Induced erotomania by online romance fraud - a novel form of de Clérambault's syndrome.

BACKGROUND: Although the impact of internet usage on mental health is extensively documented, there is a notable scarcity of reports in the literature concerning internet-induced erotomania. Erotomania is a rare and likely underdiagnosed delusional disorder. It is characterized by an irrational belief held by the affected persons that someone of higher socioeconomic status harbor romantic feelings toward them. Here, we describe the psychopathology of erotomanic delusion induced by online romantic fraud in a female patient. Employing this case as a focal point, we illuminate novel aspects of erotomania that warrant attention and examination. CASE PRESENTATION: We present a compelling case involving a 70-year-old married Caucasian woman diagnosed with medically controlled persistent depressive disorder for several years. The intricacies of her condition became evident as she became deeply engrossed in online profiles featuring the image of a renowned musician, inadvertently falling victim to an online romantic fraud. Subsequently, this distressing experience triggered the emergence of erotomanic delusions and a suicide attempt. The patient's history reveals an array of medical conditions and stressful life events, contributing to her vulnerability. The diagnosis of erotomanic delusional disorder, dysthymia, and mild cognitive impairment with cerebral vascular background was established. Treatment involved her previous antidepressant with low-dose risperidone, alongside supportive individual and group therapy. Her delusion showed remission four weeks later, prompting her discharge for outpatient follow-up. Although she retained some false beliefs, the intensity of the symptoms had notably diminished and her functionality improved. CONCLUSION: This case underscores the complex interplay between mental health, online activities, and the consequences of delusions, including suicidal thoughts, shedding light on the need for a comprehensive approach in addressing such challenging psychiatric scenarios.

Myths about suicide - validating the Hungarian version of the Literacy of Suicide Scale (H-LOSS) on a community sample.

BACKGROUND: Suicide was exceptionally high in Hungary in the last century. According to Eurostat, Hungary ranks second in the EU in death by suicide and was among the few countries where the suicidal tendencies increased in 2020. Primary tasks of suicide prevention programs are to develop suicide literacy and dispel myths and misconceptions about suicide. Therefore, the goal of our research was the Hungarian validation of the 26-item Literacy of Suicide Scale (LOSS). METHODS: 749 people (382 female (51.0%), 364 male (48.6%), 3 identify as non-binary or other (0.4%); 4 identifying as transgender (0.5%)) participated in our online cross-sectional survey with a mean age of 32.4 years (SD = 14.5 years). The H-LOSS questionnaire was adapted using the 2PL (two-parameter logistic) model with WLSE (weighted least squares) estimation in item response theory method, similarly to the original English version. RESULTS: Scale unidimensionality was confirmed. Model fit indices and internal reliability indicators were acceptable. Item infit and outfit values were adequate, item discrimination values were within range, but one item had extremely high and three items had extremely low item difficulty parameters. Few items had differential item functioning by age, gender and own suidice attempt. CONCLUSIONS: The H-LOSS scale deemed to be appropriate for assessing suicide literacy in Hungarian speaking samples.

Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomized sham-controlled trials.

BACKGROUND: Several meta-analyses demonstrated the efficacy of unilateral High-Frequency Left-sided (HFL) repetitive Transcranial Magnetic Stimulation (rTMS) for individuals with Major Depressive Disorder (MDD); however, results are contradictory due to heterogeneity of the included studies. METHODS: A systematic literature review (SLR) of English language articles published since 2000 was performed in March 2022 on PubMed and Scopus databases. Empirical evidence on the relative efficacy of rTMS treatment compared with standard pharmacotherapy in Treatment-Resistant Depression (TRD) were extracted. Random effects models were used to assess the effects of rTMS on response and remission rates. RESULTS: 19 randomized double-blinded sham-controlled studies were included for quantitative analysis for response (n = 854 patients) and 9 studies for remission (n = 551 patients). The risk ratio (RR) for response and remission are 2.25 and 2.78, respectively for patients after two treatment failures using rTMS as add-on treatment compared to standard pharmacotherapy. Cochrane's Q test showed no significant heterogeneity. No publication bias was detected. CONCLUSIONS: rTMS is significantly more effective than sham rTMS in TRD in response and remission outcomes and may be beneficial as an adjunctive treatment in patients with MDD after two treatment failures. This finding is consistent with previous meta-analyses; however, the effect size was smaller than in the formerly published literature.

[Recent approaches in suicide research. The psychology and neurobiology of the pre-suicidal state].

