Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients.

INTRODUCTION AND HYPOTHESIS: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. METHODS: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. RESULTS: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.

The association among health behaviors, shift work and chronic morbidity: A cross-sectional study on nurses working in full-time positions.

BACKGROUND: Nurses are known to work in conditions of stress and physical overload. Health behaviors are modifiable factors that may reduce the adverse effects of work on general health. The present study examined health-related behaviors and their association with current night shift work and chronic morbidity among female nurses. DESIGN AND METHOD: Four hundred seventy-two female nurses (M ± SD = 44.28±7.14 years) self-reported their health habits, physical activity, body mass index (BMI), and chronic disorders that required current treatment. Instruments used in the study consisted of an author-developed questionnaire and the Health Behavior Inventory (HBI). Reported diagnoses were classified as cardio-vascular, gastro-intestinal, malignant neoplastic, endocrine, or other. RESULTS: The most common reported disorders were cardiovascular disorders (5.7% of nurses) followed by other (7.6%), endocrine (7.4%), gastro-intestinal (6.4%), and malignancy (0.2%). On average, health-related behaviors on the HBI were average (83.49 ± 14.33). Overweight and/or obesity (i.e., BMI ≥ 25 kg/m2) were reported by 41.5% of nurses, 24.2% were current smokers, and 36% reported no recreational physical activity. The remaining 64% of nurses who performed physical activity did not report activity levels that met World Health Organization recommendations. Physical activity and HBI scores (total and subscales; i.e., positive attitude, preventive behaviors, proper dietary habits, health-related practices) were not associated with current night shift work or morbidity. CONCLUSION: Health-promoting programs are needed to support weight control and promote health-related behaviors among nurses. Future research should identify potential barriers to healthy lifestyle recommendations in the workplace.

Does Parental Alcohol Use Influence Children's Age at First Alcohol Intake? A Retrospective Study of Patients with Alcohol Dependence.

Parental alcohol misuse has detrimental effects on the entire family. In particular, the safety and general health of the children of parents with alcohol abuse/dependence are of concern to health authorities around the globe. The present study aimed to examine the impact of parental history of alcohol abuse/dependence on the age of first alcohol intake in adult patients with alcohol dependence. Questionnaire data were collected from 294 (57 females) patients with alcohol dependence (M ± SD, 42 ± 10.96 years). The majority of males (61.2%) and over half (50.9%) of females reported no history of parental alcohol abuse/dependence. Male patients with alcohol dependence were less likely to report living with both parents with alcohol abuse/dependence than female patients with alcohol abuse/dependence (p < 0.05). However, male patients who lived with both parents with alcohol abuse/dependence were younger at first alcohol intake than their female counterparts (median age: 12.00 vs. 18.00, p = 0.002) and males raised by parents without alcohol abuse/dependence (median age: 12.00 vs. 16.00, p = 0.036). Our findings suggest that age at first alcohol intake may serve as a marker of household dysfunction, including poor parental management. Our study supports the global need for systemic interventions to help alcohol abusing/dependent parents to carry out their parental responsibilities.

Somatic comorbidities of inpatients receiving treatment for alcohol withdrawal syndrome on a psychiatric ward and their relation to delirium tremens.

Purpose: This study aimed to assess the influence of somatic diseases and patient characteristics (age, gender) in relation to delirium tremens (DT) episodes in alcohol withdrawal syndrome (AWS). We also analysed the influence of age, gender and specific somatic diseases on the duration of hospital stay and the frequency of comorbid somatic diseases among AWS and DT patients. Methods: The medical records of patients admitted to an AWS treatment ward in a Polish psychiatric hospital in 2019 were analysed. In total, 800 hospitalisations of 656 patients (625 hospitalisations for AWS and 175 for DT) were evaluated. Results: The most frequent group of somatic diseases among AWS and DT patients was cardiovascular diseases, with essential hyper tension as the main medical condition. Patients suffering from DT were diagnosed with respiratory system diseases (p < 0.001) and pneumonia (p < 0.000) more often than AWS patients. Hospital stays were longer for patients with pneumonia, chronic obstructive pulmonary disease and duodenal ulcers. Patients with acute pancreatitis were hospitalised for a significantly shorter period of time than other patients. Patient gender and age did not significantly affect the development of DT. However, age was positively correlated with duration of hospitalisation (p < 0.001). Conclusions: The presence of respiratory system diseases, especially pneumonia, was found to influence the incidence of DT in AWS patients. Increased clinical vigilance for the prevention of lower airway infections in AWS patients is essential.

