[Unmet needs in the recognition and treatment of childhood depression]. / Hiányosságok a gyermekkori depresszió felismerésében és gyógyításában.

In spite of the fact that the good mental health is indispensable condition of the development of sound personality, in the past years the somatic and mental state of our children did not improve. The author ascertains that there are several obstacles in the recognition, treatment and prevention of child-depression that causes a serious public health problem. He stresses the neurologic, neuropsychiatric, psychopathological and diagnostic deficiencies, and the low number of Child and Youth Dispensaries. He describes the situation of Hungarian Child and Youth Dispensaries network, and states positively that today the child-psychiatric services are not able to provide optimal provision for every depressive child. In the brief historical introduction he refers the earlier excellent child-psychiatric initiative. He emphasises the huge number of somatic and psychiatric signs and symptoms among the children. He devotes a separate chapter to the causes of child-depression, the prevention, recognition, creation of diagnosis and treatment. According to the literature data and own examination he demonstrates that the depressive and other psychopathological symptoms among children are not really interested the parents, health-workers and teachers. There are several depressive symptoms among the children without mental disorders. The new revisions of BNO and DSM are unable to help the diagnostic of child-depression. He summarizes the most important tasks for the prevention and treatment of child-depression. In the near future a great deal more should be done for prevention and treatment of child-depression than what we have accomplished so far in order to ensure every child the development of sound personality and becoming healthy adult. The deep, ramified, complicated roots of self-destructive behaviour are originated from the early mental abnormalities, primarily from the Conduct, Depressive and Anxiety Disorders. The prevention and treatment of child-depression are unimaginable without (1) the better understand of central nervous system, (2) adequate, exact symptom list (3) a new diagnostic system, (4) exact neuro-psychopharmacology, (5) powerful health-policy, (6) well-trained primary care health system and (7) paramount Child and Youth Dispensaries-network which based on the Evidence Based Medicine.

[Major obstacles in the development of child and adolescent psychiatry in Hungary]. / A magyar gyermek- és ifjúságpszichiátria fejlodésének legfontosabb akadályai.

The author ascertains that healthy personality development faces increasingly serious obstacles and consequently the number of children in need of mental healthcare is on the rise. Child and adolescent psychiatry has drawn increasing appreciation, however, it is only formal and deficient in Hungary today and cannot assure optimal mental care according to the principles of evidence-based medicine. The author emphasizes that 75% of the first manifestation of the psychiatric disorders occurs during adolescence and young adulthood. In spite of legal regulation, several deficiencies hinder the development of children into healthy adults. The author analyses the most important obstacles in the development of child and adolescent Psychiatry. The author emphasizes the role of keypersons, describes the situation of and problems faced by Hungarian child psychiatric care. The author lists in detail the most important contradictions, deficiencies and obstacles and outlines suggestions for resolving the present crisis. The author emphasizes (1) the responsibility of institutions, and people dealing with society and children, and the disinterest of competent authorities. (2) The somatic, mental, cultural and spiritual ignorance/illiteracy among parents, teachers, healthcare workers, and the general population partly related to crises among the pedagogues. (3) The lack of holistic approach to treatment of children suffering from mental disorder. (4) The importance and the lack of knowledge concerning central nervous system function in child psychiatry. (5) Application of evidence-based medicine in child and adolescent psychiatry based on understanding the relationship between central nervous system alterations and mental functions. (6) Respecting keypersons' competence limits. (7) Immediate development of inpatient and outpatient child and adolescent psychiatry in the whole country. (8) Reform of child psychiatry board exam. (9) Development of currently missing textbooks and handbooks and promoting benefits of internet use. (10) The almost complete lack of the permanent and systematic mental health prevention in education and healthcare, especially in primary health care. (11) The ignorance of possible and achievable opportunities. Overcoming the obstacles of child and adolescent psychiatry can only be achieved by a coordinated action of dedicated child psychiatrists, child psychologists, informed parents, well-trained pediatricians, district nurses, excellent teachers and other committed keypersons.

[Autotelic activities aimed at the alteration of the human body from socially accepted to pathological forms: about non-suicidal self-injury]. / Az emberi test megváltoztatására irányuló öncélú tevékenységek a szociálisan elfogadottól a patológiás formákig: a nem öngyilkossági szándékkal történo önsértésrol.

