Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries.

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

Evaluation of the effectiveness of rehabilitation of people diagnosed with schizophrenia using clinical tools, psychological tests, QEEG, and the brain-derived neurotrophic factor (BDNF). / Ocena skutecznosci rehabilitacji osób z rozpoznaniem schizofrenii z wykorzystaniem narzedzi klinicznych, testów psychologicznych, QEEG i neurotropowego czynnika BDNF.

OBJECTIVES: The aim of the study was to evaluate the level of cognitive and social functioning in two groups of schizophrenia patients using clinical tools, psychological tests, QEEG, and changes in the brain-derived neurotrophic factor (BDNF) activity in subjects' serum. METHODS: Randomly selected men diagnosed with schizophrenia were enrolled in the study and divided into two groups. Gr. 1 was formed by patients who did not undergo a structured rehabilitation program, while Gr. 2 was formed by patients undergoing standard rehabilitation, as provided in theprogramof the Psychiatric Rehabilitation Unit. Both groups underwent a comparative analysis of demographic parameters and based on: PANSS, AIS, GSES, and BCIS, psychological tests CTT-1, CTT-2, d2, QEEG, and changes in blood BDNF levels. To assess the effect of rehabilitation, the results obtained in both groups were compared after 12 weeks and their analysis was performed in accordance with assumptions for the experimental project. The study presents research hypotheses and pre-test and post-test comparisons of the groups, on the basis of selected research tools. RESULTS: The data obtained in measurement 1 indicate that both groups did not differ significantly in terms of: age, education, place of residence, treatment at outpatient facilities, medicines taken, and suicide attempts. Differences concerned: marital status, children, number of hospitalizations, and employment status. Furthermore, no significant differences were found for the studied groups concerning: serum levels of the brain-derived neurotrophic factor, values obtained on the PANSS, AIS, and GSES, and alpha/theta, theta/beta and theta/SMR ratios. The analyses performed in measurement 2 indicate that structured rehabilitation influences reduce negative symptoms, cause an increase in BDNF levels, cause an improvement in cognitive and social functioning and positively influence the perception speed and accuracy. CONCLUSIONS: The positive effect of structured rehabilitation influences allows to say that rehabilitation represents a necessary part of the comprehensive psychiatric treatment and should already be implemented during the first episode of the illness.

Can brain-derived neurotrophic factor (BDNF) be an indicator of effective rehabilitation interventions in schizophrenia? / Czy czynnik neurotropowy BDNF moze byc wskaznikiem skutecznych oddzialywan rehabilitacyjnych w schizofrenii?

The increasing body of evidence implies that brain-derived neurotrophic factor (BDNF) is the most common neurotrophin in the nervous system, playing an important role as an effectiveness indicator for rehabilitation interventions in schizophrenia patients. Currently, with the modern laboratory and instrumental diagnostic methods it is possible to diagnose deficits influencing the level of patient's functioning and use them as a basis for establishing individual re-adaptation programs for schizophrenia patients considering various forms of the therapy in different environments. Based on the PubMed and Scopus search tools a review of the available literature was performed and the paper presents current results of studies analyzing a relationship between selected rehabilitation interventions used in schizophrenia patients and changes in BDNF levels (a correlation between BDNF levels and physical activity and EEG Biofeedback therapy). Out of 240 records identified in total, the ones concerning the subject matter of the paper were taken into account. Studies concerning use of the presented method appear to indicate usefulness of BDNF factor in evaluation of effectiveness of implemented rehabilitation interventions in this group of patients. Changes in neurotrophin levels may indicate a synergy of the central and the peripheral nervous system, and high BDNF levels depending on physical activity and a neuromodulating effect of the EEG Biofeedback therapy may indicate their effectiveness. Use of various neurorehabilitation methods may improve the social functioning in schizophrenia patients. Treating BDNF as a biological indicator of those processes may represent an interesting hypothesis.

Disrupted iron metabolism in peritoneal fluid may induce oxidative stress in the peritoneal cavity of women with endometriosis.

