A group of 14 experts representing the Polish Association for the Study of Pain, the Polish Society of Palliative Medicine, the Polish Palliative Care Society, the Polish Society of Anaesthesiology and Intensive Therapy, the Polish Society of Regional Anaesthesia and Pain Therapy, the Polish Psychiatric Association, and the Polish Society of Phytotherapy developed a position statement on the place and role of cannabinoids in the standards of chronic pain management in Poland, based on a comprehensive and up-to-date review of the literature. During a series of meetings, the experts critically appraised the available evidence on the use of medical cannabis in patients with chronic pain, with particular emphasis on systematic reviews and more recent randomized controlled trials that had not been included in earlier reviews. Major medical databases, including PubMed, MEDLINE, and Cochrane, were searched using the following keywords: “cannabinoids”, “tetrahydrocannabinol (THC)”, “cannabidiol (CBD)”, “endocannabinoid system (ECS)”, “chronic pain”, “cancer-related pain”, “neuropathic pain”, “multiple sclerosis (MS)”, “fibromyalgia”, “pain pharmacotherapy”, and “perioperative management”. The analysis included publications describing the mechanisms of action of the endocannabinoid system and the effects of cannabinoids on CB1 and CB2 receptors, as well as other receptors functionally associated with this system and clinically relevant. The concept of the endocannabinoidome (eCBome) was introduced, encompassing not only endocannabinoids but also related proteins, enzymes, and lipids that interact with the cannabinoid system. These components are relevant to health and well-being beyond the classical CB receptor-mediated effects. The experts’ work focused on evaluating the efficacy of cannabinoids, particularly CBD and THC, their therapeutic potential depending on chemotype (i.e., concentration, composition, and ratio – THC-dominant, balanced THC/CBD, or CBD-dominant), as well as possible routes of administration of cannabis-based medicinal products (CBMPs). Proposed principles for the use of cannabinoids in the management of various types of chronic pain were also developed, including cancer pain, neuropathic pain, pain associated with multiple sclerosis, fibromyalgia, and perioperative management in patients receiving CBM/CBMPs. The most common adverse effects of cannabinoids and the risk factors for their occurrence were discussed. Attention was also given to potential drug–drug interactions resulting from the influence of individual cannabinoids on enzymatic systems, and specific medications requiring careful clinical monitoring when co-administered with cannabinoids were identified. Relevant practical and legal considerations were also presented. This position statement is intended for practicing physicians of various specialties involved in the diagnosis and management of patients with difficult-to-control chronic pain. The experts hope that these recommendations will support everyday clinical practice and improve the quality of care and the effectiveness of pain management. At the same time, the need for further research was emphasized, as current scientific evidence does not keep pace with political changes, public opinion, and the growing commercial and professional interest in the use of medical cannabis as an adjunctive therapy, including its potential opioid-sparing effect. The current state of knowledge does not support the efficacy of medical cannabis as a standalone analgesic. However, it may represent a component of an individually tailored, multimodal approach to chronic pain management, particularly in patients receiving palliative care, with the potential to improve quality of life. Future research should focus on standardizing dosing regimens, comparing different routes of administration, and evaluating the effectiveness of medical cannabis when used in combination with established pharmacological and non-pharmacological therapies.

Background: Trazodone is commonly used in the treatment of major depressive disorder (MDD) in adults. This study aimed to establish consensus on the clinical scenarios and patient profiles for which trazodone treatment is considered suitable. Methods: A two-round Delphi process was conducted across eight European countries. Statements regarding trazodone were rated by a panel of 32 experts for agreement or disagreement using a 9-point Likert scale; those with <70% agreement among panelists were revised and reassessed by the panel. Results: There was strong consensus agreement on 68 out of 91 statements (75%) related to trazodone. According to the panel, trazodone is well tolerated, with low anticholinergic activity, minimal impact on sexual function, weight neutrality, and low potential for clinically relevant drug-drug interactions. Consensus agreement supported trazodone use across a broad spectrum of patients with MDD, including those with insomnia, anxiety, psychomotor agitation, substance use, physical comorbidities, neurological conditions, and treatment-resistant depression; consensus agreement was also achieved for trazodone use in elderly patients, and those experiencing adverse effects with other antidepressants. Conclusions: This study suggests that trazodone is useful in the treatment of MDD across multiple patient profiles. These findings offer practical guidance to support individualized and evidence-based decision-making in clinical practice.

