Atypical antipsychotics offer clear advantages in the management of schizophrenia, compared with conventional neuroleptics, but weight gain is a significant adverse effect with some of these agents.

To review the literature on weight gain associated with atypical antipsychotic treatment in schizophrenia.

Relevant sources were identified from Medline searches to February 2003 using combinations of keywords including ‘schizophrenia’, ‘antipsychotics’, ‘weight gain’, ‘adverse events’, ‘obesity’, and ‘diabetes’.

Most atypical antipsychotics induce some weight gain, but the magnitude of the effect varies markedly. The greatest increases are seen with clozapine and olanzapine: risperidone has a slight effect, comparable with that of conventional neuroleptics, while ziprasidone and aripiprazole appear from current data to have little effect. In addition, atypical antipsychotics have been associated with metabolic disturbances, particularly glucose dysregulation and dyslipidemia. These effects tend to be more marked with olanzapine and clozapine than with other agents. Weight gain associated with atypical antipsychotics imposes substantial morbidity, in addition to that associated with schizophrenia itself. Furthermore, weight gain can significantly impair patients' quality of life, and leads to non-adherence with treatment. Effective weight management should include the selection of an appropriate atypical antipsychotic and for effective weight management, as well both diet and exercise, formal weight management programs tailored to the needs of schizophrenic patients may be useful, and some patients may benefit from weight-reducing drugs.

Weight gain associated with atypical antipsychotics is a common problem that requires effective management. The selection of an agent with a low risk of weight gain, such as risperidone or ziprasidone, is central to such management.

Sleep disorders are widespread among patients with schizophrenia and contribute to adverse clinical outcomes. Antipsychotic drugs exert varying effects on sleep, and the effects of atypical agents may differ from those of conventional neuroleptics.

To review the literature on the effects of atypical medication on subjective and objective sleep quality in patients with schizophrenia.

A non-systematic literature review of Medline was performed in August 2003 searching the period from January 1985 to August 2003 for studies of the effects of atypical antipsychotics on sleep.

We found published studies of clozapine, olanzapine, and risperidone, but none on quetiapine or ziprasidone. Studies with clozapine showed that it increased total sleep time, sleep efficiency, stage-2 non-rapid eye movement sleep and rapid eye movement (REM) sleep density, and decreased stage-4 sleep, slow wave sleep (SWS) and stage-1 sleep. Single-dose studies with olanzapine have shown that it increases SWS, sleep continuity, total sleeping time, subjective sleep quality, and delta sleep. Long-term studies with risperidone have shown improvements in total sleep, sleep efficiency, sleep continuity, SWS, and stage-2 sleep, and reductions in sleep latency, number of awakenings, and proportion of time awake. These benefits were paralleled by improvements in subjective sleep assessment and psychopathology, and psychosocial functioning.

The evidence presented in this review suggests that atypical antipsychotics exert favorable effects on sleep profile compared with conventional agents, including improvement of subjective sleep quality and modification of specific sleep stages known to be associated with better clinical outcome.

Apart from insomnia, poor quality of sleep, decreased sleep duration, tiredness after awakening and frequency of using sleeping drugs are important indicators of sleep problems.

The aim of this study was to assess the prevalence of indicators of sleep disturbance, such as quality of sleep, sleep duration, feeling of restfulness in the morning and drug utilization in a randomly selected Polish adult population.

A stratified scheme of sampling involving two steps was used. A representative Polish population sample of 47 924 non-institutionalized adults was interviewed. Assessments of sleep-related problems were based on six questions. Standardized prevalence ratios (SPRs and their 95% confidence intervals) were calculated.

Almost one-tenth of Polish inhabitants usually slept badly or very badly, a problem that was more common among women than men. Quality of sleep decreased together with ageing and this process was more rapid in women than in men over 40 years of age. Highly educated respondents had the highest quality of sleep. Up to one-fifth of the general Polish population usually woke up tired in the morning. Mean sleep duration was 7.7 h, with no gender differences. Usage of over-the-counter (OTC) medications was significantly lower than usage of those prescribed by the physician (5 vs. 16%). Women used OTC drugs twice as often as men.

It would appear to be necessary to introduce educational programmes for the community as well as for general practitioners in order to correct improper attitudes.

The aim of this study was the assessment of −308G/A tumor necrosis factor (TNF)-α gene polymorphism and intPLA2 gene polymorphism in patients with anorexia nervosa (AN) and healthy controls.

We studied 91 non-related patients with AN and 144 healthy women (blood donors and students). The mean age of women from study group was 18.22 years (SD ± 3.13 years) and from control group was 31.71 years (SD ± 8.22).

Gene polymorphisms were studied with the use of polymerase chain reaction-restriction fragment length polymorphism method. TNF-α gene polymorphism consists of G/A substitution in −308 promoter region. IntPLA2 gene polymorphism is related to intron 1, in which restrictive region is found and recognized by BanI enzyme.

