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.

Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task.

INTRODUCTION: Theory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder. METHOD: 31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described. RESULTS: In the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = -3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance. CONCLUSIONS: Overall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.

Investigation of peripheral inflammatory biomarkers in association with suicide risk in major depressive disorder.

Suicide is the most severe complication of major depressive disorder (MDD). Novel research assumes the role of immunological dysregulation in the background - several studies have reported alterations in the number of inflammatory cells related to both MDD and suicidality. There are currently no objective, routinely measured parameters to indicate suicidal vulnerability. However, altered inflammatory cell numbers and ratios have been proposed as potential biomarkers of suicide risk (SR). The present research aims to examine changes of these values related to increased SR in MDD as an assumed inflammatory state. We investigated laboratory parameters of psychiatric in-patients diagnosed with MDD (n = 101) retrospectively. Individuals with recent suicide attempt (SA) (n = 22) and with past SA (n = 19) represented the high SR group. MDD patients with no history of SA (n = 60) composed the intermediate SR group. We compared the number of neutrophil granulocytes, monocytes, lymphocytes, platelets, white blood cell count (WBC), neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red blood cell distribution width (RDW) and erythrocyte sedimentation rate (ESR). Furthermore, we evaluated alterations of these parameters related to antidepressant (AD) and antipsychotic (AP) treatment, which have been proved to have anti-inflammatory effects. We found a significant increase in neutrophil granulocyte count, NLR, monocyte count, MLR, WBC and ESR in patients with recent SA compared to patients with no history of SA. Moreover, there was a significant elevation in monocyte count, MLR, ESR and RDW in patients with high SR compared to patients with intermediate SR. AD treatment resulted in a significant decrease in neutrophil granulocyte count and NLR, however, it did not affect monocyte count and MLR. Assuming immunological mechanisms in the background of MDD and suicidality, our findings support the role of NLR as a biomarker of acute SR, though its alterations may be masked by possible anti-inflammatory effects of AD treatment in the long term. However, MLR, a marker exhibiting changes which are not attenuated by pharmacotherapy, may be a possible indicator of both acute and long-term suicidal vulnerability.

[The role of mental health support for medical students.] / Az orvostanhallgatók számára fenntartott mentálhigiénés segítségnyújtás szerepe.

INTRODUCTION: The mental health of medical students is of critical importance during their medical studies, which can be a long and challenging period. Academic expectations, high workload, and emotional stress can contribute to mental burden and burnout among medical students, placing an increased burden on the healthcare system in the future. Therefore, psychological support and mental health services play a crucial role in medical education. OBJECTIVE: The aim of this study is to present and examine the role of the Psychological Counseling Service at the University of Pécs Medical School in supporting the mental health of medical students since its establishment in 2007. METHOD: In this study, we present the combined quantitative and qualitative results from the period between November 2021 and May 2023, as registered by the students and staff utilizing the Service as well as the counseling psychologists working at the Service. The data include the number of consultations, the patterns of the most frequently occurring problems (based on the Counseling Professional Protocol), and the mental well-being of the population receiving psychological support (GHQ-12). RESULTS: During the examined period, a total of 1111 individuals made use of the Service in 2012 appointments. Both students and staff most commonly sought assistance from the Service in addressing relationship difficulties (37.6%) and coping with negative life events (33.1%). Based on the data collected since October 2022 (n = 113), nearly 10% of the attendees were taking medication for psychiatric treatment, a significantly higher percentage among international students. Furthermore, 38.9% had previously received professional help. The average score on the GHQ-12 questionnaire is 8 points, which is significantly above the 5-point threshold achieved by 78.6% of respondents. CONCLUSION: The results demonstrate that the Psychological Counseling Service at the University of Pécs Medical School plays a significant role in supporting the mental health of medical students. It contributes to more effective coping with academic challenges, reducing the risk of emotional stress and burnout. Orv Hetil. 2023; 164(45): 1778-1786.

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.

The effect of reading literary fiction on the theory of mind skills among persons with schizophrenia and normal controls.

