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Objectives: Thus far, the diagnosis of insomnia is based on purely clinical criteria. Although a broad range of altered physiological parameters has been identified in insomniacs, the evidence to establish their diagnostic usefulness is very limited. Purpose of this WFSBP Task Force consensus paper is to systematically evaluate a series of biomarkers as potential diagnostic tools for insomnia., Methods: A newly created grading system was used for assessing the validity of various measurements in establishing the diagnosis of insomnia; these measurements originated from relevant studies selected and reviewed by experts., Results: The measurements with the highest diagnostic performance were those derived from psychometric instruments. Biological measurements which emerged as potentially useful diagnostic instruments were polysomnography-derived cyclic alternating pattern, actigraphy, and BDNF levels, followed by heart rate around sleep onset, deficient melatonin rhythm, and certain neuroimaging patterns (mainly for the activity of frontal and pre-frontal cortex, hippocampus and basal ganglia); yet, these findings need replication, as well as establishment of commonly accepted methodology and diagnostic cut-off points. Routine polysomnography, EEG spectral analysis, heart rate variability, skin conductance, thermoregulation, oxygen consumption, HPA axis, and inflammation indices were not shown to be of satisfactory diagnostic value., Conclusions: Apart from psychometric instruments which are confirmed to be the gold standard in diagnosing insomnia, six biomarkers emerge as being potentially useful for this purpose.

Insomnia is one of the most common health problems in developed countries. Its prevalence increases with age, with up to one in two people over the age of 65 experiencing symptoms of insomnia. The older people are also the patients who mostly commonly are among chronic sleep medication users. The aim of this article is to present the current recommendations for the management of insomnia in people over 65 years of age. The recommendations were prepared as a position of an expert panel, which included people from a number of clinical disciplines: family medicine, cardiology, psychiatry, sleep medicine and clinical psychopharmacology. The first step in treating sleep disorders is to establish proper diagnosis and, if possible, to initiate causal treatment. Moreover, cognitive and behavioural therapy for insomnia should also be used as the primary form of treatment, which can be supplemented, if not sufficiently effective, with pharmacological treatment. The main group of drugs used for treating insomnia are nonbenzodiazepine sedative hypnotics (zolpidem, zopiclone, eszopiclone, zaleplon). However, these drugs do not fully meet the needs of people over 65 years of age, primarily with regard to treatment safety. Therefore other classes of medicines, which are used for treatment of mental disorders, are prescribed off-label in this group of patients. Melatonin in a prolonged-release form is also indicated for this age group due to the high safety of the therapy. The management of insomnia in people over 65 years of age is a challenging task, given the need to seek compromise between treatment efficacy and safety. The treatment plan also has to take into account comorbidities as well as drugs used to treat them.

The outbreak of the COVID-19 pandemic increased the occupational burden experienced by healthcare workers. The aim of this study was to investigate a change in work satisfaction during the pandemic and specific factors contributing to mental health among healthcare providers. We obtained data from 367 healthcare professionals. Respondents were asked about their satisfaction with selected aspects of work (clarity of procedures, access to personal protective equipment, the flow of information, financial stability and general security) during the epidemic and retrospectively how satisfied they were before the outbreak. They also completed measures assessing mental health: the World Health Organization-Five Well-Being Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale and the Insomnia Severity Index. The results showed that satisfaction with all safety-related work aspects decreased during the pandemic. The flow of information and financial stability were significant predictors of WHO-5, PHQ-9 and ISI scores. GAD-7 scores were predicted by satisfaction with the clarity of procedures, the flow of information and financial stability. The COVID-19 pandemic significantly changed the lives of everyone. However, due to conditions of employment in Polish healthcare, the COVID-19 pandemic put a great financial strain in addition to pandemic stressors specific to medical staff.

