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INTRODUCTION: Nowadays, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured and become long-term survivors due to risk and response-adapted treatment strategies. A well-known side effect is cognitive dysfunction that appears in HL patients after chemotherapy. In the present study, we aimed to measure cognitive dysfunction in our HL patients in this study and to find potential correlations between patient-related factors, the signs and symptoms of their diseases, or therapeutic factors. METHODS: We carried out a computer-assisted assessment (CANTAB) of cognitive dysfunction in 118 patients. We examined the domains of visual memory, attention, working memory, and planning. RESULTS: The median age of 64 females and 54 males at diagnosis was 29 (13-74) and 41 (21-81) years at the completion of CANTAB. Fifty-two percent of all patients showed cognitive impairment. Attention was impaired in 35% of patients, the working memory and planning were impaired in 25%, while visual memory was affected in 22%. All the three functions showed a significant association with inactive employments status. A close correlation was found between visual memory/working memory and planning, higher age at HL diagnosis or the completion of CANTAB test, and disability pensioner status. DISCUSSION: Our investigation suggests that patients with inactive employment status and older age require enhanced attention. Their cognitive function and quality of life can be improved if they return to work or, if it is not possible, they receive a cognitive training.
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Disfunción Cognitiva , Enfermedad de Hodgkin , Cognición , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Femenino , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/psicología , Humanos , Hungría , Masculino , Memoria a Corto Plazo , Pruebas Neuropsicológicas , Calidad de Vida , Sobrevivientes/psicologíaRESUMEN
The present study aimed to assess: (1) whether a more active involvement of patients is associated with an improvement of clinical symptoms, global functioning, and quality-of-life; and (2) how patients' satisfaction with clinical decisions can lead to better outcome after 1 year. Data were collected as part of the study 'Clinical decision-making and outcome in routine care for people with severe mental illness (CEDAR)', a longitudinal observational study, funded by the European Commission and carried out in six European countries. Patients' inclusion criteria were: (a) aged between 18 and 60 years; (b) diagnosis of a severe mental illness of any kind according to the Threshold Assessment Grid (TAG) ≥ 5 and duration of illness ≥ 2 years; (c) expected contact with the local mental health service during the 12-month observation period; (d) adequate skills in the language of the host countries; and (e) the ability to provide written informed consent. The clinical decision-making styles of clinicians and the patient satisfaction with decisions were assessed using the Clinical Decision Making Style and the Clinical Decision Making Involvement and Satisfaction scales, respectively. Patients were assessed at baseline and 1 year after the recruitment. The sample consisted of 588 patients with severe mental illness, mainly female, with a mean age of 41.69 (±10.74) and a mean duration of illness of 12.5 (±9.27) years. The majority of patients were diagnosed with psychotic (45.75%) or affective disorders (34.01%). At baseline, a shared CDM style was preferred by 70.6% of clinicians and about 40% of patients indicated a high level of satisfaction with the decision and 31% a medium level of satisfaction. Higher participation in clinical decisions was associated with improved social functioning and quality-of-life, and reduced interpersonal conflicts, sense of loneliness, feelings of inadequacy, and withdrawal in friendships after 1 year (p < 0.05). Moreover, a higher satisfaction with decisions was associated with a better quality-of-life (p < 0.0001), reduced symptom severity (p < 0.0001), and a significantly lower illness burden associated with symptoms of distress (p < 0.0001), interpersonal difficulties (p < 0.0001), and problems in social roles (p < 0.05). Our findings clearly show that a higher involvement in and satisfaction of patients with clinical decision-making was associated with better outcomes. More efforts have to be made to increase the involvement of patients in clinical decision-making in routine care settings.
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Salud Mental , Participación del Paciente , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Masculino , Estudios Longitudinales , Participación del Paciente/psicología , Satisfacción Personal , Satisfacción del Paciente , Toma de Decisiones Clínicas , Toma de DecisionesRESUMEN
Theory of mind is one of the most intensively studied phenomena in the development of schizophrenic symptoms and impairments in social adjustment. Complex theory of mind processing requires both visual and verbal aspects of the social-perceptual and social-cognitive components of mind reading. Reliable assessment methods are considered essential for the proper conduct of research. The current study aims at investigating the psychometric properties of the Theory of Mind Picture Stories Task (ToM PST). Forty-seven patients with schizophrenia were enrolled in the study from three sites. Data from ToM PST were used for computing the consistency, reliability, and internal and construct validity of the test.Our preliminary findings showed less appropriate consistency. Therefore, we attempted to carry out structural changes on the task while preserving its scales and subscales, which measure crucial factors of ToM. The newly structured task has four scales. They show proper consistency (Sequencing: Cronbach's α = 0.70, Theory of a Single Person's Mind: α = 0.74, Switching Between Minds: α = 0.70, Comprehension of Misleading Behaviour: α = 0.67, Total: α = 0.80) with appropriate internal and construct validity, a moderate test-retest reliability over a four-month-course, and a proper inter-rater reliability.
