Biomedical subjects
József Gerevich
Publications and source records attributed to József Gerevich.
[Violence and alcohol consumption in intimate heterosexual relationships].
Health and addiction harm of violence related to drinking is a very important aspect of the recent research studies. The social exchange theory, the family systems approach of alcoholism, the psychopharmacological model, the economic motivational model, and the tripartitate conceptual framework of Goldstein focus on the phenomenon within different causal contexts. According to recent studies approximately half of the cases is related to the alcohol consumption. Especially the binge drinking can facilitate violence. The problem is moderated by social, cultural, and ethnic specialties. The likelihood of alcohol related aggression increases in a rapidly changing society. Exposure to drinking related violence is frequent among women with pregnancy.
Innovations: Alcohol & drug abuse: Methadone maintenance in Europe and Hungary: degrees of sociocultural resistance.
Opiate substitution treatment, commonly referred to as maintenance treatment, was introduced in the United States and Europe in the 1960s. This column discusses approaches to opioid maintenance treatment in Europe and focuses on the introduction of methadone maintenance treatment in Hungary. Although persons have received methadone maintenance in Hungary since 1987, consensus guidelines were not adopted until 1998 and were not confirmed by the Hungarian parliament until 2000. Hungary encountered initial difficulties in introducing methadone maintenance, and it is hoped that Hungary's joining the European Union in 2004 will help to make opiate substitution treatment more widely available.
[Prevalence of hazardous alcohol use].
Determining the prevalence of reckless drinking indicates the degree of the problem in the population at risk and can provide an opportunity to prevent the development of harmful effects. The authors assessed the prevalence of hazardous drinking in Hungary by applying the Alcohol Use Disorders Identification Test (AUDIT), which is widely used in international research and has good reliability indicators, as well as other psychopathological measures in a nationally representative sample (N=1200). 32.9% of the male drinkers (N=449) and 10% of the female drinkers can be regarded as being at risk. Applying the 8-point screening criteria of the AUDIT, it was found that 8.3% of the total sample can be regarded as drinkers at serious risk. This rate was 14.6 % for men and 2.7 % for women. Men scored significantly higher than women in all items of the questionnaire. Consumption of alcohol was markedly higher among men aged 45-64 years, in contrast with the younger age groups and the group over 64 years. In the case of women, we found significantly higher average total scores for the youngest age group (18-29 years) compared to the older age groups. The Hungarian prevalence data found in the present research project do not differ significantly from the earlier findings of Hungarian and international studies.
[Distal antecedents and sociodemographic characteristics of suicidal attempts among alcoholics seeking treatment].
The correlation between being a subject to physical abuse in childhood and violent and suicidal behaviour in adulthood has long been proved. The present research was aimed at answering the question whether an abuse event suffered in childhood creates a tendency to aggressive and suicidal behaviour in adulthood, and whether a correlation exists between these two forms of behaviour. The study sample consisted of 235 clinically treated alcoholics. The instruments used for the investigation were the European Addiction Severity Index (EuropASI), the Buss and Perry Aggression Questionnaire, and the Janus Questionnaire. The most important findings suggest that persons who were physically abused in childhood by their parents were more likely to strike or beat someone in the course of their lives (Chi(2) =9.79, p<0.001). Within the most aggressive group, 18 % had not suffered physical abuse in childhood, while 81% had been abused (Chi(2) =13.25, p<0.001). If the subject had been physically abused, struck or beaten, that person later in his life also abused, struck or beat someone (Pearson r=.397). Physical abuse in childhood perpetrated by parents shows a significant relationship with suicide attempts later in life (Chi(2) =9.73, p<0.01). The more aggressive the group to which a patient belongs, the more likely it was that he had attempted to commit suicide (Chi(2) =9.99, p<0.01). These results draw attention to the importance of preventing suicide and treating aggression in alcoholics involved in clinical treatment.
[The influence of alcohol use and violent behaviour on the beliefs related to alcohol use and aggression].
The authors examined the effect of personal involvement (drinking, violent behaviour) on beliefs concerning the causal connections between drinking alcohol and aggressive behavior. The sample of the study comprised 1200 persons representative of the population over 18 years of age and was selected by a two-step, group stratified sampling method. The measuring instruments used for the study were the questionnaire on alcohol-aggression beliefs applied by Paglia and Room, the Buss and Perry Aggression Questionnaire, and the sociodemographic characteristics of gender, age and education. Analyses using multivariate regression models showed that aggressive behaviour, particularly verbal and physical aggression, and heavy drinking significantly influence the belief of a causal connection between alcohol and aggression. The more a person drinks and the more aggressive he becomes, the more likely he is not to believe the opinion that drinking leads to aggression. Women and older people have a stronger belief in the causal role played by alcohol in aggressive behaviour. These results draw attention to the importance of the cognitive effect of personal involvement. Heavy drinking and aggressivity can prevent a person from recognizing the danger that drinking can have aggressive, criminal consequences. This relationship can be used well in clinical and criminological practice of crime prevention strategy for patients treated with drinking problems and facing proceedings or condemned for criminal actions. The findings of the study also raise a theoretical consideration that the theory of social learning is not a sufficient explanatory model for the connections between drinking and aggression.
[Screening for alcohol-related disorders: Hungarian adaptation of the CAGE].
The CAGE scale, which was developed in the 1970s and consists of four items designed to screen alcoholism and related problems, has not yet been adapted for Hungary. In a research project carried out in a nationally representative sample, the authors tested the validity of CAGE, comparing the results with another widely used screening test (AUDIT). The reliability and validity of the CAGE test is regarded to be excellent. Comparing the diagnostic reliability of the two instruments, we found that 94% of the subjects were classified by these scales similarly into problem and non-problem drinking groups. According to the CAGE test 85 persons (7.1%) were classified as problem drinkers, compared to 99 persons in the case of AUDIT. On the basis of the study, we recommend the use of CAGE for the quick screening of severe clinical cases among middle-aged or older persons, in whom direct questions concerning drinking habits may provoke resistance.
[Victimization and alcohol problems in the families of disabled persons].
Few research data are available on the addiction problems that occur in the families of persons living with disability. There is even less information on the extent of violence disabled people experience in their families as violence directed at them, and little is known how this is connected to alcohol and drug use that may occur in the families of the different groups of disabled persons as compared to healthy control samples. We sought an answer to this question through a case-control study involving 245 young people with disability and 60 healthy controls, using structured interview methods (EuropASI, EuroADAD) and self-assessment questionnaires (Temperament and Character Inventory, Juvenile Victimisation Questionnaire, Child Abuse and Trauma Scale). The presence of a drinking problem in the family was clearly identified as a predictor of an increased risk of victimization, of the occurrence of various types of victimization events, and of their greater frequency. The strong effect of a drinking problem in the family on substance use, psychiatric state and difficulties in aggression management was also confirmed. The predictive effect of a drinking problem was manifested in various ways in different disability groups. Our data draw attention to the link between victimization and drinking problems that can be observed in the families of disabled people, and to the importance of prevention which could help in improving the quality of life of the persons living with disability.
[The beginnings of modern biological psychiatry in Hungary: the atropine coma. A historical overview].
In the authors' opinion modern biological psychiatry in Hungary started with the investigations into the biological mechanism of atropine coma therapy. Atropine coma was used in the period between 1950 and 1975 mainly in the treatment of various psychoses and obsessive compulsive disorder. In a previous communication the method, indications and adverse effects of atropine coma were outlined and the professional and broader social reasons for its eventual disappearance were discussed. In this paper the therapeutic effectiveness and research into the biological mode of action of atropine coma are summarized. Although thousands of patients received atropine coma therapy in the United States and in several Central-Eastern European countries including Hungary, this therapeutic modality is hardly ever features even in papers on the history of psychiatry. This is all the more surprising because initial therapeutic results with atropine coma were favourable and it seemed to be a more safe and efficient treatment than the more widely used insulin coma.
Intimate partner violence, suicidal intent, and alcoholism.
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Reliability and validity of the Hungarian version of the European Addiction Severity Index.
We attempted a Hungarian adaptation of the European version (EuropASI) of the widely used Addiction Severity Index (ASI) within the frame of a multi-stage quality development programme. The ASI is characterised by good reliability and validity indicators. The empirical background for our research was the data obtained from ASI ratings for 266 alcohol- and drug-using patients presenting for treatment in addiction medicine clinics in different regions of the country. The reliability indicators for measurement tool rating (interrater) and time (test-retest) were high, with the exception of the correlation value for employment and support. The internal consistency of the test was good. The degree of correlation between the individual items did not exceed that found internationally. The psychometric results corresponded to the results obtained in foreign investigations. The Hungarian version of the ASI can be regarded as a useful and reliable measuring tool that can be used to identify the problems of addiction patients and to assess treatment efficacy.
[Methadone maintenance: adoption of a new harm reduction approach in Hungary].
