VOLUME 18, ISSUE 2, JUNE 2016
Tünetmentes hozzátartozók vizsgálata szkizofréniában – endofenotipikus markerek azonosítása felé
Tényi Tamás és Csábi Györgyi
Ahogy jól ismert, a szkizofrénia klinikailag heterogén és komplex kóreredetű betegség, mely kialakulásának hátterében a genetikai faktorok jelentős szerepet játszanak (a heritabilitás 0,41-0,87% között mozog). A betegség kutatásának egyik legjelentősebb nehézsége, hogy jelentős ismeretlen terület húzódik a kórkép kialakulásáért felelős gének és a gyakorlatban látott klinikai tünetek között. Ennek oka, hogy a szkizofrénia patogenezise igen összetett és bonyolult, amely gyenge prediktív kapcsolatot eredményez a klinikai diagnózis és a háttérben meghúzódó genetikai okok között. Az endofenotípusok (intermedier fenotípusok) kutatása jelentős szerepet játszhat a fenti nehézségek megoldásában és tisztázásában. Az endofenotípusok kvantitatív neurobiológiai sajátságok, amelyek azonban a mindennapi klinikai gyakorlatot művelő „puszta szem” számára csak ritkán vagy nem láthatók, amelyek kutatása azonban közelebb vihet a kórkép etiológiájának feltárásához (Braff, 2015). Gottesman és Gould (2003) definíciója szerint az endofenotípus (1) egy adott betegséghez kapcsolódik, (2) öröklődik, (3) állapot-független, a betegség bármely szakaszában – így a premorbid időszakban és remisszióban is – észlelhető, (4) tünetmentes hozzátartozókban magasabb gyakoriságú, mint az átlag populációban és (5) családi halmozódást mutat.
Ede Frecska, Petra Bokor, Gábor Andrássy and Attila Kovács
Ayahuasca is a decoctum made of admixture plants containing dimethyltryptamine and
harmine. For millennia it has been used as a central element of spiritual, religious, initiation,
and other – foremost healing – rituals, originally by the indigenous groups of the Amazon
basin and later by the mestizo populations of the region. During the last two decades the
brew has raised increased scientific and lay interest about its healing potentials within the
framework of Western therapeutic settings. The typical ayahuasca effects consist of strong
somatic reactions, vivid visions, relived personal memories, cathartic emotions, and insightful,
introspective experiences when the emerging mental contents take different context and get
deeper perspectives. The ayahuasca-experience can be exhausting necessitating the presence
of an experienced leader for helping participants to pass difficult phases and for maximizing
therapeutic benefits. No health damaging adverse effect has been confirmed thus far as result
of its well-structured, institutionalized use. The scientific investigation of ayahuasca is hindered
by legal issues, methodical problems, and sociocultural preconceptions. The present review
outlines the therapeutic potentials of ayahuasca use in psychiatry with its psychobiological
and spiritual background.
Keywords: addictions, ayahuasca, depression, dimethyltryptamine, post-traumatic stress
Behavioural aspects of a modified crosstalk between basal ganglia and limbic system in Parkinson’s disease
Orsolya Gyorfi, Helga Nagy, Magdolna Bokor and Szabolcs Keri
Dysfunctions in dopaminergic neurotransmission lead to motor symptoms and cognitive impairments associated with behavioural disturbances. Parkinson’s disease is a neurodegenerative disorder which is primarily characterized by an abnormal basal ganglia activity. Recently, increased attention has been directed towards the hippocampus in the development of non-motor symptoms. Given the temporal progression of the disease, dopaminergic depletion firstly affects the dorsal striatum leaving the ventral striatum relatively intact. However, it is possible that the structure and function of the hippocampus shows alterations even in early stages of Parkinson’s disease. Subtle cognitive impairments occur in the earliest stages, and therefore Parkinson’s disease could provide a unique model to investigate the effect of replacement therapies on a neural network with different baseline dopaminergic levels. Strong evidence suggests that dopaminergic medications improve the motor symptoms, but these medications might have disadvantageous effects on cognitive functions. In this review, we examine the role of dopaminergic changes across several cognitive and behavioural impairments observed in Parkinson’s disease, with a special reference to hippocampal
(Neuropsychopharmacol Hung 2016; 18(2): 087–092)
Keywords: Parkinson’s disease, hippocampus, dopaminergic neurotransmission, cognitive function
The author ascertains that healthy personality development faces increasingly serious obstacles
and consequently the number of children in need of mental healthcare is on the rise. Child
and adolescent psychiatry has drawn increasing appreciation, however, it is only formal and
deficient in Hungary today and cannot assure optimal mental care according to the principles
of evidence-based medicine. The author emphasizes that 75% of the first manifestation of the
psychiatric disorders occurs during adolescence and young adulthood. In spite of legal regulation, several deficiencies hinder the development of children into healthy adults. The author
analyses the most important obstacles in the development of child and adolescent Psychiatry.
