Clinical Neuroscience

[Pharmacotherapeutic protocols in psychiatry]


MARCH 20, 1993

Clinical Neuroscience - 1993;46(03-04)

[Introduction 1. Organic and gerontopsychiatric disorders. 2. Schizophrenic psychoses paranoid states and affective disorders. 3. Alcohol and drug-induced psychoses, dependencies and addictions. 4. Sedatohypnotics, anxiolytics. Note to the plan]



Further articles in this publication

Clinical Neuroscience

[Post-stroke depression]

ASZALÓS Zsuzsa, PATAKY Ilona, SIMON Andrea, NAGY Zoltán

[The pathogenesis of depression following cerebrovascular accident (post-stroke depression) is poorly understood. Thirty seven (28%) out of 134 patients from the „Budapest Stroke Data Bank" were found to be depressed. Thirty two patients (86%) in this group were affected by depression within three months or the stroke. Diagnosis of depression was bades on CES-D, Ham-D and Zung scales, and a word fluency test was performed with 11 depressed and 11 non-depressed patients. Comparing the frequency of post-stroke depression in groups with ischemic damage of the carotid versus the vertebrobasilar system, as well as the left versus right middle cerebral artery, no significant differences were found. Depression reduced the activities of daily living (score: 7.8) compared to the activities of non-depressed patients (score: 3.8) at the same score of stroke – severity (4.7 versus 4.1). These observations suggest that post-stroke depression influences the rehabilitation of stroke patients, therefore the diagnosis and treatment of post-stroke depression may increase the efficacy of stroke rehabilitation.]

Clinical Neuroscience

[The role of brainstem auditory evoked potentials in the diagnosis of vertebrobasilar insufficiency]


[The diagnostic usefulness of brainstem auditory evoked potentials was compared with other diagnostic possibilities. Brainstem auditory evoked potential was examined in patients with vertebrobasilar insufficiency. Based on the duration of clinical symptoms, patients were divided into three groups: 85 patients with transient ischaemic attack (TIA), 31 patients with prolonged ischaemic symptoms, and 35 patients with chronic symptoms were examined. The latency and interpeak latency of the auditory evoked potentials increased in 49,3 per cent. A subgroup within the TIA group was specially tested. The patients belonging to this group were admitted to the clinic soon after the onset of TIA. Acoustic evoked potentials showed increased latencies and interpeak latencies in 45,8 per cent of this group. The increasing latencies of the waves I. and III. and the interpeak latancies of I-II. and I-V. waves were the most frequent differences. Otoneurology demonstrated more frequent functional disturbances in brainstem than in acoustic evoked potentials in the second and third group. Computerized tomography is a really helpful only in examining chronic cases, while the CT reports 3,6 per cent hypodensities in the first group and 17,3 per cent in the third group. Brainstem auditory evoked potential testing is the most sensitive diagnostic method in the diagnosis of transient ischaemic attack.]

Clinical Neuroscience

[Spontaneous intracerebral haematomas in children]


[The authors report two cases of spontaneous intracerebral haematomas in children. Both children presented with serious symptoms of acute intracerebral haemorrhage. Investigations do not reveal the cause of the haemorrhage in either of the cases and angiography detected no arteriovenous malformation. The term ,,occult” is reserved for these cases, as spontaneous intracerebral haematomas do not result in space-occupying process or CSF passage blockage and may be treated medically.]

Clinical Neuroscience

[The effect of cerebrospinal fluid drainage on middle cerebral artery blood flow velocity in conditions with raised intracarnial pressure]


[Middle cerebral artery (MCA) blood flow velocity and intracranial pressure (ICP) were recorded in 42 patients suffering from raised ICP. A major (ICP25 mmHg) or moderate (251CP15 mmHg) degree of intracranial hypertension was reduced by means of either continuous or intermittent CSF drainage. Measurements of MCA blood flow velocity were carried out with transcranial Doppler sonography (TCD). Three types of reactions were observed with regard to cerebral blood flow velocity (CBFV) changes in response to CSF drainage. Patients in Group 1 demonstrated pressure passive CBFV changes throughout the observed cerebral perfusion pressure (PP) range. In Group 2, cerebrospinal fluid (CSF) drainage brought about a transitory increase in CBFV for a few minutes. In Group 3, the reduction of ICP to the normal level did not influence CBFV at all. The pulsatility index (PI) of the cerebrovascular reserve capacity (CVR), which was highest in Group 1, changed in contrast with the CBFV changes in Groups 1 and 2. The pressure-passive velocity pattern (in Group 1) suggests that the blood vessels were at nearly maximum dilatation and were perhaps failing to constrict properly in response to increased PP. As recovery proceeded (Group 2), the mechanism became effective, thereby reestablishing autoregulation. Whereas clinical signs and computed tomography reveal only the trend of the ICP, TCD provides the possibility of a semi-quantitative evaluation of ICP changes and seems especially promising in the rapid assessment of the efficacy of treatment aimed at ICP reduction.]

