INTRODUCTION: The aim of this work was to summarize relationships between two subtypes of major depressive disorder (melancholic and atypical) and four core features of depression that reflect the domains identified consistently in previous studies of major depressive disorder endophenotypes (exaggerated reactivity to negative information, altered reward processing, cognitive control deficits, and somatic symptoms) on the one hand and selected peripheral inflammatory markers (C-reactive protein [CRP], cytokines, and adipokines) on the other. METHODS: A systematized review was conducted. The database used for searching articles was PubMed (MEDLINE). RESULTS: According to our search, most peripheral immunological markers associated with major depressive disorder are not specific to a single depressive symptom group. The most evident examples are CRP, IL-6, and TNF-α. The strongest evidence supports the connection of peripheral inflammatory markers with somatic symptoms; weaker evidence indicates a role of immune changes in altered reward processing. The least amount of evidence was found for the role of peripheral inflammatory markers in exaggerated reactivity to negative information and cognitive control deficits. Regarding the depression subtypes, a tendency for higher CRP and adipokines was observed in atypical depression; increased IL-6 was found in melancholic depression. CONCLUSION: Somatic symptoms of depression could be a manifestation of a specific immunological endophenotype of depressive disorder. Melancholic and atypical depression may be characterized by different profiles of immunological markers.
OBJECTIVE: To evaluate the need for cardiac monitoring in unselected patients recovered from COVID-19 and to estimate the risk of heart complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MATERIALS AND METHODS: During March 2020 and January 2021, 106 patients who had recovered from SARS-CoV-2 (alpha and beta variants) were enrolled in prospective observational cohort study CoSuBr (Covid Survivals in Brno). The diagnosis was based on a reverse transcription-polymerase chain reaction swab test of the upper respiratory tract. Demographic parameters, patient history, clinical evaluation, cardiac biomarkers, ECG and echocardiography were recorded during three visits (Visit 1 at least 6 weeks after infection, Visit 2 three months later, and Visit 3 one year after Visit 1). RESULTS: 58.5% of the study group (n = 106) were female, while the mean age was 46 years (range 18-77 years). The mean time interval between the onset of infection and the follow-up visit was 107 days. One quarter (24.5%) of the patients required hospitalization during the acute phase of the disease; the rest recovered at home. 74% suffered a mild form of the disease, with 4.8, 18.1, and 2.9% suffering moderate, severe, and critical forms, respectively. At the time of enrolment, 64.2% of the patients reported persistent symptoms, while more than half of the whole group (50.9%) mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue). In the 1-year follow-up after COVID-19 infection, left ventricle ejection fraction showed no significant decrease [median (IQR) change was -1.0 (-6.0; 4.0)%, p = 0.150], and there were no changes of troponin (mean change -0.1 ± 1.72 ng/L; p = 0.380) or NT-proBNP [median (IQR) change 2.0 (-20.0; 29.0) pg/mL; p = 0.315]. There was a mild decrease in right ventricle end diastolic diameter (-mean change 2.3 ± 5.61 mm, p < 0.001), while no right ventricle dysfunction was detected. There was very mild progress in left ventricle diastolic diameter [median (IQR) change 1.0 (-1.0; 4.0) mm; p = 0.001] between V1 and V3, mild enlargement of the left atrium (mean change 1.2 ± 4.17 mm; p = 0.021) and a non-significant trend to impairment of left ventricle diastolic dysfunction. There was a mild change in pulmonary artery systolic pressure [median (IQR) change 3.0 (-2.0; 8.0) mmHg; p = 0.038]. CONCLUSION: Despite a lot of information regarding cardiac impairment due to SARS-CoV2, our study does not suggest an increased risk for developing clinically significant heart changes during the 1-year follow-up. Based on our results, routine echocardiography and biomarkers collection is currently not recommended after COVID-19 recovery.
