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Objectives: The aim of this exploratory study is to evaluate whether implicit motor learning impairments observed in schizophrenia (SZ) and bipolar disorder (BD) are associated with the resting state functional connectivity (rs-FC) within large-scale functional networks., Methods: The study involved 30 BD patients, 30 SZ patients and 30 healthy controls (HC). Implicit motor learning was evaluated with the use of serial reaction time task (SRTT). Prior to the training patients underwent resting state functional magnetic resonance imaging (rsfMRI) examination. We have measured rs-FC within salience network (SAN), default mode network (DMN), frontoparietal network (FPN), sensorimotor network (SMN), limbic network (LN) and visual network (VIN) and their associations with implicit motor learning indices., Results: rs-FC within SAN, DMN, FPN, SMN, LN and VIN reveal no significant association with implicit motor learning indices. BD, SZ and HC groups did not differ in terms of rs-FC within abovementioned networks., Conclusions: We have shown that in the studied groups SRTT performance could not be predicted by rs-FC within the major large-scale functional networks, i.e., SMN, FPN, VIN, LN, SAN and DMN. The observation of the independence of implicit motor learning from the initial activity of these systems is important for proper understanding of neuronal underpinnings of this process and planning further neuroimaging research on this topic.

Objectives: The purpose of this study was to examine relationship between anhedonia, disruption of biological rhythms, functioning and depression severity in patients with bipolar disorder (BD)., Methods: The sample included 58 patients with bipolar depression aged 18-65 years. The participants were assessed using the following scales: Dimensional Anhedonia Rating Scale (DARS), Snaith-Hamilton Pleasure Scale (SHAPS), Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Functioning Assessment Short Test (FAST). Correlations between the variables were calculated. We built linear regression models with FAST or QIDS-SR as a dependent variable. Mediation analysis was performed., Results: Statistically significant correlations were observed between the included variables. Biological rhythms dysregulation and anhedonia were independent predictors of the level of functioning or depression severity. Mediation analysis demonstrated statistically significant mediation of the relationship between anhedonia and depression severity/functioning by the BRIAN score., Conclusions: We demonstrated for the first time the interactions between anhedonia, dysregulation of biological rhythms and functioning/depression severity in patients with BD. Reward deficits by causing disruption of rhythm of daily activities and social contacts may result in more difficulties in functioning and higher intensity of depressive symptoms.

Objectives: The aim of this pilot study was to compare the level of empathy, temperament and character traits before and after 6 months of treatment in a group of patients staying in a psychiatric day care unit in groups with different (internalising vs. externalising) disorder types., Methods: The study was conducted in a group of 44 patients (33 girls and 11 boys), aged 15-20, treated between 2016 and 2021 in the Clinical Day Care Unit of the Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Krakow. 40% of the adolescents had externalising disorders and 60% had internalising disorders. The Davis Empathy Scale and the Cohen Empathy Scale were used in the study, as well as the Cloninger' Temperament and Character Inventory (TCI)., Results: Six months of treatment in a day care unit resulted in statistically significant changes in the "Fantasy" scale from the Davis Empathy Scale, in the "Reward dependence", "Self-directedness" and "Self-transcendence" subscales on the Temperament and Character Inventory in the group of adolescents with internalising disorders. In the group of adolescents with externalising disorders, there were changes at the level of statistical trend in the values of the "Fantasy" scale and the "Harm Avoidance" scale of the Temperament and Character Inventory., Conclusions: The obtained results are in line with the available data in terms of differences in temperament and character profiles between types of mental disorders and constellations of traits that are unfavourable for mental health, such as low self-directedness, harm avoidance and reward dependence.

Introduction: There is a large body of preclinical data implicating that grapefruit juice (GJ) inhibits many CYP 450 isoforms. The potential of GJ-to-drug is of high relevance to clinical psychiatry, because a wide range of psychotropic medicines undergo CYP 450 metabolism and P-gp transport., Areas Covered: Relevant data were identified by searching the electronic databases up to February 2024. This work constitutes a summary of preclinical and clinical data on GJ impact on CYP 450 metabolism, P-glycoprotein, and organic anion-transporting polypeptides (OATPs), with focus on studies that assessed GJ-to-psychotropic drug interactions. Additionally, an unpublished case series of nine patients is provided., Expert Opinion: The impact of GJ on CYP 3A4 appears to be the critical mechanism for the majority of GJ-to-psychopharmacotherapy interactions described in human studies or case reports. However, there are studies and cases of patients clearly showing that this is not the only route explaining the GJ effect, and at times, this particular is of no relevance and that other CYP 450 isoforms as well as drug transporting proteins might be involved. The risk of GJ-to-psychotropic drugs needs to be further evaluated in a 'real-world' setting and apply not only measures of pharmacokinetics but also treatment effectiveness and safety.

Objectives: The aim of the pilot study was to compare the level of empathy among adolescents treated in a psychiatric day unit in groups with varied age, gender and type of disorder (conduct and emotional disorders and depressive-anxiety disorders)., Methods: The study was carried out in a group of 117 adolescents (69 girls and 48 boys) aged 13-20, treated in the Clinical Day Unit of the Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Kraków between 2016-2021. The Davis Empathy Scale and the Cohen Empathy Scale were used for the study., Results: Girls scored significantly higher compared to boys on the Cohen and Davis Empathy scales and on the Davis subscale: Personal Distress. Statistically significant interactions were observed for the factors of gender and age, as well as age and disorder type. Older boys had statistically significantly higher scores on the Davis Empathy Scale compared to younger boys, while the reverse pattern was observed for girls (non-significant). Older patients with conduct disorders had significantly lower Cohen's Empathy Scale scores compared to younger patients; the opposite pattern was observed in the group of patients with anxiety-depressive disorders (non-significant)., Conclusions: Girls exhibit higher levels of affective and cognitive empathy than boys. The intensity of empathy increases with age in the group of boys, while for girls the obtained differences are not statistically significant. The intensity of empathy is significantly lower in the group of older adolescents (versus younger) with conduct and emotional disorders. Among depressive-anxiety disorders, the opposite pattern was noted (non-significant). The unique results obtained indicate a different trajectory of empathy development in the group of patients with conduct disorders and with depressive-anxiety disorders.

