Viktor Vörös

Life events and psychopathology in a group of suicide attempters

Researchers examined the incidence of negative life events and associated these events with psychological scales (depression, hopelessness, self-esteem and state-trait anger) in a group of suicide attempters (n = 101) within the framework of the WHO/EURO Multicenter Study on Suicidal Behavior. Certain negative life events (especially relationship problems and physical/mental abuse in childhood) turned out to be the main indicators of severe mental problems in the family of the attempters (e.g. addiction, self-destructive behavior or psychiatric hospitalization). Significant positive correlations were found between the number of events and some psychopathological symptoms like depression, hopelessness, anger and lack of self-esteem. The role of stressful life events in suicidal behavior is emphasized. Particularly traumatic events (e.g. abuse in childhood) may be involved in the development of psychological and/or biological vulnerability (stress-diathesis model) and cognitive dysfunction. Therefore, in the psychotherapy of suicide attempters, it is essential to explore and discuss negative life events.

The main factors of repetition: Review of some results of the Pecs center in the WHO/EURO multicentre study on suicidal behaviour

The authors obtained more information about the characteristics of suicide attempters in order to examine the most important differences between those who attempted suicide for the first time (first-evers) and those who had a previous attempt (repeaters). Within the framework of the WHO/EURO Multicentre Study on Suicidal Behaviour in Pecs Center, 1158 cases of parasuicide were collected over 4 years (July 1, 1997-June 30, 2001). In the monitoring sample, 728 (62.9%) parasuicide acts were committed by women and 430 (37.1%) by men, and more than half of the attempters had made a previous attempt In the logistic regression model a higher risk of repetition was found to be related to being divorced (OR 1.84), unemployed or economically inactive (OR 1.45), and without higher education (OR 2.54). In the sample, mental disorders were the most significant risk factor for repeated attempts. The odds ratio was highest (OR 5) for personality disorders. The results may reflect (besides some factors of social destabilization) a higher importance of major mental health problems among repeaters. For this reason, more effective recognition and treatment of the underlying psychiatric and social conditions of suicide attempters has special importance to prevent future suicidal behaviour.

‘Clonal Pluralization of the Self’: A New Form of Delusional Misidentification Syndrome

The authors present a patient with paranoid schizophrenia, who has the delusion that he exists in plural numbers. The patient declares these doubles to be both psychologically and physically completely identical to him, and he believes ‘them’ to be in fact women. In connection with the case, the authors discuss the phenomena of reduplicative paramnesia and clonal pluralization, and they suggest introducing the psychopathological term ‘clonal pluralization of the self’ for the reported phenomenon.

Precision phenotyping, panomics, and system-level bioinformatics to delineate complex biologies of atherosclerosis: rationale and design of the "Genetic Loci and the Burden of Atherosclerotic Lesions" study.

BACKGROUND Complex biological networks of atherosclerosis are largely unknown. OBJECTIVE The main objective of the Genetic Loci and the Burden of Atherosclerotic Lesions study is to assemble comprehensive biological networks of atherosclerosis using advanced cardiovascular imaging for phenotyping, a panomic approach to identify underlying genomic, proteomic, metabolomic, and lipidomic underpinnings, analyzed by systems biology-driven bioinformatics. METHODS By design, this is a hypothesis-free unbiased discovery study collecting a large number of biologically related factors to examine biological associations between genomic, proteomic, metabolomic, lipidomic, and phenotypic factors of atherosclerosis. The Genetic Loci and the Burden of Atherosclerotic Lesions study (NCT01738828) is a prospective, multicenter, international observational study of atherosclerotic coronary artery disease. Approximately 7500 patients are enrolled and undergo non-contrast-enhanced coronary calcium scanning by CT for the detection and quantification of coronary artery calcium, as well as coronary artery CT angiography for the detection and quantification of plaque, stenosis, and overall coronary artery disease burden. In addition, patients undergo whole genome sequencing, DNA methylation, whole blood-based transcriptome sequencing, unbiased proteomics based on mass spectrometry, as well as metabolomics and lipidomics on a mass spectrometry platform. The study is analyzed in 3 subsequent phases, and each phase consists of a discovery cohort and an independent validation cohort. For the primary analysis, the primary phenotype will be the presence of any atherosclerotic plaque, as detected by cardiac CT. Additional phenotypic analyses will include per patient maximal luminal stenosis defined as 50% and 70% diameter stenosis. Single-omic and multi-omic associations will be examined for each phenotype; putative biomarkers will be assessed for association, calibration, discrimination, and reclassification.

Risk factors of attempted suicide in the elderly: The role of cognitive impairment.

The authors’ aim was to assess the prevalence and importance of dementia and cognitive impairment in relation to suicidal behaviour in elderly psychiatric inpatients. The level of cognitive functioning (according to the Mini Mental State Examination – MMSE) of the elderly suicidal inpatients (N=62) were compared to the general elderly inpatients (N=152). There were significant differences in cognitive functioning between the two groups, in the non-suicidal group the level of cognitive function was significantly lower. However, mild cognitive deficit or mild dementia were registered in 60% of the suicide attempters. The results indicate that not only mood disorders, but other risk factors (especially mild cognitive impairment), have a key role in developing suicidal behaviour in the elderly. Thus, in the treatment and prevention of suicidal behaviour in the elderly, it is important to apply the complex bio-psycho-social model, in which (besides adequate pharmacotherapy) psychotherapeutic approaches and procedures to enhance cognitive functioning are of outstanding significance.

Delusions of Pregnancy with Post-Partum Onset: An Integrated, Individualized View

Background and Objectives: Bizarre hypochondriacal delusion is an im- portant content of delusion of pregnancy during post-partum period. Methods: Here we report two cases with postpartum delusion of pregnancy; one with pre-existing schizophrenia and another one with family history of pseudocyesis and schizoaffective disorder but with no pre-existing psychiatric illness. Results: Nosological, phenomenological and aetiological issues are discussed. In the context of novel deficit-and motivational theories of delusion formation we provide an in- tegrated view of the reported cases. Conclusions: The complexity of the delusion of pregnancy should be considered in the treatment planning-particularly in the post-partum period.

Rationale, Design, and Methodological Aspects of the BUDAPEST-GLOBAL Study (Burden of Atherosclerotic Plaques Study in Twins—Genetic Loci and the Burden of Atherosclerotic Lesions)

The heritability of coronary atherosclerotic plaque burden, coronary geometry, and phenotypes associated with increased cardiometabolic risk are largely unknown. The primary aim of the Burden of Atherosclerotic Plaques Study in Twins—Genetic Loci and the Burden of Atherosclerotic Lesions (BUDAPEST‐GLOBAL) study is to evaluate the influence of genetic and environmental factors on the burden of coronary artery disease. By design this is a prospective, single‐center, classical twin study. In total, 202 twins (61 monozygotic pairs, 40 dizygotic same‐sex pairs) were enrolled from the Hungarian Twin Registry database. All twins underwent non–contrast‐enhanced computed tomography (CT) for the detection and quantification of coronary artery calcium and for the measurement of epicardial fat volumes. In addition, a single non–contrast‐enhanced image slice was acquired at the level of L3‐L4 to assess abdominal fat distribution. Coronary CT angiography was used for the detection and quantification of plaque, stenosis, and overall coronary artery disease burden. For the primary analysis, we will assess the presence and volume of atherosclerotic plaques. Furthermore, the 3‐dimensional coronary geometry will be assessed based on the coronary CT angiography datasets. Additional phenotypic analyses will include per‐patient epicardial and abdominal fat quantity measurements. Measurements obtained from monozygotic and dizygotic twin pairs will be compared to evaluate the genetic or environmental effects of the given phenotype. The BUDAPEST‐GLOBAL study provides a unique framework to shed some light on the genetic and environmental influences of cardiometabolic disorders.

Effectiveness of intramuscular aripiprazole injection in patients with catatonia: report on three cases.

In the recent literature, orally administered aripiprazole, a second generation antipsychotic, was demonstrated to be eff ective in the resolution of catatonia. Our present paper is the fi rst report of three cases of catatonia where intramuscularly administered high doses of aripiprazole were found to be eff ective in resolving severe catatonic states, independent of the features, or of the origin of catatonia, presenting either in schizophrenia or in major depression. On the basis of the unique mechanism of action of the drug and based on our clinical experience, we recommend the use of high doses of intramuscular aripiprazole as an alternative treatment for catatonia, when benzodiazepines or electroconvulsive therapy are not eff ective or not proposed.

Assessing and managing suicidal behaviour in the primary care setting: A model for an integrated regional suicide prevention strategy

Although suicide rates are decreasing in most countries, suicide is still a major health concern. Our aim was to introduce a complex, integrative, regional suicide prevention strategy. Based on reviewing the literature and on our previous studies we developed a suicide prevention model, which includes recognition, risk assessment and intervention. The main steps of the model are the recognition of warning signs (communicative or behavioural), exploration of crisis situation and/or psychopathologic symptoms, assessment of protective and risk factors, estimation of suicide risk and a plan for management of suicidal patients through different levels of interventions. In the management of suicidal behaviour, the complex stress-diathesis model has to be adjusted by considering biological markers and psycho-social factors. Only after the assessment of these factors can primary care professionals, as gatekeepers, manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic interventions in the recognition, treatment and prevention of suicidal behaviour.

Mirtazapine treatment and sexual functions: Results of a Hungarian, multicentre, prospective study in depressed out-patients

Since many antidepressants can cause sexual dysfunction, the aim of this study was to follow-up sexual functions during mirtazapine (RemeronSolTab®) treatment. One hundred and two (44 male and 58 female) outpatients with major depression were recruited to this prospective, observational, non-interventional study. The screening was followed by three visits, during which the 17-HAMD, CGI and 9-BDI scales were used. The change of sexual life was monitored by a self-completing questionnaire, based on the modified Psychotropic-Related Sexual Dysfunction Questionnaire. During the treatment both the depression rating scales and the CGI have shown a significant improvement and significant amelioration of previous sexual problems was found; patients were evaluating their sexual life better and better. Our results indicated that mirtazapine is an effective tool for depressed patients who suffer from sexual dysfunction.