The role of oxidative stress in the pathomechanism of major mood disorders: a narrative review with a special focus on uric acid.

Major mood disorder (i.e. major depressive disorder [MDD] and bipolar disorders [BPDs]) are among the most prevalent and disabling mental illnesses. Several, frequently intertwining theories (such as the monoamine, neuroinflammatory and neurotrophic theories) exist to explain the etiopathogenic background of mood disorders. A lesser-known hypothesis addresses the role of oxidative stress (OS; i.e. the overproduction and accumulation of free radicals) in the pathogenesis of these mental disorders. Free radicals are capable of damaging phospholipids, polyunsaturated fatty acids, proteins and nucleic acids. In the brain, OS impairs inter alia synaptic signalling and neuroplasticity. In the current paper, in addition to a brief description of the aforementioned pathophysiological processes involved in mood disorders (with a special focus on OS), we discuss in detail the results of studies on changes in non-enzymatic antioxidant uric acid (UA) levels in major mood disorders. Findings to date indicate that UA - a routinely measured laboratory parameter - may be a candidate biomarker to distinguish between MDD and BPD. Since the diagnostic criteria are identical for major depressive episodes regardless of whether the episode occurs in the context of MDD or BPD and also bearing in mind that the treatment for those two disorders is different, we may conclude that the identification of biomarkers to enable MDD to be distinguished from BPD would be of great clinical relevance.

[Fortification of drinking water with lithium to reduce suicide in the population].

Antimanic and phase-prophylactic features of lithium (Li) in subjects with affective disorders has been known for a long while. Furthermore, it has also been proven for decades that - partially due to its aforementioned effects - Li has marked antisuicide properties in subjects with mood disorders. Intriguingly, consistent findings from several studies conducted in the last 15 years suggest that the antisuicide effect of Li can also be detected in those members of the population who consume drinking water with high Li contents (in connection with this, we must note that the level of Li in tap water is several orders of magnitude less than the therapeutic dose of Li). Based on these results, and also taking into the consideration the long-known anti-goiter effect of iodized table salt, some experts suggest considering the enrichment of tap water with microdose Li. This paper paper briefly summarizes our current knowledge on this topic as well as the related clinical and ethical dilemmas.

[The importance of the staging model in bipolar disorder].

The staging model is widely used in medicine to determine progression, prognosis, and therapeutic decisions. The application of the staging model in psychiatry is currently limited due to etiological and clinical heterogenity. Accor ding to our current knowledge, bipolar disorder is a progressive psychiatric disease with different stages, which can be differentiated based on the course, clinical symptoms and responsiveness to therapy. In our review, we describe the most important clinical staging models of bipolar disorder and the neuroprogressive processes which are underlying them.

['Writer of the soul' - Virginia Woolf's bipolar disorder in light of her life story and traumatization].

Virginia Woolf was one of the most talented and innovative writers of the 20th century. In our study, we review the family background of Virginia Woolf, affective spectrum disorders occuring in her family, as well as the genetic and psychosocial factors, such as the writer's childhood traumatization and coping strategies, which influenced the course and symptoms of her bipolar disorder. We summarize the data which are related to the supposed neuroprogressive processes and suicidal behaviour.

Clozapine Withdrawal-Induced Malignant Catatonia or Neuroleptic Malignant Syndrome: A Case Report and a Brief Review of the Literature.

ABSTRACT: In our brief literature review, we discuss the changes in the concept of catatonia as well as its various types and symptoms. We also succinctly review the possible symptoms of clozapine withdrawal. In addition, we analyze the main features of the very few published cases of clozapine withdrawal-induced catatonia and the relationship between neuroleptic malignant syndrome and the malignant subtype of catatonia. Furthermore, we present the case of a 29-year-old male patient with schizophrenia in whom a malignant catatonic episode/neuroleptic malignant syndrome (with negativism, stupor, mutism, autonomic signs [eg, fever, hyperhidrosis], and elevated creatine kinase levels) began 5 days after the patient decided arbitrarily to cease his clozapine treatment. His catatonic symptoms quickly (ie, within a few days) resolved after the reinstitution of clozapine. Finally, we attempt to provide a theoretical explanation for the surprising finding in the literature that the withdrawal of clozapine, unlike the withdrawal of any other antipsychotics, may be associated with catatonia (frequently its malignant subtype). The take-home message of our case is that clinicians should bear in mind the risk of catatonia (especially the malignant subtype of it) after the prompt withdrawal of clozapine therapy.

