INTRODUCTION: Self-stigma plays a role in many areas of the patient's life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups. METHODS: This cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past. RESULTS: We examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment. CONCLUSION: The study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist's recommendation. This connection was present in all diagnostic groups.

• Klíčová slova
• adherence, discontinuation of drugs, mental disorders, self-stigma,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Discontinuation of anti-TNF therapy in patients with inflammatory bowel diseases (IBD) in remission remains a controversial issue. The aims of our study were to assess the proportion of patients who relapse after cessation of biological treatment, and to identify potential risk factors of disease relapse. METHODS: Consecutive IBD patients who discontinued anti-TNF therapy in steroid-free clinical and endoscopic remission were prospectively followed. Multiple logistic regression and Cox proportional-hazards models were used to assess the predictors of disease relapse. RESULTS: Seventy-eight IBD patients (Crohn's disease, CD 61; ulcerative colitis, UC 17) were included and followed for a median of 30 months (range 7-47). A total of 32 (53%) CD patients and nine (53%) UC patients relapsed by the end of the follow-up with a median time to relapse of 8 months (range 1-25) in CD patients and 14 months (range 4-37) in UC patients, respectively. The cumulative probabilities of maintaining remission at 6, 12, and 24 months were 82%, 59%, and 51% in CD patients, and 77%, 77%, and 64% in UC patients, respectively. Survival of CD patients who were in deep remission (clinical and endoscopic healing; faecal calprotectin <150 mg/kg; CRP ≤5 mg/l) was not better compared with those who did not fulfill these criteria. In multivariate models, only colonic CD protected patients from disease relapse. CONCLUSIONS: Approximately half of the IBD patients relapsed within 2 years after anti-TNF discontinuation. In CD patients, no difference between those who were or were not in deep remission was found. Colonic localization protected patients from relapse.

• Klíčová slova
• Crohn's disease, anti-TNF, treatment discontinuation, ulcerative colitis,
• MeSH
• adalimumab škodlivé účinky   terapeutické užití   MeSH
• antiflogistika nesteroidní škodlivé účinky   terapeutické užití   MeSH
• C-reaktivní protein metabolismus   MeSH
• časové faktory MeSH
• Crohnova nemoc farmakoterapie   patologie   MeSH
• dospělí MeSH
• feces chemie   MeSH
• gastrointestinální endoskopie MeSH
• indukce remise MeSH
• infliximab škodlivé účinky   terapeutické užití   MeSH
• leukocytární L1-antigenní komplex analýza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• nenasazení léčby MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• recidiva MeSH
• rizikové faktory MeSH
• senioři MeSH
• TNF-alfa antagonisté a inhibitory   MeSH
• ulcerózní kolitida farmakoterapie   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• adalimumab MeSH
• antiflogistika nesteroidní MeSH
• C-reaktivní protein MeSH
• infliximab MeSH
• leukocytární L1-antigenní komplex MeSH
• TNF-alfa MeSH

BACKGROUND: In practical sleep medicine, therapists face the question of whether or not to discontinue the ongoing use of hypnotics in patients, as well as the possible effects of discontinuation. The aim of this study was to evaluate the effects of discontinuing third-generation hypnotics on the results of cognitive-behavioural therapy (CBT) for primary insomnia in patients after long-term abuse. METHODS: Twenty-eight outpatients were treated by CBT for 8 weeks. The treatment outcome was estimated by means of differences among subjective clinical scales and polysomnography variables assessed before and after the treatment period. The therapeutic effect in a subgroup of 15 patients who had previously received hypnotics and were successively withdrawn during weeks 2-6 was compared to the effect achieved in patients who had not used hypnotics before CBT. RESULTS: There were no significant differences in baseline subjective and objective sleep characteristics between the hypnotic abusers and non-abusers. According to clinical scales and most polysomnographic measures, CBT was highly effective in both groups of subjects; it produced the greatest changes in total sleep time, REM sleep and sleep efficiency. Unexpectedly, discontinuation of hypnotics, as a factor in the analysis, was followed by an additional improvement of sleep efficiency and wake after sleep onset parameters. CONCLUSION: Our study confirmed the efficacy of CBT in both hypnotic-abusing and non-abusing patients with chronic insomnia. The results of this study suggest that tapered withdrawal of third-generation hypnotics during CBT therapy for chronic insomnia could be associated with improvement rather than worsening of sleep continuity.