Transcranial magnetic stimulation (TMS) is a method of noninvasive brain stimulation developed since the 1980s. Repetitive transcranial magnetic stimulation (rTMS) is one of the methods of noninvasive brain stimulation, which is increasingly used to treat psychiatric disorders. Recent years witnessed a dynamic growth in the number of sites offering therapy with rTMS and of the interest of patients in this method in Poland. This article presents the position statement of the working group of the Section of Biological Psychiatry of the Polish Psychiatric Association concerning the proper patients selection and safety of use of rTMS in the therapy of psychiatric conditions. Before starting to use rTMS, the involved personnel should undergo a period of training in one of the centers with relevant experience. Equipment dedicated to perform rTMS should be appropriately certified. The main therapeutic indication is depression, including drug-resistant patients. rTMS may also be used in obsessive-compulsive disorder, negative symptoms and auditory hallucinations in schizophrenia, nicotine addiction, cognitive and behavioral disturbances in Alzheimer's disease, and post-traumatic stress disorder. The strength of magnetic stimuli and the overall dosing of stimulation must be based on the recommendations of the International Federation of Clinical Neurophysiology. The main contraindications are the metal elements in the body, especially medical electronic devices near the stimulating coil, epilepsy, hearing loss, structural changes in the brain, which may be associated with epileptogenic foci, pharmacotherapy, which lowers the seizure threshold, and pregnancy. The main side effects are induction of epileptic seizure, syncope, pain and discomfort during stimulation, as well as induction of manic or hypomanic episodes. The respective management is described in the article.

Purpose: Insufficient sleep increases sensitivity to chronic stress and may be a precursor to the deterioration of mental health and the development of burnout. The aim of our study was to verify whether symptoms of insomnia mediate the relationship of occupational stress with mental health among nurses who work shifts., Materials and Methods: The analyses included 117 female nurses and midwives who work shifts. They filled in the 16-item Effort-Reward Imbalance Questionnaire (ERIQ) assessing occupational stress, the Insomnia Severity Index (ISI), the Patient Health Questionnaire (PHQ-9, the question about sleep was excluded from the analyses), the Generalized Anxiety Disorder Assessment (GAD-7), and the 16-item Oldenburg Burnout Inventory (OLBI) consisting of two scales - Disengagement and Exhaustion (OLBI-D and OLBI-E)., Results: Insomnia partially mediated the association of the effort-reward imbalance ratio with depression, anxiety and the exhaustion dimension of burnout. We found no association of insomnia symptoms with the depersonalization dimension of burnout, but the effort-reward imbalance ratio was associated with the depersonalization scale., Conclusion: The results showed that occupational stress has varying degrees of influence on mental health, partly depending on the severity of insomnia symptoms among nurses and midwives who work shifts., Competing Interests: The authors declare no conflicts of interest in this work., (© 2022 Gustavsson et al.)

Early onset of schizophrenia (before the age of 18 years) is associated with a higher risk of delayed or missed diagnosis, more severe course of the disease, and an increased susceptibility to adverse reactions to antipsychotic drugs. The objective of this paper is to present the recommendations for the diagnostic and therapeutic management of patients with early-onset schizophrenia, developed on the basis of a literature review and a consensus of a group of experts working with schizophrenia therapy. The formal criteria that must be met to diagnose schizophrenia are the same for children and adults. Early-onset schizophrenia must be thoroughly differentiated from uni - or bipolar affective disorder, autism-spectrum disorders (ASDs) and anxiety disorder. Diagnostic assessment for psychotic disorders is also necessary in the case of abnormal, destructive or aggressive behaviour, or self-harm. The mainstay of schizophrenia treatment is pharmacological therapy, which is used in the treatment of acute episodes and in maintenance treatment - prevention of relapses. However, the use of pharmacological interventions in children and adolescents only to reduce the risk of psychosis development is not justified. Antipsychotic agents significantly differ by their tolerance profile and clinical efficacy. Second-generation antipsychotic agents approved for the treatment of early-onset schizophrenia - aripiprazole, lurasidone and paliperidone - enable its effective and safe treatment. The necessary complement to pharmacological therapy is non-pharmacological interventions that should be adapted to the patient's age, cognitive abilities, disease stage and the needs of the whole family.

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., (© 2021 European Sleep Research Society.)

