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Biomedical subjects

Janusz Rybakowski

Publications and source records attributed to Janusz Rybakowski.

28 records · Page 2Linked to original sources
PubMedDate not supplied

[Frequency of bipolar affective disorders among depressive outpatients treated by psychiatrists].

AIM: To assess the frequency of bipolar disorders among outpatients with affective illness treated by 96 Polish psychiatrists, representing all regions of Poland. METHODS: The study was performed on 880 patients (237 male, 643 female). They were identified, according to the criteria used, into the following diagnostic categories: 1. Bipolar affective illness, type I (Bipolar I); 2. Bipolar affective illness, type II (Bipolar II); 3. Bipolar spectrum disorder; 4. Unipolar affective illness. RESULTS: Affective disorders having bipolar features were found in 61.2% of the patients studied, bipolar I more frequent in men (27.4% vs 17.6%) and bipolar II more frequent in women (31.7% vs 21.5%). Bipolar spectrum was identified in 12% of the studied patients. Patients with bipolar affective illness compared with unipolar affective illness had a family history of bipolar disorder significantly more frequently, premorbid features of hyper- or cyclothymic personality, early onset of depression (before 25 years), symptoms of atypical depression (hypersomnia and hyperphagia), episodes of psychotic depression, postpartum depression, and treatment-resistant depression. The group of bipolar spectrum had most clinical features similar to classic types of bipolar affective illness and showed significant differences with unipolar affective illness. CONCLUSIONS: In outpatients, who had a depressive episode in the past and were treated by psychiatrists in Poland, bipolar disorders may amount to 60% of them. Patients with bipolar affective illness significantly differ from patients with unipolar affective illness as to the numerous clinical features, not connected with manic, hypomanic or mixed states. The results of the study may also indicate a legitimacy to delineate a bipolar spectrum disorder.

Adult↗
PubMedDate not supplied

[Escitalopram--second generation of serotonin transporter inhibitors?].

Escitalopram is the first antidepressant introduced according to chirality rules, it is an S-enantiomer of citalopram, the drug which has been used for many years. Experimental studies showed that the property of serotonin transporter inhibition--one of the main mechanisms of antidepressive action is connected with the S-enantiomer of citalopram, and that escitalopram is the most selective inhibitor of this transporter. The results of most clinical studies in patients with depression show significant superiority of escitalopram, 10-20 mg/day, over placebo, as early as within the first week of treatment, and a faster onset of action and higher therapeutic efficacy of escitalopram, compared to citalopram, 20-40 mg/day. A similar efficacy of escitalopram, 10 mg/day, and sertraline 50-200 mg/day, as well as escitalopram, 20 mg/day, and venlafaxine, 225 mg/day was demonstrated. It has also been shown that escitalopram, 10-20 mg/day, exerts therapeutic efficacy in general anxiety disorder, panic disorder and social phobia. Escitalopram may meet many criteria for the optimal antidepressant. The drug is efficacious in depressions of various intensity, has a rapid onset of action and, in long-term treatment, prevents the relapses of the illness. It exerts therapeutic activity in anxiety disorders. The dosing is convenient, and the drug is safe and well tolerated due to a mild profile of side-effects and favorable pharmacokinetic properties. Further studies are needed, aiming e.g. at the comparison of the therapeutic efficacy of escitalopram with other antidepressant drugs in different patients and the assessment of the effect of the drug on cognitive functions. The results of such studies may provide a convincing answer to the question whether escitalopram can be regarded as an antidepressant drug belonging to the second generation of serotonin transporter inhibitors.

Animals↗
PubMedDate not supplied

[The case of a patient with treatment-refractory obsessive-compulsive disorder operated by stereotactic bilateral cingulotomy].

This case report presents the first patient in Poland with treatment-refractory obsessive-compulsive disorder, operated by stereotactic bilateral cingulotomy. The patient, aged 38 years, with 20-year duration of illness, despite intensive pharmacological and psychotherapeutic treatment was totally unable to function due to obsessive-compulsive symptoms of extreme intensity. The paper presents the neuroimaging documentation of psychosurgery performed on 3rd December 2002. On the basis of nearly two-year follow-up of the patient, the result of the psychosurgery can be assessed as moderately favorable. The patient's subjective mood and social functioning have improved, as well as his cognitive functions measured by means of neuropsychological tests. In patients with severe, chronic and treatment-refractory obsessive-compulsive disorder psychosurgical treatment may be a therapeutic option.

