Introduction: 2013/2014 academic year

Istvan BitterDepartment of Psychiatry and Psychotherapy

Semmelweis University11 September, 2013

Dept. of Psychiatry and Psychotherapy Semmelweis University of Medicine

• Vice Chair for Education: Dr. Zsuzsa Czenner

• Educational Coordinators• 5th year: Hajnal KISS 210-0330/51322; e-mail:

kiss.hajnal@med.semmelweis-univ.hu• 6th year Ilona SZÉKELY 210-0330/51322; e-mail:

szekely.ilona@med.semmelweis-univ.hu

• TUTORS for the English program5th year: Dr. Imola SERES E-mail: seres.imola@med.semmelweis-univ.hu

TUTOR for the 6th year English program6th year: Dr. Erika SZILY E-mail: szily.erika@med.semmelweis-univ.hu

• Textbook: KAPLAN&SADOCK’s S ynopsis of Psychiatry(DSM-IV/ICD-10)

• IMPORTANT: 6th year’s information

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http://www3.weforum.org/docs/

WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.

pdf

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DALY: Disability Adjusted Life Years

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University Department of Psychiatry in Budapest

1882 Dept of Psychiatry in „Szent Rókus” Hospital: 50 beds in 2 rooms as part of the dept of Internal Medicine and Neurology

1908 New Building in Balassa street

Neurology and Psychiatry

• 1925: K. Schaffer became chairman in Budapest* Strong research into the anatomy and

pathology of nervous system (Hirnpathologische Beiträge)

* Neurology and psychiatry as closely related disciplines

* Schaffer’s school: Long term influence of the development of Hungarian psychiatry.

• Antagonistic findings in the pathology of glia cells in schizophrenia&epilepsy

• clinical observations about the antagonism between schizophrenia and epilepsy (Nyírő and Jablonsky)

• Emigration to the USA (President, Association for Biological Psychiatry)

Meduna, László: First convulsive treatment January 23, 1934

Meduna and the origins of convulsive therapy. Fink M.

Am J Psychiatry. 1984, Sep;141(9):1034-41

Where did Meduna work?

Miskolczy, DezsőEarly description of degenerative

changes of the fronto-parieto-temporal

cortex in schizophrenia (1933)

„the first serious proponent of the concept of psychosis as a disorder of H. sapiens-specific association cortex (photo courtesy of Professor Zoltan Janka, University of Szeged).”

T.J. Crow / Progress in Neuro-Psychopharmacology & Biological

Psychiatry 30 (2006) 785–796

The Budapest School of Psychoanalysis

• S. Ferenczy: First in the world Dept. of Psychoanalysis

• M. Bálint: Balint Groups for GP-s (UK)• S. Radó: Columbia University

• Persecution of psychoanalysis: Nazis and - after a short period of freedom after WWII - by the communist regimes

Bálint, Mihály

Bálint groups for GPs

The recent situation

• Integration into the EU.

• Budget issues in research support, in health care and education.

• The University has a 3T MRI (fMRI)

• Genetic and EEG studies of psychiatric disorders in our Department.

New brain mapping - 256 channel EEG (dr. Pál Czobor)

Genetics

To the history of psychiatryin the world

Narrenturm

(„Madhouse tower”) , Vienna

Williambsburg, Public Hospital (1773-1885) (Virginia,USA):

Nazi programs

• Sterilization

• Killing of mentally retarded children (e.g. Steinhof, Vienna)

•

• Killing of psychiatric patients

Church: Otto Wagner

Psychiatric patient in Bangladesh (21st century)

How frequent are psychiatric disorders? (epidemiology)

• Alcohol: point prevalence: 8-10%!• Schizophrenia: point prevalence 0,8%, life time

prevalence ca. 1%• Anxiety disorders: life time prevalence ca. 25%• Depression: life time prevalence ca. 15%, one

year prevalence ca. 7%• Bipolar disorders: life time prevalence ca. 3-5%

• More than 50% of the internal medical patients and patients of GPs suffer from one or more psychiatric disorder.