From the point of view of the prevention of suicidal behaviour, the recognition of acute suicidal risk is of particular importance, therefore one of the most important goals of recent suicidal research is the more precise detection of the psychological symptoms leading to a suicidal act. Classic risk factors can often be discovered in the background of suicidal thoughts, but they are not suitable for screening out those who will turn their thoughts into action. Since many people have suicidal thoughts, why, how and when suicidal thoughts are followed by a self-destructive act is a particularly important question. In order to answer this question, in my paper I review the symptom-focused models of the pre-suicidal state based on the recent suicidality literature, emphasizing the importance of "ideation to action" models. I summarize the psychological, interpersonal and neurobiological characteristics of the pre-suicidal state, highlighting the factors of the suicide capability. The new models of the pre-suicidal status represent a major step forward in the detection of the characteristics of the suicidal crisis and - in addition to the classic risk factors - in the more accurate assessment of the suicidal risk, in the more effective prediction of suicidal behaviour and thus in providing more effective treatment. Research on the characteristics leading to suicide can enrich our knowledge of the physical, neurobiological, and psychological processes underlying suicidal behaviour with important information. This is of great importance in terms of the screening and adequate treatment of our patients at risk of suicide.

Repetitive transcranial magnetic stimulation may be a cost-effective alternative to antidepressant therapy after two treatment failures in patients with major depressive disorder.

BACKGROUND: The cost-effectiveness of treatment strategies for patients with Major Depressive Disorder (MDD) who have not responded to two adequate treatments with antidepressants (TRD) are still unclear. The aim of this analysis was to evaluate the cost-effectiveness of add-on repetitive Transcranial Magnetic Stimulation (rTMS) compared with standard treatment. METHODS: A Markov-model simulated clinical events over one year from the perspective of healthcare payer. Third- and fourth-line treatment pathways (augmentation, antidepressant switch or combination, and Electro-Convulsive Therapy (ECT)) were defined based on medical practice guidelines. Transition probabilities were derived from a recent meta-analysis and scientific publications. Resource utilization and cost estimates were based on the patient-level database of a large university hospital. RESULTS: Incremental Quality-Adjusted Life Years (QALYs) and costs were 0.053 and 785 €, respectively, corresponding to an Incremental Cost-Effectiveness Ratio (ICER) of 14,670 € per QALY. The difference in cost between standard treatment and rTMS is explained by the rTMS sessions used in acute (€660) and maintenance (€57/month) treatments, partly offset by lower hospital costs due to higher remission rates in the rTMS arm. Key parameters driving the ICER were incremental utility of remission, unit cost of rTMS treatment and remission rate. At a threshold of €22,243 add-on rTMS is a cost-effective alternative to pharmacotherapy. Evidence on long-term effectiveness is not yet available, so results are estimated for a one-year period. CONCLUSION: Not only does rTMS treatment have beneficial clinical effects compared with drug therapy in TRD, but it also appears to offer good value-for-money, especially in centres with larger numbers of patients where unit costs can be kept low.

[Comments].

No abstract available.

[Text and behavior - analysis of farewell notes - pilot study].

Studying suicide notes, - last personal documents before a suicide act - as well as investigation of media and internet texts on self-destruction (including contents, "messages") can have a great significance. Individual and cultural valuations appear in the way farewell notes, media letters and other personal documents present self-destruction. These "messages", ideas about life, death and suicide are deeply embedded within the public context of culture too. In the present content analysis formal, syntactic and grammatical characteristic features, as well as speech patterns and verbal expressions of selected notes, samples have been investigated. Suicidal - fatal (n=49) and nonfatal group (n=31) of farewell letters were compared with the sample of a control group (n=33). Results have been discussed, interpreted and concluded. These appear to be useful and important not only in understanding of suicidal phenomenon and its psychodynamic background in clinical work or in suicide hotlines, but also in prevention, social-, and clinical intervention of self-destruction. The investigation of these new data may provide a much broader perspective in understanding suicidal process.

[Memories and thoughts on the 100-year-old Pécs Psychiatric Clinic].

No abstract available.

Untreated depressive symptoms significantly worsen quality of life in old age and may lead to the misdiagnosis of dementia: a cross-sectional study.

BACKGROUND: Several studies demonstrated the role of depressive mood and cognitive impairment in the background of elevated mortality and decreased Quality of Life (QoL) in old age. Our aim was to assess depressive and cognitive symptoms among older people in order to determine if those are recognized and treated or not, to elucidate the association between them and to investigate their impact on QoL. METHODS: In the framework of the ICT4Life project self-administered questionnaires and clinical screening tools were used to assess QoL, depressive symptoms and cognitive functions of 60 older persons over the age of 65. RESULTS: Males found to be depressed (53.8 vs. 40.4%) and cognitively declined (53.8 vs. 48.9%) more frequently; and had higher scores on the depression (6.85 vs. 5.32) and lower on the QoL (47.38 vs. 50.19) scales. Depressed older persons had lower cognitive levels (24.39 vs. 21.52) and their QoL was significantly poorer (53.97 vs. 43.85) than that of the non-depressed subjects. Depressive symptoms were detected in almost half of the older adults (43.9%), and the majority (80.77%) did not receive antidepressant medication. CONCLUSIONS: Depressive and cognitive symptoms found to be common among older people, but were not recognized and treated in most cases. Close correlation between depression and cognitive impairment was also confirmed, as well as the key role of depression in the background of pseudo-dementia and QoL decline. Early recognition of depressive symptoms is important not only to treat the underlying mood disorder, but also to improve QoL of older persons.