Objectives: Virtual reality (VR) is growing in popularity in treating various psychiatric disorders, including psychotic ones. However, no studies have been published on mindfulness interventions aided by virtual reality in psychotic patients to date., Methods: 25 patients with schizophrenia or schizoaffective disorder were assessed at three time points with 4-week intervals using the six-item Positive and Negative Syndrome Scale (PANSS-6), Quick Inventory of Depressive Symptomatology (QIDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), and the Addenbrooke's Cognitive Examination III (ACE-III). Additionally, the intensity of seven emotions was rated using the Visual Analog Scale (VAS) before and after each training session., Results: The subjects achieved a significant reduction in symptom severity after completing mindfulness training. This was reflected by the PANSS-6 total score, as well as by the subscales for negative and positive symptoms. A significant increase in cognitive functioning (ACE-III scores) was also found. No significant changes in these measures were observed when only the standard intervention was used., Conclusions: Our study indicates good feasibility of the developed mindfulness intervention in VR in schizophrenic patients. The results indicate potential benefits in terms of lessening of the symptoms and improvement in cognition.

Objectives: "Schizotypy" is a term describing personality traits reflected in emotional, perceptual and cognitive styles. Affective temperaments are trait-like features which were observed to be stable in time and predispose to mood disorders. The purpose of this study was to examine relationship between schizotypal features, affective temperaments and anhedonia in patients with bipolar depression., Methods: 54 patients with bipolar depression were included in the study. Participant were administered the following psychometric tools: Dimensional Anhedonia Rating Scale (DARS), Snaith-Hamilton Pleasure Scale (SHAPS), Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR). Correlations between the variables were calculated and linear regression models were built., Results: Only hyperthymia (affective temperament) and introvertive anhedonia (schizotypal domain) were statistically significantly correlated with anhedonia. In regression models, introvertive anhedonia predicted higher whereas hyperthymic features lower severity of anhedonia (measured by the SHAPS scale)., Conclusions: Hyperthymic features are protective and introvertive anhedonia is a risk factor for consummatory anhedonia.

Background: Clozapine (CLO) is a very effective antipsychotic, whose use is associated with dose-dependent risk of complications. Due to high interindividual variability in CLO metabolism, there is a need to identify factors affecting the blood concentrations of CLO and its active metabolite, norclozapine (NCLO)., Methods: A total of 446 blood samples (collected from 233 women and 213 men, aged from 18 to 77 years) were included in this study and analyzed for CLO and NCLO concentrations. The patients were treated at a psychiatric hospital in Warsaw in the years 2016-2021. Serum CLO and NCLO concentrations were determined with high-performance liquid chromatography coupled to UV., Results: The following factors were shown to increase serum CLO and NCLO levels: higher CLO dose ( p < 0.001), female sex ( p < 0.001), nonsmoker status ( p < 0.001), the use of more than two additional psychotropic drugs (only in the case of CLO; p = 0.046), concomitant use of beta-blockers (for CLO p = 0.049; for NCLO p < 0.001), and older age (for CLO p < 0.001; for NCLO p = 0.011). Despite the use of CLO at daily doses within the recommended range (200-450 mg), the evaluated serum CLO and NCLO levels were within the therapeutic ranges in only 37% and 75% of cases, respectively, with 5.6% of cases exceeding the CLO toxicity threshold., Discussion: The use of CLO at recommended doses does not guarantee achieving therapeutic concentrations of CLO or NCLO. Women and nonsmokers were at the highest risk of having toxic CLO levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Mach, Wnorowska, Siwek, Wojnar and Radziwoń-Zaleska.)

Objectives: Fibromyalgia (FM) is often comorbid with psychiatric disorders. Moreover, several studies show that psychiatric disorders may be linked to the severity and impact of FM. Therefore, the study described in the article had two main goals: (1) to explore various psychopathological symptom dimensions in patients with fibromyalgia and secondly, (2) to examine the links between psychopathology and response to treatment with serotonin and norepinephrine reuptake inhibitors (SNRI)., Methods: This cross-sectional study was performed between December 2020 and November 2022. The definition of resistance to SNRI was <30% reduction of pain after ≥8 weeks of treatment. 30 FM subjects responsive to SNRI (FM T[+]), 32 patients non-responsive to SNRI (FM T[-]) and 30 healthy controls were enrolled. Participants were examined by physicians and completed self-report tools to evaluate levels of depression (Quick Inventory of Depressive Symptomatology, Hospital Anxiety and Depression Scale), anxiety (State and Trait Anxiety Inventory), anhedonia (Snaith-Hamilton Pleasure Scale), bipolar symptoms (Mood Disorder Questionnaire, Hypomania Checklist), and dissociation (Dissociative Experiences Scale - Revised). ANOVA analysis and a series of simple logistic regressions were used to examine the associations between psychopathological variables and response to SNRI., Results: FM T[-] vs. FM T[+] showed higher levels of: depression, state and trait anxiety and anhedonia as well as higher proportion of scores indicating the presence of anxiety disorder. Increased severity of depression, anxiety and anhedonia were predictors of resistance to SNRI., Conclusions: Modifiable psychopathological symptoms vary in FM T[+] vs. FM T[-] and are predictors of resistance to SNRI. Psychological assessment should be integrated into standard care for FM patients.

The aim of our study was to evaluate the efficacy of cariprazine augmentation of clozapine in treatment-resistant schizophrenia in a retrospective chart review. Among 916 medical records of schizophrenia patients, we identified 12 individuals treated with a combination of those drugs for a duration of 3-60 weeks [median 32 (10-40)]. Clinical Global Impression-Improvement (CGI-I) scores were used to measure the treatment response between the introduction of cariprazine augmentation of clozapine and the last point of observation. The majority of the patients presented treatment response (9/12 patients, 75%) after 4-16 weeks of therapy [median 6 (4-12)]. Treatment was associated with the decrease in positive, negative, affective, and anxiety symptom severity, as well as improvement of patient global functioning. One patient discontinued the treatment due to side effects (akathisia), and two patients halted the therapy due to the exacerbation of psychotic symptoms. Our study presents a thorough clinical description of the largest number of treatment-resistant schizophrenia patients medicated using cariprazine augmentation of clozapine in a "real-world" setting. Our results suggest that the use of this combination may lead to the improvement in a broad range of symptoms of patients with this condition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Siwek, Chrobak, Gorostowicz, Król and Dudek.)

