Felnőttkor - gyermekkor - felnőttkor: Hosszútávú kezelés a gyermek és felnőtt pszichiátriában

The aggregation of psychiatric disorders within families is well-known. The relative role of biological, psychogenic and socialization-related factors varies with the individual case. Another well-known fact is that parents play a very important role in influencing whether their child gets the right treatment when it is necessary. In this paper we highlight the complex links between childhood and adulthood through the presentation of three psychiatric cases. The first story starts with a lactation psychosis of a mother and ends when the daughter who became psychotic at the age of 15 enters adulthood. During these 18 years several psychiatrically relevant episodes happened in the family. During our care, step by step, in relation to emerging psychological problems, the family revealed more and more secrets, explaining past events, and offering a possibility for psychoeducation and psychotherapy. Knowledge concerning the life and psychiatric history of parents, in spite of the fears of the family, largely contributed to evaluating the symptoms of the daughter, reaching a diagnosis, initiating and maintaining therapy and achieving the present balanced state. The next two cases present the stories of two boys with Attention-Deficit/Hyperactivity Disorder (ADHD). One of the children was 6 years old when the family sought professional help, and now he is 11, the other child was 8 years old when the parents sought help and he is 15 now. The two families reacted differently to the offered treatment, but in both cases the family stayed continuously in touch with their child psychiatrists. With these two different stories on ADHD we would like to present several issues and successes which may surface during the long-term treatment of ADHD

Electroconvulsive therapy in a Hungarian academic centre (1999-2010).

BACKGROUND: Since the 1930s, the Department of Psychiatry and Psychotherapy at Semmelweis University (DPPSU) in Budapest has played a leading role in convulsive therapy in Hungary. The aim of this study was to describe the pattern of ECT use at the DPPSU over an 11-year period. SUBJECTS AND METHODS: Analysis of the medical notes of all patients treated with ECT in this academic centre between 1999 and 2009. RESULTS: During the study period, 28,230 patients were admitted to the DPPSU, of whom 457 (1.6%) received ECT. More than 50% of patients receiving ECT were diagnosed with schizophrenia. The percentage of female patients receiving ECT significantly exceeded that of the male patients, above what was expected in view of the diagnostic mix. CONCLUSION: The data indicate that in the first decade of the 21(th) century, ECT use shows a declining tendency in this Hungarian academic centre. The mean number of treatment sessions was relatively low and nearly the same across diagnostic groups. ECT was mainly used as a last resort for treatment-resistant patients. In the majority of cases, bifronto-temporal brief pulse stimulation was applied. Seizures were monitored with EEG and EMG

Endogén pszichózisok klinikuma, összehasonlító nozológiája, genetikai, pszichometriai szociológiai és experimentális vizsgálata, 21-33 éves követéses vizsgálatuk alapján = Clinical, sociological, psychometric, experimental, genetic research and comparative nosology, of functional psychoses based on their 21-33-year follow through investigation

