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Journal Article 2007; 28(Suppl 1): 71-93 PubMed PMID: 17262006 Citation  Keywords:  Anticonvulsants:therapeutic use, Antidepressive Agents:therapeutic use, Antimanic Agents:therapeutic use, Antipsychotic Agents:therapeutic use, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Drug Therapy, Combination, Humans, Lithium Carbonate:t.   

: Several lines of clinical, genetic, and pharmacological evidence point to an association between bipolar and psychotic disorders. The goals of maintenance and prophylactic treatment of bipolar disorder include the prevention of new episodes and the improvement of social, family, and occupational functioning. This goal can be mainly achieved by using long-term adequate pharmacological treatment that is tolerable to patients. Among mood-stabilizers, the main drugs used for such treatment, the role of atypical antipsychotics has greatly increased in recent years. Lithium still remains the drug that has produced the most convincing evidence of prophylactic action and has undergone the longest periods of observation. There has also been good confirmation for the maintenance efficacy of such anticonvulsant drugs as carbamazepine, valproate, and lamotrigine, the last having the strongest properties for prophylaxis of depressive episodes. The case for the usefulness of second-generation antipsychotic drugs in the long-term treatment of bipolar disorder has been rapidly accumulating. Based on controlled trials, the best evidence for maintenance efficacy exists for olanzapine. The vast majority of patients with bipolar illness experience inadequate response to monotherapy with mood-stabilizing drugs during long-term treatment. Some issues connected with polypharmacy targeting optimal maintenance results are discussed. In addition, the long-term management and the role of antidepressants in treatment of non-bipolar I illness is also briefly described....

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Journal Article 2007; 28(Suppl 1): 95-116 PubMed PMID: 17262005 Citation  Keywords:  Antipsychotic Agents:metabolism, Humans, Patient Compliance, Risk Factors, Schizophrenia:drug therapy, Schizophrenic Psychology, Treatment Refusal,.   

: Adherence to treatment is a general indicator of quality and success of communication between the physician and the patient. It means the extent to which patient behaviour, in terms of taking medications, following diets, or executing life-style changes, coincides with medical or health advice. Nonadherence to antipsychotic therapy in patients with schizophrenia is far more widespread than clinicians assume. Lower nonadherence in therapy based on antipsychotics of the second generation compared with conventional medications has already been indicated by early reports. The consequences of nonadherence include exacerbation of symptoms, an increased relapse rate, psychiatric hospitalization hospitalisation, and less favourable patient prognosis. There are several factors that cause treatment nonadherence in schizophrenia: causes derived from the schizophrenic disorder itself, patient characteristics, causes associated associated with the health-care system, and the antipsychotic treatment itself....

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Journal Article 2007; 28(Suppl 1): 117-133 PubMed PMID: 17262004 Citation  Keywords:  Antipsychotic Agents:adverse effects, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Humans, Long-Term Care, Quality of Life, Schizophrenia:drug therapy, Treatment Outcome,.   

: Health-related quality of life (QoL) represents important measure of treatment outcome in mental disorders. Numerous studies indicate that QoL of people with schizophrenia and bipolar disorder is similar to that of patients with chronic physical conditions. It has been shown that schizophrenia patients can themselves reliably assess their QoL; in addition to the objective scales various self-reporting instruments are used. Patients with bipolar disorder have QoL consistently higher than patients with schizophrenia and similar to that found in people with unipolar depression. Quality of life can be negatively affected by drug-induced side-effects and subjective treatment response. The second-generation antipsychotics (SGA) have superior efficacy on QoL over classical antipsychotics in approximately half of the studies with schizophrenia; in the other half those groups are comparable. However, in none of the trials novel antipsychotics were inferior. All SGA (clozapine, olanzapine, risperidone, amisulpride, quetiapine, ziprasidone, or remoxipride) have been found to be beneficial for patients well-being. The most investigated drugs that convincingly improve QoL in schizophrenia are olanzapine and risperidone (including depot form). Results of several studies indicate that individual antipsychotics may differ in their effects on QoL, with suggested superiority of olanzapine. In bipolar disorder, SGA consistently showed their superiority over placebo in effects on QoL. The most studied SGA in bipolar disorder is olanzapine. More long-term controlled double-blind trials are needed to definitively uphold superiority and different effects of individual SGA on QoL of patients with schizophrenia and bipolar disorder....

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Journal Article 2007; 28(Suppl 1): 135-145 PubMed PMID: 17262003 Citation  Keywords:  Family Therapy, Humans, Patient Compliance, Psychotherapy, Psychotherapy, Group, Schizophrenia:therapy, Schizophrenic Psychology,.   

: The author gives a critical overview of various psychotherapeutic approaches used with persons with schizophrenia and their families. It is emphasized that these approaches are to be used in conjunction with pharmacological treatment and should always be individualized for each patient depending on the phase and severity of illness. Individual psychotherapy, particularly cognitive-behavioural modality, group therapy, and family therapy are described in some detail. Special attention is given to compliance therapy....

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Journal Article 2007; 28(Suppl 1): 147-159 PubMed PMID: 17262002 Citation  Keywords:  Caregivers, Family, Family Relations, Humans, Patient Compliance, Quality of Life, Schizophrenia:therapy, Schizophrenic Psychology, Socioenvironmental Therapy,.   

: Family represents an important supportive social network for most patients with schizophrenia. In order to provide safe and low-stress environment, necessary for the successful long-term treatment of schizophrenia the family must be helped. Family members suffer both emotionally and financially. Their burden is high and quality of life is low. Relatives change their life values and preferences when a severe mental illness occurs in the family and are ready to cooperate. Family interventions constitute an integral part of complex schizophrenia treatment. To be successful interventions must take into account relatives beliefs, perspectives and issues of concern. The goal of this paper is to 1) overview studies on family burden, 2) provide theoretical background for family interventions, 3) describe a family psychoeducational approach as an optimal treatment modification....

