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A growing body of data has accumulated in the past decades about the possible role of nutritional factors in influencing the initiation and course of mental disorders as well as in the treatment of these disorders. As a result of the aggregation of this data a new field emerged - "nutritional psychiatry". In our current review paper we discuss some of those natural agents that supposedly have antidepressive properties and, accordingly, may play a role in the stand-alone and/or adjuvant treatment of major depressive disorder.

The risk of suicidal behaviour in major mood disorders is an inherent phenomenon and it strongly relates to the presence and severity of depressive episode. However, since the majority of mood disorder patients never commit or attempt suicide, special clinical characteristics of the illness as well as some personality, familial, psycho-social and demographic factors should also play a contributory role. Considering the clinically explorable suicide risk factors - discussed in this paper - in patients with major mood disorders, suicidal behaviour is predictable with a relatively good chance. As suicidal behaviour frequently develops later in the course of mood disorders, successful treatment of initially nonsuicidal major depressives and bipolar patients can prevent the later developing suicidal behaviour. This phenomenon could be called as "hidden suicide prevention". It means that preventing suicide is more easy than to predict it.

According to the results of epidemiological studies mood disorders with unipolar (major and minor depressive disorder; dysthymia) or bipolar features are among the most prevalent psychiatric disorders. These disorders with their frequent comorbidities (alcohol and/or drug use disorders, smoking, suicide, cardiovascular disorders) pose great public health challenge and cause substantial individual and familar burdens as well. Since SSRIs and other new antidepressant agents entered the market the possibilities to treat depression improved substantially but 25-35 percent of major depressives do not respond even to the second antidepressant trial but the rate of patients who are resistant after the third and fourth adequate antidepressant trial are around only 15-25 and 10 percent, respectively. Pharmacotherapy-resistant depression is a multicausal phenomenon. Along with its well-known risk-factors investigations of the past decade have revealed that unrecognised or hidden (subsyndromal or subthreshold) bipolarity is one of the most frequent causes of treatment resistance. In the case of bipolar depression (either as a part of syndromal bipolar I or II disorder or a subsyndromal manifestation) antidepressant monotherapy should be avoided and, instead of it, the administration of a mood stabilizer (primarily lithium and lamotrigine) or some atypical antipsychotics (preferably quetiapine) are recommended. If antidepressant is inevitably necessary in bipolar depression, we should use it always in combination with mood stabilizers or atypical antipsychotics.

Introduction: Both suicidal behaviour and consumption of arsenic-contaminated drinking-water represent major public health problems. Previous epidemiological and animal studies showed that high arsenic intake may also be associated with the elevated risk for depression. Since untreated depression is the most powerful risk factor for suicidal behaviour, we postulated that the consumption of arsenic-contaminated tap drinking-water may also be related to suicide., Method: Based on the level of arsenic in their drinking water Hungarian settlements with more then 500 inhabitants (n=1639) were divided into four groups. Then average age-standardized suicide rates of the four groups were compared., Results and Discussion: We found that the higher is the arsenic level in the drinking water the higher is the suicide rate of the settlements. In addition to the practical consequences of our preliminary results (e.g. in the suicide prevention) they also suggest that high level of arsenic in drinking water might contribute, at least in part, to the well-known and stable in time regional differences in suicide mortality of Hungary since the highest arsenic levels in drinking water have been found in counties with traditionally high suicide rates, such as Bacs-Kiskun, Csongrad, Bekes and Hajdu- Bihar.

Major Depressive Disorder (MDD) is one of the most common psychiatric diagnoses, accompanied by several psychological, behavioural and emotional symptoms, and in addition to the symptoms affecting the quality of life, it can lead to severe consequences, including suicide. Sequence learning plays a key role in adapting to the environment, neural plasticity, first language acquisition, social learning and skills, at the same time it defines the behaviour of the patient and also therapeutic possibilities. The aim of this paper is to review sequence learning and its consolidation in MDD. We know little about the effects of mood disorders on sequence learning; the results are contradictory, therefore, further studies are needed to test the effects of MDD on sequence learning and on the consolidation of implicitly acquired sequence knowledge.

Suicidal behaviour has a complex and multicausal background and poses a challenge not only for psychiatry, but also for medicine in general and the whole society. The majority of suicides are committed by psychiatric - mainly affective disorder - patients, and even within this illness group bipolar disorder patients are at an especially high risk. Therefore among bipolar patients, reducing suicide risk, recognition and prevention of imminent suicide requires the investigation, description and understanding of risk factors, including those specifically associated with bipolar disorders.

