Lege Artis Medicinae

[Psychological relations and the feasibility of psychoterapy in irritable bowel syndrome]

TÚRY Ferenc1, ÚJSZÁSZY László2

APRIL 01, 2000

Lege Artis Medicinae - 2000;10(04)

[The authors overview the recent data on the psychiatric relations of irritable bowel syndrome. The characteristic personality factors (mostly depressive and anxiety traits) must be emphasized as well as comorbidity between certain psychiatric disorders and irritable bowel syndrome, with the role of sexual abuse and stress explained. From the field of psychotherapy, the effectiveness of the cognitive-behavioural methods is analyzed most commonly. Data are available supporting the advantages of other therapeutical methods, too. ]

AFFILIATIONS

  1. Miskolc, Megyei Kórház I. Pszichiátriai Osztálya
  2. Miskolc, Semmelweis Kórház I. Belgyógyászati Osztálya

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[THE ROLE OF INFECTIOUS AGENTS IN THE ETIOLOGY AND PATHOGENESIS OF ATHEROSCLEROSIS]

VÁLYI-NAGY István, PETŐ Mónika, CSÁSZÁR Albert, VIRÓK Dezső, BURIÁN Katalin, HELTAI Krisztina, GÖNCZÖL Éva

[The well-known risk factors of atherosclerosis (high level of serum cholesterol, high blood pressure, diabetes, smoking) can only be re cognized in about half of the patients. Athero sclerosis begins in childhood. In vivo and in vitro data suggest that certain pathogens, like the intracellular bacterium Chlamydia pneu moniae (member of the Chlamydia genus) and cytomegalovirus (member of the herpesvirus family) may play a role in the development of atherosclerosis. Both pathogens infect the pop- ulation in childhood. Infected patients are often symptom-free, sometimes Chlamydia pneumoniae may cause respiratory disease. Both Chlamydia pneumoniae and cytomega- lovirus can be detected in atherosclerotic plaques and patients with atherosclerosis carry pathogen-specific antibodies more frequently and in higher titers. Aortic lesions similar to human atherosclerotic plaques can be indu ced by infection with Chlamydia pneumoniae or cytomegalovirus in experimental animals. Antichlamydial treatment results in the regres sion of these lesions in the infected animals. In vitro infection of tissue culture cells of human arterial origin with Chlamydia pneumoniae or cytomegalovirus results in the induction of cel- lular changes characteristic to atherosclerosis. Strategies to prevent or treat atherosclerosis might be complemented by antimicrobial treatment if the infectious origin of the disease is further confirmed. ]

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[Disparity in the perception of the disease in asthmatics and their pulmonologists plus resource in Hungary (HUNAIR study)]

MAGYAR Pál, GYURKOVITS Kálmán, HERJAVECZ Irén, BÖSZÖRMÉNYI Nagy György

[INTRODUCTION - Bronchial asthma is a chro­nic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (H UNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asth­matic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self-assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric cent­res in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA ) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asth­ma. An approximate "one-third " rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost work­ days, 1/3 by drug costs and 1/ 3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics , 1/3 by emergency medicines and 1/3 by other medi­cines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and '1 3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's perception more than the patient's self-assessment; 2. the resource utilisa­tion was twice as high in asthmatic children as in adults ; 3. the resource utilisati on was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - lt can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost-effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which con­sider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.]

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[Modern approach to functional gastrintestinal disorders]

LONOVICS János

[Functional gastrointestinal disorders defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemichal abnormalities, are everpresent in the society and in physicians' offices. These conditions account for half of the referrals to gastroenterologists, at least in the ,,developed countries". The pathophysiological mechanisms involved in the pathogenesis of these disorders are complex. The symptoms are believed to be biologically multidetermined, abnormalities in motor activity, visceral sensation (hypersensitivity and hyperalgesia) and/or central perception are the best known pathogenetic factors. Cultural/familiar influence, psychosocial status, life stress and early life events may also play important role in the development or amplification of the symptoms. Since functional gastrointestinal disorders are interrelated in their pathophysiology and clinical expression, many patients will have overlapping clinical features. Predominant symptoms, however, may be used for classifying these disorders (functional dyspepsia, irritable bowel syndrome etc) and for the positive (symptom-based) diagnostic approach of the functional gastrointestinal disorders. A biopsychosocial model created to explain complex pathophysiology described above provides the rationale also for the use of a multidisciplinary approach in the therapy. ]

Lege Artis Medicinae

[Funcitonal Dyspepsia]

SIMON László, LONOVICS János

[Functional dyspepsia is defined as a group of different epigastric symptoms without definite morphological, biochemical or infectious origin, having overlapping clinical features. The pathogenesis of the syndrome is surely multi factorial, involving the alterations of visceral perception, as well. Gastric acid hypersecretion does not play an essential role in the development of symptoms, however its pharmacological inhibition may result in symptomatic improvement. Several clinical studies have proved recently that Helicobacter pylori infection has secondary importance in the clinical history of functional dyspepsia patients, nevertheless (in the ulcer-like functional dyspepsia subgroup) eradication therapy is generally accepted as a preventive tool. The dysmotility-type subgroup of the functional dyspepsia syndrome is caused primarily by a multifactorial mixture of gastrointestinal motility disorders and altered visceral perception. The need for positiv diagnosis is emphasized by the authors. The correct doctor-patient relationship plays the most important role in the management of functional dyspepsia patients, complete with a well proven series of acid-inhibitory, prokinetics and anti-anxiety drugs.]

