Magnetic Resonance Imaging and Manganism: A Narrative Review and Laboratory Recommendations.

In recent years, a series of articles has been published concerning magnetic resonance imaging (MRI) studies in a group of patients exposed to manganism, specifically factory workers, welders, and individuals with liver diseases, as well as those abusing home-produced ephedrone. Some potential symptoms of manganese toxicity include motor disturbances, neurocognitive problems, sleep disorders, and psychosocial changes. Despite various publications on MRI research in individuals with an elevated risk of manganism, there is a noticeable absence of a comprehensive review in this field. The detection of the accumulation of manganese in the brain through MRI can confirm the diagnosis and guide appropriate treatment. Due to the high cost of determining manganese ion levels in biological material, an additional aim of the manuscript was to identify simple medical laboratory parameters that, when performed concurrently with MRI, could assist in the diagnosis of manganism. Among these types of parameters are the levels of bilirubin, magnesium, liver enzymes, creatinine, hemoglobin, and hematocrit.

Pulmonary embolism masked by symptoms of mental disorders.

Purpose: The objective of this article is to draw attention to an unusual clinical manifestation of pulmonary embolism (PE) as symptoms suggesting an underlying mental disorder. This seems all the more important since PE is one of the most common causes of potentially preventable hospital deaths and delayed diagnosis of PE in patients consulted at emergency departments has been shown to be most common in elderly patients and the ones presenting with significantly altered mental status. Views: PE is a life-threatening condition that requires prompt diagnosis and appropriate management. There is no symptom that can be found characteristic for PE. Clinical picture of this condition is varied and may resemble many other disorders. The article emphasises that PE may also manifest with psychopathological symptoms that mimic psychiatric emergencies. Three most common groups of psychopathological symptoms that can mask a developing PE, such as panic attacks, symptoms of psychosis, and catatonia, are discussed here based on the literature review. Conclusions: Particular care must be exercised while evaluating such a patient because initial misdiagnosis results in the patient being referred to a mental health care unit instead of a unit treating somatic disorders. There are no diagnostic or treatment facilities in large psychiatric hospitals to assist such a patient. This, in turn, leads to a significant delay in management and, consequently, to major complications or death.

Advanced Biomarkers of Hepatotoxicity in Psychiatry: A Narrative Review and Recommendations for New Psychoactive Substances.

One of the factors that increase the effectiveness of the pharmacotherapy used in patients abusing various types of new psychoactive substances (NPSs) is the proper functioning of the liver. However, the articles published to date on NPS hepatotoxicity only address non-specific hepatic parameters. The aim of this manuscript was to review three advanced markers of hepatotoxicity in psychiatry, namely, osteopontin (OPN), high-mobility group box 1 protein (HMGB1) and glutathione dehydrogenase (GDH, GLDH), and, on this basis, to identify recommendations that should be included in future studies in patients abusing NPSs. This will make it possible to determine whether NPSs do indeed have a hepatotoxic effect or whether other factors, such as additional substances taken or hepatitis C virus (HCV) infection, are responsible. NPS abusers are at particular risk of HCV infection, and for this reason, it is all the more important to determine what factors actually show a hepatotoxic effect in them.

Reasons, Form of Ingestion and Side Effects Associated with Consumption of Amanita muscaria.

In recent months, there has been a new trend involving the consumption of Amanita muscaria. The aim of this article was to investigate the reasons for consumption, the form taken and the adverse symptoms that were indicated by those consuming Amanita muscaria. After analysing 5600 comments, 684 people were included in the study, who, in social media groups such as Facebook, stated the purpose of consuming the mushroom (n = 250), the form of mushroom they were taking (n = 198) or the adverse symptoms they experienced (n = 236). The gender of the subjects differentiated the parameters analysed. In the study group of women, the main purpose of consuming Amanita muscaria was to reduce pain, as well as to reduce skin problems, while in men it was mainly to relieve stress, reduce the severity of depressive symptoms and reduce insomnia (p < 0.001). With regard to the form of mushroom ingested, tincture was predominant in the women's study group, while dried was predominant in the men (p < 0.001). In terms of side effects, women reported primarily headaches, while men reported nausea, vomiting, abdominal pain and drowsiness (p < 0.001). Advanced research on Amanita muscaria should be carried out to make the community aware of the toxicity of this fungus.

