[How can subjects be objectified? - or a critical overwiev of the concept of personality disorders appearing in the new classificational systems].

The development of the new diagnostic systems (DSM-5; ICD-11) once again generated an interesting discussion around the personality disorders. In this paper we first review the historical traditions, than we examine and compare the new diagnostic suggestions appearing in DSM-5 and ICD-11. Our main goal is to help with the under standing of the new dimensional models and to clarify the questions that arose during the creation of these models. Although the DSM-5 keeps the classic categorical system, it also proposes a hybrid dimensional-categorical diagnostic alternative. Within the hybrid model, the first step is to investigate the impairment of the personality by evaluating the damages to the self and the interpersonal functions. The next step is to form categories along the Big-Five traits. The constellation of the impaired traits dimensions creates the final categories. ICD-11 broke up with the category approach and moved on with the hybrid proposal of DSM-5. Here the first step is to determine the severity of the personality disorder. After that the personality disorder can be specified by a new code. This system does not use the dimensions of the intact personality traits (Big-Five), but the dimensions emerging from the factor analysis of personality disorders. Since in ICD-11 the borderline diagnostic possibility appears in addition to the dimensions, in the last part of the study we review the critical, scientific data of this specific borderline syndrome and its therapy.

[Health related quality of life and disease burden of patients with schizophrenia in Hungary]. / A szkizofreniaval elo betegek egeszseggel osszefuggo eletminosege es betegseg-terhe Magyarorszagon.

INTRODUCTION: According to the international literature disease burden of schizophrenia is substantial, however data from Eastern Central Europe is scarce. Our aim was to assess the quality of life and costs of patients with schizophrenia in Hungary. METHODS: A cross sectional questionnaire survey was performed in 3 hospital based psychiatry centres involving patients with schizophrenia. Demographics, disease severity (Clinical Global Impression, CGI), functional ability (Global Assessment of Functioning, GAF) and general health status (EQ-5D) was assessed. Health care utilisation and aids were surveyed for the past 12 months. Costing was performed from the societal perspective and human capital approach was applied. RESULTS: Altogether 78 patients (female 43.6%) were involved with a mean age of 44.2 (SD=13.1) years, disease duration was >10 years at 49 (62.8%) cases, 66 (84.6%) patients were disability pensioners. Distribution between CGI 3-4-5-6 levels were 12 (16%), 33 (43%), 21 (28%), 10 (13%) patients, respectively, mean GAF was 52.6 (SD=13.9). The average EQ-5D score was 0.64 (SD=0.3) and it was significantly worse than the age-matched general population's score in Hungary (p < 0.01). Mean yearly cost was 13 878 Euros/patient (conversion 1 Euro=280.6 HUF), the rate of direct medical,direct non-medical and indirect costs was 28.5%, 5.4% and 66.1%, respectively. Among direct costs hospitalisation and drug costs were dominant. Total cost correlates with disease severity (CGI). CONCLUSION: Schizophrenia leads to notable deterioration in health related quality of life and induce high costs to society, mainly due to the productivity loss of the patients. Nevertheless disease related costs in Hungary are lower than in economically more developed European countries. Our study offers basic data about disease burden of schizophrenia in Hungary to support clinical and health policy decision making.

[The role of ventromedial prefrontal cortex in addiction disorders]. / A ventromedialis prefrontális kéreg szerepe addiktológiai kórképekben.

Recently a significant conceptual change emerged in the interpretation of addictological disorders. Despite this significant progress, the exact neuronal mechanisms of these disorders are still unknown. By the development of cognitive neuroscience novel clinical tests became available which are devoted to the evaluation of more properly defined neuronal structures. These novel approaches are designed to separately investigate memory/attention-related and affective processes in decision-making. These investigations along with animal models and functional neuroimaging approaches suggest the crucial role of a complex neuronal network in the pathomechanism of addictological disorders, including the ventromedial prefrontal cortex and the amygdala-accumbens system. The aim of this paper is to review these novel findings in order to gain insight into the neurocognitive mechanisms of addictological disorders.