[Impact of the type of hematopoietic stem-cell transplant on quality of life and psychopathology]. / A haematopoeticus ossejt-transzplantáció hatása az életminoségre és a pszichés tünetekre.

Background and purpose:

Despite the decrease in transplant-related mortality, patients who receive hematopoietic stem-cell transplants often suffer from short-and long-term morbidities, poorer quality of life, and psychosocial functioning deficits. Several studies have compared the quality of life and affective symptoms of patients after undergoing autologous and allogeneic hematopoietic stem-cell transplants. Some studies have reported similar or greater quality of life impairments in allogeneic hematopoietic stem-cell recipients, but the findings have been inconsistent. Our purpose was to examine the influence of the type of hematopoietic stem-cell transplantation on the quality of life and affective symptoms of patients.

The study sample comprised 121 patients with various hematological diseases who underwent hematopoietic stem-cell transplantation at St. István and St. László Hospitals, Budapest. The study had a cross-sectional design. Quality of life was evaluated using the Hungarian version of the Functional Assessment of Cancer Therapy–Bone Marrow Transplant scale (FACT-BMT). Anxiety and depressive symptoms were assessed using Spielberger’s State and Trait Anxiety Inventory (STAI) and the Beck Dep­ression Inventory (BDI), respectively. Basic sociodemographic and clinical variables were also recorded. Comparisons between autologous and allogeneic recipients were analyzed using a t-test when the variables were normally distributed and a Mann–Whitney U test otherwise. A stepwise multiple linear regression analysis was performed to identify the risk factors that contributed to the quality of life and the affective symptoms in each group.

Quality of life (p=0.83) and affective symptoms (pBDI=0.24; pSSTAI=0.63) were similar between the autologous and allogeneic transplant groups. The BDI scores of allogeneic transplant patients indicated mild depression, but their STAI scores were similar to those of the general population. Allogeneic transplant patients with symptoms of graft-versus-host disease (GVHD) experienced more severe clinical conditions (p=0.01), poorer functional status (p<0.01) and received more immunosuppressive treatment (p<0.01) than those without graft versus host disease. Patients suffering from graft versus host disease experienced more severe depression (p=0.01), and constant anxiety (p=0.03) than those without graft versus host disease. Quality of life was affected by depressive and anxiety symptoms and psychiatric comorbidity in both the alloge­neic and autologous groups.

Graft versus host disease-related severe somatic complaints seemed to influence the allogeneic transplant patients’ quality of life by inducing depressive and anxiety symptoms.

Preliminary Assessment of Pre-Electroconvulsive Therapy Evaluation Practices in European Countries: The Need for Guidelines.

OBJECTIVES: Pre-electroconvulsive therapy (ECT) evaluation is an essential part of ECT preparation, a standard treatment in the psychiatric field. However, no routine pre-ECT evaluation has been published so far. This preliminary study aimed to explore different practices in pre-ECT evaluation across European countries. METHODS: The data were collected as a snowball sample approach using an online survey from September 2019 to April 2020. The final analysis included data from 18 clinics placed in 16 European countries. RESULTS: Regulations on the pre-ECT evaluation were found in 9 countries. All clinics reported doing complete blood count, serum electrolytes, and renal function analysis as a part of regular laboratory testing, alongside with a cardiovascular assessment. Ten clinics reported using psychiatric scales. Six clinics reported doing a cognitive assessment, of which all had regulations on the pre-ECT evaluation. Not one evaluation had the same sets of procedures and diagnostics. CONCLUSIONS: The differences in assessment approaches mirror high variability of the pre-ECT evaluation practice across Europe. Cognitive assessment and objectification of psychiatric symptoms should be a regular part of the pre-ECT evaluation because of the monitoring of the most common adverse effect and observing the clinical response to ECT. Standardization of the pre-ECT evaluation and ECT in general would remove criticisms and opposition to the treatment, make it based on the best of our knowledge, and provide a method respectful of patients' best interests and rights.

Weekly patterns of suicide and the influence of alcohol consumption in an urban sample.

