Escaping the Long Shadow Cast by Agranulocytosis: Reflections on Clozapine Pharmacovigilance Focused on the United Kingdom.

PURPOSE/BACKGROUND: A recent article in this journal presented a US perspective regarding the modernization of clozapine prescription and proposed an escape from the long shadow cast by agranulocytosis. METHODS: Here, an international group of collaborators discusses a point of view complementary to the US view by focusing on worldwide outcomes of clozapine usage that may be uneven in terms of frequency of clozapine adverse drug reactions. FINDINGS/RESULTS: Studies from the Scandinavian national registries (Finland and Denmark) did not find increased mortality in clozapine patients or any clear evidence of the alleged toxicity of clozapine. Data on clozapine-associated fatal outcomes were obtained from 2 recently published pharmacovigilance studies and from the UK pharmacovigilance database. A pharmacovigilance study focused on physician reports to assess worldwide lethality of drugs from 2010 to 2019 found 968 clozapine-associated fatal outcomes in the United Kingdom. Moreover, the United Kingdom accounted for 55% (968 of 1761) of worldwide and 90% (968 of 1073) of European fatal clozapine-associated outcomes. In a pharmacovigilance study from the UK database (from 2008 to 2017), clozapine was associated with 383 fatal outcomes/year including all reports from physicians and nonphysicians. From 2018 to 2021, UK clozapine-associated fatal outcomes increased to 440/year. IMPLICATIONS/CONCLUSIONS: The interpretation of fatal outcomes in each country using pharmacovigilance databases is limited and only allows gross comparisons; even with those limitations, the UK data seem concerning. Pneumonia and myocarditis may be more important than agranulocytosis in explaining the uneven distribution of fatal outcomes in clozapine patients across countries.

Sick leave duration as a potential marker of functionality and disease severity in depression.

Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.

[Can we influence the negative drug attitude? Interpretation of the rejection of COVID-19 vaccine in the light of results of a pilot study].

Background and purpose: Vaccination refusal is a serious obstacle to minimizing the spread of COVID-19. Nevertheless, the rejection of vaccine can be considered the result of a negative attitude towards medical treatment, and according to our previously published data, it can be influenced by the underlying affective state. Increased incidence of affective disorders and anxiety could be observed globally during the pandemic, which may have a significant impact on vaccination acceptance. The aim of our pilot study was to determine the association between clinical improvement of affective and neurocognitive symptoms and change of drug attitude and health control beliefs in a sample of psychiatric patients. Methods: A data set of 85 patients with psychiatric disorder has been analysed with the use of Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) with 5 subscales (Negative Aspect of Medication - NA; Positive Aspect of Medication - PA; Doctor health locus of control- Doctor HLOC; Internal HLOC; Psychological Reactance - PR); Hospital Anxiety Depression Scale (HADS-Anx; HADS-Dep) and neurocognitive tests, such as the Stroop test and the Trail Making Tests. All the tests were performed before and after a 14 days treatment. Paired t-tests and generalized linear models were performed to assess the associations between the variables. Results: The baseline scores of NA and HADS-Anx correlated significantly (p=0.001) and after two weeks of treatment NA decreased (p=0.001), while Doctor HLOC and Internal HLOC increased (p=0.001 and p=0.006). The patients performance of the neurocognitive tests improved (all p<0.05). The reduction of HADS-Anx (p=0.002) and HADS-Dep (p=0.006) scores showed significant associations with the decrease of NA. Increase of the PA score was associated with reduction of HADS-Dep (p=0.028). Improvement of neurocognitive functions had no effect on PHBQPT scores. Conclusion: Important conclusions can be drawn regarding the rejection of the COVID-19 vaccine based on the associations found between the intensity of affective and anxiety symptoms and the attitude towards treatment. Our findings suggest that affective symptoms have a negative influence on the attitude towards treatment and that the improvement of these symptoms can facilitate the acceptance of the therapy, regardless of diagnosis. The modest effect of the improvement of neurocognitive functioning on the attitude towards drugs and the significant role of affective-emotional factors suggest that the accep-tance of vaccination probably cannot be facilitated solely with the aid of educational programs. Considering the increasing incidence of affective disorders during the COVID-19 pandemic, the screening of affective and anxiety symptoms and treatment of these disorders could be an important step towards the acceptance of the vaccine. Although psychiatry is not considered as a frontline care unit of the COVID cases, more attention is needed to pay on the availability of mental health services because refuse of vaccine can develop due to affective disorders too.

