Search

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]

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]

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]