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Prediction of the Antidepressant Effect of Ketamine Based on Clinical Parameters and Intoxication Phenomenology
Andrashko, Veronika ; Horáček, Jiří (advisor) ; Papežová, Hana (referee) ; Juřica, Jan (referee)
Background: ketamine is a rapid and potent antidepressant treatment, however no sufficient predictors for tailored treatment have been identified to date. The aim of the thesis was to identify possible clinical and phenomenological characteristics, associated with better antidepressant response in patients receiving ketamine. Materials and methods: data from 86 depressed patients from cohorts A (2010-2015) and B (2018-2022) were utilized. All patients underwent ketamine infusion and demographic as well as clinical assessment (severity of depressive symptoms, subjective and objective anxiety and anhedonia before and after ketamine application). In addition, an electrocardiogram was taken to assess heart rate variability in cohort A and blood pressure, heart rate, and altered state of consciousness scales were recorded in cohort B during ketamine intoxication. Results: in cohort A, the use of higher doses of benzodiazepines was associated with worse response at day 3 (p = 0.04) and day 7 (p = 0.02) after ketamine administration. Responders showed higher heart rate (p = 0.001) and differed from nonresponders in heart rate variability (p = 0.011). In cohort B, responders reached higher values od systolic (p = 0.003) and diastolic (p = 0.005) blood pressure during intoxication, but not higher heart...
Role of dopaminergic and serotonergic neurotransmission in animal models of schizophrenia
Páleníček, Tomáš ; Höschl, Cyril (advisor) ; Papežová, Hana (referee) ; Šulcová, Alexandra (referee) ; Zvolský, Petr (referee)
The dissertation presents the results of our studies on animal models of psychosis. In the pharmacological model parameters are evaluated by behavioral and electrophysiological correlates of which are subject to influence by direct modification of the serotonergic and dopaminergic neurotransmission.
Aggression in patiens with psychosis
Nichtová, Andrea ; Vevera, Jan (advisor) ; Papežová, Hana (referee) ; Končelíková, Dana (referee)
Most psychiatric patients do not behave aggressively, but they very often become victims of aggressive behaviour. However, in the practical part of this work, we focused on the phenomenon of aggressive behaviour in psychotic patients, and we address victimization of psychotic patients in the theoretical part because it is one of the most important predictors of aggressive behaviour not only in psychiatric patients but also in the general population. In the literature, we encounter three basic immediate causes of aggressive behaviour - psychotic, impulsive, and predatory (planned) - which we observed in hospital conditions. Specifically, we focused on impulsive behaviour in aggressive patients, given that it is assumed that psychotic patients have difficulties in this area. The aim of this study was to examine the immediate causes of aggressive behaviour and provide data from the Czech Republic on their prevalence. Another goal was to determine whether the factor structure in our work is consistent with the three hypothesized factors described by Nolan et al. Another goal was to explore impulsive behaviour in psychotic patients in light of the reported reduced impulse control and emotional dysregulation associated with the emergence of aggressive behaviour in psychotic patients. The study aimed to...
Monitoring one's own activity using digital technologies in treatment of eating disorders
Eliášová, Marie ; Papežová, Hana (advisor) ; Maulisová, Alice (referee)
The diploma thesis approaches the issue of monitoring one's own activity using digital technologies in the context of eating disorders. The aim of the research part is to use a non- interventional quantitative quasi-experimental study to map the impact of using a smart watch, i.e. a specific type of monitoring tool that monitors daily physical activity, on selected areas of treatment for eating disorders. The treatment was assessed in terms of general symptomatology, excessive exercise, regulation of emotions and overall assessment of therapy. Data collection was carried out at the Center for Eating Disorders at the Psychiatric Clinic of the 1st Faculty of Medicine of Charles University and the General University Hospital in Prague. The research compared scores obtained at two time points, based on the use of smart watches patients with an eating disorder (n = 35) were divided into two groups in the analysis. The statistical analysis of the data showed that patients using smart watches did not achieve statistically significantly more severe manifestations of eating disorders, even during specialized treatment. However, it seems that the group using smart watches shows a tendency towards more severe manifestations in the area of general symptoms and excessive exercise. Key words eating disorders;...
Facilitators and barriers in treatment initiation of eating disorders from the perspective of patients and their mothers
Kosjuková, Gabriela ; Papežová, Hana (advisor) ; Veverová, Kateřina (referee)
This master's thesis deals with the process of seeking and initiating treatment for eating disorders. The aim is to explore the facilitators and barriers reflected by patients and their mothers in the process of initiating treatment. The theoretical part presents selected aspects of eating disorders, the treatment system, previous findings in the area of treatment seeking and initiation, and finally summarizes the research to date. The empirical part of the thesis describes the qualitative research conducted in the form of semi-structured interviews with five patients and their mothers. The output is a schematic representation of the treatment pathway with time data and a chronological ordering of important factors. Thematic analysis identified a number of barriers and facilitators on the part of both groups of respondents. The major barriers according to the patients were denial of the disease, lack of motivation, negative attitudes towards treatment and comorbid illness. In contrast, facilitators included negative aspects of the disease, influence of loved ones, positive experience with professionals and awareness. Mothers on the barrier side reflected non-recognition of the disease, daughter's resistance, negative experience with health care and comorbid disease. Their own care, daughter's...
