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This study aimed to examine attitudes towards people with mental illness and psychiatry and interest in career choice in psychiatry among medical students from three medical schools in Czechia and Slovakia. A total of 495 medical students participated in a cross-sectional study. Participants completed (1) the Medical students' version of mental illness: clinicians' attitudes (MICA-2) scale, (2) the Reported and intended behaviour scale (RIBS), (3) the Attractiveness of working on a psychiatry-related position scale (P-ATTRACT), and (4) the Status of psychiatry scale (P-STATUS). Descriptive statistics, group comparisons and regression models were calculated. From 23 to 30% of students considered a specialization in psychiatry. However, only about 1% of them had a strong interest in psychiatry as a future career, moreover, students of higher years of study found psychiatry less attractive compared to those who are in the beginning of the study. The consideration of specialization in psychiatry was found to be statistically significantly associated with less stigmatizing attitudes and lower social distance towards people with mental illness. There were statistically significant differences in stigmatizing attitudes among medical schools, with a medical school emphasizing the education in psychiatry the most showing more positive attitudes. It is necessary to increase the interest in psychiatry and minimize stigma among medical students. Psychiatry curriculum in Central and Eastern European region should include more psychiatry-related courses, training in community and out-patient facilities, peer-lectors, and offer counselling after exposure to emotionally challenging clinical situations.

The definitions of the roles of peer support workers (PSWs) are unclear, creating one of the main challenges to PSWs' successful involvement in mental health care. In this empirical qualitative study conducted in the Czech Republic, four common roles of PSWs (N=15) were identified: friend, professional, staff member, and expert-by-experience. Conflicts were observed between the roles of friend and professional and between staff member and expert-by-experience. These conflicts may have a detrimental effect on the PSWs' well-being. The authors therefore call on organizations to prioritize regular supervision, team education, clear definition of the PSW position within an organization, and the destigmatization of people with mental illness in mental health services.

COVID-19 pandemics places extreme demands on healthcare workers. Mental health support is supposed to be an indispensable part of complex care for workers for the sake of their adequate professional performance and prevention of psychological disturbances and psychiatric disorders. The most common problems connected with hard work conditions are reviewed and specific techniques to deal with acute stress are presented.

A survey among medical students of all medical schools in the Czech Republic was conducted to investigate attitudes and views of psychiatry and career choice of psychiatry. A Czech version of the Attitudes to Psychiatry Scale (APS) and a questionnaire surveying demographic characteristics and choices of future specialty were distributed to all medical students of eight medical schools in the Czech Republic via the schools’ internal communication systems in the form of an anonymous online questionnaire. Out of a total of 10,147 medical students in the Czech Republic (academic year 2019/2020), 2418 students participated in the survey (response rate 23.8%). Psychiatry as a non-exclusive career choice was considered by 31.3% respondents; child and adolescent psychiatry was considered by 15.4% respondents. Psychiatry as the only choice was considered by 1.6%, and child and adolescent psychiatry was not considered at all. The interest in both specialties was declining since the first year of study. The status of psychiatry among other medical specialties was perceived as low; students were rather discouraged from entering psychiatry by their families. They did not feel encouraged by their teachers to pursue career in psychiatry despite the fact that they were interested in psychiatry. They also felt uncomfortable with patients with mental illness. Despite high enthusiasm for psychiatry in the first year of medical school, only a small proportion of medical students consider to choose psychiatry, and especially child and adolescent psychiatry, as a career at the end of medical school.

Rodinna psychoedukace je komplexni intervence urcena pacientům a jejich blizkým. Dodava systematicke, relevantni, dostatecněsiroke a aktualni informace o onemocněni, poskytuje emocni podporu a výuku dovednosti ke zvladani životnich okolnosti,ktere s sebou chronicke dusevni onemocněni přinasi. Nejvice důkazů o ucinnosti psychoedukacnich programů pochazi zestudii onemocněni schizofrenniho okruhu, bipolarni poruchy a depresivni poruchy. Přehledový clanek se zaměřuje na praktickeaspekty psychoedukace, předevsim uspořadani programů, výběr temat a dostupnost v Ceske republice.

