METABOLIČKI SINDROM U SHIZOFRENIJI: PREPOZNAVANJE I MOGUĆNOSTI PREVENCIJE

Shizofrenija je etiološki kompleksna, kronična progresivna bolest, koja zbog svoje dugotrajnosti i prirode simptoma nosi rizik za razvoj različitih tjelesnih bolesti. Poremećaj metabolizma poznat kao metabolički sindrom ili sindrom X (kao konstelacija visceralne debljine, povišenog krvnog tlaka, dislipidemije i intolerancije glukoze), ženski spol, etnička pripadnost, viša životna dob, dužina trajanja bolesti, pušenje i uzimanje antipsihotične terapije, rizični su čimbenici za razvoj kardiovaskularnih i cerebrovaskularnih bolesti, dijabetesa melitusa tipa 2 i rani mortalitet shizofrenih bolesnika. Primjena antipsihotika u shizofrenih bolesnika, naročito antipsihotika nove generacije, bitno povećava pojavnost metaboličkog sindroma. Dosadašnje studije nedvojbeno su utvrdile povezanost primjene nekih novih antipsihotika i povećanu pojavnost metaboličkog sindroma. Sukladno toj spoznaji proveli smo tijekom jedne godine istraživanje čiji je cilj bio probir shizofrenih bolesnika s kriterijima za metabolički sindrom koji su zbog akutne bolesti primani na bolničko liječenje u Kliniku za psihijatriju KBC-a Zagreb i Neuropsihijatrijsku bolnicu „Dr. Ivan Barbot“ u Popovači. Analizom rezultata utvrdili smo da je pretilost značajno povezana s pojavom metaboličkog sindroma kao i da pojavnost metaboličkog sindroma pokazuje tendenciju češćeg javljanja u bolesnika s pet i više godina trajanja bolesti. U zaključku ističemo da je debljina temeljni čimbenik razvoja metaboličkog sindroma te sukladno s tim nalazom smatramo uputnim uvesti rutinsko praćenje pokazatelja metaboličkog sindroma s ciljem prevencije tjelesnih komplikacija i angažiranjem samih bolesnika u brizi za osobni izgled, socijalno i tjelesno zdravlje i poboljšanje kvalitete života

ANTIPSYCHOTICS: TO COMBINE OR NOT TO COMBINE?

Antipsychotic monotherapy is strongly recommended in the treatment of schizophrenia. However, antipsychotic polypharmacy (APP) is common in clinical practice, and appears to be related to illness severity and duration, treatment-refractoriness, hospitalization status, duration of hospitalization, geographic region and age. Given the high number of different antipsychotic combinations reported in the literature and prescribed in clinical practice, there are perhaps more differences than similarities between such combinations. While the majority of combinations increase side-effect burden, limited evidence suggests benefits of certain combinations.Until more data are available, APP should be reserved for difficult-to treat patients, with careful consideration of pharmacodynamics properties and doses of each drug, as well as close monitoring

Latent Toxoplasma gondii infection is associated with decreased serum triglyceride to high-density lipoprotein cholesterol ratio in male patients with schizophrenia

BACKGROUND: Previous studies suggested a complex association between Toxoplasma gondii (TG) infection and host lipid metabolism. Both TG infection and metabolic disturbances are very common in patients with schizophrenia, but this relationship is not clear. ----- METHODS: In this cross-sectional study, we evaluated the association between TG seropositivity, serum lipid levels, body mass index (BMI) and metabolic syndrome (MetS) in 210 male inpatients with schizophrenia. ----- RESULTS: In our sample of schizophrenia patients, with the mean age of 43.90 ± 12.70 years, the rate of TG seropositivity was 52.38% and the prevalence of MetS was 17%. Patients with the TG antibodies had lower serum triglyceride levels and body weight compared to TG seronegative patients, despite having more frequently received antipsychotics (clozapine, olanzapine risperidone and quetiapine), which are well known to induce weight gain and metabolic abnormalities. However, the only significant change in metabolic parameters, observed in TG seropositive patients with schizophrenia, was decreased serum triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio. No associations were observed between TG seropositivity and serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and glucose levels, waist circumference, BMI and the rate of MetS. ----- CONCLUSION: This is the first report of the association between TG infection and decreased serum triglyceride to HDL-C ratio in a sample of carefully selected men with chronic schizophrenia

Neuroimmunomodulatory effect of Toxoplasma gondii in schizophrenia

Složena etiologija i biološka podloga shizofrenije te skromne spoznaje o utjecaju infekcija na razvoj ove bolesti, potaknule su ovo istraživanje neuroimunomodulatornog učinka parazita Toxoplasma gondii (TG) u shizofreniji. Rezultati upućuju da TG seropozitivni bolesnici imaju težu kliničku sliku bolesti, karakteriziranu većim brojem bolničkih liječenja, dužim psihijatrijskim tretmanom i češćom refrakternošću na terapiju. Međutim, TG seropozitivni bolesnici, usprkos starije dobi i češćeg uzimanja atipičnih antipsihotika, imaju nižu koncentraciju triglicerida, omjer triglicerida i lipoproteina visoke gustoće (HDL), opseg bokova i tjelesnu težinu, te posljedično i manji rizik razvoja kardiovaskularnih bolesti. U našem istraživanju nisu utvrđene statistički značajne razlike u koncentraciji trombocitnog serotonina i aktivnosti trombocitne monoaminooksidaze tipa B (MAO-B), kao niti u koncentraciji C reaktivnog proteina (CRP-a) i interleukina 6 (IL-6) između TG seropozitivnih i TG seronegativnih ispitanika sa shizofrenijom. Stoga su potrebna daljna istraživanja koja će dodatno razjasniti povezanost infekcije sa TG i razvoja shizofrenije.Complex etiology and biological basis of schizophrenia, and modest knowledge regarding effects of infections on its development, stimulated this study of Toxoplasma gondii (TG) neuroimmunomodulatory effect in schizophrenia. Results suggest that TG seropositive patients have more severe clinical presentation, with higher number of hospitalisations, longer psychiatric treatment and more frequent treatment-resistance. However, TG seropositive patients, despite older age and more frequent usage of atypical antipsychotics, had lower triglyceride concentration, triglyceride/high-density lipoprotein cholesterol (HDL-C) ratio, hip circumference and body weight, suggesting lower risk for cardiovascular disease. No differences in concentrations of platelet serotonin levels and higher platelet monoamino oxidase type B (MAO-B) activity, as well as of C-reactive protein (CRP) and interleukin-6 (IL-6) levels between TG seropositive and TG seronegative subjects with schizophrenia were found. Further research is needed to further clarify the association between TG infection and development of schizophrenia

Neuroimmunomodulatory effect of Toxoplasma gondii in schizophrenia

Složena etiologija i biološka podloga shizofrenije te skromne spoznaje o utjecaju infekcija na razvoj ove bolesti, potaknule su ovo istraživanje neuroimunomodulatornog učinka parazita Toxoplasma gondii (TG) u shizofreniji. Rezultati upućuju da TG seropozitivni bolesnici imaju težu kliničku sliku bolesti, karakteriziranu većim brojem bolničkih liječenja, dužim psihijatrijskim tretmanom i češćom refrakternošću na terapiju. Međutim, TG seropozitivni bolesnici, usprkos starije dobi i češćeg uzimanja atipičnih antipsihotika, imaju nižu koncentraciju triglicerida, omjer triglicerida i lipoproteina visoke gustoće (HDL), opseg bokova i tjelesnu težinu, te posljedično i manji rizik razvoja kardiovaskularnih bolesti. U našem istraživanju nisu utvrđene statistički značajne razlike u koncentraciji trombocitnog serotonina i aktivnosti trombocitne monoaminooksidaze tipa B (MAO-B), kao niti u koncentraciji C reaktivnog proteina (CRP-a) i interleukina 6 (IL-6) između TG seropozitivnih i TG seronegativnih ispitanika sa shizofrenijom. Stoga su potrebna daljna istraživanja koja će dodatno razjasniti povezanost infekcije sa TG i razvoja shizofrenije.Complex etiology and biological basis of schizophrenia, and modest knowledge regarding effects of infections on its development, stimulated this study of Toxoplasma gondii (TG) neuroimmunomodulatory effect in schizophrenia. Results suggest that TG seropositive patients have more severe clinical presentation, with higher number of hospitalisations, longer psychiatric treatment and more frequent treatment-resistance. However, TG seropositive patients, despite older age and more frequent usage of atypical antipsychotics, had lower triglyceride concentration, triglyceride/high-density lipoprotein cholesterol (HDL-C) ratio, hip circumference and body weight, suggesting lower risk for cardiovascular disease. No differences in concentrations of platelet serotonin levels and higher platelet monoamino oxidase type B (MAO-B) activity, as well as of C-reactive protein (CRP) and interleukin-6 (IL-6) levels between TG seropositive and TG seronegative subjects with schizophrenia were found. Further research is needed to further clarify the association between TG infection and development of schizophrenia

Toxoplasma gondii in psychiatric disorders

Toxoplasma gondii je intracelularni parazit svih stanica s jezgrom, ali poseban afinitet ima prema endotelu i živčanom tkivu. U posljednje vrijeme infekcija parazitom Toxoplasma gondii povezuje se s razvojem pojedinih psihijatrijskih poremećaja. Jedan od najčešće proučavanih psihijatrijskih poremećaja na ovom polju jest shizofrenija. Međutim, postoje podatci i o povezanosti toksoplazme s drugim psihijatrijskim poremećajima kao što su opsesivno-kompulzivni poremećaj, te poremećaji raspoloženja, bipolarni poremećaj i depresivni poremećaj. Dobro je poznato kako bolesnici sa shizofrenijom imaju abnormalnu funkciju neurotransmitora, osobito dopamina, glutamata i GABA-e. Mogući mehanizam pomoću kojeg Toxoplasma gondii utječe na razinu dopamina je taj da Toxoplasma gondii posjeduje 2 gena koja kodiraju enzim tirozin hidroksilazu, važan enzim u sintezi dopamina. Toxoplasma gondii u tahizoitnom obliku sklona je izazvati intenzivan imunološki odgovor i posljedično oslobađanje velikog broja citokina. Upravo bi ruptura ciste ispunjene tahizoitima mogla biti potencijalni etiološki čimbenik razvoja psihijatrijske patologije. Izloženost infekciji toksoplazmom povezana je s kognitivnim deficitom u shizofrenih bolesnika, ali i u ostaloj populaciji. S obzirom na porast broja istraživanja na ovom polju medicine i na temelju rezultata koji su objavljeni, postoji vjerojatnost kako je infekcija parazitom Toxoplasma gondii povezana s patološkim promjenama u mozgu. No, na brojna pitanja još uvijek nisu pronađeni odgovori.Toxoplasma gondii is an obligate intracellular parasite which usually invades endothelial cells and neural tissue. Over the past years there has been an increasing interest in the possibility of an association of Toxoplasma gondii infection and psychiatric disorders. Schizophrenia is the most frequently analyzed in this field. However, Toxoplasma gondii infection can also be linked with other psychiatric disorders, such as obsessive-compulsive disorders and mood disorders, including bipolar disorder and depression. It is well known that individuals with schizophrenia have dysfunctional neurotransmitters, especially dopamine, glutamate and GABA. A possible mechanism by which Toxoplasma influences the function of the dopaminergic system is that the genome of Toxoplasma contains two genes for the enzyme tyrosine hydroxylase, the key enzyme for the synthesis of dopamine. Tachyzoites induce more intense inflammatory cytokine-mediated response. Cyst rupture in the brain could be related to the onset of mental diseases. Toxoplasma gondii exposure has been associated with cognitive impairment in both schizophrenic and non-schizophrenic subjects. Due to the growing interest in this subject in medicine, there the association between the exposure to Toxoplasma and neurodevelopment disorders can be considered likely. However, many of these questions are still unanswered

QUETIAPINE ADD-ON THERAPY MAY IMPROVE PERSISTENT SLEEP DISTURBANCES IN PATIENTS WITH PTSD ON STABILE COMBINED SSRI AND BENZODIAZEPINE COMBINATION: A ONE-GROUP PRETEST-POSTTEST STUDY

Background: To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine and non-benzodiazepine hypnotic adjuvant treatment as well as to first-generation antipsychotic add-on treatment. Subjects and methods: Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine, were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10 and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuropsychiatric Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the assessment period were used as efficacy measures. Results: All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one hour (p<0.001), sleep latency decreased by 52.5 minutes (p<0.001), median number of arousals per night decreased from two to one (p<0.001), CAPS recurrent distressing dream item median decreased from five to four (p<0.001), and the number of patients dissatisfied with their sleep quality and quantity decreased from 45 to two (p<0.001). Conclusion: Quetiapine prescribed in the evening may be successful therapy for persistent sleep disturbances in patients with PTSD and generally good response to an SSRI and benzodiazepine combination, who previously failed to respond to some of the usual hypnotic medication or addition of first-generation antipsychotics: zolpidem, flurazepam, nitrazepam, promazine, and levopromazine

Contrastes : método de alfabetización en español como lengua extranjera

Resumen basado en el de la publicación. Existe una versión impresa de 1999 con el mismo títuloSe presenta la edición electrónica del método 'Contrastes de alfabetización en español como lengua extranjera' en euros y se materializa y visualiza la movilidad con la que fue diseñado. El método Contrastes integra la alfabetización y la didáctica de segundas lenguas en el Nivel I de las Enseñanzas Iniciales de la Educación Básica de Personas Adultas, especialmente dentro del contexto de la inmigración. También se incluye 'Cuenta conmigo', que es un método funcional con materiales didácticos y complementarios para el uso de los decimales a través del euro y el conocimiento de la Unión Europea en el Nivel I de las Enseñanzas Iniciales de la Eduación Básica para Personas Adultas en Español como Lengua Extranjera. Ambos métodos se estructuran en módulos, unidades didácticas, tareas y situaciones comunicativas.MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]