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Journal Article 2001; 22(1): 53-73 PubMed PMID: 11393163 Citation  Keywords:  Adrenal Glands:physiology, Animals, Biological Clocks, Blood Pressure:physiology, Chronobiology Disorders:physiopathology, Chronobiology Phenomena, Chronotherapy, Circadian Rhythm:physiology, Drug Administration Schedule, Genomics, Homeostasis, Humans, Pi.   

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Journal Article 2006; 27(Suppl 1): 7-16 PubMed PMID: 17261999 Citation  Keywords:  Biomarkers:blood, Dental Amalgam:toxicity, Environmental Pollutants:toxicity, Humans, Hypersensitivity:diagnosis, Inflammation, Lymphocyte Activation, Metals:toxicity, T-Lymphocytes:immunology, Titanium:toxicity,.   

: Environmental factors are recognized as a cause of the increasing frequency of allergic and autoimmune diseases. In addition to external pollutants, metal ions released from dental restorations or from other body implants might trigger inflammation in susceptible subjects. In humans, genes governing metal-induced inflammation and autoimmunity are not yet known. In clinical praxis, metal-sensitive patients will present various symptoms ranging from oral mucosal changes and skin disease to excessive fatigue and autoimmune diseases. Since genetic markers of genetic susceptibility in man are not known, one has to rely on the phenototypic markers. Such biomarkers might be certain detoxification enzymes but also the presence of metal-specific memory cells in the blood. With the increasing use of metal implants in medicine and dentistry, it is important to have a proper tool for the diagnosis of metal allergy in susceptible subjects. After nickel, gold is now the second most common sensitizer. In addition to patch test, an in vitro blood test, an optimized commercially available lymphocyte transformation test (MELISA) is discussed. Both tests were used for the diagnosis of metal allergy in a selected group of 15 patients who suffered from clinical metal sensitivity in addition to other health problems. The concordance of the two tests was good but MELISA detected more metal allergies than patch test. The removal of incompatible dental material (RID) resulted in long-term health improvement in the majority of patients. We postulate that in vivo, metal ions activate T-cells, initiating systemic inflammation, which, through cytokines, affects the brain and hypothalamus-pituitary-adrenal axis. We postulate that in vivo metal ions will activate T-cells starting systemic inflammation which, through cytokines affect the brain and hypothalamus-pituitary-adrenal (HPA) axis. The treatment and rehabilitation of metal sensitive patients is based on a firm understanding and recognition of individual susceptibility. RID has to be done done with extreme caution and according to standard working protocol. If performed properly, this treatment can result in decreased systemic inflammation and improved health in sensitized patients....

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Case Reports 2006; 27(Suppl 1): 17-24 PubMed PMID: 17261998 Citation  Keywords:  Adult, Aged, Dental Amalgam:toxicity, Environmental Exposure, Female, Humans, Hypersensitivity:diagnosis, Immunoassay:methods, Lymphocyte Activation, Metals:toxicity, Middle Aged, Occupational Exposure, Reproducibility of Results, Sensitivity and Specific.   

OBJECTIVES: Chronic low-level metal exposure may result in metal sensitization and undesirable side-effects. The main sources of metal exposure are from the environment or from corrosion of dental metal alloys. Affected patients are routinely diagnosed with the epicutaneous (patch) test. However, such testing may induce false-positive (irritative) reactions and may in itself sensitize or exacerbate symptoms. Alternatively, MELISA (Memory Lymphocyte ImmunoStimulation Assay), an optimized lymphocyte transformation test (LTT), can be used. In this study we analyzed the overall frequency and distribution of metal sensitization among symptomatic, metal-exposed patients. In addition, we determined the reproducibility of the assay and assessed its clinical relevance for detecting and monitoring hypersensitivity to metals.

METHODS: To analyze the frequency and distribution of metal sensitization, blood from 700 consecutive patients was tested against a total of 26 metals in the validated LTT-MELISA. For reproducibility testing, 391 single metal tests from 63 patients were performed in parallel. Finally, to assess clinical relevance, 14 patients with known metal exposure showing local (dry mouth, Oral Lichen Planus, Burning Mouth Syndrome, eczema) and/or systemic (chronic infections, fatigue, autoimmune disorders, central nervous system disturbances, depression) effects were tested in LTT-MELISA. In 7 cases testing was repeated following removal of the allergy-causing metals or, in 2 additional cases, without therapeutic intervention.

RESULTS: Of the 700 patients tested, 74.6% responded to >/= 1 metal in LTT-MELISA, with a subgroup of 17.9% responding to >/= 3 metals. Reactivity was most frequent to nickel (68.2%), followed by cadmium (23.7%), gold (17.8%), palladium (12.7%), inorganic mercury (11.4%), molybdenum (10.8%), beryllium (9.7%), titanium dioxide (4.2%), lead (3.7%), and platinum (3.4%). Reproducibility was 94.9%, with most discordant results in a low-positive range. Removal of the alloys or prostheses containing allergenic metals resulted in remarkable clinical improvement correlating with a significant reduction or complete normalization of specific lymphocyte reactivity. In contrast, both LTT-MELISA reactivity and clinical symptoms remained unchanged in follow-up samples from the 2 patients who did not remove the source of metal exposure.

CONCLUSION: The optimized LTT-MELISA test is a clinically useful and reliable tool for identifying and monitoring metal sensitization in symptomatic metal-exposed individuals....

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