Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task

INTRODUCTION

Theory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder.

METHOD

31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described.

RESULTS

In the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = -3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance.

CONCLUSIONS

Overall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.

[Online romance scams - report on an old victim with mental disorder]

Az online romantikus csalás a kiberbűnözés egyik formája, amely a közösségi média és a társkereső alkalmazások megjelenésével terjedt el. A bűnelkövetés e sajátos formájában az elkövetők szerelmi kapcsolatot imitálva csapják be az áldozatot. Feltételezhetjük, hogy a mentális zavarban szenvedő páciensek kiszolgáltatottabbak a kiberbűnözés e formájával szemben is, eddig azonban alig történtek ez irányú vizsgálatok, illetve esetközlések. Egy idős nőbeteg esetének bemutatása során összefoglaljuk az online romantikus csalás jellemzőit, valamint az áldozattá válás felismerésének és a következmények enyhítésének lehetőségeit. A 70 éves nőbeteg gyógyszeres öngyilkossági kísérletet követően került pszichiátriai kezelésbe, mivel férjével való konfliktust követően nagyobb mennyiségben vett be benzodiazepineket. Az öngyilkossági kísérlet hátterében online romantikus csalás és annak negatív következményei körvonalazódtak. A depresszióban és enyhe kognitív zavarban szenvedő páciens esetében az online romantikus csalás erotomán deluzív zavart és szuicid kísérletet indukált. A szakirodalomban elsőként mutatjuk be egy olyan, mentális zavarban szenvedő páciens esetét, akinél az online romantikus csalás elszenvedése erotomán típusú paranoid zavar kialakulásához vezetett. Következtetésünk, hogy mentális zavarral élő pácienseink kezelése során figyelmet kell fordítanunk online aktivitásukra is, hiszen fokozottan veszélyeztetettek arra, hogy online – romantikus – csalás áldozatává váljanak, különösen akkor, ha egyéb rizikófaktorok is jelen vannak. Orv Hetil. 2024; 165(5): 192–196.

Investigation of peripheral inflammatory biomarkers in association with suicide risk in major depressive disorder

Suicide is the most severe complication of major depressive disorder (MDD). Novel research assumes the role of immunological dysregulation in the background - several studies have reported alterations in the number of inflammatory cells related to both MDD and suicidality. There are currently no objective, routinely measured parameters to indicate suicidal vulnerability. However, altered inflammatory cell numbers and ratios have been proposed as potential biomarkers of suicide risk (SR). The present research aims to examine changes of these values related to increased SR in MDD as an assumed inflammatory state. We investigated laboratory parameters of psychiatric in-patients diagnosed with MDD (n = 101) retrospectively. Individuals with recent suicide attempt (SA) (n = 22) and with past SA (n = 19) represented the high SR group. MDD patients with no history of SA (n = 60) composed the intermediate SR group. We compared the number of neutrophil granulocytes, monocytes, lymphocytes, platelets, white blood cell count (WBC), neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red blood cell distribution width (RDW) and erythrocyte sedimentation rate (ESR). Furthermore, we evaluated alterations of these parameters related to antidepressant (AD) and antipsychotic (AP) treatment, which have been proved to have anti-inflammatory effects. We found a significant increase in neutrophil granulocyte count, NLR, monocyte count, MLR, WBC and ESR in patients with recent SA compared to patients with no history of SA. Moreover, there was a significant elevation in monocyte count, MLR, ESR and RDW in patients with high SR compared to patients with intermediate SR. AD treatment resulted in a significant decrease in neutrophil granulocyte count and NLR, however, it did not affect monocyte count and MLR. Assuming immunological mechanisms in the background of MDD and suicidality, our findings support the role of NLR as a biomarker of acute SR, though its alterations may be masked by possible anti-inflammatory effects of AD treatment in the long term. However, MLR, a marker exhibiting changes which are not attenuated by pharmacotherapy, may be a possible indicator of both acute and long-term suicidal vulnerability.

[The role of mental health support for medical students.]

INTRODUCTION

The mental health of medical students is of critical importance during their medical studies, which can be a long and challenging period. Academic expectations, high workload, and emotional stress can contribute to mental burden and burnout among medical students, placing an increased burden on the healthcare system in the future. Therefore, psychological support and mental health services play a crucial role in medical education.

OBJECTIVE

The aim of this study is to present and examine the role of the Psychological Counseling Service at the University of Pécs Medical School in supporting the mental health of medical students since its establishment in 2007.

METHOD

In this study, we present the combined quantitative and qualitative results from the period between November 2021 and May 2023, as registered by the students and staff utilizing the Service as well as the counseling psychologists working at the Service. The data include the number of consultations, the patterns of the most frequently occurring problems (based on the Counseling Professional Protocol), and the mental well-being of the population receiving psychological support (GHQ-12).

RESULTS

During the examined period, a total of 1111 individuals made use of the Service in 2012 appointments. Both students and staff most commonly sought assistance from the Service in addressing relationship difficulties (37.6%) and coping with negative life events (33.1%). Based on the data collected since October 2022 (n = 113), nearly 10% of the attendees were taking medication for psychiatric treatment, a significantly higher percentage among international students. Furthermore, 38.9% had previously received professional help. The average score on the GHQ-12 questionnaire is 8 points, which is significantly above the 5-point threshold achieved by 78.6% of respondents.

CONCLUSION

The results demonstrate that the Psychological Counseling Service at the University of Pécs Medical School plays a significant role in supporting the mental health of medical students. It contributes to more effective coping with academic challenges, reducing the risk of emotional stress and burnout. Orv Hetil. 2023; 164(45): 1778-1786.

Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomized sham-controlled trials

BACKGROUND

Several meta-analyses demonstrated the efficacy of unilateral High-Frequency Left-sided (HFL) repetitive Transcranial Magnetic Stimulation (rTMS) for individuals with Major Depressive Disorder (MDD); however, results are contradictory due to heterogeneity of the included studies.

METHODS

A systematic literature review (SLR) of English language articles published since 2000 was performed in March 2022 on PubMed and Scopus databases. Empirical evidence on the relative efficacy of rTMS treatment compared with standard pharmacotherapy in Treatment-Resistant Depression (TRD) were extracted. Random effects models were used to assess the effects of rTMS on response and remission rates.

RESULTS

19 randomized double-blinded sham-controlled studies were included for quantitative analysis for response (n = 854 patients) and 9 studies for remission (n = 551 patients). The risk ratio (RR) for response and remission are 2.25 and 2.78, respectively for patients after two treatment failures using rTMS as add-on treatment compared to standard pharmacotherapy. Cochrane's Q test showed no significant heterogeneity. No publication bias was detected.

