Integration of complementary biomarkers in patients with first episode psychosis: research protocol of a prospective follow up study.

In this project, we recruited a sample of 150 patients with first episode of psychosis with schizophrenia features (FEP) and 100 healthy controls. We assessed the differences between these two groups, as well as the changes between the acute phase of illness and subsequent remission among patients over 18-month longitudinal follow-up. The assessments were divided into four work packages (WP): WP1- psychopathological status, neurocognitive functioning and emotional recognition; WP2- stress response measured by saliva cortisol during a stress paradigm; cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT) and during activation paradigm (with Transcranial Ultrasonography Doppler (TCD); WP3-post mortem analysis in histologically prepared human cortical tissue of post mortem samples of subjects with schizophrenia in the region that synaptic alteration was suggested by WP1 and WP2; WP4- pharmacogenetic analysis (single gene polymorphisms and genome wide association study (GWAS). We expect that the analysis of these data will identify a set of markers that differentiate healthy controls from patients with FEP, and serve as an additional diagnostic tool in the first episode of psychosis, and prediction tool which can be then used to help tailoring individualized treatment options. In this paper, we describe the project protocol including aims and methods and provide a brief description of planned post mortem studies and pharmacogenetic analysis.

EEG Analysis and Spect Imaging in Alzheimer's Disease, Vascular Dementia and Mild Cognitive Impairment.

BACKGROUND: Alzheimer's disease (AD) and vascular dementia (VaD) represent a leading public-health problem given the rising age of the population. Early diagnosis of dementia, especially at the stage of mild cognitive impairment (MCI) has become an important goal of the modern patient work-up. Brain perfusion single-photon emission computed tomography (SPECT) has become a mainstay of diagnostic algorithms in patients with dementia showing specific patterns of hypoperfusion in temporal and parietal lobes. Clinical electroencephalography (EEG) is a relatively simple and inexpensive diagnostic tool showing potential in assessing cortical thinning and lower perfusion in temporoparoetal regions. SUBJECTS AND METHODS: Our study was a cross sectional and included retrospective analysis of the group of patients diagnosed with AD, VaD and MCI. The study group consisted of 50 patients - 29 females and 21 males. All patients underwent EEG and SPECT analysis as part of regular work-up. RESULT: Patients with AD exhibit EEG changes mostly in the form of theta waves, focal abnormalities and spike-and-wave complexes in frontotemporal regions with the reduction in the amplitude of alpha waves. SPECT in most patients exhibited hypoperfusion in temporoparietal regions with occasional unilateral abnormalities in frontotemporal region. EEG changes in patients with VaD are predominantly in the form of theta waves while SPECT findings show mostly "patchy" abnormalities. EEG readings are normal or exhibit minimal changes in the group of patients with MCI, while SPECT imaging exhibits mostly normal CBF. CONCLUSION: EEG and SPECT are diagnostic methods which show specific changes, especially in AD. EEG can be used to monitor the therapeutic effect and progression of AD as well as the possible transition from MCI to early stage AD. SPECT on the other hand, being a more expensive and less available method, can be utilized as an add-on method to increase the specificity and sensitivity of the diagnostic algorithm.

Impact of Invasive EEG Monitoring and Resective Neurosurgical Treatment on the Quality of Life in Patients with Drug Resistant Epilepsy - Preliminary Results.

BACKGROUND: Neurosurgical treatment is one of important way to cure drug resistant epilepsy. After invasive EEG monitoring and the invasive neurosurgical treatment (resective surgery) there are possible complications (intracranial haemorrhage, cortical lesions and infections), however there are possible neuropsyhologic outcomes such as memory outcomes, language outcomes and psychiatric outcomes. The quality of life in epilepsy (QOLIE-31) scale is a self-completed questionnaire which contains seven subscales which address the following aspects: emotional well-being, social functioning, energy/fatigue, cognitive functioning, seizure worry, medication effects and overall quality of life. Our study aimed to examine the quality of life in patients with drug resistant epilepsy who had undergone invasive EEG monitoring and resective neurosurgical treatment through the application of the QOLIE-31 scale. SUBJECTS AND METHODS: The study included 9 patients with drug resistant epilepsy who had undergone invasive EEG monitoring followed by resective neurosurgical treatment in the period from 2010 to 2016, and the control group of 15 patients with drug resistant epilepsy who had not undergone neurosurgical procedures. Clinical variables of interest for this study were obtained through phone contact, and the QOLIE-31 scale was applied. RESULTS: In the domaine of seizure worry, patients in the examined group were more concerned about the seizures (54.7) compared to the examined group (80), as well as in the overal quality of life (examined group 57.5; control group 77.5). Patients in the control group complained more in the domain of antiepileptic therapy (score 70.7) than patients in the examined group (score 100). In the other domains: emotional well-being, energy/fatigue, cognitive functioning, and social functioning there were minor deviations between the examined and control groups. CONCLUSION: There was no statistically significant difference between individual QOLIE-31 questionnaires, as well as between the two groups of respondents.

Characteristics of the Group Process in Long-Term Psychodynamic Group Psychotherapy for Patients with Psychosis.

This study aimed to investigate the development of the group process through group climate parameter dynamics during long-term psychodynamic group psychotherapy for 30 outpatients with psychosis. The group process in four groups was monitored using MacKenzie's Group Climate Questionnaire-Short Form (GCQ-S) that was completed by the therapist after each session over the two-year period. The trends of engagement, avoidance and conflict parameters differed between groups, and no clear indicators of the development phases were found. The results suggested that these groups remained in the first developmental phase during the observation period, and highlighted the characteristics of resistance and difficulties in establishing social relations in patients with psychosis.