IntroductionMajor depressive disorder (MDD) constitutes a significant global mental health concern. Although selective serotonin reuptake inhibitors (SSRIs) are first-line treatment, their effectiveness may be limited by adverse effects including anhedonia, emotional blunting, sleep disturbances, and sexual dysfunction. Trazodone, a serotonin antagonist and reuptake inhibitor, offers a more favorable tolerability profile, particularly in its extended-release (XR) formulation. Previous studies within the trazodone effectiveness in depression (TED) project demonstrated more pronounced improvements with trazodone XR compared to SSRIs in reducing depressive, anxiety, and insomnia symptoms. The present analysis extends these findings by comparing trazodone XR with SSRIs and quantifying the extent and clinical importance of treatment outcomes through effect size estimates.MethodsThis single-center, non-randomized, open-label, 12-week naturalistic study—conducted as part of the TED project—included adults aged 18–65 diagnosed with MDD. Symptom severity and outcomes were assessed at baseline and weeks 2, 4, 8, and 12 using validated clinician- and self-rated scales. Cohen’s d quantified the magnitude and clinical relevance of differences between trazodone XR and SSRIs.ResultsEffect-size analyses demonstrated consistently greater and earlier improvements with trazodone XR versus SSRIs across all measures. In both self-rated (QIDS-SR) and clinician-rated (QIDS-CR; MADRS) scales assessing depressive symptoms, trazodone XR showed larger effect sizes from week 4, with further increases through week 12. Similar patterns were observed for anhedonia (SHAPS), anxiety (HAM-A) and insomnia (AIS), where trazodone XR produced greater and progressively increasing effect sizes, while SSRIs reached a plateau. These findings indicate a more robust and sustained therapeutic impact of trazodone XR, reflected by consistently higher effect-size magnitudes across domains.DiscussionTrazodone XR demonstrated greater and progressively increasing effect sizes compared with SSRIs, indicating a more sustained antidepressant response over 12 weeks. This trajectory, marked by continued symptom reduction without a linear response pattern, suggests a cumulative therapeutic effect potentially attributable to trazodone’s multimodal serotonergic mechanism and favorable pharmacokinetics. By concurrently addressing mood, anxiety, and sleep-related domains, trazodone XR appears to facilitate both symptomatic improvement and broader functional stabilization. These findings highlight the need for randomized, controlled investigations to further elucidate its comparative efficacy and real-world relevance.

"Brain health" encompasses key functions such as cognition, emotion, and behaviour, and is increasingly relevant given its role across neurological and psychiatric conditions. One of these, depression is the most common psychiatric comorbidity in people with epilepsy (PWE). When unrecognized and untreated, depression is associated with increased seizure severity and poorer treatment response, significantly impacting patients' prognosis and quality of life; conversely, the rate of epilepsy is 2-fold higher in individuals with incident depression compared to those without depression. Several studies have confirmed a strong bidirectional relationship between epilepsy and depression; an advisory panel of psychiatrists and neurologists with expertise in epilepsy and mood disorders convened for a virtual meeting held in 2024 to assess the impact of the interplay between these two conditions. A comprehensive, interdisciplinary approach to discussion was adopted to address challenges in diagnosing and managing depression in PWE, focusing on early intervention, patient education, and tailored treatments strategies; additionally, the meeting emphasized the importance of integrated care between neurologists and psychiatrists to address this unmet medical need. The authors identified depression in PWE as being underdiagnosed due to overlapping symptoms, stigma, and limited psychiatric care integration. Management is challenging as some antiseizure medication worsen depression and certain antidepressants may lower the seizure threshold, requiring careful selection and monitoring to balance efficacy and safety. Potential interactions between these medicines underscore the importance of carefully selecting therapeutic combinations to minimize adverse effects. Effective management involves an interdisciplinary approach, integrating neurologists and psychiatrists. Key strategies include early screening, psychoeducation, a personalized approach to pharmacological and nonpharmacological treatment, and increased awareness among healthcare providers, patients, and caregivers regarding the overlap of neurological and psychiatric disorders. Furthermore, educational resources, as well as digital tools, can help inform and educate patients and caregivers on holistic brain health management.