Matrix metalloproteinase-3 serum levels in schizophrenic patients.

OBJECTIVES: It has been reported that matrix metalloproteinase, MMP-3 may play a significant role in the pathophysiology of mental disorders. However, there are no data on the level of MMP-3 in people suffering from schizophrenia, or its influence on the mental state of these people. The aim of this study was to investigate the effect of an antipsychotic treatment on the blood levels of MMP-3, as well as investigating its relationship with insight into schizophrenia. METHODS: Thirty people with schizophrenia were included in the study. The concentration of MMP-3 in the blood serum was assessed using enzyme-linked immunosorbent assay. Insight into the disease was assessed using the Beck Cognitive Insight Scale. RESULTS: The antipsychotic treatment applied decreased the levels of MMP-3 in patients with schizophrenia (p = 0.005), however, the statistically significant interaction (p = 0.02) indicates that the decrease only concerned men. There was also a statistically significant correlation between the level of MMP-3 and insight into the disease (p = 0.02). CONCLUSION: MMP-3 may be associated with gender, treatment and symptoms in schizophrenic patients.KEY POINTSMMP3 could be used as a potential biomarker for schizophrenia.The level of MMP-3 decreased due to the applied antipsychotic treatment.The higher the level of MMP-3 in a group of people with schizophrenia, the better insight into their disease.

The risk of pulmonary embolism in the context of various clinical situations and management in psychiatric patients. / Ryzyko zatorowosci plucnej w kontekscie róznych sytuacji klinicznych oraz postepowania leczniczego w psychiatrii.

Pulmonary embolism (PE) and deep vein thrombosis are components of venous thromboembolism (VTE), being the third most common cardiovascular disease. PE is the most common life-threatening cardiovascular disorder, which is associated with mortality of 30% when managed incorrectly. Patients with mental disorders are at higher risk of thromboembolism as compared to general population and PE is commonly noted in this group. This mainly results from additional thromboembolic risk factors associated with symptoms and treatment of mental disorders. The scores recommended to estimate the VTE risk do not include factors typical of this group of patients. This article discusses how components of Virchow's triad are activated by symptoms of mental disorders, i.e. psychosis, anxiety, depression and catatonia. The current state of knowledge on the thromboembolic risk associated with coercive measures that involve physical restraint of four limbs is presented. Current data on potentially thrombotic effect of antipsychotics, antidepressants and electroconvulsive therapy are summarised. Recommendations for the prevention of PE in patients with mental disorders are discussed.

Ganser syndrome - a dissociative disorder or a factitious disorder? A case report. / Zespól Gansera ­ zaburzenie dysocjacyjne czy zaburzenie pozorowane? Opis przypadku.

Ganser syndrome (GS) is one of afew eponyms that have survived in psychiatry until the present day. GS is a little-known and rare disorder. It is most often described as a response to a stressor (e.g. incarceration), that is why it is an important issue in forensic psychiatry. Organic causes are taken into consideration. The basic symptoms of the syndrome are: approximate answers, visual and auditory hallucinations, clouding of consciousness and conversion symptoms. Additionally, patients may perform activities in an awry manner and suffer from insensitivity to painful stimuli.GS is usually acute and subsides spontaneously. Usually patients do not remember they had an episode of the disease. Diagnostic criteria of GS are imprecise and its classification has been changed over the years. GS was not listed in the DSM-5 classification, although in the DSM-IV it was classified as a dissociative disorder. Currently some authors tend to classify it rather as a factitious disorder. WHO (ICD-10 and ICD-11) classifies GS as a dissociative and conversion disorder, which seems to be appropriate in the light of current knowledge. The presented case report describes apatient with a nearly identical pattern of full-blown GS, which occurred twice. The symptoms appeared shortly after the patient was incarcerated. The course of the disorder was chronic and recurrent. The patient was insensitive to pain stimuli. Somatic causes were excluded in the diagnostic process.

Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists.