INTRODUCTION: Data on the possible role of peritoneal fluid free radical-mediated oxidative damage in the pathogenesis of endometriosis still remains inconsistent. The aim of the study was to determine iron metabolism markers and their influence on oxidative stress arameters in the peritoneal fluid of women with endometriosis. MATERIAL AND METHODS: 110 women with endometriosis and 119 patients with benign ovarian cysts were included in the study. All visible peritoneal fluid was aspirated during laparoscopy from the anterior and posterior cul-de-sacs. under direct vision to avoid blood contamination. Haemoglobin, iron, total oxidative status, and total antioxidant status were measured using standard colourimetric kits. RESULTS: Haemoglobin, iron levels, as well as total oxidative status values were significantly higher, whereas total antioxidant status values were significantly lower in the peritoneal fluid of patients with endometriosis, in comparison to the reference groups. No differences were observed in peritoneal fluid concentrations of all parameters measured in relation to the phase of the menstrual cycle. CONCLUSIONS: Peritoneal fluid of women with endometriosis is characterized by disrupted iron metabolism. This is most likely related to an increased number of erythrocytes in the peritoneal cavity of endometriotic women, which leads to a higher concentration of haemoglobin in this environment. Impaired iron homeostasis may have a significant influence on the pathophysiology of peritoneal endometriosis by the direct impact of haemoglobin derivatives and/or formation of the pro-inflammatory and pro-oxidative environment. Peritoneal cavity oxidative stress occurs predominantly in women in advanced stages of the disease.

Differences in the dynamics of changes in the concentration of kynurenic acid in the blood serum of depressed patients treated with electroconvulsive therapy.

BACKGROUND: Nowadays, depression is a serious clinical problem, as the prevalence of its various forms increases and there are growing numbers of patients with severe forms of depression and treatment-refractory depression. Depressed patients have been observed to have decreased levels of kynurenic acid (KYNA), which is the only endogenous antagonist of ionotropic N-methyl-D-aspartate (NMDA) receptors. The aim of this study was to identify subgroups of patients differing in the dynamics of changes in KYNA concentration during electroconvulsive therapy (ECT). SUBJECTS AND METHODS: The study included 32 patients with an ICD-10 diagnosis of a major depressive episode receiving ECT treatment and 48 healthy volunteers. Blood serum KYNA concentrations were determined using HPLC-based methods, and clinical assessment was performed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impressions (CGI) Scale. RESULTS: Three subgroups of patients with depression were identified which differed in baseline KYNA levels and in the dynamics of changes in blood serum KYNA concentrations during and after ECT. CONCLUSIONS: The largest number of patients with clinical improvement (83%) was observed in the subgroup with significantly lower pre-treatment, treatment and post-treatment KYNA concentrations than those determined in the control group. This subgroup of patients also showed the lowest dynamics of changes in KYNA concentrations during ECT. Clinical improvement was observed in 75% of depressed patients who had insignificantly lower pre-treatment levels of KYNA and slightly higher levels of this acid after 6 and 12 ECT sessions than controls. The smallest number of patients with clinical improvement (50%) was observed in the subgroup of patients who had similar pre-treatment and treatment concentrations of KYNA to controls and whose post-treatment concentrations of KYNA were significantly lower than those of healthy individuals.

Prolonged therapy with antidepressants increases hippocampal level of kynurenic acid and expression of Kat1 and Kat2 genes.

BACKGROUND: Accumulating data suggest an important role of disturbed kynurenine pathway and altered glutamatergic transmission in the pathogenesis of depression. In here, we focused on detailed analyses of kynurenic acid (KYNA) status in vivo following single and 14-day administration of selected tricyclic antidepressant drugs (TCAs) and serotonin selective reuptake inhibitors (SSRIs) in rats. METHODS: The effect of antidepressants on serum and brain KYNA levels, as well as on the activity of kynurenine aminotransferases (KATs I and II) and expression of Kat1 and Kat2 genes mRNA was studied in three brain regions. RESULTS: Chronic, but not acute, application of antidepressants invariably stimulated KYNA production in hippocampus (amitriptyline, imipramine, fluoxetine and citalopram) and sporadically in cortex (amitriptyline, fluoxetine), whereas no change in KYNA level was observed in striatum. Cortical and hippocampal expression of Kat1 and Kat2 genes was increased after chronic, but not single administration of all studied antidepressants. The activity of semi-purified enzymatic proteins, KAT I and II, was not paralleling changes of Kat1 and Kat2 genes. CONCLUSION: Our data indicate that prolonged administration of antidepressants targets expression of KYNA biosynthetic enzymes. Furthermore, post-translational modulation of KATs seems to play an important role in tuning of KYNA synthesis within brain structures. We suggest that consistent increase of hippocampal KYNA levels may represent hallmark of antidepressant activity. Mechanisms governing region- and drug-selective action of antidepressants require further investigations.

