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Controlled Clinical Trial 2009; 30(1): 39-45 PubMed PMID: 19300399 Citation  Keywords:  Age Factors, Aged, Aged, 80 and over, Alzheimer Disease:diagnosis, Anisotropy, Corpus Callosum:diagnostic imaging, Diffusion Magnetic Resonance Imaging:methods, Echo-Planar Imaging:methods, Female, Humans, Male, Middle Aged, Organ Size, Psychological Test.   

OBJECTIVE: The aim of the study was to assess structural changes in gray matter (GM) volume and fractional anisotropy (FA) in patients with Alzheimer's disease (AD) compared to control subjects using Voxel-Based Morphometry (VBM). Fractional anisotropy in the corpus callosum of both groups was also calculated using ROI analysis.

METHODS: Twenty-one patients and twenty-three control subjects underwent MRI examination using T1-weighted 3D MPRAGE sequence and diffusion spin-echo echo-planar imaging sequence in six directions. Structural MRI analyses for GM volume and FA were performed using an optimized VBM protocol implemented in SPM5. The influence of age and Mini-Mental State Examination (MMSE) was dealt with multiple regression analysis either for the whole group or for AD patients and controls separately.

RESULTS: Patients showed significant reduction of GM volume mainly in the temporal lobes. In AD patients, no correlation was observed between GM volume and age or MMSE. FA was reduced in AD patients mainly in frontal and temporal lobes. In both groups no correlation was found between FA and age or MMSE. Patients with AD showed a significant decrease in FA and an increase in mean diffusivity (p<0.0001) in the corpus callosum.

CONCLUSIONS: In patients with AD we observed a significant reduction in FA values and GM volume; however, no correlation with age and MMSE was proven for both FA and GM for AD patients. This finding supports the hypothesis that morphological changes in patients with AD are not a continuous aging related process but represent qualitative changes....

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Journal Article 2009; 30(1): 99-106 PubMed PMID: 19300381 Citation  Keywords:  Adolescent, Adolescent Behavior:psychology, Adolescent, Hospitalized:psychology, Child, Child Behavior:psychology, Child Behavior Disorders:diagnosis, Child, Hospitalized:psychology, Female, Genetic Predisposition to Disease, Humans, Life Change Events, M.   

OBJECTIVES: The aim of this study was to identify risk factors and possible predictors of severity of suicidal behavior of children and adolescents.

METHODS: Seventy-seven patients (15 boys and 62 girls) aged 15.5+/-1.6 years on average, hospitalized due to a suicidal attempt in the department of pediatric psychiatry, were examined. Structured interviews with patients and their parents were used to clinically assess circumstances of suicidal behavior, relevant risk factors and severity of suicidal behavior.

RESULTS: The results indicated that patients with any previous traumatic experience tended to have somatically less severe suicidal attempts (p=0.050). Intensity of suicidal intent was associated with a history of depression (p=0.014) and anxiety disorders (p=0.004), and the current stress from a mental disorder (p=0.014). Somatic severity of suicidal behavior was significantly associated with intensity of suicidal intent (p=0.014). A history of any trauma (previous traumatic experience predicted less severe suicidal behavior, p=0.053) and the current stress from sexual problems (p=0.067) were identified as predictors of somatic severity of suicidality. These two predictors showed only a trend level of significance. The only significant predictor of intensity of suicidal intent was the current stress from a mental illness (p=0.017).

CONCLUSIONS: Several risk factors of somatic severity of suicidal behavior and intensity of suicidal intent were described. The most important finding of the study was the association between a history of psychological trauma and a tendency to have less somatically severe suicidal behavior....

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Journal Article 2009; 30(6): 723-728 PubMed PMID: 20038931 Citation  Keywords:  Adult, Antidepressive Agents:administration & dosage, Depressive Disorder, Major:diagnosis, Drug Resistance, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Retrospective Studies, Secondary Prevention, Sever.   

OBJECTIVE: The aim of this retrospective study was to compare the efficacy of combination therapy (combinations of antidepressants and various augmentations) and antidepressant monotherapy in the treatment of patients, who failed to respond at least to one previous antidepressant trial in the routine clinical practice.

