Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation.

OBJECTIVE: To review the current status of psychiatry in selected countries of Central and Eastern Europe: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Russia, Slovakia, and Slovenia. METHOD: A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages. RESULTS: There is a shift from traditional in-patient facilities towards out-patient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West. CONCLUSION: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

[Efficacy and acceptability of tianeptine and sertraline in the acute treatment phase of depression]. / Efficacité et tolérance de la tianeptine et de la sertraline dans le traitement d'attaque de la dépression.

Efficacy and acceptability of tianeptine were investigated in a multicenter, randomized, double blind, and sertraline-controlled study. As a total, 212 in- or outpatients with DSM IV major depression single episode, recurrent and bipolar depression, were treated for 42 days either with tianeptine (37.5 mg) or with sertraline (50 mg). At inclusion, sociodemographic, physical and psychological parameters showed no significant intergroup differences. MADRS responders (50% reduction of baseline score) were 66% and 67% with tianeptine and sertraline, respectively. No statistical interdrug differences were observed either in the number of withdrawals or in the efficacy and acceptability parameters.

Gender differences in major depressive disorder in a Hungarian community survey.

INTRODUCTION: The aim of this study was to investigate the characteristics of Major Depressive Disorder (MDD) in males and females in a sample of the Hungarian adult population. METHOD: 2953 randomly selected subjects between 18 and 64 years old were interviewed using the Hungarian version of the Diagnostic Interview Schedule (DIS), which generated DSM-III-R diagnoses. RESULTS: The lifetime and period prevalences of MDD were more than twice as high in women than in men. The gender difference appeared in early adolescence and continued up until the age of 50. An increased risk for anxiety disorders was found in patients with MDD, irrespective of gender, and in the majority of cases (65%) the anxiety symptoms preceded the onset of MDD. Depressed women tended to have more symptoms and a more marked tendency for recurrence than men. The preponderance of females was twice as high in MDD with comorbid anxiety than in MDD without it, in spite of the fact that the likelihood of the coexistence of MDD and anxiety disorders did not differ by gender. CONCLUSION: The higher MDD prevalence rate in women might be the consequence of a higher rate of pre-existing anxiety disorder(s).

Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary.

BACKGROUND: The aim of this study was to analyze the lifetime comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a community sample of a Hungarian population. METHODS: Randomly selected subjects (aged between 18 and 64 years, N=2953) were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. RESULTS: The prevalence of generalized anxiety disorder, agoraphobia and simple phobia was the highest among bipolar II patients (20.8, 37.5 and 16.7%, respectively), social phobia was most prevalent in (nonbipolar) major depression (17.6%), while the rate of panic disorder was the same in the (nonbipolar) major depressive and bipolar II subgroups (12.4 and 12.5%, respectively). Bipolar I patients showed a relatively low rate of comorbidity. CONCLUSIONS: The findings support previous results on the particularly high rate of lifetime comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness. LIMITATIONS: Underestimation of the prevalence of bipolar II disorder by the diagnostic methodology used, resulting in a small number of bipolar II cases, lack of analysis of data by gender, no data on obsessive-compulsive disorder.

Suicide attempts in the Hungarian adult population. Their relation with DIS/DSM-III-R affective and anxiety disorders.

Prevalence of suicide attempts and their relationship with DIS anxiety and affective disorder diagnoses were investigated in a Hungarian adult community sample. Despite the high suicide mortality rate, the rate of suicide attempts was similar to that reported in other studies using similar methods. Suicide attempts occurred more frequently among women and previously married persons. Although the presence of any lifetime anxiety and/or affective disorder increased the rate of reported suicide attempts, the effect of co-morbidity, recurrence and chronicity might be considered significant predictors. The highest odds of an attempt were related to the diagnoses of dysthymic or bipolar disorders. Agitation was the only depressive symptom, which increased the odds of a suicide attempt.

[Prevalence of mood and anxiety disorders in the Hungarian adult population]. / A hangulat- és szorongásos zavarok elöfordulása a felnött magyar lakosság körében.

The prevalence rates of affective and anxiety disorders in the Hungarian adult population were assessed with a well-structured questionnaire which has been successfully applied in several multinational epidemiological studies. The Hungary material showed significantly higher lifetime and period prevalence rates of bipolar disorders than is found in most of related literature. However, the frequency of other affective disorders and the anxiety states strongly corresponded with international findings.

The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey.

In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population (18-64 years) selected at random was interviewed using the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. The lifetime rate for Major Depressive Disorder (MDD) was 15.1%, and for Bipolar Disorders (BD) 5.1%. The female-to-male ratio was 2.7 for MDD and nearly equal for BD. The 1-year and 1-month period prevalence rates were 7.1% and 2.6% for MDD and 0.9% and 0.5% for manic episodes. A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD. Besides these, the lifetime diagnosis of BD coexisted with higher rates of the never-married state. The highest hazard rate for the development of BD or MDD was in the range 15-19 years but in MDD another peak was also found in the range 45-50 years. The first peak was characteristic of the recurrent, and the other one of the single form of MDD. Insomnia, loss of energy, decreased interest, concentration problems were the most common symptoms during the depressive episode, independent of polarity. Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD. BD was associated with GAD (Generalized Anxiety Disorder), and panic disorder more often than chance.

The prevalence of affective and anxiety disorders in primary care practice in Hungary.

The lifetime and point prevalence of affective and anxiety disorders were investigated with the aid of the DIS questionnaire in 15 primary care practices among patients aged 18 to 60. According to the DSM-III-R criteria, 43% of the eligible 301 patients had had some kind of affective or anxiety disorder till the time of the assessment. Major depression was found to be the most common lifetime diagnosis (18%). At the time of the investigation 15% of the patients were suffering from affective or anxiety disorder (point prevalence) calling for clinical therapy. Females had significantly higher numbers of lifetime and point diagnoses of affective and anxiety disorders. Sixty percent of patients failed to report psychiatric complaints to their doctor, and in social phobia this figure was as high as 87%. Our results are in accordance with international findings and underline the need to diagnose and treat psychiatric patients already at the stage of the primary care service.

Family therapy in a transitional society.

This paper is concerned with the application and adaptation of traditional models of family therapy as developed in Western societies, to the understanding and therapy of families in a society where the sociopolitical structures are changing rapidly. References were found in the literature only in connection with certain ethnic groups (Gray and Cosgrove 1985; McGoldrick-Pearce 1982), religious fellowships (Aradi 1988), and sociopolitical contexts (Auerswald 1983; Elkaim 1982). The authors began to deal with these phenomena several years ago. Our first publication examined differences in religious, social, and class relations within the family and the way in which these factors affect family roles and their implementation (Füredi et al. 1989). Subsequent events directed our interest to the effects of political changes on family relationships and what the strategy of the family therapist could be in this situation.

Different steps in schizophrenic patients' rehabilitation.

The author revises different views and principles of rehabilitation, its connections with prevention and treatment. He tries to place it in the process of a schizophrenic patient's recuperation. In his opinion rehabilitation can be separated into different steps and the patient has by degrees to go through these forms of therapeutic methods and organizational facilities. Standing at the service of rehabilitation are special methods of therapies--as pharmaco--/long-acting drugs/, psycho-/different forms of group psychotherapy/socio-/work, creativity, music, sport and so on/therapies and different in-patient and half-way departments. These could be utilized only on the basis of careful theoretical planning and continuous control by the whole therapeutic team. Rehabilitation should be carried out as a process, starting in the admission ward but mainly done in an intermediate in-patient unit and/or in a half-way institute, but an only be completed by a follow-up. It is regarded first of all as a social activity, but without meantime neglecting any kind of medical measures.