Psychometric properties of the polish version of the Alcohol Use Disorders Identification Test (AUDIT).

BACKGROUND: Alcohol consumption is one of the risk factors associated with over 200 types of diseases, being strongly correlated with unemployment, low socioeconomic status, traffic accidents, and violence. Alcohol is also one of the main causes of premature deaths, especially among males. Early diagnosis based on screening may help to prevent the evolution from alcohol misuse to dependence by counseling or treatment. METHODS: 1024 participants took part in the study: 300 of alcohol dependents and 724 of controls (405 students and 319 patients from General Practice) (M ± SD age = 33.7 ± 15.4 years). Finally, group of 877 participants were included to the statistical analysis due to the missing data - 453 were male and 424 were female. The median AUDIT score was 17 (IQR = 11). RESULTS: Correlation analysis showed that AUDIT scores were strongly correlated with MAST (rho = 0.764, p < 0.001) and CAGE scores (rho = 759, p < 0.001). The ROC analysis resulted in an area under the curve (AUC) of 0.95 (p < 0.001; 95 % C.I.: 0.936-0.963). The cutoff point of 22 for alcohol dependence corresponded to a sensitivity of 0.893 and a specificity of 0.863. CONCLUSION: According to our results, the AUDIT scale proved to be a useful tool with high sensitivity and specificity and therefore can be used as a valid screening measure in Poland.

The role of childhood adversities, FKBP5, BDNF, NRN1, and generalized self-efficacy in suicide attempts in alcohol-dependent patients.

BACKGROUND: Alcohol-dependent (AD) patients report higher number of adverse childhood experiences (ACEs), develop poor social skills, and have a higher rate of suicide attempts than the general population. We hypothesize that the association between ACEs and lifetime suicide attempts in AD patients is mediated by generalized self-efficacy and selected functional single nucleotide polymorphisms (SNPs) in genes involved in the stress response and neuroplasticity, including: FKBP5 rs1360780, BDNF rs6265, and NRN1 rs1475157. METHODS: 176 AD patients and 127 healthy controls self-reported ACEs with the ACE Study questionnaire and three additional questions that inquired about ACE categories of acute stress; generalized self-efficacy-with the Generalized Self-Efficacy Scale. Genotyping for the three analysed SNPs was performed according to the manufacturer's standard PCR protocol. Hypotheses were tested with bivariate analyses, multiple regression model, and mediation models. RESULTS: Higher levels of generalized self-efficacy were associated with a blunted effect of ACEs on the risk of suicide attempts. The prevalence of the three analyzed SNPs genotypes and alleles did not differ between AD patients with a positive vs. negative lifetime history of suicide attempt and was not associated with GSES scoring. CONCLUSIONS: Generalized self-efficacy should be considered as a target for psychotherapeutic interventions aimed at reducing the risk of suicide attempts in AD patients who were exposed to childhood victimization. The negative results concerning the hypothesized role of the three analysed SNPs should be carefully interpreted due to the relatively small study sample, but represent a theoretical foundation for further research studies with larger study samples.

A need for intervention: Childhood adversities are a significant determinant of health-harming behavior and poor self-efficacy in patients with alcohol dependence. An observational, cross-sectional study on the population of Central Poland.

