SJEZD PSYCHIATRICKE SPOLECNOSTI CLS JEP

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1 SJEZD PSYCHIATRICKE SPOLECNOSTI CLS JEP BUDOUCNOST PECE 0 DUSEVNE NEMOCNE V SOUVISLOSTECH CERVNA 2014 HOTEL HARMONY, SPINDLERUV MLYN Poradatele: Martin Holly, Pavel Doubek, Marek Pav

2 Pofadatele sborniku MUDr. Martin Holly MUDr. Pavel Doubek, Ph.D. MUDr. Marek Pav, Ph.D. Psychiatricka lecebna Bohnice, Psychiatricka klinika, L lekarska fakulta UK a Vseobecna fakultni nemocnice, Praha Sekretariat GUARANT International spol. s r. o. Na Pankraci 17, Praha 4 guarant@guarant.cz Za odbornou a jazykovou stranku tohoto sborniku odpovidaji autori jednotliv}'ch pfispevku. ISBN OBSAH UvODNi SLOV vedecky PROGRAM SYMPOZIA A WORKSHOPY Patek 13. cervna SYMPOSIUM SPOLECNOSTI PRO NAVYKOvE NEMOCI: BUDOUCNOST PECE 0 zavisle V CR garant MUDr. Petr Popov BUDOUCNOST PECE 0 zavisle VCR V HISTORICKEM KONTEXTU: PSYCHIATRIE -ATOLOGIE -ADIKTOLOGIE? P.Popov PSYCHIATRIE V KONTEXTU KONCEPCE SiTE SPECIALIZOVANE ADIKTOLOGICKE PECE: vyzva NEBO NUTNOST? M.Miovsky MOZNOSTI SPOLUPRACE ADIKTOLOGA A PSYCHIATRA V AMBU- LANTNi PECI 0 za VISLE PACIENTY V CESKE REPUBLICE o. Sklenar SYMPOSIUM SPOLECNOSTI PRO KBT: KOGNITIVNE BEHAVIORALNi TERAPIE- INTEGRATIVNi PRiSTUPY garant prof Jan Praska METAKOGNITIVNi TRENINK A JEHO POUZITi U PSYCHICKYCH PORUCH P.Mozny SCHEMA TERAPIE J. Praska, J. Vyskocilova, A. Grambal ETICKA DILEMATA PRENOSU A PROTIPRENOSU V KOGNITIVNE BEHA VIORA.LNJ J. Vyskocilova SKUPINOVA INTEGRATIVNi KOGNITIVNE BEHA VIORALNi TERAPIE V LECBE PPACIENTtJ S HRANICNi PORUCHOU OSOBNOSTI A. Grambal, J. Praska, J. Vyskocilova EXPERIMENTALNf A NA RATIVNi PPRiSTUPY V KOGNITIVNE BEHA VIORALNJ TERAPII J. Praska, J. Vyskocilova, A. Grambal, M. Ociskova VARIA I DPS ONDREJOV COBY BUDOUCi CDZ? M. Jarolimek TERAPEUTICKA PR.A.CE S CASOVOU PERSPEKTIVOU - KAZUISTIKA E. Bazinkova

3 DEKUJEME PARTNERUM SJEZDU Janssen PHARMACEUTICAL COMPANIES OF gotmro1i.. gofm.un Zlatl partneri Z0 NTIVA SPOLECNOST SKUPINY SANO Fl BUDOUCNOST PECE O DUSEVNE NEMOCNE V SOUVISLOSTECH Sbornik pfispevku X. sjezdu Psychiatricke spolecnosti CLS JEP s mezinarodni ucasti ~ ~~S~ NC?~E~~~S~ Partneii -~ ~SERVIER Brno 2014

4 !"' LI ;! /1 SYMPOSIUM PSYCHIATRICKE KLINIKYVFN A 1. LF UK: BIOLOGICKA DIAGNOSTIKAA LECBA DUSEVNiCH PO RUCH garant prof. Jili Raboch ENERGETIC.KY METABOLISMUS U PACIENTC- S DEPRESi A ALZ HEIMEROVOU DEMENCi J. Hroudova 1, Z. FiSar 1, R. Jirak 1, H. Hansikova2, L. Wenchich2, J. Raboch 1 1 Psychiatricka klinika, 1. lekafskafakulta, Univerzita Karlova v Praze a VSeobecnafakultnf riemocnice v Praze, Praha, Ceska Republika 2 Klinika detskeho a dorostoveho lekafstvf, Univerzita Karlova v Praze a Vseobecnafakultnf nemocnice v Praze, Praha, Ceska Republika Summary ENERGY METABOLISMUS IN PATIENTS WITH DEPRESSION AND ALZHEIMER'S DISEASE Mitochondrial dysfunctions are concerned in a range of diseases, neurodegenerative and psychiatric disorders included. We examined effects of depressive disorder and/or Alzheimer's disease (AD) on both mitochondrial enzyme activities (citrate synthase, complexes of electron transport chain) and cellular respiration in blood platelets. Enzyme activities were measured spectrophotometrically, kinetics of oxygen consumption by mitochondria was measured electrochemically. Physiological respiration, maximal capacity of electron transport system (ETS) and respiratory rate after complex I inhibition were decreased in intact platelets of depressive patients, compared