Lege Artis Medicinae

[Depression, anxiety and suicidal behavior. Recognition and care]


AUGUST 30, 2018

Lege Artis Medicinae - 2018;28(06-07)

[Depression and anxiety disorders are major problems both in psychiatric and in general practice because of their frequency and recurring character. Owing to their common complications (suicide, suicide attempts, secondary alcoholism / drug disease, increased cardiovascular and cerebrovascular morbidity and mortality, loss of work, social isolation, etc.) they are the cause of significant individual, family and social burdens. In our paper we review the clinically revealable suicide risk and protective factors that can be observed in depression and anxiety disorders as well as the main aspects of the recognition and care of suicidal patients. With available medicines and non-pharmacological therapies, the vast majority of depressive and anxiety patients can be successfully treated and in most cases we can prevent suicidal behavior associated with these diseases. Besides psychiatrists general practitioners as well play a significant role in preventing suicidal behavior and in the recognition of suicide risk. ]



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Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part II. - Breastfeeding, complementary feeding and weaning in the Large-sample of the “For Healthy Offspring” project]

SZABÓ László, SCHEURING Noémi, DANIS Ildikó, NÉMETH Tünde, VÁRADY Erzsébet

[INTRODUCTION - Complementary feed-ing is the transitional period from exclusive breastfeeding to family foods, while breastfeeding is continued. It should be started, when breastmilk itself no longer meets the infant’s nutritional requirements, ideally at the age of around 6 months. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Comple­mentary feeding practices and issues of weaning were analyzed. RESULTS - In our sample complementary feeding was started at the age of 5.5±1.8 months. 6% of infants younger than 4 months and about two third of infants at the age between 4 and 6 months were started on complementary feeding. 32% of the 7-12 month old infants were continued on breastfeeding. The proportion of breastfed infants and young children in the 12-24 and 25-36 month age group was 24% and 5.5% respectively. The daily feeding frequency of breastfed infants was 6.7±1.6. The infants and young children, who were breastfed along with complementary feeding were feeding 5.6±1.5 times/day. After completed weaning the range of feeding frequency was limited to 4.9±0.9 occasions/day. 60.4% of mothers regarded their feeding style on demand, while 39.6% on set schedule. 16% of mothers reported that their child had feeding difficulties. CONCLUSIONS - Complementary feeding indicators should be part of infant feeding data collection, such as time of introduction of complementary food, feeding frequency, food consistency, energy density of food and safe preparation. Responsive feeding is part of responsive parenting and should be promoted, along with continuing breastfeeding at least till one year of age, and for as long as mother and infant wish to continue. ]

Lege Artis Medicinae

[Health economics in Hungary: great potential, missed opportunities?]

NÉMETH Bertalan

Lege Artis Medicinae

[Mobbing and bullying among physicians - when colleagues become enemies]

KAPOCSI Erzsébet

[Workplace mistreatment, mobbing, bully-ing, or psychoterror has become a prioritised field of research in social sciences in the past two-three decades. Mobbing means more than a simple conflict situation between two individuals; it is a complex problem that could and should be investigated in various individual and organisational contexts. In spite of its large-scale theoretical and empirical research, the phenomenon still does not have a uniform definition; it is most commonly de-scribed via its social manifestations. Although the interpersonal constellation of mobbing is diverse, its trigger factors, stages and participants show similar patterns. The description and the evaluation of consequences is also uniform in the literature: workplace mobbing is accompanied by considerable health impairment, and it has severe psychosomatic and mental health effects on both the targeted individuals and the whole community. The latter group has to deal with poor performance, impaired morale and dissatisfaction. All these factors add up and lead to significant financial damage as well. The prevalence of mobbing is especially high in health care. Hierarchy, continuous overload, as well as emotional and physical stress all favour the development of mobbing. In turn, the professional-social culture of medicine that is based on traditions contributes to its acceptance, understatement and denial. The first time medical students have to face psychoterror is typically during their university years. The positive aspects of socialisation and finding their vocation cannot always compensate for the negative experiences. The model role of physicians, their behaviour towards colleagues and students can be protective, but it can also trigger further mobbing. Prevention is essential both at the organisational and individual level, and it requires complex measures whose effect will only be felt in the long term. ]

Lege Artis Medicinae

[Vision or reality? Can Hungary become hepatitis C virus free by 2030?]


