[Depressed reality].

No Abstract Available.

Polymorphisms in genes of melatonin biosynthesis and signaling support the light-at-night hypothesis for breast cancer.

Light-at-night triggers the decline of pineal gland melatonin biosynthesis and secretion and is an IARC-classified probable breast-cancer risk factor. We applied a large-scale molecular epidemiology approach to shed light on the putative role of melatonin in breast cancer. We investigated associations between breast-cancer risk and polymorphisms at genes of melatonin biosynthesis/signaling using a study population of 44,405 women from the Breast Cancer Association Consortium (22,992 cases, 21,413 population-based controls). Genotype data of 97 candidate single nucleotide polymorphisms (SNPs) at 18 defined gene regions were investigated for breast-cancer risk effects. We calculated adjusted odds ratios (ORs) and 95% confidence intervals (CI) by logistic regression for the main-effect analysis as well as stratified analyses by estrogen- and progesterone-receptor (ER, PR) status. SNP-SNP interactions were analyzed via a two-step procedure based on logic regression. The Bayesian false-discovery probability (BFDP) was used for all analyses to account for multiple testing. Noteworthy associations (BFDP < 0.8) included 10 linked SNPs in tryptophan hydroxylase 2 (TPH2) (e.g. rs1386492: OR = 1.07, 95% CI 1.02-1.12), and a SNP in the mitogen-activated protein kinase 8 (MAPK8) (rs10857561: OR = 1.11, 95% CI 1.04-1.18). The SNP-SNP interaction analysis revealed noteworthy interaction terms with TPH2- and MAPK-related SNPs (e.g. rs1386483R ∧ rs1473473D ∧ rs3729931D: OR = 1.20, 95% CI 1.09-1.32). In line with the light-at-night hypothesis that links shift work with elevated breast-cancer risks our results point to SNPs in TPH2 and MAPK-genes that may impact the intricate network of circadian regulation.

Does working in an extremely cold environment affects lung function?: 10 years follow-up.

OBJECTIVE: The aim of this study is to investigate whether there is an association between brief but repeated exposures to extremely cold temperatures over many years and pulmonary function. METHODS: We performed a retrospective analysis of the data collected over 10 years in the context of the extended medical examinations of storeworkers exposed to extremely cold temperatures. We considered forced vital capacity (FVC), forced expiratory volume in one second (FEV1), Tiffeneau-Pinelli index (FEV1/FVC), CO diffusion capacity (DL,CO) and Krogh-factor (CO diffusion capacity relative to recorded alveolar volume, DL,CO/VA) reported as %-predicted. We analysed trends in outcome parameters with linear mixed models. RESULTS: 46 male workers participated in at least two extended medical examinations between 2007 and 2017. Overall 398 measure points were available. All lung function parameters had values above the lower limit of normality at the first examination. In the multivariate model including smoking status and monthly intensity of cold exposure (≤ 16 h/month vs. > 16 h/month) FEV1%-predicted and FVC %-predicted had a statistically significant positive slope (FEV1, 0.32% 95% CI 0.16% to 0.49% p < 0.001; FVC 0.43% 95% CI 0.28% to 0.57% p < 0.001). The other lung function parameters (FEV1/FVC %-predicted, DL,CO %-predicted, DL,CO/VA %-predicted) showed no statistically significant change over time. CONCLUSIONS: Long term intermittent occupational exposure to extreme cold temperatures (-55 °C) does not appear to cause irreversible deleterious changes in lung function in healthy workers, thus the development of obstructive or restrictive lung diseases is not expected.

Accidents, diseases and health complaints among seafarers on German-flagged container ships.