Social functioning and the quality of life of patients diagnosed with schizophrenia.

INTRODUCTION: Schizophrenia to a considerably great degree impairs the social functioning of the persons affected in the spheres of interpersonal and occupational contacts, as well as self-care. It brings about serious cognitive, perceptual, motor and emotional deficits, inevitably leading to the social withdrawal of patients. This phenomenon may assume various forms, from the limitations in interpersonal relations, through narrowing these relations to only some circumstances, to the total cessation of social contacts. OBJECTIVE: The objective of the study is presentation of the most important problems related with social functioning and quality of life of patients diagnosed with schizophrenia, based on scientific studies conducted in Poland and worldwide. STATE OF KNOWLEDGE: The family of a schizophrenia patient exerts a great effect on the social functioning. While undertaking proper actions the family may become a co-therapist and significantly facilitate the patient's adjustment to life in society and his/her playing a specified role. Analysis of disorders in social functioning of patients with schizophrenia, in the context of social cognition, indicates the fact that these disorders have their source in the lack of capabilities for identification of own and other people's internal states, whereas mentalization is the essence of social cognition. CONCLUSIONS: Therapy, any psychosocial impact as well as rehabilitation, neutralizes the causes for patients' withdrawal from social life. Training of social skills is necessary which teaches patients to return to the situation when they would be able to function properly in their environment.

Limbic brain structures and burnout-A systematic review.

More profound understanding of the relationship between the burnout and the limbic system function can provide better insight into brain structures associated with the burnout syndrome. The objective of this review is to explore all evidence of limbic brain structures associated with the burnout syndrome. In total, 13 studies were selected. Four of them applied the neuroimaging technology to investigate the sizes/volumes of the limbic brain structures of burnout patients. Six other studies were to investigate the hypothalamus-pituitary-adrenal (HPA) axis of burnout patients. Based on the results of the studies on the HPA-axis and neuroimaging of the limbic brain structures, one can see great impact of the chronic occupational stress on the limbic structures in terms of HPA dysregulation, a decrease of BDNF, impaired neurogenesis and limbic structures atrophy. It can be concluded that chronic stress inhibits the feedback control pathway in the HPA axis, causes the decrease of brain-derived neurotrophic factor (BDNF), then impaired neurogenesis and eventually neuron atrophy.

Blood serum concentrations of kynurenic acid in patients diagnosed with recurrent depressive disorder, depression in bipolar disorder, and schizoaffective disorder treated with electroconvulsive therapy. / Stezenia kwasu kynureninowego w surowicy krwi pacjentów leczonych elektrycznie z rozpoznaniem zaburzenia depresyjnego nawracajacego i depresji w przebiegu choroby afektywnej dwubiegunowej oraz zaburzenia schizoafektywnego.

OBJECTIVES: The aim of the present study was to compare blood serum kynurenic acid (KYNA) concentrations measured before ECT and after 1, 6 and 12 electroconvulsive treatment (ECT) sessions in patients with diagnoses of recurrent depressive disorder (RDD), depression in bipolar disorder (DBD) and schizoaffective disorder (SAD). METHODS: The study group comprised of 50 patients with ICD-10 diagnoses of RDD, DBD and SAD. Blood serum KYNA concentrations were determined and clinical assessment was performed using the MADRS and the GAF scale. RESULTS: Significant differences were found in blood serum KYNA levels between RDD, DBD and SAD patients treated with electroconvulsive therapy and healthy controls: 1) KYNA concentrations in DBD patients measured before ECT and after 12 ECT sessions were significantly lower than in the control group; 2) KYNA concentrations in the serum of RDD patients measured before ECT and after one and 12 ECT sessions were significantly lower than in the control group, while those measured after 6 ECT session did not differ significantly from KYNA concentrations in healthy controls; 3) higher pre-treatment blood serum concentrations of KYNA in DBD patients correlated with a higher number of illness phases and poorer general functioning before treatment; 4) significant relationships were found between higher blood serum concentrations of KYNA in RDD patients after 1 ECT session and male gender, and between higher KYNA concentrations after 6 ECT sessions and increased depression and poorer functioning before treatment in those patients. CONCLUSIONS: Results show that KYNA concentrations in all diagnostic groups were lower before ECT (not statistically significant for the SAD group) and that there were no significant changes in those concentrations (compared with the baseline) during ECT.

