The timeliness of Telepsychiatry.

Both worldwide and in Hungary, telemedicine and telepsychiatric guidelines and legal regulations have come into force in connection with the outbreak of the COVID-19 epidemic, which are aimed at both the current situation and the future. Due to the need for social distance and isolation during the epidemic, there was a need for the use of telemedicinal solutions in psychiatric care as well. This consisted primarily of telephone and videophone visits from the home of psychiatric patients. By now, we seem to be facing protracted waves of epidemics, which could also mean a prolongation of the quarantine state, so changes in psychiatric patient care are even more necessary and will be expected, so telemedicine/telepsychiatry is expected to gain even more ground. The rapid development and introduction of the practical application of telepsychiatric applications, which appeared many years ago (mainly in the United States), can be expected. In the United States, for example, the frequency of telepsychiatric visits is predicted to be 47% for the near future, and the American Psychiatric Association is constantly publishing new and newer guidelines for telepsychiatry related to the COVID-19 epidemic. The recommendation of the Psychiatry and Psychotherapy section of the Professional Health College of EMMI in connection with the COVID-19 care system has also been published in Hungary. According to the latter, the use of telepsychiatry and e-prescription was also recommended, which is also included in the rules of procedure issued by the Child Psychiatry Section. (Neuropsychopharmacol Hung 2021; 23(2): 266-271).

[Psychopharmacological aspects of nutrition]. / A táplálkozás pszichofarmakológiai vonatkozásai.

Nowadays the role of nutrition is increasingly appreciated in the development of the various mental disorders as well as in employing effi cacious therapies. Realizing this development and following international professional examples we have established the Hungarian Psychiatric Association's Nutritional Science Section in 2018. Our present paper reports on the connection between mental disorders and nutrition, reviewing the relevant literature from two directions. On the one hand, insuffi cient consumption of essential micronutrients, trace elements, (pro) vitamins cause defi ciencies leading to disrupted production and function of essential enzymes and neurotransmitters and consequentially to emergence of psychopathological symptoms as well as impeding the development of eff ect of adequately administered psychopharmacons and the effi ciency and success of pharmacotherapy. On the other hand, our paper also reviews potentially dangerous pharmacokinetic and pharmacodynamic interactions of nutraceuticals and dietary supplements used for health prevention purposes in parallel to pharmacotherapies which may infl uence or decrease eff ectiveness of medications.

[Possible effects of climate changes (particularly heat waves) on body functions with a special emphasis on subjects taking psychopharmacons: a narrative review]. / A klímaváltozás - elsosorban a hoség - lehetséges hatásai az emberi szervezet muködésére, különös tekintettel a pszichiátriai gyógyszereket szedo páciensekre.

Climate change and global warming have become increasingly discussed in the last few years - but mainly as an economical-social problem. Due to the preceding years' hot summers, as a clinical psychiatrist I considered it important to examine the effect of heat on body functions especially among those who are taking psychiatric drugs. The problem has a clinical significance, since heat is an extreme environmental factor with unexpected consequences. Due to heat various adverse reactions are expected especially in subjects on combined pharmacotherapy regimes. The present article points out the clinical importance of heat and also its potential adverse (and sometimes life-threatening) consequences.

[Dissolving anxiety as an essential ingredient for any therapy]. / Szorongásoldás mint a gyógyítás nélkülözhetetlen kelléke.

Anxiety frequently develops in human life and it is usually useful for the organism. Anxiety helps accomodation to the social environment, however, it may be harmful when it is intensive and long-lasting. It can also cause psychosomatic diseases. Anxiety may present itself as mild or moderate stress, psychosomatic diseases or psychiatric disorders. In the general practice, about one third of the patients suffer from anxiety, but it is not easy to identify these patients because of the frequent somatic complaints which may cover anxiety symptoms. The prevalence of anxiety disorders is between 12.6% and 17.2% per year and, in a considerable proportion of patients, both anxiety and depression are present. Therapy of anxiety is complex including psychopharmacotherapy (antidepressants, anxiolytics, hypnotics), psychotherapy and life style changes.

Construct validity evaluation of the European Scleroderma Study Group activity index, and investigation of possible new disease activity markers in systemic sclerosis.

OBJECTIVES: To evaluate the construct validity of the European Scleroderma Study Group (EScSG) activity index and to propose modifications if necessary. METHODS: One hundred and thirty-one consecutive patients were investigated and re-evaluated 1 year later. Modified Rodnan skin score (MRSS), skin ulcers and joint contracture numbers, hand anatomic index (HAI), BMI, spirometry, carbon monoxide diffusing capacity (DL(CO)), left ventricular ejection fraction, pulmonary arterial hypertension, HAQ Disability Index (HAQ-DI), patient skin self-assessment questionnaire and several biomarkers were recorded, in addition to the data required for the EScSG activity index. Statistical analysis was performed by categorical principal component analysis (CATPCA). RESULTS: The EScSG activity index appeared in the same dimension as the HAQ-DI, ulcer score and joint contractures, MRSS, patient-reported skin score and HAI by CATPCA. Parameters of lung involvement appeared in another dimension. We constructed a 12-point activity index that was equally associated with both dimensions, by adding the forced vital capacity/DL(CO), change in DL(CO), change in the ulcer scores, HAQ-DI and patient-reported skin score. Biomarkers including vascular endothelial growth factor, soluble P-selectin glycoprotein ligand-1, CRP and albumin were related to both the EScSG and the 12-point index, though they did not improve the total variance of the model. CONCLUSION: The construct validity of the EScSG activity index is good, though the lung-related disease activity may not be sufficiently represented. Further validation steps may be required for both the EScSG and our 12-point activity index.

[Difficulties in changing drugs--from clozapine to aripiprazole in ambulatory care]. / A gyógyszerváltás nehézségei--clozapin/aripiprazol váltás ambuláns keretek között.

Although there are well-established psychiatric procedures available concerning switching of antipsychotic drugs, in practice we often face a situation where we have to consider not only the patient's demands, but also requests from relatives. In this article we describe a case where we encountered this situation. Our patient was a 48-year-old married man suffering from paranoid schizophrenia with extreme obesity. We had to consider the modification of the antipsychotic treatment because of the patient's persistent residual symptoms (significant lack of initiative, serious under-motivation, emotional plainessness, considerable passivity) his overweight and its consequences (metabolic syndrome). In our paper we describe the psychoeducational process and the clozapine/aripiprazol switch.

Establishment and partial validation of a patient skin self-assessment questionnaire in systemic sclerosis.

OBJECTIVES: To construct a patient self-assessment questionnaire testing whether patients can provide valid information about their skin thickness, tethering and thinness. METHODS: The questionnaire contained questions about the 17 body areas identical to those investigated in the Modified Rodnan Skin Score (MRSS). The baseline and 1 yr follow-up values of thickening, tethering and thinning were scored on a scale of 0-3, by 131 consecutive patients. RESULTS: The questionnaire was feasible. The test-retest reliability was good, with an intraclass correlation coefficient of 0.5-0.6. The MRSS correlated with the 17-area thickness score (rho = 0.435, P < 0.001). Both the patient-reported thickness and tethering scores and the expert-measured MRSS and tethering scores correlated highly with each other (rho = 0.523, P < 0.001 and rho = 0.637, P < 0.001, respectively). The patient-reported thinness scores did not show any correlation with the examiner-measured skin thickening/tethering. All thickness-related scores were sorted into the same factor by principal component analysis. Conversely, skin thinness scores were sorted into a distinct factor. Skin thickness scores reported by diffuse SSc patients were different from those of the limited SSc cases (P < 0.05). CONCLUSIONS: We validated the skin thickness domain of the questionnaire, except the responsiveness. Because of the low mean MRSS of patients in this investigation, the patient self-assessment validation procedure should be repeated with cases exhibiting more extensive skin involvement. Patient-reported and examiner-measured tethering may not be used as independent instruments of skin involvement. The skin thinness domain may contain valuable independent information, therefore it also merits further investigation.

[Remission with long-lasting antipsychotic agent]. / Remisszió tartós hatású készítménnyel.

We hospitalized a 50 year-old-woman because of prolonged violent suicide. Coming she had depressive symptoms, but her psychical observation and the heteroanamnestic data have shown psychotic symptoms--paranoid schizophrenia. During hospitalisation her checkup was very correct: long-lasting risperidone-therapy formed the centre of her psychopharmacotherapy. We applied close control and long-lasting antipsychotic treatment--, so the patient became well, without psychotic symptoms. So it was proved, that the long-lasting parenteral antipsychotic risperidone play important role of good compliance.

[Depressive symptoms as differential-diagnostic problem]. / Differenciáldiagnosztikai problémaként jelentkezõ depressziós tünetegyüttes.

The 59 year-old, high-qualified male patient had been treated for psychiatric illness due to depressive symptoms, "pathological crying", amplified somatic style and severe insomnia. Earlier he had one depressive episode. There was no psychotrauma detected to cause these symptoms and no neurological symptoms, either. The clinical appearance was psychotic depression, so combined antidepressant, anxiolytic, hypnotic, and antipsychotic therapy was started. The MAWI examination showed mild intellectual deficit, so cerebral MRI was done, also. This examination helped to verify the correct diagnosis: post-stroke depression.