SJEZD PSYCHIATRICKE SPOLECNOSTI CLS JEP BUDOUCNOST PECE 0 DUSEVNE NEMOCNE V SOUVISLOSTECH 12.-15. CERVNA 2014 HOTEL HARMONY, SPINDLERUV MLYN Poradatele: Martin Holly, Pavel Doubek, Marek Pav
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, 140 21 Praha 4 guarant@guarant.cz www.guarant.cz Za odbornou a jazykovou stranku tohoto sborniku odpovidaji autori jednotliv}'ch pfispevku. ISBN 978-80-263-0702-0 OBSAH UvODNi SLOV0... 16 vedecky PROGRAM... 18 SYMPOZIA A WORKSHOPY... 20 Patek 13. cervna 2014... 20 SYMPOSIUM SPOLECNOSTI PRO NAVYKOvE NEMOCI: BUDOUCNOST PECE 0 zavisle V CR... 20 garant MUDr. Petr Popov BUDOUCNOST PECE 0 zavisle VCR V HISTORICKEM KONTEXTU: PSYCHIATRIE -ATOLOGIE -ADIKTOLOGIE?... 20 P.Popov PSYCHIATRIE V KONTEXTU KONCEPCE SiTE SPECIALIZOVANE ADIKTOLOGICKE PECE: vyzva NEBO NUTNOST?... 23 M.Miovsky MOZNOSTI SPOLUPRACE ADIKTOLOGA A PSYCHIATRA V AMBU- LANTNi PECI 0 za VISLE PACIENTY V CESKE REPUBLICE... 26 o. Sklenar SYMPOSIUM SPOLECNOSTI PRO KBT: KOGNITIVNE BEHAVIORALNi TERAPIE- INTEGRATIVNi PRiSTUPY... 28 garant prof Jan Praska METAKOGNITIVNi TRENINK A JEHO POUZITi U PSYCHICKYCH PORUCH... 28 P.Mozny SCHEMA TERAPIE... 31 J. Praska, J. Vyskocilova, A. Grambal ETICKA DILEMATA PRENOSU A PROTIPRENOSU V KOGNITIVNE BEHA VIORA.LNJ... 34 J. Vyskocilova SKUPINOVA INTEGRATIVNi KOGNITIVNE BEHA VIORALNi TERAPIE V LECBE PPACIENTtJ S HRANICNi PORUCHOU OSOBNOSTI... 37 A. Grambal, J. Praska, J. Vyskocilova EXPERIMENTALNf A NA RATIVNi PPRiSTUPY V KOGNITIVNE BEHA VIORALNJ TERAPII... 41 J. Praska, J. Vyskocilova, A. Grambal, M. Ociskova VARIA I... 44 DPS ONDREJOV COBY BUDOUCi CDZ?... 44 M. Jarolimek TERAPEUTICKA PR.A.CE S CASOVOU PERSPEKTIVOU - KAZUISTIKA... 46 E. Bazinkova
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
fungovani jedince ve spoleenosti je pak tedy predevsim souhrou vrozenych a ziskanych faktoru - tedy geneticke v:ybavy a stylu v:ychovy. UrCita patologie, v nasem pnpade predevsim zv:ysena tendence k agresivnimu chovani a od ni odvisle nasledne delikventni chovani, nevznika nahle a bez pficiny. Naopak, ma urcicy v}'voj, kter:y je easto motne zaznamenat jiz v ranem obdobi zivota jedince. Vyzkumy zab}'vajici se timto tematem hovon o mnoha faktorech, ktere pozitivne koreluji prave s budoucim kriminalnim, a potazmo nasiln}'m, chovanim. V tom to ohledu dulezita oblast vedeckeho zkoumani, tedy v}'vojova psychopatologie, se konkretne zamefoje na evoluci psychiceych poruch, na jejich zmenu v ease a pfedevsim pak na jejich dopad na osobnost daneho jedince. Varovn:Ym signalem se tak dle fatly studii zda b:yt napriklad v}'skyt agresivniho chovani a sklon k poru5ovani nastavenych pravidel v ranem detstvi. Zda se totiz, ze prave tyto znaky easto predchazeji porucham chovani a jejich v}'skyt v ranem detstvi je tak velmi spatnou progn6zou do budoucnosti a to predevsim tehdy, pokud jsou pfidrufony i dalsi faktory. Predevsim z mnozstvi zahranicnich v:yzkumu pak take vypl}'va, ze poruchy chovani u adolescentu jsou mnohem zavaznejsi a signifikantnejsi pro predikci dalsiho v}'voje, pokud muzeme jejich pocatek nalezt jiz v detstvi. Zda je motno ta to zjisteni aplikovat i na domaci podminky je otazkou, vzhledem k nedostatecnemu mnozstvi domacich v:yzkumu z teto oblasti. Cilem prezentovane pilotni studie je poukazat na tuto problematiku a odhalit faktory, ktere je mozno oznacit za signifikantni prediktory nasilneho chovani u budoucich pachatelu trestnych cinu. Soubor v prezentovane pilotni studii jsme vysetrui skupinu adolescentu ve veku 16-22 let, kten byli odsouzeni za funyslny trestny Cin nasilneho charakteru (n=30) a kontrolni skupinu studentu SS a VS bez historie protipravniho jednani (n=30). Testova baterie byla slofona z dotazniku zamereneho na anamnesticke udaje o dosavadnim v}'voji, zvl. s ohledem na v}'skyt projevli v}'vojove psychopatologie, socialni adaptaci a vzdelani. V testove baterii byla dale obsazena pilotni verze MMPI-A a HCR-Y. Vtomto pnspevku prezentujeme pouze nalezy v oblasti projevli psychopatologie v anamneze. Vysledky V souboru adolescentu odsouzenych za funyslny nasilny trestny Cin lze v anamneze hodnotit tyto statisticky v:yznamne rozdily oproti kontrolni skupine (p<0.01) i. Poruchy chovani (43 % vs 6,6 %) 2. ADHD (63 % vs 13 %) 3. Porucha opozicniho vzdoru (16, 6 % vs o %) 4. Aspergeruv