BACKGROUND: For seafarers on the high seas health hazards are various and due to the setting also specific. The spectrum of job-related health impairments and accidents is mainly influenced by the maritime characteristics. The aim of this study is to assess the kind of accidents and the frequency of diseases and health complaints among seafarers on German container ships by evaluating medical log books. METHODS: A systematic analysis of 14,628 medical entries from 95 medical log books of 58 container ships under German flag from 1995 to 2015 was performed. This monocentric retrospective and descriptive study used information on accidents, diseases and health complaints among different occupational groups and medical treatment procedures for the analysis and evaluation. RESULTS: The analysis showed that more than one third of all consultations with the Health Officer on board are related to internal (33.7%) and surgical (31.3%) symptoms. Almost twenty percent of consultations were due to respiratory infections (19.6%) and accidents (17.9%). Accidents represented the most frequent reason for unfitness for sea service (31.2%). Based on occupational categories, most injuries occurred among deck crew (22.5%), followed by ratings working in the engine room (18.9%). In 106 cases, telemedical contact with a physician ashore was necessary. In total, 15 seafarers had to be evacuated from the ship for further medical treatment onshore. Medicine/drug application was the most common therapeutic measure on board, accounting for 77% of all consultations. CONCLUSIONS: The high proportion of health complaints and accidents among seafarers shows that there is a need to optimize medical care at sea and accident prevention, e.g. by standardized treatment algorithms or improving the medical training of Health Officers. The development and introduction of a digital patient file to record medical treatments on the vessels could also improve medical documentation on board.

Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters.

BACKGROUND: Even almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes. METHODS: Data from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen's κ, and accuracy. RESULTS: Vital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = - 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = - 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = - 0.283, - 0.274, resp.; both P < 0.05). DISCUSSION: The importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.

Evolution of work ability, quality of life and self-rated health in a police department after remodelling shift schedule.

BACKGROUND: There exists a great diversity of schedules concerning the way shift work is organized and implemented with ample agreement regarding recommendable features of a shift system. In order to adapt the shift schedule of a metropolitan police department to current recommendations, a remodelled shift schedule was introduced in 2015. The aim of this study was to evaluate the potential associations between the remodelled shift schedule and work ability, quality of life and self-rated health after one and five years. METHODS: A controlled before-and- after study was conducted during the piloting phase (2015-2016) as well as a 5-year follow-up using paper questionnaires. Outcome parameters included work ability, quality of life and self-rated health. RESULTS: Work ability, quality of life and self-rated health improved after the first year of the newly implemented shift schedule among police officers working in the piloting police stations compared to those working according to the former schedule. In 5-year follow-up differences between indicators diminished. CONCLUSIONS: The implementation of a remodelled shift schedule including more 12-h shifts accompanied by more days off and a coherent weekend off duty was not associated with detrimental effects to work ability, quality of life or self-reported health among police officers.

[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.

[Mentalizing deficit among patients with traumatic brain injury]. / Mentalizációs deficit traumás agysérült betegek körében.

BACKGROUND AND PURPOSE: Mentalization or theory of mind as an aspect of our social cognition, is our ability to infer mental states of others (intentions, desires, thoughts, emotions) and to predict their behavior accordingly. This function significantly affects our participation and orientation in the social world and plays an important role in conversational situations, social interactions, social integ-ration and adaptation. The brain regions that serve as the basis for mind-reading function can be damaged as a consequence of traumatic brain injury, which frequently occurs among the younger population. Traumatic brain injury can cause focal or diffuse cerebral injuries, often leading to theory of mind deficit. METHODS: In this topic such publications were researched that compared theory of mind ability between traumatic brain injury patients and control subjects (comparative case-control studies). We searched for the studies in the following internet based/online databases: PubMed, Web of Science, ScienceDirect, Google Scholar, APA PsycNET (PsycARTICLES) and EBSCO Host. The search was performed using the following key word combinations: theory of mind or mentalizing or social cognition AND traumatic brain injury or head/brain injury or diffuse axonal injury. RESULTS: Based on the results of the included and processed studies (21 pc), traumatic brain injury often leads to mentalization deficit with different severity. CONCLUSION: With this present review we aim to draw attention to the fact that the appearance and severity of mind reading dysfunction can considerably affect the outcome of the disease, the length of rehabilitation time and the prognosis of traumatic brain injury patients. Besides this, with this review, we aim to take sides in whether theory of mind ability is domain-specific or domian-general based on studies including traumatic brain injury patients.

[Differences in implicit and spontaneous mentalization in schizophrenia].

