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In our brief literature review, we discuss the changes in the concept of catatonia as well as its various types and symptoms. We also succinctly review the possible symptoms of clozapine withdrawal. In addition, we analyze the main features of the very few published cases of clozapine withdrawal-induced catatonia and the relationship between neuroleptic malignant syndrome and the malignant subtype of catatonia. Furthermore, we present the case of a 29-year-old male patient with schizophrenia in whom a malignant catatonic episode/neuroleptic malignant syndrome (with negativism, stupor, mutism, autonomic signs [eg, fever, hyperhidrosis], and elevated creatine kinase levels) began 5 days after the patient decided arbitrarily to cease his clozapine treatment. His catatonic symptoms quickly (ie, within a few days) resolved after the reinstitution of clozapine. Finally, we attempt to provide a theoretical explanation for the surprising finding in the literature that the withdrawal of clozapine, unlike the withdrawal of any other antipsychotics, may be associated with catatonia (frequently its malignant subtype). The take-home message of our case is that clinicians should bear in mind the risk of catatonia (especially the malignant subtype of it) after the prompt withdrawal of clozapine therapy.

Background and Objectives: The role of affective temperament in the genesis and outcome of major mood disorders is well studied, but there are only a few reports on the relationship between panic disorder (PD) and affective temperaments. Accordingly, we aimed to study the distribution of affective temperaments (depressive (DE), cyclothymic (CT), irritable (IRR), hyperthymic (HT) and anxious (ANX)) among outpatients with PD. Materials and Methods: Affective temperaments of 118 PD outpatients (80 females and 38 males) with or without agoraphobia but without any other psychiatric disorder at the time of inclusion were evaluated using the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and compared with the affective temperament scores of control subjects. All patients were followed up for at least 1.5 years in order to detect the onset of any major affective disorders, substance use disorders and suicide attempts. Results: Among females, the dominant ANX and DE temperaments were four and three times as common as in a large normative Hungarian sample (for both cases p &lt, 0.01). Among male PD patients, only the dominant DE temperament was slightly overrepresented in a non-significant manner. Females with PD obtained significantly higher scores on ANX, DE and CT subscales of the TEMPS-A, whereas males with PD showed significantly higher scores on ANX, DE and HT temperament subscales compared with the members of a large normative Hungarian sample and also with a gender- and age-matched control group. During the follow-up, newly developed unipolar major depression and bipolar spectrum (bipolar I or II and cyclothymic) disorders appeared in 64% and 22% of subjects, respectively. Conclusions: Our preliminary findings suggest that a specific, ANX-DE-CT affective temperament profile is characteristic primarily for female patients, and an ANX-DE-HT affective temperament profile is characteristic for male patients with PD, respectively. These findings are in line with expectations because PD is an anxiety disorder par excellence on the one hand, whereas, on the other hand, it is quite frequently comorbid with mood (including bipolar) disorders.

In our review we describe the development of savant syndrome as a concept, its historical antecedents, most important characteristics and spectrum of savantism, and the frequency and features of the most common savant abilities. We present the relationship between autism and savant syndrome, the eff ect of genetic and familial factors, and the characteristics of savant memory functions and intelligence. We provide an overview of the most important theories explaining savantism and the future direction of research.

We determined the prevalence of untreated depression in patients with hypertension (HT) and/or diabetes (DM) and estimated the extra health care use and expenditures associated with this comorbidity in a rural Hungarian adult population. We also assessed the potential workload of systematic screening for depression in this patient group. General health check database from a primary care programme containing survey data of 2027 patients with HT and/or DM was linked to the outpatient secondary care use database of National Institute of Health Insurance Fund Management. Depression was ascertained by Beck Depression Inventory score and antidepressant drug use. The association between untreated depression and secondary healthcare utilization indicated by number of visits and expenses was evaluated by multiple logistic regression analysis controlled for socioeconomic/lifestyle factors and comorbidity. The age-, sex- and education-specific observations were used to estimate the screening workload for an average general medical practice. The frequency of untreated depression was 27.08%. The untreated severe depression (7.45%) was associated with increased number of visits (OR 1.60, 95% CI 1.11–2.31) and related expenses (OR 2.20, 95% CI 1.50–3.22) in a socioeconomic status-independent manner. To identify untreated depression cases among patients with HT and/or DM, an average GP has to screen 42 subjects a month. It seems to be reasonable and feasible to screen for depression in patients with HT and/or DM in the primary care, in order to detect cases without treatment (which may be associated with increase of secondary care visits and expenditures) and to initiate the adequate treatment of them.

The Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A) is a widely used measure of affective temperaments. Affective temperaments refer to people's prevailing moods and are important precursors of affective disorders. With the two studies presented in this paper, we aimed to develop a short version of the Hungarian TEMPS-A.A total number of 1857 university students participated in two studies. The original 110-item version and the newly developed short version of TEMPS-A, the anger, depression, and anxiety scales of the PROMIS Emotional Distress item bank, the Altman Self-Rating Mania Scale, the Satisfaction With Life Scale, and the Well-Being Index were administered to participants.Out of the original 110 items, 40 items of TEMPS-A loaded on five factors that represented the five affective temperaments. Factors of the short version showed moderate to strong correlations with their original counterparts. All factors had good to excellent internal reliability. Factors of the newly developed short version of TEMPSA showed meaningful correlations with measures of emotional distress, mania, and indices of psychological well-being.The short version of the Hungarian TEMPS-A is a promising instrument both in clinical fields and for academic research. The newly developed short version proved to be a valid and reliable measure of affective temperaments.