Eating disorders and excessive physical activity
Hrubá, Jitka ; Holanová, Petra (advisor) ; Papežová, Hana (referee)
1 Abstract Introduction: Eating disorders are a serious disease the incidence of which is rising in the population. The most serious are anorexia and bulimia nervosa. These diseases are often accompanied by excessive physical activity, which is used to reduce weight and simultaneously as a compensatory mechanism for dissatisfaction with one's own body. The persistent presence of excessive exercise is often a common cause of relapse of the eating disorders. The treatment must be comprehensive and time consuming. Target: The main aim of the study was to map the incidence and nature of excessive physical activity in female patients with a diagnosis of anorexia nervosa and bulimia nervosa. To determine whether it affects the weight gain of underweight patients and whether there are differences in the frequency or nature of excessive exercise among patients attending a day hospital and patients hospitalized in the ward. Methodology: The research group includes 50 female patients of the Centre for Eating Disorders at the General University Hospital in Prague (Všeobecná fakultní nemocnice v Praze). The patients were diagnosed with anorexia nervosa or bulimia nervosa and were older than 18 years. All filled in an EED19 questionnaire at the beginning of the treatment, were weighed, measured, and their body mass...
Eating Disorders: Epidemiology and Risk Factors
Pavlová, Barbara ; Papežová, Hana (advisor) ; Kocourková, Jana (referee) ; Šípek, Jiří (referee)
This thesis explores the epidemiology and risk factors of eating disorders. It focuses on the impact of the political and cultural changes that occured in the Czech Republic in the early 1990s. The term eating disorders includes mental illnesses characterized by disturbances in eating behaviour: anorexia nervosa, bulimia nervosa and various eating disorders not otherwise specifieed. It appears that the incidence of anorexia nervosa was increasing until 1970s and remains stable since. The incidence of bulimia nervosa was rising until the end of 1990s. However, the data come from the western countries only. The epiemiological data from the Central and Eastern Europe region remain sparse. Eating disorders have multifactorial aetiology; which includes the recently emerging factors related to migration and acculatuation. Therefore, we hypothesised that the prevalence and incidence of eating disorders in the Czech Repulic rose in the 1990s and that factors associated with migration experiences may play a role in the development and maintenance of eating disorders. This thesis contains three different papers exploring different aspects of this hypothesis. The first paper shows that the number of hospital admissions for eating disorders in females aged 10-39 quadrupled between 1981 and 2001, and remained high till...
Anorexia nervosa - selected genetic determinants and endophenotypes
Kaminská, Deborah ; Papežová, Hana (advisor) ; Baxová, Alice (referee) ; Pacák, Karel (referee)
Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are diseases with considerable individual variation. Genetic background plays an important role in disease susceptibility and severity. To evaluate the relationship between certain genetic loci and diseases subtypes we genotyped and analysed evolution of selected clinical parameters. We investigated a group of 75 pacients with AN (1. study), 127 DSM-4 and ICD-10 diagnosed patients with AN and BN (2. study), and contributed to sample of 2907 AN patients in large GWAS study. Results from the 1st study support association of polymorphism -1438G/A in serotonine receptor 5-HT2A with AN and compare the results from other studies with metaanalyses. In next, polymorphism responsible for the serotonine neurotransmission (serotonine transporter 5-HTT, polymorphisms LPR and VNTR) the study shows different association trend of LPR with AN in Czech population compared to other studies. 5-HTT VNTR polymorphism had no observed association. The second study investigated the role of hemeoxygenase 1 (plays a pivotal role in metabolic stress protecting cells) in eating disorders, in interaction with enviromental stress. We investigated the usefulness of an aggregate measure of the risks of AN and BN that is based on genetic susceptibility loci and the added effect of...
Treatment of eating disorders through neurostimulation methods
Baumann, Silvie ; Papežová, Hana (advisor) ; Ustohal, Libor (referee) ; Stárková, Libuše (referee)
Background: Eating disorders are psychiatric illnesses whose treatment is difficult and usually the classic procedures fail. Recently, the number of researches in neuromodulatory methods has increased. I present an overview of basic stimulation methods, their use in the treatment of anorexia nervosa (AN), bulimia nervosa and binge-eating and the results of our study focused on the treatment of AN by transcranial direct current stimulation (tDCS). Methods: It was a randomized, double-blind, sham-controlled trial. Forty-three inpatients with AN were divided to receive either active (n=22) or sham (n=21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2mA for 30 minutes). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung depression scale (ZUNG), we measured them the thermal pain threshold, the objective dissatisfaction with their own body by Anamorfic program and evaluated BMI before the first and after the last tDCS. Follow-up was after 2 and 4 weeks. It was evaluated using ANOVA and OPLS model. Results: Compared to sham tDCS, active tDCS improved self-evaluation based on one's body shape (p < 0,05) and significantly decreased the need of excessive control over calorie intake (p < 0,05) in 4-week follow-up (questions 4 and 23 in EDE-Q). Question 21 in EDE-Q was more...
Execise Therapy in Female Adolescents Hospitalised with Anorexia Nervosa
Ulrichová, Michaela ; Radvanský, Jiří (advisor) ; Krch, František (referee) ; Papežová, Hana (referee)
Objective: Body image disturbance is one of the main characteristics of anorexia nervosa (AN). It is present in different stages of the disease, often persisting even after the end of the treatment, and is one of the predictors of a relaps. Body image is composed of two main components - the perceptual component, and the attitudinal component. Anorexia nervosa patients show a disturbed attitudinal component of the body image. The perceptual component disruption hasn't been completely proven yet. Many authors do, however, warn about the overestimation of bodily proportions of patients with AN and it's possible relation with characteristics such as BMI. Goals: The main goal of the dissertation thesis was the objectivization of the body image disturbance of the patients hospitalized with anorexia nervosa, the comparison of their results with a group of healthy girls of the same age, and the search for factors connected to the defect of the body image. A side goal of the dissertation thesis was the measurement of the effect of kinesiotherapy on the anxiety level of AN patients. Methods: As a part of the practical section, the measurements of 27 hospitalized patients and 20 healthy girls were completed. Probands underwent body size estimation of 4 bodily segments. They estimated the length of their arm,...

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