Objective: Paired Associates Learning (PAL) test assesses brain functions in those brain regions affected earliest by Alzheimer’s dementia. The aim of the present study was to assess
the usability of our implementation of the PAL test for screening mild cognitive impairment.
Methodology: Based on Petersen criteria, 14 out of the 63 subjects were diagnosed with
mild cognitive impairment. Visuospatial learning was assessed by our implementation of PAL
test. The ability of the PAL test to differentiate between study groups was compared to the
Addenbrook Cognitive Examination (ACE) and to the Mini Mental State Examination (MMSE).
Linear logistic regression was used for statistical analysis, and the results are presented as
Receiver Operating Characteristics (ROC) curves. All analyses were performed by SAS 9.2.
Results: All the results of neuropsychological tests differed significantly between the study
groups. However, considerable difference could be detected between the tests regarding
specificity and sensitivity. The PAL test reached the sensitivity of the ACE, while its specificity
was slightly under the ACE. Discussion: The PAL test developed in the framework of the present
study is found to be able to differentiate between MCI and healthy controls. It outperformed
the MMSE in terms of sensitivity and specificity, while it needs comparable time to perform.
Its sensitivity, the important parameter for screening, is comparable to ACE, while it needs
significantly shorter time and less assistance.

(Neuropsychopharmacol Hung 2013; 15(3): 139-146)

Due to their increasing frequency, mental disorders among the elderly have special importance
in the clinical practice. In this article we summarize the characteristics, diagnostic problems
and modern treatments of mental disorders (especially depression) in old age. As this period
of life means special somatic and psychic features in people’s condition, it may be difficult to
find the most effective and well-tolerated treatment, especially in case of comorbid dementia or agitated behaviour. In this article we review the therapeutic experience with the SARI
antidepressant trazodone. Clinical studies and everyday practice indicate that trazodone due
to its special multifunctional receptorprofile can be particularly effective in the treatment of
depression accompanied by severe insomnia and anxiety. Due to its special anxiolytic and
sleep normalising effect and well-tolerated side effect profile trazodone is found to be clinically
useful not only in the treatment of depression in the elderly, but also in the case of serious
comorbidity with dementia or agitated behaviour. We also illustrate the possibilities of using
trazodone in the everyday practice with the presentation of two case reports. Furthermore
we review the viewpoints of complex therapy which facilitates the successful treatment of
depression in the elderly and the restoration of quality of life.

(Neuropsychopharmacol Hung 2013; 15(3): 147-155)

Currently detoxification of drug and alcohol dependent patients is pharmacologically
unresolved, and long-term treatment following the acute phase is also not very successful including a high number of relapses. We would need medications that on the short
term cease: the severe vegetative symptoms, the pain, the extremely distressing psychosyndrome characterised by restlessness, anxiety or acute depressive symptoms, and the craving.
The optimal would be if there was one medication capable of simultaneously alleviating or
diminishing all the above symptoms without causing dependency and preventing relapse
in the long-term. Dependency is almost all cases accompanied by primary and/or secondary mood disorder or sleep disorder which should also be treated. It should be considered,
however, that following withdrawal of the agent benzodiazepine dependency often develops. The serotonin antagonist and reuptake inhibitor (SARI) trazodone is effective in the
treatment of depression accompanied by sleeping disorder and it has also shown efficacy
in alcohol and benzodiazepine-dependency. Its administration may improve the efficacy of
detoxification and treatment of following conditions, may decrease medication load and the
risk of the development of benzodiazepine dependency. In our clinical practice we frequently
use this agent to treat our patients simultaneously suffering from depression and addiction
problems, gaining experience comparing it to other pharmacotherapies (benzodiazepines
or other antidepressants). The medication is not approved for alcohol and drug dependence,
however, treatment t of comorbid conditions is not against to the official recommendations.
Our aim was, in addition to reviewing the literature, to share our experience which, although
cannot be considered an evidence based study, we deemed worthy of publishing. We cannot,
at this point, put forward a protocol addressing all related scientific problems and problems
of off-label treatment, and we could not so far treat enough patients with trazodone so that
our results would be statistically proven. ”Acute” and long term treatment of dependency is
not sufficiently effective with a substantial relapse rate, which is in part related to the lack of
specific medication also for long term treatment. Among the available psychopharmacons,
trazodone is a possible choice, since, as based on patients’ reports and clinical observations,
improvement of their depressive conditions and sleep problems potentially decreases the
risk of relapse of drug and alcohol dependence.

(Neuropsychopharmacol Hung 2013; 15(3): 157-164)

Treatment guidelines suggest antipsychotic monotherapy in the treatment of psychosis.
20-40% of patients take combination therapy in clinical practice due to inadequate treatment
response to monotherapy. First-generation antipsychotic monotherapy was ineffective in
case of our patient who had severe psychotic symptoms. Switching to a second generation
antipsychotic had partial therapeutic effect, the severe psychotic condition was persistent.
For this reason the therapy was changed to olanzapine-clozapine combination. Due to this
combination the patient’s psychotic symptoms disappeared. He was able to maintain the
relationship with psychiatrist. During this therapy we observed good compliance, no more
drug abuse and lack of relapse. 

Hyponatremia is a potential side-effect of antidepressants that was observed most frequently
in connection with compounds acting on the serotonin system. Risk of hyponatremia was
found to be higher in the elderly. Authors report a case of a 65-year old male patient who was
treated with venlafaxine-mirtazapine combination for recurrent depression. Serious, intensive
care-requiring hyponatremia emerged in connection with the treatment. Authors emphasize
the importance of the regular check of serum sodium levels during antidepressant treatment,
especially in elderly patients.