- MeSH
- disociační poruchy MeSH
- lidé MeSH
- schizofrenie (psychologie) MeSH
- schizofrenie * komplikace diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- úvodníky MeSH
OBJECTIVE: The MATRICS consensus cognitive battery (MCCB) is a widely used neuropsychological battery for the assessment of cognitive dysfunction in schizophrenia. However, the accuracy of measurement is dependent on suitable normative data which are in the Czech Republic lacking. METHOD: The Czech academic research translation of the MCCB battery was administered to a sample of healthy volunteers aged 17 to 62 years (N = 573) and the effects of age, education and sex were examined. In addition, a comparison was made to examine the differences between the US and current normative data. RESULTS: Consistent with previous studies, significant effects of age, sex and education were found, however, in sex and education in distinct MCCB-domains. By comparing the original and current normative data, significant differences with small to large effect sizes were revealed in all domains except for Verbal Learning. CONCLUSIONS: We present nationally specific MCCB regression-based and tabular normative data applicable in research and clinical settings.
- MeSH
- kognice * MeSH
- konsensus MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- schizofrenie (psychologie) * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. METHODS: Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. RESULTS: The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. CONCLUSIONS: The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct "cores" of schizophrenia, the "Positive" and the "Negative," while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- progrese nemoci MeSH
- schizofrenie (psychologie) * MeSH
- schizofrenie diagnóza MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
OBJECTIVES: Biological strategies to improve treatment efficacy in clozapine-treated patients are urgently needed. Repetitive transcranial magnetic stimulation (rTMS) merits consideration as intervention for patients with persistent auditory hallucinations (AH) or negative symptoms (NS) not responding sufficiently to clozapine treatment. METHODS: Data from 10 international RCTs of rTMS for patients being treated with clozapine were pooled. Two levels of symptomatic response were defined: improvement of ≥20% and ≥50% on study-specific primary endpoint scales. Changes in the positive and negative syndrome scale (PANSS) from baseline to endpoint assessment were also analysed. RESULTS: Analyses of 131 patients did not reveal a significant difference for ≥20% and ≥50% response thresholds for improvement of AH, negative or total symptoms between active and sham rTMS groups. The number needed to treat (NNT) for an improvement in persistent AH was nine following active rTMS. PANSS scores did not improve significantly from baseline to endpoint between active and sham groups in studies investigating NS and AH. CONCLUSIONS: rTMS as a treatment for persistent symptoms in clozapine-treated patients did not show a beneficial effect of active compared to sham treatment. For AH, the size of the NNTs indicates a possible beneficial effect of rTMS.
LEARNING OBJECTIVE: After participating in this activity, learners should be better able to:• Evaluate the anti-hostility effects of available atypical antipsychotic agents. ABSTRACT: In addition to hallucinations and delusions, persons with schizophrenia may exhibit hostility. In clinical trials of antipsychotics, hostility is routinely measured as part of rating scales such as the Brief Psychiatric Rating Scale or Positive and Negative Syndrome Scale. The availability of the atypical antipsychotic clozapine in 1989 led to the observation that it is possible to have a treatment effect on hostility that is independent of the treatment effect on hallucinations or delusions, and independent of general sedative effects. The data supporting this notion of a specific anti-hostility effect are the most robust for clozapine as the data include specifically designed randomized, controlled clinical trials. A specific anti-hostility effect is also observable to various degrees with most of the other atypical antipsychotics, as evidenced in post hoc analyses of clinical trials originally conducted for regulatory purposes, supplemented by post hoc analyses of large effectiveness trials. The generalizability of these studies, however, may be limited. Participants in these trials were not selected for aggressive and hostile behavior. Some of the studies also excluded patients with substance use disorders. The latter is particularly important because alcohol and substance use are well known to increase risk for hostility and aggression. Nevertheless, the repeated demonstrations of the specificity of an anti-hostility effect (in terms of statistical independence of effects on other positive symptoms and of sedation) are of potential clinical importance.
Depresivní příznaky u schizofrenie jsou časté a mohou mít dalekosáhlé následky. Nejzávažnější je suicidální jednání. Ohroženi jsou zejména nemocní v iniciální fázi onemocnění. Je zřejmě více etiopatogenetických mechanismů, které vedou k rozvoji deprese u schizofrenní poruchy. Z léčebných přístupů je na prvním místě doporučována manipulace s antipsychotiky (snížení dávky, změna), dále augmentace antidepresivy. Málo údajů máme o dalších možnostech, např. augmentaci stabilizátory nálady. Z nefarmakologických přístupů jsou nadějné stimulační metody. U nemocných s výraznými zánětlivými markery může být účinná augmentace protizánětlivými látkami.
Depressive symptoms occur frequently in patients with schizophrenia and may have far-reaching consequences. Suicidality is the most severe problem. Patients during the initial phase of the disease are particularly at high risk. There are obviously more etiopathogenetic mechanisms leading to development of depression in schizophrenia. Among treatment approaches at the first place a manipulation with antipsychotics (low-ering the dosage, switching antipsychotics); further, augmentation with antidepressants are recommended. We have limited data about other possibilities, for example augmentation with mood stabilizers. Non-pharmacological approaches such as stimulation methods seem to be promising. In patients with marked inflammatory markers an augmentation with anti-inflammatory agents might be successful.
