Hana Přikrylová Kučerová

Cognitive deficits in the euthymic phase of unipolar depression

Although neuropsychological deficits have been reported in patients with major depressive disorder (MDD) during an acute episode, relatively little is known about the persistence of these deficits in remission. This study investigated the performance of attention, executive function and verbal memory during remission from unipolar depressive episodes. We tested the hypothesis that outpatients do not differ in cognitive variables from controls. We did this using a well-defined outpatient sample, consisting of medicated and unmedicated patients, with a history of MDD. Ninety-seven subjects with MDD in remission ranging from young to old were compared with 97 healthy control subjects. Both samples were balanced for age, gender, and education levels. The Auditory Verbal Learning Test (AVLT) and the Trail Making Test (TMT) were used. Patients with remitted MDD, in comparison with controls, were impaired on tasks of attention, executive function and verbal memory. The individual level of depressive symptoms was not related to the cognitive performance. Small- to medium-sized significant correlations exist between cognitive test variables (as represented by Trail Making B and AVLT delayed recall) and level of depressive symptomatology (as measured by MADRS or BDI-II) in the total sample, indicating that higher levels of depressive symptomatology are associated with lower cognitive function. These findings suggest deficits in attention and delayed verbal recall can serve as an indicator for MDD in outpatients.

Gray matter morphology and the level of functioning in one-year follow-up of first-episode schizophrenia patients.

UNLABELLED Schizophrenia is a condition with a highly variable course that is hard to predict. The aim of the present study was to investigate if local gray matter volume (GMV) can differentiate poor (PF) and good (GF) functioning patients using voxel-wise analysis in a group of first-episode schizophrenia subjects (FES). METHOD 32 FES male patients were assessed twice: at the time of the first episode of schizophrenia and one year later. 18 healthy controls matched for age, gender, and handedness were also included. Local gray matter volume was analyzed using voxel-wise full-factorial design with factors group (GF, PF) and time. RESULTS FES subjects had bilateral gray matter reduction in the lateral prefrontal cortex as compared with healthy controls. PF subjects had smaller GMV in the left orbitofrontal and frontopolar cortex. CONCLUSION GMV in the left prefrontal cortex differentiates later poor and good functioning schizophrenia patients. Morphological analysis might be considered a candidate for a biological marker in outcome prediction. However, the small sample size, and the lack of female subjects limit generalization of results. Moreover, studies analyzing the predictive value of brain morphology on a single-subject level should be performed to assess its real usefulness in outcome prediction.

Can Repetitive Transcranial Magnetic Stimulation Be Considered Effective Treatment Option for Negative Symptoms of Schizophrenia

Objective Despite the development of second-generation antipsychotic drugs, treatment-resistant symptoms still represent a serious problem in schizophrenia. The aim of the present article was to review studies with repetitive transcranial magnetic stimulation for negative symptoms of schizophrenia and draw conclusions for clinical decision making. Method Literature for this review was identified by searching MEDLINE and ISI Web of Science up to the year 2011. Results Five open studies, 13 sham-controlled studies, and 2 meta-analysis and 2 review articles were included in the present paper. The effect size of the high frequency repetitive transcranial magnetic stimulation (rTMS) over the left prefrontal cortex in the treatment of negative symptoms of schizophrenia is thought to be mild to moderate (Cohen d = 0.43–0.68). Conclusion Despite the promising results of some rTMS studies, the potential of rTMS for the treatment of negative symptoms is currently relatively unclear. Large clinical studies are therefore needed, especially large multicentric studies such as depression rTMS studies. Clinical RecommendationsThere is an evidence showing that rTMS can be considered the effective treatment option for negative symptoms of schizophrenia.Based on the results of current meta-analyses, the effect size of high-frequency rTMS in the treatment of negative symptoms of schizophrenia seems to be mild to moderate (Cohen d = 0.43–0.63).Despite limited evidence base, the associations between efficacy and stimulation approaches (higher stimulation intensity, higher number of sessions or 10 Hz stimulus frequency) appear. Additional CommentsNeither the European Medicines Agency nor the Food and Drug Administration has approved rTMS for the treatment of negative symptoms of schizophrenia.Furthermore, large clinical studies are necessary to verify the natural benefit of rTMS for general clinical practice.

Role of Long-Acting Injectable Second-Generation Antipsychotics in the Treatment of First-Episode Schizophrenia: A Clinical Perspective

Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life.

Occurrence of epileptic paroxysm during repetitive transcranial magnetic stimulation treatment.

The paper is about an induction of epileptic paroxysm during high frequency repetitive trancranial magnetic stimulation treatment.

Attentional networks in euthymic patients with unipolar depression.

