Když se řekne psychiatr

Pavla Horáková

Psychiatr. praxi 2019; 20(2): 51  

What prevents more successful pharmacological treatment of depressive disorder?

MUDr. Petr Šilhán, Ph.D., MUDr. Martin Hýža, MUDr. Tomáš Skřont, Mgr. Jan Vantuch

Psychiatr. praxi 2019; 20(2): 56-59 | DOI: 10.36290/psy.2019.013  

Depressive states belong to most common reasons for psychiatric care seeking. However, the treatment of depressive disorder remains insufficiently successful. Antidepressants are considered as comparably efficacious, but most studies assessing the treatment effectiveness neglect a heterogeneity of depressive conditions. Biomarker research has not yielded a significant shift in disease diagnostic, treatment or prognosis yet. Therefore, a comprehensive application of currently available options and the treatment individualization are the main remaining way. A specific clinical presentation might be a guide for correct treatment option. Patients´ expectations,...

Inflammation as a part of the pathophysiology of depression and the possibility of its influence by polyunsaturated fatty acids

PharmDr. Bc. Hana Kotolová, Ph.D., PharmDr. Tomáš Hammer

Psychiatr. praxi 2019; 20(2): 60-63 | DOI: 10.36290/psy.2019.014  

Depression and other affective disorders are among the most prevalent mental disorders. The pathophysiology of this diseaseis complex, and pro-inflammatory processes appear to play an important role in it. The article aims to summarize the existingknowledge of the research of the interconnection of affective disorders and inflammation and their possible influence by recentlyhighly discussed polyunsaturated fatty acids.

Pharmacotherapy of cognitive dysfunction in depressive disorder

prof. MUDr. Eva Češková, CSc.

Psychiatr. praxi 2019; 20(2): 64-68  

Cognitive dysfunction frequently occurs in acute depression and can persist into remission. Cognitive impairments impacts on patient functioning and negatively influence ability to perform adequately at work. As evidenced by the results of numerous studies drugs with anticholinergic effect (e.g. tricyclic antidepressants) may adversly affect cognitive functions. The most frequently prescribed antidepressants, selective serotonin reuptake inhibitors may improve cognitivy dysfunction in depression. Agents also including a noradrenergic component such as selective serotonin and noradrenaline reuptake inhibitorts appear to be more effective in respect...

Drug-drug interactions of frequently prescribed antidepressants

MUDr. Michal Prokeš, PharmDr. Josef Suchopár

Psychiatr. praxi 2019; 20(2): 69-76  

This article describes drug-drug interactions of antidepressants. Potentially fatal pharmacodynamic interactions include serotonin syndrome, whose diagnosis is difficult. QT prolongation is a marker of increased risk of ventricular tachycardia. Administration of SSRIs and NSAs increases the risk of bleeding, especially from GIT. From pharmacodynamic interactions, the article highligts interactions via CYP2D6. Many antidepressants and antipsychotics are CYP2D6 substrates, with paroxetine, fluoxetine and fluvoxamine being CYP2D6 inhibitors. Some of the interactions are contraindicated, in other cases doctor should consider pros and cons, and patients...

Monitoring of adverse events and safety of antidepressants

prof. MUDr. Eva Češková, CSc., PharmDr. Kateřina Horská

Psychiatr. praxi 2019; 20(2): 77-81 | DOI: 10.36290/psy.2019.017  

Primum non nocere is one of the fundamental principles in medicine. All psychopharmaceuticals, in addition to their therapeutic effects, also have adverse events. Adverse events of individual drugs are known and included in the SPC (Summary of Product Characteristics), and it is the psychiatrist’s responsibility to inform patients about adverse events. Apart from subjective discomfort, adverse events are a major reason for treatment discontinuation. Therefore, the choice of antidepressant medication should be based particularly on individual vulnerability to adverse events. Furthermore, safety and tolerability should be monitored continuously;...

Postpartum mental disorders: specifics and pharmacotherapy. Part Two: psychotic disorders and bipolar disorder

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

Psychiatr. praxi 2019; 20(2): 82-85 | DOI: 10.36290/psy.2019.018  

Postpartum period is accompanied by an increased risk of onset of severe mental disorders that require intensive psychiatric care and may result in long-term separation of mother and baby. This may disrupt the whole family system. The most frequent cause of postpartum relapse of schizophrenia or bipolar disorder is discontinuation of drug treatment during pregnancy. The etiology of postpartum psychosis, which is often a first manifestation of bipolar disorder, is still unknown. There is no evidence of a causal link between lactation and postpartum psychosis. Thus, pharmacological suppression or cessation of lactation is not indicated for postpartum...

Treatment of depression with prolonged form of trazodone

doc. MUDr. Dana Kamarádová, Ph.D.

Psychiatr. praxi 2019; 20(2): 86-87 | DOI: 10.36290/psy.2019.019  

Trazodone is one of the most common molecules used to treat mental disorders. It is a multimodal antidepressant, with a favorablespectrum of adverse effects. Because of its ease of use, it is popular with both doctors and patients. Due to its advantageous pharmacokinetics,its prolonged form allows the use of trazodone in a single daily dose. This prolonged form can be advantageouslyused in the treatment of depression.

Abstinence from Alcohol: When and Why

MUDr. Karel Nešpor, CSc.

Psychiatr. praxi 2019; 20(2): 96-98  

The number of people abstaining from alcohol is much higher than people suppose. A physician should recommend abstinence from alcohol to substance dependent persons, pathological gamblers, the adult children of alcohol dependent parents, when there is the risk of the interactions between alcohol and drugs, to persons with impaired self-control and tendency to behave impulsively or dangerously. Abstinence should be recommended to pregnant women and those who do not exclude pregnancy. Abstinence is especially important for children and adolescents because alcohol interferes with the development of their brain and can cause irreversible impairment of...

Issuing of medical reports on inability to participate in criminal proceedings

MUDr. Jiří Švarc, Ph.D.

Psychiatr. praxi 2019; 20(2): 92-95  

Psychiatrists often issue a certificate on the inability to participate in criminal proceedings at the request of patients (or their lawyers), typically without having any knowledge of their patient’s criminal activity. The aim of this article is to aid psychiatrists in understanding that they are sometimes manipulated to issue such certificates. It is not a therapist’s duty to issue reports in criminal proceedings; conversely, to issue a grossly misleading medical report for criminal proceedings is a crime. In psychiatric terms: those deemed unable to participate in actions in criminal proceedings are the ones not understanding their meaning...

Agomelatin – tolerance with great effect

MUDr. Vlastimil Nesnídal

Psychiatr. praxi 2019; 20(2): 88-91 | DOI: 10.36290/psy.2019.020  

Agomelatine is antidepresive substance, which development started in early 90s and was introduced into clinical practice in the first decade of new millenium. Agomelatine has extraordinary and clear farmacological profile that puts it into individual antidepresant group. Efficiency of agomelatine is simillar to the effect of SSRI antidepresives. Only minimal side effects connected to sexual dysfunctinon and weight gain are reported. Agomelatine has dual effect. It repairs disturb sleep rhytms due to stimulation of melatonergic receptos in nucleus suprachiasmatichus and andepressive effect is caused by anatagonist function on serotonergic receptors...