Differences in onset of disease and severity of psychopathology between toxoplasmosis-related and toxoplasmosis-unrelated schizophrenia.

OBJECTIVE: Toxoplasmosis is a lifelong parasitic disease that appears to be associated to schizophrenia. However, no distinguishing attributes in Toxoplasma-infected schizophrenia patients have been described as yet. METHOD: We searched for differences in symptom profile, cognitive performance and treatment response between 194 Toxoplasma-free and 57 (22.7%) Toxoplasma-infected schizophrenia patients treated in Prague Psychiatric Centre between 2000 and 2010. RESULTS: Infected and non-infected patients differed in severity of symptoms (P = 0.032) measured with the Positive and Negative Symptom Scale (PANSS). Infected patients scored higher in positive subscale of PANSS, but not in the general and negative subscales. Infected men scored higher also in Total PANSS score, and negative, reality distortion, disorganisation and cognitive scores. Higher PANSS scores of positive, negative and disorganised psychopathology were associated with the lower titres of anti-Toxoplasma antibodies suggesting that psychopathology deteriorates with duration of parasitic infection. Infected patients remained about 33 days longer in hospital during their last admission than uninfected ones (P = 0.003). Schizophrenia started approximately 1 year earlier in infected men and about 3 years later in infected women, no such difference was observed in uninfected subjects. CONCLUSION: Latent toxoplasmosis in schizophrenia may lead to more severe positive psychopathology and perhaps less favourable course of schizophrenia.

[Alcohol in the elderly]. / Alkohol u senioru.

We summarize specific features of alcohol-related problems in elderly patients. About one third alcohol dependent elderly patients develop their alcohol dependence while already aged. It often happens after stressful life events such as retirement or bereavement. Such patients can be treated more easily and alcohol does not cause so many somatic complications in them when compared with those elderly who develop their dependence earlier. Alcohol-related problems in elderly patients should be recognized and treated as soon as possible. Cognitive-behavioural therapy, supportive group therapy with peers (especially in lonely patients), self-help groups, such as Alcoholics Anonymous, and family therapy are appropriate. Modern anticraving medication can be also effective but comparatively high price limits its use.

Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres.

BACKGROUND: This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts. METHODS: Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule. RESULTS: Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years. CONCLUSION: Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization.

[Report on the Who meeting on problems of prevention and control of stress]. / Referát z porady WHO o problematice prevence a zvládnutí stresu.

The report informs of the Consultation organized by the World Health Organization, Regional Office for Europe in Prague, 24.-26. June 1992. It was attended by 27 experts from 15 countries. The scope of the Consultation was to review effective approaches to stress management in the community setting. Considering the fact the growing number of persons and population groups in Europe Region are exposed to major stressful situations there is great need for help either from the health and social welfare system as well as from various non-professional organization. During the Consultation the definition of the stress management and prevention, examples of intervention programmes and particularly set of recommendation to the WHO and its Member States in European Region were elaborated.

[An international study of the course and outcome of schizophrenia coordinated by the World Health Organization]. / Mezinárodní studie prubehu a vyústení schizofrenie koordinovaná svetovou zdravotnickou organizací.

Psychiatry Demography Unit of Psychiatric Center Prague is one of the participating sites in the transcultural study on Long-term Course and Outcome of Schizophrenia coordinated by World Health Organization (WHO). The aim of the project is to learn more about factors predicting the long-term course and outcome and to investigate socio-cultural differences in schizophrenic patients. The present research builds upon the earlier WHO coordinated studies: International Pilot Study of Schizophrenia (IPSS) carried out in 1968-1969 in 13 centers including Czechoslovakia (N = 1202) and Study on Determinants of Outcome of Severe Mental Disorder (DOSMed) taken place between 1978-1980. The finding of IPSS and DOSMed were notable: incidence of narrowly defined schizophrenia did not vary greatly across cultures in opposite of the variation of short term outcome of illness that was more favourable in developing than in industrialized nations. The present follow-up study of the DOSMed and the IPSS patients (after 14 and 24 years) allow the examination of a large enough sample in a relatively short time and facilitate the development of new instruments, which provide a unique opportunity of their further cultural valid application for our center.

[Characteristics of favorable and poor development of health services and social conditions for the aged]. / Charakteristika príznivého a nepríznivého vývoje zdravotní a sociální situace ve stárí.

Two stage probability samples were selected to represent the populations resident in one metropolitan (Prague-1 n = 484) and one country (Opava n = 538) geographical and administrative district. The index cases were contacted and surveyed in a field study. Data were collected by means of standardized interviews by nurses and social workers and complemented from GP's case notes, if available. A significant proportion of cases had no contact with health services at all. Both samples were followed-up for three years. The description of cases was condensed into 27 meaningful variables assessing social, health and living characteristics at the time of the beginning of the study. 11 follow-up course and outcome criteria were derived from the follow-up data in a similar way. Results of the metropolitan and country sample comparison of social and health care needs of five age groups, and of multivariate analysis of predictive relation between the initial characteristics and development and outcome criteria dependent variables are presented and discussed.