Psychopathological symptoms, defense mechanisms and time perspectives among subjects with alcohol dependence (AD) presenting different patterns of coping with stress.

BACKGROUND: The problem of coping with stress is an important one in the context of development and persistence of alcohol dependence. In the literature to date very little attention has been paid to coping patterns construed as a configuration of specific coping styles, particularly as regards the functioning of addicted individuals. The aim of the study was to verify whether individuals with alcohol dependence characterized by different coping patterns differ with respect to the severity of psychopathological symptoms, defense mechanisms and time perspectives. METHODS: Participants were given a battery of psychological tests-Coping Inventory for Stresfull Situations (CISS), Defense Style Questionnaire (DSQ 40), Syndrom Checklist (SCL-90) and Short Zimbardo Time Perspective Inventory (SZPTI-PL). The sample comprised 112 individuals with alcohol dependence, aged 20 to 63 years old, the average age was 37.86; 78 percent were men. There were identified three sub-groups of individuals characterized by a distinctive patterns of coping with stress -"emotional-avoidant", "task oriented" and a "mixed one". RESULTS: Individuals with the predominant emotional-avoidant coping pattern are characterized by significantly higher severity of psychopathological symptoms, less mature defense mechanisms and past time perspectives. Subjects reliant on task-oriented coping pattern were characterized by the highest level of adaptation and the most constructive way of functioning in the face of difficulties. CONCLUSION: It is worth regarding the examination of patterns of coping as an indispensable element of collecting medical history from alcohol dependent individuals.

Clinical Phenotype of Depression Affects Interleukin-6 Synthesis.

Major depressive disorder (MDD) is not a single disease, but a number of various ailments that form one entity. Psychomotor retardation, anhedonia, sleep disorders, an increased suicide risk, and anxiety are the main symptoms that often define the clinical diagnosis of depression. Interleukin-6 (IL-6), as one of the proinflammatory cytokines, seems to be overexpressed during certain mental disorders, including MDD. Overexpression of IL-6 in depression is thought to be a factor associated with bad prognosis and worse disease course. IL-6 may directly affect brain functioning and production of neurotransmitters; moreover, its concentration is correlated with certain clinical symptoms within the wide range of depressive symptomatology. Furthermore, there is a strong correlation between IL-6 synthesis and psychosomatic functioning of the patient. This article discusses potential sources and significance of IL-6 in the pathogenesis of depression.

Vulvodynia and depression - a case study. / Wulwodynia i depresja ­ opis przypadku.

The analysis of the case of vulvodynia coexisting with depression. Remission in terms of pain and affective symptoms was achieved simultaneously after including gabapentin in the treatment at a dose of 900 mg/d. Depressive disorders may constitute a risk factor for vulvodynia and occur as a secondary condition to pain. The frequency of other functional pain syndromes such as fibromyalgia and temporomandibular syndrome is much higher in patients with vulvodynia than in the overall female population. The risk of suicide in vulvodynia, similarly to other chronic pain syndromes, is relatively high, especially with coexisting depressive symptoms.

Personality traits in alcohol-dependent individuals in the context of childhood abuse. / Cechy osobowosci u osób uzaleznionych od alkoholu w kontekscie doswiadczen przemocy w dziecinstwie.

OBJECTIVES: The aim of this study was to identify groups of alcohol-dependent individuals differing in the severity of childhood physical, emotional and sexual abuse and to find the personality variables that discriminate between those groups. METHODS: The study included 90 individuals dependent on alcohol. The following questionnaires were used: the Temperament and Character Inventory (TCI), the Coping Inventory (COPE), the Buss and Perry Aggression Questionnaire (BPAQ), Cattell's IPAT Anxiety Scale, and the Early Trauma Inventory (ETI). RESULTS: Two groups of subjects addicted to alcohol were identified: group 1 with high and group 2 with low childhood physical, emotional and sexual abuse indices. The subjects in Group 1 had significantly higher scores than the subjects in Group 2 on the TCI Temperament scales of NS and HA and lower scores on the TCI character scales of SD, C2 and C4. Group 1 subjects were significantly more likely than those from Group 2 to use avoidant coping strategies; they were also less likely to use problem-focused strategies and had significantly higher scores on general anxiety, overt anxiety, latent anxiety, level of aggression, physical aggression, hostility and anger. CONCLUSIONS: The higher severity of childhood physical, emotional and sexual abuse in alcoholics is associated with those personality traits that seem to be crucial for maintaining abstinence and the quality of cooperation in therapy.