Social functioning of patients with psychotic disorders in long-term psychodynamic group psychotherapy: preliminary research.

BACKGROUND: In recent years, social functioning of patients has increasingly been used as a criterion for assessing therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. SUBJECT AND METHODS: The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. RESULTS: The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. CONCLUSION: Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders.

Usefulness of low iodine diet in managing patients with differentiated thyroid cancer - initial results.

BACKGROUND: Low iodine diet (LID) is recommended in patients with differentiated thyroid cancer before radioiodine administration. Patients with increased thyroglobulin (Tg) level, but negative (131)I whole body scan present diagnostic and therapeutic dilemma. This study was designed to evaluate the benefit of a two-week LID in patients with elevated serum Tg levels and negative (131)I whole body scans. PATIENTS AND METHODS.: For the impact assessment of two-week LID on radioiodine tissue avidity, radioiodine scans before and after LID were compared. Sixteen patients with serum Tg > 2 µg/L, negative Tg-antibodies, and negative radioiodine scans underwent two-week LID before the (131)I administration. Fourteen patients underwent diagnostic scanning and two patients received radioiodine therapy. Iodine concentration in the morning urine specimens were measured in each patient, a day before and 15(th) day after starting LID. RESULTS: Following self-managed LID, patients were able to significantly reduce their iodine body content by 50% (range 28-65%, p<0,001). 13 patients (82%) accomplished mild iodine deficiency (50-99 µg/L) and one patient (6%) achieved targeted moderate iodine deficient state (<50 µg/L). All diagnostic post-LID scans were negative. Both post-therapy (131)I scans showed radioiodine accumulation outside of normal (131)I distribution (neck region and diffuse hepatic uptake). This study demonstrated that two-week LID is effective way to decrease total body iodine content, although without a visible effect on post-LID diagnostic (131)I scans. CONCLUSIONS: A more stringent dietary protocol and longer iodine restriction period are probably needed to achieve targeted moderate iodine deficiency in patients preparing for (131)I administration. This might result in higher radioiodine avidity of thyroid remnant/metastases.

Epilepsy due to malformations of cortical development--correlation of clinical, MRI and Tc-99mECD SPECT findings.

Malformations of cortical development (MCD) have been increasingly recognized as an important cause of intractable epilepsy. The aim of our study was to define epileptogenicity of MCDs by correlating MRI, EEG and semiology of epileptic attacks, and to determine the effect of MCD on drug resistant epilepsy. We also intended to reveal the utility of interictal single photo emission computed tomography (SPECT) in verification of MCD lesions and relative prevalence of different MCDs. Based on interictal EEG finding, semiology of the epileptic attacks and brain magnetic resonance imaging (MRI) "electroclinical epileptogenicity" of MCD was defined. Brain MRI revealed cortical dysplasia (CD) in nine patients, polymicrogyria in four patients, lissencephaly and schizencephaly in one patient each. Three patients had a combination of malformations. The localization of SPECT hypoperfusion corresponded to MCD lesion in ten (66.67%) patients. Electroclinically confirmed epileptogenicity of MCD overlapped with MR and interictal SPECT findings in fourteen (93.3%) and nine (60.0%) patients, respectively. Our study results demonstrated the MCD lesions to be highly epileptogenic and a frequent cause of intractability.

[Psychotherapeutic effect on cerebral blood flow--case report]. / Utjecaj psihoterapije na mozdanu cirkulaciju--prikaz bolesnika.

This is a case report on a 36-year-old Croatian war veteran who was seeking psychiatric treatment because of disturbances which were manifesting in: difficult impulse control, aggressive acting out reactions, continuous conflict with surroundings, and in traumatic and repeating nightmares. Posttraumatic stress disorder (PTSD) was diagnosed according to MKB-10 criteria and comorbid diagnoses were not found. After detailed psychiatric, psychological and neurological testing, brain SPECT was performed while the patient was medication free. Brain imaging was done twice within two-week period to avoid possible artefacts and to enhance statistical significance of possible pathological findings. SPECT results showed significant unilateral increase of regional cerebral blood flow (over 20% increased brain activity in dominant hemisphere, analyzed semiquantitatively using region-of-interest based method, and normalized to the mean brain activity) relative to opposite hemisphere in projection area of amygdala/nucleus accumbens. After the completion of all testing the patient started intense group psychotherapy of one year duration which was focused on interpersonal and social relations. After one year symptoms diminished, his impulse control became more adequate and he had no more aggressive acting out reactions, all of which was also objectified with information from patient family. Brain SPECT imaging was then repeated, twice within two-week period, and it showed normalization of findings and no significant differences in regional cerebral blood flow between cerebral hemispheres.

Alterations in brain activation in posttraumatic stress disorder patients with severe hyperarousal symptoms and impulsive aggressiveness.

OBJECTIVE: We wanted to assess possible alterations in brain activation in PTSD patients with severe hyperarousal symptoms and impulsive aggressiveness. METHOD: 25 Croatian War (1991-1995) veterans with combat-related PTSD with severe hyperarousal symptoms and impulsive aggressiveness were assessed for possible alterations in cerebral blood flow in single photon emission computed tomography brain scans. RESULTS: Increased regional cerebral blood flow in projection area of nucleus accumbens was found in 13 of 25 subjects, and for all in the dominant brain hemisphere. DISCUSSION: We believe that at least some of PTSD symptoms, and especially the impulsive aggression, can be associated with increased regional cerebral blood flow in the projection area of nucleus accumbens.