2005. december, VII. évfolyam 4. szám
Neurobiology and treatment of mentalisation in schizophrenia
Róbert Herold, Tamás Tényi
Mentalisation is one of the key elements of social cognition. There is an increasing interest in influencing social cognition in schizophrenia research. The neuroanatomy of mentalisation is fairly well-known. Dopamine and serotonin systems have important role in the regulation of mentalisation. Second generation antipsychotics are suggested to influence the deficits in mentalisation through modulation of dopamine system. Psychosocial interventions seem to effectively remediate impaired mentalisation as well.
About the menopausal depression
Background: According to studies performed in the last some years, several factors may increase the risk for depression during menopause to occur. Perimenopause, the period mostly associated an increase in the rate of depressive symptomatology, is characterised by decline of estrogen level. But the other changing reproductive physiology, as progesterone, inhibin level, CNS activity of gonadal steroids may have role in depression during menopause.
Pharmacoeconomic review of the use of injectable long-acting risperidone
György Bartkó, László Fehér
Schizophrenia is a severe and chronic illness as well as one of the most expensive illnesses to treat. Relapse and rehospitalisation contributes significantly to the economic burden of schizophrenia. Partial compliance with antipsychotic medication was associated with an increased risk of inpatient hospitalization. Health care resource use is significantly reduced in patients with stable schizophrenia or schizoaffective disorder receiving long-acting, injectable risperidone. It is highly likely that these reductions will decrease healthcare costs in patients receiving long-acting risperidone. In this article cost-effectiveness models of long-acting risperidone developed for different countries are discussed. Long-acting risperidone produced additional clinical benefit and cost savings compared with other treatment strategies, despite significant variations in cost-effectiveness. One factor remained valid for each country: improved adherence arising through the use of long-acting risperidone provides a cost-effective strategy for treating patients with schizophrenia. On the basis of the cost-effectiveness evaluations in different countries long-acting risperidone seems to offer a cost saving treatment option for patient with schizophrenia under Hungarian circumstances. Further assessment of these models in a pragmatic study and actual monitoring of health care resource utilization should confirm the above assumption.
Pharmacovigilance as new direction of research
Gábor Gaszner, Zoltán Makkos, Péter Gaszner
Pharmacovigilance: permanent collection and assessment of the safety data of the drug, in the interest of precise knowledge of the safety profile of the pharmacon; permanent collection of unexpected adverse drug reactions, effects on special patient populations, drug interactions, adverse drug reactions of long-term treatment, adverse drug reactions of long latency. Our study was performed under the tutelage of the Drug Safety Programme in Psychiatry (AMSP), 2004. We review the side effects occuring in the different organ systems; side effects during the use of antidepressive and antipsychotic therapy. We review how the danger of polypharmacy can be avoided by reducing the dose of the current drug; by using therapeutic drug; or just by monitoring therapeutic and adverse effects.
Changes in sexual function in mirtazapine treatment. Primary data of a national, multicenter, prospective observational study in depressed patients
Péter Osváth, Sándor Fekete, Viktor Vörös, János Almási
Introduction and object: It is a well-known fact, that in most of the psychiatric diseases problems can break out on the field of sexual life as well, which frequently occurs particularly in depression. The problems can be even worse, because of the side effects of the antidepressants causing sexual dysfunction. Nowadays there are some new antidepressants, which have more favourable side effect profiles. The aim of this study was to follow up the occuring side effects during mirtazapine treatment with special regard to incidence of sexual problems.
Patients and method: Altogether 102 outpatients (44 men, 58 women) were recruited to this prospective, observational, non-interventional study, who were suffering from depression and had stable partner, permanent sexual life and who signed the informed consent. The screening was followed by three visits, when the 17-HAMD, CGI and 9-BDI scales were used. The change of sexual life was monitored by a self- completing questionnaire.
Results and conclusion: Both the depression rating scales and the CGI have shown a significant mood improvement. From monitoring the changes in sexual life it turned out, that patients reported sexual problems much rarer as they had done it at the beginning of the study (screening: 93.2%, one month later 61%, three months later 27.1%, at the end of the study only 24.6%) Patients were evaluating their sexual life better and better during the study, and parallel to this, frequency of sexual intercourse was also increased. On the basis of the results it can be established, that mirtazapine is an effective tool for even those depressed patients who suffer from sexual dysfunction. Together with curing the depression and improving the sexual life mirtazapine can also help to restore the good quality of life.
Trends in pharmacotherapy of unipolar depression at the beginning of the century in Hungary
At the first glance the treatment of depression not seems to be a difficult task for the physicians. However, prescribing an effective drug, determining the right dose and choosing a suitable adjunctive therapy are all important factors requiring up-to-date knowledge and experience by the physicians. The results of evidence based studies, experimental facts, and anecdotal knowledge are taken into practice by the physicians so it is of vital importance to gain information about the actual pharmacotherapeutic trends they use in everyday practice. Since these facts are rarely revealed, the aim of my study was to give an overview of the therapeutic trends of depression in Hungary.
Method: A questionnaire constructed by the author was filled in by psychiatrists working in outpatient clinics in different regions of Hungary for each patient turned to them in the period between 1 and 11 June, 2004. The inclusion criteria was the diagnosis of unipolar major depression and the exclusion criteria was the existing comorbid psychiatric disorder both based on the judgement of the clinician. Since neither the physician, nor the patient was identified the study was blind to the investigator.
Results: By evaluating 170 questionnaires 20,6% of the patients were found to take one, 46,5% two, 24,7% three, and only 8,2% four or more kinds of psychotropic drugs simultaneously. Only 4 patients were not given any antidepressants at all and 19 (13,5%) were on two antidepressants. 64,1% of the patients took some SSRI (citalopram>sertraline>paroxetine), 22,4% some dual action (mirtazapine>venlafaxine), and 22,4 other antidepressants (tianeptine, moclobemid etc). Not any kind of classical TCS was given. 71,8% of the patients found to be on anxiolytic, 7,7% on mood stabilizer, 4,2 on antipsychotic and 16,5% on hypnotic drug. The doses used by clinicians did not show any deviation from the guidelines. 95 patients (55,9%) could be kept balanced with the therapy above and only 8 patients (4,7%) were in serious condition. More than half of the patients (54,1%) was given the same antidepressant for one year and the long term use of anxiolytics was found to be typical.
Conclusion: The results show the current trends in the pharmacological treatment of depression. Only psychiatrists participated in the study because mostly they have the responsibility for the correct diagnosis, assessment and therapeutic choice up to the present in Hungary. These data can be compared with the international trends, professional expectation, or the future results of trials and also can be used in education.
Original or generic?
Iván György Magyar
Ethical problems in the use of SSRI-s