What is the dominant treatment attitude of psychiatric patients?

Background: Patients' attitude towards drug treatment is of prognostic value regarding adherence. However, few detailed analyses have been performed regarding the influencing factors of the treatment attitude of psychiatric patients. Methods: We enrolled in the study 295 psychiatric inpatients and analyzed the data obtained using the recently developed Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT), the Behavioural Inhibition/ Activation System (BIS/BAS) Scale, and the Hospital Anxiety and Depression Scale. We created a 'dominant treatment attitude' (DTA) variable from the 5 subscales of the PHBQPT. Results: The most common DTA was the Doctor HLOC and the rarest proved to be the Psychological Reactance. The double DTA carriers were the most frequently occurring multiple DTAs. We found that the Doctor-HLOC coupled most frequently with the Positive Aspect and the DoctorHLOC with the Internal-HLOC. The Doctor-HLOC score was higher while the BAS Fun seeking score lower in the case of patients treated for affective disorders compared to patients who belonged to the psychosis and personality disorder subgroups. Conclusions: Screening of DTAs in psychiatric patients can provide useful information for the planning of a more effective therapeutic strategy. (Neuropsychopharmacol Hung 2021; 23(2): 308-318).

[Validation and analysis of the Patient's Health Belief Questionnaire on Psychiatric Treatment in a sample of Hungarian psychiatric patients].

OBJECTIVES: Patients' attitude towards treatment is one of the most signifi cant factors which has determining eff ect on suffi cient adherence. Data are lacking on Hungarian patients' attitude towards psychiatric treatment, however, high prevalence of suicide suggests that eff ectiveness of psychiatric treatments need to be improved. To pave the way for such studies, we performed the validation of the recently developed Patients' Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) in a sample of Hungarian psychiatric patients. METHODS: We enrolled 188 Hungarian patients diagnosed with psychiatric disorders. The PHBQPT was translated into Hungarian by our group. Comparison of item and subscale mean scores with the original data are presented. Internal consistency, item-total and item-item correlations were calculated and factorial structure was analysed. RESULTS: Single item means, the highest item score and subscale mean scores were similar to data published in the original article. The factorial analysis confi rmed the validity of a fi ve-subscale structure in our sample. The eff ects of gender and age were not signifi cant on any of the subscales. CONCLUSIONS: The PHBQPT is a valid, reliable instrument with replicable psychometric properties. The Hungarian version is suitable for clinical practice and for further investigations on attitudes towards psychiatric treatment.

Practical Approach to Measuring and Predicting Medication Adherence by Outpatient's SelfReport After More than 10 Years of Research in Psychopharmacology.

Schizophrenia, bipolar disorder and major depression are associated with nonadherence registered mean figures of around 50%, highlighting the relevance of having simple adherence tools to incorporate into daily clinical practice. For 10 years we have focused on self-report as an assessment method and have studied thousands of outpatients taking thousands of psychiatric medications in three countries. Measurement of treatment adherence during use of polypharmacy is a really complex task as patients could adhere differently to the various medications prescribed, making it essential to assess adherence to each individual medication. This was not possible until the introduction of the Sidorkiewicz Adherence Tool that allows one to separate adherence to each medication, whether poor or not. Health psychologists have developed the Health Belief Model which has not received enough attention by psychiatrists. Based on this model, we have focused on personality styles and specific beliefs concerning specific medications as possible predictors of poor adherence. We developed the Patient Health Beliefs Questionnaire on Psychiatric Treatment which provides 5 self-reported personality dimensions: negative aspects of medication (pharmacophobia), positive aspects of medication (pharmacophilia), high/low psychological reactance, high/low doctor health locus of control (HLOC) and high/low internal HLOC. Based on the Beliefs about Medicines Questionnaire we have developed a measure of skepticism, defined as a patient's high concern about adverse reaction to an individual medication and a low belief in its necessity. Our research experience based on the tools for assessing and predicting adherence is presented in a practical manner by using seven boxes and examples. (Neuropsychopharmacol Hung 2021; 23(4): 336-346).

Adherence to psychiatric medications: Comparing patients with schizophrenia, bipolar disorder and major depression.