Suicide attempt and completed suicide are rare events in the community, but they are quite common among psychiatric patients who contact their GPs before the suicide event. The current prevalence of unipolar and bipolar major depressive episode in general practice is around ten percent but unfortunately about half of these cases remain unrecognized, untreated or mistreated. Major depressive episode is the most common current psychiatric diagnosis among suicide victims and attempters (56-87%) and successful acute and long-term treatment of depression significantly reduces the risk of suicidal behaviour even in this high-risk population. As over half of all suicide victims contact their GPs within four weeks before their death, primary care doctors play an important role in suicide prediction and prevention. Five large-scale community studies demonstrate that education of GPs and other medical professionals on the diagnosis and appropriate pharmacotherapy of depression, particularly in combination with psycho-social interventions and public education improve the identification and treatment of depression and reduces the rate of completed and attempted suicide in the areas served by trained doctors.

The current prevalence of DSM-IV depressive disorders were surveyed among 984 primary care attendees in 6 PCPs in Hungary, using the Beck Depression Inventory (BDI) and the PRIME-MD screening instrument. The current prevalence rate of any DSM-IV depressive disorders, including symptomatic major depressive episode (MDE) were 18.5% and 7.3% respectively. BDI identified any current depressive disorders with 95% sensitivity and 56% specificity and the same figures for MDE were 83% and 23%, respectively. Current MDE was found 50% of patients with positive family history of suicide, comparing to the 14.3% of those without. The BDI and the PRIME-MD are useful screening tools for detecting depressive disorders in PCPs. Family history of completed suicide as a clinical marker could improve suicide prevention through the more effective management of MDE in primary care.

Seasonal Affective Disorder (SAD) is characterized by patterns of major depressive episodes that occur and remit with the change of seasons. Two seasonal patterns have been identified: summer-type depression with typical depressive signs and symptoms, and winter-type depression with atypical features of depression. In the subsyndromal form of SAD (S-SAD) symptoms are milder, although vegetative symptoms are clinically significant. SAD needs to be differentiated from atypical depression, cyclothymic disorder, and dysthymia or chronic MDD which may be characterized by a winter worsening of symptoms. Full remission of symptoms must occur after the passing of the season for the disorder to merit the diagnosis of SAD. The mean prevalence of SAD in the temperate zone is 3 to 10%, while that of S-SAD is 6 to 20%. In Hungarian general population the occurrence of SAD is 4.6%, and S-SAD is 7.2%. The pathophysiology of SAD seems to be heterogeneous, studies suggest abnormal circadian rhythm and neurotransmitter function (phase shift hypothesis, role of serotonin, dopamin and norepinephrine). Genetic studies focusing on candidate genes involve 5-HTR2A, 5-HTR2C, DRD4, G protein, and clock-related genes.

Although suicide is very complex, multicausal human behaviour, untreated major mood disorders, particularly in combination with adverse life situations, carry the highest risk for it. As medical contact before suicide is quite frequent healthcare workers, particularly general practitioners, play important role in suicide prevention. This paper summarizes the healthcare-based educational programmes that have been shown effective in reducing suicide morbidity and mortality even in this high-risk population.

With the increase of life expectancy the ratio of elderly people in our society also increases and consequently health problems related to old age gain more attention. The prevalence of depression does not decrease in the elderly, affective disorders in old people, however, often manifest masked by physical illness worsening the course of these somatic disorders. Elderly depression also tends to present with a peculiar clinical picture. Atypical and also only few symptoms are characteristic of depression in the elderly. Vegetative symptoms are often primary and depression in old people often manifests solely in somatic symptoms. Typical cognitive alterations and pseudodementia are also characteristic features. At the same time, typical affective symptoms of depression are often absent, and instead of psychomotor retardation, psychomotor agitation manifested as irritability or motor restlessness is frequent. In the diagnostic process depression in the elderly should be separated from somatic diseases and dementia. The correct diagnosis and treatment of depression in the elderly is very important, since old age depression does not only cause significant distress, but often leads to suicide, and in addition, it generally increases morbidity and mortality, worsens the general somatic condition of the patient and increases social isolation.

It has been known for a long time that people with salient social and artistic creativity suffer more frequently from psychiatric illnesses than the average population. In their review paper, the authors assess the Hungarian and international scientific literature regarding the association of creativity and psychopathology. They conclude that contrary to the concept prevailing in the first part of the 20th century about the strong association between schizophrenia and creativity, the results of empirical research now unambiguously suggest that prominent social and artistic creativity is associated primarily with affective, and more specifically with bipolar affective illnesses. In addition, we already know that as regards the development of creativity, it is not the given affective (depressive, manic, hypomanic) episode which is important, but the hyperthymic or cyclothymic temperament structure which also predisposes for affective illness.