Aripiprazole, cariprazine and brexpiprazole are antipsychotic drugs (APD) whose action is associated with partial agonism at the dopamine D2/D3 receptors. They are increasingly more widely used in clinical practice, also off-label. The aim of this article is to present the current state of knowledge on the use of these drugs in the treatment of mental disorders. The position statement was developed by the panel of experts appointedby the Executive Board of the Polish Psychiatric Association, consisting of individuals with many years of experience in treating patients with mental disorders. The evaluation included the analysis of literature databases (Medline, Embase, Cochrane) and information obtained from metaanalyses and summaries of product characteristics. A key property of D2/D3 partial agonists is that they display diverse effects on dopamine pathways: (a) blockade of mesolimbic signalling that is overactive in the acute phase of schizophrenia and mania, (b) stimulation of mesocortical pathways with an improvement (or at least with no deterioration) of cognitive functions and negative symptoms, (c) no blockade of the tuberoinfundibular pathway and, consequently, low risk of increased prolactin secretion, (d) no blockade of nigrostriatal pathway and, consequently, low risk of extrapyramidal symptoms. Selective profile of action and intrinsic activity at dopamine D2 (aripiprazole > brexpiprazole) and D3 (cariprazine) receptors in combination with the lack of antihistamine and anticholinergic properties make aripiprazole, brexpiprazole and cariprazine different form other APD in terms of their safety and tolerability. This is the reason for the increasing use of these drugs in the treatment of schizophrenia and mood disorders, and in the case of aripiprazole also in obsessive-compulsive, autism-spectrum and tic disorders.

D2/D3 dopamine receptor partial agonists (aripiprazole, brexpiprazole, cariprazine) are increasingly often used in the treatment of mental disorders due to a more favourable tolerability profile as compared to other antipsychotics. The article presents the position statement on the use of these drugs in the treatment of special populations: people with comorbid somatic diseases, people over 65 years of age, including those with dementia, children and adolescents, pregnant and breastfeeding women. The position statement was developed by the panel of experts appointedby the Executive Board of the Polish Psychiatric Association consisting of people experienced in the treatment of patients with mental disorders. The evaluation included the analysis of literature databases and information obtained from summaries of product characteristics, as well as reports and registers on the safety of the three evaluated drugs. D2/D3 dopamine receptor partial agonists can be used in the treatment of people who must be provided with the highest safety standards of the therapy. It results from their low risk of producing side effects, such as weight gain, metabolic disorders, akathisia, extrapyramidal symptoms, increased prolactin levels, prolongation of QTinterval in ECG, sedation and anticholinergic effects. Since dopamine receptor partial agonists are available for arelatively short time, there is less information on their use in pregnant women than for other antipsychotics.

Background: Although the efficacy of electroconvulsive therapy (ECT) has been well established, the utilization rate of ECT has decreased in Poland in recent years. One of the main reasons could be the negative attitude towards ECT in the community and by mental health professionals. The aim of this study was to assess the knowledge about and attitudes toward ECT in Polish mental health professionals including psychiatrists and non-physicians: nurses, psychologists, social workers., Subjects and Methods: Psychiatrists and other mental health professionals in two large Polish hospitals were approached to participate in the survey by completing a 28-item questionnaire. The specific hospitals have been selected due to the fact that they were located in the same province of Poland (Mazowsze), had similar catchment area and profile, provided similar mental health services with only one exception; one offered ECT while the other did not. Of the 185 questionnaires that had been distributed, 165 were completed yielding a response rate of 89.19%. The study population consists of 85 psychiatrists and trainees and 80 non-physicians., Results: Psychiatrists did not differ from other mental health professionals with respect to the knowledge and attitudes toward ECT. However, there were significant differences in the attitude (9.1±3.8 vs 7.1±3.3; p<0.001) and knowledge (5.9±3.8 vs 2.8±4.1; p<0.001) scores between those professionals, who have ever worked in a psychiatric ward where they could observe ECT sessions and those who have not had such an opportunity., Conclusions: Frequent witnessing of ECT sessions seems to be the most effective educational intervention to change negative attitudes towards ECT.

Sedative antidepressants are commonly used drugs in the treatment of insomnia. However, some recommendations claim that only hypnotics have been proven effective in the treatment of sleep initiation and maintenance disorders. The aim of this article is to compare the effect of hypnotics and trazodone on sleep, and to analyse the evidence for the use of trazodone in the treatment of insomnia. Three studies investigated the effects of trazodone on sleep in primary insomnia, 5 studies on insomnia in the course of affective disorders and 6 studies on insomnia in other indications (PTSD, Alzheimer's disease, alcohol and opiate dependence, somatoform disorder, and insomnia during pregnancy). In the treatment of insomnia, trazodone is less effective than hypnotics in the treatment of sleep onset insomnia (i.e., disorders of falling asleep). For this indication it needs to be administered earlier than hypnotics, at least 1 hour before bedtime. It is, however, very effective in the treatment of sleep-maintenance insomnia, especially in patients with comorbid mental disorders or patients treated with activating antidepressants. Hypnotics and trazodone have the opposite effect on deep sleep. Trazodone increases the duration of deep sleep, which is associated with better sleep quality as assessed by patients. In contrast, hypnotics decrease slow-wave activityin sleep EEG, which is the biomarker of deep sleep. The main mechanism through which trazodone promotes sleep is its antagonistic effect on 5-HT2 serotonin receptors, while hypnotics are agonists of gamma-aminobutyric acid GABAA receptors, and other sedative antidepressants block H1 histamine receptors. This is associated with a low risk of weight gain, which is rare with trazodone treatment.