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Esquizofrenia , Teoría de la Mente , Humanos , Psicometría , Reproducibilidad de los Resultados , Procesos Mentales , Esquizofrenia/diagnósticoRESUMEN
BACKGROUND: Mild cognitive impairment (MCI) often presages the development of Alzheimer's disease (AD). Accurate and early identification of cognitive impairment will substantially reduce the burden on the family and alleviate the costs for the whole society. There is a need for testing methods that are easy to perform even in a general practitioner's office, inexpensive and non-invasive, which could help the early recognition of mental decline. We have selected the Test Your Memory (TYM), which has proven to be reliable for detecting AD and MCI in several countries. Our study was designed to test the usability of the Hungarian version of the TYM (TYM-HUN) comparing with the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in MCI recognition in the Hungarian population. METHODS: TYM test was translated and validated into Hungarian (TYM-HUN) in a previous study. The TYM-HUN test was used in conjunction with and compared with the MMSE and the ADAS-Cog. For our study, 50 subjects were selected: 25 MCI patients and 25 healthy controls (HC). Spearman's rank correlation was used to analyse the correlation between the scores of MMSE and ADAS-Cog with TYM-HUN and the receiver operating characteristic (ROC) curve was established. RESULTS: MCI can be distinguished from normal aging using TYM-HUN. We established a 'cut-off' point of TYM-HUN (44/45points) where optimal sensitivity (80%) and specificity (96%) values were obtained to screen MCI. The total TYM-HUN scores significantly correlated with the MMSE scores (ρ = 0.626; p < 0.001) and ADAS-Cog scores (ρ = - 0.723; p < 0.001). CONCLUSIONS: Our results showed that the TYM-HUN is a reliable, fast, self-administered questionnaire with the right low threshold regarding MCI and can be used for the early diagnosis of cognitive impairment.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Enfermedad de Alzheimer/diagnóstico , Disfunción Cognitiva/diagnóstico , Estudios Transversales , Humanos , Hungría , Pruebas Neuropsicológicas , Sensibilidad y EspecificidadRESUMEN
The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p < 0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = -0.10, p < 0.0001) and staff-rated (B = -0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.
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Trastornos Mentales/terapia , Evaluación de Necesidades/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Relaciones Profesional-Paciente , Psicoterapia/normas , Adulto , Europa (Continente) , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Concerns regarding the projected prevalence of Alzheimer's disease (AD) over the next several decades have stimulated a need for the detection of AD in its earliest stages. A self-administered cognitive test (Test Your Memory, TYM) is designed as a short, cognitive screening tool for the detection of AD. Our aim was to validate the Hungarian version of the Test Your Memory (TYM-HUN) test for the detection of AD. The TYM-HUN was applied in case of individuals aged 60 years or more, 50 patients with AD and 50 healthy controls were recruited into the study. We compared the diagnostic utility of the Hungarian version of the TYM in AD with that of the Mini-Mental State Examination (MMSE). The sensitivity and specificity of the TYM-HUN in the detection of Alzheimer's disease were determined. The patients with AD scored an average of 15.5/30 on the MMSE and 20.3/50 on the TYM-HUN. The average score achieved by the members of the healthy control group was 27.3/30 on the MMSE and 42.7/50 on the TYM. The total TYM-HUN scores significantly correlated with the MMSE scores (Spearman's rho, r=0.8830; p<0.001). Multivariate logistic regression model demonstrated that a one-point increase in the TYM score reduced the probability of having AD by 36%. The optimal cut-off score on the TYM-HUN was 35/36 along with 94% sensitivity and 94% specificity for the detection of AD. The TYM has a much wider scoring range than the MMSE and is also a suitable screening tool for memory problems, furthermore, it fulfils the requirements of being a short cognitive test for the non-specialists. The TYM-HUN is useful for the detection of Alzheimer's disease and can be applied as a screening test in Hungarian memory clinics as well as in primary care settings.