Introduction: Recent research data suggest that theory of mind (ToM) skills may improve after reading literary fiction. However, beside this short term favorable effect, regular long-term reading of literary fiction may also support ToM development or may improve ToM performance. The presence of impaired ToM abilities is well-documented in schizophrenia; however, the role of reading in these deficits is unknown. In the present study our aim was to assess the effect of prior reading experiences on theory of mind performance in patients with schizophrenia, and in healthy controls. Materials and methods: ToM assessment was done with the Short Story Task, which is based on the interpretation of a Hemingway short story. After reading the short story, questions were asked in an interview format regarding comprehension, explicit and implicit ToM skills, then comparative analysis of schizophrenia patients was performed (n = 47) and matched to a normal control (n = 48) group concerning deficits of ToM abilities. Participants were also stratified according to their prior reading experiences. Results: Previous reading experience was associated with better comprehension and explicit ToM performance both in patients with schizophrenia, and in healthy controls. However, the explicit ToM performance of patients with prior reading was still weaker compared to healthy controls with reading experiences. Path model analysis revealed that reading had a direct positive effect on ToM, and an indirect effect through improving comprehension. Conclusions: Prior reading experience is associated with better ToM performance not just in healthy controls but also in patients living with schizophrenia. Previous reading experience also improves comprehension, which in turn has a favorable impact on ToM. Our results support the idea that literary fiction reading may have a therapeutic potential in the rehabilitation of schizophrenia.

[Questions and challenges in the diagnostics of gender identity disorder. Review and case vignettes].

Professionals working in the field of psychiatry have recently been increasingly encountering patients seeking help who define themselves as transsexual. Gender identity and gender self-expression of transsexual people do not match their biological sex, and they also feel an intense desire and urge to change their officially registered gender at birth and their physical appearance - even by using hormone therapy or surgery. In their case, the diagnosis of gender identity disorder as a disease category enables the use of medical interventions and health services necessary for transition. At the same time, the diagnosis is complicated by the fact that there is currently no specific psychodiagnostic procedure suitable for the clear identification of gender identity disorder, and gender incongruence can also appear as a symptom of many other mental disorders. Therefore, careful differential diagnosis is essential to establish a well-founded diagnosis, with the help of this literature review that summarizes other mental illnesses with similar symptoms as well as the more common comorbid pathologies.

[The role of socialisation in psychosexual development].

INTRODUCTION: In the recent research and interpretation of the genetical-biological and environmental-social factors shaping psychosexual development, in addition to scientific arguments, more and more ideological and political aspect have received unfortunate emphasis. OBJECTIVE: Since the literature investigating the development of gender identity and gender orientation has not only increased, but also polarized, it is timely to look at the scientific exchange of ideas and debates among the differing positions. METHOD: Exploring the significance of genetic, biological and social factors involved in the development of gender identity and gender orientation based on international literature data. RESULTS: Based on the current state of science it can be concluded that, in addition to the indisputably marked genetic-biological factors, education and social patterns, as well as the extremely complex environmental and media-related influence with its variable intensity and diverse emotional content also play a significant role in the psychosexual development. This is supported, among other observations, by the data indicating that homoerotic behavior is more common in people raised by same-sex couples. CONCLUSION: As psychosexual development is determined jointly by both genetic-biological and social factors (like education, media etc), belonging to a sexual minority group is not a choice, not the result of a personal decision. Therefore, any kind of discrimination in this regard is unacceptable. Further scientific studies are necessary to answer a large number of questions that still remain open.

High prevalence of suicide-related internet use among patients with depressive disorders - a cross-sectional study with psychiatric in-patients.

The association between Internet use and suicidal behavior is a subject of intense research. Internet use patterns of patients with depressive disorders were assessed to determine the prevalence and aim of browsing for suicide-related contents and its impact on help-seeking. Self-administered questionnaire among psychiatric in-patients treated for depression was used to assess suicidal behavior, characteristics of Internet use and help-seeking preferences. 113 psychiatric in-patients with depressive disorders participated in the study. One-third had a history of life-time suicide attempt and the majority had already encountered suicide-related contents while browsing the Internet. 27.4% reported intentional and specific search for suicidal contents. This suicide-related Internet user (SRIU) group was characterized by younger age, single status, more frequent suicidal ideations, and they more likely considered that they would attempt suicide in the future. Among patients with depressive disorders, a sub-group was identified with a potential higher suicide risk. The frequent use of the Internet and online help-seeking preference may provide an opportunity to prevent suicidal behavior in this high-risk sub-group. Further research is needed into the possibilities of using the Internet more effectively for suicide prevention.

