[The level of cortisol, DHEA, DHEA-s in plasma serum and the connection with the lipids and response to treatment in women with depression]. / Poziom kortyzolu, dehydroepiandrosteronu i jego siarczanu (DHEA i DHEA-S) w surowicy krwi a obraz lipidogramu i reakcja na leczenie u kobiet z depresja.

UNLABELLED: In depression an increase, decrease, or a relative deficiency of dehydroepiandrosterone (DHEA) and the beneficial effects of its administration were observed. The correlation of low serum DHEA level and increased cardiac risk was confirmed in healthy subjects only in men (not in women). Taking into consideration the increased risk of heart disease in depression, it is interesting to investigate the level of DHEA, DHEA-S, and cortisol, as so its correlation with lipid profile, and reaction to treatment in women with depression. AIM: To assess serum ACTH, cortisol, DHEA and DHEA-S, and their relationship with lipid profile in depressed females, including the treatment response and stress load. METHOD: In 11 healthy females and 18 with depression, the following were examined before and after treatment: the severity of symptoms (on the Hamilton and Beck Inventory Depression scale), serum cortisol, DHEA, DHEA-S, and lipidogram. The results were compared in healthy and depressed females, and in relation to the therapy and stress load. The correlation of DHEA, DHEAS, and cortisol with lipid profile was analysed. RESULTS: In females poorly responsive to antidepressant treatment higher serum cortisol, ACTH and DHEA. The lipid profile did not vary in the depressed and healthy females. Serum DHEA correlated negatively with serum cholesterol (total and LDL fraction) in healthy women but not in depressed women. CONCLUSIONS: DHEA deficiency and the rationale for its supplementation were not confirmed in depressed women. The protective action of DHEA to hypercholesterolemia was confirmed in healthy, but not in the depressed women.

[Dehydroepiandrosteron (DHEA) in the mechanisms of stress and depression]. / Dehydroepiandrosteron (DHEA) w mechanizmach stresu i depresji.

There is growing interest in the role of Dehydroepiandrosteron (DHEA) in depression. To evaluate the validity of its administration in depression, the role of DHEA in the mechanism of depression and cardiovascular risk, as so the results of clinical trials must be considered. According to accessible literature, both concepts of depression--monoaminergic and glucocorticoid--are related. The key role may be played the impairment in regulatory function of monoaminergic, glucocorticoid and GABAergic receptors in the limbic area of the brain, caused by a genetic factor or acquired by stress. Consequently even weak stimulation could lead to inefficiency of the Limbic- hypothalamic-pituitary-adrenal (LHPA) homeostasis, with overproduction of cortisol. The excess of cortisol is facilitating the development of depression by damaging the limbic, especially hippocampal neurons. Furthermore, the cortisol is increasing cardiovascular risk by its atherogenic properties. The DHEA, because of its antiglucocorticoid activity is supposed to be a protective factor against depression and cardiovascular risk. Positive effects of administration of DHEA in depression were observed in clinical trials. However the results of estimation of DHEA and SDHEA in the blood of depressed patients were inconsistent. In animals, administration of high doses of DHEA was decreasing the experimental atherogenesis. However the investigation in numbered human populations showed correlation of increased level of DHEA with a decreased risk of cardiovascular disorder in men--but not in women. Further research on relation between depression, DHEA and cardiovascular risk, with special concern upon the differences in men and women is needed.

[Personality and behavioural disturbances, with delusional-hallucinatory and delirium episodes in the course of hyponatremia due to paraneoplastic inappropriate vasopressin secretion (SIADH)]. / Zaburzenia osobowosci i zachowania oraz epizody urojeniowo-omamowe i zaburzen swiadomosci w przebiegu hiponatremii wywolanej paranowotworowym nadmiernym wydzielaniem wazopresyny (SIADH).

AIM: To broaden the knowledge about somatic mechanisms of psychic disturbances. METHOD: Presentation of a 54 year old male with psychic disturbances and hyponatremia. RESULTS: After six months with head ache, nausea, exhaustion, irritability, lacking drive, and appetite--acute psychic disturbances abruptly arose. These recurrent episodes with agitation, aggression, delusions, hallucinations, sometimes--disorientation and memory loss; appearing simultaneously with hyponatremia (Na in blood 104-118 mEq/L); were classified as organic delusional disturbances, and (in case of disorientation and memory loss) as delirium (F06.2, F05 - in ICD-10). The symptoms were manifested for 6 months and were classified as personality disturbances due to brain dysfunction (F07.8 in ICD 10). The acute psychic disturbances interrupted the hospitalization in the medical ward, twice and caused three psychiatric hospitalizations; until the diagnosis of hyponatremia in the course of inappropriate vasopressin secretion (SIADH), due to small cell carcinoma of the left lung was established. CONCLUSION: The SIADH syndrome with hyponatremia, and polymorphic psychic disturbances had preceded the clinical and radiological manifestations of the hidden development of left lung small cell carcinoma for a long time. The legitimated involuntary admission to a psychotic ward in a general hospital with easy access to specialized laboratory tests and consultations facilitated establishing the diagnosis. The restriction of water administration with oral salt supplementation stabilized the psychic state and enabled treatment in the Institute of Oncology. The case illustrates the complicated somatic mechanisms of psychic disturbances and the necessity of multi-specialist cooperation in the border area between psychiatry and other medical disciplines.