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11 záznamů v Medvik Filtry

Článek

Disociativní poruchy a možnosti psychofarmakoterapie
[Dissociative disorders and possibilities of psychopharmacotherapy]

Večeřová-Procházková, Alena, 1971-
Autor Autorita Psychiatrická ambulance, Gyncare s. r. o., Praha

Psychiatrie pro praxi. 2013 ; 14 (2) : 62-65.

Psychiatr. praxi (Print)
ISSN 1213-0508
Medvik
Zdroj

V psychopatologii se disociace projevuje především poruchami integrace funkcí paměti, identity a vědomí, v situacích, kdy se psychika jedince není schopna vyrovnat s určitým psychickým obsahem. Za jádrové symptomy jsou považovány amnézie, depersonalizace, derealizace a narušení identity. Spektrum komorbidit zahrnuje symptomy afektivních, úzkostných, psychotických poruch a poruch kontroly impulzů. Terapeutickou metodou volby je psychoterapie, psychofarmakoterapie je cílená na zmírnění či odstranění příznaků komorbidních poruch. Používají se antidepresiva SSRI a SNRI, antipsychotika druhé generace, antiepileptika a thymostabilizéry.

The pathological dissociation is manifested primarily in loss of normally integrated functions of memory, identity and consciousness, in situations where the individual psyche is not able to cope with an unacceptable mental content. Amnesia, depersonalization, derealisation and identity disturbances are considered as the core symptoms The wide range of comorbid symptoms include affective symptoms, anxiety, psychotic misperception and impulse-dyscontrol.The therapeutic method of choice is psychotherapy, psychopharmacotherapy is targeted to reduce or eliminate comorbid symptoms. SSRIs and SNRI antidepressants, second -generation antipsychotics, anticonvulsants and mood stabilisers are recommended.

MeSH
disociační poruchy * diagnóza farmakoterapie klasifikace MeSH
lidé MeSH
posttraumatická stresová porucha komplikace patofyziologie MeSH
psychotropní léky * terapeutické užití MeSH
Check Tag
lidé MeSH
Publikační typ
přehledy MeSH

Článek

EEG complexity and attentional processes related to dissociative states

Clinical EEG and neuroscience. 2011 ; 42 (3) : 175-9.

Clin EEG Neurosci
ISSN 1550-0594
Medvik
Zdroj

Reported findings indicate that attentional narrowing is related to decreased complexity and increased inhibition of neural assemblies. These findings suggest that analysis of electroencephalogram (EEG) complexity could present a useful method for research of attentional changes related to dissociation. To examine this model we used a case study to test the two hypotheses: (1) that successful anticonvulsant medication would result in dissociative symptom alleviation, improvement of inhibitory neural functions, and decreased EEG complexity, and (2) that cognitive conflict, related to aversive events in the patient's past experience, during reliving of a dissociative state would lead to greater allocation of attention and decreased EEG complexity. Three EEG studies recorded in the eyes closed non-drowsy state were performed: (1) at baseline, (2) post-induction of dissociative state, and (3) post-anticonvulsant medication following induction of dissociative state. A dissociative state was achieved following an interview regarding the patient's aversive past experiences through use of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The patient's level of dissociation was measured using the Dissociative Experiences Scale-II (DES-II). The PDEQ interview and DES-II assessment were also used one hour following the oral consumption of an anticonvulsant medication (clonazepam 2mg). Analysis of the data revealed that complexity values (PD2) are significantly lower following the oral consumption of clonazepam (2mg) in the majority of EEG channels. Additionally, complexity during the reliving of a dissociative state was statistically significantly lower than both the baseline and post-medication conditions in all but two EEG channels. Results of the case study suggest that changes in attentional processes linked to dissociation are related to: (1) decreased complexity when attention is extremely focused because of attentional narrowing to the disturbing past experience, and (2) increased complexity during ordinary experiences when attention is less narrowly focused.

MeSH
antikonvulziva terapeutické užití MeSH
arousal fyziologie MeSH
disociační poruchy diagnóza farmakoterapie patofyziologie MeSH
dospělí MeSH
elektroencefalografie metody MeSH
klonazepam terapeutické užití MeSH
lidé MeSH
pozornost fyziologie MeSH
psychometrie MeSH
úzkostné poruchy diagnóza patofyziologie MeSH
Check Tag
dospělí MeSH
lidé MeSH
mužské pohlaví MeSH
Publikační typ
časopisecké články MeSH
kazuistiky MeSH
práce podpořená grantem MeSH

Článek

Panic disorder, autonomic nervous system and dissociation - changes during therapy

Neuro-endocrinology letters. 2011 ; 32 (5) : 641-51.