CONCLUSIONS

rTMS is significantly more effective than sham rTMS in TRD in response and remission outcomes and may be beneficial as an adjunctive treatment in patients with MDD after two treatment failures. This finding is consistent with previous meta-analyses; however, the effect size was smaller than in the formerly published literature.

The effect of reading literary fiction on the theory of mind skills among persons with schizophrenia and normal controls

Introduction

Recent research data suggest that theory of mind (ToM) skills may improve after reading literary fiction. However, beside this short term favorable effect, regular long-term reading of literary fiction may also support ToM development or may improve ToM performance. The presence of impaired ToM abilities is well-documented in schizophrenia; however, the role of reading in these deficits is unknown. In the present study our aim was to assess the effect of prior reading experiences on theory of mind performance in patients with schizophrenia, and in healthy controls.

Materials and methods

ToM assessment was done with the Short Story Task, which is based on the interpretation of a Hemingway short story. After reading the short story, questions were asked in an interview format regarding comprehension, explicit and implicit ToM skills, then comparative analysis of schizophrenia patients was performed (n = 47) and matched to a normal control (n = 48) group concerning deficits of ToM abilities. Participants were also stratified according to their prior reading experiences.

Results

Previous reading experience was associated with better comprehension and explicit ToM performance both in patients with schizophrenia, and in healthy controls. However, the explicit ToM performance of patients with prior reading was still weaker compared to healthy controls with reading experiences. Path model analysis revealed that reading had a direct positive effect on ToM, and an indirect effect through improving comprehension.

Conclusions

Prior reading experience is associated with better ToM performance not just in healthy controls but also in patients living with schizophrenia. Previous reading experience also improves comprehension, which in turn has a favorable impact on ToM. Our results support the idea that literary fiction reading may have a therapeutic potential in the rehabilitation of schizophrenia.

[Questions and challenges in the diagnostics of gender identity disorder. Review and case vignettes]

Professionals working in the field of psychiatry have recently been increasingly encountering patients seeking help who define themselves as transsexual. Gender identity and gender self-expression of transsexual people do not match their biological sex, and they also feel an intense desire and urge to change their officially registered gender at birth and their physical appearance - even by using hormone therapy or surgery. In their case, the diagnosis of gender identity disorder as a disease category enables the use of medical interventions and health services necessary for transition. At the same time, the diagnosis is complicated by the fact that there is currently no specific psychodiagnostic procedure suitable for the clear identification of gender identity disorder, and gender incongruence can also appear as a symptom of many other mental disorders. Therefore, careful differential diagnosis is essential to establish a well-founded diagnosis, with the help of this literature review that summarizes other mental illnesses with similar symptoms as well as the more common comorbid pathologies.

Ambiguous handedness and visuospatial pseudoneglect in schizotypy in physical and computer-generated virtual environments

Virtual reality (VR) technology has increased clinical attention in the health care of schizophrenia spectrum disorders in both diagnoses of the symptoms and assessment of schizotypal traits. However, the exact nature of VR-induced positive treatment effect in schizotypy is still unknown. In this study, VR technology was used as a non-invasive neurocognitive trigger to test the asymmetric visuospatial representational instability found in individuals with high schizotypy. The study aimed to reveal the brain functional hemispheric laterality in physical and virtual realities in individuals with schizotypal traits. Fifty-one healthy, right-handed participants (24 males and 27 females) were enrolled through public advertisements. Hemispheric functional asymmetry was measured by the Line Bisection Task (LBT). The results revealed that (a) LBT bias in the physical reality showed a handedness-related leftward pseudoneglect, however, similar handedness-related pseudoneglect in VR has not been found. (b) Comparing LBT bias in physically real and VR environments showed rightward drift in VR environments independently to the degree of handedness. (c) The schizotypy has no association with handedness, however, the cognitive schizotypy is related to the LBT bias. Higher cognitive schizotypy in VR associated with left hemispatial pseudoneglect. In conclusion, schizotypy is associated with ambiguous behavioral and cognitive functional laterality. In individuals with high cognitive schizotypy, the VR environment enhanced the representational articulation of the left hemispace. This effect may be originated from the enhancement of the right hemisphere overactivation and is followed by a lower mental control of the overt behavior.

Repetitive transcranial magnetic stimulation may be a cost-effective alternative to antidepressant therapy after two treatment failures in patients with major depressive disorder

BACKGROUND

The cost-effectiveness of treatment strategies for patients with Major Depressive Disorder (MDD) who have not responded to two adequate treatments with antidepressants (TRD) are still unclear. The aim of this analysis was to evaluate the cost-effectiveness of add-on repetitive Transcranial Magnetic Stimulation (rTMS) compared with standard treatment.

METHODS

A Markov-model simulated clinical events over one year from the perspective of healthcare payer. Third- and fourth-line treatment pathways (augmentation, antidepressant switch or combination, and Electro-Convulsive Therapy (ECT)) were defined based on medical practice guidelines. Transition probabilities were derived from a recent meta-analysis and scientific publications. Resource utilization and cost estimates were based on the patient-level database of a large university hospital.

RESULTS

Incremental Quality-Adjusted Life Years (QALYs) and costs were 0.053 and 785 €, respectively, corresponding to an Incremental Cost-Effectiveness Ratio (ICER) of 14,670 € per QALY. The difference in cost between standard treatment and rTMS is explained by the rTMS sessions used in acute (€660) and maintenance (€57/month) treatments, partly offset by lower hospital costs due to higher remission rates in the rTMS arm. Key parameters driving the ICER were incremental utility of remission, unit cost of rTMS treatment and remission rate. At a threshold of €22,243 add-on rTMS is a cost-effective alternative to pharmacotherapy. Evidence on long-term effectiveness is not yet available, so results are estimated for a one-year period.

CONCLUSION

Not only does rTMS treatment have beneficial clinical effects compared with drug therapy in TRD, but it also appears to offer good value-for-money, especially in centres with larger numbers of patients where unit costs can be kept low.

Mentalizing abilities and serum lipid levels in adult MDD patients with childhood maltreatment – preliminary results

Introduction

Childhood maltreatment (CM) contributes to negative mental and physical health outcomes including major depressive disorder (MDD), and an elevated risk for cardiovascular disease (CDV) in adults. Also, childhood maltreatment can be related to mentalizing deficits in MDD. Cardio-metabolic diseases often coincide with MDD and worsen its course and outcome. Little is known on the interplay of these factors.

Objectives

We examined MDD patients with and without CM to explore the effects of CM on serum lipid and lipoprotein levels and assessed their mentalizing abilities. Self-oriented mentalizing was operationalized as emotional self-awareness/alexithymia, other-oriented mentalizing was defined as theory of mind (ToM).

