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Cilj rada bio je odrediti postojanje eventualnih razlikovnih osobitosti između skupina počinitelja i nepočinitelja kaznenih djela paranoidno shizofrenih bolesnika. Ispitivanje je provedeno na uzorku od 122 bolesnika s dijagnozom paranoidne shizofrenije F.20.0, od kojih su 61 bili počinitelji kaznenih djela i liječeni po nalogu suda, a 61 nisu bili počinitelji kaznenih djela, a liječeni su prema indikacijama za bolničko psihijatrijsko liječenje. Ispitanici su bili izjednačeni po spolu, dobi i naobrazbi. Svi ispitanici su bili testirani upitnicima: Wechsler WB za ispitivanje intelektualnih sposobnosti, MMPI-201 za ispitivanje osobina ličnosti, Eysenckov upitnik ličnosti (EPQ-RA), Frajburški upitnik ličnosti (FPI), Upitnik životnog stila (LSI), Temperament-karakter inventar (TCI) i upitnik socio-demografskih podataka. Primjenom dijagnostičkih mjernih instrumenata nastojalo se utvrditi prisustvo međuovisnosti psihopatoloških simptoma i drugih čimbenika od mogućeg utjecaja na počinjenje djela te utvrditi razlikovne osobitosti u odnosu na skupinu nepočinitelja iste dijagnostičke kategorije. Konačni cilj istraživanja je bio utvrditi eventualne čimbenike koji bi bili od značaja u predikciji budućeg kažnjivog ponašanja.Istraživanja govore da su paranoidno shizofreni počinitelji kaznenih djela značajno zastupljeniji u kategoriji nasilničkog kriminaliteta, uključujući i krvne delikte u odnosu na distribuciju počinjenja kaznenih djela u općoj populaciji. Žrtve njihova nasilja su uglavnom unutar obitelji i rodbine. Komorbidno u skupini počinitelja kaznenih djela više je poremećaja ličnosti, zatvorskog ranijeg iskustva i ranijeg forenzičkog tretmana, utjecaja psihoaktivnih tvari tempore acti, dok je kod nepočinitelja kaznenih djela više ovisnosti o alkoholu, ali bez statističkih značajnosti. U našem istraživanju potvrdili smo postojanje psihopatoloških, kriminogenih specifičnosti psihotičnih počinitelja kaznenih djela po kojima se oni razlikuju od psihotičnih bolesnika koji nisu počinili kazneno djelo. Identificirana su tri prediktorska modela od značaja u predikciji za počinjenje kaznenog djela.Rezultate ovoga istraživanja smatramo više vjerojatnim tendencijama nego čvrstim činjenicama, pa rad upućuje na daljnje traganje za specifičnim ponašanjem paranoidno shizofrenih, na većem uzorku, kako bi preventivni i terapijski programi za ovu skupinu bolesnika bili primijenjeni na vrijeme i adekvatno., Aim of this study was to determine presence of eventual differential specificities between patients with paranoid schizophrenia who are perpetrator of criminal offence and ones who aren’t. Research was made on a sample of 122 patients with diagnosis of paranoid schizophrenia F20.0, 61 of them were perpetrators of criminal offence and they were treated by the court order, and 61 weren’t perpetrators of criminal offence and they were treated by indications for hospital treatment. Participants were equaled by gender, age and education. All participants were tested by questionnaires: Wechsler WB for analyzing intellectual abilities, MMPI-201 for analyzing pathological characteristics of personality, Eysenck’s Personality Questionnaire (EPQ_RA), Freiburg Personality Inventory (FPI), Life Style Index (LSI), Temperament and Character Inventory (TCI) and Sociodemographic Data Questionnaire. Set of diagnostic measure instruments was used to try to determine presence of interdependence of psychopathological symptoms and other factors from possible impact on perpetration of criminal offence, and to correlate it with a group of non-perpetrators of criminal offence in same diagnostic category. Ultimate aim of this study was to determine eventual factors which would be significant in prediction of future criminal behavior. Researches show that paranoid-schizophrenic perpetrators of criminal offence are significantly more present in a category of violent criminality, including homicide, in relation to distribution of perpetration of criminal offence in general population. Perpetrators’ of criminal offence victims are mostly within family and relatives population. In a group of perpetrators of criminal offence there is comorbidity of more personality disorders, earlier prison experience and earlier forensic treatment, impact of psychoactive substances tempore acti, and in a group of non-perpetration of criminal offence there is more alcohol addictions, but without statistical significance. In this research presence of psychopatological and criminal specificities are comfirmed in criminal defense perpetrators wich differ them from non-perpetrators of criminal defense.Three predicting models significant in prediction of criminal defense were identified. We consider results of this study more as probable tendencies than firm facts, so this study refer to further research in specific behavior of paranoid-schizophrenic patients, on a greater pattern, to enable usage of preventive and therapeutic programs for this group of patients adequately and on time.

Background: Anxiolytics such as benzodiazepines are widely used in the treatment of anxiety disorders, although they are no longer recommended as first-line therapy for these conditions due to increased risk of dependence, as well as cognitive adverse effects, especially among the elderly. High prescribing rates of anxiolytics may be indicative of higher prevalence of anxiety-related phenomena in a given society, either in a form of an anxiety disorder or as pressure on physicians to keep prescribing them, against current guidelines. Subjects and methods: We inspected prescribing rates of anxiolytics in 21 European countries and compared them with six dimensions of Hofstede's cross-cultural framework, namely uncertainty avoidance (UAI), power distance (PD), individualism (IDV), masculinity (MAS), long-term orientation (LTO) and indulgence (IND). Results: According to our findings, anxiolytic prescribing patterns in selected European countries correlate positively with Hofstede's dimensions of UAI and PD and negatively with IDV. Conclusion: Differences in prescribing rates of anxiolytics and trends in their use may be affected by cross-cultural factors. More research is needed to shed light on these regional differences in anxiolytic prescribing.

Ketamine, synthesized in 1962, approved in 1970, is considered safe for use in controlled conditions, mainly as an anesthetic, especially in pediatric populations and in people suffering from pulmonary diseases, as well as in emergency departments and in war situations. Dissociative states (derealization and depersonalization) produced by ketamine made it a popular recreational drug, which led to increased regulation in most countries. Intravenous application of ketamine has shown rapid, although transitory antidepressant and antisuicidal effects in patients with unipolar and bipolar depression. Esketamine, the S(+) enantiomer of ketamine, with better pharmacodynamic selectivity, has just been approved for treatment-resistant major depressive disorder, in the form of a nasal spray. Presently, the high cost of the spray not only limits its widespread use, but also makes it less prone to abuse and diversion. Additional measures are needed to hinder it from becoming a new "street drug".

Violence in society is not a new problem. However, with the emergence of new communication media it has gained a new tool, giving the perpetrator the benefit of anonymity as well as a vast field and a diverse selection of social communities in cyberspace from which they can choose a victim. Cyberbullying and trolling are a relatively new problem in Croatia and are slowly gaining media space. Research on the incidence of offenses, impact on society and ultimately the seriousness of the problem is scarce and dated. Recently, there have been some changes made in the legislation to meet the needs that the new phenomena have posed, but the question remains whether they can keep up with the fast-changing times and customs.

Modern psychiatric treatment is no longer limited to mere reduction of symptoms and psychological suffering, but is oriented towards achieving a balance of mind and body by reaffirmation of those potentials of the personality which facilitate a high quality and speedy rehabilitation and resocialization and to increase coping mechanisms for patients. This is achieved by a holistic and personalized approach, life coaching, social skills training and other activities. The concept of treatment which combines new and innovative models of treatment with the classic approach with psychopharmacs and psychotherapy is the most appreciated and recognized. The natural resources provide a key for rehabilitation and mind-body balance, over bridging anxiety, depression, autistic behaviour and many neurological disorders by exposure to the nonverbal and pre-verbal archetypal and multisensory stimuli. To be in an institution but not institutionalized is a challenge in the field of psychiatry and cognitive neuroscience where even more severe disorders, those that require hospitalization, can be treated by maximal utilization of outdoor resources and facilitation of the physical and mental return to nature and experience of harmony. Rab Psychiatric Hospital is the first mental health institution in Croatia to introduce therapeutic gardens as a complement to traditional therapies. The gardens serve for physical therapy, animal-assisted therapy, horticultural therapy, as well as for socialization or a place for retreat in solitude.

