Biomedical subjects
Publications and source records attributed to J Rybakowski.
This article presents a comparison of costs of the first, the second, the third or next episode of depression, based on preliminary results of an observation clinical trial.
The results of investigations of regional cerebral blood flow using 99mTc HMPAO SPECT in 19 depressed patients before treatment and after 6 weeks of pharmacotherapy are presented.
The influence of lithium, carbamazepine or valproate treatment on the cognitive functions is presented.
Clinical picture of psychiatric disturbances occurring in dysfunctions of thyroid or adrenal axes is presented.
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Cognitive deficits have been viewed as being characteristic features of schizophrenia. Neuropsychological impairment has been also identified in depression and mania. Recent studies have suggested that patients with bipolar disorder do not make full recovery between episodes of illness and that neuropsychological dysfunction may persist beyond these episodes. Remitted bipolar patients performed worse on Wisconsin Card Sorting Test, Verbal fluency and Stroop Test than healthy controls, the results of the patients with affective disorders with psychotic features were comparable with those of schizophrenics. Some studies suggest an association between the course of illness and the intensity of cognitive deficits, this link was not confirmed in other reports. Imaging studies have shown the presence of white matter lesions and other abnormalities in the brains of bipolar patients. The relative reduction in cerebral tissue may contribute to neuropsychological impairment in subgroup of bipolar patients. Results of studies on the role of white matter lesions are inconsistent. Recent studies point to an association between decreased prefrontal cortex volume and cognitive disturbances. Attention is focused on hippocampus volume as well, since it is associated with cognitive deficits in bipolar disorder. Further studies are needed to elucidate whether a severe course of illness is associated with more pronounced cognitive disorders and whether presence of psychotic symptoms during the acute phase of the illness is a predictor of the occurrence of cognitive deficits in patients with bipolar affective disorder.
The authors present information on the key role of lipid disturbances (mainly phospholipids) of neural membranes in the etiopathogenesis of schizophrenia and affective disorders. Current theories on membrane phospholipid disturbances in the etiopathogenesis of schizophrenia and affective disorders are connected to the idea that the primary metabolic disorder in both these disorders is due to the altered activity of phospholipase AZ, which in turn brings about disturbances in other lipid elements. Especially the functional insufficiency of some necessary fatty acids, as well as disturbed prostaglandin secretion has been shown in these disorders. In the recent years evidence has been collected on the action of pharmacologic substances used in these disorders on the lipid enzyme metabolism.
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Carbamazepine treatment was used with 54 patients suffering from endogenous depression and organic depression. The anti-depressive effect was found to be the best in those patients with organic depression, while in endogenous depression it was better with bipolar affective disorder and with irregular EEG recordings.
The authors conclude that most male schizophrenic patients display poorer premorbid functioning during the early stages of the illness. They more often display structural micro-abnormalities of the brain, organic deficits, are more chronic and have poor prognosis. Female patients are more often burdened with genetic factors, more often express productive and affective symptomatology, are more sensitive to neuroleptics and the course of their illness is more satisfactory.
The authors discuss the influence of stress on the immunological system. They describe changes in this system in depressive and in schizophrenic patients and analyze the eventual effect of these changes in the pathogenesis of endogenous psychopathology. The authors conclude that despite the fact that research into the immunology of these aspects are in the beginning stages, the data so far collected indicate a promising result.
Dexamethasone Suppression Test was performed during an acute phase in 81 patients with endogenous depression and 105 schizophrenic patients. The lack of suppression of cortisol was found in 1/3 if those ill with depression and 1/3 of those ill with schizophrenia. A relationship between those results and age was shown in female schizophrenic patients. In both groups a yearly rhythm was observed, however female patients differed from male patients.
20 schizophrenic patients (14 men and 6 women), aged 18-50, were studied using the BPRS, Hamilton scale and dexamethasone test before and after treatment with neuroleptic drugs. In the BPRS global rating and positive and negative symptoms rating were analyzed separately. The neuroleptic treatment improved mostly positive symptoms and slightly less depressive symptoms. The smallest effect was exerted on the negative symptoms. The neuroleptic treatment significantly reduced all cortisol levels measured during the dexamethasone test (most the cortisol level measured 17 hours after dexamethasone). The dexamethasone test result normalization depends probably on the neuroleptic treatment -- it did not correlate closely with the clinical improvement.