This consensus statement has been prepared by a group of experts consisting of professionals with long experience in the treatment of psychiatric disorders, who were appointed by the Management Board of the Polish Psychiatric Association. The evaluation involved the analysis of literature databases and information derived from meta-analyses of these data for years 2010-2020. The searched publications were in English, German and Polish language versions and involved interventions performed in groups of adult patients. The efficacy of nonpharmacological methods applied for treatment of negative symptoms of schizophrenia were compared with effects of adifferent treatment/combined treatment/a group with no intervention. When formulating the recommendations, the experts analysed the source data in terms of their application in the Polish conditions. The current recommendations of academic societies and literature on the treatment of schizophrenia with predominant negative symptoms were taken into account. The experts included items that involved a comparison of a study group in terms of non-pharmacological interventions, and pharmacologically treated cases were taken into account only when divisions were made into standard treatment and additional intervention. The results were divided into 7 sections: 1. Psychoeducation, 2. Psychotherapy (individual, group and family therapy), 3. Psychiatric rehabilitation, 4. Emotional intelligence, social skills and mindfulness training, 5. Cognitive remediation/rehabilitation, cognitive training, 6. Clinical efficacy of physical activity, behavioral activation and metacognitive training, 7. Other rehabilitation methods (including biological methods). The recommendations were debated by experts, approved by the Management Board of the Polish Psychiatric Association,and -upon consideration of the submitted comments - adopted as aconsensus statement of the Association with the recommendation of their application in the treatment of schizophrenic patients in Poland.

Introduction: 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., Method: 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., Results: 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., Conclusions: 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., Competing Interests: Declaration of competing interest We have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

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., (© 2019 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

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 (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence)., (© 2017 European Sleep Research Society.)

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.

Cognitive dysfunctions often occur long before the onset of psychotic symptoms of schizophrenia. They include mostly deficits in attention, memory (including working memory) and executive functions. The level of cognitive impairment strongly influences the subjective quality of life and the ability to perform in social and professional roles. Therefore improvement of cognitive functioning is an important challenge in the treatment of schizophrenia. Until recently, the lack of a widely accepted standard for the measurement of cognitive change in schizophrenia has constituted an important obstacle in the development of cognition-enhancing treatments. The MATRICS Consensus Cognitive Battery (MCCB) has been created as a standard tool for the assessment of the level of cognitive functioning in schizophrenia patients and its changes in short time intervals. MCCB includes ten cognitive tests which measure seven separable cognitive domains: speed ofprocessing, attention/vigilance, working memory (both verbal and nonverbal), verbal learning, visual learning, reasoning and problem solving, and social cognition in schizophrenia. In validation studies, the MCCB demonstrated excellent reliability, minimal practice effects and significant correlations with measures of functional capacity. In this article we describe the MCCB and present a project aimed to adapt the MCCB to Polish.

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.

Aim: 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., Methods: 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., Results: 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., Conclusions: 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.

Background: 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., Aim of the Study: 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., Methods and Results: 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., Conclusions: 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.

Background: 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., Material and Methods: 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., Results: 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., Conclusions: 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.

Background: 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., Aim: 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)., Methods: 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., Conclusions: 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.

Background and Purpose: 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., Material and Methods: 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., Results: 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., Conclusions: 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.

