Given the key roles of the cerebellum in motor, cognitive, and affective operations and given the decline of brain functions with aging, cerebellar circuitry is attracting the attention of the scientific community. The cerebellum plays a key role in timing aspects of both motor and cognitive operations, including for complex tasks such as spatial navigation. Anatomically, the cerebellum is connected with the basal ganglia via disynaptic loops, and it receives inputs from nearly every region in the cerebral cortex. The current leading hypothesis is that the cerebellum builds internal models and facilitates automatic behaviors through multiple interactions with the cerebral cortex, basal ganglia and spinal cord. The cerebellum undergoes structural and functional changes with aging, being involved in mobility frailty and related cognitive impairment as observed in the physio-cognitive decline syndrome (PCDS) affecting older, functionally-preserved adults who show slowness and/or weakness. Reductions in cerebellar volume accompany aging and are at least correlated with cognitive decline. There is a strongly negative correlation between cerebellar volume and age in cross-sectional studies, often mirrored by a reduced performance in motor tasks. Still, predictive motor timing scores remain stable over various age groups despite marked cerebellar atrophy. The cerebello-frontal network could play a significant role in processing speed and impaired cerebellar function due to aging might be compensated by increasing frontal activity to optimize processing speed in the elderly. For cognitive operations, decreased functional connectivity of the default mode network (DMN) is correlated with lower performances. Neuroimaging studies highlight that the cerebellum might be involved in the cognitive decline occurring in Alzheimer's disease (AD), independently of contributions of the cerebral cortex. Grey matter volume loss in AD is distinct from that seen in normal aging, occurring initially in cerebellar posterior lobe regions, and is associated with neuronal, synaptic and beta-amyloid neuropathology. Regarding depression, structural imaging studies have identified a relationship between depressive symptoms and cerebellar gray matter volume. In particular, major depressive disorder (MDD) and higher depressive symptom burden are associated with smaller gray matter volumes in the total cerebellum as well as the posterior cerebellum, vermis, and posterior Crus I. From the genetic/epigenetic standpoint, prominent DNA methylation changes in the cerebellum with aging are both in the form of hypo- and hyper-methylation, and the presumably increased/decreased expression of certain genes might impact on motor coordination. Training influences motor skills and lifelong practice might contribute to structural maintenance of the cerebellum in old age, reducing loss of grey matter volume and therefore contributing to the maintenance of cerebellar reserve. Non-invasive cerebellar stimulation techniques are increasingly being applied to enhance cerebellar functions related to motor, cognitive, and affective operations. They might enhance cerebellar reserve in the elderly. In conclusion, macroscopic and microscopic changes occur in the cerebellum during the lifespan, with changes in structural and functional connectivity with both the cerebral cortex and basal ganglia. With the aging of the population and the impact of aging on quality of life, the panel of experts considers that there is a huge need to clarify how the effects of aging on the cerebellar circuitry modify specific motor, cognitive, and affective operations both in normal subjects and in brain disorders such as AD or MDD, with the goal of preventing symptoms or improving the motor, cognitive, and affective symptoms.