to controls. Complex II activity was significantly decreased in depressive patients. In AD, we found decreased physiological respiration and ETS capacity; whereas respiratory rate after complex I inhibition was increased. Unchanged respiratory rate was observed in permeabilized platelets. Significant decrease of citrate synthase and complex N activities were observed in AD patients. Complex I was significantly increased in AD patients, complex II was increased in subgroup of AD patients with depression. Results suggest that insufficient substrate availability, rather than ETS functional disturbances, is responsible for decreased mitochondrial respiration. It can be concluded that changes of mitochondrial functions participate in the pathophysiology of depression and AD. Their modulation can contribute to therapeutic and/ or adverse effects of antidepressants and mood stabilizers. Keywords: depression; Alzheimer's disease, electron transport chain complexes, cellular respiration, high resolution respirometry Cile Nan'.istajid dukazy, ze mitochondrialni dysfunkce souvisi s narusenim energetickeho metabolismu a jsou zahrnuty v patogenezi Alzheimerovy choroby (AD) [1, 2]. Narusena funkce mitochondrii vede nejen ke snizeni produkce ATP, ale take ke zv}'sene produkci volnych radikalu, ke zmenam nitrobuneeneho kalcia, oxidaenimu stresu a apopt6ze. 66 Pfodpokladame, ze zmeny energetickeho metabolismu hunky se podili na patofyziologii AD, poruch nalady a na terapeutick}'ch nebo vedlejsich ucincich antidcpresiv [3]. Sledovali jsme respiraeni rychlost a aktivity mitochondrialnich cmzymu v krevnich destickach u pacientu s AD, u pacientu s depresivni epizodou 11 v remisi, u zdrav}'ch kontrol. Cilem prace bylo zjistit, zda je aktivita citratsynthazy, komplexu elektronoveho transportniho fetezce a buneena respirace ovlivnena pfi depresi a pfi AD. Snahou studie je nalezeni biologick}'ch parametril, ktere by mohly hyt vhodn}'mi markery onemocneni a ktere by mohly byt diem lecby psychofarmaky. Metody J)o studie byli zafazeni pacienti s depresivni epizodou; tize jejich deprese byla ohodnocena pomod Hamiltonovy skaly deprese (HRSD-21), kontrolni skupina byla tvofena zdrav}'mi dobrovolniky. Byli zarazeni pacienti s AD a vekove odpovfdajid kontroly. Kognitivni postizeni bylo ohodnoceno pomod skaly minimental state examination (MMSE), deprese u AD byla identifikovana geriatrickou skalou deprese (GDS); diagn6za AD byla potvrzena v}'pocetni tomografii mozku nebo magnetickou rezonanci. Zmeny buneeneho dychani byly mefeny v krevnich destickach pacientu v depresivni epizode, v remisi au pacienru s AD, a byly porovnavany se zdrav}'mi kontrolami. Dychani mitochondrii, tj. celkova aktivita systemu oxidaeni fosforylace (OXPHOS), bylo mefeno s pouzitim oxygrafu s Clarkov}'mi elektrodami. Respirometricka mefeni s vysok}'m rozlisenim byla provadena v intaktnich a take v permeabilizovanych bunkach (v pfitomnosti substratu a inhibitoru OXPHOS). Rychlost spotfeby kysliku byla hodnocena v nekolika respiracnich stavech. Aktivita citratsyntazy a komplexu elektronoveho transportniho fetezce byla mefena spektrofotometricky. Statisticka v}'znamnost byla hodnocena pomod Mannova Whitneyova U testu. Vysledky Fyziologicka respirace v krevnich destickach depresivnich pacientu se nelisila od kontrol; ke statisticky v}'znamnemu snizeni doslo po lecbe antidepresivy. Respiracni rychlost po inhibici komplexu I a maximalni kapacita elektronoveho transportniho