Cilj ovog rada je bio prikazati kako se psihički i psihosomatski simptomi mogu shvatiti deskriptivno ali i kao simboli koji imaju svoju poveznicu sa životnim iskustvima, posebice onim traumatskim. U tom smislu simptomi / simboli imaju poveznicu sa dubljim psihološkim značenjem. Put do ovog cilja vodi kroz prikaz slučaja šezdesetogodišnje bolesnice u koje je dvadesetak godina prisutna klinička slika sa smetnjama iz kruga depresije, a zadnjih pet godina i ponašajni obrasci koji govore za poremećaj ličnosti. Simptomi koje navodi prilikom nedavne hospitalizacije imaju konverzivne značajke i psihotični nivo. Učinjena dijagnostička obrada je isključila tjelesna oboljenja kao mogući uzrok duševnih tegoba. Psihijatrijska anamneza je govorila u prilog zapostavljanja i zlostavljanja tijekom djetinjstva (moguće i seksualnog) te odrastanju u narušenim obiteljskim okolnostima. U somatizacijama i sumanutostima koje je bolesnica iznosila ležala je skrivena simbolika trpnje koju nije mogla izraziti i stoga ju je potisnula u nesvjesno. U pacijentice je prisutna snažna poveznica između traumatskih iskustava u djetinjstvu i nabrojenih psihičkih simptoma/simbola koji nam mogu pomoći u razumijevanju psihopatoloških fenomena i njihovog značenja, te otvoriti put u nesvjesno.

Cilj: Ispitali smo utječu li, i u kojoj mjeri, koncentracije lipida i glukoze u plazmi te vrijednosti indeksa tjelesne mase (engl. body mass index; BMI), na težinu kliničke slike shizofrenije u hrvatskih bolesnika, ovisno o njihovom pušačkom statusu. Ispitanici i metode: U istraživanju je sudjelovalo 263 kroničnih bolesnika (muškarci/žene: 139/124). Težina kliničke slike procijenjena je korištenjem ocjenske ljestvice PANSS-a (engl. Positive and Negative Syndrome Scale) u akutnoj fazi bolesti tijekom posljednje hospitalizacije. U pušače su klasificirani ispitanici koji puše najmanje jednu cigaretu dnevno u periodu duljem od godine dana, a u nepušače oni koji su popušili manje od 100 cigareta tijekom života. Rezultati: Koncentracije triglicerida, glukoze i vrijednosti BMI-a nisu pokazale povezanost s PANSS psihopatologijom, niti u bolesnika, niti u bolesnica, ovisno o pušačkom statusu (svi P > 0,05), a na težinu kliničke slike u bolesnica, utjecale su isključivo koncentracije kolesterola. Bolesnice pušači s višim koncentracijama LDL kolesterola (engl. low density lipoprotein cholesterol) imale su značajno niže vrijednosti općih i ukupnih simptoma (P = 0,023 i P = 0,015), dok su u bolesnica nepušača s višim koncentracijama HDL kolesterola (engl. high density lipoprotein cholesterol), uočene značajno niže vrijednosti pozitivnih i ukupnih PANSS simptoma (P = 0,041 i P = 0,002). Koncentracija LDL kolesterola opisuje približno 20% varijabilnosti općih simptoma i 23% varijabilnosti ukupnih simptoma u bolesnica pušača, a vrijednosti HDL kolesterola pridonose s otprilike 39% težini pozitivnih simptoma te s 69% težini ukupnih simptoma u bolesnica nepušača. Zaključak: Na temelju naših rezultata možemo zaključiti da na težinu kliničke slike shizofrenije utječu isključivo koncentracije kolesterola u bolesnica. Nadalje, koncentracije kolesterola opisuju mali do umjereno veliki udio varijabilnosti PANSS psihopatologije., Aim: We aimed to investigate whether, and to what extent, plasma glucose and lipid concentrations and body mass index (BMI) values, influence schizophrenia severity in Croatian patients, according to their smoking status. Patients and methods: Our study comprised 263 chronically ill patients (males/females: 139/124). Severity of schizophrenia was assessed via Positive and Negative Syndrome Scale (PANSS) psychopathology data during an acute illness state at the time of last hospital admission. Smokers were defined as individuals who smoked more than one cigarette each day for more than one year, and nonsmokers were defined as those who had smoked fewer than 100 cigarettes during their lifetime. Results: Plasma triglyceride and glucose levels and BMI values were not associated with PANSS psychopathology, neither among males, nor among females, according to their smoking status (all P > 0.05), whereas data of PANSS psychopathology among females were associated only with plasma cholesterol concentrations. Female smokers with higher LDL cholesterol (engl. low density lipoprotein cholesterol) concentrations had significantly lower general and total PANSS symptom values (P = 0.023 and P = 0.015), whereas among female nonsmokers with greater HDL cholesterol (engl. high density lipoprotein cholesterol) concentrations, significantly lower positive and total PANSS symptom values were observed (P = 0.041 and P = 0.002). The LDL cholesterol concentrations account for approximately 20% of the general symptom variability and 23% of the total symptom variability among female smokers; among nonsmoking females, HDL cholesterol concentrations contribute by approximately 39% to positive symptom severity and by approximately 69% to total symptom severity. Conclusion: According to our results, we can conclude that plasma cholesterol concentrations influence schizophrenia severity in female patients only. Furthermore, the contribution of cholesterol concentrations to PANSS psychopathology varies from small to moderate.

Cilj: Shizofreniju karakterizira visoka učestalost ovisnosti o pušenju, kao i visoka učestalost metaboličkog sindroma. Unatoč tome, malo se zna o učinku pušenja na komponente metaboličkog sindroma u toj bolesti. Cilj ovog rada bio je ispitati doprinosi li, i u kojoj mjeri, pojava ovisnosti o pušenju, koncentracijama lipida i glukoze u plazmi, te vrijednostima indeksa tjelesne mase (BMI), u skupini hrvatskih bolesnika sa shizofrenijom. Ispitanici i metode: U istraživanju je sudjelovalo 263 kroničnih bolesnika (muškarci/ žene: 139/124) s dijagnozom shizofrenije utvrđenom prema DSM-IV klasifikaciji (engl. Diagnostic and statistical manual for mental disorders – DSM-IV). U pušače su klasificirani ispitanici koji puše najmanje jednu cigaretu dnevno u periodu duljem od godine dana, a u nepušače oni koji su popušili manje od 100 cigareta tijekom života. Rezultati: Unatoč visokoj stopi ovisnosti o pušenju (muškarci: 70, 5% ; žene: 60, 5%), nije pronađena značajna razlika u koncentracijama lipida i glukoze u plazmi te vrijednostima BMI-a između muškaraca pušača i nepušača, a u žena su se samo koncentracije triglicerida razlikovale ovisno o pušačkom statusu. Pri tome su bolesnice koje puše imale nešto više vrijednosti triglicerida u usporedbi s bolesnicama nepušačima (1, 6 ± 0, 7 vs. 1, 3 ± 0, 5 ; F = 4, 25, P = 0, 042). Ipak, multipla regresijska analiza pokazala je da je samo dob značajni prediktor vrijednosti triglicerida u bolesnica (β = 0, 41 ; promjena R2 = 0, 171 ; P < 0, 001), dok je učinak pušenja na koncentracije triglicerida, kao i na ostale ispitane metaboličke parametre, u bolesnika i bolesnica, ostao izvan granica statističke značajnosti (P > 0, 05). Zaključak: Na temelju naših rezultata, možemo zaključiti da pušenje ne utječe na koncentracije lipida i glukoze u plazmi te vrijednosti BMI-a niti u bolesnika, niti u bolesnica sa shizofrenijom.

