[Personality development in East and West, and some clinical implications ]
PUREBL György
PUREBL György
[Exploring human personality focused mainly on trait and state markers of behaviour so far. Nevertheless, the concept of the universal, culture-independent model of personality carries more disturbing difficulties: hardly understandable inter-cultural conflicts, culture-related mental disorders and scientific experiences with unexpected outcomes. It can be hypothesized, that beside personality concept represented by the Euro-Atlantic civilisation and mainstream psychology there is an alternative concept of personality. Opposed to the independent, autonomous ego concept of individualistic cultures, collectivistic (primarily far-eastern) cultures are providing an interdependent model. According to this model, the core element of personality are determined rather by social embedding instead of the person’s own characteristics, which are secondary to the personal traits and characteristics. This study attempts to briefly outline the concept of interdependent personality, with some illustrative clinical examples. ]
Lege Artis Medicinae
Lege Artis Medicinae
[The fact that there are two significant Hungarian pioneers in humanistic psychotherapy is still not recognised in the Hungarian academic community. In order to redress this omission the author compares and considers the careers of András Angyal and Béla Mittelmann. Both individuals left Hungary in 1920, settling first in Europe and subsequently in America, where they separately enjoyed successful careers. According to the author the trajectory of their lives is quite representative of many Hungarian emigrants during this period in history. This study examines the course of their life and explores their main achievements in the context of their contemporary relevance and enduring legacies. In the case of Angyal, it is the holistic-organismic theory of personality and influence on Maslow, which are his paramount achievements. As regards Mittelmann his topical contribution has been to the practice of “coaching” on the one hand and the application of dance and body therapy to recovery on the other. ]
Lege Artis Medicinae
[In Hungary, there was a ward related psychotherapy already since the 1960s, yet without any national network to the 1980s. In Debrecen the spreading of the psychotherapeutic approach started in the psychiatric facilities since the 1990s. Daytime Hospital was founded first in the County Hospital and later on in the Department of Psychiatry of the University. The latter option was provided by separating the psychiatry from neurology. This study presents the development of the day care at the Psychiatric Department along the opportunities and shows the structure of the actually functioning system finally reports on our future plans respectively. Initially started the occupational therapy, gymnastics, community cooking and walking, which did not require any separate rooms. The 22-bed psychotherapeutic unit was established 2014 with its joined capacity for 11 persons in the Daytime Hospital. The County Hospital is engaged primarily in socio-therapy of psychotic psychiatry patients, however the Psychiatric Department is rehabilitating mainly patients with affective spectrum disorders. Patients are treated in socio-therapy and psychotherapy small groups for a half or one year. Afterward they enter the outpatient program, may join the Patient Club or decide for therapeutic occupation aiming the best way of recovery. According to the feedback, there is a long-term change in the mental state of the patients leading to improvement in their quality of life, which we plan to prove by an efficacy research program. ]
Lege Artis Medicinae
[This study describes an integration of a county-level psychiatric care unit with two elements of primary social care, namely the community psychiatric care and the daycare for psychiatric patients via mediation of a specific foundation. Adequate trainings make the connection and dual employment possible in the presented system. On the health care side development is characterized by extended psychiatric care with effective psychosocial interventions. Adding specialized group psychotherapies and sociotherapies to the activity of the social care also brought a quality change, extension of which provided self-help and the consumers' applicability as therapy leaders in sociotherapy group. Based on our ten years of practice we may declare that recovery-based psychiatric rehabilitation can be realized more effectively in this community-based biopsychosocial model of care. ]
Lege Artis Medicinae
[The authors are focusing on a special type of long term psychiatric care taking place in Hungary outside of the conventional mental health care system, by introducing some institutional aspects of the not well known world of so called social homes for psychiatric patients (asylums). After reviewing several caracteristics of institutional development of psychiatric care in Hungary based on selected Hungarian and international historical sources, the main structural data of present Hungarian institutional capacities of psychiatric health and social care services are shown. Finally, the authors based on own personal experiences describe several functional ascpects of the largest existing asylum in EU, a social home for long term care of psychiatric patients. By the beginning of the 20th century, Hungarian psychiatric institutions were operating on an infrastructure of three large mental hospitals standing alone and several psychiatric wards incorporated into hospitals. Nevertheless, at the very first session of the Psychiatrists’ Conference held in 1900 many professionals gave warning: mental institutions were overcrowded and the quality of care provided in psychiatric hospital wards, many of which located in the countryside of Hungary, in most cases was far from what would have been professionally acceptable. The solution was seen in the building of new independent mental hospitals and the introduction of a family nursing institution already established in Western Europe; only the latter measure was implemented in the first half of the 20th century but with great success. However, as a result of the socio-political-economic-ideological turn following the Second World War, the institution of family nursing was dismantled while different types of psychiatric care facilities were developed, such as institutionalised hospital and outpatient care. In the meantime, a new type of institution emerged in the 1950s: the social home for psychiatric patients, which provided care for approximately the same number of chronic psychiatric patients nationwide as the number of functioning hospital beds for acute psychiatric patients. This have not changed significantly since, while social homes for psychiatric patients are perhaps less visible to the professional and lay public nowadays, altough their operational conditions are deteriorating of late years. Data show, that for historical reasons the current system of inpatient psychiatric care is proportionately arranged between health care and social care institutions; each covering one third. Further research is needed to fully explore and understand the current challenges that the system of psychiatric care social- and health care institutions are facing. An in-depth analysis would significantly contribute to the comprehensive improvement of the quality of services and the quality of lives of patients, their relatives and the health- and social care professionals who support them. ]
Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.
Clinical Neuroscience
Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithymia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share common pathology of neuroanatomical structures. We hypothesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship between WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.
Hypertension and nephrology
[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]
Clinical Neuroscience
[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmelweis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]
Clinical Neuroscience
[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease3.
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Clinical Neuroscience
Cases of inborn errors of metabolism diagnosed in children with autism2.
Clinical Neuroscience
[The first Hungarian patient with Guillain-Barre syndrome after COVID-19]3.
Clinical Neuroscience
Retinal morphological changes during the two years of follow-up in Parkinson’s disease4.
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