Sedmačtyřicetiletá pacientka byla hospitalizována pro svoji 5. depresivní epizodu v rámci periodické depresivní poruchy, současnou těžkou fázi se suicidálními ideacemi. Opakované pokusy antidepresivní léčby byly neúspěšné a pacientka plánovala eutanazii v zahraničí. Celkové skóre 8položkové verze Sheehanovy škály suicidality (S-STS 10.0) bylo 28. Mimo depresivní poruchy sužovaly pacientku četné somatické komorbidity. Pro závažné suicidální ideace jsme zahájili akutní léčbu ketaminem 2× týdně, nejdříve intranasálně a později subkutánně. Po 4 aplikacích ketaminu byla pacientka propuštěna do ambulantní udržovací léčby. Tam se po 9. aplikaci ustálil interval subkutánní aplikace ketaminu na frekvenci 1× týdně. Od 14. aplikace přešla pacientka na i. m. aplikaci ketaminu, kterou hodnotila jako efektivnější. V době publikace kazuistiky trvá udržovací léčba ketaminem 12 měsíců. Poslední hodnota celkového skóre suicidality S-STS 10.0 byla 6. Jedná se o redukci celkového skóre suicidality o více než 70 %. Dlouhodobá léčba ketaminem byla efektivnější v léčbě rezistentní deprese se suicidálními ideacemi než kombinace antidepresiv.
A 47-year-old female patient was hospitalized for her 5th depressive episode within periodic depressive disorder, the current phase severe with suicidal ideation. Despite repeated treatment with antidepressants, she considered euthanasia abroad. She had reached a total score of 28 on the 8-item version of the Sheehan Suicidality Scale (S-STS 10.0). In addition to depressive disorders, the patient suffered from numerous somatic comorbidities. We started acute treatment with ketamine twice a week, first intranasally and later subcutaneously. After four applications of ketamine, the patient was discharged to outpatient maintenance treatment. Considering the duration of ketamine ́s effect, the interval of once per week was established after nine applications and the patient switched to i. m. applications, which she rated as more effective compared do s.c. Ketamine maintenance treatment lasts 12 months at the time of publication. The last value of the total suicidality score of the S-STS 10.0 was 6. This is a reduction of the total score by more than 70%. Long-term treatment with ketamine was more effective in treating treatment resistant depression with suicidal ideation than a combination of antidepressants.
- MeSH
- antidepresiva aplikace a dávkování škodlivé účinky MeSH
- bolest farmakoterapie komplikace MeSH
- chování sebezraňující etiologie farmakoterapie MeSH
- depresivní poruchy * etiologie farmakoterapie komplikace patologie MeSH
- ketamin * aplikace a dávkování MeSH
- klinická studie jako téma MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- migréna farmakoterapie komplikace terapie MeSH
- sebevražedné myšlenky MeSH
- tryptaminy škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
PROBLEM: Up to 75 % of at-risk perinatal women do not receive treatment in Czechia. BACKGROUND: Pregnant women with mental health difficulties are more likely to undergo less controversial nonpharmaceutical treatment during pregnancy, but structural and psychological barriers interfere with their capacity to seek professional help. AIM: We tested the effectiveness of the telephone-based peer support intervention Mom Supports Mom (MSM) in Czech pregnant women at risk of mental disorder. METHODS: The Edinburgh Postnatal Depression Scale (EPDS) was used to assess risk in women (EPDS ≥ 10). Women at risk were randomized into two groups; the intervention group received the MSM, while the control group received the care as usual, which did not contain any psychological support intervention. One month after completing the EPDS, the women's mental statuses were again measured and compared, this time with data before and after the intervention, using the Perinatal Anxiety Screening Scale (PASS) to measure anxiety, the EPDS to measure depression, the Prenatal Psychosocial Profile (PPP) to measure stress, and the Prenatal Attachment Inventory - Revised (PAI-R) to measure attachment. The trial was registered under the name Pregnancy without psychosocial stress (ClinicalTrials.gov ID NCT04853693). FINDINGS: A total of 167 women were included in the study and randomized into two groups. Depressive symptoms did not decrease (Cohen ́s d; 95 % CI = 0.48; 0.17-0.79; p = .002), but levels of anxiety (Cohen ́s d; 95 % CI = 0.44; 0.13-0.75; p = .005) and psychosocial stress (Cohen ́s d; 95 % CI = 0.55; 0.20-0.82; p = .002) were reduced in women in the intervention group compared with women in the control. In addition, prenatal attachment increased among intervened women (Cohen ́s d; 95 % CI = 0.48; 0.17-0.79; p = .002). DISCUSSION: The telephone-based peer support intervention MSM is effective in reducing stress and anxiety and increasing prenatal attachment but does not reduce depression among high-risk women.