In recent years, an increase in the problem of polypharmacotherapy in psychiatric patients has been observed, including the widespread problem of groups of people taking new psychoactive substances. One reason for this problem may be the poor knowledge of pharmacological interactions in psychiatry. The aim of this study was to explore the opinions and knowledge of psychiatrists from around the world on various aspects related to polypharmacotherapy. A total of 1335 psychiatrists from six continents were included in the study. The respondents' opinion on the problem of hepatotoxicity in psychiatry was also examined. The greatest discrepancy among psychiatrists from different continents in the answers given concerned the definition of polypharmacotherapy (p < 0.001) and the approach to hepatotoxicity (p < 0.001). It is noteworthy that only about 20% of the psychiatrists surveyed (p < 0.001) believe that polypharmacotherapy is associated with a higher rate of patients' hospitalisations. The most commonly used type of polypharmacy by psychiatrists was antidepressants and antipsychotics. Most of them also stated that polypharmacy was associated with reduced patient compliance with the doctor's recommendations related to taking medications due to the increased complexity of the therapy. The continent that diversified the analysed questions to the greatest extent was Africa. Future educational activities for trainee psychiatrists should include more discussion of polypharmacotherapy in psychiatry.

Manganese concentration in patients with encephalopathy following ephedrone use: a narrative review and analysis of case reports.

BACKGROUND: Numerous case reports describe manganese encephalopathy in patients using ephedrone (methcathinone). The aim of this narrative review of case reports was to relate manganese ion concentrations in peripheral blood to the reported neurological deficits. METHODS: International databases, including Thomson (Web of Knowledge), PubMed/Medline, Science Direct, Scopus and Google Scholar were searched for literature items published between 2007 and 2020, in which the authors measured the manganese concentration in patients taking ephedrone. RESULTS: We identified 39 patients in two case series comprising of twenty-three and twelve patients, respectively, and four case reports meeting inclusion criteria. The study showed that 93% of them had elevated blood manganese concentration in relation to the accepted norm (>219 nmol/L), and the median was 364 nmol/L. The median duration of ephedrone use in individual groups of patients was approximately 48 months, and it did not show a relationship with the manganese concentration in the blood. A greater percentage of the people with manganese concentration higher than 250 nmol/L exhibited more severe gait, speech and handwriting disorders. The median duration of ephedrone withdrawal was a month in the group of people with the highest level of manganese ions (>500 nmol/L). CONCLUSION: Manganese concentrations did not vary with the duration of ephedrone use.

The scientific path of Jakub Frostig in the light of his correspondence with the leading representatives of world psychiatry - from psychoanalysis and phenomenological approach to biological psychiatry. Part 1. Towards psychoanalysis and phenomenological approach. / Droga naukowa Jakuba Frostiga w swietle jego korespondencji z czolowymi przedstawicielami psychiatrii swiatowej ­ od psychoanalizy i podejscia fenomenologicznego do psychiatrii biologicznej. Czesc 1. Ku psychoanalizie i podejsciu fenomenologicznemu.

Jakub Frostig (1896-1959) was one of the most active Polish psychiatrists of the interwar period, with broad scientific interests, maintaining close scientific contacts with the leading specialists of world psychiatry, from the German -and English-language areas. This aspect of his activity is presented in the two-part publication based on new sources, which have never been used before, especially on the correspondence with Ludwig Binswanger (1881-1966), Max Müller (1894-1980) and Adolf Meyer (1866-1955), spanning several years. In addition, the German-language work of the psychiatrist and its reception in this language area are described in more detail for the first time. The first part of the article discusses the little known participation of Frostig in the Polish psychoanalytic movement and his attempts to popularize psychoanalysis in Lviv in the 1920s, as well as the philosophical inspirations of his work from the early period of his scientific activity. Frostig's ambitions and chances for a scientific career did not always go hand in hand. The work presents the causes of these discrepancies, which limited his career in the period before and after his emigration to the United States in 1938.

The scientific path of Jakub Frostig in the light of his correspondence with the leading representatives of world psychiatry - from psychoanalysis and phenomenological approach to biological psychiatry. Part 2. Towards biological psychiatry. / Droga naukowa Jakuba Frostiga w swietle jego korespondencji z czolowymi przedstawicielami psychiatrii swiatowej ­ od psychoanalizy i podejscia fenomenologicznego do psychiatrii biologicznej. Czesc 2. W strone psychiatrii biologicznej.

