Lege Artis Medicinae

[Epidemiology, comorbidity, etiology of depression and cardiovascular diseases]

PÉTER László1, RIHMER Zoltán2

JULY 20, 2019

Lege Artis Medicinae - 2019;29(06-07)

DOI: https://doi.org/10.33616/lam.29.026

[Psychiatric problems are a common comorbid condition in patients with cardiovascular disease. Depression is a well-known risk factor for the development of cardiovascular disease and mortality too. Psychiatric and cardiovascular diseases are prevalent public health problems in the western world. Depression is associated with endo­thelial dysfunction and increased platelet aggregation, which may explain the consequent cardiovascular complications. Specific affective temperaments may be associated with special cardiovascular diseases. Antidepressant therapy does not only reduce depression but also cardiac mortality.]


  1. Magyar Honvédség Egészségügyi Központ, Pszichiátriai osztály
  2. Semmelweis Egyetem, ÁOK, Pszichiátriai és Pszichoterápiás Klinika és Országos Pszichiátriai és Addiktológiai Intézet



Further articles in this publication

Lege Artis Medicinae

[One Million Patients Live with Diabetes in our Country, but the Dismal Trends Seem to Turn Around]


Lege Artis Medicinae

[The Good, the Bad and the Ugly ]


[Reading the title most of us (but not everyone) can recall from our memories the classic heroes of the movie of Sergio Leone and we can almost hear (or not?) the melody of Ennio Morricone. This sentence is full of strangeness, isn’t it? However it’s hardly at all sure that everyone had seen the movie (indeed certainly not) and the catching music is maybe elusive. Like or not we are related to classics of lipidology, as well. Most of the readers of this review of the three clinicians know much (but not everything!) of these topics but probably for some of them this paper will arise their further interest. We are going to separate the “inseparable”, only together functioning whole thing in order to build a model in our thinking regarding its operation. This is what we do with the scientific cognition. We are making models, simplifying indeed… (sometimes erroneously) proclaiming. Let’s throw out our (or at least try to do it) the stereotypes living inside us. Let’s talk about the “always” good HDL-cholesterol, the bad LDL-cholesterol and the ugly (or cruel) triglyceride, actually (and now the analogy is lost of the three key players of the classic western movie) about the other faces of the together ugly and bad lipoprotein(a) according to a lot of opinions! As everything is connected with everything in the human body and nothing is accidental - nothing can be only good, bad or ugly nor the Good, the Bad and the Ugly yet.]

Lege Artis Medicinae

[The Magic Flute – Mozart’s Opera in the Crossfire of Interpretations ]


Lege Artis Medicinae

[How many cardiovascular events can be avoided by a lipid lowering therapy based on preventive guidelines?]

MÁRK László

[The lipid lowering therapy became one of the most important elements in the cardiovascular prevention, yet it is not appropriately evaluated neither by the doctors, nor by the patients. The lipid goal attainment should to be improved according to Hungarian and international data. Using a recommendation guided lipid lowering therapy the most benefit can be expected in the patients at very high risk who alrea­dy had a cardiovascular event, where the LDL-cholesterol goal is 1.8 mmol/L. Calculating upon the data of 170000 patients of Cholesterol Treatment Trialists’ Collaboration a decrease of LDL-cholesterol level from 2.5 mmol/L to 1.8 in 100 patients in 10 years would avoid 3 myocardial infarctions, strokes or death, lowering that from 3.5 mmol/L to the goal would prevent these 3 events within 5 years. Using the traditional LDL-cholesterol lowering medication, high dose statin and ezetimibe, if the attitude of doctors and the compliance of patients would be ideal, the 1.8 mmol/L goal attainment rate would be over 80%. Unfortunately, up to now the reimbursed administration of ezetimibe in Hungary is still bound to a specialist’s recommendation, adding it to any dose of any statin an additional 20% LDL-cholesterol can be expected. The reimbursed administration of PCSK9-inhibitors is possible only based on a special request to National Health Insurance Fund. To achieve a better national cardiovascular morbidity and mortality the attitude of the doctors and the adherence of the patients to the lipid lowering therapy should be improved (it’s the goal of the present paper as well).]

Lege Artis Medicinae

[Empirical examination of the persistence value among the students studying health-care at the beginning of student professionalization]

DINYÁNÉ Szabó Mariann, PUSZTAI Gabriella

[INTRODUCTION – Students in healthcare studies can help maintain the mental base and maintain their health if the lecturers know the degree of student persistence. When entering higher education, it is possible to measure the pre-university experience. Persistence determines the student's relationship to learning and can be a predictor of learning success. PARTICIPANTS AND METHODS – A questionnaire study (N = 200) of the 1st year student (N = 200) of the Health Care Organization (BSc) of the University of Debrecen and Semmelweis University. For the continuous Persistence Variable a descriptive statistical method was used, an independent two-sample t-test was used for comparison between groups, and Hedges-g was used to express the effect size. We used the GLM (General Linear Model) model for fitting the persistence model. By means of factor analysis, we constructed factors from the significant predictor variables of the GLM model, which helped us assessing students' chances of learning. To quantify the strength of evidence against null hypothesis P < 0.05 (5% significance) was chosen as a standard level for concluding that there is evidence against the hypothesis tested. Statistical analysis was performed with IBM SPSS Statistics 24.0 (SPSS, Chicago, IL). RESULTS – The persistence factor loadings can be divided into three types: high, medium and low. High persistence rearranges student preferences, low interest persistence, minimal interest in academic engagement. In the case of middle-ranking people, the importance of volunteering (life-experience) and friendship is paramount. CONCLUSIONS – The results indicate that at the beginning of the student life there is a willingness, diligence, acceptance of academic values, interest or lack of interest in future success studies. During the stu­dies, these features can be monitored and the necessary interventions can be made in time.]

