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Irritable bowel syndrome is a significant health problem that can affect up to 11% of the general population. The problem is far more common among women and young people, especially in their thirties. The aetiology of the disease is not fully understood, but it is now thought that dysregulation of the gut-brain axis may be one of the causes. In addition, psychogenic factors, genetics and dietary habits have been attributed a role in the development of the disease. The diagnosis of the disease is based on the clinical picture and the exclusion of other organic causes that may lead to clinical symptoms. According to the Rome IV criteria, diagnosis of IBS is possible when recurrent abdominal pain is found, occurring at least once a week, for the last 3 months. The pain must be accompanied by at least 2 of the following criteria: it is associated with a bowel movement, with a change in the frequency of bowel movements or with a change in the consistency of the stool. Irritable bowel syndrome is a chronic, recurrent condition, with varying frequency of exacerbations and quiescence, dependent on a number of factors. As no clear aetiology has been established to date, we therefore have no causal treatment and no effective and lasting cure. In this situation, treatment must be comprehensive, involving non-pharmacological management related to changes in lifestyle and eating habits and, in the absence of adequate therapeutic effects, pharmacological treatment. Pharmacological treatment should be symptomatic, targeting the predominant complaints and types of IBS, and we can reach for muscle relaxants, drugs to stimulate intestinal peristalsis, antidepressants, rifaximin, laxatives, antidiarrheals and drugs for bloating, probiotics and herbal medicines, e.g. peppermint oil.

Milena Shrashimirova,1,* Ivan Tyanev,2,* Wiesław J Cubała,3,* Adam Wichniak,4,* Claudia Vodickova-Borzova,5,* Alessandro Ruggieri,6,* Annalisa Bonelli,6,* Paola Lipone,6,* Alessandro Comandini,6,* Agnese Cattaneo6,* 1Diagnostic Consultative Center 14, Hospital VITA, Sofia, Bulgaria; 2Multiprofile Hospital for Active Treatment, Medical Clinic, Targovishte, Bulgaria; 3Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland; 4Third Department of Psychiatry and Sleep Disorders Center, Institute of Psychiatry and Neurology, Warsaw, Poland; 5Psychiatry and Neurology, Brain-Soultherapy.s.r.o, Kladno, Czech Republic; 6Global Medical Department, Angelini Pharma S.p.A, Rome, Italy*These authors contributed equally to this workCorrespondence: Alessandro Ruggieri, Global Medical Department, Angelini Pharma S.p.A, Viale Amelia 70, Rome, 00181, Italy, Tel +390691045309, Email alessandro.ruggieri@angelinipharma.comPurpose: This was an observational, prospective, single-group, multicentre, international study aimed to describe the clinical response, functional impairment, and quality of life (QoL) of patients suffering from major depressive disorder (MDD) and in treatment with Trazodone Once-A-Day (TzOAD) monotherapy, over a 24-week period.Patients and Methods: A total of 200 patients with a diagnosis of MDD who had been treated with TzOAD monotherapy were enrolled from 26 sites across 3 European countries (Bulgaria, Czech Republic, and Poland), including psychiatric private practices, and outpatient departments from general and psychiatric hospitals. Study assessments were completed by physicians and patients during routine visits within the normal practice of care.Results: Clinical response was assessed by Clinical Global Impressions – Improvement (CGI-I) responders’ percentage at 24 (± 4) weeks. The majority of patients (86.5%) reported an improvement on the CGI-I compared to baseline. Results of the study confirm the well-known safety and tolerability of TzOAD, as well as its effectiveness on depressive symptoms, such as improvement in QoL, sleep quality, and overall functioning accompanied by favourable adherence and low drop-out rate.Conclusion: To our knowledge, this is the first observational, long-term study in patients suffering from MDD, conducted with TzOAD. The improvement observed in clinical response, overall functioning, depressive symptoms, and QoL along the 24 weeks (+4) maintenance period and the very good retention rate, suggest that TzOAD may represent an effective and well tolerated treatment option for patients suffering from MDD.Keywords: major depressive disorder, trazodone, patient-reported outcome, real-world evidence, effectiveness, long-term follow-up