syndrom (6,6 % vs o %) Jedna se o v}'vojove poruchy diagnostikovane psychiatrem. Zuver z prezentovaneho pilotniho v:yzkumu je patrne, ze v}'vojove poruchy jsou statisticky v:yznamn:ym prediktorem budouciho kriminalniho chovani. Rozhodne se nejedna o jediny faktor. Na rozvoji kriminalni chovani se dale podili cela fada 338 specificeych faktoru. Nicmene prezentovane nalezy, ktere jsou v souladu se zahranicni odbornou literaturou, zcela jasne poukazuji na nutnost dostateene psychiatricke a psychologicke pece deti s projevy v}'vojove psychopatologie. Fodpofeno projektem FRVOUK FSYCHOLOGIE UK. Literatura Tremblay ER, Nagin SD, Seguin RJ. Physical Aggression During Early Childhood: Trajectories and Predictors. Pediatrics 2004; 114: e43 - e48. Moffitt ET. Adolescence-Limited and Life-Course-Persistent Antisocial Behavior: A Developmental Taxonomy. Psychological Review 1993; 100: 674-701. Hoffmann PJ. A Life-Course Perspective on Stress, Delinquency, and Young Adult Crime. Am J Crim Just 2010; 35:105-120. VLIV KOGNITIV NA MITOCHONDRL\LNi RESPIRACI A AKTIVl TU KOMPLEXlJ ELEKTRONOvEHO TRANSPORTNIHO RETEZCE N. Singh, J. Hroudova, Z. FiSar Fsychiatricka klinika, 1. lekafskafakulta, Univerzita Karlova v Fraze a Vseobecnafakultni nemocnice v Fraze, Fraha, Ceska Republika Summary EFFECT OF COGNITIVE DRUGS ON MITOCHONDRIAL RESPIRA- TION AND ACTIVITY OF ELECTRON TRANSPORT CHAIN COM- PLEXES Drugs like 7-MEOTA (7-methoxytacrine), tacrine, memantine, galanthamine, donepezil, latrepirdine (Dimebon) and piracetam are currently being tested to treat patients suffering from neurodegenerative disorders especially Alzheimer's disease (AD). Most of them show reversible acetylcholinesterase-inhibiting activity, except for memantine, latrepirdine and piracetam. Defects in mitochondrial metabolism and particularly of electron transport chain (ETC) may play a significant role in pathogenesis of AD; complex IV of ETC plays a major role in controlling of oxidative phosphorylation. We examined in vitro effects of pharmacologically different cognitive (7-MEOTA, memantine, galanthamine, donepezil) and nootropic drugs Oatrepirdine, piracetam) on both mitochondrial enzyme activities (citrate synthase and complex IV of ETC) and respiration of isolated brain mitochondria. High-resolution respirometry was used to determine respiratory rate driven by substrates of complex I or II of ETC. Results demonstrated no significant drug-induced changes in the activity of citrate synthase. Significantly decreased activity of complex IV was observed for cognitive drugs and increased complex IV activity for nootropic drugs. Slight druginduced decrease in rate of oxygen consumption was observed for galanthamine, memantine and donepezil, and slight increase for latrepirdine and memantine. Our results support the view that modulation of mitochondrial functions may participate on therapeutic effects of cognitives and nootropics. Keywords: mitochondria; cognitive drug; nootropic; oxidative phosphorylation; mitochondrial respiration 339
Souhrn Ll.tky, jako 7-MEOTA (7-methoxytakrin), takrin, memantin, galanthamin, donepezil, latrepirdin (Dimebon) a piracetam jsou pouzivana ci testovana pro lecbu osob trpicich neurodegenerativnimi poruchami, predevsim Alzheimerovou nemoci (AD). Vetsinou se jedna o reverzibilni inhibitory acetylcholinesterazy, krome memantinu, latrepirdinu a piracetamu. Vyznamnou ulohu v patogenezi AD mohou mit poruchy v mitochondrialnim metabolismu a zvlaste v elektronovem transportnim retezci (ETC); napr. komplex IV dychaciho retezce m [1 v.yznamnou ulohu v kontrole oxidaeni fosforylace. Testovali jsme in vitro ucinky fady farmakologicky odlisnych kognitiv (7-MEOTA, memantin, galanthamin, donepezil) a nootropik Oatrepirdin, piracetam) jak na aktivity jednotliv)rch mitochondrialnich enzymu (citratsyntazy a komplexu IV), tak na celkovou respiracni aktivitu mitochondrii izolovanych ze zvirecich mozku. Pro mereni respiracni rychlosti se vstupem elektronu pres komplex I, nebo pres komplex II, byla pouzita respirometrie s vysok)rm rozlisenim. Mereni ukazala nev.yznamny vliv testovanych latek na aktivitu citratsyntazy. Kognitiva zpusobovala snizeni a pro nootropika zv.yseni aktivity komplexu IV. Mime snizeni rychlosti spotfeby kysliku mitochondriemi