The study examines the psychometric properties of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) based on 717 (438 females and 279 males) healthy subjects in a Hungarian normative sample. The questionnaire is a self-report 110-item tool that postulates five affective temperaments: depressive, cyclothymic, irritable, hyperthymic, and anxious. Most of the TEMPS-A scales have excellent internal consistencies (0.78-0.84), except for the Depressive Temperament Scale, which had a Cronbach's alfa coefficient of 0.63. The item-analyses have identified a few deficient items which do not fit into the scale. In line with the literary data, women had higher mean scores on the depressive, cyclothymic, and anxious subscales, whereas men scored higher on the cyclothymic subscale. Cut-offs for each temperament were based on z-scores higher than + 2S.D. Dominant nervous-anxious (4.3%), depressive (3.8%), cyclothymic (3.2%), and irritable (3.2%) temperaments were the most common in this normative population, whereas dominant hyperthymic (1.8%) temperament was relatively uncommon. Factor analyses of the TEMPS-A items yielded considerable overlap between depressive and cognitive anxiety traits. The strongest correlation was observed between the anxious and the depressive temperament subscales in line with some international findings (r=0.62**). To test construct validity, we administered the Beck Depression Inventory, Profile of Mood States (shortened version) and the Cloninger Temperaments and Character Inventory, which all supported the validity of TEMPS-A subscales. Based on the results obtained with the Hungarian normative sample, the TEMPS-A is a reliable and valid instrument in personality psychology, and further refinement on clinical samples opens new and interesting research avenues.

Introduction: Several studies have focused on the role of the 5HTTLPR polymorphism of the serotonin transporter gene in the background of affective and anxiety disorders. Results have indicated that the presence of the s allele of this gene is associated with neuroticism, affective and anxiety disorders. Less attention has been paid to the relationship of this polymorphism with a tendency for depression and anxiety within a healthy population., Methods: We investigated the association of 5HTTLPR and a tendency for depression and anxiety in 102 psychiatrically healthy females. Each subjects completed the Zung Self-rating Depression Scale (ZSDS) and the Spielberger State-Trait Anxiety Inventory (STAI). All subjects were genotyped for 5HTTLPR by PCR. Psychometric scores of the three genotype groups (ss, sl and ll) and the two phenotype groups (subjects carrying the s allele vs. subjects not carrying the s allele) were compared using analysis of variance., Results: Subjects carrying the s allele scored significantly higher on all three scales than subjects not carrying the s allele. Comparing the three genotype groups, on the ZSDS ss and sl subjects scored significantly higher than ll subjects. On the state anxiety scale subject carrying the sl genotype had a significantly higher score than subjects carrying the ll genotype., Conclusion: Our results indicate that even in a psychiatrically healthy population there is an association between 5HTTLPR and a tendency for depression and anxiety or subclinical manifestation of depressive and anxiety symptoms. Identifying the genetic correlates of personality traits can lead to the identification of so-called endophenotypes, characteristics which can be associated with disorders and correspond to specific biochemical measures, which could be useful in delineating the genetic background of psychiatric disorders as well.

Background: Only a minor part of headaches are associated with an organic abnormality in the nervous system. In case of migraine and tension headache, the main provoking factor is psychological stress. Furthermore, these syndromes often occur together with depression and anxiety disorders, and when these comorbid conditions are present headache attacks tend to be more frequent, longer and stronger, causing an increase in the consumption of antimigraine agents, and at the same time increase the consumption of antidepressant and anxiolytic agents. Further to drugs, modified versions of Schultz-type autogenic training is also frequently used for anxiolysis. The aim of our research was to study the effect of the cognitive and symbol therapy enhanced autogenic training on headache and related drug consumption in three different types of primary headaches., Method: Twenty five female patients with migraine, tension-type headache or mixed headache participated in an eight-month follow-up study. Headache frequency, analgesic, antimigraine and anxiolytic consumption were measured by means of a headache diary. During the first four months (observation phase) patients became familiar with using the diary, and in the second four months they participated in autogenic training. The data of the second, third and fourth months were considered as baseline data., Results and Conclusion: Our method decreased headache frequency and drug consumption in all three headache groups. This means that the cognitive and symbol therapy enhanced autogenic training is an effective alternative for medications in the treatment of primary headaches.