IntroductionMajor depressive disorder (MDD) constitutes a substantial global health burden, profoundly undermining psychosocial functioning and quality of life, and the persistent limitations of treatment efficacy—despite advances in neurobiology and pharmacotherapy—underscore its considerable clinical complexity. Recent research increasingly delineates the heterogeneity of depressive symptomatology, particularly emotional blunting, and emerging evidence further implicates metabolic and inflammatory pathways processes in shaping treatment response. Insulin resistance (IR), immune dysregulation, individual circadian preference, and trait-level vulnerabilities associated with neurodevelopmental or trauma-related characteristics may contribute to reduced responsiveness to standard therapies and limited adherence to antidepressant treatment. Taken together, these converging findings emphasize the need for individualized interventions rather than continued reliance on broad diagnostic categories.ObjectivesThe study consists of two phases with distinct hypotheses: phase I) evaluating emotional blunting along other clinical/psychopathological variables as potential predictors of treatment non-response to SSRI/SNRI in MDD, and phase II) assessing relationships between IR and treatment non-response to vortioxetine in MDD. Further exploratory objectives encompass assessment of: links between psychopathological and metabolic predictors of health status; longitudinal association between emotional blunting and both sexual and cognitive functioning.Materials and MethodsThe METOD study is an open, non-randomized two-phase observational study conducted in accordance with clinical standards and with all required ethical approvals. The protocol was prepared in line with STROBE recommendations. In Phase I, MDD patients meeting eligibility criteria and initiating antidepressant treatment with one of the first-line SSRIs or SNRIs are observed, whereas in Phase II, individuals showing an inadequate response are switched to vortioxetine as a second-line option. Validated clinical assessment tools are administered alongside anthropometric and laboratory evaluations.Expected Implications/SignificanceBy examining these interrelations within a naturalistic cohort treated in accordance with current clinical standards, this innovative study—with its strong emphasis on patient-reported outcomes—may increase insight into the lived experience of depression, enhance understanding of the pathophysiological mechanisms shaping its diverse symptomatology, and provide a foundation for more precisely targeted therapeutic approaches.

Introduction:Clozapine (CLO) remains the gold standard for the treatment of drug-resistant schizophrenia. It is commonly accepted that there is a linear relationship between CLO dose and blood concentration, although deviations from this pattern are frequently observed in clinical practice. The aim of the present naturalistic study was to further investigate this relationship using a real-world database of CLO therapeutic drug monitoring (TDM) samples, with a particular focus on: i) identifying cases of "unexpected" CLO levels during repeated within-subject blood sampling in the process of CLO dose adjustment and ii) assessing linearity of the cross-sectional, between-subject CLO dose-concentration relationship and identifying potential breakpoints. Methods:The study was based on a single-center TDM database derived from routine monitoring of CLO concentration in psychiatric inpatients, supplemented with data from medical records. The database was reviewed independently by a laboratory medicine specialist and psychiatrist to identify individual cases of "unanticipated" dose-concentration relationships. The study also employed the Multivariate Adaptive Regression Splines (MARS) to detect non-linear relationships in the prediction of CLO levels, as determined by high-performance liquid chromatography. Analyses incorporated variables such as daily CLO dose, smoking status, age, sex, and co-medications. Results:Individual cases of "unanticipated" CLO concentrations supporting the partially non-linear within-subject dose-concentration relationship were unambiguously identified by both specialists. The MARS model revealed a breakdown in the between-subject CLO dose-concentration linear relationship identifying a hinge point around 400 mg/day, below which CLO concentrations were less dose-dependent. CLO dose and smoking were the most important predictive factors, but the model explained only about 25% of CLO concentration variability. Conclusion:Our data suggest that the non-linear relationship between CLO concentration and its daily dose can be a real-life clinical problem with CLO doses of ∼400 mg/day as the provisional hinge point. Although preliminary, the present results warrant further investigations on non-linear aspects of CLO pharmacology, including "unexpected" CLO concentrations, toxicity, and lack of therapeutic activity.