The impact of depressive mood and cognitive impairment on quality of life of the elderly.

BACKGROUND: The quality of life (QOL) of the elderly can be influenced by numerous factors. We assessed QOL, cognitive functions, depression and clinical data in elderly aged 65 and over with the aim of analysing factors affecting their QOL. METHODS: Semi-structured interviews were conducted with elderly over the age of 65, and their QOL, cognitive functions and depressive symptoms were assessed by validated clinical tests and screening tools. RESULTS: The correlation between QOL scales and cognitive tests was not significant. In contrast, the results of depression scales showed significant negative correlation with the scores of the QOL scales. A better QOL was determined by lower age, lack of depressive symptoms, and higher scores in the QOL-AD (Alzheimer's disease) scale. Depressive mood has much more negative impact on the QOL of the elderly than cognitive impairment. CONCLUSIONS: Our results demonstrated a close correlation between QOL and depressive mood in the elderly. The early detection and effective management of affective and cognitive symptoms in the elderly can not only restore mental health but may also improve their QOL.

[New results of neuroscience research - the background of symptomatological and etiological diversity of mental disorders]. / Az idegtudományi kutatások új eredményeinek tanulságai ­ a mentális zavarok tünettani és etiológiai heterogenitásának háttértényezôi.

BACKGROUND AND PURPOSE: Nowadays, the focus of genetic, neurobiological, neuropsychological and psychosocial research is on a more accurate discovery of the etiology of mental illnesses, especially with regard to the role and complex interactions of certain risk factors. It is increasingly challenging to interpret the results of different aspects and methodologies in a coherent theoretical framework, as this can only lead to a more accurate understanding of the complexity and mechanism of the psychiatric disorders. The main aim of this paper to overview recent studies on etiological background of mental disorders and to present the most important aspects of the Research Domain Criteria (RDoC) system. METHODS: Review of reports from comprehensive studies published in the most important psychiatric journals over the past five years summarizing new findings on the etio-logy of mental disorders. RESULTS: Although current classifications indicate that mental disorders are strictly distinct diagnostic categories, new findings suggest that these marked differences in symptomatic, genetic, and neurobiological backgrounds are not detectable, as many mental disorders have been identified as having common molecular genetic risk factors, which may indicate common neurobiological pathomechanisms. CONCLUSION: Research results support the need for a rethinking of psychiatric nosology on an etiological basis and represent an important step forward in the more accurate exploration of the neurobiological background factors of mental disorders and thus in the development of more targeted therapeutic approaches. The development of the RDoC system can be a great help in this, as this dimensional approach offers the possibility of integrating the - often diffuse or even contradictory - neuroscientific research findings into a unified theoretical framework for the etiology, nosology and treatment of mental disorders.

[Beyond the diagnosis - applying the transdiagnostic approach and RDoC aspects in the modern neuroscience].

The new psychiatry classification systems, despite long lasting preparation and broad consensus, do not provide an answer to the fundamental dilemmas of modern psychiatry. This is because categorical approaches are independent of the underlying neurobiological and genetic factors and cannot integrate the results of modern research, which is a big barrier of the neuroscientific development. Recent neuroscience research, with revolutionary new methods and tools and the analysis of huge databases, provides more and more information about the normal and abnormal functioning of the central nervous system. It is an enor - mous challenge to interpret these new findings, so there is a growing need to develop theoretical models that help to better understand the complexity of mental disorders and the mechanism of their development. In my paper, I summarize recent research methods related to the symptomatic heterogenity and etiological back - ground of mental disorders and present the results of some new transdiagnostic studies, in order to illustrate the key aspects of the Research Domain Criteria (RDoC) system developed to integrate the new results. The RDoC framework helps to interpret the results of neuroscience research in a complex way and facilitates the detec - tion of differences in genotypes and (endo)phenotypes, as well as a better understanding of the pathophysiological mechanisms and developmental differences responsible for the development of mental disorders. This can mean signi ficant progress not only in renewing psychiatric nosology, but also in identifying new preventive and therapeutic targets.

[Werther- and Papageno-effects in suicidology notes].