- Publikační typ
- časopisecké články MeSH
Objectives: Osteocalcin is a protein secreted by osteoblasts with a versatile endocrine role. Several domains in which it plays a role-stress response, monoamine synthesis, and cognitive functioning-are implicated also in the pathophysiology of major depressive disorder. In search of possible objective biomarkers of depression, the aim of the study was to assess the relationship between osteocalcin and depressive symptoms during the treatment of depressive episode. Methods: The study included female inpatients with at least moderate depressive episode. In these patients, depression severity was measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), and osteocalcin levels were assessed before the stabilization of antidepressive treatment and after 6 weeks. Relationships between osteocalcin levels and symptoms were analyzed with mixed-effect and linear models, taking into account age, menopausal status, and body mass index. Results: In 11 out of 13 enrolled inpatients, osteocalcin levels decreased during the first 6 weeks of treatment; this decrease was significant according to the mixed-effects model (t = -2.345, p = 0.019). According to the linear model, this decrease was significantly associated with reduction in depressive symptom severity (t = 2.673, p = 0.028). Osteocalcin was not associated with initial depressive symptom severity, and initial osteocalcin levels did not predict response to treatment. Limitations of the study include low sample size and inclusion of both pre- and postmenopausal women of various ages. Conclusions: This preliminary study suggests that osteocalcin may be a candidate biomarker of antidepressive treatment response and that this topic warrants further investigation.
- Publikační typ
- časopisecké články MeSH
Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.
- MeSH
- absentérství * MeSH
- antidepresiva terapeutické užití MeSH
- deprese terapie MeSH
- lidé MeSH
- pracovní neschopnost * MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
The cellular pathology of schizophrenia and the potential of antipsychotics to target underlying neuronal dysfunctions are still largely unknown. We employed glutamatergic neurons derived from induced pluripotent stem cells (iPSC) obtained from schizophrenia patients with known histories of response to clozapine and healthy controls to decipher the mechanisms of action of clozapine, spanning from molecular (transcriptomic profiling) and cellular (electrophysiology) levels to observed clinical effects in living patients. Glutamatergic neurons derived from schizophrenia patients exhibited deficits in intrinsic electrophysiological properties, synaptic function and network activity. Deficits in K+ and Na+ currents, network behavior, and glutamatergic synaptic signaling were restored by clozapine treatment, but only in neurons from clozapine-responsive patients. Moreover, neurons from clozapine-responsive patients exhibited a reciprocal dysregulation of gene expression, particularly related to glutamatergic and downstream signaling, which was reversed by clozapine treatment. Only neurons from clozapine responders showed return to normal function and transcriptomic profile. Our results underscore the importance of K+ and Na+ channels and glutamatergic synaptic signaling in the pathogenesis of schizophrenia and demonstrate that clozapine might act by normalizing perturbances in this signaling pathway. To our knowledge this is the first study to demonstrate that schizophrenia iPSC-derived neurons exhibit a response phenotype correlated with clinical response to an antipsychotic. This opens a new avenue in the search for an effective treatment agent tailored to the needs of individual patients.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Covid-19 je infekční onemocnění, které je způsobené virem SARS -CoV-2 (syndrom těžké respirační tísně koronaviru 2) (1). Celková mortalita je nízká: pod 0,5 %. Úmrtí jsou převážně ve věkové skupině nad 60 let a u pacientů s jiným těžkým chronickým onemocněním. Většina nemocných se uzdraví v průběhu jednoho či dvou týdnů, nicméně u 5–10 % pacientů část symptomů přetrvává týdny a měsíce. Post-covid syndrom je multi -systémové onemocnění s překrývajícími se symptomy a zasahuje jedince bez ohledu na tíži předchozí akutní infekce. Při pohledu na počet postižených v České republice odhadujeme, že během následujících měsíců zde bude nejméně 50 000 postižených vyžadujících pozornost minimálně praktického lékaře, ale patrně i dalších specialistů. K zvládnutí následků pandemie SARS -CoV-2 je nezbytná znalost post-covid syndromu a tvorba účinných doporučení, ideálně založených na důkazech.