- MeSH
- dospělí MeSH
- lidé MeSH
- matky psychologie MeSH
- prenatální péče metody MeSH
- psychiatrické posuzovací škály MeSH
- sociální opora * MeSH
- těhotenství MeSH
- těhotné ženy MeSH
- vyrovnaná skupina * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Lateral ventricular enlargement represents a canonical morphometric finding in chronic patients with schizophrenia; however, longitudinal studies elucidating complex dynamic trajectories of ventricular volume change during critical early disease stages are sparse. METHODS: We measured lateral ventricular volumes in 113 first-episode schizophrenia patients (FES) at baseline visit (11.7 months after illness onset, SD = 12.3) and 128 age- and sex-matched healthy controls (HC) using 3T MRI. MRI was then repeated in both FES and HC one year later. RESULTS: Compared to controls, ventricular enlargement was identified in 18.6% of patients with FES (14.1% annual ventricular volume (VV) increase; 95%CI: 5.4; 33.1). The ventricular expansion correlated with the severity of PANSS-negative symptoms at one-year follow-up (p = 0.0078). Nevertheless, 16.8% of FES showed an opposite pattern of statistically significant ventricular shrinkage during ≈ one-year follow-up (-9.5% annual VV decrease; 95%CI: -23.7; -2.4). There were no differences in sex, illness duration, age of onset, duration of untreated psychosis, body mass index, the incidence of Schneiderian symptoms, or cumulative antipsychotic dose among the patient groups exhibiting ventricular enlargement, shrinkage, or no change in VV. CONCLUSION: Both enlargement and ventricular shrinkage are equally present in the early stages of schizophrenia. The newly discovered early reduction of VV in a subgroup of patients emphasizes the need for further research to understand its mechanisms.
- MeSH
- dospělí MeSH
- lidé MeSH
- longitudinální studie MeSH
- magnetická rezonanční tomografie * MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mozkové komory diagnostické zobrazování patologie MeSH
- progrese nemoci MeSH
- schizofrenie * diagnostické zobrazování patologie patofyziologie MeSH
- studie případů a kontrol MeSH
- ventriculi laterales diagnostické zobrazování patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Negative symptoms (NS) represent a detrimental symptomatic domain in schizophrenia affecting social and occupational outcomes. AIMS: We aimed to identify factors from the baseline visit (V1) - with a mean illness duration of 0.47 years (SD = 0.45) - that predict the magnitude of NS at the follow-up visit (V3), occurring 4.4 years later (mean +/- 0.45). METHOD: Using longitudinal data from 77 first-episode schizophrenia spectrum patients, we analysed eight predictors of NS severity at V3: (1) the age at disease onset, (2) age at V1, (3) sex, (4) diagnosis, (5) NS severity at V1, (6) the dose of antipsychotic medication at V3, (7) hospitalisation days before V1 and; (8) the duration of untreated psychosis /DUP/). Secondly, using a multiple linear regression model, we studied the longitudinal relationship between such identified predictors and NS severity at V3 using a multiple linear regression model. RESULTS: DUP (Pearson's r = 0.37, p = 0.001) and NS severity at V1 (Pearson's r = 0.49, p < 0.001) survived correction for multiple comparisons. The logarithmic-like relationship between DUP and NS was responsible for the initial stunning incremental contribution of DUP to the severity of NS. For DUP < 6 months, with the sharpest DUP/NS correlation, prolonging DUP by five days resulted in a measurable one-point increase in the 6-item negative symptoms PANSS domain assessed 4.9 (+/- 0.6) years after the illness onset. Prolongation of DUP to 14.7 days doubled this NS gain, whereas 39 days longer DUP tripled NS increase. CONCLUSION: The results suggest the petrification of NS during the early stages of the schizophrenia spectrum and a crucial dependence of this symptom domain on DUP. These findings are clinically significant and highlight the need for primary preventive actions.
BACKGROUND: The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. METHODS: Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. RESULTS: There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. DISCUSSION: Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.
Schizophrenia is frequently associated with obesity, which is linked with neurostructural alterations. Yet, we do not understand how the brain correlates of obesity map onto the brain changes in schizophrenia. We obtained MRI-derived brain cortical and subcortical measures and body mass index (BMI) from 1260 individuals with schizophrenia and 1761 controls from 12 independent research sites within the ENIGMA-Schizophrenia Working Group. We jointly modeled the statistical effects of schizophrenia and BMI using mixed effects. BMI was additively associated with structure of many of the same brain regions as schizophrenia, but the cortical and subcortical alterations in schizophrenia were more widespread and pronounced. Both BMI and schizophrenia were primarily associated with changes in cortical thickness, with fewer correlates in surface area. While, BMI was negatively associated with cortical thickness, the significant associations between BMI and surface area or subcortical volumes were positive. Lastly, the brain correlates of obesity were replicated among large studies and closely resembled neurostructural changes in major depressive disorders. We confirmed widespread associations between BMI and brain structure in individuals with schizophrenia. People with both obesity and schizophrenia showed more pronounced brain alterations than people with only one of these conditions. Obesity appears to be a relevant factor which could account for heterogeneity of brain imaging findings and for differences in brain imaging outcomes among people with schizophrenia.