BACKGROUND: Adverse childhood experiences (ACEs) are known to be associated with a lasting effect on physical and psychological well-being in adulthood. Patients with alcohol dependence (AD) are a particular clinical subgroup who report a higher number of ACE categories than the general population and who develop several health-harming behaviors and poor social skills. OBJECTIVES: To our knowledge, this is the first study on patients with AD that aimed to assess whether ACEs correlate with health habits and general self-efficacy in adulthood. MATERIAL AND METHODS: The study comprised 196 patients with AD (F = 50) with a mean age of 43.8 years. The following research tools were used: the Health Behavior Inventory (HBI), the Generalized Self-Efficacy Scale (GSES) and the ACE Study score, expanded with 3 more questions about exposure to sudden stress and violence outside the family. Additionally, the patients' sociodemographic and clinical characteristics were assessed and included in the multiple stepwise regression analysis for variation in health habits and general self-efficacy. RESULTS: The mean scores of the patients were 64.4 ±16.6 points on the HBI and 28.4 ±6.2 points on the GSES. The study revealed a mean number of 3.3 ±2.7 ACEs. The multiple regression analysis showed that the ACEs were significantly and inversely associated with self-efficacy assessed by the GSES and with health habits evaluated by the HBI (ß = -0.377; p = 0.026 and ß = -1.210; p = 0.007, respectively). The ACEs accounted for 3.2% of the GSES model variability and 3.9% of the HBI variability. CONCLUSIONS: Adverse childhood experiences might promote the development of health-harming behaviors and inferior general self-efficacy in adult patients with AD. The study suggests the need for primary and secondary preventive strategies targeted at ACEs and at general self-efficacy impaired by childhood adversities for further better well-being. However, although the influence of the ACEs was significant, there are many other factors that were not included in the analysis, which explain the remaining variability of health behaviors and general self-efficacy.

Childhood Adversities are not a Predictors of SSTR4met in Alcoholics.

BACKGROUND: Genome methylation may modulate synaptic plasticity, being a potential background for mental disorder. Adverse childhood experiences (ACEs), known to be frequently reported by patients with alcohol dependence (AD), have been proposed as one of environmental inequities influencing DNA methylation. The study is aiming 1.To assess a promoter region methylation in gene for somatostatin receptor subtype-4 (SSTR4), a receptor for somatostatin, a neurotransmitter engaged in neuroplasticity and memory formation, in patients with AD; 2. To verify if SSTR4 promoter methylation is associated with ACEs and other selected environmental factors. Methodology: 176 patients with AD and 127 healthy controls were interviewed regarding 13 categories of ACEs; a structured self-reported questionnaire - to measure the sociodemographic and clinical characteristics; a module of Catalogue of Healthy Behavior - to assess nutritional health habits; the Alcohol Use Disorders Identification Test - to assess drinking severity. The SSTR4 promoter region methylation status was performed via methylation-specific PCR, and the genotyping for the SSTR4 rs2567608 functional polymorphism - according to the manufacturer's standard PCR protocol. RESULTS: SSTR4 promoter region was found methylated in 21.6% patients with AD and 2.3% controls. None of following characteristics: current age, gender, term and kind of labor, 13 categories of childhood trauma, diet, alcohol drinking severity, age at alcohol drinking initiation, age at onset of problem drinking, cigarette smoking, and SSTR4 rs2567608 was a significant predictor for SSTR4 promoter region methylation. CONCLUSIONS: SSTR4 promoter region methylation in here studied participants may be either inherited epigenetic modification or secondary, but not to here assessed variables.

SSTR4, Childhood Adversity, Self-efficacy and Suicide Risk in Alcoholics.