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (1). Overall COVID-19-related rates of mortality are low; deaths usually occur in patients older than 60 and those suffering from serious chronic diseases. Most of the patients recover within one or two weeks. However, in approximately 5–10 % of the patients some of the symptoms persist for weeks and months. Post-COVID-19 syndrome is a multisystem disease with overlapping symptoms and may occur even in patients who were relatively mildly affected during the acute phase of the disease. Evaluating the number of patients with or after the novel coronavirus infection in the Czech Republic, it can be estimated that in the next months there will be about 50,000 new patients suffering from long-COVID-19 requiring attention of general practitioners in the least, and, in all probability, also of other medical specialists. A thorough knowledge of the syndrome and efficient ideally evidence-based guidelines have to be formulated to combat the adverse impact of the pandemic.
- Klíčová slova
- post -covid-19 syndrom, dispenzární péče,
- MeSH
- COVID-19 * komplikace MeSH
- lidé MeSH
- následná péče MeSH
- SARS-CoV-2 MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Virtuální realita (VR) je technologie, která umožňuje simulovat realistické prostředí a interakci uživatele s ním. Nejčastější způsob, jakým je simulované prostředí prezentováno uživateli, je tzv. projekční helma (Head Mounted Display, HMD). Využití VR v psychiatrii je zkoumáno již od 90. let 20. století, byl to ale teprve rozvoj technologie v posledních letech a s tím spojená větší finanční dostupnost, které zájem o VR výraznou měrou zvýšily. Aplikace VR v psychiatrii využívají především následující vlastnosti této technologie: navození pocitu přítomnosti (presence) v simulovaném prostředí, poskytnutí libovolných vjemů, manipulace se senzorickými modalitami a možnost měření chování uživatele. Stěžejní vlastnost, která nejvíce odděluje VR od jiných médií, je právě navození pocitu přítomnosti, který může zvyšovat dopad prezentovaných stimulů na uživatele. Největší množství literatury se zabývá možností využití této technologie jako intervencí, které zahrnují terapii, rehabilitaci, zvyšování kvality života, prevenci a profylaxi. Z intervencí se pak nejčastěji využívají implementace postupů kognitivně-behaviorální terapie (KBT) a zejména pak expoziční terapie ve VR (VRET). Druhá nejčastější oblast, která je zkoumána, je možné využití VR v diagnostice a hodnocení tíže symptomů psychiatrických poruch. Tato skupina aplikací využívá možnost měřit chování uživatele ve virtuálním prostředí. VR může být využita jako prostředek objektivní a ekologicky validní diagnostiky. Třetím potenciálním využitím je výzkum duševních poruch, jejich patofyziologie, ale také vlastností VR ve vztahu k duševním poruchám. Poslední skupinou využití je trénink a edukace. V této skupině aplikací může být VR využita k tréninku zdravotnických specialistů nebo k edu-kaci o duševních poruchách. Nejvíce je zkoumáno VR u úzkostných poruch, a to většinou jako intervenční postup, konkrétněji VRET. Podobné aplikace se týkají také poruch vyvolaných stresem a návykových poruch. U psychotických poruch je VR využívána hlavně pro výzkum. Relativně velké množství aplikací se věnuje poruchám příjmu potravy, kognitivnímu deficitu, autismu a poruchám pozornosti s hyperaktivitou. Naopak minimum aplikací se týká obsedantně-kompulzivní poruchy, afektivních poruch a poruch osobnosti. Limitace použití VR u pacientů s psychiatrickými poruchami nejsou plně prozkoumané. První možné omezení může vyplývat z nežádoucích účinků VR. Nejčastěji uváděný nežádoucí účinek je VR nevolnost. Z recentní literatury je patrné, že mohou existovat i jiné nežádoucí účinky, například ?následky po expozici? VR (angl. aftereffects), které mohou být vizuální a kognitivní. Dále je patrné, že stále plně neznáme jazyk VR jako média - není jasné, jaký je vztah mezi účinností aplikací, intenzitou pocitu přítomnosti a způsobem prezentace stimulů. Hlavním problémem aktuální literatury ohledně VR je obecně nízká metodologická kvalita studií, možné publikační bias, časté využívání čekacích listin jako kontrol. Autoři často nedostatečně referují o technickém zpracování VR aplikací a o použitém hardwaru. S tím souvisí omezená standardizace použitého hardwaru a softwaru. Pravdou také je, že zatím byly v psychiatrii využity jen konceptuálně jednodušší aplikace. Zatím se jeví, že VR může nalézt využití v pochopení, diagnostice i terapii řady duševních poruch. K širšímu využití v psychiatrii musí VR ještě dozrát jak po stránce technické, tak po stránce metodologické a konceptuální. Vzhledem k možnostem technologie a současnému stavu poznání je VR vděčným cílem pro další výzkum.