Affective Temperaments, Panic Disorder and Their Bipolar Connections.

Background and Objectives: The role of affective temperament in the genesis and outcome of major mood disorders is well studied, but there are only a few reports on the relationship between panic disorder (PD) and affective temperaments. Accordingly, we aimed to study the distribution of affective temperaments (depressive (DE); cyclothymic (CT); irritable (IRR); hyperthymic (HT) and anxious (ANX)) among outpatients with PD. Materials and Methods: Affective temperaments of 118 PD outpatients (80 females and 38 males) with or without agoraphobia but without any other psychiatric disorder at the time of inclusion were evaluated using the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and compared with the affective temperament scores of control subjects. All patients were followed up for at least 1.5 years in order to detect the onset of any major affective disorders, substance use disorders and suicide attempts. Results: Among females, the dominant ANX and DE temperaments were four and three times as common as in a large normative Hungarian sample (for both cases p < 0.01). Among male PD patients, only the dominant DE temperament was slightly overrepresented in a non-significant manner. Females with PD obtained significantly higher scores on ANX, DE and CT subscales of the TEMPS-A, whereas males with PD showed significantly higher scores on ANX, DE and HT temperament subscales compared with the members of a large normative Hungarian sample and also with a gender- and age-matched control group. During the follow-up, newly developed unipolar major depression and bipolar spectrum (bipolar I or II and cyclothymic) disorders appeared in 64% and 22% of subjects, respectively. Conclusions: Our preliminary findings suggest that a specific, ANX-DE-CT affective temperament profile is characteristic primarily for female patients, and an ANX-DE-HT affective temperament profile is characteristic for male patients with PD, respectively. These findings are in line with expectations because PD is an anxiety disorder par excellence on the one hand, whereas, on the other hand, it is quite frequently comorbid with mood (including bipolar) disorders.

[Definition and characteristics of affektive temperaments, their effects on psychiatric disorders and suicidal behavior].

In our review, we present the theory of affective temperaments, the evolution of the temperament-concept, and the characteristics of the various forms of temperament (depressive, cyclothymic, hyperthymic, irritable, and anxious). We describe their relationship with the bipolar and unipolar spectrum, the ethological and evolutionary importance of temperaments, and their neurochemical, genetic basis. We present the self-report questionnaire (TEMPS-A) used for distinguishing between temperament forms. We analyze the relationship of affective tempera - ments with psychiatric disorders and suicide acts and the revealed associations.

[Savant-syndrome - something for something?] / Savant-szindróma ­ "Valamit valamiért".

In our review we describe the development of savant syndrome as a concept, its historical antecedents, most important characteristics and spectrum of savantism, and the frequency and features of the most common savant abilities. We present the relationship between autism and savant syndrome, the eff ect of genetic and familial factors, and the characteristics of savant memory functions and intelligence. We provide an overview of the most important theories explaining savantism and the future direction of research.

[Childhood sexual traumatization in males - historical aspects, prevalence, characteristics, consequences].

In the review I discuss the historical, social aspects of childhood and adolescent sexual abuse of males and the factors influencing trauma research and obstructing its exploration. In the light of the literature, I present the prevalence and the characteristics of the abuse, the risk factors, the short and long-term effects of sexual trauma and the consequential psychiatric disorders.

Associations between untreated depression and secondary health care utilization in patients with hypertension and/or diabetes.

PURPOSE: We determined the prevalence of untreated depression in patients with hypertension (HT) and/or diabetes (DM) and estimated the extra health care use and expenditures associated with this comorbidity in a rural Hungarian adult population. We also assessed the potential workload of systematic screening for depression in this patient group. METHODS: General health check database from a primary care programme containing survey data of 2027 patients with HT and/or DM was linked to the outpatient secondary care use database of National Institute of Health Insurance Fund Management. Depression was ascertained by Beck Depression Inventory score and antidepressant drug use. The association between untreated depression and secondary healthcare utilization indicated by number of visits and expenses was evaluated by multiple logistic regression analysis controlled for socioeconomic/lifestyle factors and comorbidity. The age-, sex- and education-specific observations were used to estimate the screening workload for an average general medical practice. RESULTS: The frequency of untreated depression was 27.08%. The untreated severe depression (7.45%) was associated with increased number of visits (OR 1.60, 95% CI 1.11-2.31) and related expenses (OR 2.20, 95% CI 1.50-3.22) in a socioeconomic status-independent manner. To identify untreated depression cases among patients with HT and/or DM, an average GP has to screen 42 subjects a month. CONCLUSION: It seems to be reasonable and feasible to screen for depression in patients with HT and/or DM in the primary care, in order to detect cases without treatment (which may be associated with increase of secondary care visits and expenditures) and to initiate the adequate treatment of them.

