Lucie Motlová

ITAREPS: Information Technology Aided Relapse Prevention Programme in Schizophrenia

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 programmes 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<0.004). Variables significantly influencing the number of hospitalizations after the ITAREPS entry (medication compliance along with factors intrinsic to the ITAREPS, i.e. adherence to the programme and involvement of a family member) suggest a critical role of the programme in controlling the number of relapses and subsequent hospitalizations in psychosis.

Differences in onset of disease and severity of psychopathology between toxoplasmosis-related and toxoplasmosis-unrelated schizophrenia.

Toxoplasmosis is a lifelong parasitic disease that appears to be associated to schizophrenia. However, no distinguishing attributes in Toxoplasma‐infected schizophrenia patients have been described as yet.

The Information Technology Aided Relapse Prevention Programme in Schizophrenia: an extension of a mirror-design follow-up

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.

Effectiveness of the information technology-aided program of relapse prevention in schizophrenia (ITAREPS): a randomized, controlled, double-blind study.

Purpose. To evaluate the effectiveness of the Information Technology-Aided Program of Re lapse Prevention in Schizophrenia (ITAREPS). Methods. 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. Results. 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 (p<0.05) and costs (p<0.05). Conclusion. Future ITAREPS trials should target the underlying mechanisms that cause low investigator adherence to the program. Trial registration: Clinical Trials NCT00712660 (Journal of Psychiatric Practice 2012;18:269–280)

Prolactin response to D-fenfluramine challenge test as a predictor of treatment response to haloperidol in acute schizophrenia.

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.

Relapse prevention in schizophrenia: does group family psychoeducation matter? One-year prospective follow-up field study

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.

A Brief Mental Health Outcomes Measure: Translation and Validation of the Czech Version of the Schwartz Outcomes Scale-10

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 α 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.

Effects of haloperidol treatment on prolactin response to D- fenfluramine challenge in acute schizophrenia

Abstract 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.

Analysis of parasuicide, psychiatric care and completed suicides, implications for intervention strategy (Czech Republic, 1996–2000)

SummaryBackground: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.Methods: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.Results: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.Conclusions:Implications for age specific primary and secondary prevention are discussed.

Are there any differences in the efficacy among second generation antipsychotics in the treatment of schizophrenia and related disorders

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.