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.

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.

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.

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.

[Is suicide a sin?]

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.

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

No abstract available.

[Design and development of a new information technology platform for patients with dementia].

AIM: As dementia, including Alzheimer's disease is a major public health issue worldwide, there are many efforts at European level to promote active and healthy ageing. University of Pecs joined the ICT4Life project - supported by the European Union H2020 programme - in 2016. The aim of this three-years project is to improve qualityof- life and autonomy of patients with mild or moderate dementia with developing a new Information and Communication Technology (ICT) platform, which may provide help for patients, caregivers and professionals. METHOD: The ICT4Life research is conducted among patients with cognitive decline, their relatives, caregivers, and professionals involved in their care. The needs of the different actors are assessed with semi-structured interviews and clinical scales (cognitive and affective scales, quality-of-life measurements, functionality, caregiver burden), which help to develop a user-friendly, adaptive and personalized platform. RESULT: Using the integrated ICT platform (bio-sensors, smart TV, tablet, mobile, bracelet) may contribute to monitor (physical, psycho-motor and emotional states) elderly with cognitive decline and to provide better and personalized care for them. The platform includes cognitive enhancement with gamification, and focuses also on the decrease of professional and caregiver burden. CONCLUSION: Here we report on the ICT4Life programme, which develops an ICT solution for individuals with early stage cognitive impairment while contributing in a user-friendly way to extending their independence and improve their quality-of-life.

Word Use and Content Analysis of the First Verses of Six National Anthems: A Transcultural Aspect of Suicidal Behaviour.

BACKGROUND: Suicide is a major health concern worldwide, although suicide rates widely differ among different countries and cultures. Transcultural studies suggest that national anthems reflect national attitudes towards self-harming behaviour as well. Our aim was to analyse the linguistic characteristics of six national anthems, and compare these results with national suicide rates. METHODS: Word use assessment and content analysis of six national anthems were performed. RESULTS: In the anthems of countries with similar historical or cultural background, similar linguistic patterns were found in word use and in content. Anthems of countries with lower suicide rates tend to contain relatively more positive contents, emotions and intentions, while in the anthems of countries with higher suicide rates more ambivalence, denial, loss or even aggressive and self-destructive implications were found. CONCLUSION: This transcultural analysis strengthens previous data that anthems could be indicators for national attitudes toward self-harm.

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.

Motion and viewing analysis during minimally invasive surgery for autostereoscopic visualization.

PURPOSE: Autostereoscopic 3D visualization (ASV) forms a potentially appealing alternative to stereoscopic 3D displays to help surgeons regain depth perception during minimally invasive surgery (MIS). However, the feasibility of using single-viewer ASV has not yet been demonstrated in a clinical context. The purpose of the study is to analyze the current surgical workflow and display usage and assess the potential for using ASV in MIS applications. Additionally, the study seeks to acquire a better understanding of key design requirements, such as the eye-tracking performance and the lenticular lens 3D workspace. METHODS: Two types of gynecologic interventions were investigated. A vision-based tracking system was developed, consisting of depth cameras mounted on the displays and ArUco markers placed on the hair caps of clinicians and the wall of the operating room. This allowed simultaneous tracking of the pose of operating staff and displays. RESULTS: Overall 20 surgeries were recorded, where 4 clinicians operated using 3 displays. Users were typically standing at a mean distance of 1900 mm in a range from to 1200 to 2300 mm from the display. Left-right motion was from - 600 to 658 mm. Clinicians stood on average 1000 mm from each other. The head roll angle was below 16[Formula: see text]. CONCLUSION: Surgeons were looking predominantly (99%) to the same display. Observations took place from fairly well-defined places and with sufficient potential to differentiate between clinicians, suggesting that single-viewer ASV would be feasible.

Comparison of 2D and autostereoscopic 3D visualization during mixed reality simulation.