A hagyományos pszichopatológiában manifeszt és látens tünetek között észlelhető "szakadék" feltöltését az úgynevezett "alaptünetek" általunk alkotott becslésskálába foglalásának és az általunk konceptualizált Morbaffin Személyiségtípusok Skáláinak az alkalmazásával mutattuk meg. A "Spontán önjellemzés" innovációt bevezetve sajátos megoszlást mutattunk ki egyfelől normálkontroll személyek vs. betegek, másfelől különböző betegcsoportok között. Egy másik innovációnk a "reliabilitás validitása" terminus bevezetése és verifikálása. Ezt a negyed évszázad időkülönbséggel felvett pontozó skálák és a vizsgáló pontozók közötti egyezések vizsgálatával verifikáltuk. Ajánljuk a rendszeresítését. A Wechsler intelligenciateszt morbospecificitásának komparatív nozológiai vizsgálata során szignifikáns deficiteket mutattunk ki a 21-33 éves kórlefolyásban. Tudomásunk szerint elsőként vizsgáltuk meg a Leonhardi nozológiai rendszer validitását hosszú távú követéses katamnesztikus felméréssel. Ezt a nozológiai osztályozást egy sor összefüggésben validnak találtuk. Megállapítottuk a hallucináció hosszú távú változásainak nozospecifikus mintáit. A témavezető tudomány-logikai elemzést írt a pszichiátriai jelenlegi kríziséről. Továbbá két határterületi kérdést elemzett: "Szellem és kórságai", "Deviancia és rendszerváltozás". Kimutattuk, hogy a szám-szimbólum teszttel mért neurokognitív deficit a betegségfolyamat intenzitásának és tartamának függvénye. Pethő Bertalan | We demonstrated the relevance of a special psychopathological dimension between the definitive symptoms on one hand and the latent disturbances on the other by using two rating scales developed by us. We have found nosospecific pattern by introducing an innovative term and method named "Spontaneous self-characterization". Based on analyses of the data of psychopathological rating scales on one hand and on analyses of ratings of independent investigators on the other we introduced the new term "of reliability". We verified it by comparison of two series of assessments of the same population followed-up after a quarter of century. Using the Wechsler Intelligence Scale we have found nosospecific patterns of deficits being manifested in the 21-33-year course of illness. To our knowledge no previous long-term studies of the Leonhardean classification of endogenous psychoses have been conducted. Our prospective study started in 1967-1976. The same population was followed-up by participation of a "blind control" psychiatrist in 1997-2002. Hebephrenias, group of normal persons, of schizophrenias and of systematic paraphrenias proved to be valid. Bipolar manic-depressive psychoses, cycloid psychoses and unipolar depression were also valid by forming "nosological families". The digit symbol coding impairment was found to represent the disease process, which ultimately results in a "defect-state". Bertalan Peth

TREATMENT PATTERNS OF SCHIZOPHRENIA BASED ON THE DATA FROM SEVEN CENTRAL AND EASTERN EUROPEAN COUNTRIES

Objective: The aim is to analyze how schizophrenia is pharmacologically treated in seven CEE countries: Croatia, Estonia, Hungary, Poland, Serbia, Slovakia and Slovenia. Methods: Psychiatrists from selected centers in each of participating countries were asked to complete a pre-defined questionnaire on their current clinical practice. Information on protocols and resource utilization in schizophrenia treatment was included and derived from randomly selected patient medical records. Expert opinions on country-wide treatment patterns were additionally sought. This sub-analysis focuses on pharmacological treatment patterns in the last six months and over the course of the disease. Results: 961 patients’ data show that during last six months the most commonly prescribed medications were oral atypical antipsychotics: olanzapine (n=268), clozapine (n=234) and risperidone (n=160). The most frequently prescribed atypical antipsychotics over course of disease were: risperidone (54.5%), olanzapine (52.4%) and clozapine (35.1%), along with haloperidol (39.3%). Experts reported risperidone (four countries) and olanzapine (three countries) as first-line treatment, with the same two medications prescribed as second-line treatment. Clozapine was the most reported medication for refractory patients. Approximately 22% of patients received polypharmacy with antipsychotics in at least one period over the disease course. Mean time since diagnosis was 13.1 years and on average 4.8 treatment courses received during that period. Anxiolytics (70%), antidepressants (42%), moodstabilizers (27%) were also prescribed, with diazepam (35.4%), sertraline (10.5%), valproic acid (17.5%) the most commonly reported, respectively, in each group. The most frequently reported treatment change was switch from one oral atypical antipsychotic to another (51%). Conclusion: Oral atypical antipsychotics, mostly older drugs (risperidone, olanzapine, clozapine), were most commonly prescribed for schizophrenia treatment in participating countries. Given that results are from the first large-scale analysis of RWD, we believe these findings can be a benchmark for future real-world studies, which could contribute to the optimization of treatment for this debilitating disease

Antipszichotikumok kombinációjának használata szkizofrénia kezelésében. Irodalmi áttekintés

Main indication for antipsychotic medication is the treatment of schizophrenia and other psychotic disorders. Influential protocols in the treatment of schizophrenia recommend the use of antipsychotics in monotherapy. In case of therapy resistance, combination of antipsychotics is a feasible option. Applying antipsychotics in combination is common in clinical practice, although existing efficacy and safety data concerning antipsychotic combinations are scarce. Authors, after reviewing existing scientific data, make attempt to give recommendations for combined antipsychotic therapy in everyday clinical practice

ELECTROCONVULSIVE THERAPY IN A HUNGARIAN ACADEMIC CENTRE (1999-2010)

