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Introduction: Depressive disorder, as one of the most common mental illnesses, adversely affects the lives and health of many people around the world. It occurs at any age, but most commonly between the ages of 20 and 40. Worldwide, approximately 100 million people suffer from depressive disorders each year, with many individuals experiencing partial treatment response or treatment resistance, which continually increases the need to find effective prevention and treatment strategies, as well as to monitor and evaluate currently used approaches in routine clinical practice. Materials and methods: The more broadly conceived study, working title UMBRELLA, was a non-interventional, observational, multicentre study, the first phase of which focused on the so-called "real world evidence" of reasons for changing psychopharmacological treatment and its detailed nature in patients suffering from a depressive episode of periodic depressive disorder. The final evaluation included data from 267 patients treated in psychiatric outpatient clinics in the Czech Republic that participated in the probe into their own clinical practice. Results: Data from 74 men (27.7%) and 193 women (72.3%) with a mean age of 49 years were analysed. Changes in treatment were made by the physician based on an assessment of the residual symptoms present, with persistent depressed mood, fatigue and anhedonia being the most common problems. The most commonly used medications included antidepressants (e.g., escitalopram, venlafaxine, sertraline), atypical antipsychotics (e.g., quetiapine), and classic antipsychotics (e.g., chlorprothixene). Adjustments to pharmacological treatment were most commonly made by manipulating antidepressants, changing the active ingredient, or modifying their daily doses. Discussion and conclusion: The present naturalistic observational study mapped the reasons for the change in pharmacological approach and the actual nature of the newly chosen treatment strategy. The observed heterogeneity of pharmacological treatment manipulation patterns confirms that the treatment of depressive episodes in clinical practice follows an individualized approach for each individual patient. Here, we encounter a desire for the application of recommended practices in the treatment of this widespread mental illness, which very effectively describe the treatment of initial episodes and, in the case of recurrent episodes, should provide the basic principles of a therapeutic approach to the management of this problem. The finding that, even in the context of recurrent episodes of periodic depressive disorder, effective intervention can be achieved by increasing the dose of antidepressant medication or changing it, supports the drive to educate specialists and practitioners in these basic treatment approaches. Overall, the study provides information that reflects common clinical practice and underscores the importance of initiating a strategy to change the pharmacological approach in any patient, at any stage of the treatment of this mental illness. [ABSTRACT FROM AUTHOR]

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Long-acting injectable antipsychotics are one of the mainstays of long-term treatment for schizophrenia. The production of the first classical long-acting injectable antipsychotics began in the 1970s and their use expanded, only to decline with the advent of second-generation oral antipsychotics with new properties. Taking advantage of the beneficial properties of second-generation antipsychotics, including their neuroprotective effect, with 100% certainty of adherence, is made possible by the current range of long-acting injectable second-generation antipsychotics. In the Czech Republic, the first second-generation antipsychotic in this dosage form was registered in 2003, and four active substances are currently available, the prescription of which remains limited by reimbursement restrictions. The costs for health insurers have been gradually increasing over 20 years and have tripled when comparing 2014-2022. The first generic long-acting injectable antipsychotic drugs are currently being marketed, the arrival of which will bring about a decline in reimbursement from public health insurance in this important segment of psychopharmacological treatment, theoretically allowing its further expansion towards appropriate patients. [ABSTRACT FROM AUTHOR]