Depression and anxiety are common comorbidities in patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Despite their clinical relevance and impact on disease outcomes, these mental health conditions remain frequently underrecognized in routine rheumatology practice. To evaluate the prevalence of depression and anxiety symptoms in patients with IA in a real-world clinical setting and to compare the utility of different patient-reported questionnaires for their identification. Cross-sectional, real-world observational study. Patients with RA, axSpA, and PsA were evaluated. Depression and anxiety symptoms were assessed using the PHQ-9 and GAD-7, along with specific items of the Multidimensional Health Assessment Questionnaire (MDHAQ). A total of 255 patients were included (RA n = 105, PsA n = 60, axSpA n = 90), with mean ages 59, 47, and 42 years, respectively. Across all groups, the prevalence of depression symptoms identified using PHQ-9 were more frequently observed than reflected in prior routine clinical records .In RA, depressive symptoms prevalence increased from 8.6

Post-stroke depression (PSD) and post-stroke anxiety (PSA) are common emotional complications after acute ischemic stroke (AIS). We examined the incidence and risk factors for PSD alone, PSA alone, and their co-occurrence three months post-stroke. We included 579 AIS patients who completed the Hospital Anxiety and Depression Scale (HADS) at discharge and 3 months later, using anxiety (HADS-A) and depression (HADS-D) subscales. Forty-one routinely collected parameters were analysed, including cognitive function (Montreal Cognitive Assessment) and oral health (Oral Health Impact Profile-14). Participants were grouped as: A – no PSA/PSD (n = 271), B – PSA only (n = 85), C – PSD only (n = 78), D – both PSA and PSD (n = 145). Compared with Group A, PSA was associated with female sex and anxiety at discharge; PSD with older age, ischemic heart disease, cognitive impairment, depression, and poorer functional outcomes; co-morbid PSA and PSD with female sex, infections, cognitive impairment, anxiety, depression, and worse discharge outcomes. Multivariate analysis showed PSA risk increased with anxiety at discharge (OR = 2.58; 98.3

Premenstrual disorders (PMD) are a prevalent health issue and often co-occur with mood disorders. The pathophysiology of PMD has not yet been thoroughly described. Two mechanisms appear to be crucial in PMD: (1) lower estrogen levels during the luteal phase, leading to a subsequent decrease in serotonin (5-HT) transmission, and (2) reduced sensitivity to allopregnanolone, resulting in an imbalance in γ-aminobutyric acid (GABA)/glutamate signaling and an increase in hypothalamic-pituitary-adrenal (HPA) activation. The roles of zinc (Zn), copper (Cu), and magnesium (Mg) in mood disorders are well-established, and they appear to be associated with PMD through similar pathways. Therefore, this narrative review provides background information on the roles of Zn, Cu, and Mg in mood regulation and discusses the impact of these trace elements on this process. The results presented, summarizing data from studies: (1) exploring the associations between Zn, Cu, and Mg levels and PMD, and (2) verifying the effects of Zn, Cu, and Mg supplementation on PMD symptoms. Finally, the caveats of current PMD research and the implications of the available data for everyday clinical practice are discussed.Clinical trial number: Not applicable.