Findings of three articles reporting results in 1372 stabilized outpatients taking 2454 medications in Spain, Argentina, and Venezuela were combined. Prevalence of good adherence was not obviously different across diagnoses: 69.5% (N=212) for schizophrenia, 66.3% (N=142) for bipolar disorder, and 69.8% (N=521) for depression. Besides the focus on stabilized outpatients, other study biases included use of a research sample; limited to oral medications, ignoring long-acting injectable antipsychotics; and lack of data on active substance abuse, clinical severity, and insight. Logistic regression models explored predictors of good vs. poor adherence. The six self-reported variables studied were pharmacophobia, pharmacophilia, high psychological reactance, high internal health locus of control (LOC), high doctor LOC, and skepticism concerning specific medications. ORs were significant in 56% (47/84) of the statistical tests vs. 24% (23/98) of ORs significant in case of 7 demographic/clinical variables (p=0.001). At least 2/3 of the ORs for pharmacophobia, pharmacophilia and skepticism were significantly associated with adherence in cases and controls, indicating their independence from diagnoses. In need of replication, three other self-reported measures had differential effects on adherence across diagnoses. High psychological reactance was associated with decreased adherence to antidepressant medications in general, or for patients with mood disorders. High internal LOC as associated with poor adherence may reflect the distrust patients with schizophrenia or severe bipolar disorder have of other people. High doctor LOC was significantly associated with increased adherence only in patients with bipolar disorder, but was significant for all medications, mood stabilizers and antipsychotics, indicating the relevance of the patient-psychiatrist relationship in these patients. (Neuropsychopharmacol Hung 2021; 23(4): 363-373).

Poor Adherence to Oral Psychiatric Medication in Adults with Bipolar Disorder: The Psychiatrist May have More Influence than in Other Severe Mental Illnesses.

Objective: Medication adherence in bipolar disorder (BD) may be influenced by 6 selfreported dimensions: 1) high/low psychological reactance, 2) high/low internal healthlocus of control (HLOC), 3) high/low doctor HLOC, 4) pharmacophobia, 5) pharmacophilia, and 6) skepticism about a specific medication. This study in Spain, Argentina, and Venezuela included 142 outpatients with BD prescribed 320 psychiatric medications and 1230 other psychiatric outpatients prescribed 2134 medications. Methods: Logistic regression models included adherence for each psychiatric medication, measured by the Sidorkiewicz Adherence Tool as the dependent variable. The models provided adjusted odds ratios (ORs) of dichotomous independent variables: clinical variables and 6 self-reported dimensions. Results: ORs significant in both groups were: 1) high doctor HLOC (OR=1.87 in BD, OR=1.25 in other patients), 2) high psychological reactance (respectively OR=0.572, OR=0.798), 3) pharmacophobia (respectively OR=0.361, OR=0.614), and 4) skepticism about a specific medication (respectively OR=0.300, OR=0.556). Two ORs were only significant in BD patients: medication duration > 1 year (OR=0.449), and extreme polypharmacy (OR=2.49). The study included 104 BD patients prescribed 122 mood stabilizers and 136 other patients prescribed 140 mood stabilizers. Two ORs were significant for mood stabilizer adherence only in BD patients: high doctor HLOC and skepticism (respective ORs=2.38, OR=0.390). The study included 87 BD patients prescribed 97 antipsychotics and 417 other patients prescribed 458 antipsychotics. Four ORs were significant for antipsychotic adherence only in the BD group. Conclusions: Future studies of adherence to all/specific medications should explore the specific city/commonality of these dimensions, particularly doctor HLOC, in BD versus other psychiatric patients. (Neuropsychopharmacol Hung 2021; 23(4): 347-362).

Poor Adherence to Oral Psychiatric Medication in Adults with Depression: Psychological Reactance May Have Specific Effects in Depression.