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Switching the treatment with antidepressant and antipsychotic drugs is often necessary and must be carried out effectively to minimize unjustified treatment interruptions. For these reasons, we have decided to create a simple assistance software tool the SwitchApp application. This application can serve as an “evidence-based” guide to determine the duration of administration and the dosing of individual medicinal products when switching between them, and thus substantially assist psychiatrists when switching respective therapy. Material and methods: Data for the Switch App were obtained from public sources (summaries of product characteristics, scientific literature, guidelines). The most frequently used antipsychotics and antidepressants in the Czech Republic have been selected. A website was first created based on wireframes, assignments and provided documentation (using ASP.NET Core and Angular frames), which has been internally tested by a user. When the final version of the website was approved, a mobile application was developed for Android and iOS devices (using the Apache Cordova framework). Results: The web application has a very simple intuitive interface, which can be accessed on http://www.switchapp.cz/. The application for mobile phones can be downloaded and installed under the name SwitchApp (TME solutions s.r.o. – medicine) on the Google Play (Android) and App Store (iOS) platforms. Antipsychotics and antidepressants are selected from the scrolling lists in the left part of the screen and therapeutic doses are entered in the right part of the screen. After entering the required data (active substances are mandatory, the dose does not have to be entered) and clicking on the box “evaluate”, a clear dosing chart and a text description in case of antipsychotics and a text description in case of antidepressants are displayed. Conclusion: SwitchApp is the first and the only Web portal and a mobile application in the Czech language assisting physicians to plan a schedule when switching medicinal products. The application contains a clear guide offering physicians evidence-based recommendations for the gradual change of dosing of antipsychotics or antidepressants they are discontinuing or initiating. The validity of the outcomes is confirmed by the professional guarantee of the Psychiatric Society of the Czech Medical Association of J. E. Purkyne. However, this is only a recommended proposal for the procedure when switching pharmacotherapy in such groups of patients, but the overall health status must always be taken into account. [ABSTRACT FROM AUTHOR]

The diagnostic category „Neuro-developmental disorders“ will soon enter the International Classification of Diseases. This article traces where it comes from, what it means, what its purpose is, and what direct and side effects its existence produces. The considerations of the first part of the text are based on the definition of neural development and its connections with psychopathology. Firs, the question of the semantic justification of the category "neuro-developmental disorders" in the clinical field of child psychiatry is discussed. The importance placed on neuronal substrate of mental and psychopathological phenomena has a history marked by a more or less complex understanding of their mutual causal relations and by more or less "independent" paths of research in both epistemic domains. The question of the scientific justification for the existence of this category is discussed within the context of the level of the scientific knowledge achieved, without calling into question the important contribution of neuro-science. The philosophical concept of pharmakon helps to reflect on the dual potential of scientific (here neuro-scientific) postulates and discoveries. The second part of the text is an analysis of the context through which "neuro-developmental disorders" became a diagnostic category. Is this a nosographic expression of the progress of the knowledge, or is it a regressive disruption imposed by the socio-technical conditions of contemporary society? It helps to seek an answer by reflecting both on the consequences of the struggle between scientific "chapels" and on seemingly unrelated economic, political and marketing influences. Concepts such as "narcissism of small differences", "systemic stupidity", "economic despotism" and "everyday madness" help explicit the noetic context of the birth of the diagnostic category that entails -- for reasons discussed in the article -- an impoverishing conception of the human and childhood. [ABSTRACT FROM AUTHOR]

The cost of psychiatric care reflects the psychiatric, psychological and psychotherapeutic care provided by all segments of the system, i.e. outpatient, acute inpatient and follow-up inpatient care. Health insurance companies pay for outpatient care and psychopharmacology treatment prescribed by prescription. The costs of mental health are not the final cost to insurance companies, that go into psychiatric care. At present there is no record of the amount consumed services, especially psychotherapy, that are paid directly by patients. Other direct costs to patients go towards the purchase of over-the-counter products that are used to alleviate various types of mental health problems. Total costs spent by health insurance companies on psychiatric for psychiatric care in 2020 was approximately 16 billion CZK, with the largest share of financial of the funds goes to providers of follow-up care (CZK 7 billion). For medicinal products, health insurance companies paid approximately CZK 3 billion. In the framework of the gradual changes related to the psychiatric reform of the reform of psychiatric care, there will be changes the proportion of funds spent on individual areas. Currently, it can be stated that, there is an increase in all segments, but in no case is there shifting of funding to the detriment of any other area. Highest increase has been recorded in the outpatient segment psychiatric care, with the largest increase in the outpatient sector compared to the previous year 2017 increased by 44%. [ABSTRACT FROM AUTHOR]

The ongoing mental health care reform raises many issues that need to be addressed. The cooperation of mental health professionals and people with experience of mental health problems is proving necessary to reflect the needs of people with experience of mental health problems. Involving people with experience of mental health problems in decision making at all levels related to the mental health care development ensures their needs are mirrored in the new mental health care system. The presence of people with experience of mental health problems in negotiations is a basis for a mental health care system focused on the recovery and empowerment of people with mental health problems. Working together to change the existing mental health care system also contributes to improving understanding between various stakeholders, including people with mental health problems and providers health and community services. Hence, we consider it necessary to provide a perception of mental health care reform by people with experience of mental health problems themselves, and we do so in this article. The article presents the view of people with mental health problems on their roles in mental health care reform, together with their reflection on how the interests of people with mental health problems are enforced in individual decision-making positions. As people with experience of mental health problems, we welcome the opportunity to be a part of the reform efforts. It does give us an opportunity to influence the mental health care development so it better address our needs, but it also helps us to recover and empower ourselves. [ABSTRACT FROM AUTHOR]