Cilj: Shizofreniju karakterizira visoka učestalost ovisnosti o pušenju, kao i visoka učestalost metaboličkog sindroma. Unatoč tome, malo se zna o učinku pušenja na komponente metaboličkog sindroma u toj bolesti. Cilj ovog rada bio je ispitati doprinosi li, i u kojoj mjeri, pojava ovisnosti o pušenju, koncentracijama lipida i glukoze u plazmi, te vrijednostima indeksa tjelesne mase (BMI), u skupini hrvatskih bolesnika sa shizofrenijom. Ispitanici i metode: U istraživanju je sudjelovalo 263 kroničnih bolesnika (muškarci/žene: 139/124) s dijagnozom shizofrenije utvrđenom prema DSM-IV klasifikaciji (engl. Diagnostic and statistical manual for mental disorders – DSM-IV). U pušače su klasificirani ispitanici koji puše najmanje jednu cigaretu dnevno u periodu duljem od godine dana, a u nepušače oni koji su popušili manje od 100 cigareta tijekom života. Rezultati: Unatoč visokoj stopi ovisnosti o pušenju (muškarci: 70,5%; žene: 60,5%), nije pronađena značajna razlika u koncentracijama lipida i glukoze u plazmi te vrijednostima BMI-a između muškaraca pušača i nepušača, a u žena su se samo koncentracije triglicerida razlikovale ovisno o pušačkom statusu. Pri tome su bolesnice koje puše imale nešto više vrijednosti triglicerida u usporedbi s bolesnicama nepušačima (1,6 ± 0,7 vs. 1,3 ± 0,5; F = 4,25, P = 0,042). Ipak, multipla regresijska analiza pokazala je da je samo dob značajni prediktor vrijednosti triglicerida u bolesnica (β = 0,41; promjena R2 = 0,171; P < 0,001), dok je učinak pušenja na koncentracije triglicerida, kao i na ostale ispitane metaboličke parametre, u bolesnika i bolesnica, ostao izvan granica statističke značajnosti (P > 0,05). Zaključak: Na temelju naših rezultata, možemo zaključiti da pušenje ne utječe na koncentracije lipida i glukoze u plazmi te vrijednosti BMI-a niti u bolesnika, niti u bolesnica sa shizofrenijom., Aim: Schizophrenia is associated with a high rate of nicotine dependence as well as with a high prevalence of metabolic syndrome. However, little is known about the influence of smoking on components of metabolic syndrome in this illness. In the current study we aim to investigate whether, and to what extent, smoking may contribute to plasma lipid and glucose concentrations and body mass index (BMI) values in Croatian patients with schizophrenia. Patients and methods: Our study comprised 263 chronically ill patients (males/females: 139/124) who met criteria for schizophrenia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Smokers were defined as individuals who smoked more than one cigarette each day for more than one year, and nonsmokers were defined as those who had smoked fewer than 100 cigarettes during their lifetime. Results: Although an elevated smoking rate was detected (males: 70.5%; females: 60.5%), we did not observe significant differences in plasma lipid and glucose concentrations and BMI values between male smokers and nonsmokers; whereas, among females, we revealed variations only in triglyceride concentrations according to the smoking status. In particular, triglyceride concentrations were slightly higher among female smokers than among nonsmoking females (1.6 ± 0.7 vs. 1.3 ± 0.5; F = 4.25, P = 0.042). However, multiple regression analysis revealed that only age was a significant predictor of triglyceride values in females (β = 0.41, R2 change = 0.171, P < 0.001), whereas the influence of smoking on triglyceride values as well as on other investigated metabolic parameters was not statistically significant, neither among males, nor among females (P > 0.05). Conclusion: According to our results, we may conclude that smoking does not influence plasma lipid and glucose concentrations and BMI values neither among male nor among female patients with schizophrenia.

INTRODUCTION: The release of arachidonic acid (20:4n-6, ARA) from membrane phospholipids via the activation of phospholipase A2 (PLA2) enzymes is thought to be involved in dopaminergic signaling and insulin secretion. Altered dopaminergic neurotransmission, disturbances of glucose and lipid metabolism and increased PLA2 activity are repeatedly observed in schizophrenia patients. The rs10798059 (BanI) and rs4375 polymorphisms in (PLA2)G4A and PLA2G6 genes have proved to be relevant in etiology and clinical expression of schizophrenia, as measured by the Positive and Negative Syndrome Scale and/or the age of disease onset. AIM: We investigated whether fasting plasma lipid and glucose concentrations might be influenced by rs10798059 (BanI) and rs4375 polymorphic variants among chronically ill Croatian schizophrenia patients. PATIENTS AND METHODS: Genotyping was performed by polymerase chain reaction/restriction fragment length polymorphism analysis for 263 patients (males/females: 139/124). RESULTS: Total cholesterol and LDL cholesterol concentrations in females and triglyceride levels in males were slightly elevated relative to the reference values, and mean body mass index values were in the overweight range in both genders. We revealed no significant association between PLA2G6 polymorphism and plasma lipid and glucose concentrations neither among male, nor among female patients, whereas the PLA2G4A polymorphism significantly contributed to plasma glucose levels in female patients only. Specifically, females carrying the PLA2G4A-G allele (PLA2G4A-GG homozygous and PLA2G4A-AG heterozygous) had lower glucose levels than PLA2G4A-AA homozygous carriers (5.5 ± 0.8 vs. 6.6 ± 2.0 ; F = 13.03, P < 0.001). The PLA2G4A genotype accounted for approximately 6% of the variability in glucose levels. CONCLUSION: BanI polymorphism in the PLA2G4A gene has significant, although weak influence on plasma glucose levels among female patients, yet it does not affect any other metabolic parameters, neither among males, nor among females. Finally, the rs4375 (PLA2G6) polymorphism does not contribute to lipid or glucose concentrations in the patient group.

Opraštanje sebi definira se kao strategija koja uključuje pomak ka pozitivnijem samopoimanju osobe kako bi se razriješio emocionalni stres (npr. u vidu krivnje, srama, ljutnje, žaljenja i razočaranja) koji dolazi iz percipiranog nesklada između vrijednosti do kojih osoba drži i njezinog ponašanja. Proces iskrenog opraštanja sebi uključuje suočavanje usmjereno na emocije (npr. regulacija osjećaja srama), kao i suočavanje usmjereno na problem u vidu promjene ponašanja koje je dovelo do nesklada s vrijednostima osobe. Sram je specifični emocionalni odgovor koji se često javlja kod osoba koje zloupotrebljavaju alkohol vezano za štetna ponašanja počinjena pod utjecajem sredstava ovisnosti ili zloupotrebe same po sebi te se generalno fokusira na samu osobu (npr. „Ja sam loša osoba“). Osjećaj srama posebno je štetan za samopoštovanje osobe, dovode do povećane razine negativnog afekta i alkoholne žudnje te može povećati sklonost osobe da konzumira sredstva ovisnosti u pokušaju suočavanja s tim osjećajem. U Psihijatrijskoj bolnici Rab provedeno je istraživanje (N=60) na uzorku pacijenata na liječenju od poremećaja uzimanja alkohola kako bismo ispitali povezanost crte opraštanja sebi s razinom osjećaja srama, ruminacijama o pijenju alkohola, negativnim afektom i alkoholnom žudnjom tijekom tretmana. Također, ispitali smo razlike u negativnom afektu i alkoholnoj žudnji između grupa pacijenata podijeljenih po stupnju opraštanja sebi. Ovom poster prezentacijom izvještavamo o rezultatima našeg istraživanja. Cilj nam je istaknuti važnost opraštanja sebi u tretmanu poremećaja uzimanja alkohola i terapijskih postupaka koji podržavaju ovaj proces radi poboljšavanja ishoda liječenja.

Cilj ovog rada je bio prikazati kako se psihički i psihosomatski simptomi mogu shvatiti deskriptivno ali i kao simboli koji imaju svoju poveznicu sa životnim iskustvima, posebice onim traumatskim. U tom smislu simptomi / simboli imaju poveznicu sa dubljim psihološkim značenjem. Put do ovog cilja vodi kroz prikaz slučaja šezdesetogodišnje bolesnice u koje je dvadesetak godina prisutna klinička slika sa smetnjama iz kruga depresije, a zadnjih pet godina i ponašajni obrasci koji govore za poremećaj ličnosti. Simptomi koje navodi prilikom nedavne hospitalizacije imaju konverzivne značajke i psihotični nivo. Učinjena dijagnostička obrada je isključila tjelesna oboljenja kao mogući uzrok duševnih tegoba. Psihijatrijska anamneza je govorila u prilog zapostavljanja i zlostavljanja tijekom djetinjstva (moguće i seksualnog) te odrastanju u narušenim obiteljskim okolnostima. U somatizacijama i sumanutostima koje je bolesnica iznosila ležala je skrivena simbolika trpnje koju nije mogla izraziti i stoga ju je potisnula u nesvjesno. U pacijentice je prisutna snažna poveznica između traumatskih iskustava u djetinjstvu i nabrojenih psihičkih simptoma/simbola koji nam mogu pomoći u razumijevanju psihopatoloških fenomena i njihovog značenja, te otvoriti put u nesvjesno.

Objective: Patients with schizophrenia are more likely to be smokers than the general population, which makes them an interesting group with which to study the etiology of nicotine dependency. We studied the prevalence of a gene variant of peroxisome proliferator-activated receptor alpha (PPAR alpha) in schizophrenia, together with nicotine dependency, to investigate whether the PPAR alpha-L162V polymorphism (rs1800206) influences nicotine dependency in schizophrenia. Given evidence suggesting that smoking influences the severity of schizophrenia, together with our recent data linking the PPAR alpha-L162V polymorphism to clinical manifestations of schizophrenia (in the Croatian population), we hypothesized that interactions between the two (smoking and the PPAR alpha-L162V polymorphism) might contribute to disease onset and scores for the Positive and Negative Syndrome Scale. To the best of our knowledge, this is the first study to investigate the possible associations between the PPAR alpha gene and nicotine dependency. Patients and methods: Genotyping was performed for 267 chronically ill schizophrenia patients (males/females: 140/127) by polymerase chain reaction. Results: A significant excess of PPAR alpha-L162V genotypes and PPAR alpha-162V alleles were detected among female smokers in comparison to female nonsmokers (18.2% vs. 2.0%, and 9.1% vs. 1.0%, p < 0.01, respectively). We also revealed a significant PPAR alpha genotype smoking interaction that predicted positive symptom severity among male patients (F = 4.43, p < 0.05). These data indicated that the PPAR alpha-L162V heterozygous genotype, depending on smoking status, might be of relevance as either protective, or a risk factor, for the severity of positive symptoms. No interaction between the PPAR alpha-L162V polymorphism and smoking for the time of onset of schizophrenia was detected (p > 0.05, respectively). Conclusion: We demonstrated two significant yet weak effects. The first showed an effect of the PPAR alpha-L162V polymorphism on the risk of nicotine dependency. The second linked the PPAR alpha genotype smoking interaction to positive symptoms severity among schizophrenia patients ; both effects manifested in a gender-specific fashion.