- MeSH
- antidepresiva terapeutické užití MeSH
- antipsychotika terapeutické užití MeSH
- deprese * etiologie farmakoterapie komplikace MeSH
- klinická studie jako téma MeSH
- komorbidita MeSH
- látky ovlivňující centrální nervový systém terapeutické užití MeSH
- lidé MeSH
- schizofrenie (psychologie) * MeSH
- sebevražda psychologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
OBJECTIVE: Schizophrenia has recently been associated with widespread white matter microstructural abnormalities, but the functional effects of these abnormalities remain unclear. Widespread heterogeneity of results from studies published to date preclude any definitive characterization of the relationship between white matter and cognitive performance in schizophrenia. Given the relevance of deficits in cognitive function to predicting social and functional outcomes in schizophrenia, the authors carried out a meta-analysis of available data through the ENIGMA Consortium, using a common analysis pipeline, to elucidate the relationship between white matter microstructure and a measure of general cognitive performance, IQ, in patients with schizophrenia and healthy participants. METHODS: The meta-analysis included 760 patients with schizophrenia and 957 healthy participants from 11 participating ENIGMA Consortium sites. For each site, principal component analysis was used to calculate both a global fractional anisotropy component (gFA) and a fractional anisotropy component for six long association tracts (LA-gFA) previously associated with cognition. RESULTS: Meta-analyses of regression results indicated that gFA accounted for a significant amount of variation in cognition in the full sample (effect size [Hedges' g]=0.27, CI=0.17-0.36), with similar effects sizes observed for both the patient (effect size=0.20, CI=0.05-0.35) and healthy participant groups (effect size=0.32, CI=0.18-0.45). Comparable patterns of association were also observed between LA-gFA and cognition for the full sample (effect size=0.28, CI=0.18-0.37), the patient group (effect size=0.23, CI=0.09-0.38), and the healthy participant group (effect size=0.31, CI=0.18-0.44). CONCLUSIONS: This study provides robust evidence that cognitive ability is associated with global structural connectivity, with higher fractional anisotropy associated with higher IQ. This association was independent of diagnosis; while schizophrenia patients tended to have lower fractional anisotropy and lower IQ than healthy participants, the comparable size of effect in each group suggested a more general, rather than disease-specific, pattern of association.
- MeSH
- analýza hlavních komponent MeSH
- anizotropie MeSH
- bílá hmota diagnostické zobrazování MeSH
- dospělí MeSH
- faktorová analýza statistická MeSH
- inteligence * MeSH
- kognice fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozek diagnostické zobrazování MeSH
- nervové dráhy diagnostické zobrazování MeSH
- schizofrenie (psychologie) * MeSH
- schizofrenie diagnostické zobrazování patofyziologie MeSH
- studie případů a kontrol MeSH
- Wechslerovy škály MeSH
- zdraví dobrovolníci pro lékařské studie MeSH
- zobrazování difuzních tenzorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
We aimed to validate the Czech version of the MATRICS Consensus Cognitive Battery (MCCB). The MCCB is a test battery designed to assess cognitive treatment effects in clinical trials of patients with schizophrenia. The valid, reliable and replicable measurement of cognition in schizophrenia is of substantial importance for such clinical trial studies. We performed a psychometric analysis of the MCCB composite and domain scores based on ROC analysis of 67 schizophrenia patients and 67 age- and education-matched healthy controls from a total sample of 220 controls. Also, we correlated MCCB variables with scales measuring psychosocial functioning (Personal and Social Performance scale; PSP). The internal consistency of all 10 tests in the MCCB battery was good (Cronbach's α = 0.85 (95% CI [0.83, 0.88])). The discriminative validity for the detection of neurocognitive dysfunction in schizophrenia based on the area under the curve of MCCB composite T-score was ≥90% (95% CI [0.85, 0.96]) and all MCCB domains showed ps < .001. The MCCB global composite and the Speed of Processing domain score significantly predicted the PSP ratings. A confirmatory factor analysis on the whole control sample (N = 220) showed an optimal fit for a 6-factor in comparison to 1-factor solution. In conclusion, we found high discriminative validity for the Czech MCCB version, similar to the differentiation of schizophrenia versus healthy control groups in the original MCCB studies. We also established the factorial validity of the MCCB and showed that the overall composite of the MCCB predicts psychosocial functioning in the patient group.
- MeSH
- kognice MeSH
- konsensus MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- psychiatrické posuzovací škály MeSH
- schizofrenie (psychologie) MeSH
- schizofrenie * komplikace diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
2. vydání 140 stran : ilustrace ; 21 cm
Publikace v první části přináší silné příběhy devatenácti mladých lidí, kteří onemocněli schizofrenií. Ve druhé části knihy vyprávějí matky duševně nemocných mladých lidí o tom, jak prožívaly a prožívají onemocnění svých potomků. Život člověka s vážným duševním onemocněním je tak zachycen ze dvou perspektiv. Čtenář získá autentický a dostatečně plastický pohled na to, co prožívají duševně nemocní mladí lidé i jejich blízcí. Nakladatelská anotace
- MeSH
- duševně nemocní psychologie MeSH
- péče o dítě psychologie MeSH
- schizofrenie (psychologie) MeSH
- schizofrenie * terapie MeSH
- vztahy mezi matkou a dítětem psychologie MeSH
- Publikační typ
- populární práce MeSH
- Konspekt
- Psychiatrie
- NLK Obory
- psychiatrie
- psychologie, klinická psychologie
- NLK Publikační typ
- příběhy