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Stimulants use disorder is an emerging issue in the Czech Republic and even worldwide. The treatment of this condition is complicated by multiple factors as insufficient social background, impulsivity and intense craving. The treatment remains often unsuccessful and there is no specific pharmacological treatment so far. Repetitive transcranial magnetic stimulation is a noninvasive therapeutic method well known and approved in the treatment of treatment-ressistent psychiatric disorders. In the last decade, the possibility of implementing this method to the substance use disorders (SUD) treatment has been explored. This review aims to provide an insight to the evidence published on the field of rTMS in patients using stimulants. 12 original studies were identified by the literature research (8 of cocaine use disorder and 4 of methamphetamine use disorder). The high frequency stimulation of dorsolateral prefrontal cortex delivered by common figure of eight coil was used by the majority of researchers. Some of the others used the theta burst stimulation, or deep transcranial magnetic stimulation delivered by H-coil. Cue-induced craving (craving after exposing the subjects to a drug related cue) was evaluated in most papers. A control group stimulated by a sham stimulation was included in 5 studies. Sham stimulation plays an important role in rTMS research as it can distinguish the placebo effect of the stimulation itself. Presented studies differed widely in stimulation protocols (frequency, intensity, stimulated area, total number of pulses etc.) and provided results remain inconsistent. Low numbers of subjects stand for limit as well. However, most studies presented at least some effect of rTMS on either craving or stimulants use. Also, well designed double-blind studies revealed promising results. The results of reviewed trials provide a promising perspective that rTMS can be an effective method in stimulants use disorder treatment. However, the number of double-blind sham-controlled trials remains insufficient. More controlled double-blind trials with larger number of participants need to be completed. Intensified protocols may come in handy for future as they allow researchers to deliver larger total number of pulses in shorter period. [ABSTRACT FROM AUTHOR]

Suicidal risk assessment is still a major challenge not only in psychiatric practice. The general idea indicates that the clinical evaluation is superior to the standardized methods of evaluation. However, this idea is not confirmed in prospective studies. Application of the standardized methods of evaluation achieves equal results. Moreover, application of the standardized methods of evaluation with thorough documentation can also be used as a protective aspect in the case of allegations of misconduct in the healthcare. provision. The assessment and treatment of suicidality only in the context of the psychological pathology of chosen psychiatric disease is not an optimal complex procedure. The submitted article focuses on the overview of the supplemental methods that can significantly enrich psychiatric examination in suicide assessment - selected suicide risk assessment tools including a collaborative approach and follow-up specific psychotherapy for suicidality, projective methods and ultimately application of the computational techniques such as machine learning and natural language processing, that use data from electronic medical databases. The article also discusses possible alternatives to exploration and collaborative evaluation of suicidality with a virtual doctor by interactive computer program. The risk assessment tools are also mapped in terms of individual evaluated items, administration, training possibilities, copyright and availability of their Czech, respectively Slovak version. The article focuses on a collaborative approach in the assessment and the management of a suicidal patient by application of the quantitative and the more detailed qualitative methods of responses collection and evaluation. The collaborative approach also serves as a therapeutic framework and plan in associated psychotherapy specific for the suicidality. The above-mentioned approach is also proven to be safe and effective method to reduce unnecessary and often stigmatizing hospitalizations. [ABSTRACT FROM AUTHOR]

