Lege Artis Medicinae


VINCZE Gábor, TÚRY Ferenc, MURÁNYI István, KOVÁCS József

JANUARY 20, 2005

Lege Artis Medicinae - 2005;15(01)

[INTRODUCTION - Affective disorders are widely prevalent causing a common health problem. They appear frequently as comorbid disorders in connection with somatic illnesses. In the Hungarian literature there are very little data available related to his topic. In this study the prevalence of depression was analyzed in different departments of general hospitals. PATIENTS AND METHODS - A questionnaire screening was performed in nine Hungarian hospitals among 2423 patients treated in general medical departments. The prevalence of depression and the use of antidepressants was measured. The Beck Depression Inventory was applied for the detection of depression. RESULTS - In the studied sample the mean score of depression was 12.9 on the Beck Depression Inventory. 46.4% of the patients reached a pathological score. The most prevalent depression was screened in the rheumatological, neurological and rehabilitation departments. The use of antidepressants was very low among the depressed patients (0-11.9%). CONCLUSION - Based on the data of the study it seems that screening and treatment of depression in general medical departments is of great importance, which stresses the practical significance of the consultation-liaison psychiatry.]



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[Report from the 2004 Congress of the American Society for Cardiology]


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[ALA (5-aminolevulinic acid)-induced protoporphyrin IX fluorescence in the endoscopic diagnostic and control of pharyngo-laryngeal cancer]

CSANÁDY Miklós, KISS G. József, IVÁN László, JÓRI József, CZIGNER Jenő

Lege Artis Medicinae



[Oral antidiabetic drugs are used in type 2 diabetic patients when diet and physical exercise have failed. The oral antidiabetic drugs available in Hungary can be classified according to their main effect. In this regard, antihyperglycaemic drugs with no hypoglycaemic potential (alfaglucosidase inhibitors, biguanides, thiazolidinedions) and drugs with a potential of insulin secretion (sulfonylureas, prandial glucose regulators) can be distinguished. Acarbose is mainly used in order to decrease the postprandial glucose excursion. Metformin is the drug of choice for obese, insulin resistant diabetic subjects while buformin is not preferable anymore since the availability of metformin. Rosiglitazone, the only thiazolidine-dion derivative in Hungary, can be used in combination therapy in diabetic subjects with clinical characteristics of the metabolic syndrome. The list of sulfonylureas contains five drugs in Hungary which enables differential therapeutical strategies to be performed. The prandial glucose regulators can be used either in monotherapy or in combination with other drugs at the relatively early stage of the disease. At present, the recommendations for treating diabetic patients with oral antidiabetic drugs can be based on clinical evidences.]

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Lege Artis Medicinae



[After cholecystectomy, recurrent biliary-like pain, alone or in association with a transient increase in liver enzymes may be the clinical manifestation of the sphincter of Oddi dysfunction (SOD). Most of the clinical information concerning SOD refers to postcholecystectomy patients who have been classified according to clinical presentation, laboratory results and endoscopic retrograde cholangio-pancreatography (ERCP) findings as: biliary type I, biliary type II, and biliary type III. The prevalence of SOD has been reported to vary from 9 to 11% in unselected patients having postcholecystectomy syndrome up to 68% in a selected group of patients without organic disorder and complaining of postcholecystectomy pain. Diagnostic work-up of postcholecystectomy patients for suspected SOD includes liver biochemistry and pancreatic enzyme levels plus negative findings of structural abnormalities. Usually this would include transabdominal ultrasound, gastroscopy and ERCP. Depending on the available resources, endoscopic ultrasound and magnetic resonance cholangiography may precede endoscopic retrograde cholangiopancreatography in specific clinical conditions. In SOD patients, the endoscopic sphincter of Oddi manometry is the gold-standard diagnostic method to evaluate the abnormal motor function of the sphincter of Oddi. Quantitative evaluation of bile transit with cholescintigraphy is valuable in the decision whether to perform sphincter of Oddi manometry or to treat. The standard treatment for SOD is sphincterotomy. In biliary type I patients, the indication for endoscopic sphincterotomy is straightforward without the need of additional investigations. Slow bile transit on cholescintigraphy in biliary type II patients is an indication to perform endoscopic sphincterotomy without sphincter of Oddi manometry. Positive Nardi or Debray evocative test in biliary type III patients is an indication to perform sphincter of Oddi manometry. Medical therapy with nitrosovasodilatators, Ca-channel blockers, theophyllin compounds, β2 receptor agonists and anticholinerg drugs can be useful in biliary type II and type III patients preceding endoscopic sphincterotomy. If medical therapy fails, one might proceed to perform ERCP and endoscopic sphincterotomy but only in patients with abnormal SO manometry results.]