Adult↗
PubMedDate not supplied

[Neurotrophic factors and their role in the pathogenesis of affective disorders].

Neurotrophic factors are a group of proteins with a similar structure (The regulation of neuronal plasticity and neuron protection are some of their biological functions). The group of neurotrophic factors consists of: growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT-3) and neurotrophin 4/5 (NT-4/5). BDNF is the most important neurotrophin from the affective disorders point of view. Preclinical and clinical studies of altered BDNF expression during chronic stress and increased BDNF activity during antidepressant treatment, confirm the role of BDNF in the pathogenesis of depression. Studies on animal models point to the antidepressant effect of BDNF, similar to long-term antidepressant treatment. The intracellular mechanisms mediated by this neurotrophic factor are connected with signal transduction pathways in cells (mainly mitogen-activated protein kinase cascade and cyclic adenosine 3',5'-monophosphate cascade). The BDNF serum level studies suggest a correlation between the BDNF expression in the central nervous system and its serum levels, what could make BDNF levels specific markers of depression. The molecular genetic studies focus on associations between BDNF gene polymorphisms and bipolar disorder or cognitive functioning disturbances. The novel pathogenetic theories of depression based on neuronal plasticity (Duman et al.) and disturbances in neurogenesis (Kempermann and Kronenberg) can be a kind of recapitulation of research on the role of neurotrophins in depression. However many issues related to the role of neurotrophic factors in affective disorders are still unclear and determine areas of future scientific interests in this field.

Animals↗
PubMedDate not supplied

[Depression and pain: novel clinical, neurobiological and psychopharmacological data].

Epidemiological studies confirm frequent appearance of pain symptoms in depressive patients and a marked prevalence of depression in pain conditions. These observations seem to point at a close intertwining between mood regulation and pain perception. In the pathogenesis of both depression and pain symptoms, an important role has been attributed to disturbances of serotonergic and noradrenergic neurotransmission as well as to neuropeptides such as opioids and substance P. In mood regulation as well as in the perception and emotional dimension of pain stimuli, such brain structures as the amygdala, anterior cingulate cortex and prefrontal cortex are of main significance. The action of antidepressant drugs results in a normalization of the activity of those neurotransmitter systems and brain structures. It was found that dual action antidepressants (i.e. influencing both serotonergic and noradrenergic system) such as tricyclic antidepressants and new generation drugs (venlafaxine, milnacipram, duloxetine, mirtazapine) exert a stronger antidepressant effect and possess a broader therapeutic spectrum, including also an effect on pain symptoms. These drugs have been also increasingly used for the treatment of pain symptoms in somatic illnesses (e.g. diabetic neuropathy, fibromyalgia).

Adrenergic Uptake Inhibitors↗
PubMedDate not supplied

[Disturbances of social cognition in schizophrenia].

Social cognition is an ability to perceive socially relevant stimuli and to behave accordingly. It is connected with the processing of information brought about by significant social stimuli. Recently, social cognition is a topic of intensive research in psychology, neurosciences and psychiatry. Processes involved in social cognition include: perception of emotion, input of eye contact, reaction to voice prosody or decision-making in social situations. A particular role is played by the mentalizing capabilities (mind-reading) i.e. ability to interpret behaviour of others by attributing them certain mental states. Such an ability is often conceptualized as the Theory of Mind (ToM). This paper is a review of issues connected with disturbances of social cognition in patients with schizophrenia. Deficits in perceptions of face emotion and disturbances of Theory of Mind function in schizophrenia were discussed with special regard to their potential role as endophenotypes of vulnerability to schizophrenia. Also, relations between social cognition and basic neurocognitive processes were presented, as well as the effect on social cognition of different methods of schizophrenia treatment.

Cognition↗
PubMedDate not supplied

[Working memory: neuropsychological and neurobiological issues].