Cilj: Studije koje su istražile povezanost između kliničkih značajki shizofrenije i ovisnosti o nikotinu rezultirale su proturječnim rezultatima, a velik je broj istraživanja uključio samo muške pacijente u analizu. S obzirom na to da slične studije nisu provedene u našoj populaciji, ispitali smo pridonosi li i u kojoj mjeri ovisnost o nikotinu u pacijenata sa shizofrenijom u hrvatskoj populaciji dobi nastupa bolesti i težini kliničkih simptoma ocjenske ljestvice PANSS-a (engl. Positive and Negative Symptom Scale). Ispitanici i metode: U istraživanju je sudjelovalo 265 pacijenata (muškarci/žene: 140/125). Dob prve hospitalizacije u sklopu koje je postavljena dijagnoza shizofrenije uzeta je kao približna dob početka bolesti, a evaluacija PANSS psihopatologije provedena je u akutnoj fazi bolesti tijekom posljednje hospitalizacije. Pacijenti su podijeljeni u skupinu pušača, koji puše najmanje jednu cigaretu dnevno u periodu duljem od godine dana, i skupinu nepušača, koji nikada tijekom života nisu pušili. Rezultati: Ovisnost o nikotinu, pronađena u otprilike dvije trećine pacijenata (muškarci: 70,7 %, žene: 62,4 %) dvostruko je češće zastupljena u odnosu na opću hrvatsku populaciju. Vrijednosti simptoma PANSS psihopatologije nisu se znatnije razlikovale između pušača i nepušača, niti kod pacijenata, niti kod pacijentica (P > 0,05), dok je dob prve hospitalizacije pokazala značajnu povezanost s ovisnosti o nikotinu isključivo u pacijenata. Uočeno je da muškarci koji puše obolijevaju značajno ranije u odnosu na muškarce nepušače (25,3 ± 6,8 vs. 28,8 ± 9,3; F = 5,15, P = 0,025). Pušenje pridonosi dobi prve hospitalizacije u muških pacijenata s približno 4 % (β = -0,21; promjena multiplog R2 = 0,04; P = 0,024). Zaključak: Ovisnost o nikotinu pridonosi u manjoj mjeri ranijoj pojavi bolesti u muškaraca, ali nije povezana s težinom simptoma ocjenske ljestvice PANSS-a niti u pacijenata niti u pacijentica., Aim: Studies investigating the association between clinical features of schizophrenia and nicotine dependence have yielded contradictory results, and the majority of them included only male patients in the analysis. Since similar studies have not been performed in our population, we investigated whether, and to what extent, the nicotine dependence might contribute to age of onset and data of Positive and Negative Symptom Scale (PANSS) psychopathology, among schizophrenia patients in the Croatian population. Patients and methods: The study comprised 265 patients (males/females: 140/125). Age at first hospital admission, at which the diagnosis of schizophrenia was used, was determined as the age of onset, while evaluation of PANSS psychopathology was performed during an acute illness state at the time of last hospital admission. Smokers were defined as persons who smoked more than one cigarette daily for more than one year, and nonsmokers were defined as persons who never smoked in their life. Results: Nicotine dependence, revealed among approximately two-third of patients (males: 70.7%, females: 62.4%), is twice as frequent as in the general Croatian population. PANSS psychopathology scores did not differ significantly between smokers and nonsmokers, neither among males, nor among females (P > 0.05), while nicotine dependence was significantly associated with the age at first hospital admission only among male patients. It has been detected that male smokers had a significantly earlier onset when compared to male nonsmokers (25.3 ± 6.8 vs. 28.8 ± 9.3, F = 5.15, P = 0.025). The nicotine dependence contributed to the age at first hospitalization among male patients by approximately 4% (β = -0.21; multiple R2 change = 0.04; P = 0.024). Conclusion: Nicotine dependence may contribute, to a smaller extent, to an earlier onset among males, while it is not associated with severity of PANSS psychopathology neither among male, nor among female patients.

U ovom radu će biti prikazan slučaj dvadesetšestogodišnje bolesnice kod koje se razvijala klinička slika sa polimorfnim simptomima koji su odgovarali i psihotičnom i neurološkom poremećaju ali i razvojnim smetnjama. Anamnestički podaci su govorili u prilog zlouporabi sredstava ovisnosti (alkohol, ketamin) ali jednako tako i o disfunkcionalnim obiteljskim okolnostima u kojima je odrastala. Dijagnostika je obuhvaćala somatsku i psihologijsku obradu. Nerijetko nailazimo na pacijente koji imaju miješane kliničke slike i ponekad je vrlo teško postaviti preciznu dijagnozu posebice kada je riječ o mogućim multiplim etiološkim čimbenicima.

The need for mental health care and well being has been neglected fro a long time as well as the relationship of mental health with other health problems. The global availability and quality of health care services is still not sufficient or balanced. Awareness of mental health should be integrated in all aspects of health care and social welfare policy.

BACKGROUND: Alzheimer's disease can be a result of an age- induced disparity between increase in cellular metabolism of Aβ peptides and decrease in maximal activity of a membrane-embedded protease γ-secretase. RESULTS: We compared activity of WT γ-secretase with the activity of 6 FAD mutants in its presenilin-1 component and 5 FAD mutants in Aβ-part of its APP substrate (Familial Alzheimer's disease). All 11 FAD mutations show linear correlation between the decrease in maximal activity and the clinically observed age-of-onset and age- of-death. Biphasic-inhibitors showed that a higher ratio between physiological Aβ- production and the maximal activity of γ- secretase can be observed in cells that can facilitate pathogenic changes in Aβ-products. For example, Aβ production in cells with WT γ- secretase is at 11% of its maximal activity, with delta-exon-9 mutant at 26%, while with M139V mutant is at 28% of the maximal activity. In the same conditions, G384A mutant is fully saturated and at its maximal activity. Similarly, Aβ production in cells with γ- secretase complex carrying Aph1AL component is 12% of its maximal activity, while in cells with Aph1B complex is 26% of its maximal activity. Similar to the cell-based studies, clinical studies of biphasic dose-response in plasma samples of 54 healthy individuals showed variable ratios between physiological Aβ production and the maximal activity of γ- secretase. CONCLUSIONS: The increase in the ratio between physiological Aβ production and maximal activity of γ- secretase can be an early sign of pathogenic processes in enzyme-based, cell-based, and clinical studies of sporadic and Familiar Alzheimer's disease.

Multiple sclerosis is the most common chronic disease which is disabilitating younger adult population, and disease with unpredictable and very different neurological symptoms and increasing disability. In this paper we have tried to develop the theme of multiple sclerosis as a traumatic event, the correlation of multiple sclerosis and psycho trauma, what are the psychological symptoms of multiple sclerosis, and what is the role of the helping and the family in caring for a person suffering from multiple sclerosis and also the concept of social welfare., Multipla je skleroza najučestalija kronična onesposobljavajuća bolest u mlađoj odrasloj populaciji s nepredvidivim i vrlo različitim neurološkim simptomima i rastućom onesposobljenosti. U ovom smo preglednom radu pokušali razraditi temu multiple skleroze kao traumatskoga događaja, tj. povezanost multiple skleroze i psihotraume, psihičke simptome multiple skleroze te ulogu pomažućih i obitelji u brizi za osobu oboljelu od multiple skleroze kao i koncept društvene skrbi.

Kontekst: Tjelesna aktivnost ima pozitivan učinak na različite simptome shizofrenije, a naš je cilj utvrditi kako utječe na emocionalni aspekt, na redukciju anksioznih i depresivnih doživljaja kod shizofrenih bolesnika. Metoda i ispitanici: Sudjelovalo je 38 bolesnica oboljelih od shizofrenije; stupanj anksioznosti i depresije mjereni su prije i nakon šestotjednog vježbanja, intenziteta primjerenog dobi i tjelesnoj spremi (rekreacijsko hodanje, vježbe razgibavanja i aerobik). Rezultati: Utvrđeno je značajno smanjenje depresivnih simptoma kod bolesnica s utvrđenom povišenom razinom depresije u sve tri skupine vježbanja te kod bolesnica s izraženijim anksioznim doživljajima u skupini vježbi razgibavanja. Zaključak: Fizička aktivacija povoljno utječe na raspoloženje minimizirajući karakteristike depresije te pridonosi rehabilitaciji i resocijalizaciji shizofrenih bolesnica., Context: Physical activity positively aff ects diff erent symptoms of schizophrenia. Our goal is to establish its eff ect on emotional aspects on reduction of anxiety and depressive feelings in patients with schizophrenia. Method and subjects: Th e subjects were 38 female patients with schizophrenia, degree of anxiety and depression were measured before and after sixweek - period of exercise. Exercise intensity was adjusted to individual age and physical fitness (recreational walking, stretching exercises and aerobic). Results: Depressive symptoms were considerably reduced in patients with established high degree of depression in all three groups of exercises and in patients with more pronounced anxiety in the stretching group. Conclusion: Physical activation positively aff ects mood by minimizing characteristics of depression and contributes to rehabilitation and resocialization of patients with schizophrenia.