Purpose of Review: The circular interactions between type 2 diabetes (TMD2) and major depressive disorder (MDD) are well documented but the understanding of their mechanisms has only recently gained more clarity. Latest research indicates, that the association between TMD2 and MDD is largely mediated by insulin resistance (IR)., Recent Findings: A metabolic subtype of MDD can be distinguished from other MDD subpopulations, that is characterized by predominantly atypical clinical presentation, IR and different responsiveness to antidepressant interventions. IR is a predictor of nonresponse to some antidepressants. The IR seems to be a state-marker of clinical or subclinical depression and the relationship between IR and MDD varies between sexes and ethnicities. Insulin has a direct impact on the monoaminergic systems known to underlie MDD symptoms: serotoninergic and dopaminergic, which are dysregulated in IR subjects. Several trials assessed the efficacy of insulin-sensitizing drugs in MDD with mixed results for metformin and more consistent evidence for pioglitazone and lifestyle intervention/physical activity., Summary: Recently published data suggest a significant role of IR in the clinical presentation, pathophysiology and treatment response in MDD. Further research of IR in MDD and integration of existing data into clinical practice are needed., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Vortioxetine is an antidepressant with a unique profile of receptor activity. The pharmacodynamic spectrum of vortioxetine activity is linked to the modulation of not only serotoninergic but also noradrenergic and dopaminergic transmission. At the same time, its pharmacokinetic properties determine good tolerance and safety, which are also observed in elderly patients and those burdened with somatic comorbidity. This work aims to sum up the knowledge coming from the most recent studies assessing the efficacy of vortioxetine. The efficacy of vortioxetine in the treatment of depression was confirmed in a large number of open studies, randomized controlled studies with placebo control, and meta-analyses thereof. What is more, the latest research shows that this drug allows depressed patients to achieve not only symptomatic remission but also an improvement of anhedonia and recovery in cognitive and occupational function. Furthermore, there are studies showing that vortioxetine is efficacious in the treatment of elderly patients, as well as subjects who have experienced trauma or suffer from bipolar depression. Vortioxetine is characterized by a good tolerance profile and safety; rarely does it cause severe adverse effects.

Objectives: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used drugs to treat major depressive disorder (MDD). However, about 50% of MDD patients do not achieve treatment response to SSRIs and there is little evidence on which drugs are effective as second-line treatment in those who do not respond to SSRIs., Methods: In this work, the data of 79 patients with MDD were analyzed to evaluate the effectiveness of trazodone XR in the group of individuals treated de novo and those switched to trazodone XR after failed treatment attempt with SSRIs. The assessments were performed at baseline and weeks 2, 4, 8 and 12 using tools to evaluate the degree of: depression (Montgomery-Åsberg Depression Rating Scale, clinician and patient-rated Quick Inventory of Depressive Symptomatology - the primary endpoints of the study), therapeutic effectiveness (Clinical Global Impression Scale), anhedonia (Snaith-Hamilton Pleasure Scale), anxiety (Hamilton Anxiety Rating Scale), insomnia (Athens Insomnia Scale), psychosocial functioning (Sheehan Disability Scale) and sexual functioning (Female Sexual Function Inventory in women/International Index of Erectile Function in men)., Results: The rates of treatment response and remission were largely similar in both studied groups., Conclusions: The results showed that effectiveness of trazodone XR in the treatment of patients with MDD who did not respond to SSRIs administered as first-line treatment of a particular depressive episode was comparable to that noted in patients treated de novo. Furthermore, trazodone XR effectively improved depression, anxiety, insomnia, anhedonia and psychosocial functioning in both studied groups. Additionally, trazodone XR as secondline treatment improved sexual functions in male subjects previously treated with SSRIs.

Introduction: Selective serotonin reuptake inhibitors (SSRIs) are the most often used medications to treat major depressive disorder (MDD). Despite their effectiveness in reducing depressive symptoms, several issues are associated with their use in MDD, such as limited improvement of anhedonia, emergence of emotional blunting, induction or exacerbation of insomnia, and sexual dysfunction. Due to its also devoid of the issues related to treatment noted with SSRIs. The aim of this 12-week non-inferiority naturalistic observation was to compare the effectiveness and tolerability of SSRIs and trazodone in extended release (XR) in MDD. Methods: A total of 186 subjects were recruited, of which 92 received trazodone XR and 94 received SSRIs. Patients were allocated to trazodone XR or SSRIs, according to the attending physician based on clinical evaluation. Assessments at baseline and weeks 2, 4, 8, and 12 were conducted to evaluate the severity of depression (Montgomery-Åsberg Depression Rating Scale, clinician- and patient-rated Quick Inventory of Depressive Symptomatology-the primary endpoints of the study), anhedonia (the Snaith-Hamilton Pleasure Scale), anxiety (the Hamilton Anxiety Rating Scale), insomnia (the Athens Insomnia Scale), and therapeutic effectiveness (the Clinical Global Impression Scale). Results: After 12 weeks, trazodone XR was more effective than SSRIs in reducing the severity of depression, anxiety, and insomnia. There was a trend for higher effectiveness of in reduction of anhedonia, which became insignificant after controlling the results for the duration of previous psychiatric treatment as a covariate. The proportion of treatment-responsive subjects in the trazodone XR group compared to SSRIs was comparable or higher. The proportion of patients achieving remission was higher in the trazodone XR arm vs. the SSRI arm. Discussion: In summary, the results indicate that trazodone XR is effective in MDD in the "real-world" setting. Its potential superiority over SSRIs in addressing particular symptomatic dimensions should be verified in future studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Dudek, Chrobak, Krupa, Gorostowicz, Gerlich, Juryk and Siwek.)

Background: Some new mothers have been shown to suffer from anxiety and depression associated with insomnia during the postpartum period. Our study assessed the impact of demographic, psychopathological, and biochemical factors on the incidence of depression in women during the early postpartum period., Methods: A total of 119 women were evaluated at 24-48 h postpartum with the following psychometric scales: Hamilton Depression Rating Scale (HDRS), Edinburgh Postnatal Depression Scale (EPDS), Hamilton Anxiety Rating Scale (HARS) and Athens Insomnia Scale (AIS). In addition, blood was drawn to assay interleukin 6 (IL-6) and interleukin 10 (IL-10)., Results: The factors that had the greatest impact on the risk of postpartum depression detected with the HDRS were high HARS scores and evidence of insomnia in the AIS. There were no significant differences in IL-6 or IL-10 levels in women with and without depression (based on either HDRS or EPDS scores) and insomnia (based on AIS) after childbirth. Considering demographic factors, divorced and single women were shown to be at higher risk of postpartum depression (based on EPDS scores)., Limitations: Small sample size and short observation span., Conclusion: This study highlights the relationship between postpartum depression and both anxiety and insomnia and emphasises the importance to assess symptoms of anxiety and sleep quality as part of screening in women at risk of postpartum depression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Drozdowicz-Jastrzębska, Mach, Skalski, Januszko, Jabiry-Zieniewicz, Siwek, Wawrzyniak and Radziwoń-Zaleska.)