Background and purpose: The weekly fluctuation in suicide rates is influenced by several factors including sex, psychiatric illness and alcohol dependence. The purpose of this study is to explore the impact of current alcohol use on suicid. Methods: Data on sex, date of death, results of blood and/or urine alcohol tests and history of alcohol dependence in suicide victims over the 1997-2002 period were retrieved from a forensic database in two cities in Chuvash Republic. Results: Over the six-year study period, 1,379 suicides were committed, 59% of them under the influence of alcohol. The peak incidence for men and women regardless of previous alcohol consumption was on Wednesdays and Mondays, respectively. The overall suicide rate was highest on Mondays and lowest on Thursdays. Both sexes were less likely to commit suicide during holidays than on weekends or workdays while intoxicated with alcohol. Conclusion: In this urban sample, the distribution of suicide across weekdays only partly followed the international pattern. The peak incidence of suicide showed sex difference, with the highest incidence for women on Mondays and for men on Wednesdays. The higher suicide rate on workdays might be accounted for by work-related stress, while the lower rate on weekends could be explained that people usually drink alcohol in the comforting company of family or friends, which reduces psychological tension and suicidal ideation. The majority of men consumed alcohol before committing suicide, regardless of the day of the week, while this observation was true for women only on Fridays and Sundays. Alcohol consumption greatly contributes to suicidal behavior in Chuvash Republic.

[Accessibility of electroconvulsive therapy during COVID-19 pandemic in Hungary].

OBJECTIVES: A nationwide survey in Hungary found that 22 out of 58 psychiatric units performed ECT in 2014. Shortly after identifying the first COVID cases, strict control measures were introduced, and the hospital system was fundamentally transformed in the country that affected ECT provision as well. The aim of the current study was to survey the changes in ECT use in Hungary during the four waves of the COVID-19 pandemic. METHODS: All the psychiatric units that indicated they had performed ECT in 2014 were sent a semi-structured question naire requesting information about changes in ECT practice and the treatment profile of the unit. If there was no reply, a follow-up telephone call was made. RESULTS: There were only 3 centers where ECT was performed throughout all four waves of COVID. In nine centers (47%) ECT was suspended in all four waves. The main reason why ECT was halted during COVID was the restructuring of psychiatric inpatient care: six centers were fully transformed into general COVID units, and in the remaining 13 the number of psychiatric beds was reduced in favor of general COVID care. Staff shortage constituted another barrier to the provision of ECT. The number of infected patients in a wave of COVID-19 showed a significant negative correlation with the number of active ECT centers (p=0.05). No COVID-infected patient received ECT in Hungary. CONCLUSIONS: During the COVID pandemic in Hungary, nearly half of the ECT services were suspended and thus a number of patients missed out on receiving an effective treatment.

Hungarian Psychiatrists' Recognition, Knowledge, and Treatment of Catatonia.

DSM-5 introduced a number of modifications to the catatonic syndrome, which is now closer to Kahlbaum's original concept. The aim of the present study was to assess residents' and qualified psychiatrists' knowledge, experience and views about the treatment of catatonia in acute psychiatric care in Budapest, Hungary. Authors approached all psychiatric units that provide acute psychiatric care (N = 11) in Budapest and invited all psychiatrists and residents, who consented, to participate in the survey, completing a 13 items questionnaire. Ninety-eight fully qualified and trainee psychiatrists completed the questionnaire. Although 84.7% of the participants rated their knowledge of catatonia as moderate or significant, there were a number of obvious mistakes in their answers. Most catatonic signs and symptoms were not identified by almost 50% of the respondents and the frequency of catatonia was also underestimated. The views of the majority of the participants reflected the Kraepelinian concept, in which catatonia is primarily associated with schizophrenia. Although benzodiazepines are widely recommended as a first line treatment for catatonia, only 69.4% of participants chose them as a treatment option. In view of its clinical importance, catatonia deserves more attention in the education and training of medical students and psychiatric residents.

Attitudes Towards ECT: A Survey of Polish Mental Health Professionals.

