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Prospective, randomized comparison of efficacy of antidepressant monotherapy and combinations of antidepressants in the treatment of patients with resistant depression
Bareš, Martin ; Libiger, Jan (advisor) ; Přikryl, Radovan (referee) ; Hrdlička, Michal (referee)
Martin Bareš, M.D. Faculty of Medicine in Hradec Kralové, Charles University Prague Title: Prospective, randomized comparison of efficacy of antidepressant monotherapy and combinations of antidepressants in the treatment of patients with resistant depression. Background: Approximately 60% of patients respond to first antidepressant treatment trial. Combination of antidepressants (CAD) is the strategy that is often used to overcome resistance to treatment in depressive patients. The aim of the study: This randomized, 6-week, open label study compared efficacy of CAD and antidepressant monotherapies (ADM) that had been chosen according to clinical judgment of the attending psychiatrist in the treatment of patients suffering from resistant depression. Methods: A total of 60 inpatients (intent-to-treat analysis) with major depressive disorder diagnosed according to Diagnostic and Statistical Manual of American Psychiatric Asociation, 4th revision (≥ 1 unsuccessful antidepressant treatment) were randomly assigned to the interventions. The responders who completed the acute phase of study, were evaluated for relapse within two months of follow-up treatment. The primary outcome measure was score change in the Montgomery-Åsberg Depression Rating Scale (MADRS), response was defined as a ≥50% reduction of MADRS score...
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Latent toxoplasmosis as a risk factor for the development of schizophrenia and a modulator of its course
Holub, David ; Libiger, Jan (advisor) ; Přikryl, Radovan (referee) ; Pavlovský, Pavel (referee)
Schizophrenia is serious, multifactorial and chronic disease. The crucial tasks to introduce effective preventive, diagnostic and treatment measures is to identify etiology factors, their interaction and etiology factors-genetic predispositon interactions. TG (Toxoplasma gondii) is the most promising infectious candidate with "schizophrenogenic" potential. Toxoplasmosis is a lifelong parasitosis considered as a risk factor to schizophrenia. No consistent clinical pattern has been detected in Toxoplasma-infected schizophrenia patients as yet. We assessed symptom profile, cognitive performance and treatment response of Toxoplasma- infected and Toxoplasma-free schizophrenia patients to determine whether co-occurrence of schizophrenia and Toxoplasma infection modifies clinical presentation and the course of schizophrenia. We screened for anti-Toxoplasma antibodies in 251 patients with schizophrenia spectrum disorder consecutively admitted to Prague Psychiatric Centre between 2000 and 2010. Fifty-seven patients were infected (22.7%). Infected patients spent more days in hospital during their last admission compared to uninfected ones (p=0,003; mean difference 32.9 days). Schizophrenia started approximately one year earlier in infected men and about 3 years later in infected women. This corresponds to sex related...
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Visual mismatch negativity among patients with schizophrenia
Urban, Aleš ; Libiger, Jan (advisor) ; Brázdil, Milan (referee) ; Přikryl, Radovan (referee)
Cognitive deficit is considered to be one of the basic symptoms of schizophrenia. It is associated with the social impairment and the long term outcome of the disorder. In addition to neuropsychological methods, event-related potentials can be used to study cognitive functions. In patients with schizophrenia an association was found between the amplitude changes of slow negative component of evoked responses to infrequent deviant stimuli in a series of uniform stimuli. This change is known as mismatch negativity (MMN) and it is assumed to be independent of the focused attention and effort that may interfere with neuropsychological testing. The recent accumulation of knowledge on MMN as a possible preattentive measure of perceptual processing supports its potential significance for diagnostic and functional evaluation of schizophrenia. MMN elicited by visual stimuli (vMMN) was described by several research teams, but it has not been investigated in schizophrenia as yet. Using a motion-direction paradigm, we elicited visual MMN in 24 patients with schizophrenia and schizoaffective disorder. The vMMN was computed as difference in areas under curve (AUC) of visual ERPs to standard and deviant motion direction stimuli recorded from midline derivations at the interval of 100-200 msec. AUC were compared...
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