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Validation of the Hungarian PHQ-15. A latent variable approach

STAUDER Adrienne, WITTHÖFT Michael, KÖTELES Ferenc

Somatic symptoms without a clear-cut organic or biomedical background, also called “medically unexplained” or “somatoform” symptoms, are frequent in primary and secondary health care. They are often accompanied by depression and/or anxiety, and cause functional impairment. The Patient Health Question­naire Somatic Symptom Scale (PHQ-15) was developed to measure somatic symptom distress based on the frequency and bothersomeness of non-specific somatic symptoms. The study aimed to (1) evaluate the Hungarian version of the PHQ-15 from a psychometric point of view; (2) replicate the bifactor structure and associations with negative affect described in the literature; and (3) provide the Hungarian clinical and scientific community with reference (normal) values split by sex and age groups. PHQ-15, depression (BDI-R), and subjective well-being (WHO-5) scores obtained from a large (n = 5020) and close to representative community sample (Hun­garostudy 2006) were subjected to correlation analysis and linear structural equation modeling. The PHQ-15 showed good internal consistency (Cronbach’s α = 0.810; McDonald’s ω = 0.819) and moderate to strong correlation with the BDI-R (rs = .49, p < 0.001) and WHO-5 (rs = -.48, p < 0.001). Fit of the bifactor structure was excellent; in independent analyses, the general factor was strongly associated with depression (β = 0.656±0.017, p < 0.001) and well-being (β = -0.575±0.015, p < 0.001), whereas the symptom specific factors were only weakly or not related to these constructs. The PHQ-15 score was higher in females and showed a weak positive association with age. The Hungarian PHQ-15 is a psychometrically sound scale which is positively associated with depression and ne­gatively related to subjective well-being. The bifactor structure indicates the existence and meaningfulness of a gene­ral factor representing the affective-motivational component of somatic symptom distress. The Hungarian version of the PHQ-15 is a brief and usable tool for the pre-screening of somatization disorder (DSM-IV) or somatic symptom disorder (DSM-5). The reported reference values can be used in the future for both clinical and research purposes.

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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.]

Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine


Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

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[Health reforms in recent decades have been largely based on economic considerations and have led to a significant problem in the sector today, with the issue of human resources being pushed back, which is exacerbated by burnout syndrome. The aim of this questionnaire-based study was to examine the complex background of burnout among health care workers in the cities of Komló, Pécs and Kecskemét. Baseline demographic data were recorded. Burnout was assessed by the Maslach Burnout Inventory (MBI), and the intensity of dysfunctional attitudes were also studied. Depression was detected by the Beck Scale and social supports, and effort-reward dysbalance were also examined. Overall 411 employees participated in our study. Age group distribution was middle aged access, vast majority of the workers was between 36 and 55 years. Mean burnout scale was 58.6 (SD = 16.3), 63 workers had mild (14.2%), 356 had moderate (80.7%) and 22 had severe (5.1%) burnout. In a multivariate analysis the type of work (OR = 1.018), age (OR = 2.514), marital status (OR = 1.148), job type (OR = 1.246) the lack of social support (OR = 1.189) and allowance (OR = 9.719) were independently associated with burnout (p < 0.05 in all cases). There was a significant association among burnout, depression and dysfunctional attitudes. The vast majority of our social workers suffered from moderate and a small, but significant proportion suffered from severe burnout. Our work draws attention to the modifiable and unmodifiable risk factors of burnout in this population, which may help in the development of preventive strategies.]

Clinical Neuroscience

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Background and aim - Somatic and mental health and stress factors of physicians became an issue of growing interest in both national and international researches. Our aim is to give an overviewing analysis of Hungarian physicians’ mental health state. Methods - Representative, cross-sectional, quantitative survey on a representative sample of Hungarian physicians (n=4784). The control group was formed by the population group of a national survey conducted by “Hungarostudy 2013” (n=2000). Results - Suicidal thoughts (18.8% vs. 9.6%, p<0.001), the scores of Somatic Symptom Scale (PHQ-10, 20.4% vs. 13.6%, p<0.001) were significantly higher among physicians. The suicidal attempts (1.9% vs. 3.5%, p=0.053) and BDI depression scores (7.9% vs. 29.5%, p<0.001) were significantly higher in the control group. High Perceived Stress Scale (PPS) scores occurred in 43.3% of the physicians sample, and 43.4% of them had high scores in the Athenian Insomnia Scale (AIS). The young (<35) female physicians showed significantly higher rates of suicidal thoughts, higher scores of PHQ and PPS. In the young female cohort, the AIS scores were significantly higher than of the other physicians. Conclusions - Mental health of physicians (sleep disorders, suicidal thoughts and psychosomatic symptoms) showed poorer results than the population data. BDI scores and the rate of suicidal attempts showed favourable trends. The next step in the physicians’ mental health researches is to investigate the most decisive risk factors, and to work out the prevention tools.