Cyril Höschl, MD, DSc., FRCPsych., was born on 12 November 1949 in Prague (Czechoslovakia).
He received his MUDr. (Doctor of Medicine) grade at the Charles University in Prague in 1974. He started his career in Psychiatric Research Institute (PRI) in Prague.
After completion his residency he became a research fellow and psychiatrist at PRI and assistant professor at Charles University in Prague. His research interests included psychoneuroendocrinology,
psychopharmacology and biological psychiatry.
In 1984, prof. Höschl presented his original work on neuroendocrine tests in psychiatry at several Canadian universities. In 1985, he was invited to lecture at New York University on his pioneering studies on calcium channel blockers in the treatment of affective disorders. After the breakdown of communism, he was elected a Dean of Third Medical Faculty of the Charles University in Prague (1990-1997) and appointed professor of psychiatry and chairman, Prague Psychiatric Centre (former PRI). Since 2004, he is also professor of psychiatry at the University of P.J.Safarik in Kosice, Slovak Republic.
In 1996 he became a member and 2003 fellow of the Royal College of Psychiatry, Great Britain. In 1991-1998 prof. Höschl chaired the Scientific Council of the Ministry of Health of the Czech Republic. He is founder of educational & training institute, Academia Medica Pragensis, and President of board of directors, Academia Medica Pragensis Foundation, mission of which is to support Czech medical science and education. 1993-1999 he was a member, Standing Committee on Long Range Planning, World Psychiatric Association. Since 1998, he is a board member of AEP, and member of many other societies and associations including Czech Learned Society, CINP, ECNP, etc. Since 2004, he is the President of the Czech Medical Academy.
In 1985 he was awarded with Diploma of honor from Czechoslovak Psychiatric Society of Czechoslovak Medical Society of J.E.Purkynje. In 1990 he received Presidential Prize of the Czechoslovak Medical Society J.E.Purkynje for the book „Neuroendocrinology in Psychiatry“; in 1992 co-awardee of Stanley Award (Stanley Foundation, Research Award Program, Virginia, USA); 1995 Prize of the Czech Neuropsychopharmacological Society for the participation on the work on postreceptor signal systems in schizophrenia. In 1997 he received Golden Medal of Charles University and Golden Medal of the 3rd Faculty of Medicine, Charles University for his merits in medical education. Among other things, Professor Höschl is also an author of a fundamental transformation of the medical curriculum at the 3rd Medical Faculty of Charles University in Prague. He received many other awards and honors including Honorary Diploma of the Minister of Health of the Czech Republic (2000) for merits in his position of chairman, Review Committee of the Scientific Council of Internal Grant Agency, and merits in the Czech medical research.
Prof. Höschl is honorary editor, Neuroendocrinology Letters (USA); editor-in-chief, Psychiatrie (CZ); Co-editor, International Journal of Prenatal and Perinatal Psychology and Medicine (SUE); member, editorial board of Int.J. of Psychiatry in Clinical Practice (GB) etc.
He published more than 100 publications, incl. 3 monographs, and co-edited 5 more monographs and textbooks.
Abstract: Background. The goal of this review is to summarize the results of head to head efficacy studies that compare second generation antipsychotics in the treatment of schizophrenia and related disorders. Methods. A literature search through the Medline database and Google was conducted. Articles published up to September 2005 were included. Abstracts from conference papers and posters were not included. Results. Randomized controlled trial data on possible differences in efficacy among atypical antipsychotics are limited. Moreover, the comparison is difficult, as studies differ in outcome measures. The results indicate that first-line second-generation antipsychotics (amisulpride, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone and zotepine) show comparable efficacy. Conclusion. Possible new studies should focus on long-term effects, including cost-effectiveness, quality of life, social functioning and service utilization.