systemu byla rovnez snizena statisticky v}'znamne po lecbe antidepresivy. U osob s depresi jsme zjistili statisticky v}'znamne snizeni aktivity komplexu II v porovnani s kontrolami. U pacientu s AD byla v}'znamne snizena fyziologicka respirace i max. kapacita clektronoveho transportniho systemu. U pacientu s AD bylo v}'znamne snizeni aktivity citratsyntazy a komplexu N. U pacientu s AD (bez deprese) byla zv}'sena aktivita komplexu I v porovnani s kontrolami. U podskupiny AD pacientu se symptomy deprese byla navic v}'znamne zv}'sena aktivita komplexu II oproti kontrolam i ve srovnani s AD pacienty bez deprese. Nepozorovali jsme v}'znamnou souvislost mezi aktivitami mitochondrialnich enzymu a stupnem kognitivniho poskozeni nebo tizi deprese. Zavery V patofyziologii depresivni poruchy i AD muze b}'t zahrnuta zmenena aktivita komplexu II a N dychaciho fetezce. Symptomy deprese pfi AD mohou mit jiny 67

5 ill, patofyziologici<y zaklad, nez je tomu u samotne depresivni poruchy. z v}'sledkii take vypl)'va, ze snizena respirace je dana spise nedostatecnou dostupnosti substratii nez funkcnim poskozenim elektronoveho transportniho systemu. Depresivni porucha pfed zapocetim lecby mela v}'znamny vliv na aktivitu komplexu II, ale nikoli na respiracni pomery v intaktnich destickach; lecba vedla ke zmenam techto parametrii. Pfedpokladame, ze snifoni respiracni rychlosti u depresivriich osob po dlouhodobem podavani antidepresiv odrazi inhibieni ucinky antidepresiv, ktere jsme pozorovali v pfedchozich in vitro experimentech [4]. Aktivity citratsyntazy, komplexu II a komplexu N by mely b:yt dale studovany jako mozne biomarkery AD, ktere by v kombinaci s daisimi biochemici<ymi parametry mohly napomoci v diagnostice tohoto onemocneni a ve sledovani mechanismii ucinkii nov}'ch leciv. Literatura Podporeno vyzkumnym z6:merem Ministerstva skolstvi, ml6:deze a telovychovy MSM a projektem PRVOUK-P26/ LF1/ Parker, W.D., Jr., et al., Electron transport chain defects in Alzheimer's disease brain. Neurology, (6): p Bosetti, F., et al., Cytochrome c oxidase and mitochondrial F1Fo-ATPase (ATP synthase) activities in platelets and brain from patients with Alzheimer's disease. Neurobiol Aging, (3): p Hroudova, J., et al., Mitochondrial respiration in blood platelets of depressive patients. Mitochondrion, (6): p Hroudova, J. and Z. Fisar, Activities of respiratory chain complexes and citrate synthase influenced by pharmacologically different antidepressants and mood stabilizers. Neuro Endocrinol Lett, (3): p vyznam KORTIZOLU A HOMOCYSTEINU V DIAGNOSTICE ALZ HEIMEROVY DEMENCE - vysledky Z vyzkumneho zameru M. Zvefova, z. Fi.Sar, R. Jirak, J. Hroudova, E. Kitzlerova, J. Raboch Psychiatrick6: klinika, 1. lekafsk6:fakulta, Univerzita Karlova v Fraze a VSeobecn6:fakultni nemocnice v Fraze, Praha, Cesk6: republika Summary MEANING OF CORTISOL AND HOMOCYSTEINE IN DETECTION OF ALZHEIMER'S DEMENTIA - RESULTS OF THE RESEARCH PLAN Background: Cortisol and homocysteine are presumed to be risk factors for stress- and age-related disorders, such as Alzheimer's disease (AD). The aim of this study was to investigate the association of plasma cortisol or homocysteine concentration with AD. Materials and Methods: Plasma cortisol and homocysteine concentration were measured in 80 AD patients, and 37 elderly healthy controls. Patients were recruited from the Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague. 68 Results: Plasma cortisol was positively