Virtual reality (VR) is a technology which allows simulation of a realistic computer-generated environment and user interaction with it. The most common means to present the simulated stimuli is HMD (Head Mounted Display). VR applications in psychiatry have been a focus of research since 1990 ́s, however, it was a recent development and improved availability of this technology that lead to increased attention to this topic. Applications of VR in psychiatry utilise following attributes: induction of the sense of presence, presentation of any stimuli, manipulation with sensor modalities and measurement of user be-haviour. The key attribute distinguishing VR from other ways of stimuli presentation is the sense of presence which can increase the effect of presented stimuli on the user. The largest body of literature about VR in psychiatry deals with interventions including therapy, rehabilitation, quality of life improvement, prevention and prophylaxis. The most common therapeutical interventions are Cognitive-Behavioral therapy (CBT) techniques implementations, especially Virtual Reality Exposure Therapy (VRET). The second most explored field is an assessment which takes advantage of a possibility to measure user behaviour. VR could be used as a tool for objective and ecologically valid assessment. The third possible use of the VR in psychiatry is the research of mental disorders, their pathophysiology and their relationship to the VR. The last group of applications includes training of mental health professionals and education about mental disorders. Anxiety disorders are the most frequent target of the VR applications, mostly as interventions, usually VRET. A similar situation is in stress-related disorders and addictions. In psychotic disorders, VR is used usually for research. A relatively high number of applications deal with eating disorders, cognitive impairment, autism and atten-tion deficit and hyperactivity disorder. On the other side, VR is used minimally in obsessive-compulsive disorder, affective disorders and personality disorders. Limitations of VR utilisation in psychiatry are not fully explored. The first possible limitation could stem from VR adverse reactions. VR sickness is the most often mentioned adverse reaction. In recent literature, there are how-ever notions about others, for example, "aftereffects" which could be visual or cognitive. It should also be noted that the language of VR as a medium is not fully known. There is a lack of accurate description of relationships between the effects of the VR application, the intensity of the sense of presence and ways of stimuli presentation. The main problem of actual literature on this topic is low methodological quality, possible publication bias and frequent use of waitlist controls. Authors often do not describe technological specifications which are related to reduced hardware and software standardisation. The truth also is that to this date mostly only conceptually simple applications have been explored. It appears that VR could find its place in understanding, diagnostics and therapy of several mental disorders. To reach full potential, this technology still has to mature methodologically and conceptually. Considering the possibilities of the VR in psychiatry and current state of knowledge, VR can be an exciting focus for further research.
- MeSH
- autistická porucha terapie MeSH
- duševní poruchy * diagnóza klasifikace terapie MeSH
- kognitivní dysfunkce terapie MeSH
- lidé MeSH
- nauzea etiologie MeSH
- návykové chování terapie MeSH
- počítačová simulace trendy MeSH
- poruchy nálady terapie MeSH
- poruchy příjmu potravy terapie MeSH
- psychiatrie metody výchova MeSH
- úzkostné poruchy terapie MeSH
- virtuální realita * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