Abstract: INTRODUCTION: Previous studies of patients with unipolar depression have shown that early decreases of EEG cordance (a new quantitative EEG method) can predict clinical response. We examined whether early QEEG decrease represents a phenomenon associated with response to treatment with different antidepressants in patients with treatment resistant depression. METHOD: The subjects were 17 inpatients with treatment resistant depression. EEG data and response to treatment were monitored at baseline and after 1 and 4 weeks on an antidepressant treatment. QEEG cordance was computed at three frontal electrodes in theta frequency band. The prefrontal cordance combines complementary information from absolute and relative power of EEG spectra. Recent studies have shown that cordance correlates with cortical perfusion. Depressive symptoms were assessed using Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: All 17 patients completed the 4-week study. All five responders showed decreases in prefrontal cordance after the first week of treatment. Only 2 of the 12 nonresponders showed early prefrontal cordance decrease. The decrease of prefrontal QEEG cordance after week 1 in responders as well as the increase in nonresponders were both statistically significant (p-value 0.03 and 0.01, respectively) and the changes of prefrontal cordance values were different between both groups (p-value 0.001). CONCLUSION: Our results suggest that decrease in prefrontal cordance may indicate early changes of prefrontal activity in responders to antidepressants. QEEG cordance may become a useful tool in the prediction of response to antidepressants.
Abstract: AIM: Previous studies have suggested altered structural and functional asymmetry of the brain in schizophrenia. METHODS: Functional MRI was used to assess differences in cortical activation during a verbal task in Broca's area and its contralateral homologue in four pairs of right-handed monozygotic (MZ) twins discordant and concordant for schizophrenia with low and high familial loading for the illness and four healthy control MZ twin pairs. RESULTS: Pooled data from all subjects with schizophrenia showed increased activation in the right homologue of Broca's area in contrast to healthy individuals. Concordant twins (i.e. high familial loading group) showed prominent between co-twin differences in lateralization index within given region of interest. Intra-pair differences in lateralization index were significantly higher in concordant twins compared to the controls (0.69+/-0.4 vs. 0.13+/-0.13, P<0.03), albeit no significant differences in the variable were shown between the discordant and control groups. CONCLUSION: This study provides evidence of reduced cerebral dominance for language processing in patients with schizophrenia. The findings further suggest the need for additional research on relative proportion of genetic and environmental factors underlying deviations of functional asymmetry in schizophrenia.
Abstract: PURPOSE: Borrelia burgdorferi (Bb) infection can affect the central nervous system and possibly lead to psychiatric disorders. We compared clinical and demographic variables in Bb seropositive and seronegative psychiatric patients and healthy controls. METHOD: Nine hundred and twenty-six consecutive psychiatric patients were screened for antibodies to Bb and compared with 884 simultaneously recruited healthy subjects. RESULTS: Contrary to healthy controls, seropositive psychiatric patients were significantly younger than seronegative ones. None of the studied psychiatric diagnostic categories exhibited stronger association with seropositivity. There were no differences between seropositive and seronegative psychiatric patients in hospitalization length, proportion of previously hospitalized patients and proportion of subjects with family history of psychiatric disorders. CONCLUSION: These findings elaborate on potential association between Bb infection and psychiatric morbidity, but fail to identify any specific clinical 'signature' of Bb infection.
Abstract: Atypical antipsychotics have greatly enhanced the treatment of schizophrenia. The mechanisms underlying the effectiveness and adverse effects of these drugs are, to date, not sufficiently explained. This article summarises the hypothetical mechanisms of action of atypical antipsychotics with respect to the neurobiology of schizophrenia.When considering treatment models for schizophrenia, the role of dopamine receptor blockade and modulation remains dominant. The optimal occupancy of dopamine D(2) receptors seems to be crucial to balancing efficacy and adverse effects - transient D(2) receptor antagonism (such as that attained with, for example, quetiapine and clozapine) is sufficient to obtain an antipsychotic effect, while permanent D(2) receptor antagonism (as is caused by conventional antipsychotics) increases the risk of adverse effects such as extrapyramidal symptoms. Partial D(2) receptor agonism (induced by aripiprazole) offers the possibility of maintaining optimal blockade and function of D(2) receptors. Balancing presynaptic and postsynaptic D(2) receptor antagonism (e.g. induced by amisulpride) is another mechanism that can, through increased release of endogenous dopamine in the striatum, protect against excessive blockade of D(2) receptors.Serotonergic modulation is associated with a beneficial increase in striatal dopamine release. Effects on the negative and cognitive symptoms of schizophrenia relate to dopamine release in the prefrontal cortex; this can be modulated by combined D(2) and serotonin 5-HT(2A) receptor antagonism (e.g. by olanzapine and risperidone), partial D(2) receptor antagonism or the preferential blockade of inhibitory dopamine autoreceptors.In the context of the neurodevelopmental disconnection hypothesis of schizophrenia, atypical antipsychotics (in contrast to conventional antipsychotics) induce neuronal plasticity and synaptic remodelling, not only in the striatum but also in other brain areas such as the prefrontal cortex and hippocampus. This mechanism may normalise glutamatergic dysfunction and structural abnormalities and affect the core pathophysiological substrates for schizophrenia.