The author lays down that non-suicidal self-injury (NSSI) constitutes an increasingly more common and serious public health problem, especially during the age of adolescence. In spite of the fact that the phenomenon has been known since the beginning of human mankind even in animals, we have not been able to either give a clear explanation or prevent its spreading yet. The author reviews the conceptual disturbances, behavioural phenotypes, cultural-historical and mythological antecedents related to self-injury, just as the controversial concepts, reasons of unclearness of the concepts, and clinical classification of self-injuries, and he outlines a new categorisation/ classification of the explanation of autotelic activities aimed at the alteration of the human body. He reviews the relationship between self-injuries and other psychological signs and symptoms and psychiatric illnesses, the explanations of developing self-injurious behaviour and further research directions. Besides the different models of self-injury he presents a holistic model. Besides the therapeutic guidelines of self-injurious behaviour, he calls the attention to the importance of genetic and nervous system researches, psychological and spiritual research, the importance of mental education and prevention, and he also lists some more essential questions future researchers have to find the answers for if we would like all children to be allowed to enter the adults' world in a healthy and sound state.

[The most important obstacles of the development of Hungarian psychiatry]. / A magyar pszichiátria fejlodésének legfontosabb akadályai.

A quarter of a century ago the change of the political system in Hungary precipitated a serious value-crisis and caused a lot of harmful effects in nurturing and the development of psychiatry. The author establishes that the attack against psychiatry is more intensive than previously but neither the education and health management nor the psychiatric leadership could cope with these difficulties. It can't be denied that the foundation of lifelong mental health begins in the early life years and about 75% of the first Mental Disorder manifests in adolescence and youth. We are not able to ensure the special rights of every child according to the Hungarian Constitution and the Declaration of the Rights of the Child by the United Nations. The large inequalities within the country, the lack of paramount mental education and nurturing, the lack of essential, consistent eternal values, the lack of required psychiatric care system are huge obstacles of the development of healthy individual and leads to self-destructive behaviour and several, serious physical and mental disorders. The purpose of the author is to call psychiatrists' attention to the main obstacles of the development of Hungarian Psychiatric Care System. The main obstacles of the present psychiatric care system: 1. Unclarified notions, confusion of ideas. 2. Somatic, neurologic, mental, cultural-social and spiritual ignorance. 3. Lack of organization in Mental Education and Psychiatric Care System. 4. Value-crisis in our society despite the fact that the "Council of Wise Men" created a "Scale of the Essential Consistent Eternal Values" for the Hungarian Education System in 2008. 5. Lack of mental health prevention both in education system and health care system. There is no teaching of hygiene lessons in the Hungarian schools. 6. Negligence and selfishness among the population. 7. Disinterest among competent authorities. 8. Leaving the most important possibilities out of consideration. The author establishes that the elimination of the above mentioned obstacles, the high standard of psychiatric care system, - especially the child psychiatric care system - and paramount mental education are extraordinarily important to prevent most psychiatric disorders and help the development of healthy and happy people. If human individuals are the most important ones in our society, if we eliminate the main obstacles of the development of psychiatry, we ensure to improve Hungarian psychiatry again, we shall be able to say that "the spiritual light is shining through the windows of every house", and our work will not be a quixotic struggle or "tilting at windmills".

[Most important deficits, contradictions and possibilities in suicide prevention in Hungary]. / Az öngyilkos magatartás megelozésében tapasztalt legfontosabb hiányosságok, ellentmondások és lehetoségek Magyarországon.

Suicide is not only a contradictory biological, psychological, sociocultural and spiritual phenomenon, but also a serious public health problem, which is manifold, therefore the fight against it is also complex. The aim of the present publication is to establish the current situation of the fight against suicide in Hungary, which are the most important deficits, contradictions and unexploited possibilities. The author states that although we have accomplished important steps in the prevention of suicide, we did not realise the majority of them in everyday practice. The author defines the most important problems and tasks which should be solved in the next decade. In the near future a great deal more should be done for prevention than what we have accomplished so far in order to significantly reduce the number of suicide victims in Hungary.

The importance of neuropsychopharmacology in the development of psychiatry.

