To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Several neurocognitive deficits present in the euthymic state of bipolar disorder suggest that some of them could be seen as vulnerability trait markers of the illness. Psychoeducation proved as effective therapeutic approach which decreases the risk of relapse and prolongs remission. In our study we aimed to examine the psychoeducational effects on cognitive functioning in the sample of euthymic bipolar outpatients.
A neuropsychological tests battery for assessing selective attention (Emotional and Colour-Word Stroop), cognitive control (Emotional Go/NoGo task) and social cognition (Face recognition task and Recognition of emotional expression task) was administered to 29 bipolar euthymic outpatients before and after attendance at six weeks psychoeducation program. The same procedure was applied on 10 bipolar euthymic outpatients without participating in psychoeducation.
Despite statistically insignificant differences between groups in cognitive performance, some considerable within group differences in domains of selective attention and cognitive control of emotional stimuli emerged. In the Emotional Stroop there was faster processing speed of emotional stimuli after psychoeducation compared to baseline in the intervention group which was not found in the control group. Similarly, coping with emotional stimuli in different emotional contexts markedly improved in the intervention group compared to the control group. Changes in social cognition, in particular better recognition of negative affect were found in the bipolar group with psychoeducation but not in the control group.
Though preliminary, our results support psychoeducation as clinically feasible way of cognitive rehabilitation in terms of improved cognitive control of emotional stimuli in bipolar patients.
Resistant depression is a long-term, disabling illness. The aim of this study was to compare the efficacy of antidepressant monotherapy (ADM) and combinations of antidepressants (CAD) in the treatment of resistant patient (≥1 unsuccessful antidepressant treatment) in current clinical practice.
We reviewed chart documents of resistant patients hospitalized at Prague Psychiatric Center for major depressive disorder (DSM IV) and had finished at least 4 - weeks of treatment with ADM or CAD. Clinical status was assessed using MADRS, CGI and BDI-S at baseline, after 2 weeks and in the end of treatment in the framework of regular evaluation during the hospitalization. Response to treatment was defined as a reduction of MADRS score ≥ 50%.
Results: We analyzed 78 inpatients (CAD=27, ADM=51). Both groups were equal in baseline characteristics (number of previous treatments, severity of depression etc.) and in the length of index treatment. The CAD group was superior to ADM group in the MADRS score reduction (14.6 vs 10.2 pts, p=0.02) and the proportion of responders (67% vs. 39%, p=0.03) in the end of treatment. The post-hoc effect size of CAD compared to ADM was moderate (Cohen's d=0.54).
Conclusion: The results of this study suggest that combinations of antidepressants may be more effective than a monotherapy in patients with resistant depression.
This study was supported by a grants from Internal Grant Agency of Ministry of Health of Czech Republic No. NS 10368-3 and a grant from Ministry of Health of Czech Republic MZ0PCP2005.
Although numerous studies agree that bipolar patients demonstrate extensive cognitive deficits, it is still unclear to which extent these impairments persist across different mood states, including euthymia. Given that the emotional and cognitive processes are closely intertwined, we aimed to examine selective attention, cognitive inhibition, and social cognition within different emotional context in the group of remitted bipolar outpatients.
80 euthymic bipolar outpatients and 66 healthy volunteers matched for sex, age and education participated in the study. Internal State Scale and Barratt Impulsiveness Scale were used to assess self-reported affective states and trait impulsivity. Computerised versions of Colour-Word Stroop, Emotional Stroop, Affective Go/NoGo and Ekman Recognition of Facial Expression task were administered to assess selective attention, inhibition of cognitive control and social cognition.
Several cognitive deficits in selective attention, inhibition of cognitive control and social cognition tasks have been identified in the group of euthymic bipolar outpatients. They revealed worse recognition of negative, positive and neutral affect than controls. Besides cognitive disruptions which were reflected in longer reaction times and more erroneous performance to different emotional stimuli and in different emotional contexts, also trait impulsivity was considerably elevated in the group of bipolar euthymic outpatients.
Bipolar outpatients in our study demonstrated relatively marked impairments in cognitive functioning within different emotional contexts also during the euthymia. Applied neuropsychological inventory proved as useful tool for assessing specific cognitive impairments in bipolar mood disorder, and could contribute to more effective diagnosing and treatment of patients.