Methods

MDD patients (N=42) and healthy controls (n=20) matched in age, sex, and lifestyle were investigated. Total cholesterol, triglycerides, high- and low-density lipoproteins (HDL-C and LDL-C), body mass index, and exercise in a typical week were measured. Beck Depression Inventory, Childhood Trauma Questionnaire, Toronto Alexithymia scale, and the Reading the mind in the Eyes Test were used to assess clinical symptoms, mentalizing abilities and CM.

Results

After controlling for depressive symptom severity, demographic and lifestyle variables, CM was found to be a strong predictor of serum lipid alterations. Mentalizing deficits correlated with CM. Serum triglycerides, HDL-C were significant predictors of ToM performance (P<0.05, and P=0.005) and alexithymia (P< 0.05, and P< 0.05) in the MDD group.

Conclusions

Several, inter-correlated pathways may mediate the undesirable effects of CM on the course and outcome of MDD. According to our preliminary results, diminished self-awareness and ToM can be possible mediating factors.

Disclosure

This work was financially supported by the Hungarian Brain Research Program (2017-1.2.1-NKP-2017-00002)

Internet Use Related to Suicidal Thoughts and Help-Seeking – Preliminary Results of a Study with Depressive Patients

Introduction

Suicide-related Internet use is becoming more common, and many research study its potential risks and benefits.

Objectives

Data on suicidal thoughts and Internet use of patients with depressive disorders were collected to assess their suicide-related Internet use and its relation to help-seeking preferences.

Methods

Semi-structured interviews were completed to assess Internet use patterns and suicidal thoughts among patients treated with depressive disorders, and preferred forms of help-seeking were also examined.

Results

113 patients completed the interviews, most of them spend more hours a day using the Internet. More than 80% came across suicide-related contents while browsing, a quarter reported specific search for suicidal contents. In case of suicidal thoughts, three-quarters of depressed patients would seek help from a mental health professional, two-thirds from their partners, half from friends, and nearly one-third from parents, other relatives or from GPs. Most patients would prefer offline (personal) help for their psychological problems and suicidal thoughts, online methods were less preferred, with only one-fifth choosing these options. However, a third of them also considered it probable that they would not ask anyone for help.

Conclusions

Despite of the frequent use of the Internet, online help-seeking is less common in depressive patients. However, in the times of pandemic, online help facilities may provide an opportunity to prevent suicidal behavior for those, who have suicidal thoughts and use the Internet regularly, especially searching for suicide-related contents. In the future, further research is needed to develop more effective online suicide prevention programs and applications.

Disclosure

No significant relationships.

Elevated osteopontin and IFNy serum levels and increased neutrophil-to-lymphocyte ratio are associated with the severity of symptoms in schizophrenia

Introduction

Inflammation and immune dysregulation could contribute to the pathogenesis of schizophrenia. Osteopontin (OPN) is a key cytokine-like molecule in cellular immune response and it can directly modulate the cytokine expression and survival of microglia. Furthermore, its mRNA expression is elevated in first episode psychosis. Imbalance of T-helper subtypes could also represent a vulnerability factor for schizophrenia.

Objectives

The aim of this study was to evaluate the relevance of T-helper subtype associated cytokines, OPN and NLR in the assessment of the severity of schizophrenia.

Methods

22 patients with schizophrenia were assessed for the intensity of their symptoms by PANSS and CGI scores. Serum OPN, IFNy, IL-10 and IL-8 concentrations were measured by ELISA kits and NLR was calculated from blood count. Statistical evaluation was performed using Mann-Whitney U test, Student’s t test and Spearman correlation.

Results

We found significant correlation between the level of OPN and PANSS-total, PANSS-general scores. IFNy level and NLR showed significant correlation with PANSS-total, PANSS-positive, PANSS-general and CGI score. Antipsychotic therapy only had significant effects on NLR and OPN levels, both of which were significantly reduced after long-term antipsychotic treatment.

Conclusions

Our results indicate that elevated OPN and IFNy concentrations, and increased NLR are associated with severe symptoms in schizophrenia and suggest the importance of Th1 subtype in patients with high PANSS-positive and PANSS-general score. Antipsychotic treatment had significant effects on the level of OPN and NLR, but not on the level of IFNy. Overall our results strengthen the inflammation hypothesis of schizophrenia.

Disclosure

No significant relationships.

The effects of reading literary fiction on the measurement and development of mentalization skills among schizophrenic patients

Introduction

Following the mentalization of interpersonal relations can be improved through reading for which the influence of literary fiction can also serve as a model. Schizophrenia is characterized by extensive deficits in mentalization, and the amelioration of these impairments is a major focus in psychosocial treatment research. Reading literature can be a potential tool in improving mentalizing skills.

Objectives

We aimed to examine and compare healthy participants with patients living with schizophrenia, focusing on measuring mentalizing skills and the impact of reading literary fiction on their mentalization skills.

Methods

47 persons with schizophrenia in remission and 48 healthy controls were assessed and compared with Short Story Task (SST) a new measurement of ToM. SST proved to be a sensitive tool, to individual differences. After reading the short story “The End of Something” (Hemingway) a structured interview was done with 14 questions.

Results

We found that patients with schizophrenia performed significantly worse in their ToM scores compared to healthy controls (ANOVA test, p<0,05 ). Previous reading experiences correlated significantly with mentalizing scores not just in healthy controls (Independent Samples T-test, p<0,05) but also in patients with schizophrenia. ToM scores were twice as high among those who had prior reading experiences in the schizophrenia group ((MS= 3,91, SD=3,166, M=8,08, SD=4,542; p<0,05, t=-3,509).

Conclusions

We found that mentalization skills could be improved by regular reading. Our results could also be influenced by several other factors such as empathy skills, identification with the characters etc. Our results and conclusions are in line with the results of international research on this topic.

Disclosure

No significant relationships.

Is repetitive Transcranial Magnetic Stimulation really effective in the treatment of major depression? – Results of a Meta-Analysis

Introduction

Clinical studies demonstrated the efficacy of rTMS treatment in major depressive disorder. However, the results of meta-analyses are contradictory due to the heterogeneity of the included studies.

Objectives

The aim was to analyse the effectiveness of rTMS for treatment-resistant major depression.

Methods

A systematic literature review of English-language articles published in the last 10 years was performed on PubMed and Scopus databases according to PRISMA guideline principles. To assess the effects of rTMS on response and remission rates, random-effects model and inverse variance method were used.

Results

23 randomized double-blind sham-controlled studies met the inclusion criteria for quantitative analysis for response (n= 1020 patients) and 12 studies for remission (n= 846 patients). The relative risk for response and remission were 2.19 (95% CI: 1.68-2,86, p=0.000 n=912) and 2.65 (95% CI: 1.32-5,31, p=0.002, n=603), respectively using rTMS as add on treatment (in patients after two antidepressant treatment failures) compared to standard pharmacotherapy. I²analysis showed no considerable heterogeneity in the combined effect sizes neither for remission studies (I²=23.36%) nor for response studies (I²=0.00%).