BackgroundPatients with bipolar disorder (BD) present motor dysfunctions in the form of neurological and cerebellar soft signs (NSS and CSS, respectively). Little is known about the clinical utility of these symptoms and their impact on patients’ psychosocial functioning. The aim of our study is to assess the relationships between severity of NSS and CSS, as well as various dimensions of the daily functioning of patients with BD.MethodsA total of 100 participants were enrolled to this study: 60 patients with euthymic BD and 40 healthy controls (HC). Psychosocial functioning was evaluated with the use of Functioning Assessment Short Test (FAST) total score and its subscales. NSS were assessed with the use of the Neurological Evaluation Scale (NES). CSS were measured with the International Co-operative Ataxia Rating Scale (ICARS).ResultsGeneral psychosocial functioning was decreased by CSS and NSS severity represented by total NES and ICARS scores, as well as by higher measures of kinetic functions, sensory integration, motor coordination, and speech disorders subscales. Patients’ autonomy rates were decreased by total ICARS, kinetic functions, and speech disorders scores. Occupational functioning was limited by the majority of CSS and NSS measures. Cognitive functioning was associated with motor coordination impairments. Leisure time activities were influenced by total CSS severity and kinetic dysfunctions. We have shown that the severity of both CSS and NSS is a full mediator of the associations between duration of treatment and general psychosocial functioning.ConclusionsOur results suggest that even “soft” neurological abnormalities may have an impact on the psychosocial functioning of patients with BD.

Cel pracySchizotypia to złożony termin opisujący cechy osobowości odzwierciedlające się w stylach emocjonalnych, percepcyjnych i poznawczych. Temperamenty afektywne to cechy, które są stabilne w czasie i predysponują do zaburzeń nastroju. Celem pracy było zbadanie związku pomiędzy cechami schizotypowymi, temperamentami afektywnymi i anhedonią u pacjentów z depresją w przebiegu zaburzenia afektywnego dwubiegunowego.MetodaDo badania włączono 54 pacjentów w epizodzie depresyjnym w przebiegu zaburzenia afektywnego dwubiegunowego. W badaniu wykorzystano następujące narzędzia psychometryczne: Dimensional Anhedonia Rating Scale (DARS), Snaith-Hamilton Pleasure Scale (SHAPS), Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) i Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR). Obliczono korelacje pomiędzy zmiennymi i zbudowano modele regresji liniowej.WynikiJedynie hipertymia (temperament afektywny) i introwertyczna anhedonia (domena schizotypowa) były statystycznie istotnie skorelowane z anhedonią. W modelach regresji introwertyczna anhedonia wiązała się z większym, a cechy hipertymiczne z mniejszym nasileniem anhedonii (mierzonym za pomocą skali SHAPS).WnioskiCechy hipertymiczne są czynnikiem protekcyjnym, a introwertyczna anhedonia czynnikiem ryzyka dla nasilenia anhedonii konsumpcyjnej.

BACKGROUND:Negative symptoms (NS) represent an important unmet need in schizophrenia (SZ) assessment and management. Despite NS are strongly associated with poorer functioning and quality of life, they are frequently underrecognized, inconsistently evaluated, and show limited response to current treatments. Although specific assessment tools and European Psychiatric Association (EPA) guidance on NS have been developed, their impact on routine clinical practice appears limited. This study aimed to investigate the competence and confidence of European Early Career Psychiatrists (ECPs) in NS evaluation and management. METHODS:The CARE project was a cross-sectional online survey directed towards ECPs from European countries. RESULTS:828 ECPs' responses were collected from 19 countries. The majority of ECPs were trainees (65.8%), reported theoretical training in negative symptoms (NS) and placements in schizophrenia-specialized settings (67.9% and 70.3%), while about half reported extracurricular NS training (51.1%) and involvement in clinical research (46.1%). Only 11% correctly identified NS domains, despite 65.7% felt well-trained in NS assessment tools. Just 15.9% correctly answered questions based on the EPA guidance papers. 46.7% and 25.9% ECPs reported feeling competent in NS evaluation and management, respectively. Gender (men) specialist status, research involvement, theoretical NS training, and placements in specialized SZ services predicted perceived competence. However, in-depth NS knowledge was predicted only by specialist status, engagement in clinical research, and extracurricular NS training. CONCLUSIONS:Despite reported exposure to NS training, ECPs demonstrated limited knowledge of NS. Actions need to be taken to ensure that ECPs receive the highest standard of training in NS.