Clinical Neuroscience

[Measurements of regional cerebral blood flow and blood flow velocity in experimental intracarnial hypertension: infusion via the cisterna magna in rabbits]

BARZÓ Pál, DÓCZI Tamás, CSETE Klára, BUZA Zoltán, BODOSI Mihály

[The cerebral blood flow velocity (CBFV), as measured by transcranial Doppler sonography (TCD) via the transorbital route in the intracranial segment of internal carotid artery (ICA), and the regional cerebral blood (volume) flow (rCBF) in the corresponding cortical areas, as measured by the hydrogen clearance technique, were determined in 8 New Zealand White rabbits undergoing cisterna magna infusion for elevation of the intracranial pressure (ICP). In the lower range of autoregulation, i. e. at perfusion pressures (PP) between 80 and 40 mm of mercury and even below this, the changes in (CBFV) and CBF showed a strong correlation (0,86) under conditions with standard PCO2 (PaCO2)=35+2 mm of mercury). Autoregulation was exhausted at 40 mm of mercury and the cerebrovascular resistance (CVR) was minimal. Below this PP, the CBF and CBV dropped sharply, whereas CVR, gradually increased, indicating that, despite the maximally dilated resistance vessels, the intracranial hypertension causes the vascular resistance to increase, possibly via blocking of the venous outflow. Our results confirmed that non-invasive and easily (even at the bedside) applicable measurements of CBFV changes could substitute the cumbersome and expensive isotope measurements of CBF in intracranial hypertension.]

All articles in the issue

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Clinical Neuroscience

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

Clinical Neuroscience

Management of bone metabolism in epilepsy

UÇAN TOKUÇ Ezgi Firdevs , FATMA Genç, ABIDIN Erdal, YASEMIN Biçer Gömceli

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

Clinical Neuroscience

[Can we influence the negative drug attitude? Interpretation of the rejection of COVID-19 vaccine in the light of results of a pilot study ]

POGÁNY László , HORVÁTH A. András, LAZÁRY Judit

[Vaccination refusal is a serious obstacle to minimizing the spread of COVID-19. Nevertheless, the rejection of vaccine can be considered the result of a negative attitude towards medical treatment, and according to our previously published data, it can be influenced by the underlying affective state. Increased incidence of affective disorders and anxiety could be observed globally during the pandemic, which may have a significant impact on vaccination acceptance. The aim of our pilot study was to determine the association between clinical improvement of affective and neurocognitive symptoms and change of drug attitude and health control beliefs in a sample of psychiatric patients. A data set of 85 patients with psychiatric disorder has been analysed with the use of Patient’s Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) with 5 subscales (Negative Aspect of Medication – NA; Positive Aspect of Medication – PA; Doctor health locus of control- Doctor HLOC; Internal HLOC; Psychological Reactance – PR); Hospital Anxiety Depression Scale (HADS-Anx; HADS-Dep) and neurocognitive tests, such as the Stroop test and the Trail Making Tests. All the tests were performed before and after a 14 days treatment. Paired t-tests and generalized linear models were performed to assess the associations between the variables. The baseline scores of NA and HADS-Anx correlated significantly (p=0.001) and after two weeks of treatment NA decreased (p=0.001), while Doctor HLOC and Internal HLOC increased (p=0.001 and p=0.006). The patients performance of the neurocognitive tests improved (all p<0.05). The reduction of HADS-Anx (p=0.002) and HADS-Dep (p=0.006) scores showed significant associations with the decrease of NA. Increase of the PA score was associated with reduction of HADS-Dep (p=0.028). Improvement of neurocognitive functions had no effect on PHBQPT scores. Important conclusions can be drawn regarding the rejection of the COVID-19 vaccine based on the associations found between the intensity of affective and anxiety symptoms and the attitude towards treatment. Our findings suggest that affective symptoms have a negative influence on the attitude towards treatment and that the improvement of these symptoms can facilitate the acceptance of the therapy, regardless of diagnosis. The modest effect of the improvement of neurocognitive functioning on the attitude towards drugs and the significant role of affective-emotional factors suggest that the accep­tance of vaccination probably cannot be facilitated solely with the aid of educational programs. Considering the increasing incidence of affective disorders during the COVID-19 pandemic, the screening of affective and anxiety symptoms and treatment of these disorders could be an important step towards the acceptance of the vaccine. Although psychiatry is not considered as a frontline care unit of the COVID cases, more attention is needed to pay on the availability of mental health services because refuse of vaccine can develop due to affective disorders too.]

Lege Artis Medicinae

[Commemorating the Lipótmező. Part 1.]


[“What did Lipótmező mean to you?” My friends and acquaintances asked frequently this question in the past decades, concerning the National Institute for Psychiatry and Neurology or well known as the Lipótmező my past workplace and the role it played in my life thus far. It is difficult to give a short answer, but the three and a half decades I have spent there were certainly of decisive importance in my professional and private life as well. Since I was banned from tobacco smoking due to my disease ten years ago, I cannot keep my pipe in my mouth any more. Thus, I decided to recollect the dearest stories kept in my memory, which had the deepest impact on me during my 35 years in Lipótmező both as a doctor and as a man. ]

Hypertension and nephrology

[Current evidence on the accuracy and precision of non-invasive cardiac output monitoring]

VÉGH Anna, REUSZ S György

[Purpose of review: Assessing cardiac output (CO) is an important part of monitoring the hemodynamically unstable patients. Different non-invasive CO measurement devices are currently available, that can be useful in various clinical situations. The purpose of this article is to review current literature on commonly employed methods especially regarding their accuracy and precision. Results: Most of the devices, especially the non-invasive ones have the disadvantage of questionable accuracy and precision. Generally speaking, the more a method is based on assumptions and mathematical models, the less precise it will be. There is also significant heterogeneity between individual studies. Clinically it is important to consider the purpose of the measurement before choosing a method. In terms of accuracy the most reliable ones are, the ones that are based on simple physical principles and minimal assumptions, for example transthoracic echocardiography, and thermodilution. Conclusions: To have better comparability between individual studies it would be imperative to have standardized study protocols regarding the number of cardiac cycles assessed, the used method, the clinical environment, the age and clinical condition of the study population.]