• MeSH
• depresivní porucha unipolární * MeSH
• dospělí MeSH
• konsensus MeSH
• kvalita života MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mozeček patologie   MeSH
• průřezové studie MeSH
• senioři MeSH
• stárnutí MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Ketamine offers promising new therapeutic options for difficult-to-treat depression. The efficacy of treatment response, including ketamine, has been intricately linked to EEG measures of vigilance. This research investigated the interplay between intravenous ketamine and alterations in brain arousal, quantified through EEG vigilance assessments in two distinct cohorts of depressed patients (original dataset: n = 24; testing dataset: n = 24). Clinical response was defined as a decrease from baseline of >33% on the Montgomery-Åsberg Depression Rating Scale (MADRS) 24 h after infusion. EEG recordings were obtained pre-, start-, end- and 24 h post- infusion, and the resting EEG was automatically scored using the Vigilance Algorithm Leipzig (VIGALL). Relative to placebo (sodium chloride 0.9%), ketamine increased the amount of low-vigilance stage B1 at end-infusion. This increase in B1 was positively related to serum concentrations of ketamine, but not to norketamine, and was independent of clinical response. In contrast, treatment responders showed a distinct EEG pattern characterized by a decrease in high-vigilance stage A1 and an increase in low-vigilance B2/3, regardless of whether placebo or ketamine had been given. Furthermore, pretreatment EEG differed between responders and non-responders with responders showing a higher percentage of stage A1 (53% vs. 21%). The logistic regression fitted on the percent of A1 stages was able to predict treatment outcomes in the testing dataset with an area under the ROC curve of 0.7. Ketamine affects EEG vigilance in a distinct pattern observed only in responders. Consequently, the percentage of pretreatment stage A1 shows significant potential as a predictive biomarker of treatment response.Clinical Trials Registration: https://www.clinicaltrialsregister.eu/ctr-search/trial/2013-000952-17/CZ Registration number: EudraCT Number: 2013-000952-17.

• MeSH
• bdění MeSH
• depresivní porucha unipolární * farmakoterapie   MeSH
• elektroencefalografie MeSH
• ketamin * farmakologie   terapeutické užití   MeSH
• lidé MeSH
• mozek MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• depresivní poruchy prevence a kontrola   MeSH
• lidé MeSH
• psoriáza * komplikace   psychologie   MeSH
• Check Tag
• lidé MeSH

The pre- and perinatal environment is thought to play a critical role in shaping brain development. Specifically, maternal mental health and maternal care have been shown to influence offspring brain development in regions implicated in emotional regulation such as the amygdala. In this study, we used data from a neuroimaging follow-up of a prenatal birth-cohort, the European Longitudinal Study of Pregnancy and Childhood, to investigate the impact of early postnatal maternal anxiety/co-dependence, and prenatal and early-postnatal depression and dysregulated mood on amygdala volume and morphology in young adulthood (n = 103). We observed that in typically developing young adults, greater maternal anxiety/co-dependence after birth was significantly associated with lower volume (right: t = -2.913, p = 0.0045, β = -0.523; left: t = -1.471, p = 0.144, β = -0.248) and non-significantly associated with surface area (right: t = -3.502, q = 0.069, <10%FDR, β = -0.090, left: t = -3.137, q = 0.117, <10%FDR, = -0.088) of the amygdala in young adulthood. Conversely, prenatal maternal depression and mood dysregulation in the early postnatal period was not associated with any volumetric or morphological changes in the amygdala in young adulthood. Our findings provide evidence for subtle but long-lasting alterations to amygdala morphology associated with differences in maternal anxiety/co-dependence in early development.

• MeSH
• amygdala diagnostické zobrazování   MeSH
• deprese diagnostické zobrazování   MeSH
• dítě MeSH
• dospělí MeSH
• duševní zdraví MeSH
• lidé MeSH
• longitudinální studie MeSH
• mladý dospělý MeSH
• mozek MeSH
• poporodní deprese * MeSH
• těhotenství MeSH
• zpožděný efekt prenatální expozice * diagnostické zobrazování   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Kazuistika demonstruje úspěšnou ambulantní léčbu pacientky s farmakorezistentní depresí. Přestože moderní medicína již nabízí celou řadu antidepresiv, stále se mnohdy setkáváme s opožděným klinickým nástupem účinku v rozmezí tří až šesti týdnů, nedostatečnou efektivitou či intolerancí léčby, které jsou pro efektivní léčbu značným limitem. Výsledkem je určité procento pacientů, kteří nedosáhnou remise či dlouhodobého snížení symptomů ani po vyčerpání dostupných možností léčby – kombinace antidepresiv, elektrokonvulzivní terapie (ECT), repetitivní transkraniální magnetická stimulace (rTMS), chronoterapie apod. Oproti tomu je u esketaminu evidován promptní efekt a akutní okamžitá úleva od depresivních symptomů, a to včetně sebevražedných myšlenek či plánu k její realizaci (1). Pozitivní efekty léčby esketaminem prokazuje předložená kazuistika pacientky XY, u které se výskyt příznaků depresivního onemocnění od zahájení léčby LP Spravato rapidně snižoval a již po měsíci od zahájení léčby kleslo její skóre na škále MADRS (Montgomery Asberg depression rating scale) z původních 32 na 18 bodů. Pacientka však uváděla subjektivní zlepšení svého stavu již po druhé aplikaci léku. Předložená kazuistika prokazuje zároveň i dlouhodobý efekt léčby, jelikož skóre MADRS zůstalo po dvou měsících užívání stabilně na 18 bodech.