Aim: We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review. Methodology: A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms. Results: Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: Withania somnifera : reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); Eleutherococcus senticosus : duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); Schisandra chinensis : bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); Tribulus terrestris : citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); Coptis chinensis : mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); Cimicifuga racemosa : mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); Bacopa monnieri : agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); Gynostemma pentaphyllum : duloxetine (back pain); Cordyceps sinensis : sertraline (upper gastrointestinal bleeding); Lepidium meyenii : mianserin (restless legs syndrome); and Scutellaria baicalensis : bupropion (seizures). Conclusion: Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events., Competing Interests: Author JG was employed by the Pharmacotherapy Safety Team. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Siwek, Woroń, Wrzosek, Gupało and Chrobak.)

Background: Anhedonia is the core symptom of depression. Its presence has been linked to worsened prognosis. The Dimensional Anhedonia Rating Scale (DARS) is a scale measuring desire, motivation, effort and consummatory pleasure across different domains. The aim of this paper was to confirm factor structure, assess reliability and validity of the Polish adaptation of the DARS in a clinical sample of patients with mood disorders and healthy controls (HC)., Methods: The study sample included 161 participants aged 18-65 years - 34 HC, 72 patients with bipolar disorder and 55 with major depressive disorder (in depressive episode or remission). Reliability of the Polish adaptation of the DARS was assessed using Cronbach's α and the average inter-item correlation (AIC). Convergent and divergent validity was established by Pearson's correlations between the DARS and the Snaith-Hamilton Pleasure Scale (SHAPS), the Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), the Hospital Anxiety and Depression Scale (HADS). The structure of the scale was examined by factor analysis., Results: The factor structure was consistent with the original scale. Strong internal consistency for the DARS total score (Cronbach's α = 0.95) and all subscales (0.86-0.93) was observed. The DARS demonstrated good convergent (moderate to strong correlations with measures of anhedonia and depression) and divergent validity (weak correlations with anxiety level)., Conclusion: The Polish DARS demonstrated excellent internal consistency and very good validity. The scale is a valuable contribution to the psychometrics of anhedonia measures in patients with mood disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Gorostowicz, Rizvi, Kennedy, Chrobak, Dudek, Cyranka, Piekarska, Krawczyk and Siwek.)

Introduction: Our previous studies identified a paradoxical implicit motor learning curve in schizophrenia (SZ) and bipolar disorder (BD) patients. This study aimed to verify whether those previously observed deficits may be captured by a new version of the ambidextrous serial reaction time task (SRTT), prepared for use in the MRI., Methods: This study involved 186 participants. A total of 97 participants (33 BD, 33 SZ, and 31 healthy controls, HCs) completed the original, unlimited time response variant of SRTT. A total of 90 individuals (30 BD, 30 SZ, and 30 HCs) underwent a newer, limited response time version of this procedure., Results: There was no significant difference in terms of implicit motor learning indices between both limited and unlimited response time SRTT. Compared to HCs, SZ, and BD patients presented decreased indices of implicit motor learning. Both clinical groups showed a paradoxical learning pattern that differed significantly from the HCs. Moreover, in the SZ group, the pattern depended on the hand performing SRTT., Discussion: The limited response time SRTT variant allowed us to replicate the findings of disrupted implicit motor learning in SZ and BD. The use of this paradigm in further neuroimaging studies may help to determine the neuronal underpinnings of this cognitive dysfunction in the abovementioned clinical groups., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chrobak, Siuda-Krzywicka, Soltys, Bielak, Nowaczek, Żyrkowska, Fafrowicz, Marek, Pęcherzewska, Kużdżał, Starowicz-Filip, Gorostowicz, Dudek and Siwek.)

Introduction: Fibromyalgia (FM) is often comorbid with anxiety and depression. Serotonin and noradrenaline reuptake inhibitors (SNRIs) are used in the treatment of FM, depression, and anxiety, but they are ineffective in a substantial number of patients. Recently, it has been reported that FM is associated with impaired glucose metabolism., Objectives: The aim of the study was to explore the associations between insulin resistance, psychiatric comorbidities, and treatment response to SNRIs in patients with FM., Patients and Methods: A total of 59 patients with FM and 30 healthy controls (HCs) were recruited. The study patients were classified as treatment‑nonresponsive if the SNRI treatment resulted in a reduction in reported pain by less than 30%. All participants were examined by a physician and completed self‑report questionnaires. Blood samples were drawn to assess fasting glucose and insulin levels and to calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA‑IR) values. Multivariable logistic regression models were constructed to analyze the associations between insulin resistance, psychiatric comorbidies, and the lack of response to treatment with SNRIs., Results: The SNRI nonresponders (FM [T-]) had higher body mass index (BMI), fasting insulin level, and HOMA‑IR values than the responders (FM [T+]) and HCs. The FM [T+] patients did not significantly differ from HCs in terms of BMI, levels of fasting glucose and fasting insulin, and HOMA‑IR values. Depression, anxiety, and personality disorders were significantly more prevalent in the FM [T-] than in the FM [T+] group. Insulin resistance, depression, anxiety, and personality disorders were identified as the predictors of nonresponse to SNRI treatment. The effect of BMI on the lack of response to SNRIs was fully mediated by insulin resistance., Conclusions: Increased values of certain clinical and metabolic parameters (BMI, fasting glucose, fasting insulin, HOMA‑IR) as well as the presence of psychiatric comorbidities could affect the response to treatment with SNRIs in the patients with FM.

Objectives: Virtual Reality (VR) has been widely used in psychiatry, including psychotic disorders. The main advantage of VR is its high ecological validity and controllability of the virtual environment. Our main goal was to test whether, similarly to computer-generated VR, 360-degree videos are able to elicit a state of social paranoia in prone individuals., Methods: Sixteen schizophrenia patients and twenty-three healthy individuals were assessed using Leibowitz Social Anxiety Scale and additionally, in the patient group, the Positive and Negative Syndrome Scale (PANSS-6) and Peters Delusional Inventory (PDI) were used. The participants viewed four 360-degree videos with and without social content on a VR headset. Meanwhile, subjects' heart rate was measured continuously. After the exposure, both groups were assessed with Social State Paranoia Scale (SSPS) and asked about momentary anxiety and sense of presence., Results: The schizophrenia patients reported higher momentary anxiety, although the results of SSPS did not differ significantly between groups. In the control group the heart rate decreased between first non-social and social video, whereas in the patient group it did not differ significantly. There was a significant correlation of paranoid ideation experienced on daily basis (PDI) and elicited in VR (SSPS) in the patient group., Conclusions: In conclusion, paranoid responses can be triggered in patients with schizophrenia by 360-degree videos.