Katarzyna Gustavsson,1 Wojciech Jernajczyk,1 Adam Wichniak2 1Department of Clinical Neurophysiology, Sleep Medicine Center, Institute of Psychiatry and Neurology, Warsaw, Poland; 2Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, PolandCorrespondence: Katarzyna Gustavsson, Department of Clinical Neurophysiology, Sleep Medicine Center, Institute of Psychiatry and Neurology, Sobieskiego 9, Warszawa, 02‐957, Poland, Tel +48 22 45 82 713, Email katarzyna.gustavsson@gmail.comPurpose: 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.Keywords: mental health, night work, healthcare workers, occupational stress

Major depressive disorder (MDD) and diabetes mellitus (DM) remain among the most prevalent diseases and the most significant challenges faced by medicine in the 21st century. The frequent co-occurrence and bidirectional relationship between the two conditions necessitates the identification of treatment strategies that benefit both. The purpose of this study was to systematically review and meta-analyze data on the efficacy and safety of agomelatine (AGO) in the treatment of patients with depression with comorbid diabetes to explore its potential mechanism of action in both diseases and its impact on diabetic parameters. Following PRISMA guidelines, a total of 11 studies were identified, both preclinical and clinical trials. Agomelatine has shown great potential as a treatment option for patients with diabetes and comorbid depression and anxiety. In addition to improving depressive and anxiety symptoms, it is also beneficial in glycemic control. A meta-analysis demonstrated a statistically significant reduction in glycated hemoglobin (HbA1C) and fasting blood glucose (FBG) levels following AGO administration over a period of 8–16 weeks. The administration of agomelatine was found to result in a significantly greater reduction in HbA1C than that observed with the selective serotonin reuptake inhibitor (SSRI) medications (namely fluoxetine, sertraline, and paroxetine) during 12–16 weeks of therapy. Furthermore, AGO has been found to be at least as effective as SSRIs in reducing depressive symptoms and more effective than SSRIs in reducing anxiety symptoms. The safety of such treatment is similar to SSRIs; no severe adverse events were reported, and the incidence of some side effects, such as insomnia and sexual dysfunction, are even less often reported. Particularly promising is also its potential action in improving some diabetic complications reported in preclinical trials. This might be through mechanisms involving the reduction in oxidative stress, anti-inflammatory effects, and potentially noradrenergic or NMDA receptor modulation. Further clinical studies on larger sample sizes, as well as elucidating its mechanisms of action, especially in the context of diabetic complications, are needed. Research should also focus on identifying the patient subpopulations most likely to benefit from agomelatine treatment. [ABSTRACT FROM AUTHOR]