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Enfermedad de Alzheimer/diagnóstico , Pruebas de Memoria y Aprendizaje , Memoria , Humanos , Modelos Logísticos , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Análisis Multivariante , Atención Primaria de Salud , Sensibilidad y Especificidad , TraducciónRESUMEN
Schizophrenia is a chronic, debilitating psychiatric disorder characterized by heterogeneous clinical symptoms. Although the pathogenesis of this disorder is poorly understood, several lines of evidence support the role of both common and rare genetic variants in the etiology of schizophrenia. Common variants, single nucleotide polymorphisms can be investigated by candidate gene association studies or genome-wide association studies, while rare variants, single nucleotide variants are assessable by means of candidate gene resequencing or whole-exome and genome sequencing using next generation sequencing. In this study we investigated polymorphisms of 7 candidate genes in a Hungarian schizophrenia cohort. Candidate genes were chosen on the basis of previous results and biological plausibility. 390 patients were recruited in 5 centers in the framework of the Hungarian SCHIZOBANK Consortium, the schizophrenia sample was contrasted to 1069 healthy control individuals. In this sample SNPs of DDR1 and DRD2 genes demonstrated significant association with schizophrenia. The role of DDR1 and DRD2 genes in the etiology of schizophrenia warrant further investigation, based on their genomic localization and biological functions.
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Factor Neurotrófico Ciliar , Receptor con Dominio Discoidina 1/genética , Predisposición Genética a la Enfermedad , Receptores de Dopamina D2/genética , Esquizofrenia/genética , Estudio de Asociación del Genoma Completo , Humanos , Hungría , Polimorfismo de Nucleótido SimpleRESUMEN
BACKGROUND: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. AIMS: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. METHOD: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. RESULTS: Agreement between patients and staff regarding decision making was moderate (k = 0.210.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. CONCLUSIONS: A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.
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Toma de Decisiones , Trastornos Mentales/terapia , Evaluación de Procesos y Resultados en Atención de Salud , Participación del Paciente , Relaciones Médico-Paciente , Adulto , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana EdadRESUMEN
PURPOSE: To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity. METHODS: 588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the "Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)" study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information. RESULTS: 80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977-1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130-1.508) with their clinician. CONCLUSIONS: Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.
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Conducta en la Búsqueda de Información , Trastornos Mentales/psicología , Evaluación de Necesidades , Índice de Severidad de la Enfermedad , Adulto , Toma de Decisiones , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-PacienteRESUMEN
BACKGROUND: The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) - with versions for patients (CDIS-P) and staff (CDIS-S) - for use in mental health services. METHODS: An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. RESULTS: After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CONCLUSIONS: CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. TRIAL REGISTRATION: ISRCTN75841675.
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Toma de Decisiones , Lenguaje , Trastornos Mentales/terapia , Servicios de Salud Mental/normas , Encuestas y Cuestionarios , Traducciones , Adolescente , Adulto , Diversidad Cultural , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , PsicometríaRESUMEN
BACKGROUND: Dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners (GPs) may be the first to notice the cognitive deficit; therefore, it is crucial for them to have access to a screening test that can be administered quickly and efficiently. We explored the Hungarian version of the Test Your Memory self-administered dementia screening test in general practice for the early detection of dementia and cognitive impairment. METHODS: In the four Hungarian cities with medical universities, 368 patients over the age of 50 attending GPs filled out the questionnaire within the framework of our cross-sectional study. RESULTS: The total scores of the test showed a significant correlation with education and type of occupation and a significant negative correlation with age. The results of this research showed that the clock drawing and recall subtest scores deteriorate at the earliest age. CONCLUSION: The test can be filled out in a GP's office easily and two of its subtests can raise the possibility that patients may need further assessment, especially if they have symptoms, at an earlier age than the other subtests.