In the second part of the article devoted to Jakub Frostig (1896-1959), his research from the 1930s on insulin coma treatment is presented in a broader context. Frostig began his research in the psychiatric hospital Zofiówka in Otwock and continued after his emigration to the United States. Thanks to new sources, we managed to determine the reasons underlying Frostig's departure from Poland. At the end of the 1930s, the issue of emigration became a necessity for him, saving his life and his family. Frostig was well aware of the political atmosphere at the time and the threats that followed. The inability to make a scientific career in Poland was the first impulse to look for a job abroad. After taking over the post of director of Zofiówka in 1933, this factor ceased to be decisive. The feeling of danger born on the wave of European anti-Semitism, especially in Germany, after Hitler came to power, came to the fore. Efforts to obtain awork permit in Switzerland and Australia proved unsuccessful. Eventually, just before the outbreak of World War II, Frostig managed to emigrate to the USA, where he concentrated on popularizing the treatment of psychiatric disorders with insulin comas in the local psychiatric environment. He did not accomplish a scientific career in the USA as he intended. His life story came full circle, and just as in the first years of his professional career in Lviv, he was forced to switch to a private practice. Despite the difficulties mentioned above, Frostig played a significant role in Polish psychiatry and greatly contributed to its development.

Psychoactive Substances Taken with Mephedrone and HCV Infection.

BACKGROUND: In recent years, the observed frequency of hospitalization of patients taking mephedrone with other psychoactive substances has increased. There are no data in the literature on the effect of mephedrone use on liver function in patients, including the frequency of HCV infection. We have analysed the impact of taking mephedrone together with other psychoactive substances on the incidence of HCV infection. We have also analysed the effect of taking mephedrone with heroin, alcohol, and benzodiazepines on liver enzyme levels. METHODS: The study included patients taking mephedrone with: alcohol (n = 115), heroin (n = 85) and benzodiazepines (n = 130) hospitalized in 2010-2018. The control group consisted of patients addicted to alcohol (n = 180), heroin (n = 221) and benzodiazepines (n = 152). Clinical data and laboratory findings were collected from medical records. RESULTS: Taking mephedrone together with benzodiazepines is a statistically significant predictor of HCV infection in this group of patients, OR (8.44); 95% CI 5.63-12.64; p < 0.001). A statistically significant interaction of the group with HCV infection was observed, i.e., for the level of alanine transaminase (p < 0.001) and aspartate transaminase (p < 0.001). Increased levels of liver enzymes in each of the studied groups was characteristic in patients with HCV infection (p < 0.001). Taking additional mephedrone by this group of patients did not increase the level of liver enzymes. CONCLUSION: HCV infection is a statistically significant factor affecting the increase in liver enzymes levels in the group of patients taking mephedrone.

Increasing the Effectiveness of Pharmacotherapy in Psychiatry by Using a Pharmacological Interaction Database.

Recent studies have shown that the knowledge of pharmacological interaction databases in global psychiatry is negligible. The frequency of hospitalizations in the case of patients taking new psychoactive substances along with other drugs continues to increase, very often resulting in the need for polypharmacotherapy. The aim of our research was to make members of the worldwide psychiatric community aware of the need to use a pharmacological interaction database in their daily work. The study involved 2146 psychiatrists from around the world. Participants were primarily contacted through the LinkedIn Recruiter website. The surveyed psychiatrists answered 5 questions concerning case reports of patients taking new psychoactive substances along with other drugs. The questions were answered twice, i.e., before and after using the Medscape drug interaction database. The mean percentage of correct answers given by the group of psychiatrists who were studied separately in six individual continents turned out to be statistically significantly higher after using the pharmacological interaction database (p < 0.001). This also applies to providing correct answers separately, i.e., to each of the five questions asked concerning individual case reports (p < 0.001). Before using the drug interaction database, only 14.1% of psychiatrists stated that they knew and used this type of database (p < 0.001). In the second stage of the study, a statistically significant majority of subjects stated that they were interested in using the pharmacological interaction database from that moment on (p < 0.001) and expressed the opinion that it could be effective in everyday work (p < 0.001). Using a pharmacological interaction database in psychiatry can contribute to the effectiveness of pharmacotherapy.