• MeSH
• dospělí MeSH
• farmakoterapie statistika a číselné údaje   MeSH
• hypnotika a sedativa terapeutické užití   MeSH
• kognitivně behaviorální terapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nenasazení léčby statistika a číselné údaje   MeSH
• polysomnografie MeSH
• poruchy iniciace a udržování spánku diagnóza   farmakoterapie   terapie   MeSH
• senioři MeSH
• spánek REM fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• hypnotika a sedativa MeSH

• MeSH
• BCG vakcína aplikace a dávkování   škodlivé účinky   MeSH
• incidence MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• tuberkulóza epidemiologie   prevence a kontrola   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Československo epidemiologie   MeSH
• Názvy látek
• BCG vakcína MeSH

OBJECTIVE: The aim of this study was to compare bone mineral density (BMD) and biochemical markers of bone turnover in patients receiving long-term alendronate therapy who continued alendronate, were switched to raloxifene, or discontinued antiresorptive therapy. DESIGN, PATIENTS, AND INTERVENTIONS: Ninety-nine ambulatory women who were diagnosed with postmenopausal osteoporosis and treated with alendronate (10 mg/d) for a mean period of 43 months were randomized to double-blind raloxifene (60 mg/d; n = 33), placebo (n = 33), or continuation of open-label alendronate (n = 33) for 12 months. Patients continued their assigned treatment in a subsequent 12-month, open-label extension phase. All patients received supplemental calcium (500 mg/d) and vitamin D (800 IU/d). MAIN OUTCOME MEASURES: BMD (lumbar spine, total femur, femoral neck, distal forearm, and total body) and biochemical markers (serum intact amino-terminal propeptide of type I procollagen, type 1 collagen cross-linked C-telopeptide, and osteocalcin) were measured at baseline and follow-up visits. RESULTS: Discontinuation of alendronate therapy resulted in a decrease in lumbar spine BMD at 12 months (-2.66%; P < 0.05), but did not change total femur BMD (+0.35%; nonsignificant). Raloxifene and alendronate, compared with discontinuation, prevented lumbar spine BMD loss (-0.75% and -0.54% at 12 months, respectively; P < 0.05). Raloxifene and alendronate caused a similar increase in total femur BMD at 12 months (1.45% and 1.56%; both P < 0.05 vs. baseline; nonsignificant vs. discontinuation). Patients, who discontinued alendronate therapy experienced an increase in bone turnover. Bone turnover increases were less pronounced in patients taking raloxifene and were absent in those who continued alendronate. Of the three groups, mean bone turnover in raloxifene patients was the closest to premenopausal mean values. CONCLUSIONS: BMD preservation and increase were most pronounced in patients continuing alendronate. Raloxifene treatment, compared with placebo, demonstrated beneficial effects on BMD and bone turnover after discontinuation of long-term alendronate therapy.

• MeSH
• alendronát aplikace a dávkování   terapeutické užití   MeSH
• dvojitá slepá metoda MeSH
• inhibitory kostní resorpce terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• placebo MeSH
• postmenopauzální osteoporóza farmakoterapie   MeSH
• raloxifen hydrochlorid aplikace a dávkování   terapeutické užití   MeSH
• rozvrh dávkování léků MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• alendronát MeSH
• inhibitory kostní resorpce MeSH
• placebo MeSH
• raloxifen hydrochlorid MeSH

PURPOSE: Omalizumab has demonstrated clinical efficacy in severe allergic asthma by reducing exacerbation rates and increasing quality of life. However, data concerning its sustained effect after treatment discontinuation are still needed. METHODS: This analysis was an observational pilot study (simple within-subjects design) of 12 patients experiencing severe asthma, treated with omalizumab, for 1 year after treatment discontinuation. We prospectively analyzed clinical measurements (pulmonary functions, inhaled corticosteroid [ICS] doses, Asthma Control Test [ACT] scores, skin prick test [SPT] positivity, fraction of exhaled nitric oxide, and exacerbation rates) and laboratory test results (eosinophils and total immunoglobulin E levels) at the time of discontinuation and 6 and 12 months thereafter. Baseline data (before the treatment period; range, 11-61 months) were collected retrospectively. The treatment effect until discontinuation was calculated. To determine its persistence, repeated measures were compared with baseline levels and analyzed by using a general linear model for repeated measures or the Friedman ANOVA, and χ2 tests in case of normality assumption violation or frequencies. Post hoc analysis was applied by using a simple or repeated contrasts analysis or Wilcoxon signed rank test with Bonferroni correction. FINDINGS: We proved a significant reduction in ICS doses and SPT reactivity and an increase in ACT score during the retrospective treatment phase. Moreover, persistence of these statistically significant effects was recorded 6 months after treatment discontinuation. ACT score and ICS doses (but not SPT reactivity) remained improved for 12 months after discontinuation of omalizumab treatment. IMPLICATIONS: Omalizumab treatment exhibited sustained treatment benefit after its discontinuation for patients experiencing severe allergic asthma.

• Klíčová slova
• Asthma Control Test, inhaled corticosteroids, omalizumab, severe asthma, skin prick test,
• MeSH
• antiastmatika aplikace a dávkování   MeSH
• bronchiální astma farmakoterapie   patofyziologie   MeSH
• dospělí MeSH
• eozinofily metabolismus   MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• omalizumab aplikace a dávkování   MeSH
• oxid dusnatý metabolismus   MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antiastmatika MeSH
• hormony kůry nadledvin MeSH
• omalizumab MeSH
• oxid dusnatý MeSH

BACKGROUND: This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. METHODS: We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). RESULTS: Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. CONCLUSIONS: Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation.

