectivesTo assess NSS and implicit motor learning in SZ patients.AimsTo evaluate associations between NSS and implicit motor learning scores in SZ patients.MethodsTwenty schizophrenia patients and 20 healthy controls were examined. Patients were under olanzapine, clozapine or quetiapine treatment. NSS were assessed with Neurological Evaluation Scale (NES). Implicit motor learning were assessed with a use of Serial Reaction Time Task.ResultsSZ patients presented statistically higher NSS scores than healthy controls (P < 0.001) and presented no signs of implicit motor learning. There was statistically significant negative correlation between implicit motor learning score and total score of neurological soft signs (r = −0.44), sequence of motor acts subscore (r = −0.54) and sensory integration subscore (r = −0.47) in SZ patients group (P < 0.05).ConclusionsThere is association between implicit motor learning deficits and neurological soft signs in SZ patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

CelPoniższe badanie dotyczy nieprawidłowości konwergencji (Convergence Insufficiency, CI) objawiających się jednostronną egzoforią do bliży u pacjentów ze schizofrenią (SZ) i chorobą afektywną dwubiegunową (ChAD). Celem artykułu jest opis tego objawu i dyskusja jego potencjalnych przyczyn.MetodaPrzebadano 29 pacjentów ze SZ, 14 pacjentów z ChAD i 20 zdrowych osób kontrolnych (GK). Badanie neurologiczne wykonano za pomocą skal International Co-operative Ataxia Rating Scale (ICARS) i Neurological Evaluation Scale (NES).WynikiCI zaobserwowano u 12 pacjentów z SZ oraz 1 pacjenta z ChAD. Jednostronna egzoforia do bliży pojawiła się statystycznie częściej u pacjentów SZ niż u ChAD i GK, u której nie pojawił się wcale. Pacjenci z SZ prezentujący objaw uzyskali gorsze wyniki na podskalach dyzartrii i okoruchowej ICARS. Wyniki na skalach neurologicznych nie różnicowały pacjentów z ChAD i SZ.WnioskiCI może mieć związek z zaburzeniami sieci korowo-mostowo-móżdżkowej oraz struktur śródmózgowia. Jako jedyny objaw neurologiczny różnicował grupy SZ i ChAD, więc może być pomocny w diagnozie różnicowej.

Objectives A growing number of publications describe cerebellar abnormalities in patients with bipolar disorder (BD). The aim of the following paper was to examine the functional aspects of that issue by focusing on implicit learning – a cognitive function with significant cerebellar underpinnings. Methods 27 patients with BD and 26 healthy controls (HC), matched for age and sex took part in the study. Implicit motor learning was assessed by the serial reaction time task (SRTT), in which participants were unconsciously learning a sequence of motor reactions. The indicators of procedural learning were the decrease of reaction time (RT) across the repetition of the sequence and the rebound of RT when the sequence changed into a random set of stimuli. Results BD patients did not present any indicators of the implicit learning, their RT increased across repetitions of the sequence and it decreased when the sequence changed to random. Contrary, in the control group RT decreased across the sequence repetitions and increased when the stimuli begun to appear randomly. Limitations A low subject count and a non-drug naive patients group, medicated with atypical antipsychotic and mood stabilizers, are the most significant limitations of this study. Conclusions BD patients did not acquire procedural knowledge while performing the task, whereas HC did. To our knowledge this is the first study that shows the impairment of implicit motor learning in patients with BD. This indicates the possible cerebellar dysfunction in this disease and may provide a new neuropsychiatric approach to bipolar disorder.

Recent immunohistochemical studies point to the dorsal motor nucleus of the vagus nerve as the point of departure of initial changes which are related to the gradual pathological developments in the dopaminergic system. In the light of current investigations, it is likely that biochemical changes within the peripheral nervous system may influence the physiology of the dopaminergic system, suggesting a putative role for it in the development of neurodegenerative disorders. By using Fourier transform infrared microspectroscopy, coupled with statistical analysis, we examined the effect of chronic, unilateral electrical vagus nerve stimulation on changes in lipid composition and in protein secondary structure within dopamine-related brain structures in rats. It was found that the chronic vagal nerve stimulation strongly affects the chain length of fatty acids within the ventral tegmental area, nucleus accumbens, substantia nigra, striatum, dorsal motor nucleus of vagus and the motor cortex. In particular, the level of lipid unsaturation was found significantly increasing in the ventral tegmental area, substantia nigra and motor cortex as a result of vagal nerve stimulation. When it comes to changes in protein secondary structure, we could see that the mesolimbic, mesocortical and nigrostriatal dopaminergic pathways are particularly affected by vagus nerve stimulation. This is due to the co-occurrence of statistically significant changes in the content of non-ordered structure components, alpha helices, beta sheets, and the total area of Amide I. Macromolecular changes caused by peripheral vagus nerve stimulation may highlight a potential connection between the gastrointestinal system and the central nervous system in rat during the development of neurodegenerative disorders.

A seminal article of Takahashi et al. reporting concomitant accumulation of cellular prion protein ($PrP^{c}$) and $\beta$ -amyloid ($A\beta$) in dystrophic neurites, within neuritic plaques raised an exciting issue that is important for our understanding of mechanisms of neurodegeneration. The mentioned authors interpreted their findings rather cautiously, however since the time of their publication, several reports representing different approaches and methods have seemed to indicate that both proteins appear to co-operate more intrinsically than it could have been imagined earlier. The goal of the review is to sum up the accruing research data with special attention to evidence pointing to the co-operative role of $PrP^{c}$ and $A\beta$ in cognitive impairment.