Volume 24 Issue 4, December 2022

Editoral in Hungarian

Gábor Faludi

Should we routinely add CRP to clozapine titrations? – Learning from three cases

Charles Shelton, Can-Jun Ruan, Aygün Ertuğrul, Robert O. Cotes, Jose De Leon 


Objectives: An international guideline recently provided certain personalized schedules
for titrating clozapine in adult inpatients by considering: 1) DNA ancestry group, 2) sexsmoking subgroup, and 3) presence/absence of clozapine poor metabolizer (PM) status.Measuring CRP levels at baseline and during the first 4 weeks is recommended. Titrations too fast for the metabolism of specific patients can lead to clozapine-induced inflammations and CRP elevations. Methods: Three published cases are reinterpreted. Better outcomes might have been obtained by using the guideline. Results: Case 1 was a Chinese male non-smoker, a clozapine PM due to an underlying inflammation. Case 2 was a Turkish female non-smoker who developed clozapine-induced myocarditis in the context of 4 risk factors (undiagnosed inflammation, obesity, valproate and olanzapine co-prescription).
Case 3 was a United States patient of European ancestry with no known risk factors who developed myocarditis after a routine titration and had an unsuccessful rechallenge with 12.5 mg/day. Application of the international clozapine titration guideline may have prevented: 1) Case 1 by recommending against clozapine titration for a patient with an abnormal CRP level, 2) Case 2 by considering 4 risk factors and using a slow titration for clozapine PMs, and 3) Case 3 by using CRP elevations for early identification of a possible genetic PM. Conclusions: When baseline or prior CRPs are normal and then become abnormal during a clozapine titration, this indicates: 1) clozapine-induced inflammation associated with too-rapid titration for that specific patient, and/or 2) co-occurrence of an infection. Prospective studies need to verify this hypothesis.

(Neuropsychopharmacol Hung 2022; 24(4): 153–161)

Keywords: clozapine/adverse effects, clozapine/blood, clozapine/metabolism, CYP1A2,inflammation, myocarditis/chemically induced, myocarditis/etiology

Psycho-social correlates of suicidal behaviour

Zoltán Rihmer, Annamária Rihmer, Zsuzsanna Béltecki


Although suicidal behaviour is quite rare in the absence of current major mental disorders, the majority of these patients do not complete or attempt suicide. Therefore, as the scientific literature shows, other (psychological and social) suicide risk factors also play a contributory role. In this paper we will shortly review the clinically significant psychological and social
correlates of suicidal behaviour that can help clinicians in recognising and managing suicide risk.

(Neuropsychopharmacol Hung 2022; 24(4): 162–169)

Keywords: suicide, suicide attempt, psychological suicide risk factors, social suicide risk factors


There are several approached to suicide prevention based on various psychotherapeutic interventions, which are effective, especially when these are matched to the given psychiatric patient population, environment and context. In this paper the possibilities of psychotherapeutic methods of suicide prevention and intervention are described along with their indications. The following interventions are discussed: Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), Cognitive Therapy for Suicide Prevention (CT-SP), Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT), Problem Solving Therapy (PST), Problem Adaptation Therapy (PATH), Dialectial Behavior Therapy (DBT), Schema-Focused Therapy (SFT), Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Mentalization-Based Treatment (MBT), Interpersonal Psychotherapy (IPT), Transference-Focused Psychotherapy (TFP), Collaborative Assessment and Management of Suicidality (CAMS), Teachable Moment Brief Intervention (TMBI), Motivational Interviewing (MI), Attempted Suicide Short Intervention Program (ASSIP) and other Interned-Based Interventions (IBI). The effectiveness of the above methods may vary, however, they focus on the psychological processes playing a role in the emergence of suicidal behaviours including cognitive processes, as well as difficulties of problem solving and emotion regulation. As the efficacy of these interventions are supported by clinical trials, their use is recommended in case of this vulnerable patient population. The importance of using such methods in the clinical work with suicidal patients should be prioritized in our effort to provide a complex treatment for suicidal behaviour based on the most optimal and appropriate intervention considering the given patient.

Keywords: suicide prevention, suicidal behaviour, psychotherapy, intervention, prevention, ASSIP, CAMS

Mental Health Profiles in Clinical and Non-clinical Samples in Light of the Maintainable Positive Mental Health Theory: Protocol Paper

Virág Zábó, György Purebl, Attila Oláh, Xénia Gonda, Judit Harangozó, Ágnes Vincze, Dömötör Patkó, Judit Bognár, Dávid Erát, András Vargha


Clinical psychology has invested a lot of energy in the thorough examination of the
characteristics of mental disorders, but less in the implication of the accessible mental health capacities in the recovery phase. Our aim in the present study is to verify the two-continuum mental health model in clinical and non-clinical samples in the light of the Maintainable Positive Mental Health Theory. A further aim is to investigate the interrelationship between positive mental health and mental disorder by examining various groups of mental disorders with different levels of severity. We also examine the prevalence of the diagnostic categories of the Complete Mental Health Model. Furthermore, we aim to identify mental health profiles and their correlates. In the present paper, we introduce the protocol for the ongoing research.
A cross-sectional, case-control design is employed to investigate the two-continuum model of mental health. The clinical sample (n = 400) is recruited from four Hungarian hospitals. The non-clinical sample (n = 400) is collected using an online self-report survey-based research design. The two-continuum model of mental health will be tested using exploratory factor analysis and confirmatory factor analysis, with the symptoms of mental disorders and mental health as outcome variables. We will then separate groups of mental disorders according to the leading symptoms. Analysis of variance will be used to examine mental health as the dependent variable at a certain severity level in different mental disorder groups. Analysis of covariance will be used to identify the effect of different sociodemographic indicators.The prevalence of the diagnostic categories of the Complete Mental Health Model will
be calculated and compared using chi-square tests. Finally, mental health profiles will be identified using latent profile analysis. Our study draws attention to the fact that “optimal human functioning” can be understood in ways that includes, and not excludes, people living with mental disorder.

(Neuropsychopharmacol Hung 2022; 24(4): 180–184)

Keywords: positive clinical psychology, mental health, mental disorder, Maintainable Positive Mental Health Theory, mental health test, positive psychology, psychological assessment