Objective: Medication adherence in psychiatric disorders, including depression, may be influenced by 6 self-reported dimensions: 1) high/low doctor health locus of control (HLOC), 2) high/low internal HLOC, 3) high/low psychological reactance, 4) pharmacophilia, 5) pharmacophobia, and 6) skepticism about a specific medication. This study in Spain, Argentina, and Venezuela included 521 outpatients with depression prescribed 920 psychiatric medications and 851 other psychiatric outpatients prescribed 1534 medications. Methods: Logistic regression models were completed in patients with depression and psychiatric controls. The dependent variable was adherence for each psychiatric medication (Sidorkiewicz Adherence Tool). The models provided adjusted odds ratios (ORs) of dichotomous independent variables: clinical variables, and 6 self-reported dimensions. Results: ORs significant in both diagnostic groups were: 1) pharmacophobia (OR=0.500 in depression, OR=0.599 in other patients), 2) pharmacophilia (respectively OR=1.51, OR=1.65), 3) treatment for 1 year (respectively OR=0.731, OR=0.608), 4) geriatric age (respectively OR=2.28, OR=3.02), and 5) skepticism about a specific medication (respectively OR=0.443, OR=0.569). Two ORs were significant in the depression group, but not in the controls: the country of Spain (OR=0.744), and high psychological reactance (OR=0.685). The study included 470 depression patients prescribed 510 antidepressants and 348 other patients prescribed 370 antidepressants. One OR was significant for antidepressant adherence in both groups: high psychological reactance (respectively OR=0.597, OR=0.561). Conclusions: All clinical studies using self-report include biases but the most important is lack of access to patients not coming for treatment. Future studies should further explore the specificity/commonality of these dimensions, particularly psychological reactance, in depression versus other psychiatric disorders. (Neuropsychopharmacol Hung 2021; 23(4): 374-387).

Poor Adherence to Oral Psychiatric Medication in Adults with Schizophrenia May Be Influenced by Pharmacophobia, High Internal Health Locus of Control and Treatment Duration.

Objective: This study in Spain, Argentina, and Venezuela included 212 schizophrenia outpatients prescribed 387 psychiatric medications and 1,160 other psychiatric outpatients prescribed 2,067 medications. Methods: Logistic regression models included adherence for each psychiatric medication, measured by the Sidorkiewicz Adherence Tool, as the dependent variable. The models provided adjusted odds ratios (ORs) of dichotomous independent variables: 1) clinical variables, 2) subscales from the Patient Health Beliefs Questionnaire on Psychiatric Treatment (presence/absence of pharmacophobia and pharmacophilia and high/low psychological reactance, internal health locus of control [HLOC] and doctor's HLOC) and 3) presence/absence of skepticism toward each medication measured by the Beliefs about Medicines Questionnaire (BMQ). Results: ORs significant in both groups were: 1) pharmacophobia (OR=0.389 in schizophrenia, OR=0.591 in other patients and not significantly different) and 2) pharmacophilia (respectively OR=2.18, OR=1.59 and significantly higher in schizophrenia: p=0.012). Prescribing the medication for >1 year increased adherence in schizophrenia (OR=1.92) while decreasing it in others (OR=0.687). Four ORs were significant in the schizophrenia group but not in the controls: treatment for >1 year (OR=0.161), high internal LOC (OR=0.389), extreme polypharmacy (OR=1.92) and the country of Spain (OR=0.575). Regarding antipsychotics, the study included 204 schizophrenia patients prescribed 240 antipsychotic medications and 301 other patients prescribed 315 antipsychotic drugs. Three ORs were significant for antipsychotic adherence in the schizophrenia group: pharmacophobia (OR=0.324), treatment for >1 year (OR=0.362), and skepticism about specific antipsychotics (OR=0.535). Conclusions: Future adherence studies for antipsychotic/all medications should further explore the specificity/commonality of these dimensions in schizophrenia versus other psychiatric patients. (Neuropsychopharmacol Hung 2021; 23(4): 388-404).

[Acute effects of the first period of COVID-19 pandemic on mental state]. / A COVID-19 pandémia akut hatásai a pszichés állapotra a járvány elso szakaszában.

The COVID-19 pandemic causes psychological trauma in the whole society, thus investigation of the epidemiology of psychiatric symptoms is an outstanding research field during this period. Fear of infection, exposure to updated data on death figures, social isolation, adaptation to new restricting rules, existential crisis, reduction of health care availability poses dangers for mental health. Currently published papers focus on the acute effect of first wave of COVID-19 pandemic, however, further studies on long-term consequences can make this picture more complex and sophisticated. In this review a summary is provided on the most important results concerning frequency of psychiatric symptoms during the first lockdown of COVID-19. In light of the results it can be stated that psychiatric patients showed more common and more intensive symptoms, the number of relapses is increased and the adherence is reduced. Notably, more than the half of the general population produced measurable psychiatric symptoms. Furthermore, a worrying portion of frontline healthcare workers started manifesting mental symptoms. The overall picture suggests that the mental health state shows a global decline on the level of the general society which highlights the urgent need for targeted and complex mental support programs.