BACKGROUND: The ability to mentalize is essential during social interactions. Mentalization can be divided into two separate systems: to an explicit part characterized by being conscious, reflective, verbal, and to an implicit part that is unconscious, automatic, non-verbal, intuitive. The term spontaneous mentalization is also used for the attribution of mental state that appears without explicit instruction. In schizophrenia, several studies have confirmed the deficit of explicit mentalization, but little data are available on non-explicit mentalization. Our aim is to provide a narrative review of the literature on this issue. METHODS: Based on the methodology used in different publications, we examined implicit and spontaneous mentalization separately. To search for publications on the topic, we performed a PubMed database search. RESULTS: A total of 26 studies, 9 studies examining implicit and 17 studies examining spontaneous mentalization were found. CONCLUSIONS: Based on the results, implicit mentalization is relatively retained, but the effectiveness of implicit detec - tion of intentionality may be significantly influenced by other factors (e.g., neurocognitive deficits). In contrast, studies clearly report a deficit in spontaneous mentalization. Patients with schizophrenia are less sensitive to situations requiring spontaneous mentalizing activity. Interactions are less described by complex intentional mental states, and the descriptions often do not correspond to the particular interaction. Overall, in addition to the deficit of explicit mentalization, implicit or spontaneous mentalization performance is also affected in schizophrenia, if not to the same extent. These different deficits can also have potential therapeutic consequences.

[The significance, effects and potential therapeutic use of literary fiction].

No abstract available.

[Irony comprehension in first degree relatives of patients with bipolar disorder - a pilot fMRI study].

No abstract avalilable.

Telemedical monitoring of patients with chronic heart failure has a positive effect on total health costs.

BACKGROUND: Telemedical programs for patients with chronic heart failure have shown inconsistent effects on survival and hospitalization. Few studies analyzed effects of telemedical interventions on health costs, although this outcome may determine whether or not a successful program will be adopted by health insurance providers. We evaluated a large sized telemedicine program provided by a German statutory health insurance, consisting of regular telephone contacts and, for a subgroup of the participants, provision of an electronic scale in a routine care setting. We examined the effects of the program on the total healthcare costs after one year compared to a matched control group. METHODS: The evaluation was based on reimbursement data of the statutory health insurance. Participants of the program were matched to appropriate controls using a combination of exact (e.g. 5-year age group, gender, NYHA class) and propensity score (e.g. medication, psychiatric comorbidity) matching. The total health costs after one year were calculated on the basis of regression analyses in an intention-to-treat-approach. In a sensitivity analysis, the subgroup of patients with a documented beginning of the intervention was examined. RESULTS: Two thousand six hundred twenty two patients with chronic heart failure (55% male, mean age: 73.7 years) were included in the intervention program. 1943 participants (74%) could be matched with appropriate control patients. The telemedicine monitoring program for patients with chronic heart failure reduced total health costs after 12 months of the intervention: - 276€ per quarter year in rural regions and - 18€ in urban regions compared to the control group. CONCLUSIONS: The telemedicine program could reduce total health costs, especially in rural regions in Germany.

[Patient Journey in Schizophrenia - Lessons of a Hungarian Survey].

The disorder-related experiences of schizophrenic patients are an important basis for personalized treatment. This illness experience is now described with the concept of patient journey. The patient journey shows how the symptoms and treatment interfere with the patient's personal existence and how they affect the optimal functionality. The purpose of our research was to map the patient journey in Hungary, among patients with schizophrenia, in particular how they represent their illness, what kind of met and unmet needs they have in relation to living with the disorder or their treatment. 155 patients living with schizophrenia participated in the study. The survey was conducted through self-completed questionnaires covering the following topics: first encounter with the disorder, life with the disorder, treatment expectations, experiences, support and needs. The first encounter of the patients with the disease was predominantly traumatizing, and the refusal of the diagnosis was characteristic. The inappropriate information on the disorder and the treatment might have been also responsible for this negative perception. Nevertheless, patients were expecting the information primarily from the treatment staff. The decisive majority expects from treatment the possibility of a normal life, the maintenance of stability, and according to every second patient well-being is also a basic requirement. Three-quarters of the patients think that effective medication and treatment staff are the greatest help in relation to the disorder. A significant proportion of the patients formulated the need for psychic and family support, and the need for social relations. Patients with schizophrenia have significant difficulties with financial problems, medication side effects, and stigma. Our results confirm that the subjective perception of patient journey of patients with schizophrenia is significantly determined by the met and unmet needs. The results also emphasize the importance of adequate information transfer and the therapeutic relationship.