The author emphasizes the role of keypersons, describes the situation of and problems faced
by Hungarian child psychiatric care. The author lists in detail the most important contradictions, deficiencies and obstacles and outlines suggestions for resolving the present crisis.
The author emphasizes (1) the responsibility of institutions, and people dealing with society
and children, and the disinterest of competent authorities. (2) The somatic, mental, cultural
and spiritual ignorance/illiteracy among parents, teachers, healthcare workers, and the general
population partly related to crises among the pedagogues. (3) The lack of holistic approach
to treatment of children suffering from mental disorder. (4) The importance and the lack
of knowledge concerning central nervous system function in child psychiatry. (5) Application
of evidence-based medicine in child and adolescent psychiatry based on understanding the
relationship between central nervous system alterations and mental functions. (6) Respecting
keypersons’ competence limits. (7) Immediate development of inpatient and outpatient child
and adolescent psychiatry in the whole country. (8) Reform of child psychiatry board exam.
(9) Development of currently missing textbooks and handbooks and promoting benefits
of internet use. (10) The almost complete lack of the permanent and systematic mental health
prevention in education and healthcare, especially in primary health care. (11) The ignorance
of possible and achievable opportunities. Overcoming the obstacles of child and adolescent
psychiatry can only be achieved by a coordinated action of dedicated child psychiatrists, child
psychologists, informed parents, well-trained pediatricians, district nurses, excellent teachers
and other committed keypersons.
Keywords: child and adolescent psychiatry, key persons, mental illiteracy, biological-psychological-mental-cultural-social-spiritual model, role of central nervous system alterations
Rozalia Takacs, Flora Milan, Gabor S. Ungvari, Gabor Faludi and Gabor Gazdag
Catatonic syndromes could accompany a variety of psychiatric and medical conditions. The most common conditions underlying catatonia are affective disorders followed by schizophrenia, but several medical conditions including intoxications affecting the central nervous system can also present with catatonic signs and symptoms. Therapeutic doses of disulfiram could induce catatonia with or without accompanying psychosis or mood disorder. A case of disulfiram intoxication manifesting with catatonia is reported here together with a brief overview of the literature. A patient was admitted to the toxicology ward after a suicide attempt with approximately 20 g of disulfiram. On transfer to the psychiatric ward, she was sitting still, in a semi-stuporous state and displayed motiveless resistance to instructions or attempts to move (active negativism). She was unresponsive to most of the questions (mutism), occasionally verbigerated 1-2 words and stared for more than 20 seconds between shifting attention. After developing a comatosus state her treatment continued at the toxicology ward, where a contrast-enhanced computer tomography scan revealed bilateral emollition of 1.5 cm diameter in both nucleus lentiformis at the level of the third ventricle. Following treatment her condition improved and she benefited of rehabilitation facility and a second psychiatric treatment. She was discharged free of neurological and psychiatric symptoms. In conclusion, we underscore the importance of accurate diagnosis of the underlying psychiatric or medical condition when encountering a fast emerging catatonic syndrome and focus first on treating the causative condition while simultaneously attempting symptomatic treatment of catatonia.
(Neuropsychopharmacol Hung 2016; 18(2): 110–114)
Keywords: disulfiram, intoxication, neuropsychiatric complications, catatonia
Marchiafava–Bignami disease (MBD) is caused by damage of the corpus callosum. There
are acute, subacute and chronic forms, it occurs most frequently among alcoholic patients.
A variety of neurological symptoms, epileptic seizures, and coma may be associated with the
disease, but the chronic form may start with acute confusion and dementia, interhemispherial disconnection syndrome or with slow progressive changes in behavior. In 2001, only 250
cases were reported, of which 200 died, 30 cases contributed to severe dementia or bed rest,
and favorable outcome occured in only 20 cases. The MBD diagnosis of our patient was based
on the anamnesis and cranial MRI and the treatment consisted of administration of B vitamin
complex, folic acid, memantine, piracetam and haloperidol. Reviewing the international literature currently recommended therapeutic options are thiamin and folic acid. According to
some authors the immediate administration of thiamine affects the outcome of the disease,
and there are case reports of beneficial effects of amantadine and steroids.
Keywords: Marchiafava–Bignami disease, alcoholism, dementia, corpus callosum