Working memory denotes an ability to remember information for a short-time and to manipulate it. The memory allows including correct information depending on the situation, to keep the information on present activities for a while and enables changing the reaction according to new criteria. The relation between working memory and efficiency of complex cognitive processes and also with the control of emotional processes, plasticity of behaviour and consciousness was demonstrated. Working memory is connected with the activity of the dorsolateral prefrontal cortex of the brain. Recently, it has been shown, that working memory disturbances play an important role in the aetiopathogenesis of psychiatric disturbances such as schizophrenia, bipolar affective disorder or obsessive-compulsive disorder. Working memory disturbances are also shown in a proportion of healthy first-degree relatives of patients with schizophrenia or bipolar disorders. Working memory disturbances are presently regarded as a cognitive endophenotypic marker of vulnerability to these illnesses. In recent years, an association between working memory abilities and activity of different neurotransmitters, especially with the dopaminergic system in the brain, has been shown. Molecular genetic studies show an association between working memory abilities and polymorphism of the dopaminergic system genes in schizophrenia and polymorphism of BDNF gene in bipolar affective disorders. So far not much data about the genetics of working memory in healthy subjects has been gathered. Currently in Poland such research is carried on in the Clinical Neuropsychology Unit Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz in cooperation with the Department of Adult Psychiatry and Laboratory of Psychiatric Genetics University of Medical Sciences in Poznań.

Bipolar Disorder↗
PubMedDate not supplied

[Evolutionary concepts of affective disorders].

Mood may be considered the module of the human mind, which has evolved to tune the activity ofthe organism to the specific environmental conditions in a better way. In some cases depression may be adaptive, for example in aborting the activity associated with too many obstacles. At the same time hypomania may be related to the capability of mobilising the organism to gain many resources in a short period of time. Severe mood disorders may be related to the genetic variants, eg. of the serotonin transporter or brain-derived neurotrophic factor, which in several situations may give some evolutionary advantage. Affective temperaments, observed in the relatives of patients with affective disorders may be associated with some benefits in the social life. The relationship between early adversities and adult depression may be related to the phenomenon of the stress axis programming, which has deep evolutionary roots. Some infectious factors may cause behaviours similar to the affective symptoms, which may increase their reproductive success. The evolutionary perspective, which is complementary to the current etiopathogenic theories may help in understanding, why genes and traits which

Affective Symptoms↗
PubMedDate not supplied

[The probability of bipolarity among patients with recurrent depressive disorder].

UNLABELLED: Over the last few years researchers have paid a lot of attention to the problem of the correct diagnosis of affective disorders. Propositions have appeared regarding the widening of the officially accepted criteria to be used in diagnosis. AIM: The aim of the study was to assess the probability of various types of bipolar affective disorders (type 1 and 2 CHAD, as well as spectrum) among patients (n = 246) treated for recurrent depressive disorder (CHAJ). METHOD: The analysis was based on the broadened criteria for affective disorders introduced by Ghaemi et al. and Hirschfield's Questionnaire on affective disorders. RESULTS: The appearance in the past of strange, risky behaviour was associated with a greater risk of type 1 CHAD in comparison to CHAJ (OR=24.5), as did extreme, irrational expenditure (OR=21. 1), a lack of criticism with respect to one's own social behaviour (OR=20.3), increased interest in sex (OR=17.7), as well as extreme self confidence (OR=12). A lack of criticism with respect to one's own social behaviour and strange, risky behaviour was associated with a greater risk of type 2 CHAD (OR=12.7 and OR=10, respectively). The greatest risk of spectrum CHAD type disorders were associated with hypomania, including drug induced (OR=15.8). as well as a lack of criticism with respect to one's own social behaviour (OR=11.8). Panic attacks appeared more often in bipolar affective disorders in comparison to recurring depressive disorders, but their frequency was similar in all three groups (CHAD-I, CHAD-II, CHAD-S). The early occurrence of depression (before 25 years of age) increased the risk of each of the three types of bipolar affective disorders significantly (by a factor of 3 to 5). CONCLUSIONS: The findings indicate the necessity of discussion on sharp criteria of bipolar affective disorders. The results should be helpful in the diagnosis of such disorders, which could have important consequences for effective therapy.

Adult↗