Conclusions

Transcranial magnetic stimulation became an evidence-based, effective treatment for treatment-resistant major depressive disorder, either as a monotherapy or as an augmentation of pharmacotherapy. However, because of the lack of standardized protocol, a substantial methodological heterogeneity exists. According to our results, rTMS was significantly more effective than sham rTMS in both response and remission outcomes, which is consistent with previous meta-analyses, but the effect size was a bit smaller than what was reported previously.

Disclosure

No significant relationships.

A systematic review and meta-analysis of implicit Theory of Mind in schizophrenia

Introduction

Everyday social interactions are based on Theory of Mind (ToM) or mentalizing, whose complex processes are involved in understanding, representing one’s own and other people’s mental states. ToM is supposed to have two systems. The implicit ToM seems to be a fast, automatic, non-verbal processing. The explicit ToM is characterized by a slower, but more flexible processing, which is mostly verbal, interpretative. Several studies have described explicit ToM deficit in schizophrenic patients. Less research has investigated implicit ToM in patients, however recently, there has been a growing number of articles examining implicit ToM of patients with schizophrenia.

Objectives

The aim of our systematic review and meta-analysis is to summarize the results of the implicit ToM in schizophrenia.

Methods

A systematic search was performed in four major databases. We included 11 publications. 7 studies; and 5 studies were included the quantitative synthesis and the qualitative synthesis, respectively.

Results

We found significant differences in accuracy, reaction time and brain activation patterns during implicit ToM between schizophrenic patients and controls. The systematic review revealed further alterations in visual scanning, cue fixation, face looking time, and difficulties in perspective taking.

Conclusions

Based on our results implicit ToM is affected in schizophrenia in addition to explicit ToM deficit. However, based on these results we cannot exclude the possibility, that implicit ToM or at least some elements of it might be relatively unaffected (e.g. detection of intentionality), however its effectiveness is limited by non-mentalizing deficits (e.g. certain neurocognitive impairments). Our results may have important implications for the remediation of mentalizing skills.

Disclosure

The research is supported by the Hungarian National Excellence Centrum Grant (FIKP II) and Hungarian Brain Research Program (KTIA-13-NAP-A-II/12).

The investigation of implicit Theory of Mind in patients with schizophrenia – a whole brain fMRI study

Introduction

Theory of Mind is the ability to attribute mental states to others. Investigations have distinguished implicit and explicit forms of ToM. It is known, that patients with schizoprenia have deficits in their explicit ToM, and they also show altered brain activations during examining explicit ToM.

Objectives

In this study our aim was to investigate the underlying neural substrates of implicit ToM in patients with schizophrenia with fMRI.

Methods

Seven healthy subjects and two patients with first episode schizophrenia were involved. We used: false belief condition and control condition. All movies consisted of a belief formation phase and an outcome phase. The belief formation phase started with an agent placing a ball on a table in front of an occluder. Then the ball rolled behind the occluder. The movies could continue in different ways leading to a true or false belief. At the end of each movie, the agent reentered the scene and the occluder was lowered. In the outcome phase the ball was either present or absent behind the occluder. The control conditions started with a ball rolled behind the occluder on a table ended up with two different ways as the ball was either present or absent behind the occluder. There was no agent in the control movies.

Results

We found that healthy subjects activated significantly stronger the left lingual gyrus as well as the right temporoparietal junction.

Conclusions

Our findings suggest deficits in implicit ToM in schizophrenia and our findings also might help to clarify the underlying neural substrates of implicit ToM.

Disclosure

This research project was supported by the KTIA-13-NAP-A-II/12 (2018–2022) and the Hungarian National Excellence Centrum Grant 2018–2019.

Az öngyilkossági rizikó becslése a klinikai gyakorlatban

A szuicid cselekmény hátterében álló lélektani folyamatok vonatkozásában továbbra is kevés megbízható információval rendelkezünk, továbbá a szuicidrizikó-becslő skálák is csak korlátozott prediktív értékkel bírnak. A nemrégiben leírt, úgynevezett szuicidspecifikus szindrómák – mint az akut szuicid affektív zavar és a szuicidkrízis-szindróma – azonban új lehetőségeket nyitnak a szuicid viselkedés komplex értelmezéséhez és az öngyilkossági rizikó becsléséhez. Írásunkban összefoglaljuk a szuicid viselkedés kialakulását magyarázó korszerű elméleti megközelítéseket és a szuicid viselkedés előrejelzésének lehetőségeit, valamint a praeszuicidális pszichopatológiai tünetek pontos felmérését célzó modern értékelő eljárásokat, kiemelve a szuicidspecifikus szindrómákat és az azok mérőeszközeit használó empirikus kutatások eredményeit. A fenti szindrómákra vonatkozó PubMed adatbázis szisztematikus irodalmi áttekintése alapján mind a szuicid affektív zavarra, mind a szuicidkrízis-szindrómára vonatkozó eredmények pozitívak a szuicid kísérletek megjósolhatósága szempontjából, illetve korrelálnak más, hasonló kérdőívekkel. A szuicidspecifikus szindrómák és mérőeszközeik hatékonynak bizonyulnak az elméleti kutatásokban és a klinikai alkalmazhatóság terén a szuicid kísérletek megjóslása vonatkozásában is, így hazai adaptálásuk és alkalmazásuk javasolható. Orv Hetil. 2022; 163(22): 863–870.

Implicit Mentalizing in Patients With Schizophrenia: A Systematic Review and Meta-Analysis

INTRODUCTION

Mentalizing is a key aspect of social cognition. Several researchers assume that mentalization has two systems, an explicit one (conscious, relatively slow, flexible, verbal, inferential) and an implicit one (unconscious, automatic, fast, non-verbal, intuitive). In schizophrenia, several studies have confirmed the deficit of explicit mentalizing, but little data are available on non-explicit mentalizing. However, increasing research activity can be detected recently in implicit mentalizing. The aim of this systematic review and meta-analysis is to summarize the existing results of implicit mentalizing in schizophrenia.

METHODS

A systematic search was performed in four major databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science. Eleven publications were selected. Five studies were found to be eligible for quantitative synthesis, and 9 studies were included in qualitative synthesis.

RESULTS

The meta-analysis revealed significantly lower accuracy, slower reaction time during implicit mentalizing in patients with schizophrenia. The systematic review found different brain activation pattern, further alterations in visual scanning, cue fixation, face looking time, and difficulties in perspective taking.

DISCUSSION

Overall, in addition to the deficit of explicit mentalization, implicit mentalization performance is also affected in schizophrenia, if not to the same extent. It seems likely that some elements of implicit mentalization might be relatively unaffected (e.g., detection of intentionality), but the effectiveness is limited by certain neurocognitive deficits. These alterations in implicit mentalizing can also have potential therapeutic consequences.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021231312.