Aim: Patients with schizophrenia frequently report disturbed sleep and excessive daytime sleepiness. In this study the sleep quality and daytime sleepiness of patients hospitalized due to psychotic disorders was assessed shortly before the discharge from the hospital., Method: 62 patients treated with antipsychotics (20 F/ 42 M, mean age 25.7 +/- 3.5) were examined. The patients performed a vigilance task (Mackworth clock test), clinical scales were used for the assessment of: sleep quality (Athens insomnia scale - AIS), daytime sleepiness (Epworth sleepiness scale - ESS), clinical global impression (CGI scale), drug side effects (UKU scale), psychopathology and depressive symptoms (PANSS and CDSS scales)., Results: Excessive daytime sleepiness (EDS) was reported in the UKU scale in 58% of the patients. This subjective sensation of EDS was not reflected in the results of the standardized methods for the assessment of EDS. In the ESS scale EDS was found in 20% of the patients. A disturbed vigilance was found in the vigilance task in 32% of the patients., Conclusion: Subjective feeling of EDS is common in patients treated with antipsychotics. The ESS scale allows to verify the patients' claims. EDS resulting from disturbed or shortened sleep, should be differentiated from sedation resulting from pharmacological treatment and fatigue that may be related to somatic or mental disorders.

Ninety one patients with stroke or transient ischemic attack (TIA) were screened for sleep-disordered breathing (SDB). Case fatality, rate of recurrence of cerebrovascular events, and functional outcome were analyzed during a 2-year follow-up. The patients were stratified into groups: without (AH < or =5) and with SDB (AHI >5). SDB was present in 61 (67.7%) patients with stroke or TIA. The rate of recurrence of TIA or stroke in patients with SDB was significantly higher (12 patients, OR=1.52, P<0.05) as compared with patients without SDB (3 patients) within two years of observation. Case-fatality rates were not significantly different (4 patients with SDB and 2 patients without SDB). Our data show that SDB significantly increases the incidence of recurrent cerebrovascular events in patients with TIA or stroke in a two-year follow-up. SDB in patient with stroke or TIA did not influence functional outcome of stroke during the long-term observation.

Fifty five patients with ischemic stroke and 15 patients with transient ischemic attacks (TIA) were screened for sleep related breathing disorders (SRBD). Apnea-hypopnea index (AHI) and desaturation index (DI) were analyzed. The clinical status was assessed with National Institute of Health Stroke Scale (NIHSS). The patients with stroke were stratified into groups: without (AHI10). SRBD were present in 36 patients with stroke and in 10 patients with TIA. There were significant differences in the clinical status on admission, as quantified with NIHSS, between stroke patients with mild and moderate or severe SRBD. AHI positively correlated with NIHSS on admission in stroke patients (r=0.54, P<0.01). The final NIHSS score was significantly greater in patients with moderate or severe SRBD than in those with mild SRBD: 3.4+/-1.9 and 1.8+/-1.2, respectively. Our data suggest that the severity of SRBD is related to the clinical status on admission and it influence the clinical outcome after ischemic stroke.

Unlabelled: The treatment of primary insomnia frequently lasts longer than four weeks, the maximal time allowed for daily hypnotics use. Antidepressants are important alternative for long-term insomnia treatment. The aim of the study was compared the efficacy of trazodone in the treatment of patients with primary insomnia with and without prior history of hypnotics use., Material and Methods: 28 patients (9 M/19 F, mean age 55.9 +/- 11.8) were treated with trazodone, dose 25-150 mg/d, for three months. Before the start of the treatment the patients were observed for seven days without pharmacological treatment to exclude the hypnotics dependency. The Athens Insomnia Scale (AIS), the Sheehan Disability Scale (SDS), the Clinical Global Impression (CGI), the Leeds Sleep Questionnaire (LSEQ) were completed before (Day 0) and after each month of treatment (Day 30, 60, 90). Additionally the patients completed the sleep diaries and two actigraphic recordings for seven days were performed., Results: The treatment with trazodone decreased the score in the AIS (13.5 +/- 2.4 vs. 6.3 +/- 4.3 points; p < 0.001), increased the sleep time (5.1 +/- 1.3 vs. 6.1 +/- 0.9 hours; p < 0.001) and decreased the sleep latency (82.0 +/- 69.2 vs. 45.9 +/- 41.2 minutes; p < 0.01) from sleep diaries. No significant differences were observed between the patients with and without prior history of hypnotics use. Significant improvement was observed also in all other used scales. Only the actigraphic recordings provided no significant changes during the trazodone treatment., Conclusion: Trazodone improves sleep quality and daytime functioning independently from prior history of hypnotics use.

