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 phenomenology of the clinical symptoms indicates that disturbance of the sense of self be a core marker of schizophrenia. AIMS: To compare neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia-spectrum disorders (FES, n = 35) and healthy controls (HC, n = 35). METHOD: A functional magnetic resonance imaging (fMRI) using motor task with temporal distortion of the visual feedback was employed. A task-related functional connectivity was analyzed with the use of independent component analysis (ICA). RESULTS: (1) During self-agency experience, FES showed a deficit in cortical activation in medial frontal gyrus (BA 10) and posterior cingulate gyrus, (BA 31; P < .05, Family-Wise Error [FWE] corrected). (2) Pooled-sample task-related ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task. DISCUSSION: During self-agency experience, FES demonstrate deficit in engagement of cortical midline structures along with substantial attenuation of anti-correlated DMN/CEN activity underlying normal self/other-agency discriminative processes.
- MeSH
- Gyrus Cinguli physiopathology MeSH
- Adult MeSH
- Connectome methods MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Nerve Net physiopathology MeSH
- Perceptual Disorders etiology physiopathology MeSH
- Motor Activity MeSH
- Prefrontal Cortex physiopathology MeSH
- Psychomotor Performance MeSH
- Schizophrenia complications physiopathology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Early diagnosis of schizophrenia could improve the outcomes and limit the negative effects of untreated illness. Although participants with schizophrenia show aberrant functional connectivity in brain networks, these between-group differences have a limited diagnostic utility. Novel methods of magnetic resonance imaging (MRI) analyses, such as machine learning (ML), may help bring neuroimaging from the bench to the bedside. Here, we used ML to differentiate participants with a first episode of schizophrenia-spectrum disorder (FES) from healthy controls based on resting-state functional connectivity (rsFC). METHOD: We acquired resting-state functional MRI data from 63 patients with FES who were individually matched by age and sex to 63 healthy controls. We applied linear kernel support vector machines (SVM) to rsFC within the default mode network, the salience network and the central executive network. RESULTS: The SVM applied to the rsFC within the salience network distinguished the FES from the control participants with an accuracy of 73.0% (p = 0.001), specificity of 71.4% and sensitivity of 74.6%. The classification accuracy was not significantly affected by medication dose, or by the presence of psychotic symptoms. The functional connectivity within the default mode or the central executive networks did not yield classification accuracies above chance level. CONCLUSIONS: Seed-based functional connectivity maps can be utilized for diagnostic classification, even early in the course of schizophrenia. The classification was probably based on trait rather than state markers, as symptoms or medications were not significantly associated with classification accuracy. Our results support the role of the anterior insula/salience network in the pathophysiology of FES.
- MeSH
- Adult MeSH
- Connectome methods MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Young Adult MeSH
- Cerebral Cortex diagnostic imaging physiopathology MeSH
- Schizophrenia diagnostic imaging physiopathology MeSH
- Support Vector Machine * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Cognition Disorders ethnology MeSH
- Humans MeSH
- Brain pathology MeSH
- Substance-Related Disorders MeSH
- Prognosis * MeSH
- Prospective Studies MeSH
- Recurrence MeSH
- Risk Factors MeSH
- Schizophrenia * history diagnosis epidemiology etiology drug therapy classification pathology rehabilitation therapy MeSH
- Social Stigma MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
OBJECTIVE: The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. METHODS: The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. RESULTS: Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. CONCLUSION: The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.