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BACKGROUND: The aim of this study was to develop and evaluate psychometric properties of the Clinical Decision Making Style (CDMS) scale which measures general preferences for decision making as well as preferences regarding the provision of information to the patient from the perspectives of people with severe mental illness and staff. METHODS: A participatory approach was chosen for instrument development which followed 10 sequential steps proposed in a current guideline of good practice for the translation and cultural adaptation of measures. Following item analysis, reliability, validity, and long-term stability of the CDMS were examined using Spearman correlations in a sample of 588 people with severe mental illness and 213 mental health professionals in 6 European countries (Germany, UK, Italy, Denmark, Hungary, and Switzerland). RESULTS: In both patient and staff versions, the two CDMS subscales "Participation in Decision Making" and "Information" reliably measure distinct characteristics of decision making. Validity could be demonstrated to some extent, but needs further investigation. CONCLUSIONS: Together with two other five-language patient- and staff-rated measures developed in the CEDAR study (ISRCTN75841675) - "Clinical Decision Making in Routine Care" and "Clinical Decision Making Involvement and Satisfaction" - the CDMS allows empirical investigation of the complex relation between clinical decision making and outcome in the treatment of people with severe mental illness across Europe.
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Toma de Decisiones , Trastornos Mentales/terapia , Pruebas Psicológicas , Adulto , Comparación Transcultural , Dinamarca , Femenino , Alemania , Humanos , Hungría , Italia , Lenguaje , Masculino , Participación del Paciente/psicología , Psicometría , Reproducibilidad de los Resultados , Suiza , Reino UnidoRESUMEN
AIMS: Studies have demonstrated neuropsychological deficits across a variety of cognitive domains in patients with major depressive disorder (MDD) during acute episode. However, limited data are available concerning whether these abnormalities persist in the remission phase. METHODS: In the present study CANTAB (Cambridge Automated Neuropsychological Test Battery) was used to evaluate the cognitive impairment associated with depression during acute episode and in remission. 25 patients with MDD during an acute episode and 11 patients also during remission were tested with CANTAB. RESULTS: During the acute episode, Delayed matching to sample, Paired associate learning, Spatial recognition memory, Rapid visual processing and Visuospatial planning were impaired. In remission the improvement of visual learning ability, spatial recognition memory, psychomotor speed, and executive function was observed. CONCLUSIONS: The results suggest that MDD is associated with neurocognitive dysfunctions in different domains, the most prominent deficit was found in the Paired associate learning test, which requires both the elaboration of "frontal strategies" and the "mnemonic processes". Cognitive impairment was found to improve partly in remission, suggesting that an individual's current mood interacts with the ability to perform a cognitive task. Besides these state markers, trait deficits are important because cognitive impairments which do not improve in remission might serve as endophenotypes of depression.
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Afecto , Cognición , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Depresión/psicología , Trastorno Depresivo Mayor/psicología , Pruebas Neuropsicológicas , Enfermedad Aguda , Adulto , Depresión/complicaciones , Trastorno Depresivo Mayor/complicaciones , Femenino , Humanos , Aprendizaje , Masculino , Recuerdo Mental , Persona de Mediana Edad , Aprendizaje por Asociación de Pares , Reconocimiento Visual de Modelos , Desempeño Psicomotor , Reconocimiento en Psicología , Percepción EspacialRESUMEN
INTRODUCTION: The spreading of "designer drugs" resulted in the appearance of "similar yet different" substances, the chemical structure of which are modified so regularly, which makes their research very difficult. We came across one of these substances, MDPV, while on night duty before it was mentioned in research papers. Our own research explores the changes in drug consumption patterns, especially in MDPV consumption patterns in the past few years, and gives a description of psychiatric and associated symptoms. METHOD: We compared cases of patients admitted to our ward between Jan 1., 2010 and November 30., 2012 with symptoms of drug consumption and its complications (BNO F15.00-F15.90, F19.00-F19.90). We examined symptoms that required inpatient care at the psychiatry ward. RESULTS: While in 2010 we treated only 3 MDPV users on 6 occasions, 4 Mephedrone users on 6 occasions, and 9 patients using other substances (Speed, Cannabis) on 10 occasions at our ward, in 2011 there were no Mephedrone-related hospitalizations and only 9 patients using other substances (Cannabis, Synthetic Cannabinoid, 5-MeO-AMT, Glue, Metamizole, Ketamine) were treated on 13 occasions. Between Jan 1. 2011. and Nov 30.2012 there were 40 recorded cases related to MDPV-use in the period: forty people were registered on 87 occasions. Nine people receive impatient care after observation on 10 occasions. In all these cases psychotic symptoms were recorded. CONCLUSION: The constant development of designer drugs requires better administration of the individual cases, symptoms and forms of treatments. Informing doctors about these details also seems necessary. We have found that the behaviours of drug users show a positive correspondence with changing legal environments, which calls for a more sensible drug-related policy.