All articles in the issue

Related contents

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.

Lege Artis Medicinae


VOKÓ Zoltán, SZÉLES György, KARDOS László, NÉMETH Renáta, ÁDÁNY Róza

[INTRODUCTION - Here we present the descriptive epidemiology of stroke in Hungary including mortality, morbidity, functional limitation and inpatient care based on the most recent health statistical data. METHODS - Mortality data were analysed by direct and indirect standardisation, and geographical mapping based on empirical Bayesian smoothing. Morbidity data were obtained from the General Practitioners’ Morbidity Sentinel Station Program and the National Health Surveys. The latter also provided data on functional limitation. Data on inpatient service were taken from the European Hospital Morbidity Database of WHO. RESULTS - Hungarian stroke mortality continued to decrease in recent years, and the slope of the decrease was larger than in Western Europe. Stroke mortality was highest in the Northern- Hungarian Region, and in Somogy and Zala counties. The incidence of stroke was 1.5-2 times higher than in the developed countries in most age groups. Over 64 years of age, a decline of stroke incidence was observed, especially in men. In this age group approximately 10% of men and 7% of women had already had a stroke. Of these patients more than 10% needed assistance to get out of the bed, dress up, or eat. Hospitals reported more than 60 000 stroke cases in 2005. CONCLUSION - Despite the promising trends in stroke mortality and now also in morbidity, both indices are still rather high in Hungary compared to those in Western-Europe. The relatively favourable epidemiological changes, however, may be overridden by the increased stroke burden resulting from the aging of the population.]

Clinical Neuroscience

[Ketamine administration in case of severe, therapy resistant depressed patient, case report]

MORVAI Szabolcs, NAGY Attila István, BÁLINT-SZÖLLŐSI Adrienn, MÓRÉ E Csaba, BERECZ Roland, FRECSKA Ede

[Objective - In our case report we present the treatment of a female patient suffering from therapy resistant depression. This procedure is not in practice in Hungary at present, the aim of our work to reproduce the findigs of international studies in domestic circumstances. Matter - Major depression is a common, chronic and severe mental disorder, with 16.2% lifetime prevalence. Many international randomized, placebo controlled trials found administration of ketamine infusion effective in depressed patients. Methods - Since ketamine is an anesthetic agent, its administration was performed in the post-operative monitoring room of our hospital operating-room, supervised by an anesthesiologist. According to formerly published data, a dose of 0.5 mg/kg of body weight was administered intravenously in 40 minutes by perfusor. The drug was administered in a same manner fifteen days later. Subject - The patient was admitted to our inpatient ward with severe depression. During two months of combined antidepressant therapy her condition has not improved significantly. Approval for off label drug indication was granted with urgency by the National Institute of Quality and Organizational Development in Healthcare and Medicines. Results - During the two treatments the Hamilton Depression Rating Scale 21 items rating scale score was reduced to 8 from the baseline 28, the Hamilton Anxiety Rating Scale score was reduced to 6 from 25, Beck Depression Inventory was reduced to 9 from 20. Upon administration of the drug no severe adverse event was detected, the mild dissociative state related to ketamine was ceased in a short period of time. Discussion - With administration of 0.5 mg/kg ketamine the authors managed to achieve rapid improvement in a therapy resistant depressed patient, without permanent side effects. Our future plan is to repeat the use of the drug within a double-blind, placebo controlled trial in order to prove its efficacy in hospital settings. ]

Lege Artis Medicinae

[Pathomechanism, symptoms, differential diagnosis and therapy of fibromyalgia]


[Fibromyalgia is a chronic, non-inflammatory pain syndrome characterised by diffuse muscle pain and increased tenderness of specific tender points. The exact cause or pathomechanism of the disease is unknown. In the background, nociception and the pain processing pathways of the central nervous system are suspected as dysfunctional. The disease occurs primarily in middle-aged women. Occurence of fibromyalgia is between 1-4%, increasing up to 20% in a rheumatology clinic. In Canada, the cost of treatment of fibromyalgia was 350 million $ in 1993. Unfortunately, in Hungary no similar data is available. It is frequently joined by different vegetative and functional symptoms. One characteristic feature is insomnia, causing typical morning fatigue in patients. Effective therapy has yet to be found, although successful treatment may be achieved with drug therapy (amitryptilin), psychotherapy and aerobics with supplemental electro- and hydrotherapy. Patient education and involvement is also important for good therapeutic results and for the ability to return to work as soon as possible.]

Hypertension and nephrology

[Epidemiology of hypertension in Hungary]


[The most important aspects of Hungarian hypertension epidemiology are demonstrated. The prevalence of hypertension is continuously increasing and in 2011 from the nearly 10 million population exceeded 3 million. Its occurrence rises in parallel with the increase in of systolic blood pressure and the progression of age, and exceeds 60% in those aged over 65 years. The average blood pressure is increasing in children and adolescents, and isolated systolic hypertension is often observed in those over 65-70 years. The situation is closely related to overweight in the young, while in elderly the atherosclerotic process results in low diastolic blood pressure. The prevalence is significantly different in some regions with the highest incidence in South-Transdanubia and North- Hungary. Overall, there is a higher incidence in women. Among known hypertensive patients, the ratio of men is greater till 40-45 years; thereafter, there will be an equilibration and in elderly women the incidence will be higher. It is interesting, that the morbidity and mortality have significantly increased in hypertension and diabetes since 2004, while the incidence of myocardial infarction and stroke has significantly decreased. As concerns organ damage, an increase in occurrence of left ventricular hypertrophy and microalbuminuria has been observed. Metabolic syndrome, diabetes mellitus and ischemic heart disease were the most frequent comorbidities.]