BACKGROUND: Patients with alcohol dependence (AD) are known to develop poor social skills, to report a higher number of adverse childhood experiences (ACEs) and to attempt suicide more frequently than the general population. The background for the association between ACEs and a higher risk of suicide still remains understudied. SSTR4 rs2567608 is a functional polymorphism of the gene for somatostatin receptor subtype 4, predominantly found in the CA1 hippocampus area and involved in memory formation. We hypothesize that the functional polymorphism SSTR4 rs2567608, general self-efficacy, and adverse childhood experiences influence the risk of suicide attempt in patients with AD. METHODOLOGY: 176 patients with AD and 127 healthy controls were interviewed regarding 13 categories of ACEs and assessed with the General Self-Efficacy Scale. Genotyping for the SSTR4 rs2567608 polymorphism was performed according to the manufacturer's standard PCR protocol. RESULTS: Patients with AD and the controls did not differ significantly according to the SSTR4 rs2567608 genotype and allele frequencies. Lower general self-efficacy, higher number of ACEs, and the SSTR4 rs2567608 TT genotype increased the risk of suicide attempt in patients with AD, and it persisted significant only in male patients with AD. CONCLUSIONS: Our study supports previous findings on ACEs and general self-efficacy association with a risk for suicide. Additionally, we suggest that patients with AD of the SSTR4 rs2567608 TT genotype may be more vulnerable to ACEs and at a higher risk of suicide attempt.

[Creutzfeldt-Jakob disease in the psychiatric practice--case reports of the ataxic and Heidenhain variant]. / Choroba Creutzfeldta-Jakoba w praktyce psychiatrycznej--opis przypadków postaci ataktycznej i Heidenhaina.

OBJECTIVES: Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare fatal neurodegenerative brain disorder of variable clinical manifestation. Making the right diagnosis still remains challenging. First symptoms are vague and differ between clinical subtypes of the disease. This is to present the symptoms variability and diagnostic difficulties in sCJD based on case reports of two female patients examined at time of the disease duration by psychiatrists. METHODS: Data of our patients were collected from hospital medical records. RESULTS: The case of patient A. P.' ataxic sCJD is an example of clinical picture suggesting neurological background of the disease almost from the symptoms' onset and being referred by psychiatrist to the neurological ward, where the right diagnosis of probable sCJD was established. In the opposite is the case of patient I. W.' Heidenhain variant of sCJD, misdiagnosed with dissociative disorder delivering huge diagnostic difficulties, even to neurologists. In both patients the certain diagnosis was confirmed at autopsy. CONCLUSIONS: In patients with visual disturbances of unknown etiology, even if the ophthalmological and neurological background is excluded, sCJD should be taken into consideration in the differential diagnosis.

Vascular endothelial growth factor A gene expression level is higher in patients with major depressive disorder and not affected by cigarette smoking, hyperlipidemia or treatment with statins.

Elevated levels of vascular endothelial growth factor (VEGF) are observed in conditions with vessel and neuron damage or pathological arborization and can therefore be detected in chronic inflammatory process, cardiovascular disease and depression. Hyperlipidemia and cigarette smoking are two factors that have been implicated in endothelial damage. The high comorbidity between cardiovascular disease and major depression disorder (MDD) prompted us to study the effect of cigarette smoking, hyperlipidemia and statin treatment on the VEGFA mRNA and protein expression levels measured in MDD patients. We analyzed 38 MDD patients and 38 healthy control individuals and observed that the MDD group had a significantly higher VEGFA mRNA level and protein serum concentration (P=0.001; P<0.001, respectively). We found no significant association between VEGFA expression at the mRNA or protein level and cigarette smoking, hyperlipidemia or treatment with statins (P>0.05). Interestingly, patients who had attempted suicide had a lower VEGF serum level compared with patients who had not attempted suicide. The translational value of this finding remains unknown. A higher VEGF concentration may play a potentially significant role in the pathogenesis of depression, and the expression level appears to be unaffected by additional factors.

Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder.