[Attila József - psychoanalysis - Hungarian literary history. Interview with the 70-year-old Antal Bókay]

No abstract available.

Anti-Neuronal Autoantibodies (Cell Surface and Onconeural) and Their Association With Natural Autoantibodies in Synthetic Cannabinoid-Induced Psychosis

Patients suffering from encephalitis may present psychiatric symptoms; however, the clinical relevance of anti-neuronal antibodies in patients experiencing a psychotic episode without encephalitis is still unclear. In this study, we examined the presence of anti-neuronal cell surface autoantibodies and onconeural autoantibodies in serum samples of 22 synthetic cannabinoid users presenting with psychosis. We found only two positive cases; however, seven patients had borderline results. Nonetheless, we found no significant correlation between anti-neuronal autoantibodies and the intensity of psychosis indicated by the Positive and Negative Syndrome Scale (PANSS) scores. The length of drug use and the combination of other drugs with synthetic cannabinoids have no significant effect on anti-neuronal autoantibody positivity. Nonetheless, the ratio of anti-citrate synthase (anti-CS) IgM and IgG natural autoantibodies was significantly lower (p = 0.036) in the anti-neuronal autoantibody-positive/borderline samples, than in the negative group. Interestingly, anti-CS IgM/IgG showed a significant negative correlation with PANSS-positive score (p = 0.04, r = -0.464). Our results demonstrated that anti-neuronal autoantibody positivity occurs in synthetic cannabinoid users, and the alteration of anti-CS IgM/IgG natural autoantibody levels points to immunological dysfunctions in these cases.

[The role of socialisation in psychosexual development]

INTRODUCTION

In the recent research and interpretation of the genetical-biological and environmental-social factors shaping psychosexual development, in addition to scientific arguments, more and more ideological and political aspect have received unfortunate emphasis.

OBJECTIVE

Since the literature investigating the development of gender identity and gender orientation has not only increased, but also polarized, it is timely to look at the scientific exchange of ideas and debates among the differing positions.

METHOD

Exploring the significance of genetic, biological and social factors involved in the development of gender identity and gender orientation based on international literature data.

RESULTS

Based on the current state of science it can be concluded that, in addition to the indisputably marked genetic-biological factors, education and social patterns, as well as the extremely complex environmental and media-related influence with its variable intensity and diverse emotional content also play a significant role in the psychosexual development. This is supported, among other observations, by the data indicating that homoerotic behavior is more common in people raised by same-sex couples.

CONCLUSION

As psychosexual development is determined jointly by both genetic-biological and social factors (like education, media etc), belonging to a sexual minority group is not a choice, not the result of a personal decision. Therefore, any kind of discrimination in this regard is unacceptable. Further scientific studies are necessary to answer a large number of questions that still remain open.

Hikikomori: a possible mental health consequence of the COVID-19 epidemic

Összefoglaló. A COVID-19-járvány kényszerű tartós szociális távolságtartást idézett elő az emberek között, ami az egyéb mentális rendellenességek és mentálhigiénés következmények mellett egy sajátos pszichiátriai jelenségre, a hikikomori állapotra hívja fel a figyelmet. A hikikomori tartós és szélsőséges szociális visszahúzódással járó jelenség, melynek kidolgozott kritériumrendszere egyelőre még nem található meg a mentális rendellenességeket osztályozó diagnosztikus kézikönyvekben. Kialakulásának pontos mechanizmusáról még keveset tudunk, de az állapot megjelenése és az internet térnyerése között egyes szerzők szoros kapcsolatot látnak. Klasszikusan az egyén egy társadalmi szempontból megalázó vagy előnytelenül alakuló helyzet következtében vonul vissza fokozatosan egy önként vállalt izolációba. Bár a külvilág nem teljesen érdektelen számukra, azonban a retraumatizáció elkerülése érdekében leginkább online követik a világ történéseit és tartanak kapcsolatot másokkal. A COVID-19-pandémia - különösen a lezárások következményeként előtérbe kerülő online életvitelhez kötődően - jelentős mértékben hozzájárult az internet térnyeréséhez, miközben a valós társas kapcsolatok kényszerűen beszűkültek. Ez a konstelláció jelentős kockázati tényezőnek tekinthető a hikikomori szempontjából, amely hosszú távon a világjárvány egyik nem várt szövődménye lehet, különösen az adolescens és a fiatal felnőtt korosztályban. Orv Hetil. 2021; 162(41): 1637-1642. Summary. The COVID-19 pandemic forced prolonged social distancing between people. This, among other mental disorders and mental health consequences, highlights a specific psychiatric phenomenon: the hikikomori condition. The hikikomori is a phenomenon of persistent and extreme social withdrawal. The condition's established diagnostic set of criteria is not yet to be found in diagnostic manuals classifying mental disorders. Little is known about the exact mechanism of its development, but some authors see a close link between its emergence and the rise of the internet. Typically, the individual gradually withdraws into a voluntary isolation as a result of a socially humiliating or unfavourable situation. Although the outside world is not completely irrelevant to them, they tend to follow online the events of the world and they also keep in touch with others mostly online in order to avoid retraumatization. The COVID-19 pandemic, particularly in relation to the rise of online lifestyles as a consequence of lockdowns, has contributed significantly to the more and more frequent use of the internet, while real social contact has been inevitably reduced. This constellation can be seen as a major risk factor for hikikomori, which in the long term could be an unanticipated complication of the pandemic, especially in adolescents and young adults. Orv Hetil. 2021; 162(41): 1637-1642.

[The psychoanalysis of Harold F. Searles and nonhumanism]

No abstract available.

Increased Prevalence of Minor Physical Anomalies Among the Healthy First-Degree Relatives of Bipolar I Patients - Results With the Méhes Scale

Minor physical anomalies are somatic markers of aberrant neurodevelopment, so the higher prevalence of these signs among the relatives of bipolar I patients can confirm minor physical anomalies as endophenotypes. The aim of the study was to evaluate the prevalence of minor physical anomalies in first-degree healthy relatives of patients with bipolar I disorder compared to normal control subjects. Using a list of 57 minor physical anomalies (the Méhes Scale), 20 first-degree unaffected relatives of patients with the diagnosis of bipolar I disorder and as a comparison 20 matched normal control subjects were examined. Minor physical anomalies were more common in the ear, head, mouth and trunk regions among the relatives of bipolar I patients compared to normal controls. By the differentiation of minor malformations and phenogenetic variants, we have found that both minor malformations and phenogenetic variants were more common among the relatives of bipolar I patients compared to the control group, while individual analyses showed, that one minor malformation (sole crease) and one phenogenetic variant (high arched palate) were more prevalent in the relative group. This is the first report in literature on the increased prevalence of minor physical anomalies among the first-degree unaffected relatives of bipolar I patients. The study support the concept, that minor physical anomalies can be endophenotypic markers of bipolar I affective disorder.