• Klíčová slova
• Antipsychotic medication, First episode, Predictors, Prospective studies, Schizophrenia,
• MeSH
• akutní nemoc MeSH
• antipsychotika terapeutické užití   MeSH
• dospělí MeSH
• interview psychologický MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• prognóza MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• schizofrenie diagnóza   farmakoterapie   MeSH
• ukončení terapie pacientem * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• Izrael MeSH
• Názvy látek
• antipsychotika MeSH

Thrombopoietin-receptor agonists (TPO-RAs) are highly effective in immune thrombocytopenia (ITP). Recently, reports of sustained remission after TPO-RA discontinuation in adult ITP have been reported. We aimed to describe the subset of patients in whom TPO-RA therapy may induce a durable response. We retrospectively analyzed all of our adult ITP patients treated with TPO-RAs, and focused on patients with discontinued TPO-RA therapy due to treatment response. Forty-six relapsed or refractory ITP patients were treated with TPO-RAs. In 11 of these cases, TPO-RA therapy (seven romiplostim; four eltrombopag) was stopped after achieving treatment response. No side effects of TPO-RAs were observed. These patients were pretreated with 1-3 therapy lines plus splenectomy in six patients prior to TPO-RA administration. None of these patients experienced disease relapse after therapy discontinuation over a median follow-up of 33 months (16-54). Substantial proportion of ITP patients receiving TPO-RAs can maintain a durable response after treatment discontinuation. Sustained ITP remission probably does not depend on previous treatment, splenectomy, or disease duration.

• MeSH
• chronická nemoc MeSH
• dospělí MeSH
• idiopatická trombocytopenická purpura farmakoterapie   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• počet trombocytů MeSH
• receptory Fc terapeutické užití   MeSH
• receptory thrombopoetinu agonisté   MeSH
• recidiva MeSH
• rekombinantní fúzní proteiny terapeutické užití   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• thrombopoetin terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• receptory Fc MeSH
• receptory thrombopoetinu MeSH
• rekombinantní fúzní proteiny MeSH
• romiplostim MeSH Prohlížeč
• thrombopoetin MeSH

We report a case of a patient with drug-resistant epilepsy treated with deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS). The patient developed psychiatric side effects (PSEs), namely irritability, hostility, aggressiveness, and paranoia, after implantation and stimulation initiation. The stimulation was discontinued and the PSEs were mitigated, but the patient did not return to her pre-implantation state, as documented by repeated psychiatric reports and hospitalizations. To our knowledge, this is the first report of a patient who developed long-term PSEs that did not disappear after stimulation discontinuation. We suppose that ANT-DBS caused a persistent perturbation of the thalamic neuronal networks that are responsible for long-term PSEs.

• Klíčová slova
• ANT, anterior nucleus of the thalamus, ANT-DBS, deep brain stimulation of the anterior nucleus of the thalamus, Case report, Deep brain stimulation of the anterior nucleus of the thalamus, Long-term psychiatric side effects, MRI, magnetic resonance imaging, PET, positron emission tomography, PSEs, psychiatric side effects,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Treatment adherence is one of the main factors affecting the success of treatment and, secondarily, the quality of life and social adaptation of the patients. The aim of this study was to investigate the association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment. METHODS: The cross-sectional study was conducted on 120 (98 completed all the questionnaires) neurotic outpatients treated in the University Hospital Olomouc. The following variables were evaluated: the objective and subjective Clinical Global Impression (CGI) scale, Drug Attitude Inventory (DAI-10) questionnaire measuring adherence, Internalized Stigma of Mental Illness (ISMI) scale measuring self-stigma, and a demographic data questionnaire. RESULTS: Data analysis showed no correlation between self-stigmatization and age, age of onset or length of the post-hospitalization phase. However, there were significant correlations between self-stigmatization and the severity of the disorder (assessed by both objective and subjective CGI), number of previous hospitalizations, total number of psychiatrists visited by the patient, the arbitrary discontinuation of medication in the past, and the dose of an antidepressant. Furthermore, self-stigma was significantly negatively correlated with the current treatment adherence. The rate of adherence was negatively correlated with both objective and subjective CGI only. CONCLUSIONS: Self-stigma significantly affects the current adherence to the treatment of neurotic spectrum disorders.

• MeSH
• adherence k farmakoterapii psychologie   MeSH
• antidepresiva terapeutické užití   MeSH
• anxiolytika terapeutické užití   MeSH
• dospělí MeSH
• kvalita života psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• sebepojetí * MeSH
• společenské stigma * MeSH
• úzkostné poruchy farmakoterapie   psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antidepresiva MeSH
• anxiolytika MeSH