Background: Since the 1930s, the Department of Psychiatry and Psychotherapy at Semmelweis University (DPPSU) in Budapest has played a leading role in convulsive therapy in Hungary. The aim of this study was to describe the pattern of ECT use at the DPPSU over an 11-year period. Subjects and methods: Analysis of the medical notes of all patients treated with ECT in this academic centre between 1999 and 2009. Results: During the study period, 28,230 patients were admitted to the DPPSU, of whom 457 (1.6%) received ECT. More than 50% of patients receiving ECT were diagnosed with schizophrenia. The percentage of female patients receiving ECT significantly exceeded that of the male patients, above what was expected in view of the diagnostic mix. Conclusion: The data indicate that in the first decade of the 21th century, ECT use shows a declining tendency in this Hungarian academic centre. The mean number of treatment sessions was relatively low and nearly the same across diagnostic groups. ECT was mainly used as a last resort for treatment-resistant patients. In the majority of cases, bifronto-temporal brief pulse stimulation was applied. Seizures were monitored with EEG and EMG

ELECTROCONVULSIVE THERAPY IN A HUNGARIAN ACADEMIC CENTRE (1999-2010)

Background: Since the 1930s, the Department of Psychiatry and Psychotherapy at Semmelweis University (DPPSU) in Budapest has played a leading role in convulsive therapy in Hungary. The aim of this study was to describe the pattern of ECT use at the DPPSU over an 11-year period. Subjects and methods: Analysis of the medical notes of all patients treated with ECT in this academic centre between 1999 and 2009. Results: During the study period, 28,230 patients were admitted to the DPPSU, of whom 457 (1.6%) received ECT. More than 50% of patients receiving ECT were diagnosed with schizophrenia. The percentage of female patients receiving ECT significantly exceeded that of the male patients, above what was expected in view of the diagnostic mix. Conclusion: The data indicate that in the first decade of the 21th century, ECT use shows a declining tendency in this Hungarian academic centre. The mean number of treatment sessions was relatively low and nearly the same across diagnostic groups. ECT was mainly used as a last resort for treatment-resistant patients. In the majority of cases, bifronto-temporal brief pulse stimulation was applied. Seizures were monitored with EEG and EMG

Treatment patterns of schizophrenia based on the data from seven Central and Eastern European Countries

OBJECTIVE: The aim is to analyze how schizophrenia is pharmacologically treated in seven CEE countries: Croatia, Estonia, Hungary, Poland, Serbia, Slovakia and Slovenia. METHODS: Psychiatrists from selected centers in each of participating countries were asked to complete a pre-defined questionnaire on their current clinical practice. Information on protocols and resource utilization in schizophrenia treatment was included and derived from randomly selected patient medical records. Expert opinions on country-wide treatment patterns were additionally sought. This sub-analysis focuses on pharmacological treatment patterns in the last six months and over the course of the disease. RESULTS: 961 patients' data show that during last six months the most commonly prescribed medications were oral atypical antipsychotics: olanzapine (n=268), clozapine (n=234) and risperidone (n=160). The most frequently prescribed atypical antipsychotics over course of disease were: risperidone (54.5%), olanzapine (52.4%) and clozapine (35.1%), along with haloperidol (39.3%). Experts reported risperidone (four countries) and olanzapine (three countries) as first-line treatment, with the same two medications prescribed as second-line treatment. Clozapine was the most reported medication for refractory patients. Approximately 22% of patients received polypharmacy with antipsychotics in at least one period over the disease course. Mean time since diagnosis was 13.1 years and on average 4.8 treatment courses received during that period. Anxiolytics (70%), antidepressants (42%), mood-stabilizers (27%) were also prescribed, with diazepam (35.4%), sertraline (10.5%), valproic acid (17.5%) the most commonly reported, respectively, in each group. The most frequently reported treatment change was switch from one oral atypical antipsychotic to another (51%). CONCLUSION: Oral atypical antipsychotics, mostly older drugs (risperidone, olanzapine, clozapine), were most commonly prescribed for schizophrenia treatment in participating countries. Given that results are from the first large-scale analysis of RWD, we believe these findings can be a benchmark for future real-world studies, which could contribute to the optimization of treatment for this debilitating disease