[An evaluation of a Hungarian questionnaire to assess childhood adversities: A pilot study]

BACKGROUND

Detection of childhood traumas is important both in clinical practice and in research. There is a pressing need for methods that are relatively simple but comprehensive, non-intrusive, and possess adequate psyc - ho metric properties. In this study we translated one of the most widely used and well-studied measure of childhood abuse and neglect and explored the psychometrical properties of this questionnaire.

METHODS

The study was based on data from a clinical (N=171) and a normative (N=358) sample. In total 529 adults participated in the testing process. Beside the trauma questionnaire Parental Bonding Inventory, Impact of Events Scale and Dissociative Experiences Scale were administered.

RESULTS

We examined the internal consistency of the translated trauma questionnaire. The Cronbach's a coefficients for the five subscales ranged from 0,639 to 0,934. Participants in the clinical sample reached higher scores on all trauma subscales except sexual abuse, than normative adults [PA: t (398)=-2,771; p=0,006; PN: t (398)=-5,990; p=0,000; EA: t (398)=-3,679; p=0,000; EN: t (398)=-4,759; p=0,000; total score: t (398)=-4,669; p=0,000]. Correlations among the trauma questionnaire total score and the scales of Parental Bonding Inventory indicating some medium effects (with maternal care: r=-0,661; p=0,000; with paternal care: r=-0,483; p=0,000).

CONCLUSION

Our preliminary findings suggest that this trauma questionnaire is practical and facilitates the systema - tic evaluation of adverse early life events and maximizes the possibility of detecting childhood abuse and neglect.

["Why not?" - The medical diagnoses of Michel Foucault]

No abstract available.

Aggression expression among League of Legends and Fortnite players - a brief report

BACKGROUND AND AIMS

Our primary goal was to determine and compare the anger expression strategies used by players of the two most popular online games, League of Legends and Fortnite Battle Royale, as well as those used by non-gamers.

METHODS

The study sample was comprised of 450 subjects, of whom 338 were males and 112 females. The sample was further divided into four groups: 1. Non-gamers; 2. League of Legends gamers; 3. Fortnite gamers; and 4. League of Legends and Fortnite gamers. Anger attributes were measured using the validated Hungarian version of the 20-item Anger Expression Scale (Oláh 1987; Spielberger, 1985). Multinomial Logistic Regression was used to analyze the role of age and gender of the subjects to predict whether subjects were non-gamers or gamers. Subjects were further assessed by employing the Anger Expression Scale, which determines Anger-In (turning anger inwards or suppressing anger) and Anger-Out (expressing anger outwardly) profiles of individuals. The Anger-In and Anger-Out variables were added to the model.

RESULTS

Compared to League of Legends gamers, Fortnite gamers had a more passive (Anger-In) anger expression strategy. Fortnite and League of Legends gamers possessed a more passive anger expression strategy relative to nongamers.

DISCUSSION AND CONCLUSION

Further research is needed to determine whether the games themselves have a determining influence on the gamers anger expression strategy, or whether the gamers personality and anger expression strategy predisposed them to choose one game over the other.

[Chronophrenia - a new delusion described by Bertalan Petho]

In 1985 Bertalan Petho enriched psychiatric literature by the description of a new delusion. The essence of chronophrenia is the delusion, that the patient has already lived through this life once. The phenomenon is a persis - tant delusion, that differs from the experi-ences of déja vu and déja vecu. The present article introduces the publication of Petho and interprets it in the light of research on time-sense in schizophrenia. The similarity of chrono-phrenia and the idea of Eternal Return by Nietzsche is also discussed.

["Praecox-Gefühl". A brief look]

No abstract available.

Minor Physical Anomalies in Bipolar Disorder-A Meta-Analysis

Introduction: Minor physical anomalies (MPAs) may reflect basic neurobiological features underlying bipolar disorders (BPD), as they are sensitive physical indicators of morphogenetic failure of the brain. Despite several researches about the presence of MPAs in BPD, the results are still controversial. Objectives: The aim of the present meta-analysis was to assess the standardized weighted mean effect sizes of MPAs in BPD and to examine if MPAs may be found predominantly in the head and/or facial regions in BPD patients compared to controls (HC). Methods: Four studies, involving 155 patients with BPD, and 187 HC, were involved in the analysis after searching the literature. For the investigation of MPAs in the peripheral (MPA-P) and in the head and facial regions (MPA-CF), two studies involving 121 BPD patients, and 133 HC passed the inclusion criteria. Results: The number of the MPAs in the BPD group was significantly higher compared to HC. Another important finding of the present study is that BPD patients' MPA-P scores do not significantly differ from those of the HC. In contrast, BPD patients' MPA-CF scores were found to be significantly higher compared to HC subjects. It is important to note that there was a low number of eligible publications included, which caused higher heterogeneity. Conclusions: Low quality of evidence suggests that MPAs are more common in patients with BPD than in HC and the higher rate of MPAs is found predominantly in the head and facial regions.

[The Hipnoword application in clinical practice - an interview with Erika Somogyi M.D., psychotherapiest]

No abstract available.

Examining the Relationship Between Executive Functions and Mentalizing Abilities of Patients With Borderline Personality Disorder

Patients with borderline personality disorder (BPD) experience interpersonal dysfunctions; therefore, it is important to understand their social functioning and the confounding factors. We aimed to investigate the mentalizing abilities and executive functioning (EF) of BPD patients and healthy subjects and to determine the relative importance of BPD diagnosis and EF in predicting mentalizing abilities while controlling for general IQ and comorbid symptom severity. Self-oriented mentalizing (operationalized as emotional self-awareness/alexithymia), other-oriented mentalizing [defined as theory of mind (ToM)], and several EF domains were examined in 18 patients with BPD and 18 healthy individuals. Decoding and reasoning subprocesses of ToM were assessed by standard tasks (Reading the Mind in the Eyes Test and Faux Pas Test, respectively). Relative to controls, BPD patients exhibited significant impairments in emotional self-awareness and ToM reasoning; however, their ToM decoding did not differ. Multivariate regression analyses revealed that comorbid psychiatric symptoms were negative predictors of alexithymia and ToM decoding. Remarkably, the diagnosis of BPD was a positive predictor of ToM decoding but negatively influenced reasoning. Moreover, EF had no impact on alexithymia, while better IQ, and EF predicted superior ToM reasoning. Despite the small sample size, our results provide evidence that there is a dissociation between mental state decoding and reasoning in BPD. Comorbid psychiatric symptoms could be considered as significant negative confounds of self-awareness and ToM decoding in BPD patients. Conversely, the impairment of ToM reasoning was closely related to the diagnosis of BPD itself but not to the severity of the psychopathology.

[The text "World" by I.L. and speculative realism]

No abstract available.

[The neurological illnesses of Frida Kahlo]

No abstract available.

[Two early reports on delusional symptom formation by Camillo Reuter]

No abstract available.

Persons With Schizophrenia Misread Hemingway: A New Approach to Study Theory of Mind in Schizophrenia

INTRODUCTION

Theory of Mind (ToM) is a key component of social cognition. Recently the Short Story Task (SST) was developed as a new measurement of ToM. SST uses a short story of Ernest Hemingway to assess ToM skills. SST proved to be a suitable tool, and sensitive to individual differences among healthy subjects. Our aim was to test SST to evaluate the ToM skills of persons with schizophrenia.

MATERIALS AND METHODS

SST was used to assess ToM skills. After reading the short story "The End of Something" a structured interview was done with 14 questions. Spontaneous mental state reasoning, explicit mental state inference and comprehension of nonmental aspects of the story were evaluated. 47 persons with schizophrenia in remission and 48 healthy controls were assessed and compared.

RESULTS

Persons with schizophrenia performed significantly more poorly in the explicit mental state inference questions. Ceiling effect was not detectable in explicit ToM scores. Patients made less spontaneous mental state references as well, although the occurrence of spontaneous mental state terms was infrequent in both groups. Patients were also less accurate in answering comprehension questions, but the difference was not significant after Bonferroni correction.

DISCUSSION

Our results lined up with the original findings and we found SST to be a sensitive tool to explore the individual differences in ToM performance, not only among healthy subjects, but also among persons with schizophrenia especially in explicit mental state inferences without observing the ceiling effect. We found, however, SST to be less sensitive to measure spontaneous mental state reasoning and also the lack of the use of another ToM test to assess convergent validity of SST for indicating ToM deficits in schizophrenia stands as a limitation of current study.

[Catatonia in childhood and adolescence - a brief review and case report]

The authors overview the clinical, epidemiological, pathophysiological and therapeutic aspects of catatonia in childhood and adolescence. They deal with the recent changes of the nosological position of the phenomenon, and emphasize the importance of specific therapeutic interventions.

[Irony comprehension in first degree relatives of patients with bipolar disorder - a pilot fMRI study]

No abstract avalilable.

[Diogenes Syndrome - case reports]

No abstract avalilable.

Become the expert and embrace a positive attitude: communication strategies for discussing long-acting injectable antipsychotic treatment with patients living with schizophrenia

Patients with schizophrenia often experience relapses that negatively impact long-term outcomes. Continuous antipsychotic treatment can reduce relapse risk; however, this can be hindered by nonadherence resulting from the poor insight, which is often associated with schizophrenia. A strong patient-physician-carer alliance can improve patient insight, and adherence. Long-acting injectable antipsychotic treatment (LAT) provides continuous treatment; however, its acceptance by the patient is often compromised by a lack of physician-patient communication. The COMP approach (Connectedness, Openness, Motivation, Partnership) was developed to build effective communication and aid discussions around treatment. Insights on COMP fed into the development of COMPLETE - a tool for discussing LAT with eligible patients including the following components: 'Life goals', 'Establish connection between goals and therapy', 'Therapy introduction' and 'Encourage long-term motivation'. The overarching objective of COMPLETE is to improve long-term outcomes in patients with schizophrenia. This article discusses the development of COMPLETE and its potential use in the management of schizophrenia.

[The role of repetitive transcranial magnetic stimulation in the treatment of mental disorders, especially in treatment-resistant major depressive disorder]

The rapidly evolving field of repetitive transcranial magnetic stimulation as a neuromodulational technique may mean a safe, alternative approach to the management of several mental disorders, especially treatment-resistant major depressive disorder. Our aim is to describe the current role of transcranial magnetic stimulation in research and routine clinical practice, based on the literature and clinical protocols. Since the discovery, that an outer magnetic source can depolarize neurons, both neurology and psychiatry seek the method's possible clinical utility. To date, in the field of psychiatry, the method is only approved in the treatment of major depressive disorder and obsessive-compulsive disorder, but research continues to find application in other mental disorders (schizophrenia, bipolar disorder), too. The next step in the evolution of repetitive transcranial magnetic stimulation is based on magnetic resonance guided, real-time navigation with the help of positioning algorithms. The so-called neuronavigational systems make precise aiming of neuronal circuits responsible for the development of depression, thus increasing the excitability of the left dorsolateral prefrontal cortex and decreasing it on the right hemisphere. The method has few contraindications, and the occurrence of side effects can be minimized by carefully selected patient population. For today, transcranial magnetic stimulation became an evidence-based, effective treatment for some mental disorders, especially treatment-resistant major depressive disorder. It is to be assumed that in the future neuronavigational neuromodulation techniques, including repetitive transcranial magnetic stimulation, will be widely used in the field of psychiatry and neurology. Magnetic stimulation is currently available in a number of centres in Hungary, but the financial approval and the implementation of this neuromodulation method for treating mental disorders in the everyday clinical practice are still in progress. Orv Hetil. 2020; 161(1): 3-10.

Childhood Adversity Impairs Theory of Mind Abilities in Adult Patients With Major Depressive Disorder

Background: Patients with major depressive disorder (MDD) have various theory of mind (ToM) impairments which often predict a poor outcome. However, findings on ToM deficits in MDD are inconsistent and suggest the role of moderating factors. Child abuse and neglect are strong predictors of adult MDD and are often associated with a poorer clinical course trajectory. Objective: Because early-life adversities result in various forms of ToM deficits in clinical and nonclinical samples, our aim was to investigate if they are significant confounding factors of ToM impairments in MDD. Methods: We investigated 60 mildly or moderately depressed, nonpsychotic adult patients with MDD during an acute episode, and 32 matched healthy controls. The mental state decoding subdomain of ToM was examined with the Reading the Mind in the Eyes Test (RMET). Childhood adversities were assessed with the childhood trauma questionnaire (CTQ) and the early trauma inventory. Results: There was no difference between the control and MDD groups in RMET performance. However, when we divided the MDD group into two subgroups, one (N = 30) with high and the other (N = 30) with low levels of childhood adversities, a significant difference emerged between the controls and the highly maltreated MDD subgroup in RMET performance. A series of 3 (group) × 3 (valence) mixed-model analyses of covariance (ANCOVAs) revealed that childhood emotional and physical neglect had a significant negative impact on the response accuracy in RMET in general, whereas emotional abuse specifically interfered with the accuracy in the positive and negative valences if it co-occurred with early-life neglect. To test the dose-response relationship between the number of childhood adversities and RMET capacities, we subjected RMET data of the MDD group to multiple hierarchical regressions: the number of childhood adversities was a significant predictor of RMET total scores and RMET scores in the negative valence after controlling for age, sex, years of education, and the severity of current depression. Conclusion: Childhood adversities impair ToM capacities in MDD. Exposure to early-life emotional abuse and neglect have a negative impact on the performance in the emotional valences of RMET. Multiple early-life adversities have a dose-dependent association with mental state decoding deficits.

