Smíšená úzkostná a depresivní porucha je diagnóza v 10. i 11. edici Mezinárodní klasifikace nemocí (MKN), kterou lze stanovit pokud se u pacienta současně vyskytuje úzkostná a depresivní symptomatologie, která působí významné potíže, ale není vyjádřena v takové tíži, aby bylo možno stanovit jinou úzkostnou nebo afektivní poruchu. Někdy je existence této poruchy zpochybňována pro nízkou tíži příznaků, obtížné ohraničení od podobných stavů a nízkou diagnostickou spolehlivost. Například v poslední, páté, edici Diagnostického a statistického manuálu se nevyskytuje. V kontextu MKN se ale jedná o jednu z nejčastějších psychiatrických diagnóz zejména v primární péči. V diferenciální diagnostice je nutné nejprve vyloučit možnou tělesnou příčinu potíží a následně také jiné situace, kdy se může depresivní a úzkostná symptomatologie vyskytovat současně, například komorbidní depresivní a úzkostnou poruchu. Ve farmakologické terapii se uplatňují v první řadě antidepresiva ze skupiny selektivních inhibitorů zpětného vychytávání serotoninu a při neúspěchu lze užít jiné preparáty se současnou účinností na depresivní a úzkostné příznaky. Jako adjuvantní terapii lze podávat po omezenou dobu anxiolytika. Nezbytnou terapeutickou modalitou je psychoterapie, zejména kognitivně behaviorální psychoterapie.
Mixed anxiety and depressive disorder is a diagnostic category in the 10th and 11th editions of the International Classification of Diseases (ICD). It can be made when a patient shows co-occurring anxiety and depressive symptoms causing significant distress but not expressed in such severity that another anxiety or affective disorder can be diagnosed. Sometimes the existence of this disorder is questioned because of the low severity of symptoms, the difficulty of delineating it from similar conditions and the low diagnostic reliability. For example, it does not appear in the most recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. However, in the context of the ICD, it is one of the most common psychiatric diagnoses, particularly in primary care. In the differential diagnosis, it is necessary first to exclude a possible physical cause of the disorder and then to rule out other situations where depressive and anxiety symptomatology may occur together, such as comorbid depressive and anxiety disorders. In pharmacological therapy, antidepressants from the group of selective serotonin reuptake inhibitors are primarily used. If unsuccessful, other agents with simultaneous efficacy on depressive and anxiety symptoms may be used. As adjuvant therapy, anxiolytics may be given for a limited time. Psychotherapy, particularly cognitive behavioural psychotherapy, is an essential therapeutic modality.
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
- Publikační typ
- abstrakt z konference MeSH
Vitamin D receptor polymorphisms have been the target of many studies focusing on multiple sclerosis. However, previously reported results have been inconclusive. The objective of this study was to investigate the association between five vitamin D receptor polymorphisms (EcoRV, FokI, ApaI, TaqI, and BsmI) and multiple sclerosis susceptibility and its course. The study was carried out as a case-control and genotype-phenotype study, consisted of 296 Czech multiple sclerosis patients and 135 healthy controls. Genotyping was carried out using polymerase chain reaction and restriction analysis. In multiple sclerosis men, allele and/or genotype distributions differed in EcoRV, TaqI, BsmI, and ApaI polymorphisms as compared to controls (EcoRV, pa = 0.02; Taq, pg = 0.02, pa = 0.02; BsmI, pg = 0.02, pa = 0.04; ApaI, pg = 0.008, pa = 0.005). In multiple sclerosis women, differences in the frequency of alleles and genotypes were found to be significant in ApaI (controls vs multiple sclerosis women: pg = 0.01, pa = 0.05). Conclusive results were observed between multiple sclerosis women in the case of EcoRV [differences in Expanded Disability Status Scale (p = 0.05); CT genotype was found to increase the risk of primary progressive multiple sclerosis 5.5 times (CT vs CC+TT pcorr = 0.01, sensitivity 0.833, specificity 0.525, power test 0.823)] and FokI [borderline difference in Multiple Sclerosis Severity Score (p = 0.05)]. Our results indicate that the distribution of investigated vitamin D receptor polymorphisms is a risk factor for multiple sclerosis susceptibility and progression in the Czech population. The association between disease risk and polymorphisms was found to be stronger in men. The association of disease progression with polymorphisms was observed only in women.
- MeSH
- dospělí MeSH
- genetická predispozice k nemoci MeSH
- jednonukleotidový polymorfismus * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- receptory kalcitriolu genetika MeSH
- roztroušená skleróza genetika patologie MeSH
- senioři MeSH
- sexuální faktory MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
