Publikace se zaměřuje na farmakorezistenci u schizofrenie, deprese, úzkosti a obsedantně-kompulzivní poruchy. Určeno odborné veřejnosti.; Publikace se zaměřuje na problematiku rezistence vůči psychofarmakům u pacientů se závažnými duševními onemocněními, jako jsou schizofrenie, bipolární porucha, deprese, vybrané úzkostné stavy a obsedantně-kompulzivní porucha. Autorka přináší přehled výzkumných metod a vývoje v oblasti léčby farmakorezistentních stavů a zároveň popisuje slepé cesty a výzkumné přístupy, které se původně jevily jako slibné, ale v praxi se ukázaly jako neúčinné. Vysvětluje mechanismy působení psychofarmak a rozkrývá genetické základy farmakogenomiky, které pomáhají objasnit individuální variace v účincích léků. Odhaluje také složitost výzkumu a metodologické nástrahy, jež ovlivňují interpretaci studií na poli farmakorezistence. Kniha je cenným zdrojem informací pro odborníky, kteří se chtějí zorientovat v komplexnosti farmakorezistentních stavů a efektivněji podporovat své pacienty na cestě k zotavení.

• MeSH
• Mental Disorders MeSH
• Drug Resistance MeSH
• Psychotropic Drugs MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Psychiatrie
• NML Fields
• psychiatrie
• psychofarmakologie

Although specific risk factors for brain alterations in bipolar disorders (BD) are currently unknown, obesity impacts the brain and is highly prevalent in BD. Gray matter correlates of obesity in BD have been well documented, but we know much less about brain white matter abnormalities in people who have both obesity and BD. We obtained body mass index (BMI) and diffusion tensor imaging derived fractional anisotropy (FA) from 22 white matter tracts in 899 individuals with BD, and 1287 control individuals from 20 cohorts in the ENIGMA-BD working group. In a mega-analysis, we investigated the associations between BMI, diagnosis or medication and FA. Lower FA was associated with both BD and BMI in six white matter tracts, including the corpus callosum and thalamic radiation. Higher BMI or BD were uniquely associated with lower FA in three and six white matter tracts, respectively. People not receiving lithium treatment had a greater negative association between FA and BMI than people treated with lithium in the posterior thalamic radiation and sagittal stratum. In three tracts BMI accounted for 10.5 to 17% of the negative association between the number of medication classes other than lithium and FA. Both overweight/obesity and BD demonstrated lower FA in some of the same regions. People prescribed lithium had a weaker association between BMI and FA than people not on lithium. In contrast, greater weight contributed to the negative associations between medications and FA. Obesity may add to brain alterations in BD and may play a role in effects of medications on the brain.

• MeSH
• Anisotropy MeSH
• White Matter * pathology   diagnostic imaging   metabolism   MeSH
• Bipolar Disorder * pathology   metabolism   MeSH
• Adult MeSH
• Body Mass Index MeSH
• Middle Aged MeSH
• Humans MeSH
• Brain pathology   MeSH
• Obesity * pathology   metabolism   complications   MeSH
• Gray Matter MeSH
• Diffusion Tensor Imaging methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Bipolar disorder (BD) is a complex and heterogeneous psychiatric disorder. It has been suggested that neurodevelopmental factors contribute to the etiology of BD, but a specific neurodevelopmental phenotype (NDP) of the disorder has not been identified. Our objective was to define and characterize an NDP in BD and validate its associations with clinical outcomes, polygenic risk scores, and treatment responses. METHODS: We analyzed the FondaMental Advanced Centers of Expertise for Bipolar Disorders cohort of 4468 patients with BD, a validation cohort of 101 patients with BD, and 2 independent replication datasets of 274 and 89 patients with BD. Using factor analyses, we identified a set of criteria for defining NDP. Next, we developed a scoring system for NDP load and assessed its association with prognosis, neurological soft signs, polygenic risk scores for neurodevelopmental disorders, and responses to treatment using multiple regressions, adjusted for age and gender with bootstrap replications. RESULTS: Our study established an NDP in BD consisting of 9 clinical features: advanced paternal age, advanced maternal age, childhood maltreatment, attention-deficit/hyperactivity disorder, early onset of BD, early onset of substance use disorders, early onset of anxiety disorders, early onset of eating disorders, and specific learning disorders. Patients with higher NDP load showed a worse prognosis and increased neurological soft signs. Notably, these individuals exhibited a poorer response to lithium treatment. Furthermore, a significant positive correlation was observed between NDP load and polygenic risk score for attention-deficit/hyperactivity disorder, suggesting potential overlapping genetic factors or pathophysiological mechanisms between BD and attention-deficit/hyperactivity disorder. CONCLUSIONS: The proposed NDP constitutes a promising clinical tool for patient stratification in BD.