OBJECTIVE: To investigate the possible influence of hemochromatosis gene mutations (HFE-C282Y and H63D) and transferrin gene C2 variant (TF-C2) on susceptibility to schizophrenia and schizoaffective disorder and/or age at first hospital admission. METHODS: Genotyping was performed in 176 Croatian patients and 171 non-psychiatric Croatian controls using PCR-RFLP analyses. RESULTS: Allele and genotype distributions were not significantly different between two groups. After the age at first admission was analyzed as a continuous variable using the non-parametric Mann-Whitney U-test and Kruskal-Wallis test with negative results, the variable was dichotomized using 40 years as the cutoff. H63D-TFC2 bi-carriers were over-represented among patients in the late disease-onset group [≥ 40 years ; 7.5% vs. 25%, odds ratio (OR) = 0.243, 95% confidence interval (CI) = 0.068-0.871 ; P=0.030]. Multiple regression analysis showed no effect of combined H63D-TFC2 genotype to distribution of age at disease-onset in our sample. CONCLUSION: Investigated HFE mutations and TF-C2 variant are not high-risk genetic variants for schizophrenia/schizoaffective disorder in our population. Also, our data do not support their impact on age at onset of the first psychotic symptoms.

Context: Physical activity positively affects different symptoms of schizophrenia. Our goal is to establish its effect on emotional aspects on reduction of anxiety and depressive feelings in patients with schizophrenia. Method and subjects: Th e subjects were 38 female patients with schizophrenia, degree of anxiety and depression were measured before and after six- week-period of exercise. Exercise intensity was adjusted to individual age and physical fitness (recreational walking, stretching exercises and aerobic). Results: Depressive symptoms were considerably reduced in patients with established high degree of depression in all three groups of exercises and in patients with more pronounced anxiety in the stretching group. Conclusion: Physical activation positively affects mood by minimizing characteristics of depression and contributes to rehabilitation and resocialization of patients with schizophrenia.

Knjiga je namijenjena onima koji žele naučiti hrvatsko znakovno medicinsko nazivlje kako bi mogli komunicirati s gluhim pacijentima u ambulantama i drugim zdravstvenim ustanovama.

Empatija predstavlja indirektni doživljaj tuđih emocija i ključna je za mnoge oblike adaptivnih socijalnih interakcija. Postoji kognitivna i emocionalna komponenta empatije. Kognitivna komponenta je bliksa teoriji uma ili sposobnosti mentalne predodžbe mentalnih procesa drugih osoba. To je oblika socijalne kognicije ki+oji dozvoljava procjenu tuđeg emocionalnog stanja kako bi stvorili odgovarajuću emocionalnu reakciju. Emocionalna komponenta empatije uključuje aktualnu emocionalnu reakciju. Aspekt emocija je vrlo bitan budući da motivira socijalno ponašanje i odgovarajući moralni razvoj te destimulira antisocijalno ponašanje. Istraživanja ukazuju da empatija ima mnoštvo korisnih učinaka na stavove i ponašanje. Empatija je sagledana kao inhibitor agresivnog i nasilnog ponašanja. CIlj rada je bio ispitati možemo li psihoterpijskim postupcima utjecati na poboljšanje empatijskih kapaciteta a time i na korekciju ponašanja. Uzorak čine pacijenti forenzičkog odjela kod kojih je ispitvana empatija tijekom dvije godine a bili su u terapijskom i socioterapijskom tretmanu.

Project co-financed by the European Social Fund and the state budget of the Czech Republic.

The main aim of this study has been to perceive the state of mentally ill stateless person hospitalized in Psychiatric Hospital Rab, Croatia with forensic status. This is a case report on such a person, F.V., 25 years old female, with no documents and other affirmed auto and heteroanamnestic data. Her psychical state and ability of communication do not allow realization of certain autoanamnesis and at the same time she has no family or relatives to give heteroanamnestic data. It is also unknown exact date and place of birth. Only certain data were that she lived in many orphanages, refugees camps and communes in several European countries. She immigrated illegally in Croatia where she has made some criminal acts and earned forensic status. WE tried to evaluate the complex status of our patient from several points of view and tried to answer to the questions where to start and what to do with such a person to do the best for her and including her human rights. As a conclusion, we could say that holistic and individual approach to such patients has been necessary with engagement of many profiles of professionals.

This paper evaluates and compares basic emotional reactions towards the illness, as well as the quality of life in relation to the various types of treatment of isolated long tubular bone fractures of extremities in children and adolescents. This prospective clinical research comprehends 135 patients (94 males and 41 females), aged 10 to 18, treated for the mentioned bone fractures in the period from October 2003 till March 2005 at The Departments for Pediatric Surgery of three hospitals: the Clinical Hospital Centre in Rijeka (88.8% of the patients), the Clinical Children's Hospital in Zagreb (9.7% of the patients) both in Croatia, and 1.5% of the patients in the Clinical Hospital in Mostar (Bosnia and Herzegovina). 53.3% of the patients were treated conservatively, 29.6% of them underwent the elastic stable intramedullary nailing (ESIN), while the remaining 17.1% of the patients were treated with other surgical techniques (AO-plates or Kirschner-wire ostheosyntheses). The basic methods were self-reported questionnaires: the Spielberg State Trait Anxiety Inventory (STAI1) to establish momentary anxiety and the Short Form-36 Health Survey (SF-36) to evaluate quality of life, i.e. the perception of the illness during treatment. The STAI1 was administered twice to the patients: within 1 week of the experienced trauma (at baseline) and 6 months after the trauma, whereas the SF-36 was administered only once, i.e. a month after the experienced trauma. Our results point at an increased anxiety indicators in all the patients immediately after the experienced trauma, mostly in patients treated surgically, especially those who underwent the ESIN method ; whereas after 6 months from the experienced trauma the anxiety indicators were greatly reduced. The quality of life was better in patients who underwent a conservative treatment, both physically and mentally, than in those surgically treated. This points to the fact that the surgical method itself despite its type, is an additional stressor which causes additional anxiety and depressive reaction. Our results suggest (from psychological point of view) that the conservative method of treating long bone fractures in children. and adolescents should be used since it causes less emotional reactions on the illness ascertaining a better health experience during the treatment than the active surgical treatment (regardless of the type), which should be practised with criticism and according to strict surgical indications. If the surgical treatment should be necessarily adopted, we should take into consideration the possibility of psychologically preparing the patients in order to diminish the psychological reaction on the surgical treatment.

Health related quality of life in drug addicts.

Quality of life of higher ranking rank and fiel policemen of the police was examined and compared within multinational study. Results were discussed.

Questionnaire for crosscultural examination od Quality of life was constructed and translated.

U kriminološkim studijama, unatoč pragmatični postavljenim dobnim granicama, postoji problem razgraničenja uzroka između kaznenog djela te, dobi uvjetovanom, specifičnosti ponašanja. S obzirom da je granica biološke i kronološke dobi, te s tim u svezi involutivnih promjena, vrlo individualno i gotovo administrativno postavljena, još je kompleksniji problem razgraničenja fizioloških od patoloških psihičkih promjena u starosti te njihovog forenzičko-psihijatrijskog značaja, kako u diajgnostici tako i u terapiji. Imajući u vidu moguće specifičnosti delikvencije starije dobi, napravljena je longitudinalna analiza hospitaliziranih bolesnika na Odjelu za forenzičku psihijatriju Psihijatrijske bolnice Rab, tijekom 12 godina. Cilj rada bio je utvrditi specifičnosti forenzičke populacije starije dobi kako bi se mogao planirati, usmjeriti i evaluirati tretman.