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Benzodioxoles , Drogas de Diseño , Consumidores de Drogas , Metanfetamina/análogos & derivados , Psicotrópicos , Pirrolidinas , Cannabis , Dipirona , Femenino , Hospitalización , Humanos , Ketamina , Masculino , Estudios Prospectivos , Servicio de Psiquiatría en Hospital , Estudios Retrospectivos , Detección de Abuso de Sustancias , Cathinona SintéticaRESUMEN
INTRODUCTION: According to the international literature disease burden of schizophrenia is substantial, however data from Eastern Central Europe is scarce. Our aim was to assess the quality of life and costs of patients with schizophrenia in Hungary. METHODS: A cross sectional questionnaire survey was performed in 3 hospital based psychiatry centres involving patients with schizophrenia. Demographics, disease severity (Clinical Global Impression, CGI), functional ability (Global Assessment of Functioning, GAF) and general health status (EQ-5D) was assessed. Health care utilisation and aids were surveyed for the past 12 months. Costing was performed from the societal perspective and human capital approach was applied. RESULTS: Altogether 78 patients (female 43.6%) were involved with a mean age of 44.2 (SD=13.1) years, disease duration was >10 years at 49 (62.8%) cases, 66 (84.6%) patients were disability pensioners. Distribution between CGI 3-4-5-6 levels were 12 (16%), 33 (43%), 21 (28%), 10 (13%) patients, respectively, mean GAF was 52.6 (SD=13.9). The average EQ-5D score was 0.64 (SD=0.3) and it was significantly worse than the age-matched general population's score in Hungary (p < 0.01). Mean yearly cost was 13 878 Euros/patient (conversion 1 Euro=280.6 HUF), the rate of direct medical,direct non-medical and indirect costs was 28.5%, 5.4% and 66.1%, respectively. Among direct costs hospitalisation and drug costs were dominant. Total cost correlates with disease severity (CGI). CONCLUSION: Schizophrenia leads to notable deterioration in health related quality of life and induce high costs to society, mainly due to the productivity loss of the patients. Nevertheless disease related costs in Hungary are lower than in economically more developed European countries. Our study offers basic data about disease burden of schizophrenia in Hungary to support clinical and health policy decision making.
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Costos de la Atención en Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Calidad de Vida , Esquizofrenia , Adulto , Anciano , Costo de Enfermedad , Estudios Transversales , Eficiencia , Femenino , Estado de Salud , Humanos , Hungría/epidemiología , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Esquizofrenia/economía , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
BACKGROUND: A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. METHODS/DESIGN: The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome. DISCUSSION: The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. TRIAL REGISTER: ISRCTN75841675.
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Protocolos Clínicos , Toma de Decisiones , Trastornos Mentales/terapia , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Adolescente , Adulto , Europa (Continente) , Unión Europea , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Persona de Mediana Edad , Modelos Psicológicos , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Participación del Paciente , Satisfacción del Paciente , Relaciones Profesional-Paciente , Estudios Prospectivos , Indicadores de Calidad de la Atención de Salud/normas , Calidad de Vida , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Alzheimer's disease is a progressive and fatal neurodegenerative disorder in which the novel drugs can slow down the progression in the early phase. Our purpose was to find biological markers, which would detect neuropathology in the prodromal and early phase of Alzheimer's disease. Beside the routine diagnostic methods, neuropsychological test, auditory event related potential and special laboratory tests were performed among subjects with Alzheimer's disease, vascular dementia, mild cognitive impairment and major depression compared to a healthy control group. Visual Paired Associate Learning was impaired in all patient groups, in major depression it seemed to be reversible. In amnestic mild cognitive impairment and in dementia a longer latency of late component of auditory evoked potential, P300, was found. Reduced paraoxonase activity in the serum and increased Nepsilon(gamma-glutamyl)lysine isodipeptide concentration in the cerebrospinal fluid were detected in both dementia groups. Characteristic changes of Visual Paired Associate Learning and P300 might predict the conversion to Alzheimer's disease in mild cognitive impairment. The paraoxonase activity and the isodipeptide concentration can be sensitive markers of the pathomechanism of neurodegeneration. A combined use of the above-mentioned methods can help in the early prediction and diagnosis of Alzheimer's disease.