Number of previous studies reported that low-frequency repetitive transcranial magnetic stimulation (rTMS) diminishes treatment-resistant auditory hallucinations. However, little is known about the electrophysiological effect on regional functional activity subsequent to the rTMS treatment.
Eighteen schizophrenic patients with antipsychotic-resistant auditory hallucinations were randomized to either active (n=9) or sham (n=9) rTMS. Low-frequency rTMS (0,9Hz, 100% MP, 1200 stimuli per session) was administered over the left temporo-parietal region for ten days. In case of sham rTMS a coil was tilted at 90°. EEG data were recorded within tree days before and after rTMS treatment. The localization of the differences in electrical activity (current density) was assessed by voxel-by-voxel paired t-tests of the LORETA (low resolution brain electromagnetic tomography) images. The clinical effect was assessed by the Positive and Negative Syndrome Scale (PANSS), Hallucination Change Scale (HCS) and the Auditory Hallucination Rating Scale (AHRS) by a rater blind to the treatment condition.
After two weeks of treatment, both HCS and AHRS scores were significantly improved for patients receiving active rTMS compared to the sham group. LORETA analysis revealed a decrease of current densities in high-frequency bands (alpha 2, beta 1 and beta 2) in the left frontal, temporal and parietal lobes in case of active group. No significant differences in electrical activity were observed in sham group.
Real rTMS but not sham stimulation attenuated an auditory hallucinations and was associated with a decrease of activity in high-frequency bands on the left hemisphere.
Within a decade, the Repetitive Transcranial Magnetic Stimulation (rTMS) was being used to treat depression and schizophrenia. Antidepressant response has been reported in open and double-blind, sham-controlled studies of depression. Less is known about rTMS efficacy in the obsessive compulsive disorder.
The aim of the randomized, double-blind, sham controlled study was to compare the 2 and 4 week efficacy of the 10 sessions rTMS with sham rTMS in serotonin reuptake inhibitor resistant OCD patient. Thirty seven right-handed patients were randomly assigned to either active rTMS or to sham. Active rTMS with the frequency of 1 Hz at 110% of motor threshold was administered over the left dorso-lateral prefrontal cortex. The same time schedule was used for sham administration. Thirty three patients finished the study, three patients’ dropped out at the beginning. Psychopathology was assessed by CGI, HAMA, Y-BOCS and BAI before the treatment, immediately after the experimental treatment, and 2 weeks after by an independent reviewer.
Both groups improved during the study period but the treatment effect did not differ between them in any of the instruments.
Low frequency rTMS administered over the left dorso-lateral prefrontal cortex during 10 daily sessions did not differ from sham rTMS in facilitating the effect of serotonin reuptake inhibitors in OCD patients.
The Repetitive Transcranial Magnetic Stimulation (rTMS) can modulate the cortical activity. The goal of our study was to assess whether the rTMS would facilitate effect of serotonin reuptake inhibitors in patients suffering from panic disorder.
Fifteen patients suffering from panic disorder resistant to serotonin reuptake inhibitor (SRI) therapy were randomly assigned to either active or to sham rTMS. The aim of the study was to compare the 2 and 4 weeks efficacy of the 10 sessions 1 Hz rTMS with sham rTMS add on SRI therapy. We used 1 Hz, 30 minutes rTMS, 110% of motor threshold administered over the right dorso-lateral prefrontal cortex (DLPFC). The same time schedule was used for sham administration. Fifteen patients finished the study. The psychopathology was assessed using the rating scales CGI, HAMA, PDSS and BAI before the treatment, immediately after the experimental treatment and 2 weeks after the experimental treatment by an independent reviewer.
Both groups improved during the study period but the treatment effect did not differ between groups in any of the instruments.
The low frequency Repetitive Transcranial Magnetic Stimulation administered over the right dorso-lateral prefrontal cortex after 10 sessions did not differ from sham the Repetitive Transcranial Magnetic Stimulation that was add on serotonin reuptake inhibitors in patients suffering from panic disorder.
The previous studies reported that elevated serum cholesterol levels (≥ 200 mg/dl) were associated with poorer response to fluoxetine and nortiptyline treatment in patients with depression.
The aim of this study was to examine the relationship between pretreatment serum cholesterol levels and clinical response to treatment with different antidepresants among inpatients with depressive disorder.