The aim of our study was to evaluate the effectiveness of lurasidone augmentation of clozapine in treatment-resistant schizophrenia (SZ) in a retrospective chart review. From the medical records of 916 SZ patients, we identified 16 individuals treated with a combination of clozapine and lurasidone. The detailed clinical data are described separately for each patient. We compared the Clinical Global Impression-Severity (CGI-S) scores between three points of observation: before the treatment and one month and two months after its initiation. CGI Improvement (CGI-I) scores were used to evaluate the treatment response between the first and last points of observation. The vast majority of patients (14/16, 87.5%) responded to lurasidone augmentation of clozapine (CGI-I scores 1 or 2). Therapeutic effects were observable after 3-12 weeks of treatment (median 6 (4-6)). A reduction in CGI-S scores was observed after the first month of observation. There was an observable reduction in positive, depressive and anxiety symptoms, as well as an improvement in psychosocial functioning. Two patients discontinued treatment due to side effects. Our study suggests that lurasidone augmentation of clozapine may lead to improvements in a broad range of SZ symptom dimensions.

In 2002, the first III generation antipsychotic drug was registered-aripiprazole. Its partial dopaminergic agonism underlies its unique mechanism of action and the potentially beneficial influence on the positive, negative, or cognitive symptoms. Due to its relatively high intrinsic activity, the drug could often cause agitation, anxiety, or akathisia. For this reason, efforts were made to develop a drug which would retain the positive favorable actions of aripiprazole but present a more advantageous clinical profile. This turned out to be brexpiprazole, which was registered in 2015. Its pharmacodynamic and pharmacokinetic profile (similarly to the other most recent antipsychotics, i.e., lurasidone or cariprazine) shows promise of increasing the effectiveness of schizophrenia treatment in the dimensions in which the previous antipsychotics were not sufficiently effective, including negative, depressive, or cognitive symptoms. Like other new antipsychotics, it can also be useful in the treatment of mood disorders, for instance drug-resistant depression. Previous reviews focused on the use of brexpiprazole in specific diagnostic groups. The aim of this article is to provide the readers with an overview of data on the mechanism of action, clinical effectiveness in all studied diagnostic groups, as well as potential drug-food interactions, and the safety of brexpiprazole.

These are the preliminary results of a 12-week non-randomized, open-label, non-inferiority study comparing the effectiveness of trazodone in an extended-release formulation (XR) versus SSRIs in the treatment of major depressive disorder (MDD). Participants ( n = 76) were recruited, and 42 were assigned to the trazodone XR group and 34 to the SSRIs group. The choice of drug was based on clinical presentation and relied upon the attending physician. Assessments were made at five observation time points, at the following weeks: 0, and after 2, 4, 8, and 12 weeks. The evaluations included: symptoms of depression (MADRS, QIDS-clinician, and self-rated versions-primary study endpoints), anhedonia (SHAPS), anxiety (HAM-A), insomnia (AIS), psychosocial functioning (SDS), and therapeutic efficacy (CGI). At baseline, the trazodone group had significantly more severe depressive, anxiety, and insomnia symptoms and worse psychosocial functioning compared to the SSRIs group. After 12 weeks, trazodone XR was more effective than SSRIs in reducing the severity of insomnia and depression. There were no differences between the groups in the frequencies of therapeutic response and remission, which indicated the non-inferiority of the trazodone XR treatment. In conclusion, our results showed that in a "real world" setting, trazodone XR is effective in the treatment of patients with MDD.

Introduction: Pharmacotherapy of depression is characterized by the delayed onset of action, chronic treatment requirements, and insufficient effectiveness. Ketamine, with its rapid action and long-lasting effects, represents a breakthrough in the modern pharmacotherapy of depression., Areas Covered: The current review summarizes the latest findings on the mechanism of the antidepressant action of ketamine and its enantiomers and metabolites. Furthermore, the antidepressant potential of psychedelics, non-hallucinogenic serotonergic modulators, and metabotropic glutamate receptor ligands was discussed., Expert Opinion: Recent data indicated that to achieve fast and long-acting antidepressant-like effects, compounds must induce durable effects on the architecture and density of dendritic spines in brain regions engaged in mood regulation. Such mechanisms underlie the actions of ketamine and psychedelics. These compounds trigger hallucinations; however, it is thought that these effects might be essential for their antidepressant action. Behavioral studies with serotonergic modulators affecting 5-HT1A (biased agonists), 5-HT4 (agonists), and 5-HT-7 (antagonists) receptors exert rapid antidepressant-like activity, but they seem to be devoid of these effects. Another way to avoid psychomimetic effects and achieve the desired rapid antidepressant-like effects is combined therapy. In this respect, ligands of metabotropic receptors show some potential.

Aim: To systematically evaluate prevalence and clinical characteristics of adverse effects of antidepressants and OTC drugs interactions in a retrospective chart review. Methodology: Dataset of 1,145 registered adverse events were evaluated. Reports were selected for further analysis if pharmacoepidemiological avaluation indicated the presence of high probability of a causal relationship between antidepressants and OTC interaction and the occurrence of side effect. Following variables were extracted from the records: sex, age, medical comorbidities, antidepressant and other concomitant medications, clinical consequences ant the possible interaction mechanisms. Results: 368 showed causal relationship with the simultaneous use of antidepressant with another drug. 15 adverse events (4%) were related to the use of OTC medicine, particularly omeprazole, diphenhydramine, Japanese ginkgo biloba, ibuprofen, diclofenac and sildenafil. All of the analysed side effects were categorized as the result of pharmacokinetic interactions. Here we report identified OTC drugs with corresponding antidepressants and clinical manifestations of DDI. Omeprazole: agomelatine (nausea, abnormal dreams), fluoxetine (extrapyramidal symptoms, paresthesias), sertraline (vertigo, yawning), escitalopram (oral vesiculation). Diphenhydramine: sertraline (diaphoresis, insomnia, vertigo), paroxetine (pruritus, headache), duloxetine (oropharyngeal pain). Japanese ginkgo biloba: citalopram (bradycardia), trazodone (vertigo, taste pervesion), mianserine (restless legs syndrome). Diclofenac: escitalopram (oral vesiculation), and fluoxetine (restless legs syndrome). Ibuprofen: agomelatine (anxiety and nausea), sertraline and omeprazole (QTc prolongation). Sildenafil: fluoxetine (genital oedema) and sertraline (myocardial infarction). Conclusion: The use of OTC drugs by the patients should be monitored. Pharmacokinetic interactions between nonprescribed medicines and antidepressants may increase concentration and severity of side effects of latter ones., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Woroń, Chrobak, Ślęzak and Siwek.)