Cel pracy Wstęp: Fibromialgia (FM) często współwystępuje z zaburzeniami psychicznymi. Ponadto, kilka badan wskazuje, że zaburzenia psychiczne mogą być związane z nasileniem i wpływem FM. Celem naszej pracy było po pierwsze: ocenić różne wymiary objawów psychopatologicznych wśród pacjentów z FM i po drugie: zbadać zależności pomiędzy psychopatologią a odpowiedzią na leczenie inhibitorami wychwytu zwrotnego serotoniny i noradrenaliny (serotonin and noradrenaline reuptake inhibitors - SNRI). Metoda Metoda: Niniejsze badanie przekrojowe przeprowadzono pomiędzy grudniem 2020 i listopadem 2022. Oporność na SNRI zdefiniowano jako <30% redukcję bólu po ≥8 tygodniach leczenia. Włączono 30 pacjentów z FM odpowiadających na SNRI (FM T[+]), 32 pacjentów nieodpowiadających na SNRI (FM T[-]) i 30 zdrowych ochotników. Uczestnicy byli badani przez lekarzy i wypełniali narzędzia samooceny mierzące poziom depresji (Krótki Inwentarz Symptomatologii Depresji, Szpitalna Skala Lęku i Depresji), lęku (inwentarz Stanu i Cechy Lęku), anhedonii (Skala Przyjemności Snatih’a-Hamiltona), dwubiegunowości (Kwestionariusz Zaburzeń Nastroju, Skala Hipomanii) i dysocjacji (Skala Doświadczeń Dysocjacyjnych - wersja poprawiona). Aby ocenić związki zmiennych psychopatologicznych i odpowiedzi na SNRI przeprowadzono analizy ANOVA i serię prostych regresji logistycznych. Wyniki Wyniki: FM T[-] vs. FM T[+] ujawniali wyższy poziom depresji, cechy i stanu lęku, anhedonii i wyższe proporcje wyników wskazujących na obecność zaburzeń lękowych. Większe nasilenie depresji, lęku i anhedonii były predyktorami oporności na SNRI. Wnioski Wnioski: Modyfikowalne objawy psychopatologiczne różnią pacjentów FM T[+] vs. FM[-] i są predyktorami oporności na SNRI. Ocena psychologiczna powinna być częścią standardowej opieki nad osobami z FM.

This paper presents the outcome of a clinical trial planning process developed during multicenter, multidisciplinary seminars with prospective collaborators. The study protocol, designed according to the Oxford Quality Assessment System, outlines a randomized controlled trial (RCT) evaluating a novel Virtual Reality-based Mindfulness Skills Training (VR-MST) versus standard, non-VR MST in patients with schizophrenia (SZ). The trial aims to assess the effects of VR-MST on clinical outcomes, stress-related biomarkers, and gene expression. Eligibility criteria include: (1) SZ diagnosis based on ICD-10 and DSM-5 (2), psychotic symptom severity below 75 on the PANSS (moderately ill), and (3) age between 25 and 50 years. The protocol defines procedures for participant withdrawal and managing adverse events. The design tests both specific and general hypotheses, with pre- and post-intervention assessments in both groups, and additional pre-/post-session measurements in the VR group. Assessments span biological, symptomatic, and cognitive domains, using both objective and subjective measures. This study may inform clinical practice by introducing a novel, engaging, evidence-based, nonpharmacological intervention. VR-MST could support stress reduction, enhance cognitive functioning, and improve daily life in SZ patients. The design is grounded in prior pilot studies, literature reviews, and clinical expertise, aiming to provide a scalable and impactful therapeutic tool.