Increased prevalence of minor physical anomalies in patients with epilepsy.

Our aim was to investigate the rate and topological profile of minor physical anomalies (MPAs) in adult patients with epilepsy with the use of the Méhes Scale, a comprehensive modern scale of dysmorphology. Consecutive epilepsy patients admitted for outpatient evaluation were included. Patients with comorbidities of neurodevelopmental origin (such as autism, severe intellectual disability, attention deficit hyperactivity disorder, schizophrenia, tic disorder, Tourette syndrome, bipolar disorder, specific learning disorder and specific language impairment) were excluded. All participants underwent physical examination with the use of the Méhes Scale for evaluation of MPAs, including 57 minor signs. The frequency and topological profile of MPAs were correlated to clinical patient data using Kruskal-Wallis, chi2 tests and logistic regression model. 235 patients were included, according to the following subgroups: acquired epilepsy (non-genetic, non-developmental etiology) [N = 63], temporal lobe epilepsy with hippocampal sclerosis (TLE with HS) [N = 27], epilepsy with cortical dysgenesis etiology [N = 29], cryptogenic epilepsy [N = 69] and idiopathic generalized epilepsy (IGE) [N = 47]. As controls, 30 healthy adults were recruited. The frequency of MPAs were significantly affected by the type of epilepsy [H(6) = 90.17; p < 0.001]. Pairwise comparisons showed that all patient groups except for acquired epilepsy were associated with increased frequency of MPAs (p < 0.001 in all cases). Furrowed tongue and high arched palate were more common compared to controls in all epilepsy subgroup except for TLE (p < 0.001 or p = 0.001 in all cases). A positive association was detected between the occurrence of MPAs and antiepileptic drug therapy resistance [Exp(B) = 4.19; CI 95% 1.37-12.80; p = 0.012]. MPAs are more common in patients with epilepsy, which corroborates the emerging concept of epilepsy as a neurodevelopmental disorder. Assessment of these signs may contribute to the clarification of the underlying etiology. Moreover, as increased frequency of MPAs may indicate pharmacoresistance, the identification of patients with high number of MPAs could allow evaluation for non-pharmacological treatment in time.

Ambiguous handedness and visuospatial pseudoneglect in schizotypy in physical and computer-generated virtual environments.

Virtual reality (VR) technology has increased clinical attention in the health care of schizophrenia spectrum disorders in both diagnoses of the symptoms and assessment of schizotypal traits. However, the exact nature of VR-induced positive treatment effect in schizotypy is still unknown. In this study, VR technology was used as a non-invasive neurocognitive trigger to test the asymmetric visuospatial representational instability found in individuals with high schizotypy. The study aimed to reveal the brain functional hemispheric laterality in physical and virtual realities in individuals with schizotypal traits. Fifty-one healthy, right-handed participants (24 males and 27 females) were enrolled through public advertisements. Hemispheric functional asymmetry was measured by the Line Bisection Task (LBT). The results revealed that (a) LBT bias in the physical reality showed a handedness-related leftward pseudoneglect, however, similar handedness-related pseudoneglect in VR has not been found. (b) Comparing LBT bias in physically real and VR environments showed rightward drift in VR environments independently to the degree of handedness. (c) The schizotypy has no association with handedness, however, the cognitive schizotypy is related to the LBT bias. Higher cognitive schizotypy in VR associated with left hemispatial pseudoneglect. In conclusion, schizotypy is associated with ambiguous behavioral and cognitive functional laterality. In individuals with high cognitive schizotypy, the VR environment enhanced the representational articulation of the left hemispace. This effect may be originated from the enhancement of the right hemisphere overactivation and is followed by a lower mental control of the overt behavior.