LEVOMILNACIPRAN--A SUCCESSOR OF MILNACIPRAN WITH A HIGHER NORADRENERGIC SELECTIVITY.

A new antidepressant, levomilnacipran, is the levorotatory enantiomer of milnacipran. The drug belongs to selective serotonin-norepinephrine reuptake inhibitors (SNRI) and has the highest noradrenergic selectivity of all members of this group of antidepressants. Clinical trials have confirmed the effectiveness of levomilnacipran in the treatment of depression. The drug was placed on the US market in the form of prolonged-release capsules, which greatly simplifies the treatment of psychiatric patients. The safety of the drug is also higher than the safety of a racemate, resulting in a beneficial impact on the therapeutic effect. In this paper we present current information on the pharmacological and clinical properties of the newest antidepressant--levomilnacipran.

Prevalence of self-injury performed by adolescents aged 16-19 years.

OBJECTIVES: The aim of the study was to assess the prevalence of self-injury among adolescents aged 16-19 years and to indicate demographic variable, selected environmental variables and risky behaviours coexisting with performing self-injuries by the respondents. METHODS: The research encompassed 5,685 individuals, aged 16-19 years. During the research the Questionnaire designed by the authors was used. RESULTS: Significant statistical differences were found between the number of adolescents performing self-injury and those who do not perform it, who use psychoactive agents, make suicide attempts, get drunk, run away from home, report conflicts with their parents, experience parental violence and peer violence and report alcohol addictions by family members. CONCLUSIONS: 1. Self-injury is performed by 14% of adolescents aged 16-19 years, significantly more girls than boys. 2. Significantly more adolescents who perform self-injury, as compared to those who do not do it, use psychoactive substances, get drunk, report planning suicide, neglect school and more often consume alcohol. 3. Significantly more adolescents who perform self-injury, as compared to those who do not perform it, raised in a single parent family inform about alcohol addiction of a family member, conflicts with parents and the experienced psychological and physical violence experienced from their parents and peers. Significantly more girls who perform self-injury, as compared to those who do not perform it, experienced sexual abuse. 4. Performing self-injury by adolescents coexists with factors motivating to this type of behaviours: sense of helplessness, rejection, loneliness, sense of guilt, anger, impulsiveness, desire for revenge, school problems, conflicts with parents and peers.

Compulsive buying in outline.

In spite of a hundred year long history of scientific research compulsive buying has been a hardly known phenomenon until today. Ambiguous scientific information makes it impossible to classify compulsive buying as a separate mental disorder. Recently many researchers have noticed phenomenological compatibility of compulsive buying with behavioural addictions. Nowadays, there is reasonable grounds that compulsive buying disorder can be defined as an addiction. There are many similarities occurring between a consumer type behaviours in compulsive buyers and a pathologic consumption of psychoactive substances which included the obsessive need to consumer or a compulsion to consume, personal dependence and loss of control over self-behaviour, as well as tendencies to the consumption increase. Compulsive buying disorder differs in its course from the compulsive behaviours. A strong compulsion to make a given activity, often impossible to restrain is associated with overwhelming but acceptable desire to purchase a specific item. Due to the latest information about the described phenomenon, it has been decided to present current knowledge of adequate classifications, epidemiology and therapy of compulsive buyers. In the article authors' own standpoint as regards pathogenesis and potential risk factors was described.

VORTIOXETINE - THE NEW ANTIDEPRESSANT AGENT WITH PROCOGNITIVE PROPERTIES.