BACKGROUND: Although the efficacy of electroconvulsive therapy (ECT) has been well established, the utilization rate of ECT has decreased in Poland in recent years. One of the main reasons could be the negative attitude towards ECT in the community and by mental health professionals. The aim of this study was to assess the knowledge about and attitudes toward ECT in Polish mental health professionals including psychiatrists and non-physicians: nurses, psychologists, social workers. SUBJECTS AND METHODS: Psychiatrists and other mental health professionals in two large Polish hospitals were approached to participate in the survey by completing a 28-item questionnaire. The specific hospitals have been selected due to the fact that they were located in the same province of Poland (Mazowsze), had similar catchment area and profile, provided similar mental health services with only one exception; one offered ECT while the other did not. Of the 185 questionnaires that had been distributed, 165 were completed yielding a response rate of 89.19%. The study population consists of 85 psychiatrists and trainees and 80 non-physicians. RESULTS: Psychiatrists did not differ from other mental health professionals with respect to the knowledge and attitudes toward ECT. However, there were significant differences in the attitude (9.1±3.8 vs 7.1±3.3; p<0.001) and knowledge (5.9±3.8 vs 2.8±4.1; p<0.001) scores between those professionals, who have ever worked in a psychiatric ward where they could observe ECT sessions and those who have not had such an opportunity. CONCLUSIONS: Frequent witnessing of ECT sessions seems to be the most effective educational intervention to change negative attitudes towards ECT.

[Ethical questions in the clinical use and research of electroconvulsive therapy].

Electroconvulsive therapy (ECT) is one of psychiatry's most long-standing and criticized treatments. Some of the criticisms come from the ethical aspect of ECT. The authors review the ethical issues of clinical application and research of ECT. ECT in the treatment of psychiatric patients is considered ethical, if it is conducted according to the four main principles of bioethics (beneficence, non-maleficence, autonomy and justice). ECT research should also comply with other international guidelines and research ethics codes. In recent decades, the principle of informed consent has become widespread in psychiatry, which requires objective information from the attending doctor according to the most reliable scientific information. The UN Convention on the Rights of Persons with Disabilities considers psychiatric disorders to be part of the concept of disability. For disabled psychiatric patients, assisted decision-making is a desirable way of self-determination. In doing so, it is important to use decision support instead of decision-substituting mechanisms, although for patients lacking insight, decisionsubstituting mechanisms are unavoidable.

Electroconvulsive Therapy in the Shadow of the Gas Chambers: Medical Innovation and Human Experimentation in Auschwitz.

Six years after it was first introduced into psychiatry in 1938, electroconvulsive therapy (ECT) became the subject of criminal human experiments in Nazi Germany. In 1944, at the Auschwitz III / Monowitz camp hospital, the Polish Jewish prisoner psychiatrist Zenon Drohocki started experimental treatments on prisoners with an ECT device that he had constructed himself. According to eyewitnesses, Drohocki's intention to treat mentally unstable prisoners was soon turned into something much more nefarious by SS doctors (including Josef Mengele), who used the device for deadly experiments. This article provides an account of this important and little-known aspect of the early history of ECT, drawing on an extensive array of historical literature, testimonies, and newly accessible documents. The adoption of ECT in Auschwitz is a prime example of the "grey zone" in which prisoner doctors had to operate-they could only survive as long as the SS considered their work useful for their own destructive purposes.

[The public's attitudes towards electroconvulsive therapy in Hungary]. / Laikusok elektrokonvulzív terápiával kapcsolatos attitûdje Magyarországon.

BACKGROUND AND PURPOSE: This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public's attitude towards ECT, and no such study has been published from Hungary. METHODS: Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers. RESULTS: The result showed a significant difference between healthcare workers' and lay people's knowledge and attitude towards ECT. Two third of lay participants have never heard about ECT. Those familiar with ECT were relatively well-informed about its certain aspects yet rejection of ECT was significantly higher in the group of lay participants than in health-care workers. CONCLUSION: Lay people's incomplete knowledge and negative attitude towards ECT was confirmed by this survey. The dissemination of reliable information - which should be the shared responsibility of mental health professionals and the media - would be vitally important to disperse the prejudices and doubts about ECT.

Neurocognitive functions in patients with hepatitis C infection.

