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Case Reports 2015; 36(3): 226-230 PubMed PMID: 26313387 Citation  Keywords:  Aged, 80 and over, Cataplexy:diagnosis, Comorbidity, Female, Humans, Narcolepsy:diagnosis, Parkinson Disease:diagnosis,.   

: We present the case of an 86 year old female, in whom narcolepsy with cataplexy (NC) manifested at 52 years of age. She was treated by an amphetamine-like drug phenmetrazine and tricyclic antidepressants for more than 10 years. Hypokinetic-rigid syndrome manifested at 83 years of age and Parkinson´s disease (PD) was diagnosed. Detailed examination at the age of 86 confirmed the previous diagnosis of NC and the diagnosis of PD. Severe periodic limb movements in sleep, severe sleep apnea, REM sleep behavior disorder and restless legs syndrome, which are frequently comorbid in NC and PD, were revealed. The patient's somnolence worsened, apparently accentuated by pramipexole treatment, as changing therapy to levodopa led to a reduction of sleepiness....

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Journal Article 2015; 36(3): 214-225 PubMed PMID: 26313386 Citation  Keywords:  Functional Neuroimaging:methods, Humans, Magnetic Resonance Imaging:methods, Neurobiology:methods, Panic Disorder:physiopathology, Psychotherapy:methods,.   

: Fifty years ago, when the effect of antidepressants on panic disorder was described, a significant progress in understanding this anxiety disorder has been made. Theoretical mechanisms and models of fear and panic disorder were proposed and tested in animal models and humans. With growing possibilities of non-invasive neuroimaging techniques, there is an increasing amount of information on the panic disorder. Unfortunately, a number of circumstances lead to inconsistent findings and its interpretations. In our review, we focused on functional MRI in panic disorder, limitations of current studies, possible interpretations and proposals for future direction. In our opinion, the current findings support the neuroanatomical model of panic disorder at the level of group data analysis. But at the same time, the results suggest significant inter-individual differences across the patients, which may be related to each patient's individual history, woven into their neural network and affecting the individual symptoms and response to therapy....

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Journal Article 2015; 36(3): 209-213 PubMed PMID: 26313385 Citation  Keywords:  Adult, Evidence-Based Medicine:methods, Female, Fertilization in Vitro:methods, Humans, Infertility, Female:therapy, Ovarian Reserve:physiology, Pregnancy,.   

: Despite the vast experience in controlled ovarian hyperstimulation, there are still women who respond poorly to gonadotropins, which results in few oocytes at retrieval, reduced number of embryos for transfer and consequently unsatisfactory pregnancy rates. Although such patients are quite common in IVF practice, the exact prevalence of so-called "poor responders" is difficult to estimate due to the variety of applied definitions. The urgent need for an internationally accepted definition of poor ovarian response (POR) was addressed by an ESHRE Workshop held in Bologna in 2010, where the consensus was reached and criteria were finally established. The application of this uniform definition may allow a correct estimate of POR prevalence and, what is more important, designing proper trials to assess and finally compare the interventions used in POR patients. The article describes the possible physiology of POR and patient characteristics, mentions risk factors and laboratory tests of decreased ovarian reserve. Finally it reviews the possible management of POR with different stimulation protocols in the light of EBM. Basing on published meta-analyses, various additional alternatives (such as estradiol priming, the addition of rLH, growth hormone, androgens and androgen-modulating agents, aspirin) are also summarized. Despite the two decades of trying, there is still no consensus on what is best for POR. No single treatment can be recommended over another, as the evidence for all of them is insufficient. It is obvious that interventions used in POR require properly designed large randomized studies, because until now there is no evidence-based treatment for that particular group of patients....

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Journal Article 2015; 36(3): 201-208 PubMed PMID: 26313384 Citation  Keywords:  ACTH Syndrome, Ectopic:complications, Cushing Syndrome:etiology, Humans,.   

: Ectopic adrenocorticotropic hormone secretion (EAS) is responsible for approximately 10-15% cases of Cushing's syndrome. EAS is associated with various tumors such as small cell lung cancer and well-differentiated bronchial or gastrointestinal neuroendocrine tumors. Hormonal diagnostics include assessments in basic conditions as well as dynamic tests, such as the high-dose dexamethasone suppression test and corticotrophin releasing hormone (CRH) stimulation test. Treatment selection depends on the type of tumor and its extent. In the case of neuroendocrine tumors, the main treatments are surgery and administration of somatostatin analogs that may be additionally radiolabeled for targeted radiotherapy. The tumor histology and the presence and control of hypercortisolemia and metastases are of major importance in prognosis. In this article we presented the principles of modern hormonal and imaging diagnostics techniques as well as the key issues associated with treatment of ACTH-dependent Cushing's syndrome due to EAS....

