Hana Kučerová

Repetitive transcranial magnetic stimulation reduces cigarette consumption in schizophrenia patients

INTRODUCTION High-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) seemed to decrease tobacco consumption and craving in nicotine-dependent people without psychiatric disorder or otherwise healthy people. Even if the prevalence of cigarette smoking in schizophrenia patients is high and estimated to be between 45% and 88%, this technique has not been systematically studied in this indication in schizophrenia yet. THE AIM OF THE STUDY The aim of this study was to test the ability of high-frequency (10Hz) rTMS over the left DLPFC to decrease cigarette consumption in schizophrenia patients. METHODS The study included 35 male schizophrenia patients on stable antipsychotic medication. The patients were divided into two groups: the first (18 patients) were actively stimulated and the second (17 patients) underwent sham (placebo) stimulation. The sham rTMS was administered using a purpose-built sham coil that was identical in appearance to the real coil and made the same noise but did not deliver a substantial stimulus. The rTMS was administered at the stimulation parameters: location (left dorsolateral prefrontal cortex: DLPFC), intensity of magnetic stimulation in % of motor threshold (110%), stimulation frequency (10Hz), number of trains (20), single train duration (10s), inter-train interval (30s), and total number of stimulation sessions (21). In each stimulation session, 2000TMSpulses were given, with a total of 42,000pulses per treatment course. Patients noted the number of cigarettes smoked in the 7days before treatment, during the whole stimulation treatment (21days), and again for a 7-day period after treatment. RESULTS Cigarette consumption was statistically significantly lower in the actively stimulated patients than in the sham rTMS group as early as the first week of stimulation. No statistically relevant correlations were found in the changes of ongoing negative or depressive schizophrenia symptoms and the number of cigarettes smoked. CONCLUSION High-frequency rTMS over the left DLPFC has the ability to decrease the number of cigarettes smoked in schizophrenia patients.

Prevalence of remission and recovery in schizophrenia in the Czech Republic

OBJECTIVE The aim of the study was to map the point prevalence of remission and recovery in patients with schizophrenia in the Czech Republic. METHOD The point-symptomatic remission criteria were based on the definition of remission in schizophrenia according to Andreasen, without the time criterion. The definition of complete remission contained, in addition to the point-symptomatic remission criteria, a time aspect which was determined by the absence of psychiatric hospitalisation or a change in antipsychotic medications due to inefficiency in the preceding six months. Functional remission was defined by a total score on the PSP scale in the range between 71 and 100 points. Recovery was defined by the simultaneous fulfilment of the criteria for complete and functional remission. RESULTS A total of 481 patients with schizophrenia were included in the study. The point-symptomatic remission criteria were fulfilled in a total of 258 patients (54%); complete remission occurred in a total of 214 patients (44%). Functional remission was reached by 124 patients (26%) in total. Recovery was proven in a total of 91 patients (19%). CONCLUSION The ascertained data are in accordance with the results of methodologically similar studies and confirm the known trajectories of the course of schizophrenia.

Risperidone increases the cortical silent period in drug-naive patients with first-episode schizophrenia: A transcranial magnetic stimulation study.

Objectives: Schizophrenia is accompanied by impaired cortical inhibition, as measured by several markers including the cortical silent period (CSP). It is thought that CSP measures gamma-aminobutyric acid receptors B (GABAB) mediated inhibitory activity. But the mutual roles of schizophrenia as a disease and the drugs used for the treatment of psychosis on GABA mediated neurotransmission are not clear. Methods: We recruited 13 drug-naive patients with first-episode schizophrenia. We used transcranial magnetic stimulation to assess CSP prior to initiating risperidone monotherapy and again four weeks later. At the same time, we rated the severity of psychopathology using the Positive and Negative Syndrome Scale (PANSS). Results: We obtained data from 12 patients who showed a significant increase in CSP, from 134.20±41.81 ms to 162.95±61.98 ms (p=0.041; Cohen’s d=0.544). After the treatment, the PANSS total score was significantly lower, as were the individual subscores (p<0.05). However, no correlation was found between ΔCSP and ΔPANSS. Conclusion: Our study in patients with first-episode schizophrenia demonstrated an association between risperidone monotherapy and an increase in GABAB mediated inhibitory neurotransmission.

Severe acute dystonia/akathisia after paliperidone palmitate application - a case study

Currently, there are three second-generation long-acting injectable antipsychotics on the market at our disposal - risperidone, olanzapine, and paliperidone; a fourth, aripiprazole, may also soon be available. These modern second-generation antipsychotics, including their depot forms, could be regarded as relatively safe though rare, but more serious complications may appear.

COGNITIVE DEFICIT IN SCHIZOPHRENIA AND ITS REMEDIATION

Schizophrenia is a severe mental disorder characterized by a variety of signs and symptoms. Since its earliest conception as “dementia praecox“ (i.e. early onset dementia), impaired cognitive function has also been considered a core feature. Research into cognition and schizophrenia over the past years has recently been growing. Cognitive deficit is a virtually omni-present component of schizophrenic psychopathology, independent of other aspects of schizophrenia. It underlays other symptoms of schizophrenia and affects the success of therapy, ability of social adaptation and patients’ quality of life. Cognitive skills in schizophrenia predict social functioning and may serve as outcome measures in the development of effective treatment strategies. One of the possibilities of non-pharmacological improvement of cognitive function is remediation using computer rehabilitation software. It has been proved as an effective method. In our study we found global positive effect of aproximately bimonthly (20sessions) training of cognitive function in patients with schizophrenia using computer rehabilitation software PSS CogRehab. Except verbal fluency, which appears stationary during training of cognitive function, all others domains of cognitive function improved during rehabilitation using computer training of cognitive function. The biggest improvement we located in these domains: psychomotor speed, auditive reaction time and verbal learning and memory, where improvement in neuropsychological tests reached statistically significant difference.