• MeSH
• Bipolar Disorder * genetics   MeSH
• Adult MeSH
• Phenotype * MeSH
• Attention Deficit Disorder with Hyperactivity genetics   MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Multifactorial Inheritance genetics   MeSH
• Neurodevelopmental Disorders genetics   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cílem práce je na ojedinělém případu pacienta po nadstandardní operaci šedého zákalu s preventivní primární zadní cirkulární kasulorexi (PCCC, z angl. posterior continuous curvilinear capsulorhexis) prezentovat možný vznik proliferativní sekundární katarakty. Vzhledem k negativnímu vlivu na zrakové funkce bylo rozhodnuto o ošetření Nd:YAG laserem, které bylo úspěšné s použitím minimální energie ale s porušením přední hyaloidní membrány. Kazuistika 65letý muž podstoupil na našem pracovišti v roce 2020 nekomplikovanou operaci šedého zákalu obou očí, oboustranně s primární PCCC s implantací tenzního kroužku a umělé nitrooční čočky do pouzdra. V únoru 2023 byl na doporučení spádového očního lékaře vyšetřen na naší ambulanci pro snížení zrakové ostrosti vpravo. Dominantní bylo rozmazané vidění. Diagnóza proliferativní formy sekundární katarakty byla potvrzena a zdokumentována pomocí fotografie předního segmentu v retroiluminaci a předněsegmentového OCT (Optovue, Avanti RTVue XR). Pacient byl indikován k Nd:YAG laserové disrupci proliferací v prostoru PCCC na pravém oku. Návrat zrakové ostrosti k původnímu stavu byl potvrzením správné diagnózy. V literárním přehledu a v diskuzi je shrnuta aktuální problematika sekundární katarakty a použití primární PCCC. Závěr: Sekundární katarakta je hlavní dlouhodobou komplikací moderní chirurgie katarakty. Jednou z možných řešení je preventivní provedení jednoduché PCCC, která může být provázená ojedinělým selháním.

The aim of the study is to present the possible development of proliferative secondary cataracts in the unique case of a patient having undergone premium cataract surgery with preventive primary posterior continuous curvilinear capsulorhexis (PCCC). Due to the negative effect on visual functions, it was decided to treat the patient with an Nd:YAG laser, which was successful with minimal energy but resulted in damage to the anterior hyaloid membrane. Case report In 2020, a 65-year-old man underwent uncomplicated cataract surgery in both eyes at our clinic bilaterally with primary PCCC with implantation of a tension ring and an artificial intraocular lens into the capsule. In February 2023, on the recommendation of the area ophthalmologist, he was examined at our outpatient clinic due to a decrease of visual acuity in the right eye. Blurred vision predominated. A diagnosis of proliferative form of secondary cataract was confirmed and documented using a photo of the anterior segment in retroillumination and anterior segment OCT (Optovue, Avanti RTVue XR). The patient was indicated for Nd:YAG laser disruption by proliferation in the PCCC space in the right eye. The return of visual acuity to its original state confirmed the correct diagnosis. The literature review and discussion summarize the current issue of secondary cataracts and the use of primary PCCC. Conclusion: Secondary cataract is the main long-term complication of modern cataract surgery. One of the possible solutions is the preventive implementation of a simple PCCC, which may be accompanied by isolated failure.

• MeSH
• Capsulorhexis * methods   adverse effects   MeSH
• Cataract Extraction methods   adverse effects   MeSH
• Lens Implantation, Intraocular MeSH
• Cataract etiology   MeSH
• Lasers, Solid-State therapeutic use   MeSH
• Humans MeSH
• Aged MeSH
• Capsule Opacification diagnosis   etiology   MeSH
• Visual Acuity MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

The perception of a voice in the absence of an external auditory source-an auditory verbal hallucination-is a characteristic symptom of schizophrenia. To better understand this phenomenon requires integration of findings across behavioural, functional, and neurochemical levels. We address this with a locally adapted MEGA-PRESS sequence incorporating interleaved unsuppressed water acquisitions, allowing concurrent assessment of behaviour, blood-oxygenation-level-dependent (BOLD) functional changes, Glutamate + Glutamine (Glx), and GABA, synchronised with a cognitive (flanker) task. We acquired data from the anterior cingulate cortex (ACC) of 51 patients with psychosis (predominantly schizophrenia spectrum disorder) and hallucinations, matched to healthy controls. Consistent with the notion of an excitatory/inhibitory imbalance, we hypothesized differential effects for Glx and GABA between groups, and aberrant dynamics in response to task. Results showed impaired task performance, lower baseline Glx and positive association between Glx and BOLD in patients, contrasting a negative correlation in healthy controls. Task-related increases in Glx were observed in both groups, with no significant difference between groups. No significant effects were observed for GABA. These findings suggest that a putative excitatory/inhibitory imbalance affecting inhibitory control in the ACC is primarily observed as tonic, baseline glutamate differences, rather than GABAergic effects or aberrant dynamics in relation to a task.