[Schizotypy Personality Questionnaire Brief Revisited (SPQ-BR) Hungarian adaptation and interpretation of factors].

INTRODUCTION: The purpose of the Schizotypy Personality Questionnaire - Brief Revised (SPQ-BR) is to help the diagnosis of schizotypial personality disorders within the framework of the DSM-5 and identification of people with an increased vulnerability towards schizophrenia related symptoms. The aim of our current study is twofold; validation of the SPQ-BR's Hungarian adaptation and investigating it's latent structure. METHODS: The sample consisted of 1702 Hungarian university students and university graduated persons. Exploratory factor analytic procedures were performed, cross-validating their results by the use if confirmatory factor analysis. RESULTS: The results suggested that the Hungarian SPQ-BR is best represented by a model of the hierarchical structure, reflected by seven first order factors, and two higher order dimensions of positive and negative symptoms. On lower order factors males were shown significantly greater constricted affects, and proneness to eccentric behaviors and unusual perceptions, while females were characterized by higher magical thinking, next to stronger social anxieties. Gender differences in the Ideas of references - Suspicion and odd speech scales were found to be non-significant. Concerning it''s validity with other scales we found that magical thinking and unusual perceptions from the positive symptoms significantly positively correlated with the magical ideation (MI), anxiousness (ASI), and self-concept clarity (SCCS) scales, next to a negative correlation between unusual perceptions and the self-esteem (RSES) scale. Among the negative symptoms the No close friends-Constricted affect and the Ideas of references - Suspicion subscales showed significant negative linear associations with the ASI, SCCS scales. CONCLUSION: The Hungarian version of the SPQ-BR showed adequate psychometrical properties, it was found to be reliable.

[Long-acting injection - four-times-a-year. Review of the 3-monthly paliperidone-palmitate injection].

Continuous maintenance antipsychotic treatment is one of the most important factor in the long-term course of schizophrenia. Among the therapeutic options available today, the long-acting injectable antipsychotics are those that are able to efficiently provide an optimal treatment strategy required for continuous maintenance treatment. Three-monthly paliperidone palmitate (TREVICTA) is an important milestone in this therapeutic approach, since it is the first and only antipsychotic treatment for patients with schizophrenia, which provides the yearly maintenance therapeutic dose by four injections. Clinical studies have shown that compared to the placebo, TREVICTA significantly delays time to relapse, reduces relapse rate, and its effect is equivalent to the well-known monthly paliperidone palmitate. Data on safety have revealed that TREVICTA was well tolerated and safe, and the rare side effects were consistent with that of paliperidone previously described. In conclusion, TREVICTA is a new and unique treatment option for patients who respond well to paliperidone treatment.

Continuous maintenance antipsychotic treatment in schizophrenia.

During recent years concerns have been raised about the long-term cumulative and potentially negative impact of continuous maintenance antipsychotic treatment of schizophrenia on the human body, especially on the central nervous system. This paper aims at providing a summary of literature data on continuous maintenance treatment for practicing physicians. The results show that continuous maintenance antipsychotic treatment can significantly decrease the risk of relapses and improve the long-term outcome in schizophrenia. Regarding the long-term effects of antipsychotic treatment on the central nervous system, however, further research is needed to answer the question: are brain morphological and functional changes associated with the disease or the treatment or both? 'Based on the data available, low antipsychotic doses are effective and safe while high doses of antipsychotics should be avoided. This review concludes that the minimum effective doses of antipsychotics should be administered for continuous maintenance treatment.

[Schizotypy: detachment or magical fusion].