Medical school curriculum contributes to future doctors' attitude formation towards people with mental illness.The purpose of this study was to compare stigmatizing attitudes between medical students and faculty, analyse stigmatizing attitudes among students from different years of study and identify factors predicting stigma.A cross-sectional study with the use of scales measuring attitudes and social distance was designed. Online questionnaires were distributed to all students and teachers at a medical faculty in the Czech Republic.The response rate was 32.1% ( n = 308) among students and 26.7% ( n = 149) among teachers. Teachers had a greater prevalence of stigmatizing attitudes than students. Increased tolerant attitudes in students were detected after the fourth year, that is, following introduction to psychiatry. Preferred specialization in psychiatry and attending two psychiatry courses predicted more tolerant attitudes. Among both students and teachers, men possessed more stigmatizing attitudes towards people with mental illness. Age was an important predictor of stigmatizing attitudes among teachers.Educators should pay closer attention to the role of medical psychology and communication training implementation, which may be beneficial to improving skills and increasing medical students' self-esteem and feeling of competence throughout their psychiatry rotation.

ObjectivesDespite a number of studies on effectiveness of palliative care, there is a lack of complex updated review of the impact of in-hospital palliative care consult service. The objective is to update information on the impact of palliative care consult service in inpatient hospital setting.MethodsThis study was a systematic literature review, following the standard protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Joanna Briggs Institute tools) to ensure the transparent and robust review procedure. The effect of palliative care consult service was classified as being associated with improvement, no difference, deterioration or mixed results in specific outcomes. PubMed, Scopus, Academic Search Ultimate and SocINDEX were systematically searched up to February 2020. Studies were included if they focused on the impact of palliative care consult service caring for adult palliative care patients and their families in inpatient hospital setting.ResultsAfter removing duplicates, 959 citations were screened of which 49 full-text articles were retained. A total of 28 different outcome variables were extracted. 18 of them showed positive effects within patient, family, staff and healthcare system domains. No difference was observed in patient survival and depression. Inconclusive results represented patient social support and staff satisfaction with care.ConclusionsPalliative care consult service has a number of positive effects for patients, families, staff and healthcare system. More research is needed on factors such as patient spiritual well-being, social support, performance, family understanding of patient diagnosis or staff stress.

Stigmatization of people with mental illness in health care is a serious problem contributing to poor provision of health care and preventive medicine, it decreases their willingness to seek help and reduces quality of their life and life expectancy. The aim of this study is to evaluate the impact of the anti-stigma training READ on medical students during their psychiatric module. The training was held by a psychiatrist and a peer lecturer. This study is a part of the international project INDIGO. A total of 53 medical students participated in this study (32 in intervention group, 21 in control group). Participants completed questionnaire at baseline and at immediate follow-up. It contained scales measuring attitudes, knowledge, empathy and intergroup anxiety. The intervention group demonstrated reductions in stigma-related attitudes, improvements in mental illness knowledge and reductions in intergroup anxiety. At immediate follow-up the control group demonstrated improvements in mental illness knowledge and reductions in intergroup anxiety. Based on the results of this study common psychiatric module at the medical school (including theoretical and practical education) does not contribute to the sufficient reduction of stigma. The training READ with an involvement of peer lecturers appears to be a convenient instrument how to reduce stigmatization of people with mental illness at medical schools. The contact with people who are not in the acute state of the illness is crucial for destigmatization.

