Libor Ustohal

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.

Hippocampal volume in first-episode schizophrenia and longitudinal course of the illness

Abstract Objectives: Several lines of evidence suggest an adverse effect of psychotic episodes on brain morphology. It is not clear if this relationship reflects the cumulative effect of psychotic outbursts on the gradual progressive reduction of hippocampal tissue or an increased tendency toward psychotic episodes in patients with a smaller hippocampus at the beginning of the illness. Methods: This is a longitudinal 4-year prospective study of patients with first-episode schizophrenia (FES, N = 58). Baseline brain anatomical scans (at FES) were analysed using voxel-based morphometry and atlas-based volumetry of the hippocampal subfields. The effects of first-episode duration on the hippocampal morphology, and the effect of baseline hippocampal morphology on illness course with relapses, number of psychotic episodes and residual symptoms were analysed. Results: A significant negative correlation was detected between first-episode duration and baseline hippocampal morphology. Relapse, number of psychotic episodes and residual symptoms had no correlation with baseline hippocampal volume. Conclusions: We replicated the effect of psychosis duration on hippocampal volume already at the time first-episode, which supports the concept of toxicity of psychosis. The indices of a later unfavourable course of schizophrenia had no correlation with baseline brain morphology, suggesting that there is no baseline morphological abnormality of the hippocampus that predisposes the patient to frequent psychotic outbursts.

Effect of electroconvulsive therapy on cortical excitability in a patient with long-term remission of schizophrenia: a transcranial magnetic stimulation study.

The exact effects of electroconvulsive therapy (ECT) on the brain are still not accurately known. Hypotheses considered include the effect of ECT on cortical excitability of the brain. The aim of this trial was to assess the changes in cortical excitability in the brain of a patient with remitted schizophrenia, undergoing maintenance ECT. Three successive ECT applications resulted in significant prolongation of the cortical silent period, which implies augmentation of inhibitory cortical mechanisms in the brain, most likely mediated by the GABAergic (GABA, &ggr;-aminobutyric acid) system with direct involvement of GABAB receptors. The actual therapeutic effect of ECT is therefore probably due to facilitation of cortical inhibitory mechanisms induced by GABAergic neurotransmission.

Influencing negative symptoms of schizophrenia with repetitive transcranial magnetic stimulation: a case study

Background: The present trial was designed to investigate the influence of repetitive transcranial magnetic stimulation (rTMS) on negative schizophrenic symptoms using high-frequency stimulation of the left dorsolateral prefrontal cortex in a simple blind randomized design. Methods: The study was carried out on a 42-year-old patient with schizophrenia (paranoid subtype) with prominent negative symptoms who was first treated with sham rTMS during the first 3 weeks and then with real high frequency during the following 3 weeks. He was rated before and after the sham and after the real rTMS therapy for positive, negative and depressive symptoms. Results: rTMS was superior to sham treatment in reduction of negative and depressive symptoms. Conclusion: High-frequency rTMS applied over the left dorsolateral prefrontal cortex led to a reduction of severity of negative symptoms in a patient with chronic schizophrenia and may be beneficial as an augmentation option to antipsychotics in the treatment of negative symptoms of schizophrenia.

Predictive Motor Timing and the Cerebellar Vermis in Schizophrenia: An fMRI Study

Abnormalities in both time processing and dopamine (DA) neurotransmission have been observed in schizophrenia. Time processing seems to be linked to DA neurotransmission. The cognitive dysmetria hypothesis postulates that psychosis might be a manifestation of the loss of coordination of mental processes due to impaired timing. The objective of the present study was to analyze timing abilities and their corresponding functional neuroanatomy in schizophrenia. We performed a functional magnetic resonance imaging (fMRI) study using a predictive motor timing paradigm in 28 schizophrenia patients and 27 matched healthy controls (HC). The schizophrenia patients showed accelerated time processing compared to HC; the amount of the acceleration positively correlated with the degree of positive psychotic symptoms and negatively correlated with antipsychotic dose. This dysfunctional predictive timing was associated with BOLD signal activity alterations in several brain networks, especially those previously described as timing networks (basal ganglia, cerebellum, SMA, and insula) and reward networks (hippocampus, amygdala, and NAcc). BOLD signal activity in the cerebellar vermis was negatively associated with accelerated time processing. Several lines of evidence suggest a direct link between DA transmission and the cerebellar vermis that could explain their relevance for the neurobiology of schizophrenia.

Depression and Anxiety after Acute Myocardial Infarction Treated by Primary PCI

Aims The main objective of the study was to find out prevalence of depression and anxiety symptoms in the population of patients with AMI with ST-segment elevation (STEMI), treated with primary PCI (pPCI). Secondary target indicators included the incidence of sleep disorders and loss of interest in sex. Methods and results The project enrolled 79 consecutive patients with the first AMI, aged <80 years (median 61 years, 21.5% of women) with a follow-up period of 12 months. Symptoms of depression or anxiety were measured using the Beck Depression Inventory II tests (BDI-II, cut-off value ≥14) and Self-Rating Anxiety Scale (SAS, cut-off ≥ 45) within 24 hours of pPCI, before the discharge, and in 3, 6 and 12 months). Results with the value p<0.05 were considered as statistically significant. The BDI-II positivity was highest within 24 hours after pPCI (21.5%) with a significant decline prior to the discharge (9.2%), but with a gradual increase in 3, 6 and 12 months (10.4%; 15.4%; 13.8% respectively). The incidence of anxiety showed a relatively similar trend: 8.9% after pPCI, and 4.5%, 10.8% and 6.2% in further follow-up. Conclusions Patients with STEMI treated by primary PCI have relatively low overall prevalence of symptoms of depression and anxiety. A significant decrease in mental stress was observed before discharge from the hospital, but in a period of one year after pPCI, prevalence of both symptoms was gradually increasing, which should be given medical attention.

Amisulpride therapeutic dose-induced asymptomatic bradycardia.

Severe cardiac problems including QTC prolongation, bradycardia, and cardiac rhythm disorders, including Torsade de pointes, have been repeatedly described in cases of amisulpride overdose. Another case involving cardiac problems during amisulpride therapy was described with concomitant hypocalaemia. Amisulpride overdose, drug interactions, or abnormal electrolyte serum levels did not occur in the case of our patient. Although bradycardia is a very rare complication of amisulpride therapy and is often asymptomatic, psychiatrists need to be aware of it.

Intensive repetitive transcranial magnetic stimulation changes EEG microstates in schizophrenia: A pilot study

We report our pilot study results, which show for the first time that intensive repetitive transcranial magnetic stimulation (I-rTMS) may induce specific EEG microstate changes in patients with negative symptoms of schizophrenia and these changes are linked to the stimulation treatment aftereffects.

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.

Transcranial Magnetic Stimulation in Schizophrenia

Transcranial magnetic stimulation (TMS) is a method that can be used in neurophysiological research of schizophrenia and in the treatment of some symptoms or syndromes of this mental disorder. The most important indications for TMS (or repetitive TMS-rTMS) are the negative symptoms of schizophrenia and auditory hallucinations. Other less proven indications include cognitive deficit, especially working memory. This text summarizes general knowledge about (r)TMS and its use in schizophrenia. According to recent experiences, TMS is a very promising experimental and therapeutic method, but it needs further research for its optimized use.