- MeSH
- Emotional Intelligence MeSH
- Clinical Competence MeSH
- Humans MeSH
- Needs Assessment MeSH
- Caregivers education MeSH
- Attitude of Health Personnel MeSH
- Prognosis MeSH
- Surveys and Questionnaires MeSH
- Psychiatry education MeSH
- Data Collection MeSH
- Schizophrenia * diagnosis therapy MeSH
- Mental Health Services MeSH
- Social Work, Psychiatric education methods MeSH
- Patient Education as Topic methods MeSH
- Health Knowledge, Attitudes, Practice MeSH
- Focus Groups MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
ACCESSIBLE SUMMARY: Exposure to psychotic states has detrimental effects on the long-term outcome of schizophrenia and brain integrity. Therefore, improving relapse prevention is a key component of long-term management of schizophrenia. Previous studies using continuous monitoring of an individual's early signs of relapse and adopting preventative pharmacological interventions, when early signs are detected, showed promising clinical results in terms of relapse risk reduction. This 18-month multi-centre parallel randomized controlled, open label, trial with telemedicine relapse prevention programme ITAREPS failed to show superiority of maintenance plus prodrome-based targeted medication strategy over treatment as usual. The study, marked by low investigator's adherence, confirmed that absence of pharmacological intervention at early stage of prodrome, critically influenced the risk of relapse. This and previous randomized controlled trials with telemedicine programme ITAREPS suggested that substantial improvement in relapse prevention in schizophrenia is likely to be unattainable under current clinical settings. Future preventive strategies in schizophrenia would require rapid pharmacological intervention upon occurrence of subclinical prodromal symptoms that are undetectable under conventional outpatient practice. Studies with ITAREPS suggested that integration of telemedicine relapse prevention systems and visiting nurse service might together represent practical solution capable to address those requirements. ABSTRACT: The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group (n = 72). In the active arm, investigators increased the antipsychotic dose upon occurrence of prodrome announced by the system. Intention-to-treat analysis showed no between-group difference in the hospitalization-free survival rate [Kaplan-Meier method; hazard ratio (HR) = 1.21, 95% confidence interval (CI): 0.56-2.61, P = 0.6). In a post hoc multivariate Cox proportional hazards model, out of 13 potential predictors, only ITAREPS-related variables (number of alerts without pharmacological intervention/HR = 1.38, P = 0.042/ and patient non-adherence with ITAREPS /HR = 1.08, P = 0.009/) increased the risk of hospitalization. In this trial ITAREPS was not effective. The results in context with previous ITAREPS studies suggest non-adherence of both psychiatrists and patients as the main reasons for the failure of this preventive strategy. Tertiary prevention in schizophrenia have to be regarded a major challenge, warranting the need for implementation of strategies with more active participation of both patient and treating psychiatrist.
- MeSH
- Patient Compliance * MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Psychotic Disorders prevention & control MeSH
- Recurrence MeSH
- Schizophrenia prevention & control MeSH
- Secondary Prevention methods MeSH
- Telemedicine methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Skupinová psychoedukace (SPE) je systematická, strukturovaná a didaktická informace o nemoci a léčbě, určená nemocným a jejich blízkým, jejímž cílem je naučit je dovednostem důležitým pro zvládání nemoci a usnadnit adaptaci na psychotické onemocnění. Zjišťovali jsme názory pacientů na psychoedukaci. V první fázi jsme požádali 105 pacientů (z nichž bylo 46 edukovaných), aby vyplnili detailní dotazník a test znalostí o psychotickém onemocnění. Ve druhé fázi jsme uspořádali 4 skupinové rozhovory, jichž se účastnilo 26 pacientů (z toho 16 edukovaných), a individuální rozhovory s 12 pacienty (z toho 9 edukovaných). Zjisrili jsme, že edukovaní pacienti významně častěji odpovídali správně v testu znalostí. Absolventi edukace oceňovali, že jim SPE přinesla informace o nemoci, ITAREPS (program prevence relapsu s pomocí informačních technologií) považovali za přínosný, uváděli, že psychoedukace přispěla k pochopení nemoci a motivovala je k dodržování léčebného režimu. Nejfrekventovanějším tématem byla možnost „být ve skupině" a vědomí „že nejsem s nemocí sám". Needukovaní pacienti vyjadřovali potřebu získat více informací o prevenci relapsu, vypovídali méně strukturovaně a u části z nich byl patrný nedostatek náhledu. Uzavíráme, že psychoedukace je nepostradatelnou součástí terapeutického plánu pacientů se schizofrenií, protože motivuje pacienty k léčbě a zlepšuje kvalitu života.
