Particular role of the heptadecapeptide nociceptin (orphanin FQ), the endogenous agonist of the NOP receptor, has been widely demonstrated in the regulation of pain sensation and anxietyrelated behavior. In our best knowledge this is the first study reporting plasma nociceptin levels in 26 acute stroke and 6 transiens ischemic attack (TIA) patients. We have found significantly elevated plasma nociceptin levels in all the three groups of patients studied (stroke influencing the carotis or the lacunar region and TIA).We suggest that elevated plasma nociceptin level is the consequence of stroke as in the group of patients recovered from previous stroke was found similar the control value. Plasma serotonin level was found non-significantly decreased in patients with stroke influencing the lacunar region and TIA patients. However the plasma 5-hydroxyindoleacetic acid (5HIAA) levels were found significantly elevated in patient groups with stroke influencing both the carotis and the lacunar regions. Data may serve as further evidence for the serotonergic dysregulation in stroke.

KEYWORDS: nociceptin, acute stroke, 5-HT, 5-HIAA

The increased serum prolactin is one of the side effects of antipsychotic treatment. The clinical signs of its elevated level are galactorrhea, gynecomastia, breast tenderness and sexual dysfunction. These symptoms can cause poor compliance and relapse of the psychiatric illnesses. The possible clinical interventions are: 1) reduce of the dose of the psychotropic drug and/or addition of a dopamin agonist; 2) switch to another drug. The aim of our study was to evaluate the results of the switch to quetiapine in the cases of elevated prolactin with galactorrhea. Methods and patients: Five of our patients (from the January to July in 2005) treated for more than two months with new generation antipsychotics had the symptoms of galactorrhea/breast tenderness. The diagnoses in according to ICD-10 were: schizophrenia and schizoaffective disorder. The differencialdiagnostic examination were: physical, neuroimaging and laboratory including prolactin level followed up on the 4th, 8th weeks after the therapeutical intervention. Results: The galactorrhoea disappeared and prolactin levels normalized after the switching to quetiapine.In the case of bromocriptine addition to previous therapy symptom stopped but the hormone level did not change significantly. There was remission and/or stabilisation of psychotic symptoms with quetiapine. Conclusion: The galactorrhea is one of the possible side effects of psychotropic dugs. We presented five patients with this kind of symptoms related to antipsychotic treatment. After the switch to quetiapine the galactorrhea and breast tenderness stoped, the level of prolactin normalized and the psychiatric condition of the patients showed remission. Our data support the benefit of the switch to another new generation drug, first of all to quetiapin, in the cases of galactorrhea and/or elevated prolactin level related to the antipsychotic pharmacotherapy.

KEYWORDS: antipsychotic agents, side effect, hyperprolactinaemia, prolactin, switch to another antipsychotic

On the basis of the criteria of the International Headache Society (IHS) tension-type headache (TTH) is classed among the primary headaches. The independent headache diseases are characterized with the type of headache and with the concomitant symptoms. Among the independent headaches TTH has the highest prevalence (38,3%). The prevalence which is the highest between the age of 30 and 39, in women is higher (46,9%) than is men (42,3%). The diagnosis of TTH is not automatically mean the diagnosis of depression. Depression can occur as a comorbid disease. In episodic TTH the prevalence of depression is 32%, while in chronic TTH it is 40%. The prophylactic treatment of patients suffering from chronic TTH has not been solved yet. On the basis of a double-blind, placebo-controlled study mirtazapine is said to be a good opportunity in the treatment of patients with chronic TTH, as it improved the status of the patients with 34% (AUC: Area Under the headache Curve calculated from the product of the period and the intensity of headache), moreover mirtazapine decreased the frequency, intensity and duration of headache as well. The favourable effects of mirtazapine is explained beyond its serotonergic and noradrenergic dual mode of action with its antinociceptive effects which is presumably fulfilled via 3-opiod receptors.

KEYWORDS: tension-type headache, mirtazapine, prophylactic treatment

The question of awareness, the capacity to judge the consequences of ones certain act or behaviour is a hard and typical problem in forensic medicine and neuro-psychiatry. Analysing such questions is indispensable during criminal actions where the responsibility and culpability of the offender is to be considered. The examination of the offender’s mental state may help to recognise undiagnosed neuro-psychiatric conditions. The case of a man, suspected to have violently murdered his spouse is reported. During his criminal act he was probably in a pathological mental state caused by alcoholic drunkenness and decreased emotional control; besides he may have ictal or interictal disturbance of consciousness. The alcoholic state does not limit culpability, while epileptic disturbance of consciousness may exempt the offender.

KEYWORDS: psychiatric observation, EEG, MRI, epilepsy