METHODS: We reviewed chart documents of patients hospitalized at Prague Psychiatric Center for depressive disorder from June 2005 to June 2007 and finished at least 4 weeks of new treatment. Depressive symptoms and overall clinical status were assessed using Montgomery and Asberg Depression Rating Scale, Clinical Global Impression and Beck Depression Inventory - Short Form at the baseline and in the end of treatment.

RESULTS: We identified 49 inpatients (24-combined treatment, 25-monotherapy), who were suitable for analyses. Both groups were equal in baseline characteristics and in the duration of index episode treatment. The combined treatment was superior to the monotherapy switch in the MADRS median score reduction (16 vs. 9 points, p=0.01). The combined group achieved higher response rate compared to monotherapy group (67% vs. 36%, p=0.05). Number need to treat for response was 3.3 (95% CI, 1.85-37.3).

CONCLUSION: The findings of this study suggest that combined treatment is more efficacious than switch to monotherapy in the treatment of resistant depression....

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Case Reports 2009; 30(6): 705-708 PubMed PMID: 20038924 Citation  Keywords:  Adolescent, Deglutition, Family Conflict:psychology, Female, Foreign Bodies:diagnosis, Humans, Needles, Self-Injurious Behavior:diagnosis, Suicide, Attempted:psychology,.   

: Self-harm represents a serious and pathological behavior that occurs most notably during adolescent years and currently seems to be a problem that is on the increase. Self-harm is a self destructive behavior which most frequently takes the form of cutting and burning. Relative to suicidal behavior, self-harm, in and of itself, is not intended to be lethal and tends to be repeated and addictive. However, in cases of self-harm the risk of suicidal behavior cannot be ignored. This presentation is a case study of a girl who engaged in an unusual form of self-harm, by swallowing needles....

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Journal Article 2009; 30(6): 733-738 PubMed PMID: 20038922 Citation  Keywords:  Adult, Amniotic Fluid:metabolism, Biomarkers:metabolism, Chorioamnionitis:diagnosis, Female, Fetal Membranes, Premature Rupture:diagnosis, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Interleukin-8:metabolism, Predictive Value of Tests, Pr.   

OBJECTIVE: To determine whether amniotic fluid levels of interleukin-8 (IL-8) are of value in the antenatal diagnosis of acute histological chorioamnionitis (HCA) in preterm premature rupture of membranes (PPROM).

SETTING: Department of Obstetrics and Gynaecology, Charles University, Medical School and University Hradec Kralove, Czech Republic.

METHODS: We compared amniotic fluid IL-8 levels in twenty-nine pregnant women with preterm premature rupture of membranes between 24th and 36th gestational weeks with presence and absence acute histological chorioamnionitis or/and microbial invasion in the amniotic cavity using nonparametric tests (Mann-Whitney test), given the non-normal distribution of analyte. Comparisons of proportions were performed with Shapiro-Wilk normality test.

RESULTS: Patients with HCA had a significantly higher median amniotic fluid IL-8 concentration than patients without the histological signs of chorioamnionitis (1867 pg/mL, 826-5577 versus 1045 pg/mL, 60-4133, p=0.013). Patients with MIAC had a significantly higher median amniotic fluid level than patients without invasion (1888 pg/mL, 519-5577 versus 1225 pg/mL, 60-2766, p= 0.017). Women with HCA and MIAC had a significantly higher median amniotic fluid IL-8 level than women without histological signs of chorioamnionitis and microbial invasion (3117 pg/mL, 826-5577 versus 1468 pg/mL, 394-2766, p=0.034).

CONCLUSIONS: HCA or/and MIAC are associated with a significant increase of amniotic fluid interleukin-8 levels. Amniotic fluid IL-8 seems to be a marker of intraamniotic inflammation....

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Case Reports 2009; 30(5): 558-561 PubMed PMID: 20035267 Citation  Keywords:  Adult, Angioid Streaks:pathology, Diagnosis, Differential, Eye:blood supply, Female, Humans, Optic Disk Drusen:pathology, Photochemotherapy, Skin Diseases:pathology, Ultrasonography,.   

: Angioid streaks develop as a result of damage to the Bruch's membrane. They may occur as idiopatic angioid streaks or in association with pseudoxanthoma elasticum, Paget's disease and the haemoglobinopathies. Other pathologies of the fundus of eye may coexist together with angioid streaks, such as drusen of an optic disc and granular-like retina in posterior pole known as "peau d'orange". Subretinal neovascularization as well as atrophy in macula are also observed in the cases of long-lasting pathologies. The diagnosis is based mainly on clinical manifestations. Photodynamic therapy in treatment patients with secondary choroidal neovasularisation appeared to be effective....

