Introduction: 2013/2014 academic year
Istvan Bitter
Department of Psychiatry and Psychotherapy
Semmelweis University
11 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 program
5th year: Dr. Imola SERES E-mail: seres.imola@med.semmelweis-univ.hu
TUTOR for the 6th year English program
6th 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
http://www3.weforum.org/d
ocs/WEF_Harvard_HE_Gl
obalEconomicBurdenNon
CommunicableDiseases_2
011.pdf
3
4
DALY: Disability Adjusted Life Years
6
University Department of Psychiatry in
Budapest
Dept of Psychiatry in „Szent Rókus” Hospital: 50 beds in 2
rooms as part of the dept of Internal Medicine and Neurology
1882
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.
Meduna, László: First convulsive treatment
January 23, 1934
• 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 and the origins of convulsive therapy.
Fink M.
Am J Psychiatry. 1984, Sep;141(9):1034-41
Where did Meduna work?
Miskolczy, Dezső
Early 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. sapiensspecific 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 psychiatry
in 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)
•
Church: Otto Wagner
• Killing of psychiatric patients
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
– alcoholism,
– depression,
– suicide
• High rates of sick
leave and disability
Lifetime Prevalence (%)
• High incidence and
prevalence
• Complications or
comorbidity
27
24
21
18
15
12
9
6
3
0
Any Anxiety
Disorder
Social
Anxiety
Disorder
PTSD
Generalized
Anxiety
Disorder
Panic
Disorder
Course of anxiety
disorders
Normal
GAD
„Worry”
• Fluctuating,
often progressive
disorders (e.g. AS
Panic
Level of
anxiety
GOOD AS IT GETS
Jack Nicholson -OCD)
Time
„Analyse That” (Csak
semmi pánik) Robert De
Niro
Death rates in Europe
http://epp.eurostat.ec.europa.eu/statistics_explained/index.php?title=File:Causes
_of_death_-_standardised_death_rate,_EU27,_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
1
South
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]
24.6
2009
40.0
10.6
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.
Relapse rates: a 1 year schizoprenia relapse
prevention study
1.0
Proportion of patients not
relapsing
0.9
P<0.01 vs placebo for all 3 doses
0.8
0.7
0.6
0.5
0.4
Placebo (n=71)
0.3
Ziprasidon 40 mg/day (n=71)
0.2
Ziprasidon 80 mg/day (n=68)
Ziprasidone 160 mg/dayp (n=67)
0.1
0
3
6
16
26 28
Weeks
Arato M et al. Int Clin Psychopharmacol. 2002.
40
52
Schizophrenia: Duration of untreated psychosis
positively correlates with bad outcome
100
90
Improved patients
%
80
70
60
Duration of
untreated pszchosis
50
40
10 weeks
30
24 weeks
1 year
20
2 years
10
0
0
4
8
12
16
20
24
28
32
Weeks
36
40
44
48
52
56
60
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:
Beslam, 2004
– 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
London, 2005
2005
New Orleans&Hurricane Katrine
2009 and 2010…
Flooding 2010
Hungary (Borsod county, June 30)
Transylvania, Romania
China
2011: Japan, Fukushima
5-HTT=5-hydroxy- tryptamine) =szerotonin
Thank you for your attention