The authors tested the clinical applicability of a self-developed, 6-item, clinician-rated questionnaire evaluating suicide risk in suicidal and non-suicidal psychiatric inpatients and healthy controls. Results have shown that the questionnaires able to detect marked suicide risk in psychiatric inpatients with a high sensitivity and specificity which indicates its usefulness and good applicability in clinical practice.

Suicide risk factors could be organised into a hierarchical order and a questionnaire constructed based on this hierarchical structure may help clinicians assess suicide risk. The paper presents analysis of the clinical utility of a questionnaire developed by the authors, in samples of suicidal and nonsuicidal psychiatric patients as well as among normal control subjects. Based on their results the authors suggest a shorter and expectedly more sensitive, 6-item version instead of the original 12-item version scale.

Background Psychotic symptoms are common in bipolar disorder (BD). Data suggest that BD patients with or without psychotic symptoms may differ from each other with regards to some clinical features of BD (e.g., age at onset, suicidality, psychiatric comorbidity, number of hospitalizations). However, the literature in this area is relatively scarce and not always conclusive. Therefore, the objective of the current study was to investigate whether the presence of psychotic symptoms is associated with clinical characteristics of patients with BD. Subjects and methods We enrolled 365 hospitalized patients who were diagnosed with BD according to the ICD-10 criteria. After we excluded 196 patients without current psychotic symptoms but psychotic mood episodes in their medical history, our final sample consisted of 169 patients (i.e., 89 BD patients presenting with current psychotic symptoms and 80 BD patients who were hospitalized in the same period, but who did not have psychotic symptoms either currently or during their previous hospitalizations). Clinically available data were collected, systematized and statistically processed according to the aims of the study. Results Early age of onset, bipolar-I diagnosis, comorbid personality disorder, number of hospitalizations and suicidality were significantly more common in the psychotic group compared to the never-psychotic group. On the contrary, sedative/hypnotics dependence was more frequent in the never-psychotic group. Conclusions Our results support the notion that the presence of psychotic symptoms in the context of BD may be associated with various other clinical features of this disease.

Psychotic symptoms are common in the case of manic, depressive and mixed episodes of bipolar disorder; however, the assessment of delusions and hallucinations is frequently improper, thus the patients presenting also psychotic symptoms are treated based on their diagnosis of schizophrenia, schizoaffective disorder or paranoia. Psychotic symptoms in bipolar disorder result less favourable outcomes and course of illness.365 patients (106 males, 259 females) were hospitalized in or institution from January 1st 2015 to September 30th 2016, who were diagnosed with bipolar disorder according to the ICD-10 criteria. The number of patients presenting psychotic symptoms was 89 (24%); 55 of whom (62%) belonged to the bipolar I, and 34 (38%) belonged to the bipolar II group. As a control group of the psychotic bipolar patients, we chose 80 bipolar patients hospitalized in the above mentioned period, who did not present psychotic symptoms either at the current or their previous hospitalizations.We found psychotic mania in the case of 24 patients (27%, 12 males, 12 females); and the delusions were of grandiose, religious and paranoid content. The number of depressive patients presenting psychotic symptoms was 39 (44%, 30 females, 9 males); their delusions were dominantly characterized by feelings of guilt, hypochondria and impoverishment. We treated 26 patients (29%, 18 females, 8 males) with mixed episodes accompanied by psychotic symptoms; they were characterized by depressive delusions. Compared to the non-psychotic bipolar patients, in the case of psychotic bipolar patients manic and depressive episodes, bipolar I diagnosis, early onset of the disease (under the age of 20), previous suicide attempts and comorbid personality disorder were significantly more frequent at the time of hospitalization, whereas mixed affective episodes and bipolar II diagnosis dominated in the non-psychotic group. Similarly, the residual symptoms were more common in the psychotic group (64 patients 72% vs 34 patients 43%) and previous hospitalizations was higher in the psychotic group (males 10.6, females 12.5 vs. males 7.8, females 8.6). With regard to psychotic symptoms, there was no difference between the two groups in terms of positive family history, comorbid anxiety disorder or alcohol dependency.Early onset of the disease, bipolar I diagnosis and comorbid personality disorder were typical of psychotic bipolar patients; in addition, suicide attempts and residual symptoms were more common compared to the non-psychotic group.The relatively lower number of patients (89 and 80 patients) and the fact that the data were processed retrospectively limit the generalizability of our results.

In this review the relevant investigatons of the relationship between childhood maltreatment (CM) and bipolar disorder (BD) will be described. I present the most important features of different trauma forms (physical, sexual, emotional abuse and neglect). A short overview of the direct and long-term effects of childhood-maltreatment and the consequential neurobiological, neurodevelopmental alterations are summarized. A part of the traumameasurement scales and the hidden effects of trauma examiner scales are demonstrated. The clinical variables of bipolar disorder will be shown in the context of different maltreatment forms. Methodical problems and critical commenst are overviewed as well.