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Journal Article 2015; 36(3): 196-200 PubMed PMID: 26313383 Citation  Keywords:  Adolescent, Adult, Humans, Male, Memory, Episodic, Mental Recall:physiology, Saliva:chemistry, Testosterone:analysis, Young Adult,.   

OBJECTIVES: Although there is consensus that sex hormones modulate memory, we have an incomplete understanding of their role in remembering and forgetting. Humans continuously update memory, forgetting old, out-of-date information and encoding new, more relevant information. Updating processes can be studied with the list method of directed forgetting.

METHODS: In the list method of directed forgetting task, subjects study two lists of items and, after study of list 1, are asked to either forget or remember the list for an upcoming memory test. Free testosterone level was quantified from saliva samples. Directed forgetting and saliva testosterone were evaluated in young men (aged between 18 and 28 years).

RESULTS: Following a forget cue, recall of list-1 items was reduced and recall of list-2 items was enhanced. However, only recall of list-2 items was associated with free testosterone level. Following a forget cue, participants with low testosterone levels showed higher recall of list-2 items than participants with high testosterone levels.

CONCLUSION: The selective association between testosterone level and list-2 recall is consistent with two-mechanism accounts of memory updating, where the forgetting effect is due to impaired retrieval and the enhancement effect to improved encoding. On the basis of this view, the present results indicate that low testosterone levels are associated with improved binding of the newly encoded memories to their context cue....

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Journal Article 2015; 36(3): 187-192 PubMed PMID: 26313381 Citation  Keywords:  Biological Clocks:physiology, Humans, Melatonin:physiology, Signal Transduction:physiology, Time,.   

: Temporal organization plays a key role in humans, and presumably all species on Earth. A core building block of the chronobiological architecture is the master clock, located in the suprachi asmatic nuclei [SCN], which organizes "when" things happen in sub-cellular biochemistry, cells, organs and organisms, including humans. Conceptually, time messenging should follow a 5 step-cascade. While abundant evidence suggests how steps 1 through 4 work, step 5 of "how is central time information transmitted througout the body?" awaits elucidation. Step 1: Light provides information on environmental (external) time; Step 2: Ocular interfaces between light and biological (internal) time are intrinsically photosensitive retinal ganglion cells [ipRGS] and rods and cones; Step 3: Via the retinohypothalamic tract external time information reaches the light-dependent master clock in the brain, viz the SCN; Step 4: The SCN translate environmental time information into biological time and distribute this information to numerous brain structures via a melanopsin-based network. Step 5: Melatonin, we propose, transmits, or is a messenger of, internal time information to all parts of the body to allow temporal organization which is orchestrated by the SCN. Key reasons why we expect melatonin to have such role include: First, melatonin, as the chemical expression of darkness, is centrally involved in time- and timing-related processes such as encoding clock and calendar information in the brain; Second, melatonin travels throughout the body without limits and is thus a ubiquitous molecule. The chemial conservation of melatonin in all tested species could make this molecule a candidate for a universal time messenger, possibly constituting a legacy of an all-embracing evolutionary history....

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Letter 2015; 36(3): 185-186 PubMed PMID: 26313380 Citation  Keywords:  Adult, Female, Humans, Male, Pilot Projects, Proteomics:methods, Tears:chemistry,.   

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Journal Article 2015; 36(2): 171-177 PubMed PMID: 26071588 Citation  Keywords:  Adult, Age Factors, Age of Onset, Aged, Cross-Sectional Studies, Depressive Disorder:drug therapy, Female, Humans, Male, Medication Adherence:psychology, Middle Aged, Remission Induction, Severity of Illness Index, Social Stigma,.   

OBJECTIVE: A wide range of variables may influence the rate of adherence to treatment. These variables can be associated with the disease itself, method of treatment, patient's personality, environmental factors and therapeutic relationship. Self-stigma is one of the possible factors related to poor adherence. The aim of the study was to find out the relationship between current adherence, discontinuation of medication in the past and self-stigma in stable psychiatric outpatients diagnosed with depressive disorder.

METHODS: The study included 72 stable outpatients diagnosed with depressive disorder with a mean age of 49.00 ± 12.56. Disorder severity was assessed using the Clinical Global Impression scale. Adherence was measured by the Drug Attitude Inventory - 10 items (DAI-10) scale and self-stigma by the Internalized Stigma of Mental Illness (ISMI) scale. The data were evaluated in 66 patients. Six patients were excluded because of incompletely filled in questionnaires.

RESULTS: The rate of adherence was not associated with gender, education, employment, family burden (family history) or partner status. Current adherence did not differ between patients who arbitrarily discontinued their medication in the past and those who did not. Adherence was significantly positively correlated with patient's age, age at disease onset and the level of self-stigma.

CONCLUSIONS: The study results suggest that the level of self-stigma and age of the patient can be very important factors associated with adherence in patients with depressive disorder....

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