„Hit and run”: A pszichofarmakológia régi paradigmája új köntösben

Epidemiological studies presented evidence that Alzheimer’s disease and type 2 diabetes
share common features in their pathophysiology and clinical patterns. Insulin resistance is
a characteristic feature of both diseases. According to the pathomechanism, inflammatory,
metabolic, and an atypical form based on the deficiency of zinc ions can be distinguished.
Glucose metabolic disorders, related to Alzheimer’s disease, are type 2 diabetes, and prediabetes/metabolic syndrome. Based on the common pathophysiological patterns of these two
diseases, Alzheimer’s disease is customary called type 3 diabetes. In the research on dementias,
insulin resistance stands in the highlight for its documented harmful effects on cognitive
function and causes dementia. Insulin-like growth factor also influences cognitive functions.
Reduced input of this hormone into the brain may also cause dementia, however literary data
are controversial. In Alzheimer’s disease, deposition of amyloid ß in the brain, hyperphosphorylation of tau proteins and dysruption of neurofibrilles are characteristic. Amyloid ß is
co-secreted in the ß-cells of the pancreas with insulin. Amyloid ß and hyperphosphorylated
tau protein were detected in the Langerhans islets by autopsy. Amyloid deposits, found
in the pancreas and brain presented similarities. As a consequence of hyperglycemia, glycation endproducts cause the development of amyloid plaques, dysruption of neurofibrilles,
and activated microglia, all are typical to Alzheimer’s disease. Continuous hyperglycemia
leads to oxidative stress, which used to play significant role in the development of both
diseases. Low-grade inflammation is also a significant pathophysiological factor in both disorders. The sources of inflammation are proinflammatorical adipocytokines, dysbacteriosis,
metabolic endotoxaemia, caused by lipopolysaccharides, and high fat diet which also lead
to insulin resistance. Based on recent data, microbial amyloid, the main product of bacteria,
is also contributing to the pathophysiology of the human central nervous system. Alzheimer’s
disease is a heterogeneous disorder, and as yet there is no effective therapy. Encouraging
results have emerged by using intranasal insulin spray. Insulin sensitizers like metformin,
thiazolidines have also resulted in improvements in cognitive functions, mainly in animal
experiments. Glucagon-like peptide-1, beyond its insulin-stimulating effect, also has central
pleiotropic influences. Research results with the application of these molecules seem to be
enouraging. More recently, glucagon-like peptide-1, and glucose-dependent insulinotropic
peptide were administered together, with promising early results. The real breakthrough has
not yet arrived. For the time being we have to endeavour to the prevention of both chronic
diseases via a more healthy life-style.

Keywords: Alzheimer’s disease, diabetes, insulin resistance, inflammation, amyloid ß, therapy

The author lays down that non-suicidal self-injury (NSSI) constitutes an increasingly more
common and serious public health problem, especially during the age of adolescence. In spite
of the fact that the phenomenon has been known since the beginning of human mankind even
in animals, we have not been able to either give a clear explanation or prevent its spreading yet.
The author reviews the conceptual disturbances, behavioural phenotypes, cultural-historical
and mythological antecedents related to self-injury, just as the controversial concepts, reasons
of unclearness of the concepts, and clinical classification of self-injuries, and he outlines a new
categorisation/ classification of the explanation of autotelic activities aimed at the alteration
of the human body. He reviews the relationship between self-injuries and other psychological signs and symptoms and psychiatric illnesses, the explanations of developing self-injurious behaviour and further research directions. Besides the different models of self-injury
he presents a holistic model. Besides the therapeutic guidelines of self-injurious behaviour,
he calls the attention to the importance of genetic and nervous system researches, psychological and spiritual research, the importance of mental education and prevention, and he
also lists some more essential questions future researchers have to find the answers for if we
would like all children to be allowed to enter the adults’ world in a healthy and sound state.

Keywords: non-suicidal self-injury (NSS), behavioural phenotypes, self-injurious behaviours
(SIB), self-injury, deliberate self-harm (DSH), disturbances of the development of personality,
clinical classification, treatment and prevention of self-injurious behaviours

Climate change and global warming have become increasingly discussed in the last few years
– but mainly as an economical-social problem. Due to the preceding years’ hot summers,
as a clinical psychiatrist I considered it important to examine the effect of heat on body functions especially among those who are taking psychiatric drugs. The problem has a clinical
significance, since heat is an extreme environmental factor with unexpected consequences.
Due to heat various adverse reactions are expected especially in subjects on combined pharmacotherapy regimes. The present article points out the clinical importance of heat and also
its potential adverse (and sometimes life-threatening) consequences.

Keywords: climate change, heat wave, clinics, pharmacotherapy, psychiatry

The Iowa Gambling Task is a behavioral measurement which was developed to examine
decision-making based on the Somatic Marker Hypothesis. Participants have to make series
of choices altogether 100 times from four decks of cards. The decks have different characteristics with regards to gains and losses. After the initial analyses – with a focus on patients
with damage to the ventromedial prefrontal cortex – the tool soon became one of the most
frequently used technique of measuring hot executive functions. It is also used to measure
impulsivity. Structures involved in decision-making constitute the neural basis of the Task. IGT
is applied in several different disorders (in connection with decision-making and impulsivity
as well). In recent years different versions have been developed, and these modifications may
have different effects on IGT performance, and may also influence what the Task measures
exactly. With growing empirical evidence several questions have arisen in connection with the
composition of the decks (gain-loss magnitude vs. frequency, prominent deck B phenomenon)
which suggest to use other indexes as well besides the net scores.

Keywords: Iowa Gambling Task, decision-making, impulsivity, behavioral measurement

Bipolar disorder is a lifelong illness requiring lifelong pharmacotherapy. Therefore besides
symptomatic remission, achievement of full work-related functioning and restoration
of quality of life is a priority during successful treatment. The present prospective, observational,
non-intervention study focused on investigating the effect of lamotrigine therapy on the
quality of life and work-related function of bipolar patients in outpatient care. Methods: 969
bipolar or schizoaffective outpatients participated in the study who previously did not receive
lamotrigine therapy. Our present phase-prophylactic study was a prospective, observational,
non-intervention study with a six-month follow-up. Evaluations took place at baseline and at
months 1, 2, 3 and 6. Patients were followed with a Clinical Global Impression-Severity (CGI-S)
and Clinical Global Impression-Improvement (CGI-I). Changes in work-related function was
evaluated using Social Adjustment Scale (SAS), while quality of life was assessed with the
Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) scale. Results: SAS scoreds
showed a consistent decrease in the overall sample and in all CGI-S initial groups reflecting
the improvement of work-related function during the six months of the follow-up. Q-LES-Q
values in the whole sample and in all initial CGI-S groups showed a steady increase indicating
a continuous increase in quality of life during the study. Conclusion: Our results indicate that
during long-term prophylactic lamotrigine therapy the work function and quality of life of
bipolar patients shows a significant improvement, therefore lamotrigine provides a possibility
for full functional remission and restoration of quality of life.

Keywords: bipolar disorder, lamotrigine, work function, quality of life

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