Nemzetközi vizsgálatokhoz hasonlóan hazánk felnőtt lakosságában az orvosi értelemben vett és kezelést igénylő major depressziós epizód egy hónapos prevalenciája 4-5%, míg egy éves prevalenciája 7-8% (Szadoczky et al., 1998). A kezeletlen súlyos major depressziós betegek 10-15 százaléka öngyilkosságban hal meg, és a befejezett öngyilkosok 65-75 százaléka aktuálisan (többnyire kezeletlen) major depresszióban szenved. A depresszió, és különösen a kezeletlen depresszió, gyakori és súlyos szövődményei (szuicid magatartás, szekunder alkohol- és drog-abúzus, fokozott szomatikus morbiditás és mortalitás, tartós betegállomány, rokkantosítás stb.) jelentősen behatárolják a beteg és családtagjai jóllétét, és emellett jelentős anyagi terhet rónak a társadalomra is (Rihmer, 2007; Paykel et al., 2005). Az öngyilkosság mindenütt a világon komoly népegészségügyi problémát jelent, különösen hazánkban, ahol az utóbbi 25 évben a közel 50 százalékos csökkenés ellenére évente még mindig közel 2500 ember hal meg öngyilkosság következtében, többen, mint közlekedési balesetben. Ugyanakkor a depressziók megfelelő kezelése kb. 80 százalékkal csökkenti a szuicid halálozást (Rihmer et al., 2008). A major depresszió pontprevalenciája a hazai háziorvosi gyakorlatban (hasonlóan nemzetközi adatokhoz) 6-10% (Szádoczky et al., 1997; Rihmer et al., 2011). Mivel az öngyilkosok több mint 50 százaléka élete utolsó 3 hónapjában felkeresi háziorvosát, a háziorvosi szolgálat kiemelkedő jelentőséggel bír az öngyilkosság megelőzését illetően. Megfigyelték azt is, ha a depresszió mellett testi betegség is fennáll, gyakran csak az utóbbit ismerik fel és kezelik. A családorvosi praxishoz tartozó, depresszióban szenvedő betegeknek kevesebb, mint a fele fordul orvoshoz és többségük a családorvosától kér segítséget. A diagnózis és a terápia terén az utóbbi évtizedekben végbement jelentős fejlődés ellenére a családorvosok számára továbbra is adódnak nehézségek a depresszió felismerésével és kezelésével kapcsolatban (Rihmer et al., 2011; Rihmer és Rutz, 2009). A családorvosoknak a depresszió felismerésében, kezelésében és a depresszióval kapcsolatos öngyilkosságok megelőzésében betöltött fontos szerepére először az úttörő jelentőségű Gotland vizsgálat hívta fel a figyelmet. A Svédországhoz tartozó Gotland sziget (58000 lakos) 18 családorvosának 1983 nyarán tartott két napos intenzív, a depresszió felismeréséről és kezeléséről szóló tanfolyam után nemcsak az öngyilkossági halálozás csökkent szignifikánsan, hanem lényegesen csökkent a depresszió miatti kórházba utalások és a depresszió miatti betegállományban töltött napok száma is. A szigeten eközben markánsan megnőtt az antidepresszív gyógyszerek forgalma, míg ezen változások a kontrollrégióban nem voltak észlelhetők. Az adatok elemzése azt is igazolta, hogy a tanfolyam után lényegesen lecsökkent az öngyilkossági halálozás, mely a depresszióval kapcsolatos szuicídiumok markáns csökkenése miatt következett be (Rihmer et al., 2011; Rihmer és Rutz, 2009). Azt, hogy a háziorvosok depresszió-továbbképző programjai – megfelelő közösségi beágyazottságban – az ellátási terület öngyilkossági halálozásának lényeges csökkenéséhez vezetnek, nemzetközi adatokhoz hasonlóan két nagy hazai vizsgálat is igazolta (Szanto et al., 2007; Szekely et al., 2013).

Background: The prevalence of minor physical anomalies (prenatal errors of morphogenesis)
was evaluated in patients with idiopathic epilepsy to get indirect data on the possible role
of aberrant neurodevelopment in the etiology of the disease. Aim: Connecting to current
opinions on a possible role of aberrant neurodevelopment in idiopathic epilepsy it seems
important to introduce somatic trait marker research focusing on brain maldevelopment.
Methods: A scale developed by Méhes (1985) was used to detect the presence or absence
of 57 minor physical anomalies in 24 patients with idiopathic epilepsy and in 24 matched
controls. Results: The mean value of all minor physical anomalies was significantly higher in
the group of patients compared to controls. In case of 3 minor physical anomalies we could
demonstrate statistically significant differences between children with epilepsy and the control sample. Two minor malformations (primitive shape of ears, double posterior hair whorl)
and one phenogenetic variant (inner epicanthic folds) had a significantly higher frequency
in patients compared to control individuals. Conclusion: The overrepresentation of minor
physical anomalies in idiopathic epilepsy can strongly support the view that this disorder is
related to pathological factors operating early in development.

(Neuropsychopharmacol Hung 2014; 16(3): 115–120)

Keywords: minor physical anomalies, idiopathic epilepsy, neurodevelopment, childhood
epilepsy, somatic markers

Background: At present 34 million people live with Alzheimer’s disease around the world.
This figure is expected to triple in the next 40 years. The major cause of this increase is the
well-known aging of the society in Europe and in the US as well. Aims and Methods: In this
paper we review the results of the last 10 years, and discuss those pharmaceutical and other
methods, which can be effective in the prevention of dementias. Results: The most important
pharmaceutical agents are beta secretase inhibitors, and active and passive immunizations.
Several drugs in these groups are in phase III at the moment. The results from studies with
intranasal insulin are also encouraging. As a non-drug option Mediterranean diet can be effective. However at present cognitive trainings seem to be the most effective in the prevention
of dementias. These remediation therapies are based on the lifelong plasticity of the human
brain. Conclusions: In summary we can conclude that there are promising drug developments
in progess for the prevention of dementias, but the breakthrough has not been achieved
yet. At present the best option is decreasing risk factors, that is treatment of hypertension,
prevention of obesity and diabetes, and cognitive trainings are recommended for prevention. 