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it.Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression.Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%.Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

SUMMARY Aims: Decreasing a number of hospital admissions is important for improving outcomes for people with schizophrenia. The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) programme enables early pharmacological intervention in psychosis by identification of prodromal symptoms of relapse using home telemonitoring via a phone-to-PC SMS platform. Methods: This study was a 1-year extension of a previously published mirror-design followup evaluation of programme clinical effectiveness. In total, 73 patients with psychotic illness (45 patients from original sample and 28 newly added subjects) collaborating with 56 family members participated in the clinical evaluation. Results: There was a statistically significant 77% decrease in the number of hospitalisations during the mean 396.8 ± 249.4 days of participation in ITAREPS, compared with the same time period before participation in ITAREPS (Wilcoxonsigned ranks test, p < 0.00001), as well as significantly reduced number of hospitalisation days when in the ITAREPS (2365 hospitalisation days before and 991 days after ITAREPS enrolment respectively, Wilcoxon-signed ranks test, p < 0.003). Conclusion: The ITAREPS programme represents an effective tool in the long-term treatment of patients with psychotic disorders. What’s known Studies published so far suggest that crisis interventions such as increasing the dose of antipsychotic medication, based on early detection within a relapse prevention programme, reduce readmission rates in schizophrenia. Previous findings from ITAREPS mirror-image design followup showed a statistically significant 60% decrease in the number of hospitalisations during the mean 283.3 ± 111.9 days of participation in ITAREPS compared with the same time period before entering the programme (sign test, p < 0.004).

Objective: In accordance with the definition of health by the World Health Organization, outcome measures beyond mere syndromic recovery, such as quality of life ratings, would aid psychiatric practice and research. This is the first study of psychiatric diagnosis and illness stage specific profiles of subjective quality of life (SQOL) impairment. Method: Patients ( n = 150) hospitalized at the Prague Psychiatric Center rated their SQOL using the Schwartz Outcome Scale at admission and discharge. Severity of illness and clinical improvement were measured by the Clinical Global Impression Scale. Results: The highest and lowest SQOL at admission were reported by patients with psychosis and mood disorders respectively ( F = 7.3, df = 2,147, P < 0.001). SQOL improved significantly during hospitalization in all diagnostic categories ( F = 90.0, df = 1,147, P < 0.001), with the smallest and largest improvement in patients with psychosis and mood disorders, respectively ( F = 5.6, df = 2,147, P = 0.005). There was a trend for differences in ratings of clinical improvement by patients, compared with psychiatrists, across diagnostic categories ( F= 2.9, df = 2,147, P = 0.06), with significant differences only in patients with anxiety disorders. These patients also reported the lowest SQOL at discharge ( F = 3.0, df = 2,147, P = 0.05). Global improvement correlated with improvement in SQOL only in patients with mood disorders ( r = −0.4, P = 0.005). Conclusions: Main psychiatric diagnostic categories differ in SQOL and in association between SQOL and treatment. These differences may reflect illness-specific mechanisms, such as depressive symptoms in mood disorders, low insight in psychotic patients, aggravation of anxiety before discharge in patients with anxiety disorders, and may aid in planning of specific treatment interventions. Objectif: Conformément à la définition de la santé de l'Organisation mondiale de la santé, des mesures des résultats qui iraient au-delà du simple soulagement des symptômes, comme par exemple des cotes de la qualité de vie, seraient utiles à la pratique et à la recherche en psychiatrie. La présente est la première étude portant sur le diagnostic psychiatrique, et les profils spécifiques des stades de la maladie, de la déficience de la qualité de vie subjective (QDVS). Méthode: Des patients ( n = 150) hospitalisés au Centre psychiatrique de Prague ont coté leur QDVS au moyen de l'Echelle de résultats de Schwartz, lors de l'admission à l'hôpital et du congé. La gravité de la maladie et les améliorations cliniques ont été mesurées à l'aide de l'Impression clinique globale. Résultats: La QDVS la plus élevée et la plus faible à l'admission a été déclarée par les patients souffrant de psychose et de troubles de l'humeur, respectivement ( F = 7,3, df = 2,147; P < 0,001). La QDVS s'améliorait significativement durant l'hospitalisation dans toutes les catégories diagnostiques ( F = 90,0, df = 1,147; P < 0,001), les plus modestes et les plus grandes améliorations se manifestant chez les patients souffrant de psychose et de troubles de l'humeur, respectivement ( F = 5,6, df = 2,147; P = 0,005). Il y avait une tendance aux différences entre les cotes des améliorations cliniques données par les patients, comparativement à celles des psychiatres dans toutes les catégories diagnostiques ( F = 2,9, df = 2,147; P = 0,06), mais les différences n'étaient significatives que chez les patients souffrant de troubles anxieux. Ces patients déclaraient aussi la QDVS la plus faible au moment du congé ( F = 3,0, df = 2,147; P = 0,05). L'amélioration globale corrélait avec l'amélioration de la QDVS seulement chez les patients souffrant de troubles de l'humeur ( r = −0,4; P = 0,005). Conclusions: Les principales catégories diagnostiques psychiatriques diffèrent en matière de QDVS et dans l'association entre la QDVS et le traitement. Ces différences peuvent refléter des mécanismes propres à la maladie, comme les symptômes dépressifs dans les troubles de l'humeur, une faible introspection chez les patients psychotiques, l'aggravation de l'anxiété avant le congé chez les patients souffrant de troubles anxieux, et peuvent aider à planifier des interventions thérapeutiques spécifiques.