Objectives: The efficacy of vortioxetine in major depressive disorder has been evaluated in many studies. However, there is a lack of studies assessing vortioxetine in bipolar depression., Methods: In 60 patients with bipolar depression, vortioxetine 10-20 mg daily was added to current mood stabilizing medication during 24-week, naturalistic, openlabel study. The most frequent mood stabilizers were lamotrigine, quetiapine, olanzapine, and valproates. The therapeutic efficacy was evaluated by the Clinical Global Impression - Improvement (CGI-I) and Clinical Global Impression - Severity (CGI-S) scales. Patients were classified as responding to vortioxetine when they achieved 1 or 2 points on the CGI-I scale at any stage of observation. The criterion of remission was defined as score 1 at the CGI-S., Results: 73% of all patients (44/60) responded to vortioxetine and 52% (31/60) achieved clinical remission of depressive symptoms (in mean 8.97 ± 4.05 weeks). There were no significant associations between vortioxetine response/remission rates and: (1) the dose, (2) BD type, (3) clinical stage, (4) presence of rapid cycling, (5) history of psychotic symptoms, analyzed depressive symptoms, and (6) concomitantly used mood stabilizer. 4 patients (6.7%) stopped treatment due to adverse effects (nausea), and 7 patients (11.7%) discontinued treatment due to the phase switch. 14 patients (23%) experienced a loss of vortioxetine effectiveness after the initial response or remission., Conclusions: The results indicate relatively high rates of response and remission during 24-week treatment in depressed bipolar patients receiving vortioxetine concomitantly with a mood stabilizer. This may indicate that vortioxetine added to a mood stabilizer may constitute an efficient and well tolerated therapeutic option in bipolar depression.

The aim of the study is to look from a relational perspective at how patients with bipolar disorder (BD) cope with stress. This is done firstly in the context of dyadic coping and secondly in the context of individual coping strategies that result from patients' attachment styles. The way in which BD patients start relationships is important on many levels, including in the context of treatment effectiveness and relapse prevention. Dyadic coping can act as aprotective function against both external and relational stress, and it can become a buffer that protects against relapse, or a therapeutic factor reducing theseverity of symptoms and the frequency of their occurrence. Insecure attachment is considered one of the risk factors of the development of affective disorders. The insecure attachment style of BD patients makes them more often exposed to relapse when relational support is lost. Extending the coping concept of BD patients with the attachment aspect creates a new perspective for understanding their behavioral-emotional-cognitive stress responses. In addition, by approaching the problem from the dyadic level, the picture is supplemented with the impact of close relationships on the motivational processes of both partners in coping with the illness, building relationships, their mutual satisfaction and overall well-being.

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.

Background: Some studies suggest that as much as 40% of all causes of death in a group of patients with schizophrenia can be attributed to suicides and compared with the general population, patients with schizophrenia have an 8.5-fold greater suicide risk (SR). There is a vital need for accurate and reliable methods to predict the SR among patients with schizophrenia based on biological measures. However, it is unknown whether the suicidal risk in schizophrenia can be related to alterations in spontaneous brain activity, or if the resting-state functional magnetic resonance imaging (rsfMRI) measures can be used alongside machine learning (ML) algorithms in order to identify patients with SR., Methods: Fifty-nine participants including patients with schizophrenia with and without SR as well as age and gender-matched healthy underwent 13 min resting-state functional magnetic resonance imaging. Both static and dynamic indexes of the amplitude of low-frequency fluctuation (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity as well as functional connectivity (FC) were calculated and used as an input for five machine learning algorithms: Gradient boosting (GB), LASSO, Logistic Regression (LR), Random Forest and Support Vector Machine., Results: All groups revealed different intra-network functional connectivity in ventral DMN and anterior SN. The best performance was reached for the LASSO applied to FC with an accuracy of 70% and AUROC of 0.76 ( p < 0.05). Significant classification ability was also reached for GB and LR using fALFF and ALFF measures., Conclusion: Our findings suggest that SR in schizophrenia can be seen on the level of DMN and SN functional connectivity alterations. ML algorithms were able to significantly differentiate SR patients. Our results could be useful in developing neuromarkers of SR in schizophrenia based on non-invasive rsfMRI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bohaterewicz, Sobczak, Podolak, Wójcik, Mȩtel, Chrobak, Fa̧frowicz, Siwek, Dudek and Marek.)

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., (Copyright © 2020 Sobczak, Bohaterewicz, Marek, Fafrowicz, Dudek, Siwek, Tereszko, Krupa, Bryll and Chrobak.)

This article aims to describe the experience of transforming the Clinical Department of Adult, Child and Adolescent Psychiatry of the University Hospital in Krakow (CDACAP) into award designated by the Malopolska Voivod to provide the treatment for mentally ill adults from Malopolska Voivodship and adolescents from the south of Poland during the COVID-19 pandemic. We discuss sequent stages of transformation, practical solutions and difficulties encountered in the process. 9 patients with confirmed SARS-CoV-2 infection were hospitalized in the CDACAP between 09.04 and 29.05.2020, and 97 were tended to by consulting psychiatrists in the main building of the University Hospital in Krakow between 23.03 and 23.05.2020. In our experience, the Polish healthcare facilities, especially psychiatric and long-term care ones, were ill-equipped to operate during the pandemic crisis. This situation has brought out the nationwide lack of systemic solutions, particularly in the areas of child and adolescent psychiatry as well as forensic psychiatry. Functioning during the epidemic and confronting the risk of rapid deterioration in patients'condition clearly pointed out the necessity of creating psychiatric wards within the multispecialty hospitals. The requirement for ensuring separate spaces for patients with SARS-CoV-2 infection or with exclusion thereof should be considered in the psychiatric reform which assumes the regional responsibility of stationary wards.