[According to the WHO, there are 71 million people worldwide and 3 million people in the EU who are infected with hepatitis C virus. Most of these infections, however, remain undiagnosed and only 6-7% of them received antiviral therapy. In Hun-gary, there are an estimated 50.000 infections, out of these 20.000 are identified, the remaining 30.000 infections are outside the reach of the health care sector. Early diagnosis and therapy are of utmost importance as late diagnosis leads to se-vere liver insufficiency, hepatocellular carcinoma and multiple other extrahepatic organ impacts. In Hungary, second generation direct acting enzyme inhibitor antiviral medications with a recovery rate of almost 100% are available since 2015. Since 2018, all patients are treated with this type of therapy. Nevertheless, there are several remaining professional, organisational and health policy issues to solve. Firstly, Hungary should join the EU’s HCV elimination programme which aims to eradicate hepatitis C virus from Europe by 2030. Secondly, the frequency and efficiency of national screening should be increased. Furthermore, better information of the general population, inclusion of general practitioners and civil organisations, and introduction of the compulsory screening of high risk groups and health care professionals would be necessary. This review summarises the evolution of hepatitis C virus diagnostics and therapy over the past three decades, current best practice and the still outstanding tasks. ]

Lege Artis Medicinae

[How to diagnose idiopathic pulmonary fibrosis. Part 2]


[Idiopathic pulmonary fibrosis is a severe irreversible lung disease with a progressive course. The disease onset is hard to discover due to the unspecific signs and symp­toms. It occurs mainly in elderly people. In the past decades its prevalence has increased continuously. Physical examination, restrictive pattern on lung function test with decreased diffusion capacity are characteristic features of the disease. Chest X-ray showing fibrotic pattern also points toward the diagnosis of idiopathic pulmonary fibrosis. Differential diagnosis is based on high resolution komputertomográfy. Diag­nosis of IPF is based on the appearance of usual interstitial pneumonia pattern together with the lack of external risk factors and autoimmune or other diseases also known to cause this pattern seen on chest imaging. If no firm diagnosis can be built lung biopsy is required. Multidis­ciplinary teams from clinician, radiologist and pathologist are set in predefined centres that could provide care with novel antifibrotic drugs. These can slow disease progression and are in the frontline in the treatment of the disease. Further research is required to understand the pathomechanism and foster the discovery of further treatment options. ]

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[The revised Adult Attachment Scale (AAS) developed by N. L. Collins is a widely used questionnaire to measure adult attachment. However, its psychometric properties have not been investigated in Hungary. We aimed to confirm the key psychometric properties of the Hungarian version of the AAS focusing on reliability indices on a population that consis­ted of depressed and non-depressed young adults. The AAS is a self-report questionnaire, in which two different dimensional evaluating systems are possible: the original (close, depend, and anxiety) and the alternative scoring system (anxiety, avoidance). Our study population consisted of young adults with a history of major depression (n = 264, median age = 25.7 years) and their never-depressed biological siblings (n = 244, median age = 24.0). The internal consistency of close, anxiety, and avoidance scales were satisfactory (Cronbach-α >0.7). The consistency of the depend scale was slightly lower than expected (Cronbach-α = 0.62). Test-retest reliability was good for all of the scales, it ranged from 0.73 to 0.78 after 14 months of follow-up period. The scale showed good discrimination as tested by the differences of close and anxiety attachment dimensions between the groups (p<0.01). More­over, we were able to differentiate the currently dep­res­sed subjects based on these attachment dimensions. Explo­ra­tory and confirmatory factor analyses were conducted, and a bifactor solution proved optimal model fit. The three dimensions of the AAS has not been confirmed. However, the close and anxiety scales of AAS were found to be adequate. Our results also indicate that attachment features correlate with major depressive episodes in adulthood.]

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