Anxiety disorders• High incidence and

prevalence• Complications or

comorbidity– alcoholism,– depression, – suicide

• High rates of sick leave and disability

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Any AnxietyDisorder

SocialAnxietyDisorder

PTSD GeneralizedAnxietyDisorder

PanicDisorder

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%)

Course of anxiety disorders

Panic

GAD

Normal

Level of anxiety

Time

„Analyse That” (Csak semmi pánik) Robert De Niro

„Worry”

• Fluctuating, often progressive disorders (e.g. AS GOOD AS IT GETS Jack Nicholson -OCD)

Death rates in Europe

http://epp.eurostat.ec.europa.eu/statistics_explained/index.php?title=File:Causes_of_death_-_standardised_death_rate,_EU-

27,_2009_(1)_(per_100_000_inhabitants).png&filetimestamp=20120112111913

Suicide death in Hungary

Suicide death

Suicides per 100,000 people per year[2]

Rank Country Male Female Total Year

1South Korea[3] (more info)

49.6 21.4 33.5 2010

2 Lithuania 61.3 10.4 34.1 2009

3 Guyana 39.0 13.4 26.4 2006

4 Kazakhstan 43.0 9.4 25.6 2008

5 Belarus[4][5] 25.3 2010

6 Hungary[6] 40.0 10.6 24.6 2009

http://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate

Results: The annual suicide rate in the intervention region decreased from the 5-year preintervention average of 59.7 in 100 000 to 49.9 in 100 000. In rural areas, the female suicide rate in the intervention region decreased by 34% and increased by 90% in the control region (P<07).

Conclusions:A GP-based intervention produced a greater decline in suicide rates compared with the surrounding county and national rates. The importance of alcoholism in local suicides was unanticipated and not addressed.

Szanto et al, Arch Gen Psychiatry. 2007;64(8):914-920

Psychiatric disorders: benefits of pharmacologic treatment

Cardiology and psychiatry

Placebo response rates increase in depression studies (JAMA. 2002;287:1840-1847)

Proportion of Patients Assigned to Placebo, Tricyclic Antidepressants (TCAs), and Selective Serotonin Reuptake Inhibitors (SSRIs) Who Showed a 50% or Greater Improvement in Hamilton Rating Scale For Depression Score by Year of Publication

What is the Optimal Length of

Antidepressant Treatment ?

Reimherr WR: Optimal Length of Continuation Therapy of Depression.A prospective

assessment during long-term fluoxetine treatment. Am J Psychiatry 1998:155:1247-1253.

Placebo (n=71)

Ziprasidon 40 mg/day (n=71)

Ziprasidon 80 mg/day (n=68)

Ziprasidone 160 mg/dayp (n=67)

Relapse rates: a 1 year schizoprenia relapse prevention study

Arato M et al. Int Clin Psychopharmacol. 2002.

Weeks

1.0

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P<0.01 vs placebo for all 3 doses

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0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60

Duration of Duration of

untreated pszchosis untreated pszchosis

10 weeks

24 weeks

1 year

2 years

Schizophrenia: Duration of untreated psychosis positively correlates with bad

outcome

Environment – life events

Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study

Lancet 2011 Sep 3;378(9794):888-97    

Wisnivesky et al Divisions of General Internal Medicine, Mount Sinai School of Medicine, New York, NY,

USA; Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, New York, NY, USA.

FINDINGS: 9-year cumulative incidence of

• asthma was 276% (number at risk: 7027)

• sinusitis 423% (5870), and

• gastro-oesophageal reflux disease 393% (5650).

In police officers, cumulative incidence of

• depression was 70% (number at risk: 3648),

• PTSD 93% (3761), and

• panic disorder 84% (3780).

In other rescue and recovery workers, cumulative incidence of

• depression was 275% (number at risk: 4200),

• PTSD 319% (4342), and

• panic disorder 212% (4953).

• 9-year cumulative incidence for spirometric abnormalities was 418% (number at risk: 5769); three-quarters of these abnormalities were low forced vital capacity. Incidence of most disorders was highest in workers with greatest WTC exposure. Extensive comorbidity was reported within and between physical and mental health disorders.

Posttraumatic stress disorder (PTSD)

• An extreme traumatic event is an event that a person may experience, see, or learn about and that causes intense fear, helplessness, and horror.

• For example:– Physical attack, as in cases of domestic

violence or rape

– Car, plane, or train accident

– Natural disasters, such as a hurricane, flood, or tornado

– Terrorist attack

Beslam, 2004

London, 2005

New Orleans&Hurricane Katrine2005

2009 and 2010…

Flooding 2010

Transylvania, Romania

China

Hungary (Borsod county, June 30)

2011: Japan, Fukushima

5-HTT=5-hydroxy- tryptamine) =szerotonin

Thank you for your attention