One hundred and four inpatients with depressive disorder who did not respond to previous treatment were enrolled in a six-week open study. New treatment (different antidepressant monotherapies, combinations or augmentations) was chosen according to clinical judgment. Serum cholesterol levels were obtained before starting new treatment. Cholesterol levels were classified as either elevated (≥ 200 mg/dl) or nonelevated. Clinical response was defined as ≥ 50% decrease in the Montgomery Åsberg Depression Rating Scale (MADRS) score at endpoint compared to baseline.
Forty-six patient (44%) were classified as having elevated cholesterol levels at baseline. Patients with elevated cholesterol levels did not significantly differ in gender ratio, baseline MADRS score, duration of current episode and number of previous episodes but were significantly older than patients with nonelevated cholesterol levels. After adjusting for age, gender, and Body Mass Index (BMI), we did not find significant differences in response rate and as well as in the pretreatment-posttreatment change in MADRS between patients with elevated cholesterol and patients with nonelevated levels.
We did not demonstrate association between pretreatment cholesterol level and response to treatment in depressive disorder.
Study was supported by the grant NS10368 IGA MZ CR.
Protocadherins (PCHD) are cell adhesion proteins with an important role in neuronal migration, differentiation and synaptogenesis. The linkage studies suggest that the 5q31-linked protocadherin family locus should be considered as potential candidate locus in schizophrenia and bipolar disorder. In this study, we focused particularly on single-nucleotide polymorphisms (SNPs) located in PCHDα enhancer. Results from the Czech cohort of patients with bipolar disorder (BD) will be presented.
Unrelated inpatients and outpatients with BD based on Schedule for Affective Disorders and Schizophrenia - Lifetime (n=167) and blood bank donors as control subjects (n=211) were recruited in the study. Four SNPs posted in dbSNP (rs31745, rs10036519, rs3756337 and rs59497) in the PCDHα gene enhancer were analyzed. The data sets were analysed using a case control design.
In case of SNP, rs31745, a significant increase in homozygosity for the minor allele (T) was detected in patients with BD; 5% had this genotype, but no controls (p=0.001). The distribution of allels did not differ between patients and controls. No significant differences were found in allele or genotype distribution for three other SNPs.
The findings suggest that the PCHDα is an interesting gene family to consider in BD susceptibility.
Previous studies of patients with unipolar depression have shown that early decreases of prefrontal quantitative EEG (QEEG) cordance in theta band can predict clinical response to various antidepressants. We now examined whether reduction of prefrontal cordance value after 1 week of venlafaxine treatment predicts clinical response to venlafaxine in non-responders to previous antidepressant treatments.
We analyzed 25 inpatients, who finished 4-week treatment with venlafaxine. EEG data were monitored at baseline and after 1 week of treatment. QEEG cordance was computed at 3 frontal electrodes in theta frequency band. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale (MADRS).
Eleven of 12 responders (reduction of MADRS ≥50%) and only 5 of 13 non-responders decreased prefrontal QEEG cordance value after the first week of treatment. The decrease of prefrontal cordance after week 1 in responders was significant (p=0.03) and there was no change in nonresponders. Positive and negative predictive value of cordance reduction for response was 0.7 and 0.9, respectively.
The reduction of prefrontal theta QEEG cordance value after first week of treatment is a useful tool in the response prediction to venlafaxine.
This study was supported by a grant from Internal Grant Agency of Ministry of Health of Czech Republic No. NR/9330-3 and a grant of Ministry of Education of Czech Republic MSMT 1M0517.
Transcranial magnetic stimulation (TMS) is a non-invasive method that induces functional changes in a relatively small area of the cerebral cortex. It is supposed that the effect of the method in therapy of neuropatic pain is based on the induction of spinothalamic tract inhibiton, which leads to the symptom withdrawal.
To prove the clinical and electrophysiological effect of rTMS in the therapy of chronic neuropatic pain.
29 patients with medication-resistant neuropatic pain were examined by Visual analog scale (VAS), McGill Pain Questionnaire (MPQ) and QST(Quantitative sensory Testing, consisted of von Frey and thermic treshold examination),then treated by high frequency rTMS in the study using double-blind randomized sham-controlled parallel design. rTMS parameters: 5 rTMS sessions (2 weeks treatment), where each session consisted of three 10 Hz rTMS series using:
1) 85%MT (motor treshold),
2) 90%MT and
Each rTMS série consisted of 20 pulses in 12 trains. Location of the active coil was administered over the contralateral motor cortex, directed specifically to facial area of homunculus (according to funcional location). Sham coil was angled 90° degrees away from the skull.