The clinical implications of thyroid hormones in depression have been studied extensively and still remains disputable. Supplementation of thyroid hormones is considered to augment and accelerate antidepressant treatment. Studies on the role of thyroid hormones in depression deliver contradictory results. Here we assess theirs impact on depression severity and final clinical outcome in patients with major depression. Thyrotropin, free thyroxine (FT4), and free triiodothyronine (FT3) concentrations were measured with automated quantitative enzyme immunoassay. Depression severity and final clinical outcome were rated with 17-itemic Hamilton Rating Scale for Depression [HDRS(17)] and Clinical Global Impression Scales for severity and for improvement (CGIs, CGIi). FT3 and FT4 concentrations were significantly positively correlated with clinical improvement evaluated with CGIi (R = 0.38, P = 0.012; R = 0.33, P = 0.034, respectively). There was a significant correlation between FT4 concentrations and depression severity assessed in HDRS(17) (R = 0.31, P = 0.047). Male patients presented significantly higher FT3 serum levels (Z = 2.34, P = 0.018) and significantly greater clinical improvement (Z = 2.36, P = 0.018) when compared to female patients. We conclude that free thyroid hormones concentrations are associated with depression severity and have an impact on final clinical outcome. It can be more efficient to augment and accelerate the treatment of major depressive disorder with triiodothyronine instead of levothyroxine because of individual differences in thyroid hormones metabolism.

Vascular endothelial growth factor gene (VEGFA) polymorphisms may serve as prognostic factors for recurrent depressive disorder development.

Recurrent depressive disorder (rDD) is a multifactorial disease. Vascular endothelial growth factor (VEGF) is one of the factors that have been suggested to play a role in the etiology and/or development of this disease. Limited information related to the role of VEGFA gene polymorphism in depressive disorder is available. The aim of the study was to analyze the association between VEGFA gene polymorphisms (+405G/C; rs2010963, +936C/T; rs 3025039), VEGFA gene expression, and its serum protein levels in rDD in the Caucasian population. In the current study, 268 patients and 200 healthy controls of the Caucasian origin were involved. Genotyping and gene expression were performed using polymerase chain reaction (PCR)-based methods. Enzyme-linked immunosorbent assay (ELISA) was used for detection of circulating serum VEGF levels. The distribution of VEGFA polymorphism +405G/C differed significantly between rDD patients and healthy subjects. The results of this study indicated that the C allele and CC genotype of VEGFA are risk factors for rDD. Haplotypes CC and TG are the important factors for depression development. Further, VEGFA mRNA expression and VEGF levels were higher in rDD patients than in controls. The VEGFA gene polymorphism may serve as a prognostic factor for rDD development. Our study showed higher levels of both VEGFA mRNA in the peripheral blood cells and serum VEGF in patients diagnosed with rDD than in healthy controls. The obtained results suggest VEGF and the gene encoding the molecule play a role in the etiology of the disease and should be further investigated.

Vascular endothelial growth factor receptor 2 gene (KDR) polymorphisms and expression levels in depressive disorder.

Recent research findings suggest that vascular endothelial growth factor (VEGF) participates in the development of depressive disorder. VEGF is involved in neurogenesis and neuroprotection processes, mediated by vascular endothelial growth factor receptor 2 (VEGFR2). VEGFR2 also plays a role in angiogenesis, a process related to neurogenesis and other biological processes. We examined VEGFR2 (KDR) gene polymorphism, mRNA expression levels, as well as VEGFR2 protein levels in 268 patients diagnosed with a recurrent depressive disorder (rDD) using the ICD-10 criteria, and in 200 healthy controls. Genotyping and gene expression level analysis was performed using polymerase chain reaction (PCR)-based methods. An Enzyme-Linked Immunosorbent Assay (ELISA) was used for measurement of KDR protein levels. Our study found that distribution of KDR polymorphism +1416T/A differs significantly in patients with rDD when compared to healthy subjects, while A allele and AA genotype are risk factors for rDD. KDR mRNA and protein expression are higher in patients with rDD. We also observed a significant association between the -271A/G variant and gene and protein levels. Our study is the first to demonstrate that the KDR gene may serve as a novel genetic marker that could participate in the etiology of rDD. This new pathway may play a role in the inflammatory pathophysiology of depression.

