Editoral in Hungarian

Sándor Kalmár


A neurológiai és neuropszichopharmakológiai kutatások jelentősége a személyiségfejlődés során tapasztalt elváltozások megértése és kezelése szempontjából

Kalmár Sándor

Bizonyított tény, hogy a pszichiátriai betegségek jelentős része először a serdülőkorban és a fiatal felnőtt korban manifesztálódik, ami azt jelzi, hogy a születéstől a felnőtté válásig tartó úton számos hiányossággal és hibával kell számolni, amelyek sem felismerésre, sem megfelelő kezelésre nem kerülnek. A születéstől a felnőtté válás folyamatának (szubjektív) pszichológiai leírásait jól ismerjük, azonban az egyes fejlődési szakaszokról, azok egészséges és kóros elváltozásainak idegrendszeri morfológiai, biokémiai és funkcionális eltéréseiről kevés, a gyakorlatban hasznosítható természettudományos, organikus neurológiai ismerettel rendelkezünk. A rendkívül gazdag és színes pszichopatológiai, pszichoszomatikus és magatartási tünetről sok ismeretünk van, de ezek organikus eredete pontosan nem ismert, így azok hatékony befolyásolására, kezelésére a legtöbb esetben nincs lehetőségünk. A különböző pszichológiai leírások egyáltalán nem foglalkoznak sem a normális fejlődés, sem a kóros elváltozások idegrendszeri eredetével és okaival. Az senki előtt nem kétséges, hogy minden magatartásnak, pszichopatológiai és magatartás tünetnek a hátterében valamilyen organikus neurológiai, biokémiai elváltozás található, de ezek gyógyszeres kezelése ma még a mindennapi gyógyítás során nem biztosított.


Aim: The assessment of antidepressant efficacy of agomelatine, a new chronobiological type
of antidepressant as a function of the temporal accuracy of administration, compared to
the antidepressive effect of escitalopram. Methods: In our retrospective study at the end of
a 12-week treatment improvement rates were analysed in all depressed patients attending
our ourpatient clinic receiving agomelatine (25 or 50 mg daily) or escitalopram (10 or 20 mg
daily) monotherapy initiated between 01. 03. 2014 and 01. 03. 2015 Follow-up interviews were
conducted to evaluate temporal accuracy of agomelatine administration in the evenings and
we divided our group into accurately and inaccurately administered agomelatine groups.
Results: In the inaccurately administered agomelatine group (n=16) after 12 weeks 7 patients
(43.7 %) showed no improvement, 7 patients showed response (43.7%), and two entered remission (12.5%). In the accurately administered agomelatine group (n=63) 18 patients showed
no improvement (28.6%), 15 were responders (23.8%) and 30 patients entered remission
(47.6%). Regarding the improvement rates there was a significant difference between the two
agomelatine groups (p=0.034). Comparing the 12-week improvement ratio of the accurate
agomelatine group to all patients in the outpatient practice (n=62) receiving escitalopram
(30 vs 29 remitters, 15 vs 15 responders, and 18 vs 18) no difference in improvement rates
was shown between groups (p= 0.982). Conclusions: Our results show for the first time that
the accuracy of administration of evening agomelatine medication has a crucial importance
in terms of efficacy, furthermore confirm the results of previous international clinical trials
that the antidepressant agomelatine exerts the same strength of antidepressant effect as the
clinically proven escitalopram.

Keywords: agomelatine, escitalopram, major depression


Anxiety disorders are highly prevalent psychiatric diseases. In this short review we provide an
overview of concepts of fear, anxiety and anxiety disorders. In addition, based on the recent
literature, neuroanatomical structures involved in anxiety and functional/structural changes
of these structures in anxiety disorders are also discussed. Furthemore, the pitfalls of anxiolytic
drug discovery is also concerned in the paper.