PURPOSE: In general minimally invasive surgical procedures, surgeons are tied to 2D visualization, leading to the loss of depth perception. This can lead to large mental load for the surgeons and may be responsible for the long learning curve. To restore the sense of depth, this study investigated the use and benefits of an autostereoscopic (3D) display during a simulated laparoscopic task. METHODS: A mixed reality simulator was developed for comparing the performance of participants while using 2D and autostereoscopic 3D visualization. An electromagnetic sensor was mounted on a physical instrument, and its pose was mapped to the virtual instrument. The virtual scene was developed using Simulation Open Framework Architecture (SOFA). Finite element modeling was used to calculate interaction forces, which were then mapped to visual soft tissue deformation. RESULTS: Ten non-expert participants completed a virtual laparoscopic task, where the subjects were asked to contact eighteen target areas distributed on the surface of the vagina, both in 2D and 3D. Results showed an improvement with 3D vision in task completion time (-16%), total traveled distance (-25%) and errors made (-14%). There was no difference in the average contact forces between the vagina and the instrument. Only the difference in time and forces were shown to be statistically significant. CONCLUSION: Overall, autostereoscopic 3D showed superiority over conventional 2D visualization. The traveled trajectory increased in 2D as the instrument was retracted more between the targets to avoid contact. The 2D and 3D deformation upon contact seems not to contribute differently to force perception. However, the participants only had visual feedback, but no haptic feedback. Therefore, it could be interesting to include haptic feedback in a future study.

[Role of second-generation antipsychotics in the treatment of affective disorders -- review of the literature and future perspectives]. / A második generációs antipszichotikumok szerepe az affektív zavarok kezelésében -- a szakirodalmi adatok áttekintése és a jövö perspektívái.

This article reviews the role of the second generation antipsychotics in the treatment of affective disorders. The treatment of major depressive disorders and the acute and long-term treatment of bipolar affective disorders are also discussed. After the special role of quetiapine is highlighted, a novel psychopharmacological terminology and nomenclature are also introduced.

[Wording and content of national anthems -- preliminary findings from a transcultural investigation of suicide]. / Nemzeti himnuszok szóhasználata és tartalomelemzése - elozetes eredmények egy transzkulturális szuicidium vizsgálatból.

Suicide is still a major health concern, although suicide rates widely differ among different countries and cultures. Thus, besides biological and clinical studies, there is an increasing transcultural research activity on suicidal behaviour. We are presenting here some important transcultural aspects of suicidal behaviour and report some preliminary findings of our transcultural suicide research. Based on the previous data and on our investigations it is likely that the national character and the attitudes toward self-harm are reflecting in some major cultural, historical texts of a nation.

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.

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.

An Augmented Reality-Based Interaction Scheme for Robotic Pedicle Screw Placement.

Robot-assisted surgery is becoming popular in the operation room (OR) for, e.g., orthopedic surgery (among other surgeries). However, robotic executions related to surgical steps cannot simply rely on preoperative plans. Using pedicle screw placement as an example, extra adjustments are needed to adapt to the intraoperative changes when the preoperative planning is outdated. During surgery, adjusting a surgical plan is non-trivial and typically rather complex since the available interfaces used in current robotic systems are not always intuitive to use. Recently, thanks to technical advancements in head-mounted displays (HMD), augmented reality (AR)-based medical applications are emerging in the OR. The rendered virtual objects can be overlapped with real-world physical objects to offer intuitive displays of the surgical sites and anatomy. Moreover, the potential of combining AR with robotics is even more promising; however, it has not been fully exploited. In this paper, an innovative AR-based robotic approach is proposed and its technical feasibility in simulated pedicle screw placement is demonstrated. An approach for spatial calibration between the robot and HoloLens 2 without using an external 3D tracking system is proposed. The developed system offers an intuitive AR-robot interaction approach between the surgeon and the surgical robot by projecting the current surgical plan to the surgeon for fine-tuning and transferring the updated surgical plan immediately back to the robot side for execution. A series of bench-top experiments were conducted to evaluate system accuracy and human-related errors. A mean calibration error of 3.61 mm was found. The overall target pose error was 3.05 mm in translation and 1.12∘ in orientation. The average execution time for defining a target entry point intraoperatively was 26.56 s. This work offers an intuitive AR-based robotic approach, which could facilitate robotic technology in the OR and boost synergy between AR and robots for other medical applications.