BACKGROUND The capacity to focus and concentrate or to direct attention supports many aspects of cognitive functioning including short-term memory and higher-level cognitive functions. The purpose was to assess attentional networks in euthymic patients with unipolar depression using the Attentional Network Test (ANT). MATERIALS AND METHODS We investigated performance of attention by virtue of ANT during remission from unipolar depressive disorder and tested a hypothesis that there are no differences between outpatient group (euthymic patients, N=32) and matched controls in attentional variables, the relationship of attentional networks and everyday cognitive failures. RESULTS No differences between the groups in attentional networks were found and no relationship between attentional networks and cognitive failures was found. LIMITATIONS One assessment during remission could be insufficient to recognize long-term pattern of cognitive functions. CONCLUSIONS These data show non-impaired attentional networks possibly explained by sufficient level of remission and ameliorated influence of high education on cognition.

Screening for Neuroligin 4 (NLGN4) truncating and transmembrane domain mutations in schizophrenia

The present findings suggest that neither of two previously described NLGNX4 truncating mutations plays a major role in schizophrenia. Systematic screening of the transmembrane domain sequence of NLGN4X and NLGN4Y confirmed that this key functional region is also highly conserved in schizophrenic subjects. Our data currently do not rule out mutations in the remaining NLGN4 sequences, spanning 140kb on the X-chromosome, and 340kb on the Y-chromosome. More detailed investigations, however, including autosomal neuroligin genes, have now equally tempered expectations of a strong neuroligin genotype-phenotype association in other neurodevelopmental disorders (Vincent et al., 2004; Ylisaukko-Oja et al., 2005). Thus the phenotypic risk ascribable to truncating NLGN4 variants is most likely limited to rare monogenetic syndromes distinct from the majority of autistic and schizophrenic typologies.

Cognitive impairment and cortisol levels in first-episode schizophrenia patients

Abstract Many modalities of cognition are affected in schizophrenia. The most common findings include dysfunctions of episodic and working memory and of executive functions. Although an inverse correlation between cortisol level and memory function has been proven, few studies have focused on the relationship between cortisol level and cognitive impairment in patients with schizophrenia. In an open, naturalistic, prospective study, consecutively hospitalized males diagnosed with first-episode schizophrenia, hypothalamic–pituitary–adrenal axis activity (afternoon cortisol levels, post-dexamethasone cortisol levels) was evaluated before and at the end of acute treatment. Psychopathology was assessed using the positive and negative syndrome scale (PANSS). Cognitive functions (memory, attention, psychomotor, verbal fluency, and executive functions) were tested after symptom alleviation using a neurocognitive test battery. In the total sample (n = 23), significant decreases in total PANSS score (including all subscales), afternoon cortisol levels, and post-dexamethasone cortisol levels occurred during the course of treatment. It was found that higher afternoon cortisol levels at the beginning of treatment were significantly related to impaired performance in memory functions. Afternoon cortisol levels were not significantly associated with other measured cognitive functions. No correlation was discovered between cognitive functions and post-dexamethasone cortisol levels. The determination of afternoon cortisol levels may serve to detect potential candidates for specific cognitive intervention immediately after the first psychotic breakthrough.

A Putative DRD3 Schizophrenia Risk Haplotype Deconstructed

Meta-analyses have suggested an association between schizophrenia (SZ) and a coding polymorphism (rs6280/Ser9Gly) at the dopamine D3 receptor gene (DRD3), but results have been inconsistent. Because most studies have evaluated only rs6280, the inconsistencies might reflect associations with other variants.

Activity of the Tick Ixodes ricinus Monitored in a Suburban Park in Brno, Czech Republic, in Association with the Evaluation of Selected Repellents

ABSTRACT: The ever-increasing number of Lyme borreliosis patients led us to consider more effective procedures for disease prevention. The aim of our study was to monitor the annual activity and infectivity of Ixodes ricinus ticks in the Pisárky region, City of Brno, CR, and to test the responses of the locally-captured ticks to selected repellents. The result of regular one-hourper-week monitoring in 2011 was the collection of ticks that directly reflected the highest number of Lyme disease patients (4,835) detected throughout the period of recording in the Czech Republic. The ticks were examined for spirochaetes by dark field microscopy. The positive samples were identified by PCR analysis, confirming that 76% of these were infected with Borrelia burgdorferi sensu lato. Ticks were most abundant in May and June, with August having the highest risk for spirochaetal infection. Tick activity was statistically correlated with temperature. The moving-object-bioassay was used to study repellent efficiency on the Ixodes ricinus nymphs captured in the above-mentioned suburban park. Five selected commercial repellents based on DEET (N, N-diethyl-3-methylbenzamide) showed statistically different effects on the non-repellent control group.