BACKGROUND: Interpersonal difficulties of patients with borderline personality disorder (BPD) are closely related to rejection sensitivity. The aim of the present study was to gain further insight into the experience and cerebral processing of social interactions in patients with BPD by using fMRI during experimentally induced experiences of social exclusion, inclusion, and overinclusion. METHODS: The study involved 30 participants diagnosed with BPD (29 female and 1 male; age: M = 24.22, SD = 5.22) and 30 healthy controls (29 female and 1 male; age: M = 24.66, SD = 5.28) with no current or lifetime psychiatric diagnoses. In the fMRI session, all participants were asked to complete a Cyberball task that consisted of an alternating sequence of inclusion, exclusion, and overinclusion conditions. RESULTS: Compared to healthy controls, participants with BPD reported higher levels of inner tension and more unpleasant emotions across all experimental conditions. At the neural level, the participants with BPD showed lower recruitment of the left hippocampus in response to social exclusion (relative to the inclusion condition) than the healthy controls did. Lower recruitment of the left hippocampus in this contrast was associated with childhood maltreatment in patients with BPD. However, this difference was no longer significant when we added the covariate of hippocampal volume to the analysis. During social overinclusion (relative to the inclusion condition), we observed no significant differences in a group comparison of neural activation. CONCLUSIONS: The results of our study suggest that patients with BPD experience more discomfort than do healthy controls during social interactions. Compared to healthy participants, patients with BPD reported more inner tension and unpleasant emotions, irrespective of the extent to which others included them in social interactions. At a neural level, the participants with BPD showed a lower recruitment of the left hippocampus in response to social exclusion than the healthy controls did. The reduced activation of this neural structure could be related to a history of childhood maltreatment and smaller hippocampal volume in patients with BPD.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Článek představuje nejdůležitější zásady léčby akutní epizody schizofrenie podle doporučených postupů Psychiatrické společnosti ČLS JEP, a to v její čerstvě aktualizované verzi. Významné se jeví rozlišení, zda se jedná o první epizodu či relaps. Ve druhém případě je žádoucí pátrat po příčině tohoto relapsu. Základ léčby představuje monoterapie antipsychotikem v perorální nebo dlouhodobě působící injekční formě. V případě neúčinnosti antipsychotika první volby je vhodné nahradit toto léčivo druhým antipsychotikem s odlišným mechanismem účinku, v případě selhání i tohoto kroku je na místě zahájit podávání klozapinu. Je-li nedostatečně účinný dokonce i klozapin, měla by být zvážena jeho augmentace, popř. alternativní a experimentální přístupy. Pozornost je věnována rovněž specifickým klinickým situacím, konkrétně ovlivnění negativních příznaků, kognitivního deficitu, agitovanosti, katatonních příznaků a nově i depresivních symptomů a suicidality. I když základním prvkem terapie akutní epizody schizofrenie jsou antipsychotika, která z dlouhodobého hlediska působí jako prevence mortality z jakékoli příčiny, opominuty nejsou ani nefarmakologické metody léčby.
The article presents the most important principles of treatment of an acute episode of schizophrenia according to the guidelines of the Psychiatric Association of the CMA JEP in its newly updated version. It is important to distinguish whether it is a first episode of schizophrenia or a relapse. In the second case, it is desirable to search for the cause of this relapse. The basis of treatment is antipsychotic monotherapy in oral or long-acting injectable form. If the first-line antipsychotic treatment is ineffective, it is recommended to replace it with a second antipsychotic drug with a different mechanism of action; if this step fails, clozapine should be started. If even clozapine is insufficiently effective, it is appropriate to consider its augmentation, or alternative and experimental approaches. Attention is also paid to specific clinical situations, such as the treatment of negative symptoms, cognitive deficits, agitation, catatonic symptoms and, more recently, depressive symptoms and suicidality. Even though antipsychotics are a basic element of the therapy of an acute episode of schizophrenia, which in the long term act as a prevention of mortality from any cause, non-pharmacological methods of treatment are also mentioned.
- MeSH
- adherence k farmakoterapii MeSH
- akutní nemoc MeSH
- antipsychotika aplikace a dávkování farmakologie MeSH
- dospělí MeSH
- klozapin farmakologie terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- psychiatrická rehabilitace MeSH
- schizofrenie * farmakoterapie MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- synergismus léků MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Nefarmakologické terapeutické metody v neuropsychiatrii představují biologické postupy (invazivní a neinvazivní stimulace struktur centrálního nervového systému), psychoterapie a psychoedukace. Spektrum jimi léčených nemocí je poměrně široké a lze očekávat, že s rozvojem poznání v oblasti neurověd a s lepší dostupností těchto metod jejich použití pravděpodobně poroste.