Suicide risk management in clinical practice. Current challenges and future perspectives / Az öngyilkossági rizikó becslése a klinikai gyakorlatban. A jelen kihívásai és a jövo perspektívái

There is still little reliable information about the psychological processes underlying suicidal behaviour, and suicide risk assessment scales also have only limited predictive value. However, the recently described suicide-specific syndromes such as acute suicidal affective disorder (ASAD) and suicide crisis syndrome (SCS) open up new possibilities for a complex interpretation and prediction of suicidal behaviour. We briefly summarize modern theoretical approaches explaining the development of suicidal behaviour, the possibilities of predicting suicide risk, and contemporary methods of assessing pre-suicidal psychopathological symptoms, highlighting the suicide-specific syndromes and their screening tools. The results of the systematic review of the suicide-specific syndrome literature indicate that both the ASAD construct and the SCS may be helpful in predicting suicidal behaviour and they correlate with other similar questionnaires. Suicide-specific syndromes and the measurement tools are proven to be effective in theoretical research as well as in the field of clinical applicability in the prediction of suicidal behaviour, so their adaptation and application in Hungary may be recommended.

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.

Anti-Neuronal Autoantibodies (Cell Surface and Onconeural) and Their Association With Natural Autoantibodies in Synthetic Cannabinoid-Induced Psychosis.

Patients suffering from encephalitis may present psychiatric symptoms; however, the clinical relevance of anti-neuronal antibodies in patients experiencing a psychotic episode without encephalitis is still unclear. In this study, we examined the presence of anti-neuronal cell surface autoantibodies and onconeural autoantibodies in serum samples of 22 synthetic cannabinoid users presenting with psychosis. We found only two positive cases; however, seven patients had borderline results. Nonetheless, we found no significant correlation between anti-neuronal autoantibodies and the intensity of psychosis indicated by the Positive and Negative Syndrome Scale (PANSS) scores. The length of drug use and the combination of other drugs with synthetic cannabinoids have no significant effect on anti-neuronal autoantibody positivity. Nonetheless, the ratio of anti-citrate synthase (anti-CS) IgM and IgG natural autoantibodies was significantly lower (p = 0.036) in the anti-neuronal autoantibody-positive/borderline samples, than in the negative group. Interestingly, anti-CS IgM/IgG showed a significant negative correlation with PANSS-positive score (p = 0.04, r = -0.464). Our results demonstrated that anti-neuronal autoantibody positivity occurs in synthetic cannabinoid users, and the alteration of anti-CS IgM/IgG natural autoantibody levels points to immunological dysfunctions in these cases.

[Attila József - psychoanalysis - Hungarian literary history. Interview with the 70-year-old Antal Bókay].

No abstract available.

Implicit Mentalizing in Patients With Schizophrenia: A Systematic Review and Meta-Analysis.

INTRODUCTION: Mentalizing is a key aspect of social cognition. Several researchers assume that mentalization has two systems, an explicit one (conscious, relatively slow, flexible, verbal, inferential) and an implicit one (unconscious, automatic, fast, non-verbal, intuitive). In schizophrenia, several studies have confirmed the deficit of explicit mentalizing, but little data are available on non-explicit mentalizing. However, increasing research activity can be detected recently in implicit mentalizing. The aim of this systematic review and meta-analysis is to summarize the existing results of implicit mentalizing in schizophrenia. METHODS: A systematic search was performed in four major databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science. Eleven publications were selected. Five studies were found to be eligible for quantitative synthesis, and 9 studies were included in qualitative synthesis. RESULTS: The meta-analysis revealed significantly lower accuracy, slower reaction time during implicit mentalizing in patients with schizophrenia. The systematic review found different brain activation pattern, further alterations in visual scanning, cue fixation, face looking time, and difficulties in perspective taking. DISCUSSION: Overall, in addition to the deficit of explicit mentalization, implicit mentalization performance is also affected in schizophrenia, if not to the same extent. It seems likely that some elements of implicit mentalization might be relatively unaffected (e.g., detection of intentionality), but the effectiveness is limited by certain neurocognitive deficits. These alterations in implicit mentalizing can also have potential therapeutic consequences.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021231312.

["Why not?" - The medical diagnoses of Michel Foucault].

No abstract available.

["Praecox-Gefühl". A brief look].

No abstract available.