In this article authors analyzed two groups of male forensic inpatients currently treated in one of the forensic departments in our country: the first group comprehended inpatients with violent and deliquent behavioural patterns that were registered during forensic treatment (N=28), and the second group comprehended inpatients without excess behavioural patterns (N=44). The object of the study was to analyze the phenomenology of violent and deliquent behavior during forensic treatment and possible correlation between violence and present psychopathology especially according to axis II of DSM-IV classification. The paper has used all the relevant anamnestic data taken from medical documentation and the terapeutic team regular reports and protocols. The results of the research showed that the group of inpatients with violent and deliquent behavior patterns was mostly young-aged, a notable number of patients meet the criteriaof personality disorder especilly antisocial and borderline type, and have a significant number of previous penal sentences. Anamnestic data and clinical observation showed also a long duration of alcohol and drug abuse among them. In the group of violent and deliquent inpatients the most frequent excess behavioral patterns during the forensic treatment were larency, threat and extortion (51, 95%)and aggressivness toward the other inpatients (18, 18%). during the observed period there were 8 escapes from the forensic department that emphazied necessary assessment of security risk before admission. Other deliquent non-violent behavioural patterns were therapy rejection (38, 23%), misuse of therapeutic leave (26, 47%)and alchocol abuse. Evaluation of behavioural before forensic treatment points out that forensic inpatients with previous criminal life style, i.e. violent and deliquent behaviour, demonstrate progression of criminal behaviour before admission and criminal recidivism during treatment.

The autors showed a legal and psychiatric connection of the term "the other psychological disturbances" and basis of psychiatric as forensic judgement of mental capacity in this situation. A short historical overwiew of development of forensic evaluation of the mental capacity has been given in regards to above mentioned group of disturbances. This has been accepted by the new criminal legislation and by the Law on Protection of Persons with Psychological Disturbances. Consenquetly, we are facing the need to define the term in detail and to operate it in practice according to mutual understanding of forensic psychiatrists and jurists. To operate the term in practice presents a dimesional approach to the judgement. The autors in conclusion discuss possible problems and restrictions concerning the definition and delivering of psychiatric as forensic judgement in evaluation of the mental capacity in case of "severe psychological disturbances".

Autori su prikazali nove zakonske regulative u Republici Hrvatskoj uz osvrt na provedbu terapijskih izlazaka forenzičkih bolesnika. Anmalizirali su provedene terapijske izlaze tijekom dvije godine u jednoj od četiri ustanove gdje se takav tretman provodi. U kritičnom osvrtu na rezultate dobivenog istraživanja autori su izdvojili najznačajnije čimbenike u predikciji opasnosti od kriminalnog recidivizma.

A critical review is presented of the provisions of the new Croatian penal legislatude and Act on the Protection of Persons with Mental Disorders relevant for psychiatric practice, and the practical implementation of these laws which became operative in the Republic of Croatia in January 1, 1998. The very text of the acts revelals some major problems, i.e.: - abscense of clear criteria for precise quantification accountability has been abolished in the new Penal Code ; - insufficient differntiation between the category of patients admitted to hospital "without consent", patients hospitalized for a high level of threat to their environment of themselves and patients admitted as forensic patients who effectuated the caracteristics of a criminal act in the state of inaccountability - a fialure to carry out the security measure of compulsory psychiatric treatment because there is still no institution on the Republic of Croatia in wich this measure could be carried out. Beside describing the major difficulties in the implementation of the new Croatian psychiatric legislature, a series of suggestions to overcome them promptly and properly are offered.

Od siječnja 95. godine u primjeni je zakon o zaštiti osoba sa duševnim smetnjama koji je sa sobom donio niz promjena u organizaciji i radu psihijatrijske službe. U ovom radu dati ćemo epidemiološki prikaz prisilnih hospitalizacija na Kliničkom odjelu opće psihijatrije Psihijatrijske bolnice Vrapče i Psihijatrijske bolnice Rab u periodu od 1. siječnja 1998. godine do 1. srpnja 1998. godine. Istraživanjem su obuhvaćeni svi bolesniciprisilno hospitalizirani na Kliničkom odjelu opće psihijatrije Psihijatrijske bolnice Vrapče (njih 120) i Psihijatrijske bolnice Rab (njih 140), u promatranom periodu od šest mjeseci. Izvor podataka je medicinska dokumentacija koja se vodi za svakog bolesnika, te odluka Suda o prisilnoj hospitalizaciji. Bolesnici su analizirani s obzirom na sociodemografske podatke, te član Zakona po kojem je prisilna hospitalizacija provedena. Podaci su prikazani pomoću grafikona i tablica. Također su podaci uspoređeni i sa rezultatima istraživanja provedenog u Psihijatrijskoj bolnici Vrapče u siječnju 98. godine, odnosno u prvom mjesecu provedbe Zakona. Dobiveni rezultati upotpunjavaju spoznaje i obogaćuju iskustvo o primjeni Zakona o zaštiti osoba s duševnim smetnjama, a s posebnim osvrtom na pitanje prisilne hospitalizacije.

In this study the rate of escapes of forensic inpatients from the Rab Psychiatric Hospital during the period form January 1, 1993 till December 31, 1997, was analyzed. Thirteen of 87 inpatients (14, 94%) tried to escape, 8 of them on several occasions. Most of ascaped inpatients manifested early criminal tendencies, insufficiency of social and moral standards, significant personality imparment and alcohol abuse. The escapes were most frequently initiated within the hospital area ; a significant proportion was related to the loss of cognitive control, however, the number of instrumental escapes was also quite high. There appears to be an extremely high-risk group in the population of forensic inpatients requiring a higher level of security in forensic departments because of the real possibility and risk of relapse.

The paper discusses some issues that have occurred in forensic psychiatry practice after the adoption of the new Act on Care of Persons with Mental Disorders on January 1, 1998.

In the last decade, bolus death as one of the causes of sudden death in neurologic and psychiatric patients has been even more increasingly reported. In this study, cases of bolus death in psychiatric patients treated at the Rab-Kampor Psychiatric Hospital, recorded between 1961 and 1995 were retrospectively analyzed. Very careful follow-up of the patient, his nutritional habits, clinical picture and numerous situational factors is an important predictor of the patient`s belonging to the risk group for possible bolus death. Techinical equipment and appropriate staff training and readiness for emergency interventions in case of retained bolus are important for reducition of lethal autcome in cases of food suffication.

Analizirana je skupina bolesnika, počinitelja intrahospitalnih suicida u specijalnoj psihijatrijskoj bolnici kroz vremenski period od 35 godina. U promatranom periodu primljeno je ukupno 23.990 bolesnika, umro je 801 bolesnik, a izvršeno je 27 suicida. Analizom svih anamnestičkih podataka te ostalih podataka sadržanih u medicinkoj dokumentaciji utvrđen je visok udio psihotičnih bolesnika među počiniteljima suicida u odnosu na nepsihotične, a osobito visok udio u odnosu na shizofrene bolesnike. Iz dobivenih rezultata studije autori zaključuju da su intrahospitalni bolesnici počinitelji suicida uglavnom srednje i više životne dobi, imaju hereditarnu opterećenost duševnim bolestima, alkoholizmom ili pak suicidom. Najčešće su to samci, osobe s lošim ili nikakvim obiteljskim vezama, bez djece. Nije nađena statistička znmačajnost glede tipa odjela na kojem su bolesnici suicidanti boravili te mejsta i načina izvršenja suicida. Prema trajanju hospitalizacije do momenta suicida utvrđena je osobita rizičnost prvih tjedan dana hospitalizacije, međutim, istraživanje je pokazalo da i dugotrajna hospitalizacija ne isključuje mogućnost sucida. Među ostalim faktorima rizika značajni su višekratne hospitalizacije te raniji pokušaji suicida. Istraživanje je pokazalo da očekivanost sucida i njegovo izvršenje nisu u korelaciji, odnosno da se većina suicida događa iznenada i neočekivano, što nadalje iziskuje posebnu pažnju i iskustvo cjelokupnog terapijskog tima u cilju moguće prevencije.

Cilj ovog rada jest analizirati, iz filozofske perspektive, znanstvenu utemeljenost konstrukta psihopatije mjerenog pomoću alata Psychopathy checklist revised kojeg je razvio Robert Hare (1991 ; 2003). Znanstvena utemeljenost i opravdanost različitih klasifikacija tema je brojnih rasprava unutar filozofije znanosti te filozofije psihijatrije. Osnovni problem koji se razmatra u ovim raspravama jest reflektiraju li pojedine klasifikacije prirodne vrste te se u njima pojam prirodne vrste odnosi na postojanje objektivnih podjela u prirodi koje ne ovise isključivo o subjektivnim prosudbama onih koji su navedene klasifikacije predložili. Konstrukt psihopatije je u kontekstu navedene rasprave posebno interesantan jer navedena dijagnoza podrazumijeva značajne društvene posljedice. Vodeći se recentnim raspravama o problemu prirodnih vrsta u filozofiji psihijatrije oslanjamo se na distinkciju između dvije varijante znanstvenih kategorija ili vrsta: prirodne vrste i praktične vrste. Prirodnim vrstama smatramo one kategorije koje su ujedinjene zajedničkim kauzalnim mehanizmima ili svojstvima, a praktičnim vrstama one koje ispunjavaju praktične ciljeve postignute klasifikacijom, prvenstveno mogućnost predviđanja. U tom kontekstu, mi argumentiramo kako konstrukt psihopatije može igrati ulogu praktične vrste, ali nam trenutne znanstvene spoznaje o fenomenu psihopatije ne dopuštaju da zaključimo da se ujedno radi i o prirodnoj vrsti.