Cel pracyCelem naszego eksploracyjnego badania jest ocena, czy zaburzenia nieświadomego uczenia się motorycznego w schizofrenii (SZ) i w chorobie afektywnej dwubiegunowej (ChaD) są związane z zaburzeniami łączności funkcjonalnej w stanie spoczynku (rs-FC) w obrębie głównych sieci funkcjonalnych ośrodkowego układu nerwowego.MetodaW badaniu uczestniczyło 30 pacjentów z ChAD, 30 z rozpoznaniem SZ i 30 zdrowych ochotników (ZO). Nieświadome uczenie się motoryczne było oceniane przy użyciu zadania z pomiarem seryjnego czasu reakcji (SRTT). Przed treningiem uczestnicy zostali poddani obrazowania funkcjonalnego rezonansu magnetycznego w stanie spoczynku (resting state functional magnetic resonance imaging, rs-fMRI). W badaniu oceniono rs-FC w obrębie sieci istotności (salience network, SAN), sieci aktywności spoczynkowej (default mode network, DMN), sieci czołowo-ciemieniowej (frontoparietal network, FPN), sieci sensoryczno-motorycznej (sensorimotor network, SMN), sieci limbicznej (limbic network) i sieci wzrokowej (visual network, VIN). W pracy analizowano związek między rs-FC powyższych sieci a wskaźnikami nieświadomego uczenia się.Wynikirs-FC w obrębie SAN, DMN, FPN, SMN, LN i VIN nie wykazywała istotnych związków ze wskaźnikami nieświadomego uczenia się motorycznego. Grupy ChAD, SZ i OZ nie różniły się pod względem rs-FC wewnątrz wymienionych sieciWnioskiSiła rs-FC w obrębie głównych sieci funkcjonalnych, tj. SMN, FPN, VIN, LN, SAN i DMN nie wykazywała związku z miarami ocenianymi w SRTT. Niezależność procesu nieświadomego uczenia się motorycznego od spoczynkowej aktywności powyższych sieci stanowi istotną informację dla zrozumienia neuronalnych podstaw tego procesu oraz rozwoju dalszych badań dotyczących tej dziedziny.

IntroductionNegative symptoms of schizophrenia (SZ) are a critical unmet need of SZ treatment. In the past years, clinical tools were developed and guidance papers for the evaluation and management of negative symptoms of SZ were published. The CARE (Competence and confidence Assessment of early career psychiatrists’ (ECPs) ability to evaluate and manage negative symptoms of SZ) project was designed to examine the competence and confidence of ECPs in assessing and treating negative symptoms of SZ.ObjectiveTo publish the protocol of the CARE project and a pilot analysis of the data obtained from the Polish sample.MethodsThe CARE project is an international cross-sectional 23-item online survey on competence and confidence in assessing and treating negative symptoms of the ECPs from European countries. This work includes the protocol of the CARE project and a pilot analysis of 140 responses from the Polish ECPs population.ResultsThe majority of the participants were trainees (67.2%), not engaged in clinical research (69.3%), reported placement in clinics/wards specialized in SZ care (77.1%) and inclusion of theoretical courses (54.3%) in their specialist training curriculum, and participation in extra-curricular training (62.9%) on the negative symptoms. Few ECPs (6.4%) correctly identified the negative symptoms domains, although the majority of them (55%) reported feeling well-trained to administer and interpret at least one tool for the assessment of the negative symptoms. Respectively, 32.8% and 25.9% reported feeling competent in evaluating and managing the negative symptoms. Specialist status and longer experience were linked to higher likelihood of feeling competent in assessment and management of the negative symptoms. The large majority of ECPs (87.1%) agreed that there should be more emphasis on the negative symptoms of SZ in specialist training. Engagement in clinical research was linked to higher likelihood of correctly identifying the domains of negative symptoms.ConclusionThe results from the Polish ECPs population indicate a very limited knowledge and preparedness to evaluate and manage negative symptoms of SZ. The CARE study will explore the European ECPs’ gap in knowledge and skills in the evaluation and management of the negative symptoms of SZ to inform future educational actions.