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Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/metabolismo , Potenciales Evocados Auditivos , Pruebas Neuropsicológicas , Percepción Espacial , Anciano , Enfermedad de Alzheimer/fisiopatología , Enfermedad de Alzheimer/psicología , Arildialquilfosfatasa/sangre , HDL-Colesterol/sangre , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: The late component of the event-related potential (ERP), P300 is a marker for cognitive brain functions. The objective of this study was to examine P300 parameters in dementia and in mild cognitive impairment (MCI), to examine whether there is a correlation between the changes in P300 parameters and the type and severity of dementia, and to determine P300 abnormalities in MCI in relation to the presence/absence of CT/MRI abnormalities. METHOD: Auditory event-related potentials, P300 were recorded in 28 MCI patients (14 of them with normal CT/MRI findings and 10 subjects with mild ventricular enlargement). In another group of patients, 31 demented patients were examined, of whom 17 patients were diagnosed with Alzheimer's dementia (AD), and 14 patients with vascular dementia (VD). Forty healthy volunteers served as the control group. RESULTS: Mean P300 latency was significantly increased for both demented patient-groups. We found that prolongation of P300 latency was correlated with the severity of dementia. Mean P300 amplitude was significantly decreased in both groups of demented patients. In MCI, the mean latency of P300 was significantly longer among patients with mild cerebral atrophy compared to control volunteers and no significant changes were found for MCI patients with normal CT/MRI findings. Mean P300 amplitude was decreased only in demented patients. CONCLUSIONS: The prolongation of P300 latency was significant among patients with both vascular and Alzheimer's dementia, and also among MCI patients with mild cerebral atrophy. The severity of dementia is positively correlated with P300 latency; however, this prolongation is independent of the type of dementia. The structural brain changes in MCI are related to P300 latency prolongation and thus may indicate an increased risk for developing dementia in MCI patients.
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Encéfalo/fisiopatología , Trastornos del Conocimiento/fisiopatología , Demencia/fisiopatología , Potenciales Relacionados con Evento P300 , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/fisiopatología , Estudios de Casos y Controles , Demencia Vascular/fisiopatología , Potenciales Evocados Auditivos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Previous studies that aimed to support emotion recognition deficits and alexithymia in B cluster personality disorders have mainly focused on borderline personality disorder (BPD), and resulted in mixed findings. In our study we examine emotion recognition and alexithymia in patients with histrionic (HPD), narcissistic (NPD) and borderline (BPD) personality disorders compared to each other and healthy controls. Furthermore, the possibility is investigated that it is not the type of PD but the severity of psychopathology which predicts the severity of emotion recognition deficits and alexithymia. Patients with HPD, NPD, BPD and healthy controls (Nâ¯=â¯20 for each group) were examined by using the Ekman 60 Faces Test (FEEST) and the Toronto Alexithymia Scale (TAS-20). To measure the extent and severity of psychopathology, the Symptom-Checklist-90 Revised (SCL-90-R) was used. Patient groups performed significantly worse compared to healthy controls on the Ekman test and TAS-20, while we found no significant differences among patient groups in emotion recognition and alexithymia. Furthermore, higher scores on the SCL-90-R predicted poorer emotion recognition performance and higher alexithymic features. The empirical data supports the conclusion that the severity of psychopathology plays an important role in predicting emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders.
Asunto(s)
Síntomas Afectivos/fisiopatología , Trastorno de Personalidad Limítrofe/fisiopatología , Expresión Facial , Reconocimiento Facial/fisiología , Trastorno de Personalidad Histriónica/fisiopatología , Narcisismo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Neuropsychological deficits, such as poor episodic memory, are consistent features of mild cognitive impairment and also that of early stage of dementia. The aim of the present study was to detect cognitive dysfunction among patients with Alzheimer's disease or with mild cognitive impairment (MCI), which refers to a transitional state between the cognition of normal aeging and mild dementia regarded as a high-risk condition for the development of clinically probable Alzheimer's disease (AD). Computerized tests of memory, attention and executive functions were studied in groups of AD subjects (n=15) and MCI subjects (n=25). On all measures, the performance of the AD group was significantly weaker compared to healthy individuals or to the MCI group. The performance of both the AD and MCI patients in the Paired Associate Learning test was significantly impaired, which may suggest that MCI patients are already in the early stages of the disease.