• MeSH
• Gyrus Cinguli metabolism   physiopathology   MeSH
• Adult MeSH
• gamma-Aminobutyric Acid * metabolism   MeSH
• Glutamine metabolism   MeSH
• Hallucinations * metabolism   physiopathology   MeSH
• Cognition * physiology   MeSH
• Glutamic Acid * metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Young Adult MeSH
• Psychotic Disorders * metabolism   physiopathology   MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: This study aimed to investigate the impact of bleaching agents based on carbamide or hydrogen peroxide on dental ceramics in vitro, utilizing scanning electron microscopy (SEM) and elemental analysis via inductively coupled plasma optical emission spectroscopy (ICP-OES). METHODS: CAD/CAM ceramics (IPS e.max®CAD, IPS Empress®CAD, Vitablocs® Mark II, Celtra Duo, and inCoris TZI) were treated with bleaching agents using either 10%, 20%, 30% carbamide peroxide or with 35%, and 40% hydrogen peroxide. RESULTS: Surface elemental release was not significantly affected by the type or concentration of bleaching agent (p>0.05). Ion release in feldspathic ceramics was significantly higher than in other ceramic materials (p⟨0.0001). Microstructural surface changes were observed in all materials except for lithium disilicate and zirconia-reinforced lithium silicate ceramics. CONCLUSIONS: All bleaching agents tested in this study showed a similar impact within each material type tested regarding total mass loss, elemental composition, or surface structure. CLINICAL RELEVANCE: Lithium disilicate and zirconia-reinforced lithium silicate ceramics were the most resistant to bleaching agents. In contrast, feldspathic ceramic showed the highest ion release and surface deterioration when exposed to all bleaching agents tested.

• MeSH
• Computer-Aided Design * MeSH
• Carbamide Peroxide * chemistry   MeSH
• Ceramics * chemistry   MeSH
• Tooth Bleaching Agents * chemistry   MeSH
• Microscopy, Electron, Scanning MeSH
• Hydrogen Peroxide * chemistry   MeSH
• Surface Properties MeSH
• Materials Testing MeSH
• Zirconium chemistry   MeSH
• Dental Porcelain * chemistry   MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: The European Medicines Agency has recommended a series of restrictions on the use of sodium valproate (valproate) following research linking its exposure in utero to adverse congenital and neurodevelopmental effects in offspring. Recent research has highlighted a potential increased risk of neurodevelopmental disorders in children born to males taking valproate prior to conception. Clinicians and patients require guidance regarding suitable alternatives. AIM: To provide an overview of suitable alternatives to valproate in the management of bipolar disorder. METHOD: A narrative review was conducted. Only medications with an established evidence base in managing different phases of bipolar disorder and endorsed within clinical practice guidelines were considered. Eligible guidelines included those (i) where recommendations were informed by a formal guideline development process and (ii) published in English within the last 15 years. REPROTOX® was chosen as the primary information source regarding reproductive safety of alternative medications. RESULTS: Of all second-generation antipsychotics, quetiapine should be considered a first-line alternative to valproate. Lithium has been associated with an increased risk of cardiac malformations, especially Ebstein anomaly, following in utero exposure. However, given its robust efficacy as an antimanic agent and the absolute risk of cardiac abnormalities being low, it's use can still be considered in individuals of child-bearing potential with appropriate monitoring. Carbamazepine treatment should be avoided due to concerns for teratogenicity. Although considered safe in pregnancy, lamotrigine is largely effective at preventing relapse of bipolar depression. Thus, lamotrigine offers limited clinical utility as an alternative to valproate. CONCLUSION: Specific recommendations are made regarding alternatives to valproate in managing bipolar disorder.

• MeSH
• Antimanic Agents * adverse effects   therapeutic use   MeSH
• Antipsychotic Agents * adverse effects   therapeutic use   MeSH
• Bipolar Disorder * drug therapy   MeSH
• Valproic Acid * adverse effects   therapeutic use   MeSH
• Humans MeSH
• Disease Management * MeSH
• Pregnancy MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Comparative Study MeSH
• Geographicals
• Europe MeSH

This paper introduces a novel neutron production system for Boron Neutron Capture Therapy (BNCT) that employs a lithium beam in inverse kinematics to generate forward-directed neutrons through the 7Li (p,n)7Be reaction. The system utilizes a thin polypropylene target and an optimized beam configuration to achieve high neutron yield and precise directional control. A tape target mechanism is incorporated to effectively manage thermal loads, ensuring stable and reliable operation. The proposed system could offer substantial advantages over conventional neutron sources, including enhanced neutron directionality and a reduced shielding requirement. This approach increases the potential for precise tumor targeting while minimizing exposure to surrounding healthy tissues, paving the way for a more accessible and efficient BNCT treatment option.