Non-pharmacological methods in neuropsychiatry include biological approaches (invasive and noninvasive stimulation of central nerve system structures), psychotherapy and psychoeducation. Range of diseases treated by non-pharmacological methods is wide and with improvements of accessibility the use of these methods will probably grow.
The choroid plexus (ChP) is part of the blood-cerebrospinal fluid barrier, regulating brain homeostasis and the brain's response to peripheral events. Its upregulation and enlargement are considered essential in psychosis. However, the timing of the ChP enlargement has not been established. This study introduces a novel magnetic resonance imaging-based segmentation method to examine ChP volumes in two cohorts of individuals with psychosis. The first sample consists of 41 individuals with early course psychosis (mean duration of illness = 1.78 years) and 30 healthy individuals. The second sample consists of 30 individuals with chronic psychosis (mean duration of illness = 7.96 years) and 34 healthy individuals. We utilized manual segmentation to measure ChP volumes. We applied ANCOVAs to compare normalized ChP volumes between groups and partial correlations to investigate the relationship between ChP, LV volumes, and clinical characteristics. Our segmentation demonstrated good reliability (.87). We further showed a significant ChP volume increase in early psychosis (left: p < .00010, right: p < .00010) and a significant positive correlation between higher ChP and higher LV volumes in chronic psychosis (left: r = .54, p = .0030, right: r = .68; p < .0010). Our study suggests that ChP enlargement may be a marker of acute response around disease onset. It might also play a modulatory role in the chronic enlargement of lateral ventricles, often reported in psychosis. Future longitudinal studies should investigate the dynamics of ChP enlargement as a promising marker for novel therapeutic strategies.
- MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek patologie MeSH
- plexus chorioideus * diagnostické zobrazování patologie MeSH
- psychotické poruchy * diagnostické zobrazování patologie MeSH
- reprodukovatelnost výsledků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
Nefarmakologické terapeutické metody v neuropsychiatrii představují biologické postupy (invazivní a neinvazivní stimulace struktur centrálního nervového systému), psychoterapie a psychoedukace. Spektrum jimi léčených nemocí je poměrně široké a lze očekávat, že s rozvojem poznání v oblasti neurověd a s lepší dostupností těchto metod jejich použití pravděpodobně poroste.
Non-pharmacological methods in neuropsychiatry include biological approaches (invasive and noninvasive stimulation of central nerve system structures), psychotherapy and psychoeducation. Range of diseases treated by non-pharmacological methods is wide and with improvements of accessibility the use of these methods will probably grow.
OBJECTIVE: Patients with schizophrenia are at higher risk of cardiovascular (CVS) related mortality. Close attention is being paid to the clinical utility of readily available CVS markers. METHODS: A pilot one-year longitudinal study in inpatients with first-episode psychosis (FEP) was carried out to determine markers of inflammation and endothelial dysfunction (monocyte- and neutrophil-to-lymphocyte ratios) and basal blood pressure, pulse, and derived hemodynamic parameters (PP: pulse pressure; RPP: rate pressure product; and MAP: mean arterial pressure). RESULTS: After one year, PP and RPP increased, as did systolic blood pressure and heart rate. Systolic blood pressure, PP, total white blood cells, and neutrophils correlated with weight gain. After one year, correlations between monocyte-to-lymphocyte ratio and RPP and MAP were observed. CONCLUSION: Our study indicates worsening CVS health over the first year of treatment and emphasises the importance of early monitoring of CVS status using easily accessible parameters to prevent CVS-related mortality.Key pointsPatients with schizophrenia are at higher risk of cardiovascular mortality.The CVS risk could be evaluated using affordable, routinely available CVS markers such as monocyte- and neutrophil-to-lymphocyte ratios, blood pressure, and pulse together with the derived parameters.Our pilot study in first-episode psychosis patients indicates worsening of CVS health based on these parameters during the first year of treatment, the early monitoring of CVS status is highly relevant in clinical practice.
- MeSH
- biologické markery MeSH
- hemodynamika MeSH
- krevní tlak MeSH
- lidé MeSH
- longitudinální studie MeSH
- neutrofily MeSH
- pilotní projekty MeSH
- psychotické poruchy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