BACKGROUND AND PURPOSE: With improving treatment options, more attention is being paid to the neurocognitive symptoms related to hepatitis C infection (HCI). While HCI-related neurocognitive impairments are frequently subclinical, they can influence patients' quality of life and fitness to work. Objective - The aim of this study was to assess HCI patients' neurocognitive functions and explore the correlations between disease variables and neurocognitive symptoms. METHODS: The study was conducted between January 1, 2013 and December 31, 2015. All patients with HCI were included in the study who were registered at the Hepatology Outpatient Clinic of Szent István and Szent László Hospitals, met inclusion criteria and volunteered to participate. Patients' sociodemographic data and medical history were recorded in a questionnaire designed for the study. The 21-item Beck Depression Inventory was used to detect depressive symptoms. Six computerized tests were used to evaluate patients' neuropsychological functions. RESULTS: Sixty patients participated in the study. In comparison with general population standards, patients demonstrated poorer performance in several neurocognitive tests. Neuropsychological performance was correlated with age, sex, length of time since HCI diagnosis, Fibroscan score and the number of previous antiviral treatments. CONCLUSION: The study's main finding is that compared to general population standards, patients with hepatitis C virus-related disease exhibit impaired neuropsychological functioning in visuomotor and visuospatial functions, working memory, executive functions, and reaction time. Executive functions and reaction time were the most sensitive indicators for the length and severity of the disease. Deterioration in these functions has a major negative effect on work performance particularly in certain occupations.

[The impact of the COVID-19 epidemic on the content of the delusions].

The COVID-19 epidemic was declared a pandemic by the World Health Organization on 11 March 2020. The outbreak and spread of the disease has caused fear, insecurity and anxiety in people around the world. The pan - de mic has both direct and indirect effects on mental health problems, as fear of the virus can trigger or exacerbate mental illness and influence the onset of symptoms. Case studies suggest that this emergency can affect the content of delusions and hallucinations, as well as contribute to psychotic relapse. In addition to a brief review of the literature, we describe the case of three psychotic patients of the Jahn Ferenc South Pest Hospital, Centre for Psychiatry and Addiction Medicine, whose delusions and hallucinations were affected by the COVID-19 pandemic. In two cases, the symptoms of a reactive, transient psychotic episode presumably provoked by psychosocial stressors were determined, and in one case, the positive symptoms of a patient suffering in a psychotic disorder were determined by COVID-19.

[Accessibility to Electroconvulsive Therapy in Hungary].

INTRODUCTION: In spite of its efficacy, use of electroconvulsive therapy (ECT) has been declined in Hungary over the past decade. This survey explores the circumstances that have obstructed the accessibility to ECT in Hungary. METHODS: This study was part of a comprehensive survey on the use of ECT in which two semi-structured questionnaires with 25 and 6 questions were sent out to all psychiatric departments in Hungary. The second questionnaire was targeted those departments that did not perform ECT in 2014. Questions were asked about the reasons for not using ECT and the available treatment strategies for patients who needed ECT. RESULTS: Thirty-one of the 58 Hungarian psychiatric departments did not offer ECT in 2014. Twelve chiefs of service asserted that no patient needed ECT in that year. Due to unavailability of ECT, patients were transferred to other departments for ECT in further 12 departments. Finally, in 7 departments, patients who would have needed ECT were treated with pharmacotherapy instead of transferring them to ECT centers. As for the reasons for the lack of access to ECT, 17 departments had no ECT machine, 12 departments did not have access to anesthesiologists, 6 departments had no budget for ECT, and in 5 departments staff with expertise to deliver ECT was not available. CONCLUSION: The rate of ECT use in Hungarian psychiatric departments decreased by 20 percent between 2002 and 2014. The most important reasons for this decline were lack of the modern ECT devices or financial sources to buy a modern ECT machine. Further reasons for not using ECT were the availability of anesthesiologists or the lack of finances to employ them. The lack of experience in administering ECT was another reason for not utilizing ECT. These difficulties could be solved with the centralization of ECT provision to a few centres in the country together with defining the pathways for patients to reach these centres.

Changes in Electroconvulsive Therapy Practice in the Last 12 Years in Hungary.