bylo pozorovano vlivem galanthaminu, memantinu a donepezilu. Naopak zv.yseni respiraeni rychlosti bylo indukovano latrepirdinem a memantinem. Nase v)rsledky podporuji hypotezu, ze modulace mitochondrialnich funkci se muze podilet na terapeutickych ucincich kognitiv a nootropik. Klieova slova: mitochondrie; kognitiva; nootropika; oxidaeni fosforylace; mitochondrialni respirace Aim We aimed at measurement of drug-induced changes in the rate of oxygen consumption for cognitive and nootropic drugs and to detect the effects of these drugs on complex IV activity of electron transport chain (ETC). Method The mitochondria were isolated from pig brain cortex as described previously (Fisar et al., 2010). All chemicals were purchased from Sigma-Aldrich Co. (St. Louis, MO, USA). Mitochondrial respiratory rate was measured at 37 C using a titration-injection high-resolution oxygraph (Oxygraph-2k, Oroboros Instruments, Innsbruck, Austria) equipped with two closeable tempered glass chambers with Clark-type electrodes. DatLab 4.3 software (Oroboros Instruments, Innsbruck, Austria) was used to collect and analyse respirometric data. Changes in activity of citrate synthase or complex IV was measured spectrophotometrically (Hroudova and Fisar, 2010) at 50 µm drug concentration; Uvicon XL spectrophotometer (SECOMAM, Ales, France) was used for all assays. Results were analyzed by STATISTICA (data analysis software system, version 9.0, StatSoft, Inc., Tulsa, OK, USA). Results No significant drug-induced change in the activity of citrate synthase was found. Significantly decreased activity of complex IV of respiratory electron transport chain was observed for 7-MEOTA, galanthamine and donepezil; increased com- 340 plex IV activity was observed for nootropic drugs Oatrepirdine, piracetam). Memantine did not induce any significant change in complex IV activity. Decrease in rate of oxygen consumption was observed for galanthamine and memantine at higher drug concentrations, when mitochondrial respiration was supported through complex I; 7-MEOTA, donepezil, latrepirdine and piracetam showed almost no effect on rate of oxygen consumption. When respiration was supported through complex II, donepezil induced decrease and latrepirdine and memantine showed increase in rate of oxygen consumption; no significant changes were observed for other drugs. Conclusion Drug-induced changes in cellular energetics characterized by complex IV activity and mitochondrial respiration were analysed. Latrepirdine induced increase in was observed for both complex IV activity and respiratory rate supported through complex II. Memantine showed quite ambiguous behaviour showing decrease in respiration supported through complex I and increase in respiration supported through complex II. The results prove the cognitive enhancersinduced effects related to disturbance in electron transport chain, i.e. in cellular energetics. The results can be useful to gain in-depth understanding of mechanisms of action of drugs used in treatment of the cognitive impairment in neurodegenerative disorders. Our results support the view that modulation of mitochondrial functions may participate on therapeutic effects of cognitives and nootropics; however, currently used drugs seem not sufficiently efficient in affecting mitochondrial respiration and cellular energetics. References author PSYCHIATRICKE KOMPLIKACE PROTINADOROvE LECBY B. Slovackova 1, L. Slovacek 2 1Psychiatricka klinika FN a LF UK Hradec Kralove, Ceska republika 2Klinika onkologie a radioterapie FN a LF UK Hradec Kralove, Ceska republika Summary PSYCHIATRIC COMPUCATION OF THE CANCER THERAPY The authors report on two cases of cancer therapy-induced psychiatric complication among female patients with breast carcinoma. The case reports highlights the potential risk of chemotherapy and premedication causing psychiatric complication (i.e. bipolar disorder and drug-induced halucinatory syndrome). At the same time it indicates the need to cooperate with the psychiatrist. Early symptomatic psychopharmacological intervention enabled the smooth completion of cancer therapy). Rada literarnich zdroju uvadi, ze cytostatika a leky pouzivane v ramci premedikace, jsou latky s psychotropnim ucinkem, tj. mohou navodit u disponovanych 341