Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.

Funkcjonowanie tarczycy ma doniosłe znaczenie dla kształtowania się, dojrzewania i aktywności ośrodkowego układu nerwowego. Związek klinicznych zaburzeń czynności tarczycy z zaburzeniami psychicznymi, w tym z upośledzeniem funkcji poznawczych, wydaje się być dobrze udokumentowany. Nieprawidłowe stężenia hormonów tarczowych mogą prowadzić do pogorszenia procesów kognitywnych poprzez zmiany w neurotransmisji, nasilanie stresu oksydacyjnego, czy też wpływ na przemiany β-amyloidu i metabolizm glukozy w ośrodkowym układzie nerwowym. Wątpliwości dotyczą przede wszystkim subklinicznych form dysfunkcji tarczycy. Według niektórych danych, mają one wykazywać związek ze stanem funkcji poznawczych oraz być jednym z czynników przyśpieszających mechanizmy prowadzące do zwyrodnienia tkanki mózgowej i w konsekwencji do otępienia. Wyniki badań nad korelacją aktywności tarczycy z funkcjami poznawczymi oraz nad ewentualnym korzystnym wpływem suplementacji hormonalnej na procesy kognitywne przynoszą jednak sprzeczne wyniki, co przynajmniej częściowo może wynikać z dużych problemów metodologicznych. Nie należy także wykluczać korelacji odwrotnej, gdzie toczący się proces neurozwyrodnieniowy wpływałby na czynność tarczycy, np. poprzez zmienioną produkcję i wydzielanie tyreoliberyny. Pomimo kilkudziesięciu lat intensywnych badań, wyjaśnienie tego związku jest nadal dalekie od rozstrzygających ustaleń.

Background: Few data exist concerning the clinical correlates of Toxoplasma gondii infection in persons with schizophrenia. The aim of this study was to investigate the correlation between toxoplasmosis and schizophrenia regarding the quality of life, symptoms and course of hospitalisation in patients with schizophrenia. Methods: Acutely hospitalised patients (n = 67) were examined twice during their hospital stay. Schizophrenia psychopathology, quality of life, extrapyramidal symptoms and T. gondii antibody titres were assessed upon admission and at discharge. Results: Toxo-IgG (+) patients (59.7%) were older, less educated, more obese and less eager to undertake psychotherapy. Female gender and higher fertility were dominant in this group with abnormal involuntary movements more commonly observed. Lower antipsychotic drug doses and monotherapy were used more frequently for Toxo-IgG (+) patients. Lower education (OR 2.41, 95% CI 1.21-4.79) was the most important factor associated with higher likelihood of IgG seropositivity. High levels of Toxo-IgM antibodies correlated with lower quality of life (r = -0.37; p = 0.02) and more severe positive (r = 0.40; p = 0.01) and focal (r = 0.32; p = 0.04) schizophrenia symptoms. Conclusions: Toxoplasmosis is more common in older, obese women with lower education. Recent infection is linked to more severe schizophrenia symptoms. Patients with toxoplasmosis history were given less medication.

The diagnosis of mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. When evaluating the further prognosis of MCI, the occurrence of neuropsychiatric symptoms, particularly aggressive and impulsive behavior, may play an important role. Objective: The aim of this study was to evaluate the relationship between aggressive behavior and cognitive dysfunction in patients diagnosed with MCI. Methods: The results are based on a 7-year prospective study. At the time of inclusion in the study, participants, recruited from an outpatient clinic, were assessed with Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). A reassessment was performed after 1 year using the MMSE scale in all patients. The time of next MMSE administration was depended on the clinical condition of patients took place at the end of follow-up, that is, at the time of diagnosis of the dementia or after 7 years from inclusion when the criteria for dementia were not met. Results: Of the 193 patients enrolled in the study, 75 were included in the final analysis. Patients who converted to dementia during the observation period exhibited a greater severity of symptoms in each of the assessed CMAI categories. Moreover, there was a significant correlation between the global result of CMAI and the results of the physical nonaggressive and verbal aggressive subscales with cognitive decline during the first year of observation. Conclusions: Despite several limitations to the study, aggressive and impulsive behaviors seem to be an unfavorable prognostic factor in the course of MCI.

Purpose Depressive disorder is common among hemodialysis (HD) patients and is associated with higher mortality rate. However, depression screening and treatment in dialysis population remains insufficient. The aim of the study was to show the prevalence of depression in patients on maintenance HD and to discuss the proper diagnostic approach, including dementia screening. Patients and methods We conducted a cross-sectional study that included 103 HD patients from one Dialysis Centre in Gdańsk (Poland). Cognitive functions were evaluated using Mini–Mental State Examination (MMSE). The screening for depression was assessed using Beck Depression Inventory (BDI-II). The diagnosis of depressive disorder was confirmed and its severity evaluated by psychiatrists based upon clinical assessment and scales. Sociodemographic, laboratory and dialysis data were also collected. Results According to BDI-II depressive symptoms were present in 43% of patients while the diagnosis of clinical Major Depressive Disorder (MDD) was confirmed by the psychiatrists in 13% of all subjects. In the depressive disorder group there was a prevalence of female and patients suffering from diabetes mellitus, levels of calcium phosphate index (CaxPi) were higher and Kt/V was lower. The optimal cut-off score for diagnosing major depressive disorder using BDI-II was ≥ 20 points. Cognitive impairment on the level of major neurocognitive disorder (dementia) was found in 18 % of the study group. Conclusions The prevalence of depression assessed using self- or clinician-administered questionnaires was higher than reported by clinical interview performed by the psychiatrist. Higher scores of CaxPi and lower Kt/V in depressive patients may suggest worse compliance in this group. The psychiatrist’s examination as a part of care at the Dialysis Centre could improve diagnosis of depression and its treatment with the goal to improve quality of life and lower the mortality rate in this population.