Keywords: anxiety; neurobiology; neuroimaging; drug discovery

Antidepressants, stressors and the serotonin 1A receptor

Eszter Kirilly, Xénia Gonda, and György Bagdy


5-HT1A receptor is a receptor of surprises. Buspirone, an anxiolytic drug with a then yet unidentified mechanism of action had been marketed for years when it was discovered that it
is a 5-HT1A partial agonist. Several more years had to pass before it was accepted that this
receptor plays the key role in the action mechanism of buspirone. This was followed by
further surprises. It was discovered that in spite of its anxiolytic effect buspirone activates
the hypothalamic-pituitary-adrenal (HPA) stress axis, furthermore, it increases peripheral
noradrenaline and adrenaline concentration via a central mechanism. Thus activation of this
receptor leads to ACTH/corticosterone and catecholamine release and also increases betaendorphine, oxytocin and prolactin secretion while decreasing body temperature, increasing
food uptake, eliciting characteristic behavioural responses in rodents and also playing a role
in the development of certain types of epilepsy. Human genetic studies revealed the role of
5-HT1A receptors in cognitive processes playing a role in the development of depression such
as impulsiveness or response to environmental stress. This exceptionally wide spectrum of
effects is attributable to the presence of 5-HT1A receptors in serotonergic as well as other, for
example glutamatergic, cholinergic, dopaminergic and noradrenergic neurons. The majority of the effects of 5-HT1A receptors is manifested via the mediation of Gi
proteins through
the hyperpolarisation or inhibition of the neuron carrying the receptor. 5-HT1A receptors on
serotonergic neurons can be found in the somatodendritic area and play a significant role in
delaying the effects of antidepressants which is an obvious disadvantage. Therefore the newest serotonergic antidepressants including vilazodone and vortioxetine have been designed
to possess 5-HT1A receptor partial agonist properties. In the present paper we focus primarily
on the role of 5-HT1A receptors in stress and antidepressant response.

Keywords: 5-HT1A receptor, stress, antidepressants, anxiolytics, HPA-axis, vilazodone,


A quarter of a century ago the change of the political system in Hungary precipitated a serious value-crisis and caused a lot of harmful effects in nurturing and the development of
psychiatry. The author establishes that the attack against psychiatry is more intensive than
previously but neither the education and health management nor the psychiatric leadership
could cope with these difficulties. It can’t be denied that the foundation of lifelong mental
health begins in the early life years and about 75% of the first Mental Disorder manifests in
adolescence and youth. We are not able to ensure the special rights of every child according
to the Hungarian Constitution and the Declaration of the Rights of the Child by the United
Nations. The large inequalities within the country, the lack of paramount mental education
and nurturing, the lack of essential, consistent eternal values, the lack of required psychiatric
care system are huge obstacles of the development of healthy individual and leads to selfdestructive behaviour and several, serious physical and mental disorders. The purpose of the
author is to call psychiatrists’ attention to the main obstacles of the development of Hungarian
Psychiatric Care System. The main obstacles of the present psychiatric care system:
1. Unclarified notions, confusion of ideas.
2. Somatic, neurologic, mental, cultural-social and spiritual ignorance.
3. Lack of organization in Mental Education and Psychiatric Care System.
4. Value-crisis in our society despite the fact that the ”Council of Wise Men” created a ”Scale
of the Essential Consistent Eternal Values” for the Hungarian Education System in 2008.
5. Lack of mental health prevention both in education system and health care system. There
is no teaching of hygiene lessons in the Hungarian schools.
6. Negligence and selfishness among the population.
7. Disinterest among competent authorities.
8. Leaving the most important possibilities out of consideration.
The author establishes that the elimination of the above mentioned obstacles, the high standard of psychiatric care system, – especially the child psychiatric care system – and paramount
mental education are extraordinarily important to prevent most psychiatric disorders and help
the development of healthy and happy people. If human individuals are the most important
ones in our society, if we eliminate the main obstacles of the development of psychiatry, we
ensure to improve Hungarian psychiatry again, we shall be able to say that ”the spiritual light
is shining through the windows of every house”, and our work will not be a quixotic struggle
or ”tilting at windmills”.

Keywords: crisis of psychiatry, mental, cultural, spiritual ignorance, disinterest, lack of mental
prevention, teaching of hygiene lessons, value crisis, obstacles and possibilities.


Reading Disorder (RD) belongs to Specific Learning Disorders within the chapter of Neurodevelopmental Disorders in the Diagnostic and Statistic Manual of Mental Disorders 5th edition.
Previous research shows that the time of the diagnosis of RD – early (before starting school) or
late – has a great impact on the prognosis. In the current paper we present the cases of two
children diagnosed with RD. Our cases demonstrate that if RD is diagnosed in early childhood,
the child’s and his/her family’s quality of life can be influenced in a positive direction, while
late recognition of RD might influence the child’s and the family’s quality of life negatively.
For these reasons it is important that experts recognize RD in time, start appropriate treatment
and give proper support to children diagnosed with RD and their families.

Keywords: reading disorder, dyslexia, quality of life, diagnostics, therapy