This retrospective study analyses the differences between suicide with and without previous parasuicide. The Czech Republic was one of the countries with the traditionally highest level of suicide mortality. During collapse of the communist regime and deep societal changes in the Czech Republic after the year 1989 the escalation of suicides was expected. Mortality from suicides decreased, however the gender and age differences increased.A total of 2,711 suicides in the Czech Republic (1996-2000) were studied. Effects of socioeconomic characteristics, psychiatric diagnosis and care, and lifetime history of parasuicide on the risk of death from suicide were estimated using logistic regression.Twenty-three percent of persons who committed suicide had a prior history of parasuicide and almost twenty percent of them received no psychiatric care after the attempt. Young males with basic education, economically active and diagnosed with substance abuse related disorders and the elderly were least likely to receive psychiatric care before their suicide death.Implications for age specific primary and secondary prevention are discussed.

Background. The goal of this review is to summarize the results of head to head efficacy studies that compare second generation antipsychotics in the treatment of schizophrenia and related disorders.Methods. A literature search through the Medline database and Google was conducted. Articles published up to September 2005 were included. Abstracts from conference papers and posters were not included.Results. Randomized controlled trial data on possible differences in efficacy among atypical antipsychotics are limited. Moreover, the comparison is difficult, as studies differ in outcome measures. The results indicate that first-line second-generation antipsychotics (amisulpride, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone and zotepine) show comparable efficacy.Conclusion. Possible new studies should focus on long-term effects, including cost-effectiveness, quality of life, social functioning and service utilization.

With the progress of modern medicine, many previously lethal diseases now have become chronic conditions, as pointed out byMacleod [1]. During the prolonged course of illness, medical and social complications accumulate that may erode patients’ quality of remaining life, including their psychological well-being (“Often the organ to suffer most is the brain” [1], p. 340). Macleod questioned the role of psychiatrists in palliative medicine, however, and recommended instead that palliative medicine trainees learn about psychiatry. In response, Strouse [2] wrote that this picture was perhaps “too fatalistic” (p. 1166) and that psychiatrists, on the basis of their experience of laboring at the interface of medicine and psychiatry (e.g., in consultation/liaison work and psycho-oncology), have much to contribute to the field of palliative care. He pointed out two new forces in favor of greater involvement of psychiatry in palliative care: the expansion of integrated care, of which palliative care is a primary example, and the evolution of the clinical role of the psychiatrist/psycho-oncologist into that of a more fully formed palliative care physician [2]. In 2013, only 58 psychiatrists and 41 neurologists achieved hospice and palliative medicine subspecialty certification in the USA [2]. Fairman and Irwin [3] note that despite the fact that the American Board of Psychiatry and Neurology is one of the 10 boards of the Accreditation Council for Graduate Medical Education (ACGME), only 15 psychiatrists were certified in palliative care fellowships in 2008, 12 in 2010, and 34 in 2012. Although the numbers of board-certified practitioners have been increasing, psychiatry’s involvement is woefully inadequate, given the aging of the population and increasing clinical needs. The reasons for this lack of involvement are multifaceted and far from being adequately investigated. Training psychiatrists and other specialists in palliative medicine, moreover, is not the only goal in end-of-life care. All physicians should be able to provide help to patients with terminal illness, to communicate with them and with their families comfortably, to answer their questions adequately, to be able to alleviate their suffering (physical and psychological) adequately and appropriately, and to provide palliative care. The question is whether medical students and residents receive training for palliative and end-of-life care and whether that training is adequate. In addition, palliative care is highly misunderstood by both the general public and health care professionals. As opposed to hospice care at the end of life, which focuses on comfort measures when all medical efforts for amelioration of illness are absent, palliative care may be used at any point in serious illness, not simply at the terminal stage. Palliative care is intended to provide guidance and healing measures to improve the quality of life regardless of the state or specific course of an illness [3]. Indeed, palliative care may well be part of curative treatment, and it combines a multidisciplinary approach for multiple needs of the patient and family. Such needs include medical care, pain management, psychiatric treatment of cooccurring disorders, spiritual assistance, and help with a wide —A. D. Macleod ([1], p. 341)