The case report demonstrates the successful outpatient treatment of a patient with treatment-resistant depression (TRD). Although modern medicine already offers a whole range of antidepressants, we still often encounter a delayed clinical onset of effect in the range of three to six weeks, insufficient effectiveness or intolerance of treatment, which are a significant limit for effective treatment. The result is a certain percentage of patients who do not achieve remission or a long-term reduction of symptoms even after exhausting all available treatment options - a combination of antidepressants, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), chronotherapy, etc. In contrast, with esketamine, a prompt effect and acute immediate relief from depressive symptoms is recorded including suicidal thoughts or plans to commit suicide (1). The positive effects of esketamine treatment are demonstrated by the presented case report of the patient XY, in whom the occurrence of symptoms of a depressive illness decreased rapidly after starting treatment with Spravato. One month after starting treatment, her score on the MADRS (Montgomery Asberg depression rating scale) dropped from 32 to 18 points. However, the patient reported a subjective improvement in her condition already after the second application of the drug. The presented case report also demonstrates the long-term effect of the treatment, as after two months of using Spravato, as the MADRS score remained stable at 18 points after two months of use.

• Klíčová slova
• esketamin, Spravato,
• MeSH
• antidepresiva aplikace a dávkování   terapeutické užití   MeSH
• deprese nereagující na léčbu * farmakoterapie   komplikace   MeSH
• ketamin * aplikace a dávkování   terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• depresivní poruchy farmakoterapie   komplikace   MeSH
• dospělí MeSH
• lidé MeSH
• schizofrenie farmakoterapie   komplikace   MeSH
• těhotenství účinky léků   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství účinky léků   MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• komentáře MeSH

Hypománie nebo mánie během léčby antidepresivy (AD) u pacientů s depresivní poruchou (DP) představuje nesnadnou klinickou situaci jak z hlediska rozhodnutí o další diagnóze, tak o následné léčebné strategii. Pohled na antidepresivy navozenou hypománii a mánii (AIHM) není jednoznačný a existuje evidence pro řadu alternativních vysvětlení od pojetí AIHM jako projevu bipolární poruchy po iatrogenně navozenou reverzibilní reakci. Aktuální verze klasifikačních systémů duševních poruch (Diagnostický a statistický manuál duševních poruch, DSM-5; Mezinárodní klasifikace nemocí, ICD-11) nově doporučují považovat hypománie a mánie během léčby AD při trvání plné symptomatické manifestace po ukončení léčby za projev bipolární poruchy (BP) I nebo II. V tomto pojetí se pak další léčba řídí doporučeními pro tuto poruchu, tedy zahájení udržovací léčby. Literatura v této oblasti nicméně nabízí i přístup diferencovanější, zohledňující jak závažnost a trvání AIHM, tak přítomnost rizikových faktorů pro rozvoj bipolární poruchy (bipolární porucha v rodině, časný začátek poruchy, předchozí neuspokojivá odpověď na AD, psychotické či atypické příznaky depresivní epizody či přítomnost komorbidit) a rozhodnutí o udržovací léčbě volit individuálně podle míry „bipolarity“. Nedostatek prospektivních sledování pacientů po AIHM nicméně zatím neumožňuje definitivní závěry.