Group Family Psychoeducation is systematic, structured, didactic information on the illness and its treatment, which includes i ntegrating emotional aspects in order to enable the participants to cope with the psychotic illness. The aim of our survey was to explore patients ́views about psychoeducation. In the first phase of the research we achieved subjective feedback from 105 patients (46 out of those were educated) who filled in a detailed questionnaire and performed the test of knowledge of psychotic illness. In the se cond phase we collected data from 4 focus groups (26 patients, 16 of them educated) and 12 individual interviews (9 of them educated). Par ticipants in education performed signifficantly better in the test of knowledge compared to non-educated patients. Participants emphasize d the importance of the information about the illness, they wellcomed the ITAREPS programme (Information Technology Aided Relapse Pre - vention in Schizophrenia) and acknowledged that psychoeducation contributed to understanding of the illness and motivated them to adhere to the treatment. Patients addressed their need to share their experiences with others and appreciated the fact that the y were not alone with their problems. Non-educated patients expressed their desire to gaine more knowledge specifically on relapse prevent ion, they delivered less structured answers and some of them demonstrated lack of insight. We conclude that psychoeducation is an indispe nsable part of the treatment of psychotic disorders as it motivates patients to adhere with the treatment and improves their quality o f life.
- MeSH
- Adaptation, Psychological MeSH
- Patient Compliance MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Surveys and Questionnaires MeSH
- Psychotherapy methods MeSH
- Recurrence MeSH
- Interviews as Topic MeSH
- Schizophrenic Psychology * MeSH
- Secondary Prevention MeSH
- Aged MeSH
- Community Mental Health Services * methods utilization MeSH
- Patient Satisfaction statistics & numerical data MeSH
- Statistics as Topic MeSH
- Educational Measurement * statistics & numerical data MeSH
- Patient Education as Topic * methods statistics & numerical data MeSH
- Health Knowledge, Attitudes, Practice MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Aged MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
Uvedený príspevok k problematike stereochémie liečiv je pokusom o zvýraznenie dôležitosti stereo-chemického ponímania farmakológie a o zviditeľnenie pokrokov „chirálnej farmakológie“ v rámcisúčasných poznatkov o selektívnych účinkoch liečiv. Neexistujú jednoduché riešenia v problematike„racemáty–versus–enantioméry“ a každá látka musí byť chápaná a testovaná individuálne, t.j. naprincípe case–by–case. Pre mnoho súčasne dostupných racemátov je pomerne málo poznatkovo farmakologických, toxikologických a farmakokinetických vlastnostiach ich individuálnych enan-tiomérov, alebo o vplyve veku, zdravotného stavu, pohlavia a genetických faktorov na biologickúdostupnosť a odpoveď organizmu na liečivo. Dodatočné testovanie enantiomérov v praxi používa-ných racemátov môže viesť k objavom nových indikácií pôvodného liečiva, zlepšiť jeho klinicképoužitie a vyústiť k zvýšeniu jeho bezpečnosti a účinnosti. Ak je to tak, v tom prípade sú „chirálneúvahy“ vo farmakológii dvojnásobne hodné problémov, ktoré so sebou prinášajú.
The present contribution to the problems of the stereochemistry of drugs is an attempt at stressingthe importance of a stereochemical view of pharmacology and at informing about the advances of„chiral pharmacology“ within the framework of the contemporary knowledge of selective effects ofdrugs. There are no simple solutions in the „racemates versus enantiomers“ problems and eachsubstance must be considered and tested individually, i.e. on the case–by–case principle. For manyracemates available at present there exist relatively few items of knowledge concerning thepharmacological, toxicological and pharmacokinetic properties of their individual enantiomers, orconcerning the influence of age, health condition, sex and genetic factors on biological availabilityand response of the organism to the drug. Additional testing of the enantiomers of the racematesused in practice can lead to the discovery of new indications of the original drug, improve its clinicaluse and result in increasing its safety and efficacy. If it is so, in this case the „chiral meditations“in pharmacology are double worth the problems they pose.