Anna Z Antosik-Wójcińska,1,2 Monika Dominiak,2,3 Paweł Mierzejewski,2,3 Piotr Jażdżyk,4,5 Gabor Gazdag,6,7 Rozalia Takacs,8,9 Adam Wichniak2,10 1Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; 2Section of Biological Psychiatry of the Polish Psychiatric Association, Institute of Psychiatry and Neurology, Warsaw, Poland; 3Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland; 4Institute of Psychiatry and Neurology, Warsaw, Poland; 5Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland; 6Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest, Hungary; 7Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary; 8Psychiatric Outpatient Service, Tóth Ilona Medical Service, Budapest, Hungary; 9School of Doctoral Studies, Semmelweis University, Budapest, Hungary; 10Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, PolandCorrespondence: Monika DominiakDepartment of Pharmacology, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, Warsaw, PL-02957, PolandTel/Fax +48 22 8427644Email mdominia@wp.plBackground: The use and the characteristics of the practice of electroconvulsive therapy (ECT) in Poland have not been evaluated since 2005, when a nationwide survey revealed its rare utilization (0.11 patients/10,000 inhabitants/year). The aims of this study were to determine the current use of ECT and to compare the findings with those of the previous survey.Methods: Two questionnaires were sent to all 48 inpatient psychiatric centers in Poland. The first one - to units providing ECT to explore its practice, and the second - to units not performing ECT to explore the reasons for not using this treatment.Results: Nineteen (39.6%) of all psychiatric inpatient centers confirmed the use of ECT. The utilization rate was 0.13 patients/10,000 inhabitants. Similar to the findings from 2005, the main indications were affective disorders, and bitemporal electrode placement was the dominant method used for the delivery of ECT. Age-based and titration-based methods were applied exclusively in 50% and 25% of the centers, respectively (compared with 15% and 35% in 2005, respectively), while both methods were used in the remaining 25%. Improvements in safety were reflected by the use of comprehensive pre-ECT evaluation and treatment monitoring. None of the centers used sine-wave devices; this contrasts with their use by 29% of the centers in 2005. The main reasons for not using ECT were insufficient funding and a lack of experienced staff.Conclusion: The frequency of ECT use in Poland remains very low. In view of the improvement in the quality of health services in the past decade, such a markedly rare use of an effective treatment was unexpected. There is an urgent need of education to create more positive attitude towards ECT among health professionals and among public, and to increase the training of mental health professionals in ECT.Keywords: electroconvulsive therapy, survey, ECT utilization rate, ECT in Poland, ECT in central and eastern Europe

Background: This pilot study aimed to assess patients’ cognitive functioning with the Polish version of the THINC-it tool and to analyze its association with self-reported quality of life (QOL). Methods: Twenty-one patients (mean age: 37.8 ± 10.4) were assessed at baseline and after six weeks of a standard therapeutic outpatient program. Participants completed the World Health Organization QOL Questionnaire (WHOQOL-BREF) and the THINC-it tool at both visits. The tool consists of tasks evaluating working memory (SYMBOL CHECK), attention (SPOTTER), executive functions (TRIALS), and cognitive skills (CODEBREAKER). Results: During the second visit, patients showed significant improvements in mean latency of correct responses of SPOTTER: p = 0.021, Cohen’s d = 0.38 and in the Physical health domain: p = 0.007, Cohen’s d = 0.37. The number of correct responses for CODEBREAKER was positively associated with the Physical health domain at visit 1 (r = 0.53, p = 0.014) and visit 2 (r = 0.42, p = 0.058). The number of correct responses at SYMBOL CHECK was positively related to QOL in the Environment domain only at visit 2 (r = 0.45, p = 0.042). Conclusions: These results suggest the THINC-it tool has utility as a cognitive measure in adults with schizophrenia in both clinical and research settings.

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

Insomnia is one of the most common disorders coexisting with depression, and sometimes precedes the development of depression by a number of months. During depressive episodes, insomnia affects 60–90% of patients. At the same time, insomnia is the most prevalent residual symptom of depression, which may persist after the resolution of depression itself in up to 40–50% of patients, causing significant distress. Consequently, normalisation of disturbed sleep is an important aspect of depression therapy. Inappropriate pharmacological treatment may significantly hinder the achievement of the desired therapeutic outcomes. The paper aims to address the recommended treatment of insomnia with coexisting depression, and to discuss the advantages and disadvantages of various pharmacotherapy options and non-pharmacological interventions. In addition, the paper summarises available data on the effect of agomelatine on sleep in patients with depression. Because of its melatoninergic activity the drug synchronises the disturbed circadian rhythm of numerous physiological processes including the sleep–wake cycle. Agomelatine is a particularly beneficial therapeutic choice for patients with depression and insomnia who are prescribed treatment with serotonin or serotonin and noradrenaline reuptake inhibitors, but are worried about the deterioration of sleep quality.

