Background: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.Method: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.Results:Both groups improved during the study period but the treatment effect did not differ between them in any of the instruments.Conclusion: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.Supported by the project n. MŠMT ČR 1M0517
The burnout was assessed using Maslach Burnout Inventory,which addresses thre general scalesemotional exhaustion,depersonalization and reduced personal accomplishment. Results: The findings supported our hypothesis that this syndrome is highly prevalent among health care workers,espacially among anesthesiologists. Conclusions: The burnout syndrome is a frequent disorder among health care workers, especially among with high work demand,susc as general practitioners and anesthesiologists.Therefore,prevention strategies should be planned and carefully implemented.
Background: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.Method: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.Results:Both groups improved during the study period but the treatment effect did not differ between groups in any of the instruments.Conclusion: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.Supported by the project n. MŠMT ČR 1M0517
The study is designed to compare the short-term effectiveness of combination of cognitive behavioral therapy and pharmacotherapy in patient suffering with panic disorder with and without personality disorder.Method:We compare the efficacy of 6th week therapeutic program and 6th week follow up in patients suffering with panic disorder and/or agoraphobia and comorbid personality disorder (29 patients) and panic disorder and/or agoraphobia without comorbid personality disorder (31 patients). Diagnosis was done according to the ICD-10 research diagnostic criteria confirmed with MINI and support with psychological methods: IPDE, MCMI-III and TCI. Patients were treated with CBT and psychopharmacs. They were regularly assessed in week 0, 2, 4, 6 and 12 by an independent reviewer on the CGI for severity and change, PDSS, HAMA, SDS, HDRS, and in self-assessments BAI and BDI.Results:A combination of CBT and pharmacotherapy proved to be the effective treatment of patients suffering with panic disorder and/or agoraphobia with or without comorbid personality disorder. The 12th week treatment efficacy in the patients with panic disorder without personality disorder had been showed significantly better compared with the group with panic disorder comorbid with personality disorder in CGI and specific inventory for panic disorder – PDSS. Also the scores in depression inventories HDRS and BDI showed significantly higher decrease during the treatment comparing with group without personality disorder. But the treatment effect between groups did not differ in objective anxiety scale HAMA, and subjective anxiety scale BAI.Supported by the project n. MŠMT ČR 1M0517
Objectives. Relapse prevention is one of the most important goals of long-term schizophrenia management, as relapse is both distressing and costly. Family intervention supplementation to standard treatment could reduce the relapse rate. This study assessed the influence of a short-term, clinically based, and profesionally led family psychoeducation programme on a 1-year relapse rate. Methods. A total of 120 patients were recruited upon discharge from two psychiatric hospitals in Prague: (1) Site A (N=86), where family psychoeducation is offered to all patients with schizophrenia, schizoaffective disorder, and acute psychotic episode with schizophrenic symptoms; and (2) Site B (N=34), where no such programme was offered. Results. Compared to nonparticipants, psychoeducation participants had a shorter average length of rehospitalization stay (5.89 vs. 17.78 days, P=0.045) in a 1-year follow-up after discharge. The probability of rehospitalization during a 1-year follow-up was higher for patients from the site that did not provide psychoeducation. Conclusions. A shorter average length of rehospitalization of psychoeducation participants, a high turnout of first-episode patients, and positive responses of psychoeducation participants suggest that family psychoeducation should be supplemented early in the course of the illness to achieve favourable treatment outcomes and minimize adverse health and the social consequences of schizophrenia.
IR received twice-daily quetiapine IR 400, 600 or 800 mg/day for 4 weeks. Stable patients were then randomised (1:2) to continue taking quetiapine IR or switch to the same total dose of quetiapine SR (active dose once-daily in the evening) for 6 weeks. Primary analysis: % of patients (modified ITT population) discontinuing due to lack of efficacy or with PANSS total increase !20% at any visit, using a 6% non-inferiority margin for the upper 95% CI of the treatment difference. Per-protocol (PP) analysis was also performed. Results: 497 patients were randomised (quetiapine SR 331, IR 166); completion rates were 91.5% and 94.0%, respectively. Few patients discontinued due to lack of efficacy or had a PANSS increase !20% in both the MITT (n¼496) and PP populations (n¼393): 9.1% and 5.3% for quetiapine SR and 7.2% and 6.2% for quetiapine IR, respectively. Quetiapine SR was non-inferior to quetiapine IR in the PP population (treatment difference:-0.83% [95% CI-6.75, 3.71]; p¼0017) but not in the MITT population (treatment difference: 1.86% [95% CI-3.78, 6.57]; p¼0.0431). The incidence (quetiapine SR 38.7%; IR 35.5%) and profile of AEs were similar in both groups. Conclusion: Clinically-stable patients receiving quetiapine IR can be switched, without titration, to an equivalent once-daily dose of quetiapine SR without any clinical deterioration or compromise in tolerability.
Most clinicians tend to believe that the occurrence of the anxiety disorder in tandem with a personality disorder often leads to longer treatment, worsens the prognosis, and thus increasing treatment costs. Method: We compare the efficacy of 6weeks therapeutic program and 6weeks follow up in patients suffering with panic disorder and/or agoraphobia and comorbid personality disorder (29 patients) and panic disorder and/or agoraphobia without comorbid personality disorder (31 patients). Patients were treated with CBT and psychopharmacs. They were regularly assessed in week 0, 2, 4, 6 and 12 on the CGI, PDSS, HAMA, SDS, HDRS, BAI and BDI. Results: A combination of CBT and pharmacotherapy proved to be the effective treatment of patients suffering with panic disorder and/or agoraphobia with or without comorbid personality disorder. The 12 th week treatment efficacy in the patients with panic disorder without personality disorder had been showed significantly better compared with the group with panic disorder comorbid with personality disorder in CGI and specific inventory for panic disorder-PDSS. Also the scores in depression inventories HDRS and BDI showed significantly higher decrease during the treatment comparing with group without personality disorder. But the treatment effect between groups did not differ in objective anxiety scale HAMA, and subjective anxiety scale BAI.
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