Clinical Neuroscience

[The state of rehabilitation of the mentally ill in Hungary ]

DUBOVITZ Dénes1

MAY 01, 1966

Clinical Neuroscience - 1966;19(05)

[There is a long tradition of rehabilitation and one of its most important tools, occupational therapy, in the care of the mentally ill, both in our country and around the world. Nevertheless, the rehabilitation of the mentally ill and the use of occupational therapy in mental wards have not developed sufficiently.]

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  1. Országos Ideg- és Elmegyógyintézet Szervezési-Módszertani Osztálya

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[Adult onset panencephalitis nodosa with retinal nodule and unusual course]

POHL Ödön, REMENÁR László, HAITS Géza

[The authors describe the case of a 20-year-old man whose pathological findings showed a typhoid picture of panencephalitis nodosa. A clinically remarkable atypical course was noted. The first symptom, 3 years before death, was severe visual loss in the right and then in the left eye. Retinal oedema, haemorrhages, very marked retinal vasoconstriction, vascular tympanic visual field loss, later papillary decolorization and chorioretinitis foci were observed. Psychiatric features were a slow intellectual decline and a great lack of motivation in the weeks preceding death, reminiscent of catatonic stupor. From a neurological point of view, it is emphasised that the abnormal movements appeared only in the terminal stage, and then only in an abortive form. The authors hypothesise the possibility of an atypical ocular onset in panencephalitis nodosa on the basis of early ocular signs and attribute permeability-pathological and anoxia-vascular mechanisms for the development of both ocular and cerebral lesions.]

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[Catheter-based method of vertebral angiography]

FÉNYES György

[The author describes a catheter-based method of vertebral angiography performed through the brachial artery without complications in 110 cases. ]

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[A kortikoszteroid-pszichózisokról]

POHL Ödön, HAITS Géza

[The authors describe three cases of corticosteroid depression and typologically separate these pictures from the major depressive forms in the psychiatric literature.]

Clinical Neuroscience

[Differential diagnostic problems of debilitas and imbecillitas]

KLEININGER Ottó

[Oligophrenia is a persistent intellectual and personality development disorder with a deficit of mental decline, caused by organic damage to the central nervous system between about the ages of 0 and 3 or 4. Therefore, we wanted to differentiate debilis from imbecilis not only by differences in intellectual level but also by differences in personality traits. Thus, the debilis are characterized by: being teachable in basic operations, being formally well spoken, being emotionally infantile, having a formal sense of community, being attached to their families until puberty, lacking intellectual emotions. They are motivated in their tantrums, are emotionally unstable, and are easily neuroticised due to their reduced tolerance skills. Their instinct for species preservation is characterised by a drive for convention, self-preservation tends to occur only at puberty. Their egotism makes them incapable of serious friendship. Their willpower is reduced and they need more control when encouraged. They have active, even focused attention, but need more and more stimuli to maintain it. Their ability to remember is characterised by an inability to remember dependencies, and they are therefore self-conscious. In general, we can speak of the reproductive intellect of the retarded. Their thinking is primitive and stereotyped. IQ: between 0.85 and 0.7, according to W. Stern. They are capable of stereotypical work independently. Imbecilic: movement is characterised by inhibition or staggering and they cannot be taught to write continuously. Speech: speech disorders of a grammatical nature (speech without verbs or formulas). No sense of community. Generally attached to the family, no intellectual sense of course. Affect lability, lack of motivation in outbursts of anger. Persistent depression is rare. Self- and species-preserving instincts may be satisfied at the cost of aggression. They have no need for mates. Their will life is abnormally diminished, they are incapable of sustained activity and are highly suggestible. They have only passive attention. Their memory for words and numbers is so poor that they have difficulty learning words and confuse their meanings. They cannot be taught the four basic operations. We cannot even talk about reproductive intelligence at school age. They have some elements of objective thinking in their thinking. IQ: between 0.7 and 0.4 according to W. Stern. They are capable of stereotyped work only under constant control and guidance. We wish to emphasise once again that we do not consider it possible to separate the debilitated from the imbecilic on the basis of age of intelligence alone, but that this can only be done by taking into account all personality traits. ]

Clinical Neuroscience

[Comment]

ZSAKÓ István

[The author reports on the Hungarian medical history of family care of the mentally ill.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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[The Comprehensive Aphasia Test in Hungarian]

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

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Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.