Introduction Today, approximately one fifth of employees in the European Union works in the shift system. Insomnia is one of the most common consequences of occupational stress and shift work. Identifying factors contributing to poor sleep quality among shift workers, especially in healthcare professions, is important because insomnia increases the risks for numerous health disorders and impacts work ability. Objectives The aim of this research was to investigate to what extend does an inability to withdraw from work influences the link between occupational stress and insomnia among shift workers. We operationalized occupational stress within the Effort-Reward Imbalance Model (ERI). An imbalance between individual effort and reward obtained at work leads to experiencing a stressful work environment. Methods 153 shift working female nurses completed a short questionnaire about work schedule, the Effort-Reward Imbalance questionnaire with the Overcommitment (OC) scale and the Insomnia Severity Index (ISI). To estimate the mediating effect of OC on the association between ERI and ISI, we conducted a mediation analysis using PROCESS v3.4 macro in SPSS. Results The model including ERI and OC accounted for 12.25% of the variance in ISI scores. ERI significantly predicted OC and OC significantly predicted insomnia. The direct effects of ERI on ISI remained significant after controlling for the effects of overcommitment. 35.07% of the effect of ERI on ISI was through OC. Conclusions Ability to detach from work-related thoughts during leisure time is crucial for successful recovery from occupational stress. The research is supported by a grant no. 2019/33/N/HS6/02572 from the National Science Center in Poland. Disclosure No significant relationships.

Brexpiprazole is a new antipsychotic drug from the group of dopamine D2/D3 receptor partial agonists. It represents a development of the second-generation antipsychotics and is an important addition to the pharmacological treatment options for schizophrenia The purpose of this article is to present, illustrated by the case of brexpiprazole, how advances in the pharmacological properties of new antipsychotics translate into improved results in the treatment of schizophrenia, not only in terms of symptom reduction, but also in terms of functional improvement. The ratio of activation to blocking of the D2/D3 receptor is lower for brexpiprazole than for aripiprazole and cariprazine, which may translate into a lower risk of akathisia. Brexpiprazole has also stronger antihistaminic activity, which is likely to be associated with a stronger sedative effect, a lower risk of akathisia, excessive agitation and insomnia. Brexpiprazole meets the traditional requirements for an antipsychotic drug's efficacy, i.e., compared to placebo, it brings a greater reduction in schizophrenia symptoms in short-term studies and prevents schizophrenia relapses in long-term follow-up. The highest antipsychotic efficacy was found with the highest registered dose (4 mg/day). In addition to reducing positive symptoms, brexpiprazole treatment also leads to a reduction in negative and depressive symptoms, as well as anxiety. It has also a positive effect on patients' social and personal functioning and quality of life. This action of the drug is in line with the expectations of patients and their families regarding effective treatment. It should not only reduce symptoms, but also enable a return to health, i.e., a state that, in addition to optimal health and a sense of psychological well-being, also makes it possible to maintain proper social relations. [ABSTRACT FROM AUTHOR]

Summary: Sleep‐related rhythmic movement disorder is characterised by stereotyped and repetitive rhythmic movements involving large muscle groups during sleep with frequencies between 0.5 and 2 Hz. Most of the published studies on sleep‐related rhythmic movement disorder have focussed on children. Therefore, we performed a systematic review on this topic focussing on the adult population. The review is followed by a case report. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 2020 guidelines. A total of seven manuscripts (n = 32 individuals) were included in the review. The clinical manifestation of body or head rolling predominated in the majority of included cases (53.13% and 43.75%, respectively). In n = 11 (34.37%) cases, a combination of rhythmic movements was observed. The literature review also revealed a wide spectrum of co‐morbidities: insomnia, restless leg syndrome, obstructive sleep apnea, ischaemic stroke, epilepsy, hypertension, alcohol and drug dependency, mild depression, and diabetes mellitus. The case report presented a 33‐year‐old female who was referred to the sleep laboratory due to a suspicion of sleep bruxism and obstructive sleep apnea. Although the patient was initially suspected of having obstructive sleep apnea and sleep bruxism, after conducting video‐polysomnography she met the criteria for sleep‐related rhythmic movement disorder as she presented body rolling, which were surprisingly most evident during the rapid eye movement sleep stage. In summary, the prevalence of sleep‐related rhythmic movement disorder among adults has not been determined yet. The present review and case report is a good starting point for discussion regarding rhythmic movement disorder in adults and further research on this topic. [ABSTRACT FROM AUTHOR]