Differences in clinical characteristics between bipolar patients with current psychotic symptoms and those who have never been psychotic.

BACKGROUND: Psychotic symptoms are common in bipolar disorder (BD). Data suggest that BD patients with or without psychotic symptoms may differ from each other with regards to some clinical features of BD (e.g., age at onset, suicidality, psychiatric comorbidity, number of hospitalizations). However, the literature in this area is relatively scarce and not always conclusive. Therefore, the objective of the current study was to investigate whether the presence of psychotic symptoms is associated with clinical characteristics of patients with BD. SUBJECTS AND METHODS: We enrolled 365 hospitalized patients who were diagnosed with BD according to the ICD-10 criteria. After we excluded 196 patients without current psychotic symptoms but psychotic mood episodes in their medical history, our final sample consisted of 169 patients (i.e., 89 BD patients presenting with current psychotic symptoms and 80 BD patients who were hospitalized in the same period, but who did not have psychotic symptoms either currently or during their previous hospitalizations). Clinically available data were collected, systematized and statistically processed according to the aims of the study. RESULTS: Early age of onset, bipolar-I diagnosis, comorbid personality disorder, number of hospitalizations and suicidality were significantly more common in the psychotic group compared to the never-psychotic group. On the contrary, sedative/hypnotics dependence was more frequent in the never-psychotic group. CONCLUSIONS: Our results support the notion that the presence of psychotic symptoms in the context of BD may be associated with various other clinical features of this disease.

The development of a short version of TEMPS-A in Hungarian non-clinical samples.

BACKGROUND: The Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) is a widely used measure of affective temperaments. Affective temperaments refer to people's prevailing moods and are important precursors of affective disorders. With the two studies presented in this paper, we aimed to develop a short version of the Hungarian TEMPS-A. METHODS: A total number of 1857 university students participated in two studies. The original 110-item version and the newly developed short version of TEMPS-A, the anger, depression, and anxiety scales of the PROMIS Emotional Distress item bank, the Altman Self-Rating Mania Scale, the Satisfaction With Life Scale, and the Well-Being Index were administered to participants. RESULTS: Out of the original 110 items, 40 items of TEMPS-A loaded on five factors that represented the five affective temperaments. Factors of the short version showed moderate to strong correlations with their original counterparts. All factors had good to excellent internal reliability. Factors of the newly developed short version of TEMPSA showed meaningful correlations with measures of emotional distress, mania, and indices of psychological well-being. CONCLUSIONS: The short version of the Hungarian TEMPS-A is a promising instrument both in clinical fields and for academic research. The newly developed short version proved to be a valid and reliable measure of affective temperaments.

[Assessing suicide risk using the Brief Suicide Questionnaire - preliminary results]. / Az öngyilkossági veszély felmérése a Rövid Szuicid Kérdoív segítségével ­ elozetes eredmények.

The authors tested the clinical applicability of a self-developed, 6-item, clinician-rated questionnaire evaluating suicide risk in suicidal and non-suicidal psychiatric inpatients and healthy controls. Results have shown that the questionnaires able to detect marked suicide risk in psychiatric inpatients with a high sensitivity and specificity which indicates its usefulness and good applicability in clinical practice.

[Clinical features of psychotic and non-psychotic bipolar patients]. / Klinikai jellemzok pszichotikus és nem pszichotikus bipoláris betegeknél.