The author establishes that Psychiatry has been in a difficult situation especially in Hungary since closing down the National Institute of Psychiatry and Neurology. He reviews the most important factors which hold up the development of Psychiatry. He settles that the development of Psychiatry is inconceivable without a person's holistic approach which assumes the biological, mental, cultural-social and spiritual approach. Disturbances of perception have particular roles in the formation of psychopathological symptoms which are based on the operation of the nervous system. This fact emphasises the importance of the nervous system and the neuropsychopharmacology which we have known since the beginning of history although it is hardly half a century old. He pays the attention to the psychoactive medicine that was well-known in the ancient civilization. He reviews some of them which were actually the first neuropsychopharmacological pharmaceuticals. He emphasises the dichotomy of the psychopathological symptoms which are partly objective, partly subjective but based on the operation of the nervous system by all means. His statements not only establish a new kind of approach of both the person and the Psychiatry but enables the development of Psychiatry, the creation of a new sort of diagnostic system, eliminating the variance among the experts dealing with people, the neurologists, the psychiatrists, the psychologists, the sociologists, the philosophers and the theologians, ensuring the biological (neurological), psychological, cultural and spiritual perpetuity. The biological, genetic, psychic, cultural-social and spiritual approach, the application of nanomedicine that enable not only recognising the organic neurological bases of the psychiatric disorders that are all crucial for the future researchers but also essential in the development of the neuropsychopharmacology based on the function of the nervous system.

The possibilities of suicide prevention in adolescents. A holistic approach to protective and risk factors.

There is no other such complex physical, biological, somatic, mental, psychological, psychiatric, cultural, social and spiritual phenomenon and general public health problem, so much unexplained, meaningless, so tragic, painful, and unreasonable, so difficult, contradictory and mystified like suicide. In spite of the several already identified background factors, we do not and we can not know the real reasons behind suicide, because suicide is multi-causal, and can never be traced back to one single cause, but there are always many biological, psychological-psychiatric, historical, social and cultural factors involved in its development. However, the strongest suicide risk factor is an unrecognized and untreated mental disorder. Suicide among young people is one of the most serious public health problems. In Hungary 1395 young people lost their lives due to suicide in the 24> age group between 2000-2010, 1150 males and 245 females. According to epidemiological studies, 24.7% of children and adolescents suffer from some form of behaviour-, conduct- or other psychiatric disorders. Among adolescents (aged 15-24) suicide was the first leading cause of death in 2010. Despite great advances in the psychopharmacology and psychotherapy of mental disorders, suicides persist as a major cause of mortality, especially among the 15-24-year old population. Victims of suicide are not healthy individuals. They always suffer from psychiatric or mental, physical or somatic, cultural (social, historical, mythological) and spiritual disorders. The author tries to classify suicide protective and risk factors according to physical-biological, mental-psychological, cultural-social, and spiritual aspects. However, it must be remembered that these factors are not necessarily present in each and every case and may vary from one country to another, one person to another, depending on cultural, political, (spiritual) and economical features. Risk and protective factors can occur (1) at the physical or biological-somatic level which includes physical circumstances, genetics, health, and diseases; (2) at the mental or psychological level, which includes mental health, self-esteem, and ability to deal with difficult circumstances, manage emotions, or cope with stress; (3) at the cultural level or the broader life environment, and this includes social, political, environmental, and economic factors that contribute to available options and quality of life; (4) at the social level, which includes relationships and involvement with others such as family, friends, workmates, the wider community and the person's sense of belonging; (5) at the spiritual level, which includes faith, hope, charity, despair, salvation. Children and adolescents spend a lot of time at school, so teachers must be educated to notice any warning signs of suicide, but the majority of pedagogues not only do not know the most important mental and psychosomatic symptoms, but do not recognize them in children and do not know how to handle them either. Hopelessness is the most important spiritual risk factor. The Beck Hopelessness Scale is a tool for easy application in general practice. The author lists some important symptoms and signs that neither parents nor teachers are able to recognize and handle, and provides useful advice for prevention.

