SYMPOSIA

Abstracts of the Invited Speakers
[JS-06]
Czech NeuroPsychopharmacological Society (CNPS)
Symposium title: From models of schizophrenia to clinical outcome: A psychopharmacological perspective
Safety first, efficacy second? Fear and the need for treatment in the absence of controlled data
Pavel Mohr, David Hnidek, Dagmar Seifertova
Prague Psychiatric Center, Czech Republic
E-mail: mohr@pcp.lf3.cuni.cz
In clinical practice, physicians are routinely asked to make decisions about whether to initiate or continue antidepressant treatment in
a situation where no safety data are available. Pregnancy and breast-feeding can serve as an example, where controlled clinical trials
provide little guidance. Females of fertile age are rarely included in the early phases of clinical testing, indeed, Phase IIb and III trials have
a standard provision to use a reliable method of contraception. Pregnancy during a drug trial is considered as a ‘serious adverse event’
with subsequent study discontinuation. The reasons are not just ethical and legal but also marketing, including the drug manufacturers’
fear of having their products associated with potentially grave side effects, such as malformations. Drug treatment in pregnancy and
lactation thus pose a highly relevant clinical problem that cannot be addressed in controlled trials. Excessive concerns of negative
consequences could erroneously result in a generalized recommendation to not get pregnant or to abort an existing pregnancy. However,
the fetus may already have been exposed to drugs early in the first trimester during frequently unplanned pregnancies; in addition, recent
epidemiological data indicate increasing consumption of psychotropics, including antidepressants, by pregnant women. Psychiatrists
have to weigh the known risks of treatment discontinuation versus the potential risks for the fetus and infant. They should also consider
whether alternative non-pharmacological interventions (psychotherapy, ECT, rTMS) are accessible or effective. The only available safety
data on antidepressants come from animal studies, epidemiological trials, drug registries, case series, anecdotal case vignettes and clinical
observations.
Moreover, published findings have to be viewed with caution and interpreted correctly. For example, recent data suggested an increased
teratogenic risk for the antidepressant paroxetine. While it is true that a meta-analysis confirmed an increased relative incidence of
malformations, the absolute risk was raised from 3% to 4% for all congenital malformations and from 1% to 2% for cardiac malformations.
In 2005 the Prague Psychiatric Center established a specialized consultation outpatient center for pharmacotherapy in pregnancy and
breastfeeding. The center provides services and information on safety and treatment recommendations directly to patients, their treating
psychiatrists and other physicians as well. The database consists of patients records, data on their illness, treatment and pregnancy
outcome. Currently, a prospective study for the longitudinal follow-up of offspring exposed in utero to psychotropics has been designed.
The focus is on their developmental milestones, physical health, neuropsychological performance and general well-being.
Key words: Psychotropic drugs, pregnancy, lactation, drug safety, psychiatric disorders
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S48
Basic concepts of schizophrenia: Experimental approaches
Cyril Höschl 1
1Prague psychiatric centre, Centre of neuropsychiatric studies,
3rd Medical faculty, Charles University, Prague, Czech Rep.
E-mail: hoschl@pcp.lf3.cuni.cz
One of the crucial questions in the study of schizophrenia is, whether the diagnosis of the disease represents one entity or a group of
disorders (“Gruppe der Schizophrenien”). Nancy Andreasen suggests the term “lathomenology” for a bottleneck on the pathogenetic way
from various possible etiological factors to diverse phenomenological expressions (symptoms) (Arch Gen Psych 1999;56:781-787). In the
background of this common denominator, there is an anatomical and functional disruption in neuronal connectivity and communication,
which can be a consequence of incomplete or erroneous neuron formation, migration, synaptogenesis or pruning during ontogenesis.
Also apoptosis and activity dependent changes might play a role in this development. This all can happen from conception to early
adulthood and can lead to the impairment in fundamental cognitive functions. This leads to the development of clinical symptoms,
either positive or negative. Schizophrenia can be regarded as a “disconnection” or “information processing disorder”. There are many
S48 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org