[What is adult ADHD after all?]

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset mental disorder, demonstrates genetical effects, and is characterized by attention deficit, hyperactivity, and impulsivity. While ADHD was previously only considered a childhood disorder, longitudinal studies over the past decades have proven that in a significant number of cases, the symptoms of the disorder can also be detected in adulthood, and therefore affects 2-4% of the adult population. In Hungary, adult ADHD programs started about 20 years ago and has been able to provide help to many adults living with ADHD. However, this form of care needs further development in many aspects and suffers from capacity deficits at the national level. On July 4-6, 2023 we organized a CME course on adult ADHD at the Department of Psychiatry and Psychotherapy Semmelweis University. The objective of this course was to deepen the knowledge of participants and alleviate care difficulties in the long term through the sharing of information and good practices. As part of this, a narrative review was written, which touches on the current issues of diagnosing and treating ADHD in adults.

The message of the survival curves: I. Composite analysis of long-term treatment studies in bipolar disorder.

RATIONALE: There is a shortage of studies analyzing the time course of recurrent episodes and comparing effectiveness of long-term treatments in bipolar disorder. 'Number needed to treat' (NNT) analyses have been proven to be useful for clinically meaningful comparisons, but results vary considerably among studies. The survival curves of different trials also show a great variability preventing reliable conclusions on the time course of maintenance therapies. The variance of survival analyses on long-term medication management can be reduced with increasing the statistical power by combining the life-tables of individual studies. METHODS: In this study the survival tables of 28 studies on maintenance treatment of bipolar disorder were reconstructed from the published diagrams, and the numbers of relapsed patients in the original studies were estimated for plotting composite survival curves of an inactive, mono- and combination therapy arm. The review was finally based on 5231 subjects. RESULTS: The resulting composite diagrams indicate that within the first year 48% of patients on monotherapy, and 35% on combination therapy experienced recurrence of any affective episode ('early relapsers'). The rest of the patient population was affected by recurrences in a smaller rate over a more extended period of time ('late relapsers'). For a favorable outcome at 40 months of episode prevention in bipolar disorder the NNT was 6 for mono- and 3 for combination therapy. Log-rank analyses of the composite data supported the effectiveness of both medication protocols over placebo, and the superiority of drug combination over monotherapy; though there were some indications of decreased efficacy in the two treatment arms after extended maintenance. CONCLUSIONS: Composite analysis offers increased statistical power for studying the time course of survival data. Mood episodes in bipolar disorder are likely to recur early on and relapses in "real-life" can be more frequent than the rates published here. Our results favor combination therapy for the long-term management of bipolar disorder. Concerns are expressed that NNT analyses have significant limitations when applied to recurring events with cumulative deterioration instead of cases where cumulative improvement is expected over time.

[Health related quality of life and disease burden of patients with schizophrenia in Hungary]. / A szkizofreniaval elo betegek egeszseggel osszefuggo eletminosege es betegseg-terhe Magyarorszagon.

INTRODUCTION: According to the international literature disease burden of schizophrenia is substantial, however data from Eastern Central Europe is scarce. Our aim was to assess the quality of life and costs of patients with schizophrenia in Hungary. METHODS: A cross sectional questionnaire survey was performed in 3 hospital based psychiatry centres involving patients with schizophrenia. Demographics, disease severity (Clinical Global Impression, CGI), functional ability (Global Assessment of Functioning, GAF) and general health status (EQ-5D) was assessed. Health care utilisation and aids were surveyed for the past 12 months. Costing was performed from the societal perspective and human capital approach was applied. RESULTS: Altogether 78 patients (female 43.6%) were involved with a mean age of 44.2 (SD=13.1) years, disease duration was >10 years at 49 (62.8%) cases, 66 (84.6%) patients were disability pensioners. Distribution between CGI 3-4-5-6 levels were 12 (16%), 33 (43%), 21 (28%), 10 (13%) patients, respectively, mean GAF was 52.6 (SD=13.9). The average EQ-5D score was 0.64 (SD=0.3) and it was significantly worse than the age-matched general population's score in Hungary (p < 0.01). Mean yearly cost was 13 878 Euros/patient (conversion 1 Euro=280.6 HUF), the rate of direct medical,direct non-medical and indirect costs was 28.5%, 5.4% and 66.1%, respectively. Among direct costs hospitalisation and drug costs were dominant. Total cost correlates with disease severity (CGI). CONCLUSION: Schizophrenia leads to notable deterioration in health related quality of life and induce high costs to society, mainly due to the productivity loss of the patients. Nevertheless disease related costs in Hungary are lower than in economically more developed European countries. Our study offers basic data about disease burden of schizophrenia in Hungary to support clinical and health policy decision making.

[Cognitive functions in prepsychotic and negative-symptom schizophrenic patients]. / Kognitív funkciók prepszichotikus és negatív tünetes szkizofrén betegekben.

BACKGROUND: Relationship between schizophrenia and cognitive functions has been reported by several studies. Our work group examined the changes of cognitive functions in prepsychotic patients without any relevant psychiatric disorder in their anamnesis, and also in schizophrenic patients with predominantly negative symptoms. METHODS: Measures were carried out by Cambridge Neuropsychological Test Automated Battery (CANTAB), a complex computer-based test battery of 13 tests covering a wide range of cognitive functions. 11 prepsychotic (9 male, 2 female) and 14 negative-symptom schizophrenic patients (all male) took part in the study. RESULTS: Prepsychotic patients showed significant (p < 0.05) impairment in the tests of visual memory, spatial recognition memory, spatial working memory and sustained attention. In patients with negative-symptoms significant deficits were also found (p < 0.05) in the delayed matching to sample, the working memory test, and in the intra-extradimensional shift--an analogue of Wisconsin Card Sorting Test. CONCLUSION: The present results show CANTAB may be a useful tool to detect the emergence of psychosis in an early phase, and also it has been found that in schizophrenic patients with predominantly negative symptoms further areas of cognition are also affected. The results may provide a better understanding about the background of the disorder, and the early recognition of the cognitive deficits may help to initiate a specific therapy in proper time. This could result in the slowing of the progression and an improved chance of recovery.