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.

We have previously described an association between higher serotonin (5-HT) responsivity, indexed by prolactin response to D-fenfluramine challenge, and poorer treatment response to haloperidol in non-medicated schizophrenics. The aim of the present study was to investigate the effects of antidopaminergic treatment on the prolactin response in the repeated challenge test. D-Fenfluramine was administered to 22 young, acutely ill schizophrenics (11 females and 11 males) after 4 weeks of haloperidol treatment. Whereas neuroleptic administration significantly raised basal prolactin levels (P < 0.0001), subsequent D-fenfluramine challenge produced an additional significant increase (P < 0.001). Moreover, the magnitude of this increase was not different from the pretreatment response. Our results demonstrate that prolactin response to the challenge is mediated through the 5-HT system. An observed negative association between posttreatment prolactin response and therapeutic response to haloperidol did not reach statistical significance.

The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives’ frustrations.

Holub D, Flegr J, Dragomirecka´E, Rodriguez M, Preiss M, Nova´kT,Cˇerma´k J, Hora´cˇek J, Kodym P, Libiger J, Ho¨schl C, Motlova´LB.Differences in onset of disease and severity of psychopathology betweentoxoplasmosis-related and toxoplasmosis-unrelated schizophrenia.Objective: Toxoplasmosis is a lifelong parasitic disease that appears tobe associated to schizophrenia. However, no distinguishing attributes inToxoplasma-infected schizophrenia patients have been described as yet.Method: We searched for differences in symptom profile, cognitiveperformance and treatment response between 194 Toxoplasma-free and57 (22.7%) Toxoplasma-infected schizophrenia patients treated inPrague Psychiatric Centre between 2000 and 2010.Results: Infected and non-infected patients differed in severity ofsymptoms (P = 0.032) measured with the Positive and NegativeSymptom Scale (PANSS). Infected patients scored higher in positivesubscale of PANSS, but not in the general and negative subscales.Infected men scored higher also in Total PANSS score, and negative,reality distortion, disorganisation and cognitive scores. Higher PANSSscores of positive, negative and disorganised psychopathology wereassociated with the lower titres of anti-Toxoplasma antibodiessuggesting that psychopathology deteriorates with duration of parasiticinfection. Infected patients remained about 33 days longer in hospitalduring their last admission than uninfected ones (P = 0.003).Schizophrenia started approximately 1 year earlier in infected men andabout 3 years later in infected women, no such difference was observedin uninfected subjects.Conclusion: Latent toxoplasmosis in schizophrenia may lead to moresevere positive psychopathology and perhaps less favourable course ofschizophrenia.

