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Lege Artis Medicinae

SEPTEMBER 30, 2020

[Assessment of multidisciplinary teams in psychiatric care – Lessons of three focus groups ]

MOLNÁR László, ZANA Ágnes, GYŐRFFY Zsuzsa, SZVATH Petra

[Our research group, has studied psychiatric and psycho­the­ra­peutic teams since 2015. The aim of the present research was to identify the Hun­garian characteristics of team composition and operation. Qualitative focus group survey has been conducted on the operation of multidisciplinary teams at the annual conferences of the Hungarian Psychiatric Society in 2017, 2018 and 2019. These three groups focused on the issues of leadership, communication within the team, and competencies. The groups of an average of 17 people formed spontaneously by participation of professionals with different qualifications. The main results of the focus groups were as follows: 1. The various ty­pes of leadership within the team require the distribution and allocation of res­pon­si­bilities and roles and stop the dest­­ruc­tions. 2. Wi­thin the teams there are pre­vai­ling the informal channels of communication. 3. It is im­portant to clarify com­petencies and responsibilities. 'Actually, psy­chiat­ric spe­cia­lists' list of competencies there is not available in Hungary. It seems necessary to define more precisely and reconsider the professional competences of the specialized training in psychiatry and integrating these in the education, further promote the development of „list of competences in psychiatric specialization” by the legislators. The second phase of the research continues as a quantitative study based on the foregoing results gained by questionnaires. ]

Lege Artis Medicinae

SEPTEMBER 30, 2020

[A forgotten physician in the history of Hungarian Psychiatry. Dr. Ferenc Klein’s biography]

SZABÓ József

[The Psychiatry Department of St. Raphael’s Hospital in Zala County celebrated its 110th anniversary last year. This important anniversary raised the idea of studying deeper than usual the life of our professional ancestors. We tried to discover the personality, character, and oeuvre of our first appointed chief physician Ferenc Klein while using historical recollections and press articles published by our county, city and hospital. An image of a prominent physician, psychiatrist, patriot and individual was emerging before our very eyes by processing the available sources. As a pulmonologist, a field surgeon, or a psychiatrist he was able to meet the expectations of his age. He was highly appreciated by his patients and the people of Zalaegerszeg. Despite his significant oeuvre and martyrdom, he sank in oblivion and his name was not preserved either in the history of psychiatry or in the general memory. In the present study, we want to commemo­rate him by collecting and publishing his biography. ]

Clinical Neuroscience

MAY 30, 2020

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

Lege Artis Medicinae

MARCH 10, 2020

Lege Artis Medicinae

JANUARY 20, 2020

[History of Daytime Hospital of the Department of Psychiatry in the University of Debrecen ]

ÉGERHÁZI Anikó, CSERÉP Edina, MAGYAR Erzsébet

[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

JANUARY 20, 2020

[End of the line? Addenda to the health and social care career of psychiatric patients living in Hungary’s asylums]

KAPÓCS Gábor, BACSÁK Dániel

[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. ]

Lege Artis Medicinae

JANUARY 20, 2020

["Punishment-therapy” - chances of psycho-rehabilitation for mentally ill offenders under forced medical treatment]

BACSÁK Dániel, KRÁMER Lili

[When examining the life course of mentally disordered offenders it is unavoidable to take into consideration the legal definition of in­sanity that exempts an individual from ordinary punishment in the given context of criminal law. As technical as it is, legal language describes and prescribes institutional responses on how to deal with mentally disordered offenders - not being independent from the everyday societal stereotypes on mental illness. In Hungary, the definition of criminal liability consists of medical and legal elements. Thus, in practice court appointed psychiatric experts are solely relied upon in determining whether or not the accused are criminally liable - the formal decision is in the hands of the court. If no criminal liability is determined by the experts, the court has to acquit the accused. In some special cases this acquittal opens the way to criminal psychiatric detention that is maintained by the Hungarian Prison Service. The aims of criminal psychiatric detention are twofold: rehabilitation and punishment. We suggest that it is nearly impossible to serve both of the aforementioned aims simultaneously. Furthermore, our article argues that the philosophy of care is focused on punishment and biomedical treatment nowadays, rather than rehabilitation and holistic bio-psycho-social treatment. The approach of treatment in operation makes successful recovery of patient-detainees difficult. Moreover, there are systemic issues as well: limited effects of review proceedings, holes in the psychiatric-social institutional care system and the general societal stigmatisation of people with mental illnesses can unreasonably prolong discharging “guilty patients”, thus, they stay detained 4-5 years longer. ]

Lege Artis Medicinae

DECEMBER 10, 2019

[Why did I survived? Treatment of acute stress reaction after a road accident]

SZABÓ József, SIPOS Mária

[INTRODUCTION - Survivors and witnesses of traffic accidents often experience an acute stress reaction. Immediate or at least fast psychological support, relieving the subjective suffering is very important in the respect of preventing psychological crisis, post-traumatic stress disorder or depression and the associated increasing risk of suicide. CASE REPORT - We present the case of a 27-year-old male patient who was the victim of a traffic accident and was partly responsible for it. He lost his mother in the accident, his sister was injured, and there was a casualty in the other affected car. He applied for a psychiatric appointment one week after the accident. He complained of insomnia, loss of appetite, sadness, weakness, anxiety. The treatment consisted of low-dose anxiolytic therapy, recommended in case of need, and a psychological support via acute stress protocol (G-tep) of EMDR therapy. Both short-term feedback from his family doctor and psychiatry outpatient follow-up after three weeks showed significant symptomatic improvement. CONCLUSIONS - In the last one and a half year, he has not applied for psychiatrical treatment. According his general practitioner there were no new psychological problems during this time. Our work has been successful in terms of immediate relief of suffering and prevention of psychological crisis and PTSD.]

Clinical Neuroscience

NOVEMBER 30, 2019

[Tracing trace elements in mental functions]

JANKA Zoltán

[Trace elements are found in the living organism in small (trace) amounts and are mainly essential for living functions. Essential trace elements are in humans the chromium (Cr), cobalt (Co), copper (Cu), fluorine (F), iodine (I), iron (Fe), manganese (Mn), molybdenum (Mo), selenium (Se), zinc (Zn), and questionably the boron (B) and vanadium (V). According to the biopsychosocial concept, mental functions have biological underpinnings, therefore the impairment of certain neurochemical processes due to shortage of trace elements may have mental consequences. Scientific investigations indicate the putative role of trace element deficiency in psychiatric disorders such in depression (Zn, Cr, Se, Fe, Co, I), premenstrual dysphoria (Cr), schizophrenia (Zn, Se), cognitive deterioration/de­mentia (B, Zn, Fe, Mn, Co, V), mental retardation (I, Mo, Cu), binge-eating (Cr), autism (Zn, Mn, Cu, Co) and attention deficit hyperactivity disorder (Fe). At the same time, the excess quantity (chronic exposure, genetic error) of certain trace elements (Cu, Mn, Co, Cr, Fe, V) can also lead to mental disturbances (depression, anxiety, psychosis, cognitive dysfunction, insomnia). Lithium (Li), being efficacious in the treatment of bipolar mood disorder, is not declared officially as a trace element. Due to nutrition (drinking water, food) the serum Li level is about a thousand times less than that used in therapy. However, Li level in the red cells is lower as the membrane sodium-Li countertransport results in a Li efflux. Nevertheless, the possibility that Li is a trace element has emerged as studies indicate its potential efficacy in such a low concentration, since certain geographic regions show an inverse correlation between the Li level of drinking water and the suicide rate in that area. ]

Lege Artis Medicinae

JANUARY 20, 2019

[What brings ICD-11 to psychiatry? ]

SZEKERES György

[On 18 June 2018, after 10 years of working the World Health Organization released the 11th edition of International Clas­si­fi­cation of Diseases. User-friendly development was a definite goal. For the first time, it is completely electronic. The renewal in regard to both formal and content aspects reflects dynamic development of medicine. It contains new chapters on immune sys­tem disorders, sleep disorders, sexual health and traditional medicine. The new edition contains 55000 possible codes. It comes to effect from January 2022 in the member states and that requires users, doctors, insurers, and universities to be well prepared. Coding of mental and behavioral disorders also changes significantly. Fol­lo­wing a brief general description we look at the most important changes in the field of psychiatry. ]