A needle in the haystack--the dire straits of needle exchange in Hungary.

BACKGROUND: The two largest needle exchange programs (NEPs) in Hungary were forced to close down in the second half of 2014 due to extreme political attacks and related lack of government funding. The closures occurred against a background of rapid expansion in Hungary of injectable new psychoactive substances, which are associated with very frequent injecting episodes and syringe sharing. The aim of our analysis was to predict how the overall Hungarian NEP syringe supply was affected by the closures. METHODS: We analyzed all registry data from all NEPs in Hungary for all years of standardized NEP data collection protocols currently in use (2008-2014) concerning 22 949 client enrollments, 9,211 new clients, 228,167 client contacts, 3,160,560 distributed syringes, and 2,077,676 collected syringes. RESULTS: We found that while the combined share of the two now closed NEPs decreased over time, even in their partial year 2014 they still distributed and collected about half of all syringes, and attended to over half of all clients and client contacts in Hungary. The number of distributed syringes per PWID (WHO minimum target = 100) was 81 in 2014 in Hungary, but 39 without the two now closed NEPs. CONCLUSIONS: There is a high probability that the combination of decreased NEP coverage and the increased injection risk of new psychoactive substances may lead in Hungary to a public health disaster similar to the HIV outbreaks in Romania and Greece. This can be avoided only by an immediate change in the attitude of the Hungarian government towards harm reduction.

Psychiatric characteristics of 100 nonviolent suicide attempters in Hungary.

BACKGROUND: Previous international and Hungarian studies have shown that around 90% of persons making suicide attempts had at least one current mental disorder. The aim of this study was to investigate the current prevalence of DSM-IV Axis I psychiatric diagnoses among nonviolent suicide attempters in Budapest, Hungary. METHODS: Using a structured interview (Mini International Neuropsychiatric Interview) determining DSM-IV Axis I diagnoses, the authors examined 100 consecutively contacted nonviolent suicide attempters (68 females and 32 males), aged between 14 and 66 (mean: 36.3 years). RESULTS: A total of 64% of the subjects were repeated attempters, and the most common method was drug overdose (96%), in 21% of cases in combination with alcohol ingestion. A total of 92% of the attempters had at least one current DSM-IV Axis I psychiatric diagnosis. In 87% it was depressive disorder (59% unipolar major depression, 14% bipolar II depression and 12% bipolar I depression, 2% dysthymic disorder), in 46% anxiety disorders, in 27% substance-use disorder and in 2% psychotic disorder. Sixty percent of the attempters received two or more current Axis I diagnoses (35% depressive + anxiety disorder only, 15% depressive + substance-related disorder only, and 10% depressive + anxiety + substance-related disorder). LIMITATIONS: Nonviolent suicide attempters are not representative of all persons with attempted suicide and subthreshold Axis I diagnoses were not investigated. CONCLUSION: This study supports previous international and Hungarian findings on the high prevalence and comorbidity of Axis I mental disorders among persons with recent nonviolent suicide attempt.

Prevalence and comorbidity of affective disorders in persons making suicide attempts in Hungary: importance of the first depressive episodes and of bipolar II diagnoses.

BACKGROUND: The purpose of this study was to investigate the prevalence and comorbidity of affective disorders, especially current major depressive episode and bipolar disorder among suicide attempters in Hungary. METHODS: Using a structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 100 consecutive suicide attempters, aged 18-65. RESULTS: Eighty-eight percent of the attempters had one or more current diagnoses on Axis I. In 69% it was major depressive episode and 60% of them were suffering their first episode. Thirty-five percent of the patients with current major depressive episode had had hypomanic (n=19) or manic (n=5) episodes in the past. Seventy percent of the individuals received two or more current diagnoses on Axis I. Eighty-six percent of all current Axis I disorders (except major depressive episode) were diagnosed together with a current major depressive episode. The diagnosis of current major depressive episode and the number of current psychiatric disorders was significantly and positively related to the number of suicide attempts, but the diagnosis of past major depressive episode was not. LIMITATIONS: This study included suicide attempters who had presented selfpoisoning, but not individuals with very high risk of fatality. CONCLUSIONS: In suicide attempters there is a very high prevalence of affective disorders, especially major depression, first episode of major depression and bipolar II disorder. This study underlines the importance of early detection and treatment of psychiatric disorders for the prevention of suicidal behavior.