The aim of this study was to determine whether group mindfulness-based interventions (MBIs) offer important support for pharmacological therapy for people suffering from schizophrenia spectrum disorders. Searches of electronic databases from 2008 to December 2022, checking of reference lists, and manual searches of journals were carried out. Randomized controlled trials (RCTs) in which structured group mindfulness-based interventions (MBIs) were conducted with adult people suffering from schizophrenia spectrum disorder were taken into account. The Jadad scale and Cochrane Handbook procedure were used for trial quality. Narrative analysis included 11 studies. The results showed that structured group MBIs have positive effects on the general symptoms of schizophrenia, negative and depressive symptoms, emotional regulation, well-being, and social and occupational functioning. Structured group MBIs are safe and can be implemented in various treatment and rehabilitation structures for people suffering from schizophrenia spectrum disorder as part of a comprehensive recovery approach.

Cel pracyCelem pracy było zbadanie związku pomiędzy anhedonią, zaburzeniami rytmów biologicznych, funkcjonowaniem i nasileniem depresji u pacjentów z chorobą afektywną dwubiegunową (ChAD).MetodaDo badania włączono 58 pacjentów w wieku 18-65 lat z depresją w przebiegu ChAD. Uczestnicy byli oceniani przy użyciu następujących skal: Skala oceny wymiarów anhedonii (DARS), Skala Przyjemności Snaitha-Hamiltona (SHAPS), Krótki inwentarz objawów depresyjnych – samoopisowy (QIDS-SR), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Functioning Assessment Short Test (FAST). Obliczono korelacje pomiędzy zmiennymi. Zbudowano modele regresji liniowej z FAST lub QIDS-SR jako zmienną zależną. Przeprowadzono analizę mediacji.WynikiZaobserwowano istotne statystycznie korelacje pomiędzy uwzględnionymi zmiennymi. Rozregulowanie rytmów biologicznych i anhedonia były niezależnymi predyktorami poziomu funkcjonowania lub nasilenia depresji. Analiza mediacji wykazała istotną statystycznie mediację związku pomiędzy anhedonią a nasileniem depresji/funkcjonowaniem przez wynik skali BRIAN.WnioskiPo raz pierwszy wykazaliśmy interakcje pomiędzy anhedonią, rozregulowaniem rytmów biologicznych a nasileniem depresji/funkcjonowaniem u pacjentów z ChAD. Deficyty w układzie nagrody poprzez zakłócanie rytmu codziennych aktywności i kontaktów społecznych mogą skutkować większymi trudnościami w funkcjonowaniu i większym nasileniem objawów depresyjnych.

OBJECTIVES:An idiographic evaluation of the effectiveness of including Mindfulness Skills Training in Virtual Reality (MST-VR) in the treatment of patients with schizophrenia disorders and its comparison with the results of a group effects analysis. METHODS:Twenty-five patients with schizophrenia and schizoaffective psychosis were assessed at 4-week intervals (one month before training, at the beginning and the end of training) using: Positive and Negative Syndrome Scale (PANSS-6), Quick Inventory of Depressive Symptomatology (QIDS), Beck Depression Inventory (BDI®-II), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10) and Addenbrooke's Cognitive Examination III (ACE-III). The Reliable Change Index (RCI) was used for statistical evaluation, and Cohen's d was used to assess effect size. RESULTS:Twenty patients (80%) achieved improvements in the severity of general symptoms, positive and negative symptoms, stress, anxiety, depression, and cognitive functioning. Individual patients showed deterioration in anxiety (2 patients, 8%) and stress (1 patient, 4%). The RCI method showed greater sensitivity in detecting changes than standard monographic statistical methods. CONCLUSIONS:The MST-VR intervention as an adjunctive treatment for patients with schizophrenia and schizoaffective psychosis is safe and beneficial. The RCI method is valuable in assessing the dynamics of individual patient outcomes.