No abstract avalilable.

[Suicide risk assessment and suicide-specific syndromes].

Although more and more data is now available on the background of suicidal behaviour, classical suicidal risk factors have only limited clinical predictive value because they provide little reliable information on the acute psychological processes leading to suicidal behaviour. As the lack of recognition of acute suicidal risk limits the ability to provide adequate care, intense research has begun to develop validated methods for risk analysis and risk assessment that provide more accurate predictions of suicidal behaviour. In recent years, two specific syndromes have been described that may assist in the more accurate assessment of presuicidal psychopathology and thus in the prediction of suicidal behaviour. Researchers from the United States suggest the introduction and the clinical use of two suicide-specific syndromes, the Acute Suicidal Affective Disorder (ASAD) and Suicidal Crisis Syndrome (SCS). In this paper, we present the most important features of these newly described suicide-specific syndromes, the experience with their clinical application, and the major research findings about them. Then these syndromes are compared with the classical psychological features of pre-suicidal crisis to find out whether these are really new transdiagnostic interpretations of the symptoms of suicidal behaviour or those are merely the well-known classical symptoms with new terminology.

[The Papageno-Effect in suicidology].

No abstract available.

[Information and communication technologies in the integrated care of people with dementia]. / Információs és kommunikációs technológiák alkalmazása dementiában szenvedok komplex ellátásában.

Modern information and communication tools have increasingly become an indispensable part of our everyday life. Research data demonstrate that it can be used effectively to preserve and restore health, not just among young people but also among the elderly, as for nowadays the use of the internet is widespread among the elderly, but healthcare applications are less well-known. This supports the significance of our project since it is important to develop and introduce disease-specific healthcare applications. Our preliminary results also indicated that men are less open to these new technologies, so in their case, specific methods are needed to facilitate the use of electronic devices. The high level of internet activity and the interest in information and communication technologies provide a reliable basis for applying these new technologies to the elderly. Thus, based on our research, we can develop a complex model of care based on the bio-psycho-social principles, which can be a significant advance in the prevention and early detection of age-related mental disorders and in alleviating the physical and psychological burdens of people with dementia and their families. Orv Hetil. 2018; 159(24): 965-973.

[Competence - Congruent - Co-operation (Comment to article of Attila Nemeth)].

No abstract available.

[Experiences of a Extreme, absolutist expressions may be marker-specific to depressive or anxious states and suicide].

No abstract available.

[The role of RDoC system in the research of mental disorders - Changing the psychiatric nosology paradigm?]

Nowadays, one of the biggest challenge of psychiatry is the renewal of classification systems. The newest version of DSM, the 5th, - even though it is based on extensive professional consensus - is criticized numerously, as it could not exceed the cathegorical and simplistic syndromathologic approach. For this reason it seems to be indispensable to implement a new diagnostic system, which includes the modern neurosience researches and the clinical observations together. The main goal in the creation of the Research Domain Criteria (RDoC) model was to implement a new research criteria system which facilitates to understand the biologic and psychosocial background of mental illnesses. In our article we present the most important characteristics of RDoC system, in particular its dimensionality, its behaviour- based and neuro-bio-social approach, futhermore its developmental perspective. The benefits of this modell's application are illustrated by the newest results of the research related to depressive disorders and suicidal behaviour.

[Lottery and suicide - the effect of number of lottery tickets on Hungarian suicide rates].

AIM: The relationship of suicide and gambling is a neglected field in the study of suicidology. In Hungary, no statistical studies have been published to date with regard to the whole of the population. Our study investigates the relationship between a very popular high prize game, lottery, and suicide rates. METHOD: The relationship between daily rates of suicide by gender and age and the number of winning tickets has been analysed over the periods between 1991 and 1997 and from 1997 to 2013. During the first period of time examined, the lottery draws took place on Fridays, while they were held on Saturdays in the second. Time series covariance analysis based on ARIMA modelling on detrended data was used to test the relationship of gambling and self-destruction. RESULTS: Out of the 27 models tested, the only significant models, which are also in line with what can be expected based on the literature, could be found during the period when the draws took place on Fridays. Corresponding to the increase in the number of lottery tickets, there was also an increase in the number of suicides somewhat delayed in time. The relationship only held true for males with one exception. CONCLUSIONS: In our study, we found a weak positive relationship between rates of suicide and the spread of the lottery game. The significance of our study is well reflected by the fact that - to the best of our knowledge - this effect has never been investigated on such a large sample before. Our results point to the significance of cultural and social factors, to differences in gender roles, and to the accentuated role of the factor of hopelessness in shaping the suicide scene in Hungary. In order to clarify the role of different factors in more detail, there seems to be a need for further studies on suicide conducted on large samples.