[Correlation of suicide and antidepressant prescriptions (N06A) by gender and age groups in Hungary and Bács-Kiskun County between 1999-2006]. / Az öngyilkosság és az antidepresszív gyógyszerek fogyasztása (N06A) közötti összefüggés vizsgálata nemenként és korcsoportonként Magyarországon és Bács-Kiskun megyében 1999-2006 között.

INTRODUCTION: The author examines and determines the effect of antidepressant prescription and consumption on suicides by gender and age group in Hungary and Bács-Kiskun County. Despite the significant decrease in the number of suicides both in Hungary and Bács-Kiskun County since 1984, the figure is still very high. Behind the generally decreasing statistical figures, between 2007 and 2009 the number of suicide victims increased by 0.5%, and the number of male suicide victims increased by 2.2% in Hungary. There are several new hypotheses to explain the decrease, among which the most controversial is the one looking for connections between the decreasing number of suicide victims and the increasing consumption of antidepressants (N06A). METHODS: The connections between suicides and the consumption of antidepressants was examined and analyzed in the population in 1999-2006, in Hungary and Bács-Kiskun County on the basis of the data of the Hungarian Central Statistical Office and National Health Insurance Company. Four indicators were used in the analysis of antidepressant consumption and suicides: 1. The number of patients using antidepressants. 2. The days of treatment: DOT. 3. The amount of the selected antidepressant. 4. DHD: DDD/1000 inhabitant/day. (DDD: Defined daily dose by the WHO). The connections were identified with correlation coefficients. RESULTS: The results of the analysis supported the hypothesis that in spite of some contradictions there is a connection between the increase in antidepressant use and the decrease in the number of suicides. The increased use of antidepressants is one of the factors contributing to the decrease of suicides. CONCLUSION: Although the complex diagnostics and treatment of depression will lead to the decrease of the risk of suicide in depressed patients, there is an underlying question to be explained in future research: considering the fact that depressive disorders can be treated, why this cannot lead to a more intense decrease in the number of suicides. In future suicide prevention programs higher attention must be paid to high risk populations, especially depressed patients.

Disturbance of perception in depressive disorders in the different diagnostical systems.

INTRODUCTION: Disturbances of perception play a considerable role in depressed patients' symptoms. These symptoms are mostly secondary in the daily practice, however, the disturbances of perception of a mild degree lead to cognitive distortions, and they make the recognition of the depression significantly more difficult. PURPOSE: To review several systems of diagnostic criteria, five developed in Europe, ten in the United Kingdom, five in the United States and five other diagnostic systems with respect to the kind of significance they ascribe to the disturbances of perception in the presence of depression. RESULTS: The author establishes that the diagnostic systems examined in case of the patients suffering from depression ascribe different significances to the disturbances of perception despite the fact that all depressed patients suffer from these symptoms. In case of the 23 examined disturbances of perception, out of the 25 systems 20 ascribe significance to fewer than ten symptoms, 11 systems ascribe significance to five or fewer symptoms. In the process of the simplification of the diagnostic systems these symptoms do not obtain emphasis, which makes the establishment of the accurate diagnosis difficult. The author emphasizes that in the background of disturbances of perception the detection of the misshapen reality hides, from which the patients suffer the most. Out of the examined diagnostic systems the European and the complex diagnostic systems ascribe a more considerable emphasis to the disturbances of perception. In Kielholz's system there are 14, while in the CODE system there are 19 kinds of disturbances of perception. CONCLUSION: The author establishes that the disturbances of perception and the symptoms developed by the consequences of the disturbances of perception have a greater significance in patients suffering from depressive disorders than it is known in the common knowledge. In fact most of the psychiatric signs and symptoms may be attributable to some kind of disturbance of perception. Out of the examined diagnostic systems Paul Kielholz's and Thomas Ban's complex diagnostic system, the CODE-DD takes the significance of the disturbances of perception into consideration in the largest degree. It is necessary to keep in mind that patients suffering from depression with disturbances of perception also present have difficulty in recovery. In the process of the simplification of the diagnostic systems these symptoms may evade the doctors' attention making the recognition of the illness more difficult and weaken the efficiency of the therapy. It would be justified to indicate the disturbances of perception as a diagnostic criterion in the ICD-11 and in the DSM-V among the illnesses related to depression. Paying attention to the disturbances of perception may transform the system of psychiatric classifications and the research of psychiatric illnesses not only in case of affective disorders but also in case of psychoses. Especially the genetic research concerning the disturbances of perception may support the objective judgement of the psychiatric disorders, its biological tenability could stabilize the situation of psychiatry among medical sciences.