Methadone with its favourable physiological effects in comparison to heroin has been the most well-known and widely used tool of substitution treatment in heroinism. Research on efficiency has produced evidence of the fact that methadone maintenance as a model method of harm reduction is an efficient treatment of heroin dependent patients if used in the appropriate dose and indication. Due to its addictive effects, there has been some resistance against its worldwide spreading, especially in Central Eastern Europe. Methadone maintenance became a legal medical method in Hungary during the last ten years with approved classified protocol and manual owing to the consistent efforts of addiction-professionals, who were convinced of the treatment's efficacy. The process involved numerous conflicts, police provisions and media scandals. Professional legitimacy of methadone maintenance may hopefully be proved by research on efficiency in the near future.
[Clinical experiences with the Maudsley Addiction Profile (MAP) among heroin addicts].
There is an increasing attention to the research of the treatment efficiency of drug users and abusers. Some measure tools (Addiction Severity Index, Opiate Treatment Index) have been developed for last years. Use of these methods is limited by the relative long duration (one hour) of the interview. The Maudsley Addiction Profile (MAP) is used in more European countries because of it's easy implementation. In this study the authors have focused on the Hungarian adaptation of the MAP. 103 heroin addicts were selected on the basis of the degrees of social integration and participation in any treatment programs. The MAP offers reliable data on the substance use, health risk behaviors and personal-social functioning regarding the last 30 days before the investigation. The data of this study strengthen the reliability and applicability of the MAP. This result is in accord with a previous study of the authors and other international studies. The MAP is very sensitive for the differences of various drug using groups. Scales and problem areas of the MAP seem to be reliable and easily treatable. This interview approach has proven a very useful tool in both research and clinical practice.
A case report: Pavlovian conditioning as a risk factor of heroin 'overdose' death.
BACKGROUND: The authors present a case illustrating a mechanism leading directly to death which is not rare but has received little attention. CASE PRESENTATION: The case was evaluated by autopsy, investigation of morphine concentration in the blood, and clinical data. The heroin dose causing the 'overdose' death of a young man who had previously been treated a number of times for heroin addiction did not differ from his dose of the previous day taken in the accustomed circumstances. The accustomed dose taken in a strange environment caused fatal complications because the conditioned tolerance failed to operate. The concentration of morphine in the blood did not exceed the level measured during earlier treatment. CONCLUSION: These results are in line with the data in the literature indicating that morphine concentrations measured in cases of drug-related death do not differ substantially from those measured in cases where the outcome is not fatal. A knowledge of the conditioning mechanism can contribute to prevention of fatal cases of a similar type. The harm reduction approach places great stress on preventive intervention based on data related to drug-related death.
Drinking and intimate partner violence in a changing society.
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Dual diagnosis of psychiatric illness and drug addiction.
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Binarisms, regressive outcomes and biases in the drug policy interventions: a theoretical approach.
The golden age of drug policy was characterized by the informal regulation of drug use. Formalization of the control over regulation and its increasingly strict, aggressive character led to the emergence of a binary attitude. The main binarisms: pharmaceutical or drug; ban or tolerance; punishment or treatment; psychopathological or pathopsychological approach; subjective or objective knowledge; traditional or alternative. On the basis of Kuhn's paradigm theory, these binarisms can be integrated. Drug policy interventions based on the binary attitude have had regressive effects. Using the work of Sam Sieber, the author distinguishes nine regressive influences: functional imbalance, perverse diagnosis, ricochet, overload, goal displacement, exploitation, provocation, classification, and placation. The regressive influences have caused the escalation of "the drug problem," which in turn has led to further regressive interventions. This vicious circle could be broken by eliminating the four biases--the paternalistic, elitist, rationalist, and activist biases--underlying the regressive interventions.
Atropine coma: a historical note.
Insulin coma and various types of convulsive therapies were the major biologic treatment modalities in psychiatry before the psychopharmacological era. Except for electroconvulsive therapy (ECT), these methods disappeared from the psychiatric armamentarium after the introduction of psychotropic drugs. Atropine coma therapy (ACT) was one variety of nonconvulsive coma therapy used from the 1950s in a few state mental hospitals in the United States and in several Middle- and Eastern European countries until the late 1970s. In ACT, a coma of 6-10 hours' duration was induced with doses of parenteral atropine sulfate that were hundreds of times greater than the therapeutic dose administered in internal medicine. Although ACT was given to thousands of patients with a variety of diagnoses for nearly 3 decades, it is rarely mentioned, even in papers on the history of psychiatry. The method, indications, contraindications and adverse effects of ACT are summarized together with patients' personal accounts. Hypotheses concerning its mode of action are briefly mentioned. The reasons why ACT never gained wider acceptance are explored in the context of both contemporary psychiatric practice and the broader sociocultural climate of the era.