Objectives: To investigate bipolar traits and impulsiveness in pathological gamblers, compared to non-pathological gamblers and non-gambling general population. To investigate interaction between traits of affective temperament, impulsiveness and the severity of pathological gambling., Methods: 139 participants (63 women, 76 men; mean age: 30.32; SD = 10.69) were included in the study. The Barratt Impulsiveness Scale was used to evaluate impulsiveness and the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire was used to evaluate affective temperamental traits. The participants were also screened for bipolar affective disorder spectrum using the Mood Disorder Questionnaire and the Hypomania Checklist-32.The Canadian Problem Gambling Index (CPGI) was used to evaluate the severity of pathologicalgambling in the assessed population. Polish versions of the questionnaires were filled out anonymously via the internet., Results: Pathological gamblers (N =36) scored higher on ‛Motor impulsiveness', ‛Cyclothymic'and ‛Irritability'subscales versus non-pathological gamblers (N =61) and non-gamblers (N = 42). Cyclothymic and motor impulsiveness significantly predicted CPGI scores. Motor impulsiveness was found to moderate the influence of cyclothymic affective temperamental traits on pathological gambling., Conclusions: Our data support prior reports of higher impulsivity traits and traits from the bipolar spectrum among pathological gamblers. The results indicate that the influence of affective temperamental traits on pathological gambling severity is moderated by impulsiveness.

Objectives: With respect to bipolar disorder (BD), previous research have demonstrated saccadic eye movements abnormalities, manifested mainly as an increase in reaction time (latency) in both prosaccadic and antisaccadic task. So far, there were no studies related to vergence eye movements in subjects with BD. Our primary aim was to evaluate vergence tracking performance in this clinical group., Methods: 30 patients with BD in remission and 23 healthy controls were enrolled. Subjects underwent optometric examination where near point of convergence was measured by the use of Wolff Wand. Instrumented convergence measurements were performed using infrared eye tracker and dedicated vergence stimuli generator., Results: BD patients presented significantly higher average error between eyes' convergence and convergence required to fixate the target and higher number of saccadic intrusions compared with healthy controls group. Principal component analysis performed on oculometric parameters revealed differences between BD patients and healthy controls. Significant correlations between the vergence disturbances and saccadic intrusions were found., Conclusions: BD patients showed the alterations of the vergence eye movements similar to the disturbances of eye movements in the fronto-parallel plane. While the abnormalities of vergence eye movements in some mental disorders have been reported, we have for the first time objectively measured this phenomenon in BD.

Background: High level of comorbidity between bipolar disorder or schizophrenia and cardiovascular diseases (CVD) in clinical practice may contribute to drug-drug interactions between medications used in these conditions. The aim of this study was to evaluate harmful interactions between antipsychotics and medications used in treatment of CVD., Methods: The analysis of 52 cases of adverse reactions with a clinical picture indicates that they were the result of the combination of antipsychotic with cardiovascular medications., Results: The highest number of interactions with antipsychotics was recorded among beta-blockers (n = 13, 25% of all cases), including cardiac arrhythmias [atrial fibrillation (n = 1): risperidone plus atenolol; bradycardia (n = 1): perphenazine with metoprolol; ventricular arrhythmias: sertindole with metoprolol (n = 1) and ziprasidone with sotalol (n = 3)] and hypotension [chlorprotixene with nebivolol or metoprolol (n = 2)]. 12 cases concerned statins-myalgia, myopathy, or creatine kinase elevation appeared after combination of atorvastatin with haloperidol (n = 1), quetiapine (n = 3) or risperidone (n = 1), and simvastatin with quetiapine (n = 5) or risperidone (n = 2). There were also cases of interactions observed for the use of antipsychotics with anti-arrhythmic drugs (amiodarone, flecainide, propafenone) (n = 11), calcium channel blockers (n = 6), and other cardiac medications: clonidine, dabigatran, doxazosin, ivabradine, and losartan (n = 10)., Conclusions: Due to a high risk of interactions and related adverse effects, particular attention should be paid while using cardiovascular medications with antipsychotics. Clinical decisions should be preceded by a detailed analysis of safety, risk-benefit ratio to search for, as safe as possible, drug combinations.

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

Objective: The objective of this study was to investigate the relationship between the burden level of spouses of patients in the symptomatic remission state of the major depressive disorder (MDD; 60 patients) or bipolar disorder (BD; 65 patients) and coping styles., Methods: The Involvement Evaluation Questionnaire was used to assess the burden magnitude. Coping styles were evaluated by the Coping Inventory for Stressful Situation. Information concerning patients' clinical histories, a marriages characteristics and sociodemographic data were obtained from a structured clinical interview., Results: There were significant levels of the perceived burden in spouses of patients with either BD or MDD. In both groups the burden level was significantly higher for spouses with worse appraisal of the marital adjustment and functioning. A positive correlation between higher perceived level of burden and emotion-focused coping style was found in both groups. For the problem-oriented coping style a negative correlation with the perceived burden level was found in the BD group only. The quality of'current sexual satisfaction' was significantly lower among the spouses of BD patients. The sense of illness-driven deterioration of the quality of their sexual lives implied higher level of total and objective burden of spouses in the MDD sample. This was not the case among the spouses of patients diagnosed with BD., Conclusions: Spouses of patients with affective disorders should be offered with opportunities of training in more effective methods of coping (including problem-solving methods) with an illness of a family member, in order to decrease the level of burden.

Aim: The subject of the research presented in this paper was to analyze the relationships between bipolar disorder (BD) and the profile of moral reasoning according to the concept of James Rest., Material and Methods: 86 persons took part in the research, including 43 bipolar patients and 43 healthy individuals. To measure the severity of depression and mania symptoms the following scales were used: Hamilton Rating Scale for Depression (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS) and Young Rating Scale for Mania (YMRS). Profile of moral reasoning was defined on the basis of the results obtained in the Defining Issue Test (DIT) by James Rest., Results: Statistical analysis showed that there is a relationship between bipolar disorder (and its phases) and the profile of moral reasoning: bipolar patients significantly less often than healthy individuals chose answers indicating the postconventional thinking (p = 0.000) - and more often - answers indicating stage 3 and those belonging to the anti-institutional thinking index (p = 0.000). There was also a relationship shown between the development of moral reasoning and the phase of bipolar disorder: patients in mania less often than persons in euthymia chose answers indicating the final stage of moral thinking (p = 0.050). There were no significant differences between the results of patients with a depressive episode and the results of patients in mania and between the results of patients with a depressive episode and the results of patients in euthymia., Conclusions: The results suggest that the psychological state of the individual may have an impact on the process of moral reasoning - bipolar disorder may to some extent influence the way of thinking about moral dilemmas. The collected data also seem to emphasize the specificity of the manic phase which is especially worth exploration when conducting further studies.