[Health control beliefs and chronic illness:how do they relate?] / Egészségkontrollhit és krónikus betegség:hogyan hatnak egymásra?

The health locus of control has been extensively analyzed in diff erent patient populations suff ering from chronic somatic illnesses due to its infl uence on adherence to long-term therapies. Despite of the fact that adherence is one of the most important factors which needs to be taken into consideration in the oupatient care of psychiatric patients, there is a scarcity of studies regarding HLOC in this population. In this review we provide an overview of study results regarding HLOC in somatic and psychiatric patients. Based on these results we conclude that in the case of patients suff ering from chronic illnesses, a higher internal HLOC is associated with less severe depressive symptoms and better adherence and quality of life. Nevertheless, the results of the follow-up studies indicate that change of HLOC (from internal to external) can be adaptive when the outcome is not favourable or the treatment is not eff ective. The continuous evaluation of HLOC of psychiatric patients in treatment may provide necessary information for the planning of interventions to help this process. Taking into consideration that the patients' perception of control is often impaired due to the nature of psychiatric illnesses we propose evaluation of psychobiological factors infl uencing health locus of control in order to facilitate the planning of these interventions.

[The first lockdown due to COVID-19 pandemic from the psychiatric patients' perspective: an ambulatory care client experience survey]. / A COVID-19 járvány miatt elrendelt elso veszélyhelyzet a pszichiátriai betegek szemszögébol: gondozói felmérés.

INTRODUCTION: The coronavirus pandemic (COVID-19) required the declaration of a state of emergency in Hungary from 11 March 2020 to 18 June 2020. These governmental actions led to changes in everyday life, implementation of new rules, and reduced access to healthcare. Hospital beds were reserved for emergency use, face-to-face ambulatory care was mainly replaced by telemedicine. In our study we assessed opinion of the patients in two outpatient psychiatric care units in Budapest regarding the state of emergency. METHODS: We enrolled 438 patients in the survey (305 women and 133 men, mean age: 51.9±16.2 years). The patients completed a short questionnaire on a voluntary and anonymous basis following verbal informed consent. The questionnaire was comprised of 10 items and a 12-item "Problem Evaluation Scale" (fear, isolation and healthcare subscales). The comparison of groups was done using general linear models (GLM), pairwise comparison was performed using Tukey's test for post hoc analysis. The data set was analyzed with SPSS software, version 24.0. RESULTS: Up to 34% of enrolled patients believed that their condition worsened during the state of emergency, but 12% of these patients thought that this worsening was not related to the state of emergency. Twice as many patients (12.8%) were concerned about their financial situation than about their health status (6.1%). Loneliness and the implementation of specific regulations didn't cause relevant distress in almost half of the patients, isolation was the most frequently (55.2%) reported difficulty. The worsening of health status was reported more frequently (p=0.001) by the patients younger than 50 years, the sensation of fear was stronger (p=0.045), and they reported more serious adaptation difficulties (p=0.003) than subjects older than 50 years. Isolation caused significantly (p=0.003) more serious distress among women. The abundance of pandemic-related information caused more distress in the case of patients treated for anxiety than participants treated for psychotic disorders (p=0.024). Patients suffering from affective disorders perceived more pronounced feelings of vulnerability compared to patients treated for psychotic disorders (p=0.004). CONCLUSION: Approximately half of the enrolled psychiatric patients was able to adapt to this situation without major difficulties, the other half of this sample was more or less distressed by these circumstances. Unfortunately, depletion of emotional, psychological, social and material resources can be expected during the next stage of the pandemic. As a result, we can expect further worsening of the above presented aspects.

[Paternal depression in a "stay-at-home" father - case report]. / Apai GYES-depresszió? Esettanulmány.