Depression symptoms resulting from cognitive function impairment are emphasized by both DSM-5 and ICD-10 diagnostic criteria for major depressive disorder and depressive episodes. Nonetheless, the role of cognitive dysfunctions seem to remain underestimated in case of depressive disorders, thus they are rarely perceived as therapeutic target. Vortioxetine is a relatively new, multi-functional agent. With its unique properties and strong affinity towards serotonin transporter (5-HTT), vortioxetine is a modulator and stimulator of serotonergic transmission. Vortioxetine is an antidepressant drug suitable for therapy in various types of depression: severe, anxiety-associated, and of elders. It acts equally strong as SNRIs or agomelatine and has favorable effects on cognitive functioning. Although vortioxetine has not undergone comprehensive preclinical testing, the available data indicate that this particular agent may be more advantageous in terms of its procognitive effects, as compared to other drugs - which often seemed to be analogous in preclinical and clinical testing. In vitro examination of hippocampal pyramidal cells revealed that vortioxetine improves both synaptic transmission and neuroplasticity responsible for memory and learning patterns. Contrary to fluoxetine, the long-term treatment with use of vortioxetine on mice resulted in enhanced visual and spatial memory, along with reduced occurrence of typical depressive behavior. In addition, vortioxetine is a very first drug efficiently augmenting cognitive function in adults diagnosed with severe depressive episode, irrespective of its curative potential on the affective sphere. It may exert even stronger direct effect (assessed with DSST) on cognitive functions than duloxetine. With its supplementary capacity of acting directly on several subtypes of serotonin receptors, vortioxetine is certainly more than just a SSRI. It has been proved that it is as effective as venlafaxine and more efficient than agomelatine in MDD treatment, additionally exerting procognitive effects. In addition, vortioxetine may be beneficial in overcoming sexual dysfunction in patients, who have been suffering from such condition as a result of treatment with other antidepressant agents. The drug is generally well tolerated with the most prevalent side effects being mild to moderate nausea along with (mostly transient) headaches. Vortioxetine may significantly improve the quality of life in patients suffering from depression.

[Cardiac safety of electroconvulsive therapy in an elderly patient--a case report]. / Bezpieczenstwo kardiologiczne zabiegów elektrycznych w podeszlym wieku--opis przypadku.

Since electroconvulsive therapy (ECT) was introduced as treatment for psychiatric disorders in 1938, it has remained one of the most effective therapeutic methods. ECT is often used as a "treatment of last resort" when other methods fail, and a life-saving procedure in acute clinical states when a rapid therapeutic effect is needed. Mortality associated with ECT is lower, compared to the treatment with tricyclic antidepressants, and comparable to that observed in so-called minor surgery. In the literature, cases of effective and safe electroconvulsive therapy have been described in patients of advanced age, with a burden of many somatic disorders. However, cases of acute cardiac episodes have also been reported during ECT. The qualification of patients for ECT and the selection of a group of patients at the highest risk of cardiovascular complications remains a serious clinical problem. An assessment of the predictive value of parameters of standard electrocardiogram (ECG), which is a simple, cheap and easily available procedure, deserves special attention. This paper reports a case of a 74-year-old male patient treated with ECT for a severe depressive episode, in the context of cardiologic safety. Both every single ECT session and the full course were assessed to examine their impact on levels of troponin T, which is a basic marker of cardiac damage, and selected ECG parameters (QTc, QRS). In the presented case ECT demonstrated its high general and cardiac safety with no negative effect on cardiac troponin (TnT) levels, corrected QT interval (QTc) duration, or other measured ECG parameters despite initially increased troponin levels, the patient's advanced age, the burden of a severe somatic disease and its treatment (anticancer therapy).

[The concept of alcohol craving]. / Koncepcje tzw. glodu alkoholu.

The aim of the article was to assess how the perception of alcohol craving, which is one of the symptoms of alcohol dependence, evolved, as well as how it was reflected in the diagnostic classifications. The purpose of this article was also a discussion of the models of the origins of craving, explaining the etiology of this phenomenon and the tools for measuring this concept. The concept of craving, defined as a strong need or compulsion to drink alcohol, functioned for many years, not only in the clinical practice but also as a concept inherently associated with alcohol dependence. However, among experts and researchers, there was no consensus about the etiology of this phenomenon and its development. Some emphasize the emotional - motivational aspect of it, while in the literature also its cognitive - behavioral nature is highlighted. Craving as a symptom has been recognized as a diagnostic criterion of alcohol dependence in the International Statistical Classification of Diseases and Related Health Problems - ICD 10. In the year 2013, it was also indicated as a symptom of disorder resulting from alcohol abuse in the Diagnostic and Statistical Manual of Mental Disorders - DSM 5. It seems to be significant also to discuss the tools used to measure craving, both in clinical trials and therapeutic practice, among them: the Alcohol Specific Role Play Test, Obsessive Compulsive Drinking Scale (OCDS) Lubeck Craving Scale (LCRR) and Alcohol Urge Questionnaire (AUQ).