We did not obtain statistically significant differences in the frequency of genotypes and alleles of −308G/A TNF-α polymorphism between the study and control groups (genotypes: P = 0.106, alleles: P = 0.076). We did analogous analysis in the restrictive and bulimic subgroups. We did not observe statistically relevant differences in the frequency of genotypes (P = 0.700) and alleles (P = 0.305). We did not obtain statistically relevant difference in the frequency of genotypes and alleles of intPLA2 gene between the study group and controls (genotypes: P = 0.300, alleles: P = 0.331). We did analogous analysis in both subgroups of AN. We did not observe statistically relevant differences in the frequency of genotypes (P = 0.344) and alleles (P = 0.230).

There was no statistically relevant trend for the association between TNF-α polymorphism and AN. We did not find association between studied polymorphism of intPLA2 gene and risk of AN.

There is growing evidence that pharmacological treatment with two of the best validated anticraving drugs, acamprosate and naltrexone, is efficacious in promoting abstinence in recently detoxified alcohol-dependent subjects.

The stability of effects after termination of treatment remains to be answered, especially when combining both the drugs.

After detoxification, 160 alcohol-dependent subjects participated in a randomized, double-blind, placebo-controlled trial. Patients received naltrexone or acamprosate or a combination of naltrexone and acamprosate or placebo for 12 weeks. Patients were assessed weekly by interview, self-report, questionnaires and laboratory screening. Additionally, follow-up evaluation based on telephone interview of participants, general practitioners and relatives was conducted 12 weeks after terminating the medication.

At week 12, the proportion of subjects relapsing to heavy drinking was significantly lower in the group with combined medication compared with both placebo and acamprosate (P < 0.05). No difference was detectable between acamprosate and naltrexone, both of which were superior to placebo (P < 0.05). Relapse rates were 28% (combined medication), 35% (naltrexone), 50% (acamprosate) and 75% (placebo). After follow-up (week 24), combined medication led to relapse rates significantly lower than placebo, but not lower than acamprosate. Again, both naltrexone and acamprosate were superior to placebo. Relapse rates were 80% (placebo), 54% (acamprosate), 53% (naltrexone) and 34% (combined medication).

The results of this study highlight the stability of effects of pharmacotherapy on relapse prevention in alcohol dependence.

Memory impairment is a common adverse effect of electroconvulsive therapy (ECT). Studies on animals and humans suggest that vasopressin improves the cognitive function, and positive effects of desmopressin on memory and learning have been reported. This research was performed for evaluation of the effects of desmopressin in the prevention of memory impairment following ECT.

This randomized, double-blind controlled clinical trial with placebo administration was performed on 50 patients with psychiatric disorders who were candidates for ECT. Subjects in the case group received 60 µm of intranasal desmopressin daily (in three doses of 20 µm). For the control group 0.9% saline solution was administered in the same way. Memory function was evaluated using Wechsler's Memory Scale three times a week (the first time before the start of ECT and the second and third times after the third and sixth sessions, respectively). Results were analyzed by t-test and Paired t-test.

The mean age of patients was 29 years (range 20–40). During the course of ECT, patients in the control group demonstrated a meaningful decrease in memory scores (from a base score of 80.15–75.45 in the second test and 72.60 in the third test). Despite this, a meaningful increase in memory scores was observed during the treatment with desmopressin in the case group (from a base score of 73.27–75.70 and 79.13 in the second and the third tests, respectively). There was a meaningful difference between the two groups (P < 0.0001).

This study confirms the protective effect of desmopressin against memory impairment. The results confirm that memory impairment is a common side-effect of ECT and suggest that desmopressin may prevent ECT-induced memory impairment by its effects on memory and the learning process.

The aim was to evaluate the prevalence of psychiatric morbidity in Polish population.

The national health interview survey was based on entire non-institutionalized Polish population by means of randomized, stratified (urban and rural census tracks) two-stage method (over 39 000 respondents). Prevalence of psychiatric morbidity was based on General Health Questionnaire-12.

Psychiatric morbidity was noted in almost 1/4 of women and 1/5 of men in Poland, with small differences between urban and rural population. Every 10th woman reported such complaints at the age up to 25 years and every second above 75 years of age. Divorced and widowed respondents, irrespective of gender, have psychiatric disorders more frequently than compared groups. Higher prevalence of psychiatric morbidity was noted in out of work and especially disabled persons. The higher the level of education, the lower the frequency of psychiatric morbidity was observed.

Presented survey enabled to evaluate prevalence of psychiatric morbidity in Polish representative sample. Findings should trigger more extended epidemiological studies. The requirement for epidemiological investigations increases in reform-awaiting health care system in Poland, for at least one reason that the improvement of the quality of services is closely associated with a detailed recognition of the problem.