Background: People suffering from schizophrenia are notably vulnerable to cardiometabolic risk factors (CMRF), such as obesity, high blood pressure, hyperglycemia and insulin resistance, high serum triglycerides, and low serum high-density lipoprotein (HDL), which are related to increased mortality and decreased quality of life. The increased risk of “metabolic syndrome” (MS) is related to low physical activity, an unhealthy diet, and side effects of antipsychotic drugs. Nonpharmacological interventions seem to be important in the prevention and therapy of MS.Aim: This paper provides an overview of published studies and a critical analysis of pilot programs involving nonpharmacological measures aimed at prevention and treatment of CMRF in patients with schizophrenia.Material and Method: We searched the PubMed, PsycARTICLES, and Cochrane Library databases to identify clinical trials. We included full-text studies that met the following criteria: age > 18 years, a diagnosis of schizophrenia or schizoaffective disorder, and monitored parameters associated with MS.Results: All 1,555 references were evaluated for inclusion in the review, and 20 met the inclusion criteria. Nonpharmacological interventions led to improvement in physical health and showed a promising potential for implementation in treatment programs dedicated to this particular group of patients. However, a critical analysis revealed limitations, which have implications for the direction of future research.Conclusions: Patients suffering from schizophrenia can benefit from nonpharmacological interventions aimed at counteracting CMRF, improving either metabolic parameters, cardiovascular fitness, or their health perception. Notwithstanding, to achieve long-term effects, future studies should comprise appropriate follow-up procedures.

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Dim light melatonin onset (DLMO) is considered the most reliable marker of the circadian rhythm phase in humans. DLMO may moderately correlate with sleep onset and sleep offset time. There are no sufficient data about the correlations between DLMO and clinical scales assessing sleep quality and daytime symptoms of poor night sleep. The aim of the study was to determine the association between DLMO and basic sleep parameters from actigraphy and sleep diaries, as well as the association between DLMO and the following insomnia clinical scales: the Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and chronotype questionnaires: Morningness–Eveningness Questionnaire (MEQ) and Composite Scale of Morningness (CSM). Participants of the study were healthy volunteers. Sleep parameters were measured by sleep diaries and actigraphy, and the following clinical scales: the AIS, ISI, and ESS, and chronotype questionnaires: MEQ and CSM. DLMO was calculated based on plasma melatonin concentration. The blood samples were collected hourly at five time points between 20:00 and 00:00 during the session in dim red light (<50 lux). Melatonin concertation was determined by LC-MS/MS. Twenty-one volunteers participated in the study. DLMO was calculated in 12 participants. There was a significant correlation between DLMO and ISI (r = 0.60, p = 0.038) and ESS (r = 0.61, p = 0.034). The correlation coefficient between the DLMO and the AIS was also high, however insignificant (r = 0.57, p = 0.054). There were no significant correlations between DLMO and chronotype scales MEQ and CSM. DLMO did not correlate with sleep onset and sleep offset; however, DLMO correlated with the Sleep Fragmentation Index (SFI) (r = 0.67, p = 0.017). DLMO is associated with poorer sleep maintenance, a stronger feeling of insomnia, and sleepiness during the day. Simultaneously, chronotype pattern and circadian rhythm parameters do not correlate with DLMO. Biological circadian rhythm does not reflect the real-life sleep–wake rhythm, indicating that the lifestyle is more often disconnected from the biological clock. [ABSTRACT FROM AUTHOR]

Copyright of General Practitioner / Lekarz POZ is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)