Disorders of breathing during sleep are defined as cessation or reduction of air flow thorough the upper airway, accompanied by a decrease of oxygen saturation. The results of many studies underline the association between sleep-disordered breathing (SDB) and cerebrovascular disorders. SDB, mostly obstructive sleep apnea syndrome (OSAS), is believed to be an independent risk factor of stroke and is related to poor outcome and increased long-term stroke mortality. The present study evaluated the frequency of SDB in patients with stroke or transient ischemic attack transient ischemic attack. We studied 43 patients (mean age 68.5 +/-11.0), which included 35 males and 8 females, with acute stroke (n=37) and transient ischemic attack (n=6). The assessment included body mass index (BMI), age, cardiovascular risk factors, and localization of stroke. All patients underwent all-night screening for SDB with a portable 8-channel recorder. The apnea/hypopnea index (AHI) for the whole group was 13.3 +/-15.2. AHI <5 was found in 16 patients. Overall, SDB was present in 27 (62.8%) patients with stroke and transient ischemic attack, stratified into those with AHI 5-10, (10 patients), 10-20 (8 patients), and AHI>20 (9 patients). In 15 patients, there was an increase in AHI >or=5 on assuming the supine position. The patients' mean BMI was 27.8 +/-4.7. The analysis of BMI, age, and localization of stroke was not sufficient to identify patients with high risk for SDB. We submit that overnight screening for SDB should be routinely performed in every patient after stroke and transient ischemic attack and it should become a diagnostic tool in neurological departments.

Sleep disturbances of insomnia type belong to the most common health problems of the modern society. Chronic insomnia, one that worsens daytime functioning and lasts over one month, occurs in 9 to 15% of the general population of developed countries. Further 15-20% of the population suffers from short term insomnia. When approaching a patient with insomnia, the physician should firstly regard sleep disturbances as a symptom related to other medical conditions. The most common causes of chronic insomnia include psychiatric disorders, addictions, somatic disorders and poor sleep habits. For successful treatment of insomnia it is most important to diagnose the cause of sleep problems properly. Such management of sleep disturbances allows treating insomnia causally. The symptomatic treatment of insomnia includes sleep hygiene and intermittent administration of sleep promoting drugs such as benzodiazepines, non-benzodiazepine hypnotics of second generation, antidepressants, antipsychotics, antihistaminics or herbal and over the counter agents. This article reviews the sleep promoting drugs and substances that can be used for treatment of chronic insomnia.

The paper presents current views on the pathophysiology and treatment options in the restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS). Moreover, concepts are outlined concerning possible involvement of various cerebral structures as well as neurotransmitter and metabolic systems in the RLS pathophysiology, with the focus on the role of dopamine and iron deficiency. Dopaminergic agents (i.e. L-dopa and dopamine agonists), currently regarded as the best therapeutic option in the treatment of RLS, are discussed in detail. Favorable outcomes attained in the treatment of RLS with the opioid receptor agonists, anticonvulsants, benzodiazepines, and adrenolytic agents are also reported.

In this review article we summarise the clinical features, epidemiology and differential diagnosis of the Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep (PLMS). RLS and PLMS belong to the most common causes which disturb sleep, and the RLS prevalence in the general population is estimated to range from 5 to 15%. The RLS is encountered in 10-20% of patients presenting with a problem of initiating and maintaining sleep, and in over 10% of patients with excessive daytime sleepiness. The RLS is characterised by unpleasant sensations felt deep in the legs, usually between the ankle and knee, but occasionally involving also the upper limbs or the trunk, and occurring at rest, especially at bedtime. The paresthesias are accompanied by motor restlessness and by an urge to move the limb, which results in a temporary relief of the symptoms. In virtually all of the sleeping RLS patients PLMS are observed. These are stereotyped, periodic jerking movements of a non-epileptic origin consisting in an extension of the big toe and dorsiflexion of the ankle with an occasional flexion of the knee and hip. PLMS are accompanied by usually short awakenings or transient arousals as demonstrated by sleep LEG resulting in sleep disruption. In establishing the diagnosis of RLS/PLMS idiopathic and secondary forms should be distinguished, and in particular, a number of other conditions (e.g. uremia or iron-deficiency) need to be ruled out. The clinical diagnosis of the RLS is based on the criteria of The International Restless Legs Syndrome Study Group, and the most useful laboratory support is gained from all-night polysomnography and high-resolution actography.