U prvom dijelu istraživanja sudjelovalo je 500 bolesnika s AHI>5, koji su procijenjeni cjelonoćnim PSG-om te ESS, PSQI i STOP upitnicima. Ukupno 328 kontrolnih ispitanika prikupljeno je retrospektivno. Cilj istraživanja bilo je procijeniti doprinos ukupnih polisomnografskih odrednica i doprinos isključivo stadija spavanja prekomjernoj dnevnoj pospanosti procjenom ESS upitnika te ukupnoj kvaliteti spavanja procjenom PSQI upitnika, ovisno o stadiju ozbiljnosti OSA-e. Dodatni cilj istraživanja bila je procjena psihometrijskih značajki hrvatske inačice PSQI upitnika te usporedba polisomnografskih značajki u bolesnika s obilježjima dobre i loše kvalitete spavanja. U uzorku umjerene i teške OSA-e nije bilo moguće na temelju polisomnografskih odrednica spavanja niti na temelju raspodjele stadija spavanja, objasniti kvalitetu spavanja procijenjenu PSQI upitnikom. Na temelju polisomnografskih odrednica spavanja moguće je objasniti 7,1% varijabiliteta prekomjerne dnevne pospanosti procijenjene ESS upitnikom u bolesnika s blagom i 13,5% u bolesnika s umjerenom OSA-om. U bolesnika s teškom OSA-om nije moguće predvidjeti vrijednosti ESS upitnika na temelju modela polisomnografskih odrednica spavanja. Zadovoljavajuća psihometrijska obilježja PSQI upitnika omogućila su predviđanje učinkovitosti spavanja veće od 85% utvrđene polisomnografijom na temelju vrijednosti PSQI upitnika 6,5 koja je pokazala najveću osjetljivost i specifičnost. Bolesnici s obilježjima dobre i loše kvalitete spavanja razlikovali su se u ukupnom vremenu spavanja, vremenu NREM spavanja, vremenu budnosti tijekom spavanja, budnosti nakon prvog usnivanja, ukupnom vremenu budnosti i učinkovitosti spavanja. Bolesnici s OSA-om imali su lošije pokazatelje kvalitete spavanja mjerene PSQI indeksom u usporedbi sa zdravim kontrolnim uzorkom. U drugom dijelu istraživanja sudjelovala su 103 muška bolesnika Centra za medicinu spavanja i 103 kontrolna ispitanika uparena po dobi, spolu i ITM-u. Svi bolesnici procijenjeni su PG-om ili PSG-om, dok su kontrolni ispitanici procijenjeni STOP upitnikom. Svi sudionici istraživanja prošli su neuropsihologijsku procjenu kronometrijskim CRD instrumentom u zadacima različite složenosti. Bolesnici s OSA-om imali su najviše razlika u psihomotoričkim sposobnostima u odnosu na kontrolnu skupinu prilikom mjerenja brzine razlikovanja položaja signala (CRD311 testa), gdje su bolesnici s OSA-om bili sporiji u svim mjerama osim u najkraćem vremenu rješavanja testa. Na testovima brzine rješavanja problema bolesnici s OSA-om sporiji su u najkraćem vremenu rješavanja zadatka pojedinog testa, u prosječnom vremenu rješavanja testa te u pokazateljima završnog balasta ili završno izgubljenom vremenu uslijed fluktuacije brzine rješavanja istovrsnih zadataka u drugoj polovini testa. Na testovima složene psihomotoričke reakcije bolesnici s OSA-om sporiji su u odnosu na kontrolne ispitanike u najkraćem vremenu rješavanja zadatka pojedinog testa, ukupnom vremenu rješavanja testa te u završno izgubljenom vremenu u drugoj polovini testa., First part of the thesis included 500 respondents with AHI>5, assessed with STOP, ESS and PSQI questionnaires following PSG, and a total of 328 control respondents. The aim was to assess the contribution of PSG variables and sleep stages distribution to excessive daytime sleepiness and sleep quality, in various OSA severity groups. Additional aim was to assess the Croatian PSQI questionnaire and associate PSQI values with objective PSG data. Sleep stages and full PSG variables explained a significant amount of variability in sleep quality only in mild OSA. A total of 7,1% of variability in daytime sleepiness was explained by full PSG variables in mild OSA and 13,5% in moderate OSA, whereas daytime sleepiness in severe OSA was not associated with sleep stages distribution or full PSG data. Croatian PSQI enabled good and poor sleepers differentiation based on the score 6,5. Second part of the research included 103 male patients with AHI>15 and 103 controls assessed for the risk of OSA. All respondents went through neuropsychological assessment of reaction time in different complexity CRD tests. Participants from OSA group achieved impaired results in speed of solving simple arithmetic operations, complex psychomotor limbs coordination and visual discrimination task.

Unatoč povećanim rizicima i opterećenju tjelesnim komorbiditetima u oboljelih od poremećaja iz spektra shizofrenije (PSS-a), relativno se malo zna o kroničnom tjelesnom multimorbiditetu (KTM-u) u ovoj populaciji. Glavni je cilj istraživanja bio ispitati razlike u prevalenciji KTM-a u bolesnika mlađih od 35 godina s PSS-om u odnosu na opću populaciju (OP). Sporedni je cilj bio ispitati povezanost KTM-a s učinkom terapije za PSS mjerene brojem psihijatrijskih rehospitalizacija i upotrebom klozapina. U ovo ugniježđeno presječno istraživanje uključili smo 343 bolesnika s PSS-om i 620 sudionika iz OP-a. Primarni ishod bila je razlika u prevalenciji KTM-a u mlađoj dobnoj skupini (< 35 godina). Sekundarni ishod bio je broj psihijatrijskih rehospitalizacija nakon psihijatrijske dijagnoze. Utvrdili smo da mlađi bolesnici s PSS-om imaju gotovo tri puta veće izglede za KTM nego opća populacija. Prisutnost je KTM-a bila povezana s brojem psihijatrijskih rehospitalizacija, neovisno o mogućim zbunjujućim čimbenicima. Nismo uočili statistički značajne interakcije postojanja KTM-a i dobne skupine u predikciji upotrebe klozapina. Žene s PSS-om (< 35 godina) imale su statistički značajne, gotovo četiri puta veće izglede za KTM u odnosu na žene iz OP-a. Tjelesno zdravlje oboljelih od PSS-a treba biti u središtu pozornosti od prve pojave psihotičnih simptoma s ciljem poboljšanja ishoda psihijatrijskoga liječenja te prevencije pogoršanja tjelesnoga zdravlja., Despite the increased risks of medical comorbidities in patients with shizophrenia spectrum disorders (SSD), relatively little is known about a chronic physical multimorbidity (CPM) in this population. The main objective of the study was to explore the differences in the CPM prevalence between SSD patients and the general population (GEP). This nested crosssectional study enrolled 343 SSD patients and 620 GEP participants. The primary outcome was to explore the difference in CPM prevalence in the younger SSD and GEP groups (

