Psychosocial changes in six months of buprenorphine/naloxone substitution treatment

Zsolt Petke, József Csorba, Judit Mészáros, István Vingender, Judit Farkas, Zsolt Demetrovics, Zsuzsanna Kovács, Zsuzsa Menczel, Zoltán Pataki, Péter Simor, Anna Havasi, Katalin Melles, Ferenc  Márványkövi and József Rácz


Aims: The main target of our research was to measure the changes in psychological symptoms
(anxiety, depression, craving) of patients receiving buprenorphine-naloxone substitution
treatment for six months, and the evaluation of the changes using the clients’ dependency
parameters (ASI). Methods: The level of dependency was investigated using the Addicton
Severity Index (ASI). The psychiatric symptoms related to Axis I and II disorders were examined
using the Structured Clinical Interview for DSM-IV, SCID I and SCID II. The degree of craving
was measured using the Heroin Craving Questionnaire, the assessment of the symptoms of
depression using BDI and HAM-D, recorded by the medical attendant of the patient. To survey
the extent of anxiety, we used STAI-S, and HAM-A. All patients receiving Suboxone therapy
in Hungary between November 2007 and April 2008 were included in the study (n=80). During this time, Suboxone therapy was available in 6 locations. Results: We found significant
improvement in almost all observed fields of behavioural and symptomatic dimensions during the first month. The only exception was the dimension of subsistence/livelihood of ASI,
the changes were only at the tendency level. During the next five months of therapy, there
was no further sign of improvement or decline in the observed fields, the only exception was
again the subsistence/livelihood dimension of the ASI. Conclusions: Our results indicate that
buprenorphine/naloxone treatment is a promising possibility for patients in need of opiatesubstitution treatment.

(Neuropsychopharmacol Hung 2012; 14(1): 7-17; doi: 10.5706/nph201203001)

Keywords: Problematic drug use, behavioural and psychiatric disorder, recovery, substitution

Achetylcholinesterase (AChE) inhibition and serum lipokines in Alzheimer’s disease: friend or foe?

János Kovács, Magdolna Pákáski, Anna Juhász, Ágnes Fehér, Gergely Drótos, Csilla Fazekas Örsike, László Tamás Horváth , Zoltán  Janka and János Kálmán


Throughout the natural progression of Alzheimer’s disease (AD), the body mass index (BMI)
decreases. This is believed to be brought on by the disturbance in the central lipid metabolism, but the exact mechanism is yet unknown. Adipokines (adiponectin, leptin), hormones
produced by the adipose tissue, change glucose and lipid metabolism, and have an anorectic
effect through increasing energy consumption in the hypothalamus. The goal of our study was
to examine donepezil – an acetylcholinesterase inhibitor (AChEI) currently used in AD therapy –,
and to what degree it influences the serum adipokine levels and metabolic parameters of AD
patients. During the self-evaluation of 26 clinically diagnosed mild to moderate AD patients,
therapy with 10 mg/day donepezil was started according to current protocols. We measured
serum adiponectin, leptin, LDL, HDL, trigliceride levels, and BMI and ApoE polymorphism at the
beginning of our study, and at 3 and 6-months intervals respectively. All data were analyzed
with SPSS 17. In comparison with pre-donepezil therapy values, at the third month interval
serum adiponectin levels showed an increasing and leptin levels a decreasing tendency. At the
six month interval, adiponectin levels significantly increased (p=0.007), leptin levels decreased
(p=0.013), BMI (p<0.001) and abdominal circumference (p=0.017) was significantly lower at 6
months as compared to control values. We did not observe any changes in the lipid profile, and
ApoE4 allele carrying showed no association with the parameters. To our knowledge, we are
the first to publish that AChEI therapy with donepezil alters lipokine levels, which positively
influences the currently known pathomechanism and numerous risk factors of AD. The AChEI
treatment-induced weight loss should be considered in the long-term therapy of AD patients. 

(Neuropsychopharmacol Hung 2012; 14(1): 19-27; doi: 10.5706/nph201203002)

Keywords: Alzheimer’s disease, dementia, donepezil, lipokine, adiponectin, leptin,
apolipoprotein E, bodyweight, lipid


In spite of the wide-ranging, continuously expanding arsenal of antidepressants and intensive research on depression, the treatment of severe, recurrent mood disorders as well as antidepressant-resistant refractory mood disturbances has not yet entirely been solved. In this article we attempt to review some data from the growing body of evidence that underlie the presumed implication of the glutamatergic neurotransmission in severe mood disorders and thereby some strategies allowing reinstatement of the normal functioning of the glutamatergic system, particularly through N-methyl-d-aspartate (NMDA) receptors. Thus, here we focus on one of the most promising ones, the NMDA receptor-modulating agents including competitive NMDA antagonists, glycine site partial antagonists and channel site antagonists: high- and low-affinity non-competitive NMDA receptor blockers. The glutamate-modulating therapies that specifically affect this system, above all low-affinity non-competitive NMDA receptor antagonists such as amantadine and its derivative memantine which are clinically well tolerated and currently used in other indications hold considerable promise for the development of new, improved antidepressants to treat severe, recurrent and refractory mood disorders.

(Neuropsychopharmacol Hung 2012; 14(1): 29-40; doi: 10.5706/nph201203003)

Keywords: mood disorders, depression, glutamatergic neurotransmission, NMDA antagonists, antidepressant

Economic recession, unemployment and suicide

Tímea Duleba, Xénia Gonda, Zoltán Rihmer, and Péter Döme


Considering the ongoing global economic crisis which began in 2007 it is reasonable to
discuss its possible and expectable effects on mental health. In our narrative review we
have summarized the scientific literature on the relationship between economic downturns,
unemployment and suicide rate. In addition, we have summarized the theories about the
background of this relationship as well. Suicide is an extremely complex phenomenon since
it is influenced by several environmental and genetic factors. Furthermore, some of these factors are mutually interrelated, so the independent effect of these frequently remains elusive
and hard to investigate from a methodological point of view. Although results are somewhat
contradictory, it seems that unemployment is an independent risk factor for both suicide
and depression. The first papers about the effect of the current economic crisis on suicide
rates have been published and their results confirmed the association between the rise of
unemployment rate and the increase of suicide rate in both old and new members of the
European Union. Although psychiatric, and primarily depressive illness is a major risk factor
for suicide, understanding the contributing role of other etiologic factors in their complex
relationship may be an important task in predicting and preventing suicide both at the level
of at risk individuals and the whole population. 

(Neuropsychopharmacol Hung 2012; 14(1): 41-50; doi: 10.5706/nph201203004)

Keywords: unemployment, economic recession, suicide, depression

Adulthood – childhood – adulthood: Long-term treatment in child and adolescent psychiatry

Judit Balázs, Judit Tolna, Júlia  Gádoros and Gyöngyvér Dallos



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. 

(Neuropsychopharmacol Hung 2012; 14(1): 51-58; doi: 10.5706/nph201203005)

Keywords: Childhood, Adulthood, Psychosis, Attention-Deficit/Hyperactivity Disorder (ADHD)