Confirmation of a significant decrease of VAS item in active group, trend to improvement in tactile sensation of severed patient faces. The changes of thermic treshold were not found. Sham rTMS did not show any trend for improvement.
Although no general recommendations can be drawn based on our result, our study is another one that suggest rTMS should be considered as an effective and safe treatment option for chronic neuropatic pain.
Toxoplasma is considered as one of the most promising candidates of infectious agent that might trigger psychotic disorder in predisposed subjects or modulate the course of the disease. A clinical pattern has not been established yet in Toxoplasma infected schizophrenia patients. Psychopathological, cognitive and treatment response features of Toxoplasma seropositive and seronegative individuals suffering from schizophrenia spectrum disorder has been studied in China, Czech Republic, Ethiopia, Germany, Turkey, United States and other countries to determine whether schizophrenia and Toxoplasma infection co-morbidity modifies clinical presentation and illness course. Prague Psychiatric Centre project consisted of 251 patients with schizophrenia spectrum disorder consecutively admitted to between 2000 and 2010. Toxoplasma-infected patients spent more days in hospital during their last admission compared to Toxoplasma-free patients (p = 0.003; mean difference 32.9 days). Schizophrenia started approximately one year earlier in Toxoplasma-infected men and about 3 years later in Toxoplasma-infected women than in Toxoplasma-free patients, which corresponds to gender related toxoplasmosis incidence curves in the Czech Republic. All infected patients scored higher in the Positive Subscale of Positive and Negative Symptom Scale (PANSS). The PANSS scores and composite PANSS scores also correlated negatively with the concentration of anti-Toxoplasma antibodies indicating the increase of psychopathology with infection duration. Our findings support the hypothesis that toxoplasmosis may represent a risk factor for schizophrenia spectrum disorders.
Previous studies demonstrated predictive effect of reduction of prefrontal cordance for non-resistant outpatients or resistant inpatients treated by various antidepressants or venlafaxine. The aim of the present study was to examine whether the reduction of theta prefrontal QEEG cordance value after 1 week of bupropion administration is associated with response to 4 weeks treatment in patients with resistant depressive disorder. We extended our previous pilot data.
We analyzed 18 inpatients, who finished 4-week treatment with venlafaxine. EEG data were monitored at baseline and after 1 week of treatment. QEEG cordance was computed at 3 frontal electrodes in theta frequency band. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale (MADRS).
Nine of 11 responders (reduction of MADRS ≥50%) and no one of 7 non-responders decreased prefrontal QEEG cordance value after the first week of treatment. Positive and negative predictive value (PPV, NPV) of cordance reduction for response to treatment was 1.0 (95% CI, 0.8-1.0) and 0.78 (95% CI, 0.57-0.78), respectively.
Based on our results, the prefrontal QEEG cordance might be helpful in the prediction of the response to bupropion treatment in resistant patients.
This study was supported by a grant from Internal Grant Agency of Ministry of Health of Czech Republic No. NR/9330-3 and a grant from Ministry of Health of Czech Republic MZ0PCP2005.
In order to compare efficacy of antidepressant monotherapies and combinations of antidepressants, we reviewed retrospectively chart documents of treatment resistant depressive inpatients treated at least 4 weeks with a new antidepressant. Depressive symptoms were assessed using Montgomery and Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory-Short Form and Clinical Global Impression at the baseline, week 2, and at the end of treatment. We identified 78 patients (27 treated with combinations and 51 with monotherapies) that fulfilled the criteria for analyses. In comparison with patients on monotherapy, the combination group achieved higher reduction of MADRS score (14.6 vs 10.2 pts., p = 0.02) and response rate (≥ 50% reduction of MADRS, 67% vs 39%, p=0.03). Number needed to treat for response was 4. Based on these results, we suggest that combination of antidepressants might be more effective than monotherapy in clinical practice.
The data from previous studies suggested that folate serum level predicts outcome of treatment in patients who failed to respond to SSRI.
We examined the relationship of serum folate level and response to treatment with various antidepressant interventions (antidepressants, combinations of antidepressants and augmentations) in patients who had failed to respond to at least one previous antidepressant treatment.