Syndrom bludné misidentifikace je zastřešujícím pojmem pro chybné určování totožnosti zejména osob, ale i míst, předmětů či událostí, často doprovázené bludným přesvědčením o jejich proměně či existenci dvojníků. Mezi nejčastější fenomény řazené k této skupině patří Capgrasův a Fregoliho syndrom. Článek poskytuje stručný souhrn dosavadních informací o daných syndromech, prezentuje dvě kazuistiky pacientek hospitalizovaných na oddělení pro léčbu psychotických poruch na jaře roku 2021 a diskutuje možné klinicko-neurobiologické implikace získaných poznatků
Delusional misidentification syndrome is an umbrella term for disorders of identification of predominantly persons, but also places, objects or events, accompanied particularly by delusional belief in the existence of doppelgängers, with Capgras and Fregoli syndromes amongst the most common phenomena within the syndrome. Following article provides a brief summary of current knowledge on these conditions along with two case reports of patients treated in our ward during spring 2021 and discussion of possible clinical and neurobiological implications.
- Klíčová slova
- Delusional misidentification syndrome, Syndrom bludné misidentifikace,
- MeSH
- antipsychotika aplikace a dávkování MeSH
- bludy MeSH
- Capgrasův syndrom * diagnostické zobrazování diagnóza farmakoterapie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurokognitivní poruchy diagnóza farmakoterapie MeSH
- olanzapin aplikace a dávkování MeSH
- paliperidon palmitát aplikace a dávkování MeSH
- schizofrenie a poruchy s psychotickými rysy diagnóza farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Obesity is highly prevalent in schizophrenia, with implications for psychiatric prognosis, possibly through links between obesity and brain structure. In this longitudinal study in first episode of psychosis (FEP), we used machine learning and structural magnetic resonance imaging (MRI) to study the impact of psychotic illness and obesity on brain ageing/neuroprogression shortly after illness onset. METHODS: We acquired 2 prospective MRI scans on average 1.61 years apart in 183 FEP and 155 control individuals. We used a machine learning model trained on an independent sample of 504 controls to estimate the individual brain ages of study participants and calculated BrainAGE by subtracting chronological from the estimated brain age. RESULTS: Individuals with FEP had a higher initial BrainAGE than controls (3.39 ± 6.36 vs 1.72 ± 5.56 years; β = 1.68, t(336) = 2.59, P = .01), but similar annual rates of brain ageing over time (1.28 ± 2.40 vs 1.07±1.74 estimated years/actual year; t(333) = 0.93, P = .18). Across both cohorts, greater baseline body mass index (BMI) predicted faster brain ageing (β = 0.08, t(333) = 2.59, P = .01). For each additional BMI point, the brain aged by an additional month per year. Worsening of functioning over time (Global Assessment of Functioning; β = -0.04, t(164) = -2.48, P = .01) and increases especially in negative symptoms on the Positive and Negative Syndrome Scale (β = 0.11, t(175) = 3.11, P = .002) were associated with faster brain ageing in FEP. CONCLUSIONS: Brain alterations in psychosis are manifest already during the first episode and over time get worse in those with worsening clinical outcomes or higher baseline BMI. As baseline BMI predicted faster brain ageing, obesity may represent a modifiable risk factor in FEP that is linked with psychiatric outcomes via effects on brain structure.
- MeSH
- dospělí MeSH
- index tělesné hmotnosti MeSH
- lidé MeSH
- longitudinální studie MeSH
- magnetická rezonanční tomografie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- obezita komplikace diagnostické zobrazování patologie patofyziologie MeSH
- předčasné stárnutí diagnostické zobrazování etiologie patologie patofyziologie MeSH
- progrese nemoci * MeSH
- psychotické poruchy diagnostické zobrazování patologie patofyziologie MeSH
- rizikové faktory MeSH
- strojové učení * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Navzdory pokračujícímu výzkumu na poli schizofrenie se stále v klinické praxi setkáváme s limitujícími faktory léčby tohoto onemocnění. Navozená remise je často nekvalitní vzhledem k přetrvávajícím nežádoucím účinkům medikace, negativním příznakům a kognitivní deterioraci. V posledních letech došlo k uvedení několika nových antipsychotik slibujících posun ve výše zmíněných oblastech. Jedním z těchto preparátů je parciální agonista dopaminových receptorů kariprazin. O jeho výhodách bylo v české literatuře napsáno již několik článků. Následující kazuistiku předkládáme jako příklad praktického využití této medikace.
Despite continuous research in the field of schizophrenia, there are still limiting factors in treatment of this illness. Remission is often of poor-quality because of adverse effects of medication, negative symptoms and cognitive deterioration. Recently new antipsychotic promising advance in limitations mentioned above were introduced. One of those is cariprazine, partial agonist of dopamine receptors. Several articles regarding its advantages have been already published in Czech literature. We present this following case study as an example of practical use of this medication.
- Klíčová slova
- kariprazin,
- MeSH
- antipsychotika aplikace a dávkování terapeutické užití MeSH
- dospělí MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- piperaziny * aplikace a dávkování terapeutické užití MeSH
- psychotické poruchy diagnóza farmakoterapie MeSH
- schizofrenie * farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
