Search NEL Online

Case Reports 2013; 34(6): 514-517 PubMed PMID: 24378448 Citation  Keywords:  Adult, Chronic Pain:psychology, Cognitive Therapy, Fear:psychology, Humans, Male, Musculoskeletal Pain:psychology, Pain Management:methods, Social Behavior, Treatment Outcome,.   

: Pain-related fear may pose a serious barrier in the management of patients with chronic musculoskeletal pain, resulting in severe functional impairment in many cases. The paper describes the cognitive-behavioural therapy of a patient with a specific phobia (fear of pain and movement). The principal objective of the therapy was to educate the patient in strategies and skills to manage his fear and to verify the effect of the therapy. Both group and individual therapy was used. Group multimodal therapy of pain was provided by an interdisciplinary team of health care providers, specialising in pain management (psychotherapist, doctors and physiotherapists). The programme was based on operant therapy principles and included pacing and graded exercising and walking, relaxation, group education about ergonomics, and fear and pain relapse prevention. Reduction in the fear of pain and movement was achieved, and social bonds and physical and social activities improved after the psychotherapy, while the results were stable for two years....

Read abstract  Full text PDF

Journal Article 2013; 34(5): 426-435 PubMed PMID: 23922040 Citation  Keywords:  Bipolar Disorder:psychology, Humans, Internet, Patient Education as Topic, Recurrence, Treatment Outcome,.   

OBJECTIVE: Despite pharmacological treatment of bipolar affective disorder has many advantages; only drug treatment remains insufficiently beneficial to many patients. The combination of pharmacotherapy and internet psychoeducation seems to be the effective way how to improve remission. Internet-based therapy programs offer an exclusive chance for large underserved parts of the population to make evidence-based treatment without the need of full-time therapist. Our goal was to create a psychoeducational program for patients suffering from bipolar disorder that can be used in Czech Republic.

METHODS: There were identified studies through Web of Science, PUBMED, and Scopus databases as well as existing reviews were used in development of comprehensive internet psychoeducational program for patients with bipolar disorder. The search terms included "bipolar disorder", "psychoeducation", and "internet psychoeducation". The search was performed with no language or time restrictions.

RESULTS: The internet psychoeducational program was developed in accordance to the data from the literature review. The aim of the Internet psychoeducational program of the Department of Psychiatry University Hospital in Olomouc is to familiarize patients with the fundamental nature of bipolar affective disorder, the character and principles of pharmacotherapy, the recognition of the warning signs of relapse, inappropriate and stressful stereotypes in communication within families, and finally the practice of social skills.

CONCLUSION: Information from studies can help to prepare comprehensive psychoeducational program for bipolar patients....

Read abstract  Full text PDF

Journal Article 2013; 34(4): 322-328 PubMed PMID: 23803867 Citation  Keywords:  Adult, Antipsychotic Agents:therapeutic use, Benzodiazepines:therapeutic use, Humans, Insulin:blood, Male, Middle Aged, Risperidone:therapeutic use, Schizophrenia:blood, Schizophrenic Psychology, Severity of Illness Index, Treatment Outcome, Young Adult,.   

OBJECTIVE: Recent studies have suggested that higher insulin levels are associated with better psychopathology profiles in cross-sectional samples of patients with schizophrenia. This study examines whether drug-induced fasting insulin changes between third and eight week of treatment are related to clinical improvement in non-diabetic patients receiving the atypical neuroleptics: risperidone or olanzapine.

METHODS: non-diabetic men with a diagnosis of schizophrenia according to the DSM-IV diagnostic classification were recruited from psychiatric inpatient units. Following a drug-free period, neuroleptic treatment was initiated (risperidone n=36, olanzapine n=35) and doses were adjusted to achieve maximal clinical efficacy. All patients were hospitalized throughout the study. Initial and final evaluations of serum insulin levels and psychopathology (assessed with the Positive and Negative Syndrome Scale, PANSS), were carried out at weeks 3 and 8 after the onset of treatment, respectively.

RESULTS: There were no differences between and within the risperidone and olanzapine groups in changes of serum insulin level between the third and eighth week of treatment. In the olanzapine group, Pearson correlation analysis revealed a significant negative correlation between changes in fasting serum insulin levels and the PANSS-Total, Positive and General Psychopathology subscale scores. Only improvement in the PANSS-Negative Symptom subscale score was not correlated with insulin level change between the third and eighth week of treatment. In the risperidone group, correlations between PANSS subscales scores and the corresponding serum insulin levels change were positive, albeit statistically non-significant. In both groups the improvement in PANSS-Total scores was not correlated with changes in BMI.

CONCLUSION: Olanzapine-related changes in endogenous fasting insulin levels were correlated with clinical improvement in acutely ill non-diabetic schizophrenic patients. Because the interesting linkage between insulin and positive and negative symptoms could be an epiphenomenon, randomized studies are needed to further explore the role of insulin in therapeutic responses in patients with schizophrenia....

Read abstract  Full text PDF

Case Reports 2013; 34(2): 111-117 PubMed PMID: 23645307 Citation  Keywords:  Brain Edema:diagnosis, Female, Humans, Magnetic Resonance Imaging:methods, Meningeal Neoplasms:diagnosis, Meningioma:diagnosis, Middle Aged, Neurosurgical Procedures:methods, Skull Base Neoplasms:complications, Treatment Outcome,.   

: Meningiomas are very common neurosurgical problem. Their histological appearance, different size and localization, adherence to vital neural and vascular structures or extensive peritumoral brain edema (PTBE), especially in deep seated tumors, may lead to severe, life-threatening complications. We report a case of tuberculum sellae meningioma (TSM). A 48-year old female presented with 7-month history of blurred vision and progressive visual impairment. Intracranial tumor was confirmed by magnetic resonance imaging (MRI). After ophtalmological and endocrinological evaluation, the patient underwent surgical removal of the tumor. She immediately recovered from her visual disturbances and no tumor recurrences were seen during follow-up. Pathological diagnosis showed a meningioma of the secretory subtype (MS). We discuss the role of immunohistochemical staining in the diagnosis and the role of different factors in the PTBE formation. Selection of surgical route to the TSM is discussed, as well. Review of the literature is presented....

Read abstract  Full text PDF

Case Reports 2013; 34(2): 107-110 PubMed PMID: 23645306 Citation  Keywords:  Adult, Aged, Biopsy:methods, Female, Giant Cell Tumors:diagnosis, Humans, Hyperparathyroidism, Primary:diagnosis, Jaw Neoplasms:pathology, Male, Maxillary Neoplasms:diagnosis, Middle Aged, Parathyroid Neoplasms:diagnosis, Treatment Outcome,.   

OBJECTIVE: Giant cell tumors of the maxillofacial skeleton are uncommon, they are usually late manifestation of primary hyperparathyroidism. A series of five clinical cases in four women and one man presenting as the giant cell lesions in the maxilla and/or mandible are discussed.

METHODS: Biopsy of the lesions, biochemical and hormonal analyses, densitometry and parathyroid scintigraphy were carried out.

RESULTS: Biopsy of the lesions showed giant cell tumor of bone. The medical history and laboratory analyses showed primary hyperparathyroidism. Bone density loss was documented and scintigraphy revealed the presence of parathyroid adenomas in four cases. Surgical treatment of hyperparathyroidism, and in the second step - after 6-12 months - the subsequent excision of residual brown tumors in all cases was performed.

CONCLUSIONS: One should have in mind that osteolytic bone lesions may be due to metabolic disease of the bone. Accurate diagnosis enabling the proper treatment should be carried out, avoiding unnecessary harm to the patients....

Read abstract  Full text PDF

Case Reports 2013; 34(2): 102-106 PubMed PMID: 23645305 Citation  Keywords:  Autoimmune Diseases:diagnosis, Empty Sella Syndrome:diagnosis, Female, Glucocorticoids:therapeutic use, Humans, Hypopituitarism:diagnosis, Inflammation:pathology, Magnetic Resonance Imaging:methods, Middle Aged, Pituitary Gland:pathology, Treatment Outcom.   

: Autoimmune hypophysitis (AH) is commonly believed to be a rare chronic inflammatory condition of the pituitary gland. In clinical practice, however, the disease is often seen indeed. It typically presents with hypopituitarism and pituitary mass found by MRI. We report here unusual presentations of two females with AH followed by empty sella syndrome. The two females, aged at 64 and 57-years-old, presented with anterior pituitary dysfunction, diplopia and diabetes insipidus. By MRI the two patients shared the common characteristics with diffuse homogenous contrast enhancement of the gland and increased stalk thickness. After a long period treatment with glucocorticoids, empty sella was eventually detected by MRI....

Read abstract  Full text PDF

Case Reports 2012; 33(6): 579-589 PubMed PMID: 23160229 Citation  Keywords:  Adult, Antibodies, Monoclonal, Humanized:therapeutic use, Brain:pathology, Drug Resistance, Female, Humans, Magnetic Resonance Imaging, Male, Multiple Sclerosis:drug therapy, Natalizumab, Secondary Prevention, Treatment Outcome, Young Adult,.   

: Pediatric cerebrospinal multiple sclerosis (MS) constitutes about 2-5% of all MS cases. The International Pediatric MS Study Group (IPMSSG) applies diagnostic criteria for adults to MS in childhood and adolescence. Recent publications highlight an increasing number of MS in children resistant to the first-line treatment, i.e. disease modifying therapy (DMT). Furthermore, the number of published case studies on children with highly active MS treated with natalizumab also rises, whereas long-term risks as well as therapeutic potential of this therapy in pediatric population have been at the centre of attention. This paper presents a group of 5 children in whom natalizumab was selected to manage highly active disease or resistance to conventional MS treatment and provided very good clinical as well as MRI results....

Read abstract  Full text PDF

Case Reports 2012; 33(6): 597-599 PubMed PMID: 23160225 Citation  Keywords:  Anti-Inflammatory Agents, Non-Steroidal:administration & dosage, Female, Headache Disorders, Primary:drug therapy, Humans, Indomethacin:administration & dosage, Middle Aged, Remission Induction, Treatment Outcome,.   

: Hypnic headache (HH) is considered as a disorder of the circadian rhythm, mostly affecting the elderly and generally considered a benign disorder, but the pathophysiology of hypnic hedache remains unclear. Various treatments have been suggested for hypnic headache, especially lithium and indomethacin. We report the case of HH fulfilling The International Classification Headache Disorders, 2nd edition criteria (ICHD-II). A 64-year-old woman, who suffered from dull headaches strictly during the night for a period of 5 months. Attacks of headache lasted from 30 to 150 minutes, with a frequency usually 4 times per week. The patient was started on indomethacin 50 mg twice a day (BID). From day 25 on she was free of hypnic headache. On day 31 we tapered the daily dose of indomethacin to 50mg at bedtime, the patient was still without headache. On day 60 the treatment was stopped. 30 months after day 60, the patient was still headache free. We reported the first Czech patient with HH with very good therapeutic response to indomethacin. The effect of therapy with indomethacin 50mg BID was very fast and stable....

Read abstract  Full text PDF