Introduction: 2013/2014 academic year

1. Introduction: 2013/2014 academic year Istvan Bitter Department of Psychiatry and Psychotherapy Semmelweis University 11 September, 2013

2. 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

3. http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdfhttp://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf

5. DALY: Disability Adjusted Life Years

7. 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

8. 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.

9. 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

10. Where did Meduna work?

11. Miskolczy, Dezső Early description of degenerative changes of the fronto-parieto-temporal cortex in schizophrenia (1933) T.J. Crow / Progress in Neuro-Psychopharmacology & Biological Psychiatry 30 (2006) 785–796 „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).”

12. 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

13. Bálint, Mihály Bálint groups for GPs

14. 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.

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

16. Genetics

17. To the history of psychiatryin the world

18. Narrenturm („Madhouse tower”) , Vienna

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

21. Nazi programs • Sterilization • Killing of mentally retarded children (e.g. Steinhof, Vienna) • Killing of psychiatric patients Church: Otto Wagner

22. Psychiatric patient in Bangladesh (21st century)

23. 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.

24. Anxiety disorders • High incidence and prevalence • Complications or comorbidity • alcoholism, • depression, • suicide • High rates of sick leave and disability

25. Normal GAD Panic Course of anxiety disorders „Worry” • Fluctuating, often progressive disorders (e.g. AS GOOD AS IT GETSJack Nicholson -OCD) Level of anxiety Time „Analyse That” (Csak semmi pánik) Robert De Niro

27. 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

28. Suicide death in Hungary

29. Suicide death http://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate

31. 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

32. Psychiatric disorders: benefits of pharmacologic treatment

33. Cardiology and psychiatry

34. 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

35. 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.

36. 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 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 Arato M et al. Int Clin Psychopharmacol. 2002. Proportion of patients not relapsing 3 6 16 26 28 40 52 Weeks

37. 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 Schizophrenia: Duration of untreated psychosis positively correlates with bad outcome Duration of untreated pszchosis Improved patients % 10 weeks 24weeks 1 year 2 years Weeks

38. Environment – life events

41. 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.

42. 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

43. London, 2005

44. 2005 New Orleans&Hurricane Katrine

45. 2009 and 2010…

46. 2011: Japan, Fukushima

47. 5-HTT=5-hydroxy- tryptamine) =szerotonin

50. Thank you for your attention