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Psychoactive substance abuse is a well-known adverse factor in patients with schizophrenia. It influences a compliance, relapse rate and social adaptation. Furthermore it is more common if compared to a healthy population and it is influenceable and so it is a possible target for the treatment interventions. Method: We conducted a crossover study in patients with schizophrenia that were treated in outpatient department of the Department of Psychiatry of the University Hospital in Ostrava. The course of the disorder was evaluated as the frequency of relapse, measured by the average number of hospitalizations per year. The indicators of social adaptation (housing, employment/study, relationship) and functional abilities (PSP scale) were followed. The presence of the residual symptoms (positive, negative, affective) was observed. Results: Alltogether 102 patients were included to the evaluation. In one third of them the psychoactive substance abuse or dependence occured. The relapse rate per year was significantly higher in a combination of amphetamines and cannabinoids if compared to other psychoactive substances or their combinations or the abstainers. We didn't find any significant differences in any other of the followed variables. [ABSTRACT FROM AUTHOR]

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: An effective treatment of mental disorders and it's development require seeking for their neurobiological markers. Transcranial ultrasonography (TCS) is a brain imaging method, which is able to depict certain brain structures with a high accuracy. In depressive and selected anxiety disorders, it revealed a reduced echogenicity of the brainstem raphe, a part of which the raphe nuclei are. As this finding is not related to the disease severity, it is usually interpreted as a dispositional factor or a trait marker for these disorders. Objective: Our objective was to determine, whether the reduced brainstem raphe echogenicity is related to the dispositional factor for depressive and anxiety disorders. Material and method: One hundred students with no history of mental or neurological disease were examined using TCS and, at the same time, the five-dimension revised NEO Personality Inventory, Beck's scales of anxiety and depression, the Social Re-adjustment Rating Scale, and genetic testing in order to determine polymorphisms in the promoter of the serotonin transporter gene. Results: Anechogenic brainstem raphe was found in 11% of the participants, hypoechogenic one in 29%, and normoechogenic one in 60%. Only an increased score of the Social Re-adjustment Rating Scale, an increased agreeableness z-score, and an increased total percentage of the long allele of the promoter of the serotonin transporter gene were found in the anechogenic brainstem raphe group as compared to the normoechogenic one. Conclusion: Ascertained personal characteristics and genetic outcomes do not support the link between rapheal hypoechogenicity and known dispositional factors for depressive and anxiety disorders. Only an increased occurrence of stressful life events in anechogenic subjects during the 6 months preceding the examination is in accordance with known etiopathogenetic findings in these mental disorders. Our findings failed to prove that the reduced brainstem echogenicity is a trait marker of depressive and anxiety disorders, however, it is possible to consider a role of this condition as a state marker. Therefore, a further research in this sense is suitable. [ABSTRACT FROM AUTHOR]

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of the study was to develop a typology of adolescents from urban areas based on their antisocial behavior and to validate the typology on the basis of the relationships between antisocial behavior and substance use. Material and Methods: The sample, which was acquired as a part of an international project The Social and Health Assessment (SAHA), consisted of students of secondary schools in the regional capitals of the Czech Republic. The sample size after excluding incomplete and inconsistently completed questionnaires was 1,891 persons (59.9 % of girls). Antisocial behavior and substance use was assessed by the SAHA questionnaire. Results: The items of the antisocial behavior scale were analyzed using non- -hierarchical cluster analysis (k-means). Three types of persons were identified. The typology was validated on the basis of relations to use of substances (cigarettes, alcohol, marihuana, and other drugs). The higher was the reported level of antisocial behavior, the more the persons reported the use of substances. Conclusion: Only Type 1 (12 % of the sample) with increased levels of multiple forms of antisocial behavior seems to be a risk group. This type is characterized by higher proportion of boys and higher relative frequency of students of apprentice schools, and it is also characterized by frequent substance use, including hard drugs. [ABSTRACT FROM AUTHOR]

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ceská a Slovenská Psychiatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Encephalitis with antibodies against the N-methyl-D-aspartate receptor (NM-DAR) is an immunologically mediated form of encephalitis which is characterized by the presence of psychiatric symptoms in the beginning of the disease. It was first described in year 2007 and since then were documented more than 400 cases. Approximately in a half of cases the autoimmune reaction against NMDA receptors represents a paraneoplastic syndrome in patients with ovarial teratoma or less common other types of tumor. Most often it occurs in young females and because of prevailing psychiatric symptoms that imitate schizophrenia and younger age of patients it is not rarely misdiagnosed as a primary psychiatric disease. Properly guided therapy of this potencially lethal disease leads in most cases to complete recovery. This paper includes a case report of a male patient with diagnosed anti-NMDAR encephalitis and a review of the literature. [ABSTRACT FROM AUTHOR]