Hypomania and mania during antidepressant (AD) treatment in major depressive disorder (MDD) is a challenging situation that necessitates a re-evaluation of diagnosis and treatment management. The concept of antidepressant-induced hypomania and mania (AIHM) is not yet unified, and there is evidence for several alternative scenarios, ranging from AIHM as a manifestation of bipolar disorder (BD) to an iatrogenic, reversible effect of AD. The current versions of mental disorder classification systems (Diagnostic and Statistical Manual of Mental Disorders, DSM-5; International Classification of Diseases, ICD-11) recommend that AIHM if a fully syndromic episode persists after the cessation of AD, should be considered a bipolar disorder (BD) type I or II, and management should follow the guidelines for this illness. However, research also supports the possibility of a more differentiated approach that includes an assessment of the severity and duration of AIHM, along with the presence of risk factors for conversion to bipolar disorder (family history of bipolar disorder, early onset of illness, previous unsatisfactory response to AD, psychotic or atypical symptoms, or psychiatric comorbidities), and the decision on maintenance treatment can be made depending on the individual degree of “bipolarity”. However, the lack of prospective follow-up of patients after AIHM does not yet allow definitive conclusions.

• MeSH
• antidepresiva škodlivé účinky   terapeutické užití   MeSH
• bipolární porucha diagnóza   farmakoterapie   MeSH
• depresivní poruchy etiologie   farmakoterapie   MeSH
• duševní poruchy etiologie   klasifikace   MeSH
• lidé MeSH
• mánie * diagnóza   etiologie   farmakoterapie   MeSH
• nežádoucí účinky léčiv psychologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• depresivní poruchy psychologie   rehabilitace   terapie   MeSH
• lidé MeSH
• lůžková kapacita nemocnice MeSH
• psychiatrická rehabilitace * metody   MeSH
• psychiatrie MeSH
• ústavy pro duševně nemocné MeSH
• úzkostné poruchy psychologie   rehabilitace   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• novinové články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• antidepresiva škodlivé účinky   terapeutické užití   MeSH
• depresivní poruchy * diagnóza   farmakoterapie   komplikace   MeSH
• lidé MeSH
• primární zdravotní péče MeSH
• selektivní inhibitory zpětného vychytávání serotoninu aplikace a dávkování   terapeutické užití   MeSH
• trazodon aplikace a dávkování   terapeutické užití   MeSH
• Check Tag
• lidé MeSH

This review covers recent data on the relationship between major depressive disorder (MDD) and faecal microbiome and examines the co-relations between the use of probiotics and changes in psychiatric state. We conducted a thorough search of academic databases for articles published between 2018 and 2022, using specific keywords and previously established inclusion/exclusion criteria regarding faecal microbiota, depressive disorder, and probiotics. Of 192 eligible articles (reviews, original papers, and clinical trials), we selected 10 that fully met our criteria and performed a careful review to determine any correlation between microbiome, probiotic treatment, and depression. All patients were adults (mean age, 36.8), with at least one MDD episode and onset of depression during adolescence (duration of 31.39 years of depressive episodes). We found mixed but mostly positive results regarding the influence of probiotic/prebiotic/postbiotic effects on depression. We could not identify the precise mechanism of action that led to their improvement. Antidepressants did not alter the microbiota, according to studies that evaluated this aspect. Probiotic/prebiotic/postbiotic treatments were proven to be safe, with few and mild side effects. Probiotics seemingly could be beneficial in patients with depression, as evidenced by well-established depression scales. Based on this finding and the high tolerability and safety of probiotics, no caveats against their routine use can be made. Some unmet needs in this field include determination of the dominant type of microbiota in specific patients with depression; study of microbiome-directed/driven treatment regarding dose and duration adjustments; and multiple versus single strain treatments.

• MeSH
• deprese etiologie   MeSH
• depresivní porucha unipolární * farmakoterapie   psychologie   MeSH
• dospělí MeSH
• lidé MeSH
• mikrobiota * MeSH
• mladiství MeSH
• osa mozek-střevo MeSH
• probiotika * terapeutické užití   farmakologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH