Ágnes Gáti

Use of antipsychotics in the management of schizophrenia during pregnancy

The rapid development of pharmacotherapy has resulted in a growing clinical importance for the treatment of the increasing number of women with schizophrenia during pregnancy. An evolving database on reproductive health safety factors for women with schizophrenia has begun to be of assistance in optimising clinical benefits for women with childbearing potential.Given the prevalence of antipsychotic use during pregnancy in women with schizophrenia, it is important for the clinician to have a prepared approach to the administration of these agents. In general, the use of psychotropic medication during pregnancy is indicated when risk to the fetus from exposure to this medication is outweighed by the risks of untreated psychiatric illness in the mother. The preponderance of evidence from registries to large health surveys indicate that treatment with antipsychotic medication confers either no or a small nonspecific risk for organ malformations.According to the relevant literature published on the safety of antipsychotic medication during pregnancy, the findings are encouraging; however, the currently available data are very limited. Until there are more controlled prospective data on the impact of drugs on fetal and later development, the clinician will continue to work in a state of potential uncertainty, weighing partially estimated risks against managing individual clinical problems. The aim for the clinician should be to provide the best information available regarding the scope of possible risks associated with the treatment of schizophrenia during pregnancy. On the basis of the available data, generalisation is impossible and recommendations should be made on a drug-by-drug basis. The risks and benefits must always be carefully weighed for each patient on an individual basis. Only a woman who is well enough to acknowledge her pregnancy and her mental illness can effectively weigh the relative and partially unknown risks of treatment with antipsychotic medication against the highly probable risks of illness exacerbation if untreated.

Urinary steroid metabolites and 11β-hydroxysteroid dehyrogenase activity in patients with unipolar recurrent major depression

BACKGROUND The aim of the present study was to obtain comprehensive information on steroid metabolism in depressed patients. METHODS 24-h urinary steroids were measured by gas chromatography in patients with unipolar recurrent major depression (URMD) compared to controls, and an index of relative activity of the 11beta-hydroxysteroid dehydrogenase (11beta-HSD) enzyme was calculated. RESULTS The levels of etiocholanolone (E) (p < 0.05), beta-cortolone (beta-CL) (p < 0.01) were significantly decreased, while levels of allo-tetrahydrocorticosterone (aTHB) (p < 0.05) and cortisol (F) (p < 0.01) were elevated in depressed women. The levels of dehydroepiandrosterone (DHEA) (p < 0.01), tetrahydrocorticosterone (THB) (p < 0.01), beta-CL (p < 0.01), and aTHB (p < 0.05) were found significantly decreased in depressed men. The index of 11beta-HSD activity (p < 0.01) was significantly decreased in patients in both sexes. LIMITATIONS The sample is limited to only urine samples of patient with URMD; the correlation between the severity of depression and F and DHEA was not analyzed. CONCLUSION Our investigations confirmed that URMD associated with altered steroid metabolism, which shows gender differences, pointing to the different stress sensibility of women. These differences may be the cause as well as the consequence of the major depression (MD).

Taste reactivity deficit in anorexia nervosa.

Aim:  Anorexia nervosa is a complex psychiatric disorder posing a rapidly increasing burden on modern societies. Our purpose was to clarify perceptual‐motivational aspects of gustatory disturbances in the disease.

Urinary Steroid Measurements in Some Endocrine and Psychiatric Diseases

In 1990, the worldwide accepted Shackleton method, which provides a possibility of determining the steroid metabolites from urine, was adopted in our laboratory. The procedure is very useful in the diagnosis of different endocrine diseases and in the recognition of dysfunction or absence of enzymes with an important role in steroid metabolism, and it gives possibility to control the treatment in patients with these diseases. Besides the proximate clinical application, the method gives a convenient tool to study the steroid background of these disorders, helping us understand the mechanism of their development. In the last few years, we have examined the steroid profile of patients with hair (androgen alopecia /AA/, effluvium /E/), psychiatric problems (major depression /MD/, eating disorders /EDS/, especially anorexia nervosa and bulimia) and osteoporosis (OP). In all of the examined hair loss diseases, the levels of main androgen metabolites were increased, and elevated 5alpha-reductase activity were found. We could observe the alteration of the activity of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) enzyme and marked gender differences in the changes of the steroid metabolism in patients with major depression (MD). In women with OP, the significantly decreased level of certain metabolites points to the role of testosterone, androstenedione and DHEA in postmenopausal bone loss in women. Our experiences contribute to the knowledge of the nature and steroid background of some endocrine and psychiatric diseases.

Ghrelin, metabolic and hormonal parameters during OGTT in patients with obesity and anorexia nervosa

Anorexia and obesity are the opposite states of body weight and body fat, but it is not known that regulating mechanisms of body weight are the same or not? Anorexia nervosa (AN) is associated with high levels, obesity with low levels of ghrelin. The most effective suppressor of ghrelin is the glucose load, but the regulating role of glucose or insulin in – ghrelin suppression is questionable. This study examined the associations of ghrelin levels with leptin, glucose, insulin and growth hormone (GH) during oral glucose tolerance test (OGTT) in anorectic, overweight and normal females. Participants included overweight-OW ( n = 11), anorexia nervosa-AN ( n = 14) and normal weight-NW ( n = 10) females. The fall in serum ghrelin at 30 min during OGTT was significantly lower in the OW group than in other groups ( p = 0.026). In AN subjects, significant correlation has been found between ghrelin and GH during the OGTT ( p = 0.0001). In OW and NW subjects, the multiple regression analysis showed that the glucose was the only independent predictor of ghrelin during the OGTT (OW, p = 0.003; NW, p = 0,004). Ghrelin secretion during OGTT may be controlled by different mechanisms in individuals with anorexia nervosa than in overweight individuals.