BACKGROUND: Psychotic symptoms are common in the case of manic, depressive and mixed episodes of bipolar disorder; however, the assessment of delusions and hallucinations is frequently improper, thus the patients presenting also psychotic symptoms are treated based on their diagnosis of schizophrenia, schizoaffective disorder or paranoia. Psychotic symptoms in bipolar disorder result less favourable outcomes and course of illness. METHODS: 365 patients (106 males, 259 females) were hospitalized in or institution from January 1st 2015 to September 30th 2016, who were diagnosed with bipolar disorder according to the ICD-10 criteria. The number of patients presenting psychotic symptoms was 89 (24%); 55 of whom (62%) belonged to the bipolar I, and 34 (38%) belonged to the bipolar II group. As a control group of the psychotic bipolar patients, we chose 80 bipolar patients hospitalized in the above mentioned period, who did not present psychotic symptoms either at the current or their previous hospitalizations. RESULTS: We found psychotic mania in the case of 24 patients (27%, 12 males, 12 females); and the delusions were of grandiose, religious and paranoid content. The number of depressive patients presenting psychotic symptoms was 39 (44%, 30 females, 9 males); their delusions were dominantly characterized by feelings of guilt, hypochondria and impoverishment. We treated 26 patients (29%, 18 females, 8 males) with mixed episodes accompanied by psychotic symptoms; they were characterized by depressive delusions. Compared to the non-psychotic bipolar patients, in the case of psychotic bipolar patients manic and depressive episodes, bipolar I diagnosis, early onset of the disease (under the age of 20), previous suicide attempts and comorbid personality disorder were significantly more frequent at the time of hospitalization, whereas mixed affective episodes and bipolar II diagnosis dominated in the non-psychotic group. Similarly, the residual symptoms were more common in the psychotic group (64 patients 72% vs 34 patients 43%) and previous hospitalizations was higher in the psychotic group (males 10.6, females 12.5 vs. males 7.8, females 8.6). With regard to psychotic symptoms, there was no difference between the two groups in terms of positive family history, comorbid anxiety disorder or alcohol dependency. CONCLUSIONS: Early onset of the disease, bipolar I diagnosis and comorbid personality disorder were typical of psychotic bipolar patients; in addition, suicide attempts and residual symptoms were more common compared to the non-psychotic group. LIMITATIONS: The relatively lower number of patients (89 and 80 patients) and the fact that the data were processed retrospectively limit the generalizability of our results.

[Assessing suicide risk based on a hierarchical classification of risk factors]. / Az öngyilkossági veszély felmérése a rizikófaktorok hierarchikus osztályozása alapján.

Suicide risk factors could be organised into a hierarchical order and a questionnaire constructed based on this hierarchical structure may help clinicians assess suicide risk. The paper presents analysis of the clinical utility of a questionnaire developed by the authors, in samples of suicidal and nonsuicidal psychiatric patients as well as among normal control subjects. Based on their results the authors suggest a shorter and expectedly more sensitive, 6-item version instead of the original 12-item version scale.

[The nosological evolution of bipolar affective disorder]. / A bipoláris affektív zavar nozológiai fejlodése.

The nosological improvement of the bipolar disorder (manic-depression) follow the written history of psychiatry. The symptoms of manic and depressive episodes and mixed states were described in the ancient times. In my summary I accompany the taxonomic improvement, the changing of diagnostic categories and the work of the most important researchers from the beginning to these days.

[The role of the childhood maltreatment in bipolar affective disorder]. / A gyermaekkori bántalmazás szerepe bipoláris affektív zavarban.

In this review the relevant investigatons of the relationship between childhood maltreatment (CM) and bipolar disorder (BD) will be described. I present the most important features of different trauma forms (physical, sexual, emotional abuse and neglect). A short overview of the direct and long-term effects of childhood-maltreatment and the consequential neurobiological, neurodevelopmental alterations are summarized. A part of the traumameasurement scales and the hidden effects of trauma examiner scales are demonstrated. The clinical variables of bipolar disorder will be shown in the context of different maltreatment forms. Methodical problems and critical commenst are overviewed as well.

[Puer aeternus]. / Puer aeternus.

The social changes of the last few decades have resulted in the revaluation of the classic life-stage models. The time of finding active employment and establishing a family have been postponed, thus not supporting self reliance and undertaking adult roles. In our comprehensive study we discuss the social and demographic phenomena that have contributed to the formation of post-adolescence. We analyse the significance of optional life-patterns which appeared instead of the standard life-course, as well as the change in the criteria system of adulthood and the separation dimensions. We review the psychoanalytic and psychosocial theories of adolescence- the theory of the Erikson adolescent crisis and Marcia's psychosocial moratorium theory, together with the cognitive patterns that lie in the background of post-adolescence, and the changes in lifestyle that characterize the social adaptation of youngsters. The differences between the Peter Pan syndrome and prolonged adolescence crisis are examined in the aspect of transaction-analysis. We take account of the psychic disorders, due to which these people seek for psychiatric help.