Pharmacotherapy of Patients Taking New Psychoactive Substances: A Systematic Review and Analysis of Case Reports.

Background: In recent years, an increase in the frequency of hospitalizations of patients taking newer and newer psychoactive substances has been observed around the world. Each year, authors publish case reports of patients who consumed previously unknown NPS. Most publications of this type concern the period between 2014 and 2016. However, no publication systematically reviews the pharmacotherapy used in these cases. This study aims to review the case reports of patients taking NPS published between 2010 and 2019, as well as analyzing the pharmacotherapy used. Methods: We searched the Thomson (Web of Knowledge), PubMed/Medline, Science Direct, Scopus and Google Scholar databases. The search was performed using all possible combinations of the term "case report" describing the use of NPS, also referred to as designer medications, internet medications, research chemicals and herbal highs. Results: We analyzed 51 case reports on the intake of various types of NPS. Most of them (p < 0.001) concerned the use of synthetic cannabinoids (41.2%) and cathinones (31.4%). The pharmacotherapy applied primarily (p < 0.001) consisted of administering benzodiazepines to patients (62.7%), most of whom took only this group of medications (25.5%), followed by groups receiving benzodiazepines combined with neuroleptics (15.7%) and muscle relaxants (11.8%). Opioids were administered primarily to patients taking synthetic opioids (p < 0.001). Of the 5 cases of deaths from NPS reported in the literature, three relate specifically to the synthetic opioid MT-45. The later the time period, the more medications patients were administered (p = 0.02). Conclusion: In the pharmacotherapy for NPS poisoning, one should focus primarily on combating psychomotor agitation.

Pulmonary embolism - a considerable clinical challenge in psychiatry. Case reports.

Purpose: Pulmonary embolism (PE) is the most serious clinical manifestation of venous thromboembolism (VTE) and a common cause of death in psychiatric patients. Patients diagnosed with mental illness have additional thromboembolic risk factors. These factors are not included in scores used to assess VTE risk. The goal of this elaboration is to take notice of the increased thrombo- embolic risk in psychiatric patients, with a particular focus on patients with catatonic symptoms. Case description: Two cases of young men with catatonic symptoms who suffered from cardiac arrest during psychiatric hospitali- zation are reported on. Autopsy showed pulmonary embolism as the main cause of death. Based on the Padua Prediction Score the two patients had no indications for thromboprophylaxis. Both men were mostly treated with olanzapine. Comment: PE should be always taken into account in differential diagnosis, even if patients do not present with its typical risk factors.

Effectiveness of the methadone programme in the treatment of patients on a mephedrone binge and dependent on heroin: a retrospective study, 2010-19.

Objectives: The purpose of this research was to investigate the effectiveness of the methadone programme in a group of patients taking mephedrone with heroin.Methods: The research involved 230 people who took part in the methadone programme between 2010 and 2019: 101 people on a mephedrone binge and taking heroin and 129 people addicted to heroin.Results: Number of re-hospitalisations was higher in a group of patients on a mephedrone binge taking heroin in comparison to heroin dependent patients (91.9 vs 79.8%, p < 0.01). The interaction of the hepatitis C virus (HCV) infection with the dose of methadone taken explains 67.6% of the variance in the frequency of hospitalisation of the patients on a mephedrone binge (p < 0.001), and in the case of the dose of methadone alone - only 12% (p < 0.001). Regression analysis indicated that statistically significant majority of the subjects (p < 0.001) who received the optimal dose of methadone, namely 100-110 ml, were hospitalised once.Conclusions: The interaction of the methadone dose with HCV infection plays a very important role in the frequency of hospitalisation of patients taking mephedrone with heroin on a regular basis.KEY POINTSThe number of hospitalisations was higher in a group of patients on a mephedrone binge taking heroin in comparison to heroin dependent patientsThe interaction of the sex of the subjects and HCV infection with the dose of methadone taken explains 80.3 and 67.6% of variance in the frequency of hospitalisations, respectivelyThe most optimal dose of methadone in the group of people taking mephedrone with heroin ranges between 100 and 110 ml.