(Neuropsychopharmacol Hung 2014; 16(3): 121–126)

Keywords: dementia, cognitive training, prevention, mild cognitive impairment, beta secretase, immunization

Heroin addiction is one of the most devastating and expensive of public health problems.
The most effective treatment for this epidemic is opioid replacement therapy. Replacement
of heroin, a short-acting euphoriant with methadone or other opioids that have significantly
longer durations of action provides a number of therapeutic benefits. Opioid detoxification has a role in both preventing acute withdrawal and maintaining long-term abstinence.
Opioid-based detoxification is based on the principle of cross-tolerance, in which one opioid
is replaced which another that is slowly tapered. For the treatment of heroin addicts a wide
range of psychosocial and pharmacotherapeutic treatments is available; of these, methadone
maintenance treatment has the most evidence of benefit. Methadone maintenance reduces
and/or eliminates the use of heroin, reduces the death rates and criminality associated with
heroin use, and allows patients to improve their health and social productivity. In addition,
enrollment in methadone maintenance has the potential to reduce the transmission of
infectious diseases associated with heroin injection, such as hepatitis and HIV. The principal
effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence
syndrome, and block the euphoric effects associated with heroin. There is growing interest in
expanding treatment into primary care, allowing opioid addiction to be managed like other
chronic illnesses. Buprenorphine which is a long-acting partial agonist was also approved
as pharmacotherapy for opioid dependence. Opioid antagonists can reduce heroin selfadministration and opioid craving in detoxified addicts. Naltrexone, which is a long-acting
competitive antagonist at the opioid receptors, blocks the subjective and objective responses
produced by intravenous opioids. Naltrexone is employed to accelerate opioid detoxification
by displacing heroin and as a maintenance agent for detoxified formerly heroin-dependent
patients who want to remain opioid-free.

(Neuropsychopharmacol Hung 2014; 16(3): 127–140)

Keywords: heroin addiction, methadone maintenance, detoxification, buprenorphine,
naltrexone

The connection between mood and sleep disorders is highly complex and can be studied
and interpreted in many respects. Epidemiologic data show that the co-occurrence of the
two disorders is quite frequent. Thus an approach regarding them as a unit promotes biological psychiatric research by revealing new pathophysiological and therapeutic conclusions.
Chronobiological results related to mood disorders have recently been described in excellent
reviews including Hungarian ones. In the present review, the necessity of treatment of sleep
disorders is evaluated in the context of relapse/remission/recurrence. Scientific data suggest
that patients with insomnia have a ten-fold risk of developing depression, and insomnia plays
an important role in depression relapses, recurrence of depressive episodes and becoming
depression chronic. From neurobiological point of view, mood and sleep disorders have many
features in common. Research has revealed decreased levels of melatonin and advanced sleep
phases (shifted earlier) in depression, and altered and imbalanced monoaminergic pathways,
and REM abnormalities in sleep disorders. Some authors suggest that REM abnormalities
disappear along with the mood improvement, and the sleep structure can completely restore
after remission. However, persistent abnormalities of REM sleep and slow wave sleep have
also been found in remission, which increased the risk of the relapse and recurrence. Recently,
there is an agreement as to the early treatment of insomnia can prevent the development
of mood abnormalities. Alterations of cascades related to neural plasticity can also be a link
between sleep and mood disorders. Neural plasticity is closely related to learning, sleeping,
and cortisol regulation (coping with stress), and this draws the attention to comorbidity with
further disorders (anxiety, dementia).

(Neuropsychopharmacol Hung 2014; 16(3): 141–147)

Keywords: depression, insomnia, relapse, remission, recurrence

The author establishes that Psychiatry has been in a difficult situation especially in Hungary
since closing down the National Institute of Psychiatry and Neurology. He reviews the most
important factors which hold up the development of Psychiatry. He settles that the development of Psychiatry is inconceivable without a person’s holistic approach which assumes the
biological, mental, cultural-social and spiritual approach. Disturbances of perception have
particular roles in the formation of psychopathological symptoms which are based on the
operation of the nervous system. This fact emphasises the importance of the nervous system
and the neuropsychopharmacology which we have known since the beginning of history
although it is hardly half a century old. He pays the attention to the psychoactive medicine
that was well-known in the ancient civilization. He reviews some of them which were actually
the first neuropsychopharmacological pharmaceuticals. He emphasises the dichotomy of the
psychopathological symptoms which are partly objective, partly subjective but based on the
operation of the nervous system by all means. His statements not only establish a new kind of
approach of both the person and the Psychiatry but enables the development of Psychiatry,
the creation of a new sort of diagnostic system, eliminating the variance among the experts
dealing with people, the neurologists, the psychiatrists, the psychologists, the sociologists,
the philosophers and the theologians, ensuring the biological (neurological), psychological,
cultural and spiritual perpetuity. The biological, genetic, psychic, cultural-social and spiritual
approach, the application of nanomedicine that enable not only recognising the organic
neurological bases of the psychiatric disorders that are all crucial for the future researchers
but also essential in the development of the neuropsychopharmacology based on the function of the nervous system.

(Neuropsychopharmacol Hung 2014; 16(3): 149–156)

Keywords: neuropsychopharmacology, disturbances of perception, holistic approach,
modified consciousness, Indian psychology and mythology.