Abstract: OBJECTIVE: Borrelia burgdorferi infection can affect the CNS and mimic psychiatric disorders. It is not known whether Borrelia burgdorferi contributes to overall psychiatric morbidity. The authors compared the prevalence of antibodies to Borrelia burgdorferi in groups of psychiatric patients and healthy subjects to find out whether there is an association between this infection and psychiatric morbidity. METHOD: Between 1995 and 1999 the authors screened for antibodies to Borrelia burgdorferi in 926 psychiatric patients consecutively admitted to Prague Psychiatric Center. They compared the results of this screening with findings from 884 consecutive healthy subjects who took part in an epidemiological survey of antibodies to Borrelia burgdorferi in the general population of the Czech Republic. Sera were tested by means of enzyme-linked immunosorbent assay. Circulating immune complexes were isolated by polyethylene glycol precipitation. To control for potential confounders, the two groups of patients and healthy subjects were matched according to gender and age. Results were obtained in a sample of 499 matched pairs. RESULTS: Among the matched pairs, 166 (33%) of the psychiatric patients and 94 (19%) of the healthy comparison subjects were seropositive in at least one of the four assays. CONCLUSIONS: These findings support the hypothesis that there is an association between Borrelia burgdorferi infection and psychiatric morbidity. In countries where this infection is endemic, a proportion of psychiatric inpatients may be suffering from neuropathogenic effects of Borrelia burgdorferi.
Abstract: There is an increasing evidence that corticosteroids damage the hippocampus in rodents and in primates. Hippocampal atrophy induced by corticosteroids may play an important role in the pathogenesis of a range of neuropsychiatric disorders. Hippocampus is necessary for short-term memory consolidation and HPA axis regulation. Signs of hippocampal damage (HPA dysregulation in combination with memory impairment) are found in affective disorders, Alzheimer's disease and in posttraumatic stress disorder. MRI volumetry reveals reduced hippocampal volume in these diseases. Evidence supporting the "glucocorticoid hypothesis" of psychiatric disorders is reviewed in the first part of the paper. Unresolved questions concerning temporary aspects of neurodegeneration, causality, reversibility, type of damage, factors increasing hippocampal vulnerability, and both pharmacological (CRH antagonists, antiglucocorticoid drugs, GABA-ergic, serotonergic, glutamatergic agents) and non-pharmacological (psychotherapy) treatment approaches are discussed in the second part.
Abstract: Psychiatry as a medical discipline relies on the authority of medicine that is associated with the help to a suffering and deserving individual. If this source of authority is obscured, the discipline will be blamed for serving as a social tool for controlling undesirable phenomena and practices. Psychiatry as a medical science accumulates knowledge on the relationship of biology and psychopathology. It can provide an explanation of the extent to which mental illness participates in socially undesirable behaviour and phenomena. But it cannot explain undesirable social phenomena as a mental illness of sorts, let alone offer an effective treatment for them. We should carefully guard the boundaries of psychiatry to prevent its abuse in the future.