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Adult attachment and parental bonding in irritable bowel syndrome and in panic disorder - Implications for psychotherapy

PÉNZES István, CZEGLÉDI Edit, SZALAI Dömötör Tamás, CSALA Irén, TÚRY Ferenc

Background and purpose - Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients. Methods - In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument. Results - The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p<0.001). According to the results of multiple binary logistic analysis, optimal paternal bonding predicted secure attachment after adjusting for the background variables (OR=9.26, p=0.001). Conclusion - A high frequency of insecure attachment was present in both groups, especially in IBS. With regard to maternal bonding, IBS and PD groups showed similar patterns, while an apparent difference was observed for paternal bonding. These highlighted the developmental similarities of these two, symptomatically different disorders. While optimal maternal bonding did not predict adult attachment security, paternal bonding did thus replete with therapeutic implications. Attachment functions, like responsiveness, attunement and affection modulation were apparent in the psychotherapist-patient relationship as well.

Hypertension and nephrology

[Chronic stress in the development of essential hypertension. Role of rilmenidine in the treatment of stress induced hypertension]

SIMONYI Gábor

[Hypertension is an independent risk factor of cardiovascular diseases. Several factors contribute to its development, including chronic stress, which may induce hypertension by increasing sympathetic activity. The signs of increasing sympathetic activity can be primarily detected in the initial phase of hypertension, which is characterized by the increase in cardiac output. In addition to the hemodynamic consequences (increase in cardiac output, tachycardia, coronary vasoconstriction, proarrhythmia), the increase in sympathetic activity has many harmful effects. Numerous metabolic (insulin resistance, dyslipidemia), structural and trophic effects (endothelial dysfunction, vascular hypertrophy, myocardial hypertrophy), as well as thrombotic and humoral processes (procoagulation, enhancement of thrombocyte aggregation, sodium retention, activation of the renin-angiotensin-aldosterone axis) may develop and consequently damage body functions at many targets. Several different antihypertensive drug classes are available for reducing increased sympathetic activity, including peripheral alpha and beta blockers and centrally acting drugs. First generation antihypertensive drugs with central mechanisms of action (e.g. clonidine, guanfacine, alpha-methyldopa) is currently rarely administered and only for a few indications as they have a significant adverse events profile. Among centrally acting, second generation drugs, rilmenidine stimulates imidazoline-I1 receptors and thus beneficially influences mild or moderate hypertension that involves enhanced sympathetic nervous system activity.]

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[Comparative analysis of job and life satisfaction among theatre nurses in Hungary and Germany]

MÁTÉ Szilvia, PHIL. TIGGES-LIMMER Katharina, PUSZTAFALVI Henriette

[The aim of the study: The objective of the study was to assess and compare job and life satisfaction affected by workplace problems, stress, rewards, success and social support. We analyzed the coping strategies applied by the employees to solves the above problems. Material and method: The anonymous data collection was carried out in October, 2015 by applying AVEM and an own-edited socio-demographic questionnaire among theatre nurses from Hungarian and German clinics. Results: The employees evaluated stressful situations and problems differently in the two groups examined. Job satisfaction was equally important for both groups, but it affected life satisfaction of the Hungarian employees to greater extent. The stress management of the Hungarian employees was more effective in spite of the fact that German nurses used more coping strategies. Social support had a positive effect on overcoming the workplace problems in both groups. Conclusions: Job satisfaction of the nurses has a beneficial effect on their life satisfaction. The ability to divide work and private life and stress management are different among the nurses. Job satisfaction can be improved by workplace health promotion programs.]

Lege Artis Medicinae

[Therapeutic potential and risks of ayahuasca]

BOKOR Petra, FRECSKA Ede, CSÁNYI Barbara, BRYS Zoltán

[Ayahuasca, which originates from the Amazon Basin, is a psychoactive brew of two components. Its active agents are betacarboline and tryptamine derivatives. Near the spring of the Amazon River this brew is still a central component of many healing and tribal rituals. During the past few decades, the substance has become known among both laymen and scientistss and nowadays its use is spreading all over in Europe. In the present paper we give an overview of the scientific research and describe ayahuasca's main features, the main questions raised over its use, the risk factors and potential benefits. A growing number of scientific results seem to support the psychotherapeutic potential of ayahuasca, which has a strong serotonergic effect, whereas studies on its effect on the immune system also raise the possibility that certain ethno-medical observations can be scientifically proved.]

Lege Artis Medicinae

[The relationship of traumatic experiences and eating disorders – therapeutical options]

KOVÁCS-TÓTH Beáta, TÚRY Ferenc

[In the etiology of eating disorders (espe­cially bulimia nervosa and binge eating) traumatic experiences (sexual, physical, emo­tional abuse, neglect) play an important role. Traumatization can have a serious impact, which is influenced by the parameters of the traumatization, risk and protective factors, and the resiliency of the traumatized patient. The consequences may lead to the development of specific psychiatric and somatic disorders, and may cause lifetime revictimization. The exploration of data related to the traumatization is essential in eating disorders as well. If traumatic expericences can be detected in the back­ground of eating disorders, the targeted therapy of eating disorders while applying its specific elements should also follow the guide­lines of the general trauma-therapy. Providing safety in therapeutical relation­ship is fundamental. The therapeutic options are extensive. Along with psychodynamically oriented therapies, the newer methods based on cognitive-behavioral therapy (e.g., dialectic behavior therapy, integrative cognitive analytic therapy) are also proposed. Hyp­no­therapy can also be useful. ]