To evaluate the effectiveness of the Information Technology-Aided Program of Re lapse Prevention in Schizophrenia (ITAREPS).Relapse-prone outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n=75) or control group (n=71). In the active arm, according to the protocol, investigators were prompted to increase the antipsychotic dose upon occurrence of a pharmacological inter vention requiring event (PIRE) detected by ITAREPS.Intention-to-treat (ITT) analysis found no between-group difference in the hospitalization-free survival rate at 12 months. However, the trial suffered from high non-adherence of investigators in the active group, with no antipsychotic dose increase in 61% of PIREs. Furthermore, Cox regression analysis showed a 11-fold increased risk of hospitalization in the absence of pharmacological intervention following a PIRE (hazard ratio [HR]=10.8; 95% confidence interval [CI] 1.4-80.0; p=0.002). Therefore, a post-hoc as-treated analysis was performed, which demonstrated a nine-fold reduction in the risk of hospitalization in ITAREPS Algorithm-Adherers (IAAs, n=25) compared with the ITAREPS Non-interventional group (INIs, n=70; Kaplan-Meier survival analysis, HR=0.11, 95% CI 0.05-0.28, p=0.009; number needed to treat [NNT]=4, 95% CI 3-10). A significant difference in favor of the IAA group was seen in the number of inpatient days (p0.05) and costs (p0.05).Future ITAREPS trials should target the underlying mechanisms that cause low investigator adherence to the program.Clinical Trials NCT00712660.

Antipsychotic medication and early relapse warning signs detection are the cornerstone of relapse prevention in schizophrenia spectrum disorders. Many patients do not use antipsychotic medication because of lack of information about its preventive effects and the risk of relapse. We introduce PREDUKA--PREventive EDUcational programme for relapse prevention. The goal of the programme is to deliver the information about schizophrenia to patients and their relatives. 178 patients and 252 relatives (118 mothers and 51 fathers) took part in 25 one-day psychoeducational programmes in 6 centres in the Czech Republic between January 2008 and June 2009 and anonymously fulfilled a short questionnaire. Patients and relatives assessed the programme with an average mark 1.4 (1 best, 5 worst). 49.4% patients and 49.0% relatives had received enough information about psychotic disorders during their hospitalization. Moreover 94.1% patients and 95.7% relatives confirmed acquiring new information on how to live with psychosis as a result of PREDUKA programme. 59.6% patients and 73.8% relatives were interested in ITAREPS - Information Technology Aided Relapse Prevention Programme. Mothers were significantly more interested (82.2%) than fathers (62.2%) (p = 0.031). Expressed high interest of patients and their relatives in both programmes indicates their readiness to become active and competent partners in the long-term treatment of schizophrenia spectrum disorders.

ITAREPS presents a mobile phone-based telemedicine solution for weekly remote patient monitoring and disease management in schizophrenia and psychotic disorders in general. The programme provides health professionals with home telemonitoring via a PC-to-phone SMS platform that identifies prodromal symptoms of relapse, to enable early intervention and prevent unnecessary hospitalizations. Its web-based interface offers the authorized physician a longitudinal analysis of the dynamics and development of possible prodromes. This work presents preliminary findings from a one-year mirror-design follow-up evaluation of the programme's clinical effectiveness in 45 patients with psychotic illness. There was a statistically significant 60% decrease in the number of hospitalizations during the mean 283.3+/-111.9 days of participation in the ITAREPS, compared to the same time period before the ITAREPS entry (sign test, p

The Schwartz Outcomes Scale-10 (SOS-10) is a 10-item scale developed to measure the effectiveness of psychiatric treatments. Using standard methodology, we translated the scale into Czech and examined the psychometric properties of the Czech version. 207 in-patients admitted to Prague Psychiatric Center were included in the study. All patients completed the SOS at admission and discharge. The SOS-10 scale was also administered to 170 persons from the general population. Reliability, validity and sensitivity to treatment change of the Czech SOS-10 were analyzed. The Cronbach's alpha coefficient was 0.92. The item-total correlation coefficients varied from 0.56 to 0.82. The SOS-10 correlated well with condition-specific measures including depression (BDI) and anxiety (BAI) and a global self-rated symptom severity scale (CGI). The SOS-10 also had significant correlations with the Health, Basic needs, Relationship, and Leisure time domains of the Czech version of the Subjective Quality of Life Analysis (SQUALA-CZ). The scale discriminated well between patients and controls, with patients scoring significantly lower on all SOS items. The patient sample's admission and discharge scores were significantly different, indicating that the scale is sensitive to treatment changes. We concluded that the Czech SOS-10 is valid with reliability and factor structure similar to the American language version.