[Differences in cognitive functioning of men and women with a diagnosis of depression]. / Róznice w funkcjonowaniu poznawczym kobiet i mezczyzn z rozpoznana depresja.

UNLABELLED: Every year about 100 million people around the world, manifested symptoms of depression. The prevalence of depressive disorders concern for at least 15% of adult women and 10% of men. The aim of the study was to evaluate the effectiveness of selected cognitive processes in a group of men and women with recurrent depressive disorders. MATERIAL AND METHODS: The survey involved 30 people (age: 23-62 years, mean age = 50.46 years, SD = 8.97): 16 women (53.33%; age: 23-59 years, mean age = 51.16 years, SD = 4.74) and 14 men (46.67%, respectively, age: 23-62 years, mean age = 51.41 years, SD = 12.07) hospitalized in Department of Adult Psychiatry, Medical University of Lódz. The study used psychological tests designed to assess the effectiveness of cognitive processes (learning curve Luria, a test plot away, Stroop test, verbal test fluencji by Lucki) and Hamilton depression rating scale (HDRS, consists of 21-items). RESULTS: Observed no statistically significant differences between treatment groups in the trials conducted. Women in the study group obtained better results compared to men in the learning curve Luria, Stroop test and verbal fluency test by Lucki. Men came out better in the test plot of the road. There were no differences between treatment groups in severity of depression measured HDRS. CONCLUSIONS: The results showed no statistically significant differences between men and women in the trials conducted evaluating the effectiveness of cognitive functioning. Women in the study group obtained better results compared to men in the trials evaluating the effectiveness of short-and long-term verbal memory, verbal memory and verbal fluidity. Men in the test group proved better than women in tests assessing visual-motor coordination and visual-spatial memory operational.

[Münchausen syndrome by proxy]. / Przeniesiony zespól Münchausena.

Münchausen syndrome by proxy (MSBP), is a psychiatric disorder, a particular form of child abuse. An impaired emotional relationship exists mainly between the mother and her child. According to the variety of victims' symptoms, all medicine doctors may deal with this syndrome in every day clinical practice. Still insufficient knowledge about the syndrome and its' rare consideration in the differential diagnosis result in only severe, potentially lethal cases recognition. For many years the rest remains a source of a long-term physical and mental injuries in victims. About 30 years from the first attempt to precisely point the signalling symptoms for a proper diagnosis, we present the current knowledge on epidemiology, aetiology, diagnostic criteria, advised management and psychological portrait of the mother with the syndrome and her child, the syndrome's victim.

[The MoCA scale in diagnosis of the amnestic syndrome--case report]. / Skala MoCA w diagnostyce zespolu amnestycznego--opis przypadku.

AIM: Among main symptoms of the amnestic syndrome we can distinguish: short-term and long-term memory deterioration, deficiency of the effectiveness of learning, the anterograde amnesia and the retrograde amnesia, lack of the orientation in the place and in the time and confabulations. The aim of the study is to introduce the unknown tool of cognitive assessment named Montreal Assessment Cognitive (MoCA). The authors want to indicate the diagnostic accuracy of the scale in the examination of the amnestic patient. METHOD: In the neuropsychological examination of the amnestic patient, the Montreal Cognitive Assessment scale was used. RESULTS: The patient correctly performed the tasks which estimated effectiveness of the visual-motor coordination, language abilities (naming, repeating of the sentences) and effectiveness of the short-term memory. Difficulties in the remaining tasks indicate at deficiency of the effectiveness of the learning ability, long-term memory (recognition), abstractive thinking and the orientation in the place and time. Deterioration of the working memory and executive functions is also noticeable. CONCLUSIONS: Montreal Cognitive Assessment scale is a useful tool for the evaluation of the cognitive functions among amnestic patients.