There is a growing body of data on paternal peripartum depression (perinatal depression in father; PND-F), however, it has traditionally been investigated only in women. Recently accumulating results confirmed the prominent role of the mental health of fathers in the psychosocial development of children and new trends showed up concerning the father's role in the family. In this case report we demonstrate the clinical aspect of a depressive episode of a "stay-at-home" father of two children (a 5-year old boy living with autism and a 8-year old girl). In relation to the case we want to emphasize that various situations can be stressful for a person with affective vulnerability. It is noteworthy that although childcare is a happy period for the majority, it can be a stressful life period for vulnerable persons and it can provoke a depressive episode. Acceptance and tolerance of this correlation at the level of society is still far away, however, it is indispensible for adequate and timely intervention which is essential for the stability of families and the psychosocial development of children.

[Cotard-syndrome associated with Hashimoto encephalopathy: a case report]. / Hashimoto-enkefalopátiához társuló Cotard-szindróma: esettanulmány.

There is a growing body of data on encephalopathy-related psychiatric syndromes in the literature, however, clinical management of them still remains a great challenge. Although organic background of the rarely identified Cotard-syndrome has been reported in numerous pathological states, Hashimoto-encephalopathy has not been published in association with this clinical phenotype so far. In this paper we present a case of a 44 year old woman, who previously never had a psychiatric disorder and her clinical symptoms corresponded to Cotard II syndrome. She produced psychotic depression with nihilistic doxasmas related to shutting down, clogging and rotting of her organs. These psychiatric symptoms were accompanied by cognitive, motor and vegetative signs, therefore we systematically excluded all organic brain disorders described in the literature. Besides the bizarre mental symptoms we found significantly increased anti-TPO levels in her serum, aspecific pathological signs on scull MR scans and thyreoid disease in the medical history. After differential diagnostic analyses we diagnosed Hashimoto-encephalopathy (HE), which was confirmed by positive clinical response to steroid therapy. Certain forms of HE (also named as steroid-responsive encephalopathy associated with autoimmune thyreoiditis, SREAT) are frequently associated with psychiatric syndromes but Cotard-syndrome has not been described so far in relation with this disease. This case raises attention on the significance of autoimmune diseases in the pathomechanism of psychiatric disorders and further highlights the importance of interdisciplinary diagnostic methods in the psychiatry.

[Pharmacological treatment and health control beliefs from the perspective of psychiatric patients: differences in attitudes]. / Gyógyszeres kezelés és egészségkontrollhit a pszichiátriai betegek szemszögébol: attitudbeli különbségek.

INTRODUCTION: Patients' attitudes towards psychiatric treatment have an important influence on therapeutic outcome. Health beliefs and the patient's attitude towards the psychiatrist and medical treatment are determined by several factors about which there is only a scarce knowledge. In our study we used the Patient's Health Belief Questionnaire on Psychiatric Treatment, PHBQPT) to assess the beliefs and attitudes of patients suffering from psychiatric disorders. METHODS: We recruited 115 inpatients from the Nyíro Gyula National Institute of Psychiatry and Addictions. Patients were categorized into 5 classes based on ICD-10 (addictions-F1x; psychotic disorders-F2x; affective disorders-F3x; anxiety disorders-F4x; and personality disorders-F6x). Subjects voluntarily and anonymously completed the PHBQPT questionnaire and answered 4 additional items regarding their opinion about the efficacy of drugs and the placebo effect. We compared the scores of the items and the total scores of subscales of the PHBQPT scale between disorder categories using ANOVA tests. RESULTS: Total scores did not diff er significantly in our sample compared to those in the publication of the original version of the PHBQPT scale. The most robust diff erences were found between patients with addictions and psychotic patients on the external and internal control subscales. F1x subgroup could also be distinguished from other psychiatric disorders on certain health belief related items. However, patients with personality disorder and affective disorder felt that the efficacy of medications in general was the weakest. The impression that in the drug effect is individually modified in case of a given patient was more frequent in the F1x and F2x groups and rare in the group of subjects with anxiety disorders and personality disorders. CONCLUSION: The Hungarian version of the PHBQPT can be used in case of Hungarian psychiatric patients; the similarity shown by the results points at the fact that attitude towards treatment is independent of cultural and healthcare system diff erences. Our results highlight that there are variances between different psychiatric disorders in health belief and attitude towards drug treatment. Our study emphasizes the importance of thorough assessment of patients' attitude that is necessary to conceive an effective adherence improving intervention.

[Investigation of the acute effect of bilateral repetitive transcranial magnetic stimulation (rTMS) in therapy resistant major depression patients]. / Bilaterális repetitív transzkraniális mágneses stimuláció (rTMS) akut hatásának vizsgálata terápia rezisztens major depresszióban szenvedok körében.