Antipsychotic drugs are the most effective medication for the treatment of schizophrenia. Their side effects, however, affect most patients; some of them suffer from them for the rest of their lives, with little chance of improvement. In general, the side effects are perceived differently by patients, their relatives, psychiatrists, and the public. Being informed about the side effects of antipsychotics does not negatively affect compliance and is essential for establishing patients' confidence in doctors and in the medication.

d -fenfluramine has been identified as a highly selective serotonin (5-HT) releaser and re-uptake inhibitor. The objective of our study was to investigate prolactin response to d -fenfluramine challenge in non-medicated, first episode schizophrenics. We hypothesized that 5-HT reactivity can predict a response to the neuroleptic treatment. Twenty-three inpatients, 11 males and 12 females, at the Prague Psychiatric Center participated in the study. Inclusion criteria were: ICD-10 diagnosis of schizophrenia, first episode or duration of illness shorter than 36 months. d -fenfluramine challenge test was performed before 4 weeks of the haloperidol treatment. During the test, prolactin plasma levels were measured. The Brief Psychiatric Rating Scale (BPRS) was administered before and after the treatment. A statistically significant negative correlation was found between prolactin response to the d -fenfluramine challenge and improvement of psychopathology measured by the change in total BPRS score ( p =0.0004), in positive ( p =0.0403), negative ( p =0.0267), and anxiety-depression symptoms of BPRS ( p =0.0014). Our data support the original hypothesis that there is a relationship between 5-HT system activity and treatment response. The higher responsiveness of the 5-HT system in first episode, non-medicated schizophrenics, was associated with a poorer treatment response to haloperidol, an antidopaminergic neuroleptic.

Successful schizophrenia management should concentrate on treatment non-adherence, lack of information about the disease, poor insight, depressive symptoms, cognitive decline and stressful family atmosphere. We introduce clinically-based 6-week structured comprehensive program for out-patients with schizophrenia-spectrum disorders in the stabilization phase of the treatment. The group program consists of individual and family psychoeducation, life style improvement intervention, social skills training, cognitive rehabilitation and information technology aided relapse prevention program (ITAREPS). To assess the feasibility and effectiveness we designed one-year prospective follow-up field study. Data on psychopathology (PANSS) and quality of life (Schwartz Outcomes Scale, WHO-QOL-BREF and Social Integration Survey) will be presented. Preliminary analyses (N=58) show statistically significant improvement in total PANSS scores and in quality of life (psychological domain, WHO-QOL-BREF). Patients and their relatives welcome the opportunity to participate in such a comprehensive program.AcknowledgementThis project was supported by CNS 2005-2009 1M000237520 MSMT CR from Ministry of Education and Youth, Czech Republic.

Program ITAREPS was developed for rapid and targeted recognition of early warning signs of psychotic disorder relapse. It employs modern communication and information technology for timely intervention during initial phase of relapse. The patient and the family member participating in the project complete weekly a 10-item Early Warning Signs Questionnaire - EWSQ (Patient Version and Family Member Version). The result, 10 numbers, are sent by both of them through Short Message Service (SMS) from their mobile phones to the ITAREPS phone number. If the score in the questionnaire of the individual patient exceeds arbitrary chosen value, an ALERT message is automatically sent to psychiatrist's e-mail address. If ITAREPS signals presence of early warning signs in given patient, an Early Intervention Algorithm is recommended. Psychiatrist participating in the project have an access to his/her personal webpage that is a part of the ITAREPS website (www.itareps.com). On the personal pages psychiatrist can find a current score of the EWSQ for each of his/her patients and family members in a visual form as a line chart and a written description of a patient's clinical status during last month.This article describes our one-year clinical experience with the development and use of an automated instrument to incorporate technology for long term detection of early warning sings of schizophrenia relapse.