The clinical and etiologic implications of comorbid psychiatric and substance-use disorders are relevant across countries and cultures. The DSM-IV now places greater emphasis on the clinical and research utility of the substance-induced disorders classification, and clarifies several important diagnostic issues specific to primary and substance-induced disorders. However, no research consensus exists over the core problem of identifying and differentiating the drug and alcohol intoxication and withdrawal symptoms that can mimic psychiatric symptoms in heavy drinkers and drug users.

To investigate how various diagnostic instruments have measured comorbid psychiatric and substance-use disorders and how each instrument operationalizes the DSM-IV classification.

We review the evolution of the concept of comorbidity beginning with its formalization as the ‘primary–secondary’ distinction in the Feighner Criteria. We address the ‘organic–non-organic’ distinction found in the RDC, DSM-III, and DSM-III-R; and finally, review the ‘primary’ and ‘substance-induced’ categories of DSM-IV, DSM-IV-TR and ICD-10. We describe how these distinctions have been operationalized in widely used diagnostic instruments.

Further understanding of these classifications and the relationship of co-occurring psychiatric and substance disorders can be accomplished with the range of available measures, particularly the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), which reliably utilizes and refines DSM-IV classification distinctions.

Oxidative stress is one of the suggested mechanisms in major depression.

To determine the oxidative and antioxidative status of plasma of patients with major depression and to investigate whether there is a relationship between the potency of oxidative stress and the severity of depression.

To determine the antioxidative status of plasma, total and individual antioxidant levels which are total antioxidant potential (TAOP), total protein, albumin, uric acid, vitamin C and total bilirubin were measured. To determine the oxidative status, total peroxide level of plasma was measured in patients with drug-free depressive patients and compared with those of controls. Per cent ratio of total peroxide to TAOP was evaluated as oxidative stress index (OSI).

Plasma TAOP and individual antioxidant levels were found to be lower in patients with depression than those of controls. On the contrary, the patients had high total plasma peroxide levels. OSI values of the patients were significantly higher than those of controls (P = 0.002), and a significant positive correlation between Hamilton Depression Rating Scale (HDRS) and OSI values was found (r = 0.54, P = 0.01).

The patients with major depression are exposed to oxidative stress, and OSI may be useful to reflect the severity of the disease.

Anecdotal reports suggest that drastic changes in physical appearance may signal psychotic decompensation in schizophrenic patients.

The current study sought to explore the association between changes in appearance and psychotic vulnerability in a more systematic fashion.

A sample of undergraduates (n = 171) completed the Changes in Appearance Scale (CAS), which assesses frequency and nature of changes in outlook, along with a Schizotypy Scale (STA), the Maudsley Obsessive Compulsive Inventory (MOCI), the Fear Questionnaire (FQ) and the Beck Depression Inventory (BDI).

A modest but significant correlation was found between the CAS and STA scores. For the other symptom measures (MOCI, FQ, and BDI), no association with self-reported changes in physical appearance emerged.

Changes in physical appearance are found to be significantly associated to mild (pre)psychotic symptoms.

Alcohol dependence is a psychiatric disorder associated with an increased risk of suicidal behaviour. This is also associated with an increased number of suicide risk factors.

The current study examined the sociodemographic and clinical characteristics of a number of alcohol-dependent patients who attempted suicide.

We studied a consecutive series of 377 alcohol-dependent patients in our in-patient clinics. Their alcohol-use histories were assessed through semistructured interviews. The Suicidal Behaviors Questionnaire, the Childhood Trauma Questionnaire, the Michigan Alcoholism Screening Test and the Hamilton Depression Rating Scale were administered to all patients. Serum total cholesterol levels, mean corpuscular volume, the liver enzymes gamma glutamyl transferase, aspartate aminotransferase and alanine aminotransferase were routinely measured. In the statistical analyses, Student's t-test and chi-squared tests were applied.

Of the 377 alcohol-dependent patients, 89 (23.6%) had histories of attempted suicide. Thirty-four (42.5%) of the 80 female alcohol-dependent patients and 55 (18.5%) of the 297 male alcohol-dependent patients had attempted suicide; this gender difference was statistically significant (χ2 = 27.7, P < 0.001). A greater proportion of the suicide attempters than of the non-attempters met the Diagnostic Statistical Manual IV criteria for another psychiatric disorder (60.6%, n = 54, vs. 40.6%, n = 117; χ2 = 14.8; df = 6; P < 0.05). The difference of total cholesterol levels between female (mean = 144.0, SD = 58.3; mean = 158.0, SD = 83.9; t = 4.5; P < 0.05) and male (mean = 133.7, SD = 50.5; mean = 163.6, SD = 69.7; t = 11.7; P < 0.01) attempters and non-attempters was statistically significant.

These results suggest that suicide attempts in alcohol-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels.