Když se řekne psychiatr

Iva Pekárková

Psychiatr. praxi 2019; 20(1): 3  

Off‑label treatment with antidepressants and antipsychotics

prof. MUDr. Eva Češková, CSc.

Psychiatr. praxi 2019; 20(1): 7-10 | DOI: 10.36290/psy.2019.002  

The use of antidepressants and antipsychotics including their off‑label indications is increasing. The data concerning the situation in the Czech Republic are not well known. According the available literature circa1/3 of antidepressants is given off‑label; the percentage could be even higher with antipsychotics. There are many reasons, including larger indications and prescribing by primary care physicians. The most frequent off‑label indications of antidepressants are insomnia, as for antipsychotics dementia. Evidence for their efficacy in off label indications is generally low. The child psychiatry is undoubtedly the speciality...

Maintenance treatment of schizophrenia with long‑acting injectable antipsychotics – work with patients and their family members

doc. MUDr. Bc. Libor Ustohal, Ph.D.

Psychiatr. praxi 2019; 20(1): 12-16 | DOI: 10.36290/psy.2019.003  

The article discusses the importance of education aimed to patients with schizophrenia and their family members during the initiation and during the course of maintenance treatment with long-acting injectable antipsychotics. It is very important to choose the optimal subpopulation of patients for this type of treatment. Education should be led by experienced professional with positive attitude to this treatment. It is necessary to discuss with patients and their family members the advantages (and disadvantages) of treatment with long-acting injectable antipsychotics rather than only injection procedure. Education is needed for other staff members too....

Sexual violence and paraphilia, does pathological sexual aggression exists or not?

MUDr. Marek Páv, Ph.D., MBA, MUDr. Slavoj Brichcín

Psychiatr. praxi 2019; 20(1): 17-20 | DOI: 10.36290/psy.2019.004  

Only a minority of perpetrators of violent sexual violence acts has a diagnosed paraphilia. The risk of committing violent behavior is associated with the diagnosis of sadism and pedophilia (in the case of acts against children). A significant percentage of acts are committed by persons who since the 1960s have been diagnosed as a group of paraphilic offenders, distinguishable from sadistic perpetrators and nonparaphillic offenders. In Czech tradition, this disorder is classified as pathological sexual aggression. Their sexually aggressive behavior (sometimes referred to as predatory behavior) is characterized by skipping the stages of partner interaction;...

Postpartum mental disorders: specifics and pharmacotherapy.
Part One: depression, anxiety disorders, sleep disorders, and ADHD

MUDr. Antonín Šebela, MUDr. Jan Hanka, prof. MUDr. Pavel Mohr, Ph.D.

Psychiatr. praxi 2019; 20(1): 21-25 | DOI: 10.36290/psy.2019.005  

Transition to parenthood is accompanied by psychosocial changes in both new mother and father. There is a higher risk of exacerbation or new onset of mental disorders in this period. Early attachment and healthy parent-child bond are determinants of infant´s undisturbed neurobehavioral development. Breastfeeding plays an important role in this process. The presence of untreated mental disorder affects early parent-child relationship in a negative way. Therefore, early and effective treatment intervention is essential. Psychotropic drugs with safe profile during lactation should be chosen, so the mother should be able to breastfeed her infant. Data...

Komentář ke studii:
Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta‑analysis.

Psychiatr. praxi 2019; 20(1): 32-33  

Vortioxetin in treatment of depressive epizode within bipolar affective disorder

MUDr. Radmila Kučíková, MUDr. Katarína Hánělová

Psychiatr. praxi 2019; 20(1): 27-28 | DOI: 10.36290/psy.2019.006  

An article offers a case report of 64-year-old man who has long-term treatment for depressive episodes by various antidepressantswith insufficient improvement and frequent side effects, including possible switch to mania. In this patient, vortioxetine has beenproved to be very effective in treating depressive episodes within later diagnosed bipolar affective disorder.

Sexual function in the treatment of depressive disorder with vortioxetin

prof. MUDr. Alexandra Žourková, CSc., MUDr. Marta Holanová, MUDr. Jana Novotná

Psychiatr. praxi 2019; 20(1): 29-31 | DOI: 10.36290/psy.2019.007  

One of the most common,secondary side effects of antidepressants drugs use is sexual dysfunction.Vortioxetin, a novel antidepressant, has favorable effects on sexual function. 35 patients with depressive disorder were treatedwith vortioxetin and sexual functions were monitored according to Changes in Sexual Functions Questionnaire. After 6 weeksof treatment statistical (Wilcoxon test) signicantly improvement of sexual functions were observed.

Why medications cannot be dispensed in an outpatient setting

MUDr. Jiří Švarc, Ph.D.

Psychiatr. praxi 2019; 20(1): 45-46  

It is a common practice for psychiatrists while on duty at a hospital’s central admission office, a crisis centre, or an outpatient unit to dispense medications to outpatients to take away home (from the hospital’s or unit’s property). This practice is not in accordance with the law. The Act on Pharmaceuticals explicitly prohibits medications from being dispensed in any way other than in accordance with the Act, with medications at outpatient units only being allowed, under certain legislation, to be dispensed by psychiatrists when providing replacement therapy, and by general practitioners, general paediatricians, and emergency medical...

Working with dissociation in Gestalt therapy

PhDr. Petra Kasalová, prof. MUDr. Ján Praško, CSc.

Psychiatr. praxi 2019; 20(1): 40-43 | DOI: 10.36290/psy.2019.010  

In Gestalt therapy, we look at the function of the patient’s symptoms, trying to explore the way he/she participates in maintaining them. We also try to identify what can be done differently and how it can be done. The therapist uses a dialogue, therapeutic relationship, and experiment in an attempt to bring the patient more in touch with his/her problems and to understand what he or she needs. Gestalt therapy is not intended to change the patient; the therapist’s role is to help the patient to realize what he/she needs. Gestalt therapy focuses on increasing the patient’s awareness and integrating unconscious and neglected experiences,...

Brexpiprazole

MUDr. Miloslav Kopeček, Ph.D.

Psychiatr. praxi 2019; 20(1): 34-38  

Brexpiprazole is a second generation antipsychotic that works as a partial agonist at serotonin 5-HT1A and dopamine D2 receptors and an antagonist at serotonin 5-HT2A. Brexpiprazole showed efficacy for the treatment of schizophrenia in the range of 2 to 4 mg/d and as an adjunct to antidepressant therapy in major depressive disorder when dosed at 2 to 3 mg/d. It has European Medicines Agency approval for monotherapy treatment of adult schizophrenia but has not approval for adjunctive treatment to antidepressants for MDD as in USA. The most common adverse effects include akathisia and weight gain. Advantages of brexpiprazole include once‑daily...