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Case Reports 2009; 30(5): 553-557 PubMed PMID: 20035256 Citation  Keywords:  Calcinosis:diagnosis, Cerebral Cortex:pathology, Child, Female, Humans, Magnetic Resonance Imaging:standards, Male, Middle Aged, Reproducibility of Results, Tomography, X-Ray Computed,.   

BACKGROUND: Since magnetic resonance imaging (MRI) is a method of choice for establishing the correct diagnosis in a great majority of neurologic disorders, especially in detection the causes of seizures and both acute and slowly progressive neurologic disturbances, computerized tomography is becoming more frequently excluded from obligate spectrum of diagnostic protocol.

METHODS: MRI was performed on 1.5 T MR scanner in two patients, in one suffering from pseudohypoparathyroidism, and in another with Fahr disease, while CT was initially excluded from the diagnostic protocol. In third patient, 11-year-old boy with hypercalcemia, both CT and MRI were indicated because of seizure attack.

RESULTS: Completely normal appearing brain parenchyma was seen on T2W images in a patient with clinical diagnosis of pseudohypoparathyroidism while extensive intracerebral calcifications were noted after additionally performed computerized tomography of the brain. In another patient with Fahr disease and neurologic symptoms, extensive calcifications were evident on CT, while MR examination had revealed bilateral symmetric lesions of prolonged T2W signal in the basal ganglia, supratentorial white matter and cerebellum, most compatible toxic/metabolic demyelination. In the third patient, a boy with hypercalcemia, marked left parietal cortical calcification was noted on CT, while MRI, including T2 gradient-echo sequence was inconclusive.

CONCLUSIONS: MRI, without CT, can be not only confusing, but even misleading diagnostic modality for detection of not only subtle, but also extensive cerebral calcifications. The benefit of gradient-echo T2 sequence, that is usually included in MR protocol when intracranial calcifications are suspected, is also rather limited....

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Journal Article 2009; 30(5): 564-573 PubMed PMID: 20035251 Citation  Keywords:  Adult, Cluster Analysis, Depressive Disorder:diagnosis, Depressive Disorder, Major:diagnosis, Fatigue:diagnosis, Female, Humans, Male, Middle Aged, Pain:diagnosis,.   

BACKGROUND: Major depression is characterized by multifarious symptoms and symptoms clusters, such as the melancholic and anxiety symptom clusters. There is a strong comorbidity and a biological similarity between major depression and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

OBJECTIVE: The aim of the present study was to examine "psychosomatic" symptoms reminiscent of ME/CFS in major depression.

METHODS: Toward this end, we examined the 12-item Fibromyalgia and Chronic Fatigue Syndrome Rating (FF) Scale and the Hamilton Depression Rating Scale (HDRS) in 103 major depressed patients by means of multivariate pattern recognition methods. results: Our findings support the existence of two factors, i.e. a fatigue and somatic (F&S) factor, i.e aches and pain, muscular tension, fatigue, concentration difficulties, failing memory, irritability, irritable bowel, headache, and a subjective experience of infection; and a depression factor, i.e. sadness, irritability, sleep disorders, autonomic symptoms, and a subjective experience of infection. Cluster analysis performed on the 12 FF items found two different clusters, which were separated by highly significant differences in the F&S items, the most significant being a subjective experience of infection, aches and pain, muscular tension, fatigue, concentration difficulties and failing memory. Multivariate analyses showed that the differences between both clusters were quantitatively, and not qualitatively, and reflected the severity of the F&S dimension. There was a strong association between the F&S symptoms and melancholia and chronic depression. Treatment resistant depression was characterized by higher scores on the depression factor score. There was a strong correlation between the HDRS score and the FF items, fatigue, a subjective experience of infection, and sadness. Our findings show that F&S symptoms are a major feature of depression and largely predict severity of illness, and chronic and melancholic depression.

CONCLUSIONS: It is concluded that the diagnostic criteria of depression and melancholia and rating scales to measure severity of illness should be modified to include the F&S symptom profile....

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