Lege Artis Medicinae

[Caring about Ourselves – The Aesthetics of Health ]

KELEMEN Gábor

JANUARY 20, 2018

Lege Artis Medicinae - 2018;28(01-02)

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Lege Artis Medicinae

[Depression from the aspect of polygenic studies: the role of the relationship between genes and the environment]

GONDA Xénia

[Depression is a multifactorial disease with both genes and environmental factors as well as complex relationships between these factors playing a role in its background. However, in spite of several decades of research no genetic variants playing a straightforward and robust role in the background of depression have been identified. One reason behind this is the genetic and biological heterogeneity of depression, while another is that in the majority of studies environmental effects interacting with genetic variants have not been considered which may mask important genetic effects. Furthermore, relative contribution of genetic and environmental factors may vary in case of different manifestations and subtypes of depression which has not only etiopathological relevance but may also influence choice and efficiency of treatment. Consideration of heterogeneity of depressive syndromes, as well as environmental effects in case of both candidate gene and whole genome association studies, and qualitative analysis of environmental effects in depression and antidepressant research may extend our existing knowledge concerning the pathophysiology of depression and may also aid identification of new antidepressive therapeutic targets. ]

Lege Artis Medicinae

[From Graffiti to Public Space Art ]

HÁRDI István

Lege Artis Medicinae

[Is the evolvement of schizophrenia preventable?]

SZENDI István

[Considering the developmental nature of the majority of mental disorders, these days prevention has increasingly come into the focus of psychiatry. Schizophrenia - one of the disorders that are most frequently associated with psychosis, one of the most serious psychiatric syndromes - is the leading cause of permanent disability of the young adult generation. A prodrome lasting for several years precedes the onset of the first psychotic episode, which offers an opportunity for preventive interventions. Currently, we have two strategies for the predicition of the outburst of psychotic disorders. The Ultrahigh-risk approach can predict the first psychotic episode regardless of diagnosis, while the Basic symptom strategy predicts the development of schizophrenia specifically. However, there is an inverse relationship between the sensitivity and the specificity of different predictive criteria, which raises clinical and ethical dilemmas for the doctors. The methods of repeated assessments of the help-seeking individuals’ clinical states with designation of syndrome stages, and multivariate analyses of emprirically derived markers have proven promising tools for establishing more balance between the sensitivity and specificity of predictive criteria. Interven­tions of the secondary prevention aim to decrease the morbidity of the underlying pathomechanisms, and to help individuals’ coping with alterations of their experiences. We can consider here the psychosocial interventions as evidence based choices, which we can combine with certain food supplements and well-chosen psychopharmacons de­pending on the clinical state. With our in­terventions, we can influence the process of the individual development with vulnerable basis and steer it toward resilience. ]

Lege Artis Medicinae

[The Experience of Illness and Recovery – Patient Representation in the European Medicines Agency ]

CZIGLÉNYI Boglárka

Lege Artis Medicinae

[Classical methods in modern approach. Training for the recognition of emotions using bibliotherapy-techniques]

SZABÓ József, SIPOS Mária

[BACKGROUND - Nowadays it is an understood fact, that theory of mind has a great psychological significance. Deficits of theory of mind skills are observed in schizophrenia such as depression, dementia, autism and some personality disorders as well. Conceptions of theory of mind and emotion recognition ability have been coming in front at the expanse of the older empathy also in the present-day research in connection with helper connections and their effects. It is probably due to popular approach of cognitive neuroscience exact methods. METHODS - We intended to demonstrate, that the ability of emotion recognition can be developed, or partially restored, even in case of patients suffering from schizophrenia. We compiled an 8-seat training. Our method was a bibliotherapy training, each of chosen novels expressed one of basic emotions (by Ekman). After a common reading we projected validated portraits expressing also those emotions. Participants had to choose reflecting the emotional state of the characters photos. Then they shared stories from their own lives experiencing similar emotions. We measured the effectiveness of our method by the Reading the Mind in the Eyes measured (RMET) test. RESULTS - Comparing data before and after the training in t-test we detected significant difference (p=0.000608 <0.05). Verifying that the observed changes are not only the common effects of the other types of treatment, the same tests were performed on a similar in-patient treated control group. There was no significant difference between the RMET first time and two weeks later values of the control group (p=0.467). The rate of changes in the test and control group (RMET) was compared in a paired-sample t-test, and we also found a significant difference: p=0.000786 <0.005. CONCLUSIONS - The deficit of theory of mind in schizophrenia can be reduced, which indirectly can improve our patients' communication and adaptation skills, or worse, their deterioration can be reduced.]

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Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Clinical Neuroscience

Restless leg syndrome frequency in health workers

ÖCAL Ruhsen, ATGÜDEN Gizem, AYCAN Cagri, BALABAN Zeynep, SENAR Seran, YAVUZ Sena

Introduction - Restless Leg Syndrome (RLS) is a disease, primarily composed of sensational symptoms, caused by the urge to move lower extremities especially at night, and characterized by undesired feelings of the legs. Decreasing of the dopaminergic effect at night is thought to be responsible from these symptoms. RLS patients suffer from low quality of sleep affecting their daily life activities even causing socio-economic loss. Although RLS is a common and treatable disease, it can not be diagnosed easily due to the variability of symptoms. Aim - The purpose of this study is to determine the frequency of RLS among health workers and to define the disease causing factors. Method - A questionnaire was applied to 174 randomly selected health workers at Baskent University Medical Faculty (KA17/285). The demographic information, history of illnesses or usage of drugs, socioeconomic status, working hours and daytime sleepiness were questioned. Included in the questionnaire were diagnostic criteria for RLS, frequency assessment scale, and survey of sleep quality. We used “the diagnostic criteria of international RLS working group” for the diagnosis, and “Pittsburgh sleep quality index survey” to determine the quality of sleep. Reliability and validity studies were performed on both tests. Results - A significant relationship between socio-economic status and RLS was found (p<0.05) as an increase of RLS frequency in parallel with decreased socio-economic status. RLS was found to be common among health workers. We suggest that health workers should be checked regularly, and they should be informed about the disease in order to raise an awareness and hence increase their quality of life.

Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Lege Artis Medicinae

[Avoiding unlimited energy drink consumption is a matter of our heart]

DOJCSÁKNÉ Kiss-Tóth Éva

[Energy drinks have been gaining unbroken popularity, especially among youngsters and children since they were introduced to the market. Manufacturers promise to improve performance and stamina with consuming the products, classified as non-alcoholic soft drinks. In addition to the vitamins and plant extracts, they contain a significant amount of caffeine and other stimulants (taurine, guarana). Among the active ingredients, caffeine has an outstanding effect and thereby a danger, since its overconsumption – in addition to milder he­mo­dynamic changes – can cause severe cardio­vascular consequences, cardiac arrhythmias, ion channel diseases, increased blood coagulation, myocardial infarction or reduced cerebral blood flow in susceptible consumers. Many case studies have also reported serious cardiovascular attacks among young chronic energy drink consumers. Health impairments of excessive and long-term consumption of energy drinks have been studied increasingly, however there is limited and contradictory evidence on the safety of consumption and the effectiveness of performance enhancement. ]