Introduction: 2013/2014 academic year
description
Transcript of Introduction: 2013/2014 academic year
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:
[email protected]• 6th year Ilona SZÉKELY 210-0330/51322; e-mail:
• TUTORS for the English program5th year: Dr. Imola SERES E-mail: [email protected]
TUTOR for the 6th year English program6th year: Dr. Erika SZILY E-mail: [email protected]
• Textbook: KAPLAN&SADOCK’s S ynopsis of Psychiatry(DSM-IV/ICD-10)
• IMPORTANT: 6th year’s information
3
http://www3.weforum.org/docs/
WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.
4
DALY: Disability Adjusted Life Years
6
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
0
3
6
9
12
15
18
21
24
27
Any AnxietyDisorder
SocialAnxietyDisorder
PTSD GeneralizedAnxietyDisorder
PanicDisorder
Lif
etim
e P
reva
len
ce (
%)
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
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
P<0.01 vs placebo for all 3 doses
Pro
po
rtio
n o
f p
atie
nts
no
t
rela
ps
ing
3 6 16 26 28 40 52
Weeks
Imp
roved
p
ati
en
ts %
100
90
80
70
60
50
40
30
20
10
0
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