Antidepressant prescription and suicide rates: effect of age and gender.

To determine whether the effect of antidepressant exposure on suicide rate is modified by age and gender in Hungary, annual antidepressant prescription rates and suicide rates of about 10 million inhabitants between 1999-2005 were analyzed by age and gender groups. The suicide rate was inversely related to the increased use of antidepressants in both genders. The strongest association was found in the oldest age groups, where the increase in antidepressant use was highest, while there was no association in the under 20 or 50-69 age groups in either gender. Antidepressant prescription rate was related to suicide rate after controlling for divorce rate or unemployment rate, but not after controlling for alcohol consumption rate.

A suicide prevention program in a region with a very high suicide rate.

CONTEXT: Suicide is a major cause of mortality worldwide. Rates vary widely within and between countries. A suicide prevention program has never been tested in a region with a very high suicide rate in comparison with control regions without such intervention over the same period. OBJECTIVE: To determine the effectiveness of a depression-management educational program for general practitioners (GPs) on the suicide rate in a region with a high suicide rate in Hungary. DESIGN: Effects were compared with a control region, the larger surrounding county, and Hungary. SETTING: Southwest Hungary. PARTICIPANTS: Twenty-eight GPs servicing 73,000 inhabitants participated in the educational program. INTERVENTION: A 5-year depression-management educational program for GPs and their nurses was implemented together with establishment of a Depression Treatment Clinic and psychiatrist telephone consultation service in the intervention region. MAIN OUTCOME MEASURES: The primary study outcome measure was annual suicide rate. The secondary outcome measure was antidepressant prescription use. RESULTS: The annual suicide rate in the intervention region decreased from the 5-year preintervention average of 59.7 in 100,000 to 49.9 in 100,000. The decrease was comparable with the control region but greater than both the county and Hungary (P < .001 and P < .001, respectively). In rural areas, the female suicide rate in the intervention region decreased by 34% and increased by 90% in the control region (P < .07). The increase in antidepressant treatment was greater in the intervention region compared with the control region, the county, and Hungary and in women compared with men (P < .002). CONCLUSIONS: A GP-based intervention produced a greater decline in suicide rates compared with the surrounding county and national rates. Increases in patients with depression treated and of dosing were modest and may require additional measures such as depression-care managers. The importance of alcoholism in local suicides was unanticipated and not addressed. Optimal suicide prevention plans must consider major local risk factors.

[Adjuvant therapy with parenteral piracetam in alcohol withdrawal delirium]. / Piracetam infúziós alkalmazása adjuváns kezelésként alkoholmegvonásos delirium kezelésében.

The author reports his results of parenteral piracetam treatment in 193 patients admitted to the Psychiatric Department of Semmelweis Hospital with alcohol withdrawal delirium. Alcohol withdrawal delirium is a complex metabolic disorder, the disturbance of the highest cerebral integrative functions, which is caused by the impairment of cerebral oxidative metabolism. Piracetam is effective on most neurotransmitter systems, without a specific receptor agonism or antagonism, increases the effectivity of different biogenic amine systems, has also an effect on membrane permeability, increases the concentration of NMDA (methyl-D-aspartate) receptors in the impaired brain and improves cognitive functions. In the patients suffered from alcohol dependence piracetam produces positive morphologic changes, by decreasing lipofuscin accumulation. In early stage it prevents the development of delirium. Despite of the great number (approximately 150) of medication that were tried in the treatment of delirium, the ideal one still has not been found. Among the accessible therapeutic possibilities the author searched for methods which make the treatment more effective. The administration of parental piracetam, therefore was brought into his therapeutical protocol. Parenteral piracetam--similarly to literature data--proved to be effective in the treatment of alcohol withdrawal delirium. Considering the present--insufficient--hospital financing, it is remarkable that though the costs of the new therapy are higher than the traditional meprobamat therapy, through less side effect it is more economical (overall costs lower) and by decreasing the time of delirium it is more humane to the patients.