European Commission Seventh Framework Program.

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Objectives: The aim of the study was to examine the cytokine status in bipolar patients during immediate remission after acute episodes of mania or depression and in patients with sustained (≥6 months) remission, compared with healthy controls. Methods: The study was performed on 121 bipolar patients, of whom 35 were in immediate remission after mania, 41 were in immediate remission after depression, and 45 were in >6-month remission on lithium monotherapy or lithium combined with other drugs. The control group consisted of 78 healthy individuals without any history of psychiatric or immunological illnesses. Serum concentrations of IL-1β, IL-2, IL-6, IL-10, TNF-α and IFN-γ were determined using the Human Th1/Th2 Cytometric Bead Array method. Results: The concentration of IL-10 was higher in patients in remission after mania and the concentration of IFN-γ was higher in those in remission after depression than in healthy controls. On the other hand, cytokine concentrations in patients with sustained remission were not different from those of healthy subjects. Conclusions: The results obtained in this study show that sustained remission in bipolar patients achieved mostly by lithium maintenance brings the cytokine status to a level similar to healthy control subjects.

Zespół policystycznych jajników (PCOS) jest najczęściej rozpoznawaną endokrynopatią w okresie rozrodczym i dotyczy 5-8% kobiet w tym wieku. Charakteryzuje się hiperandrogenizmem, zaburzeniami miesiączkowania o typie rzadkich miesiączek lub ich braku oraz obrazem jajników policystycznych w ultrasonografii. Etiologia zespołu policystycznych jajników nadal nie jest do końca wyjaśniona. Istnieje wiele teorii patogenetycznych, które prawdopodobnie nawzajem się uzupełniają. Najbardziej poznana hipoteza zakłada, że do rozwoju PCOS dochodzi na skutek insulinooporności i hiperinsulinemii, które doprowadzają do hiperandrogenizmu. Na podstawie ciągle jeszcze niewielu badań można stwierdzić częstsze występowanie różnych zaburzeń psychicznych u kobiet z PCOS, należą do nich: zaburzenia depresyjne, uogólnione zaburzenia lękowe, zaburzenia osobowości, fobia społeczna, zaburzenia obsesyjno – kompulsyjne, zespół nadpobudliwości psychoruchowej z deficytem uwagi (ADHD) oraz zaburzenia odżywiania. Stwierdzono również częstsze występowanie choroby afektywnej dwubiegunowej, schizofrenii i innych zaburzeń psychotycznych u kobiet z PCOS. Większa częstość występowania zaburzeń psychicznych u pacjentek z PCOS, zwłaszcza depresji i zaburzeń lękowych, może wynikać zarówno z samego hiperandrogenizmu, jak i z objawów somatycznych będących jego konsekwencją. Objawy te niewątpliwie mogą być dla kobiet stygmatyzujące i obniżać ich jakość życia. Niniejsze opracowanie ma na celu przedstawienie przeglądu piśmiennictwa na temat zaburzeń psychicznych u kobiet z PCOS oraz badań własnych na temat depresji i zaburzeń seksualnych u kobiet z PCOS.

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Clinical staging is a tool useful in medical sciences. It assumes the presence of three key elements. Firstly, pathologic indices are progressing in subsequent stages. Secondly, the patients in the individual stages present similar pathological changes. Thirdly, treatment should be most effective in the earlier stages. Such model is particularly well established in the treatment of malignancies. Staging is useful here to define prognosis, to evaluate the results of treatment, facilitate the exchange and comparison of information among treatment centres. There is much data describing a similar model for mental illnesses including schizophrenia. There are two theories supporting the staging model for schizophrenia: the neurodevelopmental hypothesis and allostatic load concept. Both theories make a theoretical premise for creating the staging model for schizophrenia. We can describe at least three stages in the development of a schizophrenic illness: the prodrome, the first episode and chronic phase. Each stage is reflected by anatomical and functional changes in the brain. Therefore, a clinical staging model can describe a development of schizophrenia over time, to help selecting adequate treatments that are particularly relevant to a given stage and to show the relations between known biological markers and psychosocial risk factors and the stage of the illness.

In this article, a concept of staging of unipolar affective illness (recurrent depression) is presented. In respective subchapters, three most important aspects of this issue have been discussed: 1) staging of unipolar affective illness; 2) staging of treatment-resistant depression; and 3) conversion of unipolar into bipolar affective illness. The evidence for so called neuroprogression of the illness, accumulated in recent years, has allowed for a classification of staging based on a concept of allostasis and allostatic load. In the course of illness, changes in neuroendocrine system (mainly hypothalamic pituitary-adrenal (HPA) axis), immunological system, mechanisms of oxidative stress, neurotransmitters, neurotrophic factors as well as structural and functional changes of the brain occur. In their paper of 2007, Fava and Tossani elaborated a concept of staging of unipolar affective illness presenting a continuum model of five consecutive stages with specific clinical features. In the present paper, a concept of treatment-resistant depression and staging of treatment resistance is presented in the context of several models. An important determinant of treatment-resistant depression is so called subthreshold bipolarity which is connected with worse efficacy of antidepressant drugs. In the course of illness, there is a possibility of changing diagnosis from recurrent depression into bipolar affective illness. The studies on this issue show that frequency of such diagnostic conversion is 1,5% of depressed patients per year.

Aims: The aim of this study was to evaluate serum levels of the antineuronal antibodies anti-N-methyl-D-aspartate receptor (NMDAR) and anti-glutamic acid decarboxylase (GAD), and insulin-like growth factor 1 (IGF-1), in patients with bipolar disorder (BD), during manic and depressive episodes and in remission compared to euthymic patients receiving long-term lithium therapy. Methods: Serum levels of anti-NMDAR and anti-GAD 450/620 antibodies, as well as IGF-1, were measured using the ELISA method in 19 manic and 17 depressed patients both in an acute episode and in remission after the episode. All of the subjects were under pharmacological treatment. The control group included 18 euthymic BD patients receiving lithium for 9–44 years (mean 22 ± 11) in whom a single measurement was performed. Results: Serum levels of anti-NMDAR antibodies were higher in acute manic episodes than in lithium-treated patients. Serum levels of anti-GAD 450/620 antibodies were higher in acute manic and depressive episodes compared to remission after the respective episode. Their values in both acute manic and depressive episodes were higher than those in lithium-treated patients. Serum levels of IGF-1 were higher in acute manic episodes and in remission after mania than in lithium-treated patients. Conclusion: Higher levels of anti-NMDAR and anti-GAD antibodies during episodes may point to an abnormality in the glutamatergic system in BD. Increased levels of IGF-1 during an acute manic episode and in remission after mania may constitute a compensatory mechanism against excitotoxicity. Lower levels of anti-NMDAR, anti-GAD antibodies, and IGF-1 during long-term lithium treatment may reflect normalization of this processes, contributing to mood stabilization.