Abstract: Alterations in the phosphoinositide signalling system have been proposed as a possible biological marker of schizophrenia. We studied the levels of inositol 1,4,5-trisphosphate (IP3), cytosolic Ca2+ concentrations ([Ca2+]i), and the incorporation of [32P]-orthophosphate into inositol phospholipids and phosphatidic acid (PA) in blood platelets of neuroleptic-treated schizophrenics in comparison with controls. The [Ca2+]i was significantly higher in platelets of one month neuroleptic-treated patients (155+/-5.8 nM) in comparison with controls (95+/-5.4 nM). Neuroleptic therapy decreased the [Ca2+]i, but even after long-term therapy it remained significantly higher (114+/-5.7 nM) than in controls. Differences were also found in the level of IP3 between controls (30+/-4.0 pmol/10(9) platelets), drug-free schizophrenics (52+/-9.0 pmol/10(9) platelets) and treated patients (50+/-6.0 pmol/10(9) platelets). The increased turnover of PA was observed in platelets of neuroleptic-treated schizophrenic patients. The study suggests that the regulation of calcium homeostasis and pathways involved in the phosphoinositide signalling system are altered in the platelets of schizophrenics. Neuroleptic therapy did not remove the observed changes in [Ca2+]i and IP3 levels.
Abstract: OBJECTIVE: The purpose of this exploratory study was to identify a cluster of variables that would most economically explain variations in the grade point averages of medical students during the first 3 years of study. METHOD: Data were derived from a study of 92 students admitted to the 3rd Faculty of Medicine in 1992-1993 academic year and who were still in the medical school at the end of the sixth semester (third year). Stepwise regression analysis was used to build models for predicting log-transformed changes in grade point average after six semesters of study-at the end of the first, second, and third years. Predictor variables were chosen from four domains: 1) high school grade point averages in physics, mathematics, and the Czech language over 4 years of study, 2) results of admission tests in biology, chemistry, and physics, 3) admission committee's assessment of the applicant's ability to reproduce a text, motivation to study medicine, and social maturity, and 4) scores on the sentimentality and attachment scales of the Tridimensional Personality Questionnaire. RESULTS: The regression model, which included performance in high school physics, results of the admission test in physics, assessment of the applicant's motivation to study medicine, and attachment scale score, accounted for 32% of the change in grade point average over six semesters of study. The regression models using the first-, second-, and third-year grade point averages as the dependent variables showed slightly decreasing amounts of explained variance toward the end of the third year of study and within domains, changing the structure of predictor variables. CONCLUSIONS: The results suggest that variables chosen from the assessment domains of high school performance, written entrance examination, admission interview, and personality traits may be significant predictors of academic success during the first 3 years of medical study.
Abstract: Psychiatry and psychopharmacology are no longer aiming to make a decisive breakthrough at the end of the century. Rather than seeking explanations, research workers are looking for 'predictions'. Three main types of prediction are emerging: a tautological, a heuristic, and an irrelevant one. Few predictions found in the recent literature can be marked as 'logical' ones. Nevertheless, predictions play two important roles: they generate new hypotheses that can be falsified in properly designed scientific experiments; they also may serve to falsify given hypotheses. The main recent findings on predictions in psychiatry are briefly summarised.
Abstract: Eighty-six depressed inpatients were divided into four groups: patients in each of three groups were treated, respectively, with identical capsules of verapamil, amitriptyline, or placebo, whereas the fourth group was treated eclectically by the ward physician with so-called state-adjusted treatment (SAT). Each treatment period lasted 5 weeks. Psychopathology was assessed with the Hamilton Rating Scale for Depression, by the Zung self-rating scale, by the 100-mm analog scale, and by general clinical impression. Results indicated that amitriptyline and SAT were superior to verapamil or placebo. There was no significant difference between verapamil and placebo or between SAT and amitriptyline. This finding was more definitive in the homogeneous subgroup of 55 women with DSM-III diagnosis of Major depression. In addition, 12 manic inpatients (DSM-III) were treated orally with verapamil, 24 with neuroleptics, and 11 with both neuroleptics and lithium carbonate. The decline of their psychopathology, assessed by the Brief Psychiatric Rating Scale (BPRS) and general impression, was fully comparable. Using Analysis of Variance (ANOVA), the statistical difference among courses of psychopathology expressed as total BPRS scores reaches borderline significance in favor of verapamil. In contrast to neuroleptics, verapamil did not induce any sedative, hypnotic, or cataleptic effects, and was well tolerated.
