Increasing the dosage of pregabalin in patients with focal epilepsy decreases the frequency of seizures and ameliorates symptoms of anxiety, depression and insomnia.

OBJECTIVE: The effectiveness of the treatment depends on the adequate dosage of medications. In clinical practice, drugs are often used at doses that are too low, which results in suboptimal levels of clinical improvement. The aim of the study was to evaluate the effects of increasing the dose of previously taken pregabalin in a group of patients with focal epilepsy and generalized anxiety disorder (GAD). PATIENTS AND METHODS: This open study involved 993 patients (46 ± 14 years old) suffering from epilepsy with focal seizures and concomitant GAD treated with pregabalin add-on therapy. The severity of anxiety was assessed with GAD-7 Scale. The number of epileptic seizures was monitored before and after the increase of the pregabalin dose. RESULTS: On the initial visit, the mean daily dose of pregabalin was 159 ± 82 mg. During the study period (nine months) the mean dose was increased to 327 ± 163 mg. After nine months, based on the intention-to-treat analysis, 27.1% (N = 253) of the subjects experienced seizure resolution, and 57.8% (N = 539) reduction in seizure frequency by at least 50%. At the beginning of the study, despite pregabalin administration, 60.7% of patients were above the diagnostic threshold for GAD diagnosis. The add-on therapy resulted in the improvement of the depressive and anxiety symptoms, and insomnia, greater in those that experienced seizure resolution or reduction in their frequency. CONCLUSIONS: (1) Patients with focal epilepsy with concomitant anxiety disorder experience reduction in seizure frequency, improvement of anxiety, depressive symptoms and insomnia using PGB as an add-on therapy. (2) Our data suggest that pregabalin as an add-on treatment is a reasonable choice for patients with focal epilepsy who have concomitant symptoms of an anxiety disorder.

[Subjective and objective evaluation of treating schizophrenia with classic or atypical drugs]. / Subiektywna i obiektywna ocena leczenia schizofrenii lekami klasycznymi i atypowymi.

Subjective and objective evaluation of pharmacological treatment was made in 105 schizophrenic in-patients. PANSS and Calgary scale as well as Van Putten scale were used. Fifty-four percent of subjects received classic neuroleptics and 46%--new atypical drugs for an average period of 8 weeks. The severity of schizophrenic symptoms during treatment as well as subjective evaluation of first effects of the drug did not differ among subjects treated with classic or atypical drugs. Depressive symptoms decreased significantly during treatment with atypicals but not with classic drugs. Also a significant decrease of depression was found under olanzapine treatment. The severity of neuroleptic-induced side-effects did not differ in both groups. Neurological side effects were more prominent in subjects after 4 weeks of therapy with risperidone, in comparison to patients receiving olanzapine. Forty-seven per-cent of patients showed a dysphoric reaction to the first dose of medication. After treatment with atypical drugs, better subjective evaluation of pharmacotherapy correlated with less severe general and depressive schizophrenia symptoms. Patients' better evaluation of olanzapine treatment correlated with less severe schizophrenic general symptomatology. The subjective evaluation of treatment was better in patients with less severe neurological side-effects of atypical drugs (including olanzapine but not risperidone) and less severe autonomic side-effects of classic drugs. The evaluation of pharmacotherapy made by patients' family members did not correlate with subjects' opinions after distribution of the first dose of the drugs, but correlated significantly with patients' opinion after 8-weeks of treatment. The treatment received by the patients was judged better by the family members if less severe neurological side-effects were present.

[Psychological conditions of patient's decision to break off the treatment with atypical neuroleptic: a case study]. / Psychologiczne uwarunkowania samowolnego przerwania leczenia atypowym neuroleptykiem--opis przypadku.

Patient's compliance is an important factor in treatment of schizophrenia. As a part of a wide field of compliance problems, subjective experiences of neuroleptic therapy are important for adherence to treatment. Not only pharmacological action of the given drug but also the patient's subjective and psychological experiences of this action and his/her interpretations of what he/she feels are crucial for the successful treatment of schizophrenia. The change in patient's mental state is followed by changes in patient's intrapsychic attitudes, thoughts and emotions, in his/her relationship with the important persons in environment and with the global social milieu as well. In this paper the case of a psychotic patient was described. The patient responded well to low doses of risperidone but then refused to continue the treatment. Her refusal can be understood in terms of her inability to face developmental tasks (separation process) and interpreted in psychodynamic manner. It is also clear that it has transferential meaning. In conclusions the '"awakening" problem' is described. In some cases after treatment with atypical neuroleptics good clinical improvement can be seen. Sometimes it is coined as "awakening". Many "awakened" patients experience novel set of challenges after reduction in psychotic symptoms. If it is too difficult for them to try to solve these problems, like it was in the case described above, they can drop out the treatment.

[Neuroleptics, atypical antipsychotics and "awakening"]. / Neuroleptyki, atypowe leki antypsychotyczne i "przebudzenie".

Clinical response to the treatment of schizophrenic patients with atypical antipsychotics is sometimes labeled as "awakening". However, there is no general agreement what this term specifically means. The wide range of definitions starts from withdrawal of side effects of classical neuroleptics and goes through psychological phenomena to the definition that postulates arresting of the psychotic process. The paper presents a review of different points of view on "awakening" phenomena as well as problems that are connected with it. Some own experiences and attempts at generalization are presented. They deal with new problems and challenges connected with treatment of patients with acute and chronic schizophrenia with atypical antipsychotics.

[Subjective aspects of psychopharmacology in schizophrenia]. / Subiektywne aspekty psychofarmakoterapii schizofrenii.

The authors discuss the subjective and psychodynamic aspects of pharmacotherapy in schizophrenia which are important for compliance. A large number of different factors connected with psychopharmacotherapy are of particular importance when we consider their impact on compliance. Those factors are psychopathology of patient's disease, insight, and his her intrapsychic structure as well as the great number of factors which are based on social and cultural environment of the patient. One of the most important factors is associated with the patient's family and the question how the family estimate the changes in the patient's health under the influence of medication. Other important factors include those which are rooted in the therapeutic environment of mental health service institutions and particularly in the therapeutic relationship between the patient and the treating psychiatrist. Those factors, including transference and counter-transference, may cause specific impact or even distortions ona farmacotherapeutic action of the antipsychotic drugs. The attempts to classify this compound area as well as some remarks concerning meaning of psychodynamic aspects of farmacotherapy for different groups of mental health professionals are presented in the article. The psychodynamic and subjective factors of psychopharmacotherapy are seen here as a part of a more complex field of compliance but also as those which determine a successful therapeutic outcome in the care of schizophrenic patients.