Eighty-four inpatients (mean age = 46.2 ± 11.3 years, 69% woman) with major depression according to DSM IV and without gastrointestinal or other comorbidities that might influenced folate level were enrolled to the study. Clinical status was assessed using MADRS, CGI and BDI-SF at baseline and at the end of study (mean length of treatment- 5.2 ± 0.9 weeks) and response was defined as reduction of MADRS score≥50%. Folate serum levels were determined before start of treatment (normal level >2.5 ng/ml).
Low folate level was detected only in 3 patients (2 responders) in our sample. Responders (54%) and non-responders were not different in baseline folate level as well as in clinical a demographic parameters with exception of number of previous unsuccessful treatments of index episode. Furthermore we did not find any correlations between folate level and baseline or final MADRS score as well as reduction of MADRS respectively.
Despite encouraging data from previous studies, based on our data we did not suppose association of baseline serum folate level and outcome of treatment in resistant patients.
This study was supported by grants of Ministry of Health of Czech Republic NS 10368-3 and MZ0PCP2005.
Computer programs are used in rehabilitation of cognitive deficit in schizophrenia. Repetitive transcranial magnetic stimulation (rTMS) can directly affect cortical excitability and metabolism of prefrontal lobe and subsequently affect cognition. The objective of our study was to investigate augmentation of cognitive rehabilitation in schizophrenia with rTMS. Study subjects were stabilized patients with DSM-IV diagnosis of schizophrenia, treated with second-generation antipsychotics, except for clozapine (total N=34). Study with rTMS was double-blind, randomized, placebo-controlled, with 2 parallel arms. All subjects participated in eight-week computer-assisted cognitive training, during first 2 weeks Group 1 (N=8) received rTMS and Group 2 (N=8) inactive sham stimulation. Patients who refused stimulation participated in rehabilitation program only. Data were assessed fo the totatl study sample and for each group separately. The results showed that computer-assisted cognitive training significantly improved severity of cognitive deficit in schizophrenia in many domains, especially executive functions: attention shift – flexibility, attention control, and working memory. The output was faster, more precise, and more reliable. We did not detect to effect of rTMS on the change of cognition, there was no significant difference between active and sham stimulation. This finding can be explained by a significantly lower initial score in Raven test found in actively stimulated group or by a smaller sample size in a double-blind study. The study confirmed efficacy of computer-assisted rehabilitation in remediation of cognitive deficit in schizophrenia.
Supported by the projects IGA MZ CR NF7571-3 and MSMT CR CNS 1M0517
ITAREPS presents a mobile phone-based telemedicine solution for weekly remote patient monitoring and disease management in schizophrenia and psychotic disorders in general. The programme provides health professionals with home telemonitoring via a PC-to-phone SMS platform that identifies prodromal symptoms of relapse, to enable early intervention and prevent unnecessary hospitalizations. Its web-based interface offers the authorized physician a longitudinal analysis of the dynamics and development of possible prodromes. Previous one-year clinical evaluation of the programme effectiveness in 45 patients with psychotic disorder showed significant 60% decrease in the number of hospitalizations.
This work presents data from a two-year mirror-design follow-up evaluation of the programme's clinical effectiveness in 100 patients with psychotic illness.
The efficacy of the treatment of personality disorder was repeatedly been reported as less successful than the therapy of patients without personality disorder. Our study is designed to compare the short-term effectiveness of therapy in patient suffering with social phobia with and without personality disorder. The aim of the study was to asses the efficacy of the 6 week therapeutic program designed for social phobia (SSRIs and CBT) in patients suffering with social phobia and comorbid personality disorder (17 patients) and social phobia without comorbid personality disorder (18 patients). They were regularly assessed in week 0, 2, 4, and 6 on the CGI (Clinical Global Improvement) for severity, LSAS (Liebowitz Social Anxiety Scale), and in self-assessments BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory). Patients of both two groups improved in most of assessment instruments. A combination of CBT and pharmacotherapy proved to be the effective treatment of patients suffering with social phobia with or without comorbid personality disorder. The treatment efficacy in the patients with social phobia without personality disorder had been showed significantly better compared with the group with social phobia comorbid with personality disorder in CGI and specific inventory for social phobia – LSAS. Also the scores in subjective depression inventory BDI showed significantly higher degrease during the treatment in the group without personality disorder. But the treatment effect between groups did not differ in subjective general anxiety scales BAI.