• Publication type
• Journal Article MeSH

The distribution and morphology of neuronal degeneration were observed and analyzed in each sector of the zona incerta in a lithium‐pilocarpine (LiCl) Wistar rat model of status epilepticus in 12, 15, 18, 21, and 25‐day‐old rats and survival intervals of 4, 8, 12, 24, and 48 hours. Status epilepticus was induced via intraperitoneal (IP) injection of LiCl (3 mmol/kg) 24 hours before an injection of pilocarpine (40 mg/kg, IP). Motor seizures were suppressed by paraldehyde (0.3‐0.6 ml/kg, IP) two hours after status epilepticus onset. Animals were anesthetized using urethane and perfused with phosphate‐buffered saline followed by 4% paraformaldehyde. Brains were sectioned and Nissl stained for map guidance, with fluoro‐Jade B fluorescence used to detect degenerated neurons. Fluoro‐jade B‐positive neurons were plotted to a standard stereotaxic atlas, their distribution was quantified, and their long‐axis diameter was measured. Fluoro‐jade B‐positive neurons were found in pups aged 15 days and older 24 hours after status epilepticus, in which their numbers increased, and their perikaryon size decreased with advancing age. Thus, neuronal damage severity was dependent on age and survival interval. Neuronal damage was only found in the rostral sector of the zona incerta, a region that exhibits a small number of inhibitory neurons and is reciprocally connected to the limbic cortex. This system of hyperactivity, coupled with inhibitory neurons, may be the underlying cause of the neuronal degeneration and explain why it was confined to the rostral sector of the zona incerta.

• MeSH
• Lithium Chloride toxicity   MeSH
• Nerve Degeneration * pathology   etiology   MeSH
• Fluoresceins MeSH
• Rats MeSH
• Disease Models, Animal MeSH
• Neurons * pathology   MeSH
• Animals, Newborn MeSH
• Pilocarpine toxicity   MeSH
• Rats, Wistar MeSH
• Status Epilepticus * pathology   chemically induced   complications   MeSH
• Age Factors MeSH
• Zona Incerta * pathology   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Tato kazuistika popisuje případ 32leté ženy trpící bipolární afektivní poruchou, která byla hospitalizována na psychiatrickém oddělení CNS Centra Třinec kvůli ztrátě hlasu trvající 10 měsíců. Pacientka byla v psychiatrické péči od roku 2013, kdy byla přijata na oddělení krátce po porodu dcery, a to s psychotickými projevy. V roce 2014 se u ní projevily příznaky manické fáze, což vedlo k nutnosti hospitalizace a nasazení lithia jako stabilizátoru nálady. V roce 2023, po pečlivém somatickém vyšetření z důvodu dlouhotrvající ztráty hlasu, byla vyloučena organická příčina obtíží. Na základě vyšetření se ukázalo, že ztráta hlasu by mohla být způsobena nežádoucím účinkem lithia, což bylo potvrzeno dalším sledováním stavu pacientky. Tato kazuistika zdůrazňuje důležitost důkladného vyšetření a sledování vedlejších účinků psychofarmak u pacientů s bipolární afektivní poruchou.

This case study describes a 32-year-old woman suffering from bipolar affective disorder who was hospitalized in the psychiatric department of CNS Center Třinec due to a voice loss lasting 10 months. The patient had been under psychiatric care since 2013, when she was admitted to the unit shortly after the birth of her daughter, presenting with psychotic symptoms. In 2014, she exhibited signs of a manic episode, necessitating hospitalization and the initiation of lithium as a mood stabilizer. In 2023, following a thorough somatic examination due to the prolonged voice loss, an organic cause for her difficulties was ruled out. Based on the assessment, it appeared that the voice loss may have been caused by a side effect of lithium, which was confirmed by further monitoring of the patient's condition. This case study underscores the importance of comprehensive evaluation and monitoring for side effects of psychotropic medications in patients with bipolar affective disorder.

• MeSH
• Aphonia * chemically induced   therapy   MeSH
• Bipolar Disorder drug therapy   complications   MeSH
• Adult MeSH
• Humans MeSH
• Lithium * adverse effects   therapeutic use   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH