Neuropsychopharmacologia Hungarica最新文献

According to the currently available research data obsessive-compulsive disorder (OCD)is a disorder of multifactorial etiology, the causes of which include biological, genetic and environmental-social factors alike. Based on an etiology of that kind, it is justifiable to conduct a developmental psychopathological review of OCD, which may lead, through an exploration of the different factors involved, to a deeper understanding of the disorder's overall nature and specific characteristics, as well as to the development of the most efficient therapies possible. The main objective of the present comprehensive study is the developmental psychopathological analysis of the OCD, including the review of the evolutionary approaches and genetic and environmental factors, as well as an exploration of OCD's age-specific forms of manifestation, based on the recent research results and analyses available in the professional literature. According to our present knowledge, the genetic linkage of early-onset OCD is greater than that of the late-onset variant, as the onset of the syndrome can be attributed to genetic factors to the extent of 40-60%, coupled with the contribution of environmental factors like perinatal disorders, reproductive cycle, childhood infections, familial circumstances, age of the parents and traumatic life events. Evolutionary theories address OCD from a functional perspective. They strive to attribute it primarily to individual or group selection theories that a quite heterogeneous OCD syndrome, which is therapeutically difficult to change, remains to present itself with close to identical, invariably high prevalence in all cultures despite the difficulties. Obsessive-compulsive disorder is present in all ages, and it is often difficult to determine whether we are faced with a healthy or a pathological behavior, as certain obsessive phenomena may appear as part of normal development. The analysis of OCD's etiology, a better understanding of the respective function of specific symptoms, a thorough exploration of age-specific variants of the disorder, i.e. a developmental psychopathological analysis of OCD, is of key importance from diagnostic, therapeutic and vocational rehabilitation aspects alike.

The prevalence of bipolar affective disorder is 3% in the general population, with a first occurrence around the age of 20-30. The first symptoms are usually rather mild, thus it is difficult to reach a decision about the diagnosis within the first years. In the past years bipolar affective disorder received increased attention because of the relatively high lifetime prevalence. Nowadays experts in the field try to reach a consensus in understanding the earlier phases of the syndrome, as earlier therapeutic interventions tend to have a better result. General developmental psychopathological factors, and gene-environment interactions or evolutionary theories can greatly contribute to early recognition and understanding of the syndrome. The main aim of our article is to explore the possible developmental psychopathological background of bipolar affective disorder through overview of the literature on general developmental psychopathology factors, gene-environment interaction, and the evolutionary approach, which can contribute to more effective methods of treatment.

The metabolic effect of atypical antipsychotic drugs may manifest itself in weight gain, disturbances in glucose homeostasis and dyslipidemia. One confounding factor is that psychotic disorders themselves make the patients prone to specific metabolic changes. Nevertheless clinical studies have confirmed that atypical anti-psychotic drugs have a different metabolic effect. In the present prospective case-series, four male antipsychotic drug-naive psychiatric patients without any familial history of metabolic disorder were studied. The patients received risperidone or olanzapine monotherapy for 12 weeks; weight, plasma levels of triglyceride, cholesterol, HDL, and fasting glucose were measured in every 4th week. In two patients, oral glucose tolerance test (OGTT) was also performed at days 0 and 56. The average weight gain during the 12-week period was 12%. The cholesterol and triglyceride plasma concentrations were also elevated. The fasting glucose levels did not change during the observation period. In the OGTT performed in two patients, normal fasting glucose and insulin plasma levels were observed after 8 weeks; however, the plasma insulin concentrations were highly elevated after glucose intake, which may suggest the presence of insulin resistance. Our preliminary results confirmed the previous results on the metabolic effect of atypical anti-psychotic drugs, which may lead to metabolic syndrome. The regular control of the metabolic laboratory parameters, early intervention and the modification of the atypical antipsychotic treatment may help to avoid this adverse effect of the drugs.

Gender-specific differences in suicidal behaviour have been analysed in a number of recent studies. According to these, several socioeconomic, demographic, psychiatric, familial, help-seeking differences can be identified in protective and risk factors between males and females. Gender is one of the most replicated predictors for suicide. In the framework of the WHO/EURO Multicentre Study on Suicidal Behaviour, more than fifty thousand suicide attempts have been registered so far. Until now data on more than 1200 monitored suicidal events have been collected in Pecs centre. In most countries male suicid rates are higher. In contrast to suicides, rates of suicide attempts are usually higher in females. Concerning the differences in methods, it is a recognised fact that males use violent methods of both suicide and attempted suicide more often than females. The summarised clinical impression suggests that compliance of male patients is poorer than that of females. According to our data, a typical male attempter is characterised as follows: unemployed, never married, lives alone. He tends to use violent methods; if he takes drugs, it is mostly meprobamate or carbamazepine. A lot of male attempters have alcohol problems or dependence. As for the females, we found high odds ratios in the following cases: divorced or widowed, economically inactive, depressive state in the anamnesis. Female attempters are mainly repeaters using the method of self-poisoning, mostly with benzodiazepines. As suicide is a multicausal phenomenon, its therapy and prevention should also be complex and gender differences should be taken into account in building up our helping strategies.

Unlabelled: Three young people developed psychosis during/ after cannabis intake. The 17-year-old male after only a few marihuana cigarettes, the 22-year-old patient after two years of addiction developed schizoid psychosis; the 20-year-old patient after six years of cannabis addiction had schizoaffective psychosis. The first two patients become symptom-free on the antipsychotics and during the drug-free period. The third patient, who had cannabis during the psychotic symptoms, still has the schizoid psychosis.

Conclusions: The connection between cannabis and psychosis is clear in our three patients. Marihuana is working on the dopamine system and may cause schizoid psychosis, sometimes permanent psychosis. Cannabis, this light drug might not be a "safe" agent.

Objective: There is an increasing interest in the background of mentalization deficit in schizophrenia. On the one hand, according to developmental psychological studies, mentalization development is connected with the development of pragmatic language skills. On the other hand, studies suggest that mentalization is dependent on the maturation of neurocognitive skills such as executive functions. Our study investigated the role of these domains in the mentalization deficit of schizophrenia.

Method: 28 patients with schizophrenia and 20 control patients with depression took part in the first part of the study. Participants were presented first-order and second-order mentalization tasks, metaphor and irony tasks for the assessment of mentalizing skills. The pragmatic language skills were examined by "question and answer" vignettes. 20 patients with schizophrenia took part in the second part of the study. The test battery was completed with a picture recognition task and neurocognitive tests were made by all patients.

Results: Patients with schizophrenia performed significantly worse in the irony and pragmatic tasks, but there was no correlation between their performances in the irony and in the pragmatic tasks. Selective attention and verbal working memory showed correlation with the cumulative verbal mentalization index. Selective attention correlated with the recognition of complex mental states from pictures as well, but the successful decoding of complex mental states was dependent on the recognition of basic expressions. Attention correlated with mental state recognition as well.

Conclusions: Our results suggest that the mentalization deficits of people with schizophrenia cannot be explained by pragmatic language deficits alone, and the manifest impairment is the consequence of disturbances in multiple cognitive processes. Basic neurocognitive factors such as attention, selective attention and verbal working memory can influence the mentalization skills.

Bupropion has an antidepressant effect through blocking the dopamine transporter. By 99mTc-TRODAT-SPECT, we measured the baseline DAT activity of depressed patients. After 3 weeks' bupropion treatment we studied the change in DAT activity, which corresponds to the occupancy of bupropion. The average occupancy of bupropion on DAT was similar to the international findings at 20.84% in 9 depressed patients.