Neuro-endocrinol. lett.
ISSN 0172-780X
Medvik
Zdroj

OBJECTIVES: Alarming somatic symptoms and in particular the cardiovascular symptoms, are the characteristic features of panic attacks. Increased cardiac mortality and morbidity have been proposed in these patients. Power spectral analysis of electrocardiogram R-R intervals is known to be a particularly successful tool in the detection of autonomic instabilities in various clinical disorders. Heart rate variability (HRV) has been found to be the outcome of rapidly reacting cardiovascular control systems. The aim of our study is to measure very low frequency band (VLF), low frequency band (LF) and high frequency band (HF) components of R-R interval during orthostatic experiment in patients with panic disorder before and after treatment and compares it with healthy controls. METHODS: We assessed heart rate variability in 19 patients with panic disorder before and after 6-weeks treatment with antidepressants combined with cognitive behavioral therapy (CBT) and in 18 healthy controls. Diagnosis was done according to the ICD-10 research diagnostic criteria confirmed with MINI (MINI international neuropsychiatric interview). Patients were treated with CBT and psychotropics. They were regularly every week assessed using CGI (Clinical Global Impression), BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory). Heart rate variability was assessed during 3 positions (1st - 5 min supine; 2nd - 5 min standing; 3rd - 5 min supine) before and after the treatment. Power spectra were computed for very low frequency - VLF (0.0033-0.04 Hz), low-frequency - LF (0.04-0.15 Hz) and high frequency - HF (0.15-0.40 Hz) bands using fast Fourier transformation. RESULTS: Nineteen panic disorder patients resistant to pharmacological treatment entered a 6-week open-label treatment study with combination of SSRI and CBT. The combination of CBT and pharmacotherapy proved to be an effective treatment in these patients. The patients significantly improved during the study period in all rating scales. There were highly statistical significant differences between panic patients and control group in all components of power spectral analysis in 2nd (VLF, LF and H in standing) and in two component of 3rd (LF and HF in supine) positions. There was also a statistically significant difference between these two groups in LF/HF ratio in standing position (2nd). During therapy there was a tendency increasing values in all three positions in components of HRV power spectra, but HF in 1st supine position was the only component where the increase reached the level os statistical significance. CONCLUSIONS: These findings demonstrate a lower autonomic activity in panic disorder patients measured during the changes of postural position in comparison with healthy controls and tendency to increase this autonomic power during the treatment.

Článek

Disociace nesouvisela s horší odpovědí na kognitivně-behaviorální terapii u pacientů s obsedantně-kompulzivní poruchou
[Dissociation was not associated with worse treatment outcome to cognitive behavioral therapy in patients with obsessive-compulsive disorder]

Psychiatrie (Praha, Print). 2011 ; 15 (1) : 4-8.

Medvik
Zdroj

Obsedantně-kompuzivni porucha (OCD) je z 40-60 % refrakterní k léčebným intervencím. Disociace je jedním z potenciálních klinických negativních prediktorů terapie. Cílem studie bylo prozkoumat, zda vyšší míra disociace souvisí s horší odpovědí na kognitivněoehaviorální terapii (KBT) u pacientů s OCD. Metodika: Do studie bylo zařazeno 44 pacientů (25 žen) s OCD a 45 zdravých kontrol (30 žen). Pacienti podstoupili systematickou skupinovou KBT v délce 6-8 týdnů. Míra disociace byla hodnocena na začátku terapie pomocí subjektivního dotazníku - Dissociative Experiences Scale (DES). Závažnost psychopatologie byla u pacientů s OCD hodnocena pomocí objektivního dotazníku Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beckovy sebeposuzovací stupnice iízkosti (BAI - Beck Anxiety Inventory) a Beckovy sebeposuzovací stupnice deprese (BDI-II - Beck Depression Inventory-II) na začátku a na konci terapie. Výsledky: Po terapii došlo k výraznému poklesu intenzity obsesí a kompulzí. Odpověď na terapii nesouvisela s mírou disociace na začátku terapie. Absolutní, ale ne relativní, snížení intenzity OCD symptomů bylo ovlivněno počáteční závažností specifických příznaků OCD. Závěr: Disociativní příznaky na začátku terapie neměly významný vliv na změnu závažnosti OCD příznaků po KBT u pacientů s OCD. Jelikož disociace úzce souvisí s anxietou a depresivními příznaky, bylo by vhodné zkoumat vliv disociace na změnu úzkostnědepresivních symptomů u širšího spektra pacientů.

Obsessive-compulsive disorder (OCD) is refractory to therapeutic interventions in 40–60%. Dissociation is one of the potential clinical negative predictors of treatment outcome. The aim of the present study was to evaluate whether more severe dissociation is asso ciated with worse treatment outcome after cognitive behavioral therapy (CBT) in patients with OCD. Methods: The study sample comprised 44 patients with OCD (25 females) and 45 healthy controls (30 females). The patients under- went systematic group CBT for 6-8 weeks. Dissociation was assessed with by the Dissociative Experiences Scale (DES) at the begi nning of the therapy. The severity of psychopathology in patients with OCD was assessed with use of the Yale-Brown Obsessive-Compulsi ve Scale (Y-BOCS), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI) at the beginning and at the end of the treatment. Results: The severity of OCD symptoms significantly decreased as a result of the therapy. The treatment outcome was not associated with the severity of dissociation at the beginning of the treatment. Absolute, but not relative decrease of OCD symptoms was as sociated with the level of OCD symptoms at the beginning of the therapy. Patients had higher DES and SDQ-20 scores than healthy subjects . SDQ-20, unlike the DES score, correlated with the severity of OCD symptoms in patients. Conclusion: The severity of dissociative symptoms before the treatment was not associated with a change of OCD symptom severity after CBT. As dissociation is associated with anxiety and depressive symptoms, further investigation of the influence of dissoc iative states on the change of anxiety-depressive symptoms in a wider clinical spectrum of patients is needed.

Klíčová slova
výsledky léčby,
MeSH
behaviorální terapie metody MeSH
depresivní poruchy diagnóza farmakoterapie MeSH
disociační poruchy diagnóza farmakoterapie MeSH
financování organizované MeSH
kognitivně behaviorální terapie metody MeSH
lidé MeSH
obsedantně kompulzivní porucha diagnóza farmakoterapie psychologie MeSH
patologické stavy, příznaky a symptomy MeSH
prediktivní hodnota testů MeSH
psychiatrické posuzovací škály statistika a číselné údaje MeSH
skupinová psychoterapie metody MeSH
stupeň závažnosti nemoci MeSH
výsledek terapie MeSH
Check Tag
lidé MeSH
Publikační typ
srovnávací studie MeSH

Článek

Farmakoterapie disociativních poruch
[Pharmacotherapy of dissociative disorders]

Psychiatrie pro praxi. 2010 ; 11 (3) : 99-102.

Medvik
Zdroj

Disociativní poruchy tvoří skupinu onemocnění s heterogenními a mnohdy dramatickými projevy. Disociativní stavy jsou přítomny u řady jiných psychických poruch a disociativní poruchy bývají nezřídka doprovázeny jinými komorbidními psychiatrickými poruchami. Existuje shoda na psychogenní etiologii onemocnění, ve většině případů nalezneme souvislost mezi traumatickými zážitky předcházejícími rozvoj poruchy. Pohotovost reagovat na zátěž disociací vzniká dříve, často v období disharmonického dětství. Většina disociativních poruch vzniká v krátkém časovém horizontu a mají tendenci ke spontánní remisi. Pokud onemocnění trvá roky, často chronifikuje a je rezistentní vůči terapii. Terapií volby jsou především psychoterapeutické intervence. Farmakologické postupy se doporučují u komorbidních psychických symptomů. Specifická farmakoterapeutická intervence pro disociativní stavy není známá. Zkoumán je efekt transkraniální magnetické stimulace mozku.

Dissociative disorders have heterogenic and mostly dramatic manifestation. Dissociative states are frequently present in patiens suffering from other psychiatric disorders. Usually we can find a context between dissociative disorder and traumatic experience in the patients history. The psychogenic etiology is evident. The promptitude for reaction to stress with disociation begans in the disharmonious childhood. Several years persisted disorder becomes chronic and resisted to treatment. The specific therapy of the disociative disorders does not exist. The first choice of the therapies are psychoterapautic interventions. Pharmacological methods are advised to treat attendant psychiatric symptoms. The effect of the transcranial magnetic stimulation is investigated.