BACKGROUND: Schizophrenia is a serious mental illness, the pharmacological treatment of which comprises primarily the use of antipsychotics. However, non-adherence to their use and its reliable determination present a serious clinical and economic problem. This study aimed to determine therapeutic adherence in outpatients with schizophrenia spectrum disorders by combining short-term electronic monitoring of dispenser opening with the measurement of antipsychotic blood concentrations. METHODS: A total of 55 patients underwent a week-long electronic monitoring of dispenser opening and measurement of blood concentrations before and after monitoring. Patients who correctly opened the dispenser at least in 80% of scheduled time points during the weekly interval and, at the same time, did not show a change in blood concentration of the antipsychotic by more than 30% in any direction, were considered adherent. RESULTS: 69.1% of the patients met the adherence criteria, which was less than that determined by the Drug Attitude Inventory (DAI-10), the Visual Analogue Scale (VAS), and the Clinician Rating Scale (CRS). 7.3% of the patients took less than 80% of the prescribed doses and a change in blood concentrations of the antipsychotic by more than 30% was detected in 25.4% of the patients. In 70.9% of patients, the detected concentrations were within the recommended therapeutic reference interval. The groups of adherent and non-adherent patients did not differ statistically significantly in the severity of their illness as determined by the Clinical Global Impression (CGI), the Personal and Social Performance scale (PSP), and the Positive and Negative Syndrome Scale (PANSS). CONCLUSIONS: The combined method of evaluating adherence in schizophrenia patients confirmed the results determined by other methods. The benefits of this approach are described in the paper.
- MeSH
- adherence k farmakoterapii * psychologie MeSH
- antipsychotika * krev terapeutické užití MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- monitorování léčiv * metody MeSH
- prospektivní studie MeSH
- schizofrenie * farmakoterapie krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Progressive supranuclear palsy (PSP) is an atypical Parkinsonian syndrome characterized initially by falls and eye movement impairment. This multimodal imaging study aimed at eliciting structural and functional disease-specific brain alterations. T1-weighted and resting-state functional MRI were applied in multi-centric cohorts of PSP and matched healthy controls. Midbrain, cerebellum, and cerebellar peduncles showed severely low gray/white matter volume, whereas thinner cortical gray matter was observed in cingulate cortex, medial and temporal gyri, and insula. Eigenvector centrality analyses revealed regionally specific alterations. Multivariate pattern recognition classified patients correctly based on gray and white matter segmentations with up to 98 % accuracy. Highest accuracies were obtained when restricting feature selection to the midbrain. Eigenvector centrality indices yielded an accuracy around 70 % in this comparison; however, this result did not reach significance. In sum, the study reveals multimodal, widespread brain changes in addition to the well-known midbrain atrophy in PSP. Alterations in brain structure seem to be superior to eigenvector centrality parameters, in particular for prediction with machine learning approaches.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Dysarthria, a motor speech disorder caused by muscle weakness or paralysis, severely impacts speech intelligibility and quality of life. The condition is prevalent in motor speech disorders such as Parkinson's disease (PD), atypical parkinsonism such as progressive supranuclear palsy (PSP), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS). Improving intelligibility is not only an outcome that matters to patients but can also play a critical role as an endpoint in clinical research and drug development. This study validates a digital measure for speech intelligibility, the ki: SB-M intelligibility score, across various motor speech disorders and languages following the Digital Medicine Society (DiMe) V3 framework. METHODS: The study used four datasets: healthy controls (HCs) and patients with PD, HD, PSP, and ALS from Czech, Colombian, and German populations. Participants' speech intelligibility was assessed using the ki: SB-M intelligibility score, which is derived from automatic speech recognition (ASR) systems. Verification with inter-ASR reliability and temporal consistency, analytical validation with correlations to gold standard clinical dysarthria scores in each disease, and clinical validation with group comparisons between HCs and patients were performed. RESULTS: Verification showed good to excellent inter-rater reliability between ASR systems and fair to good consistency. Analytical validation revealed significant correlations between the SB-M intelligibility score and established clinical measures for speech impairments across all patient groups and languages. Clinical validation demonstrated significant differences in intelligibility scores between pathological groups and healthy controls, indicating the measure's discriminative capability. DISCUSSION: The ki: SB-M intelligibility score is a reliable, valid, and clinically relevant tool for assessing speech intelligibility in motor speech disorders. It holds promise for improving clinical trials through automated, objective, and scalable assessments. Future studies should explore its utility in monitoring disease progression and therapeutic efficacy as well as add data from further dysarthrias to the validation.
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND OBJECTIVES: Noninvasive and accurate biomarkers of neurologic Wilson disease (NWD), a rare inherited disorder, could reduce diagnostic error or delay. Excessive subcortical metal deposition seen on susceptibility imaging has suggested a characteristic pattern in NWD. With submillimeter spatial resolution and increased contrast, 7T susceptibility-weighted imaging (SWI) may enable better visualization of metal deposition in NWD. In this study, we sought to identify a distinctive metal deposition pattern in NWD using 7T SWI and investigate its diagnostic value and underlying pathophysiologic mechanism. METHODS: Patients with WD, healthy participants with monoallelic ATP7B variant(s) on a single chromosome, and health controls (HCs) were recruited. NWD and non-NWD (nNWD) were defined according to the presence or absence of neurologic symptoms during investigation. Patients with other diseases with comparable clinical or imaging manifestations, including early-onset Parkinson disease (EOPD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and neurodegeneration with brain iron accumulation (NBIA), were additionally recruited and assessed for exploratory comparative analysis. All participants underwent 7T T1, T2, and high-resolution SWI scanning. Quantitative susceptibility mapping and principal component analysis were performed to illustrate metal distribution. RESULTS: We identified a linear signal intensity change consisting of a hyperintense strip at the lateral border of the globus pallidus in patients with NWD. We termed this feature "hyperintense globus pallidus rim sign." This feature was detected in 38 of 41 patients with NWD and was negative in all 31 nNWD patients, 15 patients with EOPD, 30 patients with MSA, 15 patients with PSP, and 12 patients with NBIA; 22 monoallelic ATP7B variant carriers; and 41 HC. Its sensitivity to differentiate between NWD and HC was 92.7%, and specificity was 100%. Severity of the hyperintense globus pallidus rim sign measured by a semiquantitative scale was positively correlated with neurologic severity (ρ = 0.682, 95% CI 0.467-0.821, p < 0.001). Patients with NWD showed increased susceptibility in the lenticular nucleus with high regional weights in the lateral globus pallidus and medial putamen. DISCUSSION: The hyperintense globus pallidus rim sign showed high sensitivity and excellent specificity for diagnosis and differential diagnosis of NWD. It is related to a special metal deposition pattern in the lenticular nucleus in NWD and can be considered as a novel neuroimaging biomarker of NWD. CLASSIFICATION OF EVIDENCE: The study provides Class II evidence that the hyperintense globus pallidus rim sign on 7T SWI MRI can accurately diagnose neurologic WD.
- MeSH
- ATPasy transportující měď metabolismus genetika MeSH
- dospělí MeSH
- globus pallidus diagnostické zobrazování metabolismus MeSH
- hepatolentikulární degenerace * diagnostické zobrazování metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- měď metabolismus MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mozek diagnostické zobrazování metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
... Přehled kontrolních akcí, jejichž schválený kontrolní závěr byl v roce 2023 projednán Kontrolním výborem PSP ...
155 stran : ilustrace ; 30 cm
Závěrečná zpáva o činnosti Nejvyššího kontrolního úřadu České republiky v roce 2023. Určeno odborné veřejnosti.
- MeSH
- finanční řízení MeSH
- organizace a řízení MeSH
- veřejný sektor MeSH
- vládní organizace MeSH
- Geografické názvy
- Česká republika MeSH
- Konspekt
- Organizace a řízení veřejné správy
- NLK Obory
- státní správa
- ekonomie, ekonomika, ekonomika zdravotnictví
- NLK Publikační typ
- závěrečné zprávy
- O autorovi
- Česko. Nejvyšší kontrolní úřad Autorita
Saxitoxins (STXs) are potent neurotoxins produced by marine dinoflagellates or freshwater cyanobacteria known to cause acute and eventually fatal human intoxications, which are classified as paralytic shellfish poisonings (PSPs). Rapid analysis of STXs in blood plasma can be used for a timely diagnosis and confirmation of PSPs. We developed a fast and simple method of STX extraction based on plasma sample acidification and precipitation by acetonitrile, followed by quantification using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Our approach provides the results ≤30 min, with a limit of detection of 2.8 ng/mL and a lower limit of quantification of 5.0 ng/mL. Within-run and between-run precision experiments showed good reproducibility with ≤15% values. Standard curves for calibration were linear with correlation coefficients ≥0.98 across the assay calibration range (5-200 ng/mL). In an interlaboratory analytical exercise, the method was found to be 100% accurate in determining the presence or absence of STX in human plasma specimens, with recovery values of 86-99%. This simple method for STX determination in animal or human plasma can quickly and reliably diagnose STX exposures and confirm suspected PSP cases to facilitate patient treatment or expedite necessary public health or security actions.
INTRODUCTION: In this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia. METHODS: The Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome. RESULTS: One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome. CONCLUSIONS: Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Corticobasal syndrome (CBS) is a specific clinical manifestation shared by multiple pathologies. The exact mechanism of this phenomenon remains unclear. Differential diagnosis of CBS in everyday clinical practice is challenging, as this syndrome can overlap with other entities, especially progressive supranuclear palsy Richardson-Steele phenotype (PSP-RS). Several papers have suggested a possible role of vascular pathology as a linking factor in the pathogenesis of CBS based on different neuropathologies. This paper analyses differences in the occurrence of the most common vascular risk factors such as hypertension and lipid profile with respect to dietary habits among patients who fulfill the diagnostic criteria for probable/possible CBS and PSP-RS. MATERIAL AND METHODS: Seventy (70) patients in total were included in the study. Exclusion criteria comprised hydrocephalus, stroke in the past, the presence of marked vascular changes in white matter defined as the presence of vascular change ≥ 1 mm in 3T MRI, medical history of hyperlipidemia or the use of drugs that could impact upon lipid metabolism before the initiation of the neurodegenerative disease, and neoplastic focuses in the central nervous system. Patients with diabetes, or with BMI exceeding 18-25, or who were smokers, or who were affected by chronic stress were also excluded. Data was analysed statistically using the Shapiro-Wilk test, the U Mann-Whitney test for group comparison, and a Bonferroni correction to control the false discovery rate (FDR). RESULTS: Our obtained results indicated a statistically significantly higher level of total cholesterol in the CBS group (p = 0.0039) without a correlation with dietary habits. CONCLUSIONS AND CLINICAL IMPLICATIONS: The results obtained in our study may suggest a possible role of vascular pathology in CBS development. This issue requires further research.
Cieľ: Cieľom výskumu bolo preskúmať úlohu subjektívne vnímanej asertivity, sociálnych zručností a závažnosti symptómov ako prediktorov každodenného fungovania u pacientov s poruchami z okruhu schizofrenického spektra. Materiál a metóda: Výskumu sa zúčastnilo 30 pacientov s poruchami z okruhu schizofrenického spektra liečených v Psychiatrickom stacionári Psychiatrickej kliniky LF UK a UNB. Na hodnotenie funkčnosti boli použité metódy: Škála špecifických úrovní fungovania SLOF a Škála osobnej a sociálnej výkonnosti PSP. Závažnosť symptómov sme vyhodnocovali prostredníctvom Škály globálneho klinického dojmu CGI upravenej pre pacientov so schizofréniou. Ako ďalšie metódy boli použité Dotazník asertivity, Dotazník mylných presvedčení a Dotazník komunikačných zručností. Výsledky boli spracované cez korelačnú a regresnú analýzu. Výsledky: Celková funkčnosť bola nižšia u ľudí so závažnejšou negatívnou symptomatikou (rs = -0,394, p = 0,031) a celkovou horšou závažnosťou ochorenia (rs = -0,436, p = 0,016). Celkovo symptómy vysvetľovali cca 19,8 % variability. V prípade subjektívnej funkčnosti meranej symptómy vysvetľovali cca adjR2 = 67,4 % pozorovanej variability. Ako významné prediktory sme identifikovali závažnosť pozitívnych (rs = -0,358, p = 0,003) aj negatívnych symptómov (rs = -0,652, p < 0,001). Asertivita nesúvisela s hodnotením funkčnosti. Záver: Výsledky preukázali, že najsilnejšími prediktormi funkčnosti u pacientov s poruchami schizofrenického spektra sú symptómy ochorenia, najmä závažnosť pozitívnych a negatívnych symptómov. Subjektívne vnímaná asertivita nepredikovala subjektívne vnímané ani objektívne posudzované psychosociálne fungovanie. Pacienti boli schopní relatívne presne hodnotiť úroveň svojho fungovania, najmä v pracovnej oblasti.
Study aims: The aim of this research was to examine the role of assertiveness, social skills and the role of symptom severity as predictors of psychosocial functioning in patients with schizophrenia spectrum disorders. Material and method: Thirty patients with schizophrenia spectrum disorders treated in the Psychiatric Inpatient Unit of the Psychiatric Clinic of the Faculty of Medicine of the Comenius University and the UNB participated in the study. The following methods were used for functional assessment: the SLOF Specific Levels of Functioning Scale and the PSP Personal and Social Performance Scale. Symptom severity was evaluated using the CGI Global Clinical Impression Scale adapted for patients with schizophrenia. The Assertiveness Questionnaire, the Mistaken Beliefs Questionnaire, and the Social Skills Questionnaire were used as additional methods. The results were analyzed through correlation and regression analysis. Results: Overall functioning was lower in those with more severe negative symptoms (rs = -0.394, p = 0.031) and overall lower severity of illness (rs = -0.436, p = 0.016). Overall, symptoms explained approximately 19.8% of the variability. For subjective, symptoms explained approximately adjR2 = 67.4% of the observed variability. We identified severity of both positive (rs = -0.358, p = 0.003) and negative symptoms (rs = -0.652, p < 0.001) as significant predictors. Assertiveness was not related to functional assessment. Conclusion: The results showed that the strongest predictors of functionality in patients with schizophrenia spectrum disorders are symptoms of the illness, especially the severity of positive and negative symptoms. Subjectively perceived assertiveness did not predict either subjectively perceived or objectively assessed psychosocial functioning. Patients were able to assess their level of functioning relatively accurately, particularly in the work domain.