Capgras-féle tünettel összefüggő szülőgyilkosságok. Két eset bemutatása

Abstract:

Capgras symptom is characterized by the delusional belief that a person significant to the patient has been replaced by a ‘double’ or ‘impostor’. Capgras symptom was discussed to be associated with violent behavior. We report here the cases of two male patients with schizophrenia paranoid type, where parricide was connected to Capgras delusion. It is important to emphasize that in our observed cases, non-adherence played an essential role in the development of violent behavior, parricide. Orv Hetil. 2019; 160(42): 1673–1676.

Examining the Influence of Early Life Stress on Serum Lipid Profiles and Cognitive Functioning in Depressed Patients

Background

Early childhood adversity is a strong predictor of the development of major depressive disorder (MDD), but not all depressed patients experience early life stress (ELS). Cardio-metabolic diseases and cognitive deficits often coincide in MDD and worsen its course and outcome. Adverse childhood experiences have been associated with elevated risk for cardiovascular disease (CVD), but little is known on the impact of ELS on cardiovascular risk factors in MDD. Here, we examined MDD patients with and without ELS to explore the effects of ELS on serum lipid and lipoprotein levels and on cognitive performances of the patients.

Methods

Participants with a mean age of 35 years (18–55 years) were recruited from the university mental health clinic and general community. Three groups, matched in age, gender and lifestyle were examined: MDD patients with ELS (n = 21), MDD patients without ELS (n = 21), and healthy controls (n = 20). The following CVD risk factors were assessed: serum lipids (total cholesterol, triglycerides, high- and low-density lipoproteins), body mass index and exercise in a typical week. MDD severity was measured by the Beck Depression Inventory. Childhood Trauma Questionnaire was used to assess early life adversities. Executive functions and attentional processes were assessed by the Wisconsin Card Sorting and Conners’ Continuous Performance tests.

Results

Major depressive disorder patients with ELS had higher serum triglyceride and lower HDL-cholesterol concentrations compared to MDD patients without ELS. Linear regression analysis revealed that the severity of ELS had a significant negative association with HDL-cholesterol levels and significant positive associations with the serum levels of TG and TC/HDL-cholesterol index. We also found significant associations between some specific trauma types and lipid profiles. Finally, we could detect significant associations between depression severity and specific domains of the cognitive tests as well as between lipid profiles and certain domains of the Wisconsin Card Sorting Test. However, we could not detect any association between the severity of ELS and cognitive performance.

Conclusion

After controlling for depressive symptom severity and lifestyle variables, ELS was found to be a strong predictor of serum lipid alterations. Several, inter-correlated pathways may mediate the undesirable effects of ELS on the course and outcome of MDD.

[Immanuel Kant's concept on mental disorders]

No abstract available.

Social Cognition Analyzer Application-A New Method for the Analysis of Social Cognition in Patients Diagnosed With Schizophrenia

Introduction: Because of the importance of the assessment of social cognitive impairments in schizophrenia in clinical settings, a new computer application called SCAN (Social Cognition Analyzer applicatioN) was developed. Our first aim was to examine if patients diagnosed with schizophrenia could be differentiated from healthy individuals based on the results of SCAN, taking into consideration both response rates and response times. Our second aim was to create Scanalizer, as part of SCAN, to produce social cognitive profiles of individual patients. Materials and Methods: 86 patients (SG) and 101 healthy participants (CG) were examined with SCAN. The domains were: ToM, irony, metaphor, emotion perception from prosody and social perception. SCAN displayed the tasks, recorded the answers and the response times. For the differentiation of the two groups a two-dimensional scatter plot was used. For the graphical presentation of the social cognitive profile of patients, the calculation of the distributions of CG's results was made with Kolmogorov-Smirnov Goodness-of-fit Test and with the sum of squared residuals (SSR). Results: We found that the SG's response rates were significantly lower and the SG's response times were significantly slower compared to the CG in every condition. With the two-dimensional comparison of the summary response rates and the summary response times of the participants, the SG could be differentiated from the CG and this differentiation worked irrespective of age and education. For the graphical representation of social cognitive functions of patients, distributions of the results of the CG were calculated. We found normal distributions in the response times of all conditions and in the response rates of the ToM condition. In the low-end tail of the irony condition, and in the metaphor, social perception and emotional prosody conditions, power-law distributions were found. We also found that the summary response rates of the lowest performing 10% of the CG was in the same range as the summary response rates of all examined patients. Discussion: Scanalizer enables clinicians to measure and analyse social cognitive profiles of patients diagnosed with schizophrenia. Moreover, SCAN could also be used to detect social cognitive disabilities of vulnerable individuals.

[The Papageno-Effect in suicidology]

No abstract available.

Elevated Osteopontin and Interferon Gamma Serum Levels and Increased Neutrophil-to-Lymphocyte Ratio Are Associated With the Severity of Symptoms in Schizophrenia

Inflammation and immune dysregulation could contribute to the pathogenesis of schizophrenia. Osteopontin (OPN) is a cytokine-like glycoprotein involved in inflammation and in modulating immune responses, and it can also directly modify the cytokine expression and survival of microglia. Furthermore, elevated gene expression of OPN in first episode psychosis has recently been described, but to date OPN level has not been investigated in schizophrenia. Imbalance of T-helper subtypes could also represent a vulnerability factor for schizophrenia. In this study, we analyzed the concentration of OPN, levels of cytokines associated with T-helper subtypes: interferon gamma (IFNy) for Th1, interleukin (IL)-10 for Th2, IL-8 for Th17, and neutrophil-to-lymphocyte ratio (NLR) in 22 patients with schizophrenia assessed for the intensity of their symptoms by the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression scale (CGI) scores. Serum OPN, IFNy, IL-10, and IL-8 concentrations were measured by ELISA kits and NLR was calculated from blood count. We found significant correlation between the level of OPN and PANSS-total and PANSS-general scores. IFNy level and NLR showed significant correlation with PANSS-total, PANSS-positive, PANSS-general, and CGI score. Among the measured markers antipsychotic therapy only had significant effects on NLR and OPN level, both of which were significantly reduced after long-term antipsychotic treatment. Our results indicate that elevated OPN and IFNy concentrations, and increased NLR are associated with severe symptoms in schizophrenia and suggest the importance of Th1 subtype in patients with high PANSS-positive and PANSS-general subscore. Significant correlation between NLR and PANSS scores strengthens the inflammation hypothesis of schizophrenia.