Plasma concentrations of carbamazepine (CBZ) were studied in 24 psychiatric patients who were given 400 mg of CBZ every 12 h. The assays were performed on the 1st, 3rd, 8th, 15th, 22th and 29th day of the therapy. The highest minimum 12h plasma CBZ concentrations occurred on the 3rd day of therapy, then decreased up to the 15th day and remained stable thereafter. The CBZ half-time values also diminished up to the 15th day of therapy and then stabilized. This may suggest that the enzymatic autoinduction of CBZ is completed within the first 1-2 weeks of therapy. CBZ plasma levels were slightly but insignificantly higher in patients taking CBZ alone than in patients in which CBZ was added to other psychotropic drugs. A significant correlation was found between the minimum CBZ plasma concentration after the first dose and that at steady state. A dosing schedule for CBZ administration has been proposed with administration of 75% of the maintenance dose during the first week and the full CBZ maintenance dose from the beginning of the second week of CBZ therapy.
Monitored treatment of a depressed phase of unipolar affective disorder was conducted in 11 female patients receiving imipramine and in 12 females taking amitriptyline. Patients were randomly assigned to one of the drug and in 6 patients the drugs were switched because of the lack of response to the first used compound. In the imipramine treated group a satisfactory response after 4 weeks of management (less than 6 points on Hamilton's depression scale) was observed in 6 patients and in amitriptyline treated group in 5 patients. Patients displaying a satisfactory response to amitryptyline had significantly higher--as compared to remaining patients in the group--plasma levels of the drug after two and four weeks of treatment. Such an association was not observed in patients treated wtih imipramine. Severity of depression and motor retardation before the treatment was similar both in patients with satisfactory and with poor response to imipramine as well as to amitriptyline. However the intensity of anxiety symptoms was higher in patients exhibiting poor response to treatment with amitriptyline and imipramine as well.
37 patients (21 men, 26 women) during treatment for schizophrenia were studied with Rorschach test, BPRS and Hamilton Depression Scale. In 12 patients Rorschach test results were not interpreted because of scant answers--these patients manifested more psychopathology, especially depressive and defective symptoms. In 25 patients, in whom the interrelationships between the applied tests were studied, the results indicated that the intensity of psychopathologic symptoms showed positive correlation with the analytically-scrupulous thinking; the intensity of productive symptoms correlated with the interests in other people. The finding was more pronounced among the male patients which may suggest some dependency of schizophrenic thought disorder on patients sex. The intensity of depressive symptoms measured by Hamilton Scale showed positive correlation with the index of thinking correctness but negative correlation with impoverishment of internal and external activity. The results suggest that depressive symptoms in the course of schizophrenia may significantly influence Rorschach test results.
40 patients (26 males, 14 females), aged 18-50 years, with diagnosis of schizophrenia were studied before the treatment for recurrence of acute schizophrenic symptom was started. All patients had dexamethasone suppression test (DST) and BPRS and Hamilton Depression Scale tests. Initial cortisol plasma concentration correlated positively with the intensity of productive symptoms measured by BPRS. The cortisol plasma level measured 17 hour after dexamethasone administration correlated negatively with the global symptom intensity in the BPRS. Pathological DST results were observed in 14 patients (35%). These patients presented lower intensity of psychopathological symptoms in the BPRS as compared to the remaining patients. The intensity of depression measured by Hamilton Scale did not show correlation with DST results. We conclude that in the schizophrenic patients during acute phase of the disease, the intensity of psychopathologic symptoms (mainly productive symptoms) is related to increased activity of the hypothalamo-hypophyseal-suprarenal axis which manifests itself with increased basal levels of plasma cortisol. Reactivity of this axis, with good suppression in the DST results seems to be normal. The intensity of depressive symptoms did not show significant relation to activity of the axis judging from DST results.