BACKGROUND: Electroconvulsive therapy (ECT) was rarely used in Hungary in 2002, and the majority of patients receiving ECT were diagnosed with schizophrenia. This study aimed to explore the use of ECT in Hungary in 2014. METHODS: Two semi-structured questionnaires were sent to all acute adult psychiatric units in Hungary. The first questionnaire contained items concerning ECT use, and the second explored the reasons for not using ECT. RESULTS: Fifty-eight acute psychiatric inpatient units were identified, and 54 replied. Although 27 indicated that they used ECT, only 22 actually performed ECT in 2014. Thirty-one units did not offer ECT at all. In 2014, 174 patients received ECT in Hungary, constituting 0.59% of all inpatients treated in the departments where it was offered, equating to 0.176 patients/10,000 population. The indication for ECT shifted from schizophrenia in 2002 (55.6%) to mood disorders in 2014 (58.5%), but the absolute number of ECT-treated patients with mood disorders (110 vs 102) did not change. Reasons for not using ECT included the lack of an ECT machine, unavailability of an anesthesiologist, lack of finances, and lack of experienced staff. CONCLUSIONS: In view of the high frequency of depression and suicide in Hungary, it is very likely that a significant minority of patients who would benefit from ECT cannot access it, which constitutes a violation of their right to the best possible treatment. The main reasons for the inadequate ECT service are the underfinanced hospital system and a lack of necessary knowledge.

Observing Electroconvulsive Therapy Changes Students' Attitudes: A Survey of Croatian Medical Students.

AIM: To assess the impact of education and direct observation of electroconvulsive therapy (ECT) on medical students' attitudes toward ECT in particular and psychiatric treatment in general in Croatia. METHOD: Two self-administered questionnaires were completed by year 4 medical students twice, at the beginning and the end of the psychiatry clerkship. Students were divided into 2 groups: those who observed an ECT session (47.9%) and those who did not (52.1%). RESULTS: The survey was completed by 190 students yielding a response rate of 79.8%. Students' attitudes toward ECT and other methods of psychiatric treatment and psychiatry in general changed in positive direction after the clerkship in both groups. However, the attitudes toward ECT of students who observed a live ECT session became more positive than those who did not. Likewise, students who observed ECT were more likely to agree to receive ECT and had better knowledge about ECT compared with the other group. CONCLUSIONS: Having watched a live ECT session had a positive effect on students' attitudes toward ECT and other types of psychiatric treatment. Watching live ECT sessions should be mandatory during the psychiatric clerkship.

Use of Electroconvulsive Therapy in Central-Eastern European Countries: an Overview.

Though a number of reports on the use of electroconvulsive therapy (ECT) has been published from the Central-Eastern European region over the past two decades, a systematic review of this literature has not been published. Thus the aim of this paper was to review recent trends in ECT practice in Central-Eastern Europe. Systematic literature search was undertaken using the Medline, PSYCHINFO and EMBASE databases covering the period between January 2000 and December 2013. Relevant publications were found from the following countries: Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, Ukraine, but none from Albania and Moldova. ECT practice in the region shows a heterogeneous picture in terms of utilization rate, main indications, and the technical parameters of application. On one end of the spectrum is Slovakia where the majority of psychiatric facilities offer ECT, on the other end is Slovenia, where ECT is banned. In about half of the countries schizophrenia is the main indication for ECT. In Ukraine, unmodified ECT is still in use. Clinical training is generally lacking in the region and only 3 countries have a national ECT protocol. Possible ways of improving ECT practice in the region are briefly discussed.

Predictive value of psychosocial assessment for the mortality of patients waiting for liver transplantation.

Selecting suitable candidates for liver transplantation is the most challenging task of pre-transplant evaluation. In addition to somatic assessment, psychosocial evaluation has been proven important in identifying patients at high risk of potential failure. The Transplant Evaluation Rating Scale (TERS) is a widely used rating instrument for the assessment of psychosocial risk factors before liver transplantation. The aim of this study was to explore the predictive value of TERS for mortality in liver transplant patients before and after transplantation. The medical records of patients referred for psychiatric evaluation before liver transplantation between 2003 -2013 were analysed. Administering TERS was part of the pre-transplant evaluation. The TERS scores of patients who died before and after transplantation were compared with those who survived following transplantation. One hundred and sixteen patients were referred for pre-transplant psychiatric evaluation. Patients with successful liver transplants scored significantly lower on TERS than those who died before transplantation (30.65 ± 6.06 vs. 34.75 ± 8.25, p = .031). Patients who died after transplantation scored significantly better on TERS than those who died before transplantation (28.79 ± 2.81 vs. 34.75 ± 8.25, p = .003). There was no significant difference between the deceased and surviving transplanted patients' TERS scores (28.79 ± 2.81 vs. 31.19 ± 6.66, p = .365). TERS appears to be a suitable rating instrument to help select candidates who have higher chance to survive prior to transplantation but it could not predict post-transplant mortality.