INTRODUCTION: There is a 20-year history of rTMS treatment, however, is not available in Hungary in routine clinical practice for therapy resistant depression (TRD). In this study we analysed the change of symptom profile of a Hungarian cohort with TRD using bilateral rTMS treatment. METHODS: A cohort of 22 patients suffering from TRD was enrolled in the study. For assessment of the phenotypic profile the Beck Depression Inventory (BDI), The Beck Anxiety Inventory (BAI), The Montgomery-Asberg Depression Rating Scale (MADRS), the Snaith-Hamilton Pleasure Scale (SHAPS), the Insomnia Severity Index (ISI), and the Trail Making Test were applied. Differences of mean scores of scales were compared between the day 1 (before treatment) and the day 14 (after conclusion of treatment). Furthermore, we performed phenotypic comparisons between the gender subgroups. RESULTS: In the total sample significant reduction of symptom scores was found on the depression (pMADRS=0,022; pBDI=0,001) and the anxiety scales (pBAI=0,020) and in case of the TMT-A test (pTMT-A=0,019) at the end of the treatment. The mean scores of the SHAPS, the ISI and the TMT-B did not change up to the day 14. In the sex-specific analysis we found that in men only sleep disorder was improved (p=0,015), while in women both depression scores and TMT-A score decreased significantly (MADRSp=0,015; BDIp=0,005; TMT-Ap=0,036). There were no adverse events during the rTMS treatment. CONCLUSION: 2x5 sessions of bilateral rTMS treatment is an effective, safety applicable intervention in patients with TRD. Our results suggest that significant improvement of depressive, anxious and attention symptoms can be observed already after 10th session. Our findings highlighted that different symptoms evolve in women and men due to the acute effect of the rTMS treatment. Further follow-up study is required to evaluate the long-term effect of rTMS concerning the maintenance of symptom reduction and potential change of anhedonia and insomnia.

[The role of nutritional factors in the adjuvant treatment of major depressive disorder].

A growing body of data has accumulated in the past decades about the possible role of nutritional factors in influencing the initiation and course of mental disorders as well as in the treatment of these disorders. As a result of the aggregation of this data a new field emerged - "nutritional psychiatry". In our current review paper we discuss some of those natural agents that supposedly have antidepressive properties and, accordingly, may play a role in the stand-alone and/or adjuvant treatment of major depressive disorder.

[Psychological disorders and tumorous diseases]. / Pszichés zavarok és daganatos betegségek.

Oncopsychology affects and intensively increasing number of patients due to the growing prevalence of cancers and the rapid development of oncological therapies. The comorbidity between tumorous diseases and psychiatric disorders has been known for a long time but its significance has become outstanding in the recent years. The relationship between these two types of disorders is considerably complex and may have determining consequences for clinical practice therefore dealing with these conditions is a serious challenge for clinicians. Our knowledge concerning the association of mental illnesses and oncological diseases has been undergoing a significant change in recent years thanks to big data researches and more precise measurements of psychiatric phenotypes. This review provides a summary of the latest epidemiological results related to comorbitiy between mental and oncological illnesses. The novel, more sophisticated studies reinforce the importance of managing comorbid patients in a multidisciplinary team.

[Highlights of peripheral biomarkers in major depressive disorder: focus on HPA-axis, inflammation and neurotrophic factors]. / Perifériás biomarkerek depressziós zavarokban: fókuszban a HPA-tengely, az inflammációs rendszer és a neurotrofikus faktorok.

Investigations intensively focus on peripheral biomarkers in major depressive disorder (MDD), however, an up-to-date amd specific tool is still not available. There is an increasing body of data in the literature concerning this issue and the majority of this confirms that most promising markers are related to the HPA axis, inflammation and neurotrophic factors. Results from the addressed area suggest that testing multiple markers together can provide a valuable outcome in concerning diagnosis, treatment selection and monitoring. Several influencing factors altering the levels of biomarkers as well as biologically inappropriate phenotypic measurements contribute to the numerous difficulties of precise evaluation and validation of biomarkers is. By correcting of these biases clinically applicable lab tests can be developed in the near future which will lead to significant improvement in the personalized therapy of MDD with more successful therapeutic outcomes and it will be an important tool in the pharmaceutical developments too.