Unlabelled: Systemic Lupus Erythematosus (SLE) is autoimmunological disease of connective tissue which is characterized with clinical symptoms of many systems and organs injury. There are often neuropsychiatric symptoms. Psychotic disorder is the least frequent syndrome. Neuropsychiatric symptoms are important because they deteriorate the quality of life and are poor prognostic factor., Aim: The aim of the study is to present the patient with chronic, lasting for many years, skin lesions and laboratory tests results characteristic for SLE, who had psychotic disorder diagnosed as schizophrenia and in the next few years there were observed other neuropsychiatric symptoms including cognitive impairment and mood disorder., Conclusions: Psychotic disorder is rare syndrome of neuropsychiatric SLE (NPSLE). It may primarily originate from SLE or be secondary either to the therapy or the complications of the disease. It is not possible to define if the psychosis is the primary schizophrenic process or secondary to the autoimmune disease in presented patient. However the clinical picture pays attention to the significance of careful diagnostic process, including neuroimaging. In head CT of presented patient there were revealed massive, bilateral, calcifications of subcortical structures which probably substantially enhanced neuropsychiatric symptoms.

Background: The aim of the research was to assess the prevalence of the bipolar spectrum features among students of a variety of faculties, by dividing them arbitrarily into 'art' or 'technology' cohorts., Material and Methods: 120 subjects were examined, including 57 students of arts, and 63 students of technology. The tools used included a basic socio-demographic questionnaire and the Hirschfeld Mood Disorder Questionnaire (MDQ)., Results: The bipolar spectrum features (as identified by the MDQ responses) were significantly more prevalent among the students of arts, as compared to the students of technology (28.2% vs. 4.8%, p < or = 0.001; OR = 7.8; CI 95%: 2.13-28.51; p < 0.01). Moreover, in comparison to the students of technology, the students of arts were more likely to: 1) report mood patterns of intermittent 'highs' and 'lows' (49.1% vs. 15.9%, p < or = 0.0001; OR = 5.11; CI 95%: 2.18-11.99; p < or = 0.001); 2) seek for psychiatric or psychological support (12.3% vs. 1.5%; p < or = 0.05; OR = 5.2; CI 95%: 1.79-15.21; p < or = 0.01); 3) have a history of utilisation of psychotropic medications (31% vs. 7.9%, p < or = 0.001; OR = 8.7; CI 95%: 1.03-72.9; p < or = 0.05). They were also more likely to use psychoactive substances (other than alcohol)., Conclusions: The considerable prevalence of the bipolarity features (as measured by the MDQ), combined with higher prevalence of intermittent periods of elevated or depressed mood, higher likelihood of seeking for psychiatric or psychological treatment, and higher prevalence of using psychoactive medications/substances in the cohort of the students of arts indicate a significant association between artistic talents and creativity, and the bipolar spectrum disorders.

Depression is one of the most frequent comorbid psychiatric disorders in epilepsy. Comorbid depression in epilepsy affects negatively health-related quality of life, increases the risk for suicide and costs of medical care when compared to patients without depression. Unfortunately, affective disorders are underrecognized, and appropriate treatment is infrequent. The purpose of this article is to review strategies used in the pharmacologic treatment of depression in patients with epilepsy, choice of antidepressants, effects of antidepressants on seizure threshold, pharmacokinetic interactions between antidepressant drugs and antiepileptic drugs and psychotropic properties of antiepileptic drugs.

Depression is the most frequent comorbid psychiatric disorder in epilepsy. The occurrence of symptoms of depression in epileptic patients is the expression of multiple pathogenic mechanisms: the neurochemical and neurophysiologic changes that take place in limbic structures in the course of the epileptic disorder, an iatrogenic process (negative psychotropic properties of antiepileptic drugs, epilepsy surgery), a reactive process to a chronic disorder and genetic risk factors. Depression prevalence in patients with epilepsy has been estimated at between 9 and 62%. The literature remains inconclusive regarding risk factors of depressive disorders in epilepsy. Data concerning the role of demographic, genetic, iatrogenic variables, clinical characteristics of epilepsy and its treatment, comorbidity are ambiguous. Comorbid depression in epilepsy affects negatively the health-related quality of life, increases suicide risk and costs of medical care when compared to patients without depression Selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitor are first-line treatment of depression in patients with epilepsy.

Aim: The aim of this study is to discuss diagnostic and therapeutic challenges in a patient with a mutation in the gene responsible for the development of Huntington's disease (HD) who presented schizophrenia-like psychotic symptoms., Method: A case report., Results: A 35-year old man with genetically-confirmed HD who developed significant behavioural changes that occurred many years prior to the outbreak of choreic movements. There was a close temporal relationship between an onset of discrete involuntary movements and schizophrenia-like psychotic symptoms (delusions of persecution, reference and bodily change, as well as auditory pseudohallucinations of threatening and commanding voices). At admission (subsequently to a suicidal attempt) he was ambivalent, ambitendent and--periodically--agitated. Pharmacotherapeutic regime of olanzapine (20 mg qd) and amisulpride (400 mg qd) led to a gradual improvement of the patient's mental status., Conclusions: HD should always be included in the differential diagnosis of psychotic disorders. Patients with HD can exhibit various psychopathological symptoms (including psychotic ones) prior to the outbreak of movement symptoms. Both neurologists and psychiatrists should take part in the therapeutic process. Atypical antipsychotics seem to be effective in the discussed group of patients (although the evidence body consists mainly of scarce, low-quality data).

In the past twenty years, evidence based medicine (EBM) has become a dominant paradigm of the contemporary medical practice. Since the emergence of the significant article by Geddes and Harrison in 1997, this doctrine has become part of psychiatry too. According to the rules of EBM, the most valuable clinical data comes from randomized-controlled trials (RCT). Nevertheless there are numerous researchers who point out at some limitations making RCT less valid in psychiatry than in other medical disciplines. The authors of this paper reviewed the available literature on the place of RCT in psychiatry and subsequently presented current opinions about the reliability of those trials, as well as highlighted the possible solutions of potential controversies. We suggest that in spite of the limitations mentioned above, RCT remains the most valuable research strategy in psychiatry. Most of the obstacles do not differ significantly from the problems seen in other medical fields. There are also known methods of improving methodology of RCT (such as recruiting larger groups of patients or performing expertise-based RCT).