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Objectives. Assessment of the frequency of use and the type of drugs administered during the intervention of the Medical Rescue Teams to patients with mental disorders.

Material and methods. The study includes a retrospect­ive analysis of Medical Rescue Team interventions. The material consists of Dispatch Orders and Emer­gency Medical Services Forms. Two periods were observed: period I (1 March 2019 – 29 February 2020) and period II (1 March 2020 – 28 February 2021). The database was prepared in Microsoft Excel using MS Office 2016 for Windows 10. The variables were described using descript­ive statistics. The following measures were calculated for interval variables: mean (M) and standard deviation (SD). For categorical variables, the following measures were calculated: number (n) and frequency (%).

Results. During the two-year period of analysis, 14,972 dispatch orders (I – 7,531; II – 7,441) were carried out by the Medical Rescue Teams in the examined opera­tional area. The partial target of the analysis (patient with mental disorders) was met in 862 incidents (5.75% of the total). In 92 Medical Rescue Team interventions, pharmacological agents were administered to patients with mental disorders. This was a total of 100 drugs, most often hydroxyzine (41%), diazepam (33%), captopril (6%), and multi-electrolyte fluid MEF500 (6%). Patients were more often men (53.26%).

Conclusions. Most Medical Rescue Team interventions requiring the use of drugs are associated with alcohol abuse and a strong stress reaction. The decision to administer drugs at the pre-hospital stage must be well thought through due to interactions with drugs taken regularly. The COVID-19 pandemic did not significantly affect the frequency of drug administration during the interventions of Medical Rescue Teams.

Objectives. This paper aims to review clinically relevant aspects of the current knowledge of brexpiprazole in the treatment of schizophrenia, particularly its pharmacological properties, efficacy in the treatment of exacerbations and maintenance of remission, as well as its side effects profile.

Literature review. Brexpiprazole is an anti­psychotic drug that exhibits its effects mainly through partial agonism of D₂ and D₃ dopamine receptors and 5-HT_1A serotonin receptors; it also has antagonistic effects against 5-HT_2A, 5-HT_2B, 5-HT₇, H₁ and M₁ receptors. It is metabolised mainly by CYP3A4 and CYP2D6 enzymes, excreted via the liver and the kidneys, and has a half-life of 96 hours. At doses of 2–4 mg/d, it is clinically effective in treating acute episodes of schizophrenia as it alleviates psychotic symptoms and improves psychosocial functioning. It also shows efficacy in maintenance treatment at doses of 1 to 4 mg/d, delaying relapse as compared to a placebo. Brexpiprazole is well tolerated by patients in both acute and maintenance treatment. It is characterised by a lack of effect on metabolic profile, prolactin levels, and QTc interval, as well as a small effect on body weight and a low risk of akathisia.

Conclusions. Brexpiprazole is an effective medication in the treatment of schizophrenia. Among other drugs, it is distinguished by its favourable side effect profile, especially by a lack of metabolic side effects. With its set of features, it expands the range of therapeutic options in schizophrenia.

Objectives. Wilson’s disease (WD) is a genetically inherited disease associated with disorder of copper metabolism and its pathological deposition in many organs (mainly in the liver and brain) and their secondary damage. Clinical symptoms of WD are mainly symptoms of liver damage (from a mild increase in the activity of liver enzymes to liver failure) and the central nervous system (CNS) (mainly a wide spectrum of involuntary movements). The article aims to review currently proposed biomarkers of CNS damage in WD: 1) clinical; 2) structural (neuroimaging) and 3) molecular, including a proposal of their future role (prognostic, diagnostic or monitoring of response to treatment).

Literature review. WD is one of the few metabolic diseases that can be treated if treatment is started early and is properly administered. Treatment of WD is based on drugs causing a negative copper balance in the body (drugs that chelate copper or zinc salts). Early diagnosis of the disease, early initiation of anti-copper therapy, regular monitoring of copper metabolism, evaluation of liver function and damage of central nervous system are essential for the good prognosis. We conducted a targeted literature review of articles in English available in PubMed, searching for “Wilson’s disease”, “biomarkers”, “neurofilaments”. Below we present summary of collected data.