Nowadays, both in the clinical population, and in general communities, we tend to encounter an increasing number of personality disorder patients, whose social adjustment, partnerships and efficient life management is made difficult by the disorder. The ideas of borderline personality disorder patients, who fluctuate between farfetched expectations and fears of their selves being demolished, schizoid patients, who close their selves in their own alienating prison, avoidant patients, who try to escape difficulties, which would enhance their self-esteem, OCD patients, who build their own mythic superstitious world, and antisocial patients who tend to ignore and aggressively override others' interests are all important in the development of cultures with insecure identities. Taking into consideration the symptoms enlisted in the diagnostic system of DSM-5, it is the task of experts of cultural anthropology, psychology, psychopathology and cognitive neuroscience to explore the referring ways of personality development, relationships and of conflict management. Notwithstanding, avoiding the psychopathological terminology, rather pointing at population characteristics, we need to identify personal functionings of the general features of perception, cognition and world views, which in the long run, may modify personal developmental possibilities, individual approaches to information technology, and emotional, family or professional motivations. Based on the respective literature and clinical experience, below we intend to explore the different aspects of schizotypy, which contribute to the formation of schizoid personality disorder. We analyze the interrelations of avoiding relationships and empathy toward relationship building.

Minor physical anomalies and dermatoglyphic signs in affective disorders: A systematic review.

The increased prevalence of minor physical anomalies (MPAs) and the abnormalities of dermatoglyphic patterns may be physical manifestations of neurodevelopmental disruption in affective disorders. This paper aims to review the current state of knowledge on the frequency of MPAs and dermatoglyphic abnormalities in mood disorders. A MEDLINE, PsychInfo and Web of Science search was carried out to collect all publications on the frequency of MPAs and on dermatoglyphic traits in bipolar disorder and unipolar depression. 24 studies on MPAs, 19 on dermatoglyphics, and 5 dealing with both were found with discrepant findings. The relative contribution of neurodevelopmental retardation to the aetiology of affective disorders remains undetermined, the field is open for further research. Increased recognition of neurodevelopmental processes in the origin of affective disorders may allow for earlier and more effective intervention and prevention.

[A new method for the measurement of social cognition in schizophrenia].

Impairments in social cognitive functions and their long-term effects are well known in schizophrenia. However, so far no computer application has been available to assess these functions of patients. Our study is about introducing a new computer application measuring social cognitive abilities. The program (SCAN) is available on the following link and can be downloaded for anyone: psychiatry.pote.hu > Research > Workgroups > Schizophrenia. The hypothesis of our present study was that SCAN is able to assess the social cognitive ability of patients with schizophrenia in a rapid, complex and objective way. METHOD: 86 schizophrenia patients and 101 healthy controls were examined. SCAN was used to present verbal and nonverbal tasks to measure four different domains of social cognition. SCAN registered the responses and the reaction times as well. Furthermore, an additional application was developed (called Scanalizer) to evaluate the results of a person being tested. RESULTS: The results were evaluated by a two-dimensional analysis. This means that both task performance and the reaction time were taken into consideration while evaluating the results. As for the results, we found that the patients showed significantly worse functioning than the healthy subjects in the four domains of social cognition. CONCLUSION: Based on our results, SCAN is effective enough to detect the atypical social processing of schizophrenia patients. Moreover, Scanalizer is capable of evaluating the social cognitive abilities of schizophrenia patients in a complex, relatively fast and objective way.

Theory of Mind in Depressive Disorders: A Review of the Literature.

BACKGROUND: Theory of mind (ToM) is the ability to infer the mental states of others in order to understand and predict their behaviour. This ability is thought to be essential to social functioning and interpersonal relationships. As major depression is characterized by considerable social and interpersonal difficulties, exploration of the quality of ToM functioning can be particularly relevant in this and in related disorders. We aim to review the current state of research on ToM in depressive disorders in order to find out the extent to which ToM impairment is associated with these illnesses. METHODS: An internet database search was carried out to collect all publications on the subject. RESULTS: A total of 32 publications in English met our inclusion criteria: (a) 17 studies on ToM in major depression, (b) 4 studies on ToM in psychotic depression, (c) 3 studies on ToM in dysphoria or mild depression, (d) 4 studies on ToM in euthymic major depression, (e) 2 studies on ToM in chronic versus episodic depression, and (f) 2 studies on ToM in another psychiatric disorder with comorbid major depression. CONCLUSIONS: Despite an increased interest in the research of the topic in recent years, no firm conclusions can be drawn, as the reviewed articles present some conflicting results. Acutely depressed patients have been found to be impaired on tasks involving both ToM social-perceptual and social-cognitive components. On the other hand, a number of studies have not reported significant between-group differences between depressed patients and healthy controls or have found minimal differences. Further research is needed in order to confirm and extend these results.