correlated with cognitive impairment in AD patients. We confirmed significant correlation between homocysteine concentration and the degree of cognitive impairment in AD patients. Conclusions: The association of high cortisol and high homocysteine with degree of cognitive impairment or stage of dementia in AD indicate potential role of high plasma cortisol and homocysteine as biomarkers of the disease und/or indicators of brain damage during the progression of AD dementia. Keywords: Alzheimer's disease, biochemical markers, cortisol, homocysteine Ovod a cile V soueasnosti jsou hledana dalsi diagnosticka kriteria a dalsi biologicke markery, ktere by byly specificke pro Alzheimerovu nemoc. Zatim vsak nebyla nalezena zadna nova metoda, ktera by byla vice prii.kazna a pro pacienty mene zatezujici nez je odber mozkomisniho moku. Mezi biochemicke markery, zjistitelne v periferni krvi a podilejici se na patofyziologii neurodegenerativnich poruch, lze zafadit uptake serotoninu do krevnich desticek, aktivitu monoaminooxidazy a plazmaticke koncentrace kortizolu a homocysteinu. Krome maieho procenta geneticky podminenych pnpadii neni pncina AD znama. Mezi zname hypotezy vzniku AD provazene neurodegeneraci a kognitivnim postizenim pam hypoteza cholinergni (snizena synteza acetylcholinu), amyloidova (abnorma.ini akumulace amyloidu-~) a tau (patologicka agregace tau proteinu). Pozornost je vsak venovana fade dalsich faktorii, ktere mohou b:yt zahrnuty v etiologii AD, pfedevsim mechanismiim vedoucim k poskozeni neuroplasticity a neurogeneze, jako jsou mitochondrialni dysfunkce a dalsi. Imunoneuroendokrinni a neurochemicke cesty vedouci k neurodegeneraci jsou propojeny pres vzajemne ovlivrfovani funkci neurotransmiterov}'ch systemii a osy hypotalamus - hypofyza - kiira nadledvin (HPA). Patofyziologicke mechanismy AD zahrnuji zv}'senou aktivitu osy HPA, chronicke zanetlive procesy, zv}'seny oxidacni a nitrosaeni stres, narusenou neuroplasticitu a neurogenezi. Biologicky aktivnimi molekulami studovan}'mi pfi AD jsou proto glukokortikoidy, prozanetlive cytokiny transkripcni faktor aktivovany v odezve na zv}'seni hladin camp (CREB), mozkov}' neurotrofni faktor (BDNF), glykogensyntazakinaza-3 (GSK-3) a dalsi. Mezi biochemicke markery, ktere jsou zjistitelne z periferni krve, a ktere se podileji na patofyziologii neurodegenerativnich poruch, pam kortizol a homocystein. Kortizol (hydrokortizon) je jednim ze steroidnich hormonii syntetizovanych z cholesterolu v zona fasciculata kiiry nadledvin. Produkce je regulovana prostfednictvim HPA osy (CRH~ ACTH~ kortizol). Hlavnimi stimuly pro uvolnenijsou stres (teplo, zima, fyzicka zatez), adrenalin, vasopresin, pyrogeny, bolest a hypoglykemie. Kortizol je v plazme transportovan pfevazne ve vazbe na transcortin (90%), albumin (7%), asi 3 % plazmatickeho poolu tvon volny, biologicky aktivni hormon. Mezi hlavni fyziologicke funkce patn regulace intermediarniho metabolismu bilkovin, gluk6zy a lipidii, regulace krevniho tlaku a imunomodulaeni vliv. BiologicI<y v:yznam homocysteinu urcuje jeho ueast v zakladnich zivotnich procesech, a to v hospodafeni s kyslikem (bunecne dychani), v fuene tvorbe energie, jejim ukladani a vyuzivani, dale v synteze a recyklaci nekter)rch klifov}'ch metabolitii av rozmnofovani bunek. Zv}'sene koncentrace kortizolu a homocysteinu se povafuji za jeden z rizikov}'ch faktorii vedoucich k naru8eni kognitivnich funkci ve vyssim veku a k rozvoji Alzheimerovy demence. 69