Conclusions. Despite treatment, 10% of patients with WD experience early neurological deterioration, 50% of patients with neurological symptoms show no improvement. New therapies of treatment for WD, possibilities of faster diagnosis and better monitoring of the treatment are being sought. Identification and validation of WD biomarkers are necessary.

Objectives. Magnetic resonance imaging studies revealed changes in the brains of patients suffering from anorexia nervosa (AN), such as brain volume reduction, deepening of the brain’s sulcus and fissures, widening of the lateral ventricles, and cerebrospinal fluid amount increase.
This study aims to review research relating to changes in the brain structure under the influence of malnutrition in AN and the neuronal reconstruction of the brain during clinical recovery.

Literature review. The article was prepared based on the results of neuroimaging studies in people with AN, published in Polish and English-language journals between 1990 and 2022. The research on the influence of nutritional therapy on the regression of previously occurring structural changes in the brain in AN published in Polish and English-language journals between 1990 and 2022 was also reviewed.

Conclusions. In AN, structural changes of the CNS are formed, and the total volume of the brain (TBV) and its individual brain structures decrease, i.e., the insula, hippocampus, and cerebellum. In the process of brain regeneration, it is important that people with AN receive a varied diet with high energy and nutritional density, which will enable the proper course of reconstruction processes in the body.

Objectives. This article aims to review the literature on neurological and psychiatric complications of acyclovir with particular emphasis on mental disorders, such as the Cotard’s syndrome, in patients with renal failure who receive acyclovir. A mechanism of neuropsychiatric effects of antiviral toxicity most likely occurs when 9-carboxymethoxymethylguanine (9-CMMG), which is acyclovir’s main metabolite, crosses the blood-brain barrier and inhibits mitochondrial DNA polymerase, which leads to mitochondrial toxicity and ultimately increased uremic toxicity. Due to the rarity of this phenomenon, both the pathomechanism and treatment have not been sufficiently studied.

Literature review. The literature review centres around the occurrence of neurological and psychiatric side effects, especially nihilistic disorders, in patients with renal failure taking acyclovir or its prodrug, valacyc­lovir. Case reports refer to the patients with no history of serious mental illnesses in the past and indicate that the 9-CMMG metabolite can be used as a marker for neuro­psychiatric disorders.

Conclusions. Acyclovir is a commonly used drug which in rare cases can be neurotoxic. Neurological side effects include disorientation, confusion, impaired consciousness, dysarthria, agitation, visual and auditory hallucin­ations, psychosis and delusions of being dead, typical of the Cotard’s syndrome. Cotard’s syndrome is a rare psychiatric condition with strong delusions of being dead. Acyclovir is metabolised and oxidised to 9‑carboxy­methoxymethylguanine (9-CMMG) which may cause neuropsychiatric side effects, mainly in patients with impaired renal function. In some cases, haemodialysis and reduction of the dose have been effective in the treatment.

Introduction. The risk of metabolic syndrome in patients with schizophrenia is significantly higher than in the general population. The consequence of this fact is the shortening of life in this group of patients by as much as 20–25%. The search for methods leading to the reduction of metabolic syndrome risk factors is essential in preventing cardiovascular consequences. Dysbiosis disrupts the integrity of the intestinal barrier, contributing to general inflammation. This process is associated with metabolic disorders, sugar metabolism and obesity.

A case report. A description of a 24-year-old patient suffering from paranoid schizophrenia is presented. Due to the lack of mental state improvement and periods of lack of cooperation, pharmacotherapy was modified many times. Finally, remission was achieved after the use of clozapine with paroxetine. The patient was diagnosed with metabolic syndrome. A probiotic sealing the blood-intestines barrier was added to the treatment. After 3 months of using the probiotic, normalisation of the level of glycemia, total cholesterol, LDL, lowering of the level of insulin, and reduction in the level of insulin resistance were observed.

Conclusions. The introduction of a probiotic with properties sealing the blood-intestines barrier to the treatment may result in a reduction in the risk parameters of the metabolic syndrome. It is advisable to conduct further research to confirm the above observations.