Catatonia in disulfiram intoxication - a case report and a brief overview of the literature.

Catatonic syndromes could accompany a variety of psychiatric and medical conditions. The most common conditions underlying catatonia are affective disorders followed by schizophrenia, but several medical conditions including intoxications affecting the central nervous system can also present with catatonic signs and symptoms. Therapeutic doses of disulfiram could induce catatonia with or without accompanying psychosis or mood disorder. A case of disulfiram intoxication manifesting with catatonia is reported here together with a brief overview of the literature. A patient was admitted to the toxicology ward after a suicide attempt with approximately 20 g of disulfiram. On transfer to the psychiatric ward, she was sitting still, in a semi-stuporous state and displayed motiveless resistance to instructions or attempts to move (active negativism). She was unresponsive to most of the questions (mutism), occasionally verbigerated 1-2 words and stared for more than 20 seconds between shifting attention. After developing a comatosus state her treatment continued at the toxicology ward, where a contrast-enhanced computer tomography scan revealed bilateral emollition of 1.5 cm diameter in both nucleus lentiformis at the level of the third ventricle. Following treatment her condition improved and she benefited of rehabilitation facility and a second psychiatric treatment. She was discharged free of neurological and psychiatric symptoms. In conclusion, we underscore the importance of accurate diagnosis of the underlying psychiatric or medical condition when encountering a fast emerging catatonic syndrome and focus first on treating the causative condition while simultaneously attempting symptomatic treatment of catatonia.

Reasons for acute psychiatric admission of patients with dementia.

INTRODUCTION: The estimated number of patients living with dementia in Hungary is between 150,000 and 300,000. Hungary's prevalence of vascular dementia is much higher than that of other countries. Patients with dementia can be admitted to psychiatric hospitals for several reasons, the least common of which is cognitive decline. Comorbid psychiatric disorders or dementia-related behavioral disturbances are much more common reasons. AIM: To examine the reasons for the acute psychiatric admission of patients suffering from dementia in a psychiatric center in Budapest. MATERIALS AND METHODS: In this retrospective survey the data of dementia patients who were referred to the Centre for Psychiatry and Addiction Medicine (CPAM) at Szent István and Szent László Hospitals between August 1 and October 31, 2014 were analyzed with special attention paid to the reasons for hospitalization. RESULTS: Altogether 302 patients were admitted to the CPAM over the study period and 26.15% of them suffered from dementia. The distribution of dementia subtypes was as follows: 43% mixed type (vascular and neurodegenerative), 40.5% vascular type, 11.4% Alzheimer's disease, and 5.1% other types. A small percentage (12.7%) of patients had mild dementia, while 34.2% and 53.2% suffered from moderate and severe dementia, respectively. The major causes of hospitalization were aggressive behavior (34.2%), delirium (19%), and divagation and confusion 15.2% each. They were mainly associated with moderate and severe dementia. Suicide attempt was the reason for admission in 10.1% of cases, and delusions in 6.3%. With regard to admission outcome, 44.3% of patients were transferred to a medical ward, 12% within 3 days of psychiatric admission. Nearly 9% of patients required extended hospitalization, 21.5% were discharged home, 20.3% were transferred to a nursing home and 5.1% died while in hospital. More than half of the patients were rated on the CGI-C scale; 59% of them scored 2 points (much improved), 25% scored 1 point (very much improved) and 16% scored 3 points (moderate improvement). DISCUSSION: A high proportion of dementia patients acutely admitted to a psychiatric ward was medically compromised and either died soon after admission (5%) or was transferred to a medical ward for further treatment. This highlights the importance of a thorough medical work-up including physical examination and laboratory investigations for dementia patients requiring acute psychiatric admission. It is of note that only a small number of patients could be discharged home or to a nursing home. These figures underscore the need for more nursing home places and a better functioning social care system in this field.