The Psychiatric Characteristics of People on a Mephedrone ("bath salts") Binge.

Background: Despite solutions presented by the European Union and national regulations introduced by many countries, the problem of mephedrone (4-MMC) is growing. Objectives: The aim of this study was to investigate the effect of regular mephedrone intake with other psychoactive substances on the clinical picture of patients, including self-harms and suicide attempts. Methods: The study involved a group of 601 patients addicted to mephedrone who were admitted to a psychiatric hospital between 2010 and 2018 due to regular mephedrone intake. Results: There was a statistically significant relationship between sleep disorders and mephedrone combined with alcohol (p < .05) or cannabinols (p < .05). However, the highest number of statistically significant correlations was reported when mephedrone was combined with opioids. There was a growing year-on-year percentage of people who attempted suicide because of regular mephedrone intake (p < .001). The more psychoactive substances were combined with mephedrone, the greater the risk of attempted suicide (p < .01). 20% of the examined group were hospitalized several times. Among those hospitalized several times, significantly more people took more than one additional psychoactive substance (p < .01). Conclusions: The more psychoactive substances combined with mephedrone, the more clinical symptoms are associated with it.

Electrodermal activity and suicide risk assessment in patients with affective disorders. / Aktywnosc elektrodermalna a ocena ryzyka samobójstwa u osób z zaburzeniami afektywnymi.

There are questionnaires and scales, including self-assessment scales, used to evaluate suicide risk. Additionally, suicide risk factors (i.a., prior suicide attempts, willingness to commit suicide, somatic diseases, male gender) are also known. Their application, however, does not provide a sufficient guarantee for properly distinguishing persons with high and low suicide risk. In 1986, Gunnar Edman observed that there is an association between low electrodermal activity and suicidal tendencies, which was confirmed in other studies and meta-analyses. Electrodermal activity (EDA) is commonly considered to be a very good indicator of orienting reflex, which is a response to the information linked with a stimulus and, in a way, a physiological mechanism that helps an organism to survive. This phenomenon is related to habituation, the rate of which is a measure of EDA reactivity. Hyporeactivity consists in very rapid habituation of a stimulus, even after first exposure. According to Lars Håkan Thorell, hyporeactivity may be understood as a specific deficit of attention, which is associated with inability to arouse curiosity with ordinary, everyday events at the physiological level. This results in a greater tendency to attempt suicide shown by persons with mood disorders, and lower fear of hurting oneself. The goal of this paper is to present history of studies on electrodermal activity, relationship between EDA and suicide tendencies in persons with affective disorders and to discuss EDOR System that identifies persons at particularly high risk of committing suicide.

Optimisation of methadone treatment in a group of patients on a mephedrone binge and dependent on many psychoactive substances.

Objectives: In recent years, an increase in the frequency of hospitalisations of patients on a mephedrone binge has been observed. The literature lacks data on the optimisation of methadone treatment in this group of people.Methods: The study included 601 patients who took mephedrone on a regular basis between 2010 and 2018. Based on the pharmacological database created, it was verified which methadone interaction contributed to subsequent hospitalisations in the group of people studied and which of them had the best therapeutic effect.Results: During the study, 62.4% of patients received methadone (p < .001). The higher the number of drugs taken together with methadone, the higher the frequency of hospitalisations (p < .001). The highest frequency of re-hospitalisations was recorded in patients who combined mephedrone with at least two other psychoactive substances, as well as those who used methadone with chlorprothixene (p < .001). The most optimal therapeutic effect is characteristic for the intake of methadone with thiazolidine carboxylic acid, namely 95% of people using this type of treatment were hospitalised once (p < .001).Conclusions: Therapy with methadone and thiazolidine carboxylic acid seems to be the most optimal therapy for patients taking mephedrone.Key pointsThe number of hospitalisations of patients receiving mephedrone on a regular basis grows from year to year.The multiple use of poly-pharmacotherapy increased in a group of patients on a mephedrone binge.There is a statistically significant correlation between the number of hospitalisations of patients on a mephedrone binge and the total number of drugs taken together with methadone.Administration of methadone with thiazolidine carboxylic acid was the most effective therapy for patients regularly combining mephedrone with at least two other psychoactive substances.