VOLUME 21, ISSUE 4, DECEMBER 2019
Novel psychoactive substances (NPS) – knowledge and experiences of drug users from Hungary, Poland, the UK and the USA
Background: The recent decade witnessed growing prevalence of novel psychoactive substances (NPS) among young people in Europe and elsewhere. The study, conducted in 2011 as part of the EU-funded ReDNet project, aimed at better understanding of motives behind the demand for NPS among youth as well as at their information needs in this regard. In addition to historical values, the lessons learned during the legal status of NPS may contribute to a more general understanding of use of new drugs and to current drug policies.
Method: A self-administered anonymous questionnaire on NPS was completed via internet among young people from Hungary, Poland, the United Kingdom and the United States (N=1353) when NPS in general still enjoyed legal status. Results: The majority of respondents (82%) used NPS in the last 12 months and approximately half of them experienced adverse effects from these substances. The most frequent motives behind NSP use were willingness to experiment with new substances. However, sense of security and confidence in their composition as legal products were also important drivers of their consumption. Desired psychoactive effects and risks associated with their use were rated as the two most vital pieces of information to improve their knowledge about NPS.
Conclusions: There were some differences between participants representing different countries, however, the study also revealed many similarities, suggesting emergence of global youth consumption cultures, including NPS use. Provision of information on NPS, including their positive and negative effects, should play an important role in drug policies. Since the time of the study some qualities of NPS (such as confidence in their composition as well as quality and sense of security) may have deteriorated after delegalisation. On the other hand, opinions of NPS users suggest that delegalisation may have a deterrent effect for one third of their consumers while would not affect majority of them.
Analysis of antipsychotic prescription data and attendance of patients with schizophrenia in the Hungarian health system
Zoltán Makkos, Tamás Kováts, Péter Gaál
Regular care and sustained pharmacotherapy are inevitable for people who suff er from
schizophrenia in order to attain an acceptable level of quality of life. The National Health Care
Service Center (Állami Egészségügyi Ellátó Központ) has a health care utilization database
in which individuals can be identifi ed with a specifi c number, but anonymously (pseudoTAJ), and their patient pathways can be retraced. We analyzed the health service utilization
of patients with schizophrenia in the inpatient and outpatient care and the patterns of
prescription and drug dispensing. The results show that in a given year, 30-35% of patients
with schizophrenia do not reach the provision system and do not get adequate (“lege artis”)
therapy. Data concerning the prescription of antipsychotics show that psychiatrists working in
Hungary prefer modern medicinal therapies in accordance with the domestic and international
pharmacotherapeutic guidelines. These fi ndings suggest that proper clinical care is provided
to those patients with schizophrenia and with psychosis in general, who remain in the care
Keywords: antipsychotics, schizophrenia, care system
Introduction: Patients’ attitudes towards psychiatric treatment have an important infl uence
on therapeutic outcome. Health beliefs and the patient’s attitude towards the psychiatrist
and medical treatment are determined by several factors about which there is only a scarce
knowledge. In our study we used the Patient’s Health Belief Questionnaire on Psychiatric
Treatment, PHBQPT) to assess the beliefs and attitudes of patients suff ering from psychiatric
disorders. Methods: We recruited 115 inpatients from the Nyírő Gyula National Institute
of Psychiatry and Addictions. Patients were categorized into 5 classes based on ICD-10
(addictions-F1x; psychotic disorders-F2x; aff ective disorders-F3x; anxiety disorders-F4x; and
personality disorders-F6x). Subjects voluntarily and anonymously completed the PHBQPT
questionnaire and answered 4 additional items regarding their opinion about the effi cacy
of drugs and the placebo eff ect. We compared the scores of the items and the total scores
of subscales of the PHBQPT scale between disorder categories using ANOVA tests. Results:
Total scores did not diff er signifi cantly in our sample compared to those in the publication of
the original version of the PHBQPT scale. The most robust diff erences were found between
patients with addictions and psychotic patients on the external and internal control subscales.
F1x subgroup could also be distinguished from other psychiatric disorders on certain health
belief related items. However, patients with personality disorder and aff ective disorder felt
that the effi cacy of medications in general was the weakest. The impression that in the drug
eff ect is individually modifi ed in case of a given patient was more frequent in the F1x and
F2x groups and rare in the group of subjects with anxiety disorders and personality disorders.
Conclusion: The Hungarian version of the PHBQPT can be used in case of Hungarian psychiatric
patients; the similarity shown by the results points at the fact that attitude towards treatment
is independent of cultural and healthcare system diff erences. Our results highlight that there
are variances between diff erent psychiatric disorders in health belief and attitude towards
drug treatment. Our study emphasizes the importance of thorough assessment of patients’
attitude that is necessary to conceive an eff ective adherence improving intervention.
Keywords: drug attitude; health controlling; health belief; adherence; treatment compliance
Investigation of the acute eff ect of bilateral repetitive transcranial magnetic stimulation (rTMS) in therapy resistant major depression patients
Mónika Eleméry, Szilvia Kiss, Péter Döme, László Tombor, Gábor Faludi, Judit Lazáry
in routine clinical practice for therapy resistant depression (TRD). In this study we analysed the
change of symptom profi le of a Hungarian cohort with TRD using bilateral rTMS treatment.
Methods: A cohort of 22 patients suff ering from TRD was enrolled in the study. For assessment
of the phenotypic profi le the Beck Depression Inventory (BDI), The Beck Anxiety Inventory (BAI),
The Montgomery-Asberg Depression Rating Scale (MADRS), the Snaith-Hamilton Pleasure Scale
(SHAPS), the Insomnia Severity Index (ISI), and the Trail Making Test were applied. Diff erences
of mean scores of scales were compared between the day 1 (before treatment) and the day 14
(after conclusion of treatment). Furthermore, we performed phenotypic comparisons between
the gender subgroups. Results: In the total sample signifi cant reduction of symptom scores was
found on the depression (pMADRS=0,022; pBDI=0,001) and the anxiety scales (pBAI=0,020) and
in case of the TMT-A test (pTMT-A=0,019) at the end of the treatment. The mean scores of the
SHAPS, the ISI and the TMT-B did not change up to the day 14. In the sex-specifi c analysis we
found that in men only sleep disorder was improved (p=0,015), while in women both depression
scores and TMT-A score decreased signifi cantly (MADRSp=0,015; BDIp=0,005; TMT-Ap=0,036).
There were no adverse events during the rTMS tretament. Conclusion: 2×5 sessions of bilateral
rTMS treatment is an eff ective, safety applicable intervention in patients with TRD. Our results
suggest that signifi cant improvement of depressive, anxious and attention symptoms can be
observed already after 10th session. Our fi ndings highlighted that diff erent symptoms evolve
in women and men due to the acute eff ect of the rTMS treatment. Further follow-up study is
required to evaluate the long-term eff ect of rTMS concerning the maintenance of symptom
reduction and potential change of anhedonia and insomnia.
Keywords: rTMS; neurostimulation; depressive symptoms; mood disorder; neuromodulative