VOLUME 16, ISSUE 4, DECEMBER 2014
az idei megjelenéssel is, melynek vendégszerkesztője Kovács Gábor; a téma most a pszichiátriai betegségek komorbiditása.
A közleményeket nem csak a közös komorbiditás téma, az együttes fellépés is összeköti. Nyolc-tízen sok-sok éve tartanak előadássorozatot Kovács Gábor szervezésében és elnökletével Társaságunk rendszeres, évente október elején megrendezett tihanyi nemzetközi kongresszusán.
A Magyar Neuropszichofarmakológiai Kongresszus tavaly adminisztratív, az idén anyagi okok miatt maradt el, de korábban tizenöt alkalommal minden évben sor került rá. Talán ezért is tervezzük 2015-ben két alkalommal a létrehozatalát: az elsőre jövő év április 18-án a Fiatal Neuropszichofarmakológusok Fórumán, a budapesti Kútvölgyi Kórház előadótermében kerülne sor.
Ezért is van különleges jelentősége a most megjelent tematikus számnak, mely nem csak a legfrissebb
kutatási eredményeket, de Társaságunkat is összetartja.
Comorbidity is a multicausal, multidimensional, multifaced phenomenon in medicine. There
are many different definitions of the co-occurrence of two or more disorders, but Feinstein’s
is the most acceptable. Although epidemiological data show a high prevalence of comorbidity of somatic and psychiatric disorders, it is still underrecognized and undertreated. There
are many unanswered questions related to comorbidity, including whether comorbidity is
a valid phenomenon; whether the epidemiological results have validity; what is the linkage
between somatic and psychological processes; which factors take part in the bidirectional
manifestation; how do we treat the involved disorders; what is the right organization to
manage the patients. The aim of the author was to review different aspects of comorbidity
with the help of new knowledge. The starting point of the interpretation was the concept of
identical biological substrates (patophysiological endpoint) that generate the development
of somatic and psychiatric disorders. The formation of these substrates is influenced by risk
factors, which depend or not on the person (stressors vs genes). The effects of risk factors
and biological substrates are parallel to each other, but one of them is a dominant agent.
The author’s concept (“dominance theory”) is based on new discoveries of the biological
mechanisms of psychiatric processes to help to understand the phenomenon of comorbidity
and develop new therapies. It is very important to recognize, to diagnose and treat comorbidity because of the prevalence of excess mortality is high and the morbidity burden influences
the patient’ quality of life.
(Neuropsychopharmacol Hung 2014; 16(4): 169–180)
Keywords: comorbidity, somatic, psychiatric, risk factors, biological substrate, dominance
Gábor Gazdag, Zsuzsa Szabó and János Szlávik
It is essential for the psychiatrist working in the consultation-liaison field or with comorbid
patients to be familiar with the psychiatric aspects of central nervous infectious diseases
or infectious diseases with psychiatric symptoms. Authors have reviewed the most important psychiatric aspects of common infectious diseases. Essential knowledge for setting up
a diagnosis and starting appropriate treatment has been summarized. The most important
interactions of infectological and psychiatric treatments have also been discussed.
(Neuropsychopharmacol Hung 2014; 16(4): 181–187)
Keywords: infectious diseases, psychiatric symptoms, central nervous system, drug interactions
Over the past two decades, there has been an upsurge of interest in catatonia, which is
reflected in the attention it received in DSM 5, where it appears as a separate subsection of the
Schizophrenia Spectrum and Other Psychotic Disorders (APA, 2013). This commentary argues
that due to the lack of solid scientific evidence, the extended coverage of catatonia in DSM 5
was a premature, and consequently, a necessarily ambiguous decision. The psychopathological
foundations of the modern catatonia concept are lacking therefore its boundaries are fuzzy.
There are only a few, methodologically sound clinical, treatment response and small-scale
neurobiological studies. The widely recommended use of benzodiazepines for the treatment
of catatonia is based on case reports and open-label studies instead of placebo-controlled,
randomized trials. In conclusion, the catatonic concept espoused by DSM 5 is necessarily
vague reflecting the current state of knowledge.
(Neuropsychopharmacol Hung 2014; 16(4): 189–194)
Keywords: DSM 5, catatonia, psychopathology
Relationship between treatment of depression and suicide mortality in Hungary – Focus on the effets of the 2007 healthcare reform
Zoltán Rihmer, and Attila Németh
Major depression is a common but still underdiagnosed and undertreated illness which, with
its complications (suicide, secondary alcoholism, loss of productivity, increased cardiovascular
morbidity and mortality), is a major public health problem worldwide. Implementing the
present pharmacological and non-pharmacological treatment strategies, major depression
can be successfully treated resulting in a significant decline in suicide risk and the economic
burden caused by untreated depression is much higher than the cost of treatment. In the
present paper the authors also discuss the impact of the development of the Hungarian psychiatric care system in the past three decades and the 2008 recession on the changing national
suicide rate. Like international data, Hungarian studies also show that more widespread and
effective treatment of depression is the main component of the more than 50-percent decline
of suicide mortality in Hungary during the last 30 years..
(Neuropsychopharmacol Hung 2014; 16(4): 195–204)
Keywords: antidepressants, major depression, psychiatric care system, public health significance, suicide, suicide prevention
Movement disorders are common in psychiatry. The movement disorder can either be the
symptom of a psychiatric disorder, can share a common aetiological factor with it, or can
be the consequence of psychopharmacological therapy. Most common features include
tic, stereotipy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of
posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia,
catatonia, Tourette-disorder and psychogenic movement disorder, leading to differentialdiagnostic and therapeutical difficulties in everyday practice. Movement disorders due to
psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent
psychiatric comorbidity is found in primary movement disorders, such as Parkinson’s disease,
Wilson’s disease, Huntington’s disease, diffuse Lewy-body disorder. Complex neuropsychiatric
approach is effective concerning overlapping clinical features and spectrums of disorders in
terms of movement disorders and psychiatric diseases.
(Neuropsychopharmacol Hung 2014; 16(4): 205–211)
Keywords: movement disorder, psychiatry, tic, stereotipy, catatonia, dyskinesia, neuropsychiatry