Ova disertacija donosi filozofsku analizu prednosti i nedostataka potencijalne implementacije Revidirane liste simptoma psihopatije (dalje u tekstu PCL-R), mjernoga instrumenta psihopatije (vrste antisocijalnog poremećaja ličnosti), autora Roberta Harea, u sferu hrvatskoga pravnoga i zdravstvenog aparata. Navedeni instrument opisuje konstrukt koji tvore pojedinci s antisocijalnim i kriminalnim namjerama uz karakterističan profil ličnosti koji uključuje impulzivnost, kao i deficit emocionalnoga te empatijskog rezoniranja. Argumentiram da PCL-R treba biti uveden u hrvatski pravni i zdravstveni sustav kao dopunski alat postojećim mjernim instrumentima. Preciznije, posrijedi je rafiniraniji instrument detekcije specifične kategorije antisocijalnih pojedinaca, predikcije antisocijalnoga ponašanja i recidivizma u odnosu na aktualno upotrebljavanu klasifikaciju DSM-a (antisocijalni poremećaj ličnosti (ASPD)), odnosno klasifikaciju MKB-a (asocijalni poremećaj ličnosti (APD)). Nadalje, PCL-R potiče globalni razvoj znanstvene paradigme koja uvelike doprinosi važnomu razvoju istraživanja funkcionalnih, neuroloških, pa čak i genetskih osobitosti psihopata. Stoga bi potencijalno usvajanje takvoga mjernog instrumenta omogućilo prijenos i integraciju znanstvenih spoznaja u klinički relevantne institucije. Argumentiram da unatoč uvriježenomu kliničkom pesimizmu o psihopatiji znanstvene spoznaje i konceptualna pojašnjenja povezana s uporabom PCL-R-a nude optimističniji pogled na tretman i ophođenje sa psihopatskim pojedincima. Ističem da se PCL-R ne može upotrebljavati za isključivanje pojedinaca iz procesa kaznene odgovornosti. Zapravo, tvrdit ću da su psihopati, usprkos bitnim kognitivnim i ponašajnim odstupanjima, čije je ishodište neurološka disfunkcionalnost, kazneno odgovorni pojedinci. Jednako tako, apostrofiram stigmatizaciju kao opasnost koju sa sobom nosi potencijalna implementacija PCL-R-a. Posljedično ističem da je riječ o konstruktivnome alatu koji opravdava svoje uvođenje u hrvatsku pravnu i zdravstvenu praksu kao dopunski alat., This dissertation investigates, from a conceptual philosophical perspective, whether and how to introduce in the Croatian judicial and health system, the Psychopathy Checklist-Revised (from now on PCL-R), a measure of psychopathy, a type of antisocial personality disorder, developed by Robert Hare. This measure describes a construct that characterizes individuals with antisocial and criminal tendencies, and a typical personality profile that involves impulsivity, and diminished emotional and empathic responses. I argue that PCL-R should be adopted in Croatia as a valid supplement to currently adopted measures. It offers a more refined instrument for the detection of a specific group of individuals with antisocial personalities, and the prediction of antisocial behavior and recidivism, than the current measures of ASPD, that is based on the Diagnostic and Statistical Manual of Mental Disorders and APD, that is based on the International Classification of Diseases. Moreover, PCL-R has determined an internationally impactful scientific paradigm, that has enabled the vigorous investigation of functional, neural, and even genetic peculiarities of psychopaths. Thus, the adoption of this measure would enable the translation and use of this scientific information in relevant institutional practices. In particular, I will argue that, despite the tradition of therapeutic pessimism, scientific advancements and conceptual clarification authorise a more optimistic outlook on the possibility of intervention and management. I maintain that PCL-R should not be used as a ground for criminal exculpation. I argue that psychopathic individuals, despite significant cognitive and behavioral peculiarities, that seem to depend on neurological ones, should not be held unaccountable for their crimes based on this condition alone. I also highlight the dangers of stigmatization that this diagnosis brings. Consequently, I emphasize that it is a constructive tool that justifies its introduction into Croatian legal and health practice as a supplementary tool.

Multipla skleroza (MS) se odlikuje prisutnošću demijelinizacijskih upalnih žarišta, “ploča”, razasutih u bijeloj tvari središnjega živčanog sustava (SŽS). Trajna dinamika upalne autoimunsne aktivnosti u genetski predisponiranoj jedinki uvjetuje, pod utjecajem okolišnih čimbenika, pojavu uvijek novih oštećenja. Razasutost oštećenja u SŽS “u prostoru i vremenu” je temeljna patološka i dijagnostička karakteristika bolesti. Aktivacija T limfocita usmjerenih protiv antigena mijelina u SŽS-u ključni je fenomen u postanku oštećenja. Poremećaj sistema regulacije imunosti, te još nerasvijetljeni odnosi između selektivnog razaranja mijelina i apoptoze oligodendrocita uvjetuje razne imunohistološke i patoanatomske varijante MS. Simptomatologija MS je vrlo raznovrsna ; izražava se izoliranim ili združenim ispadima SŽS prvenstveno u mlade odrasle osobe. Svježi dijagnostički kriteriji dozvoljavaju postavljanje vrlo rane dijagnoze bolesti. Magnetska rezonanca je od temeljne važnosti u analizi bolesnika jer omogućava ranu dijagnozu i vrednovanje učinkovitosti terapije bolesti. Upalno i demijelinizacijsko žarište odgovorno za atake (relapse) bolesti, uzrokuje poremećaj živčane provodljivosti ; remisija omogućava procese remijelinizacije i funkcijske plastičnosti oštećenog SŽS ; progresija bolesti, bilo primarna bilo sekundarna, posljedica je difuznog i kroničnog oštećenja aksona te makroskopske atrofije živčane osi. Interakcija ataka i progresije modeliraju osnovne evolutivne oblike MS: relapsno-remitentni (približno u 85% bolesnika) i progresivni (približno u 15% bolesnika). Klinička pogoršanja se događaju, prosječno, svakih 18 mjeseci ; teška se invalidnost javlja pri kraju tridesete godine trajanja bolesti. Prognoza MS je strogo individualna. Atake su drugoredne važnosti u odnosu na progresiju bolesti u nagomilavanju nepovratne živčane nesposobnosti. Aktualno liječenje imunomodulatorima (interferoni- beta, acetat glatiramera) djelomično je učinkovito i ograničeno na neke oblike bolesti. Budućnost terapije MS je usmjerena prema složenim strategijama protuupalno/imunomodulacijskog liječenja te zaštite i reparacije živčanoga tkiva.

Multiple sclerosis (MS) is a chronic neuro-inflammatory autoimmune disease believed to arise from complex interactions of both environmental and genetic factors. Typical features for complex genetic diseases include modest heritability without a classic Mendelian mode of transmission and heterogeneity, which mean that variation in a large number of genes contributes to the overall susceptibility. Both human leukocyte antigen (HLA) and a broad spectrum of non-HLA genes have been implicated in the pathogenesis and signalling abnormalities of MS. Identifying susceptibility genes for MS, has been a major challenge in the past two decades. Single-nucleotide polymorphisms (SNPs) within the susceptible genes are appropriate variants able to shed light into the genetic predisposition for MS. Gene/gene interactions, as well as epigenetic mechanisms, are also believed to play an important role for the pathogenesis of complex diseases. Furthermore, distinct forms of MS exist with different underlying genetic causes. Remains an open question which loci are involved in the initial pathogenic events or influence the development and progression of the disease. Even though we are still far from knowing the full set of genes influencing the pathogenesis of MS, considerable success has been made through linkage studies, candidate gene association studies and recently through the successful development of genome-wide association studies (GWAS).

Ovaj završni rad govori o temi povezanosti zloupotrebe alkohola odnosno alkoholizma i agresivnosti. Ovisnost o alkoholu je socijalno- medicinska bolest, koja nastaje uslijed trajnog i prekomjernog uzimanja alkoholnih pića i koja dovodi do oštećenja tjelesnog i psihičkog zdravlja kao i do teških poremećaja u socijalno-radim i ekonomskim odnosima. Alkoholizam je sve veći problem današnjice, raširen je od sve mlađe pa do starije populacije. Laka dostupnost alkoholnih pića, društvena prihvatljivost, socijalno ekonomski uvjeti okoline pridonose razvoju ove teške bolesti. Cilj ovog rada je alkoholizam prikazati kao socijalnu i medicinsku bolest, njezine posljedice na pojedinca i njegovu okolinu te mogućnosti liječenja., kao i utjecaj alkohola na samu osobu i njenu osobnost. Ispitano je 70 bolesnika koji su na bolničkom liječenju od ovisnosti o alkoholu. Svi ispitanici smješteni su u Psihijatrijskoj bolnici Rab. Ispitanici su podijeljeni u skupine po dobi i spolu, mjestu stanovanja, zaposlenju, obrazovanju, bračnom i materijalnom stanju, načinu te trajanju hospitalizacije. Dobiveni rezultati ukazali su da su ispitanici koji su u većoj mjeri konzumirali alkoholna pića fizički agresivniji te imaju već stupanj srdžbe. Također, dobiveni rezultati su pokazali da su mlađi ispitanici skloniji fizičkoj agresivnosti od starijih. Navedeni rezultati ukazuju na nužnost edukacije stanovništva o štetnom djelovanju zloupotrebe alkohola već od najranije dobi kao i sa mogućnošću,procesom i ciljevima liječenja kada do pojave alkoholizma dođe., This final paper discusses the topic of the connection between alcohol abuse and alcoholism and aggression. Alcohol addiction is a socio-medical disease, which occurs as a result of persistent and excessive consumption of alcoholic beverages and which leads to damage to physical and mental health as well as to severe disorders in social-work and economic relations. Alcoholism is a growing problem of today, it is spread from the younger to the older population. Easy availability of alcoholic beverages, social acceptability, socio-economic environmental conditions contribute to the development of this serious disease. The aim of this paper is to present alcoholism as a socio-medical disease, its consequences on the individual and his environment and treatment options, as well as the impact of alcohol on the person and his personality. Seventy patients who are in hospital treatment for alcohol dependence were examined. All subjects were accommodated in the Rab Psychiatric Hospital. Respondents were divided into groups by age and sex, place of residence, employment, education, marital and financial status, manner and duration of hospitalization. The obtained results showed that the respondents who consumed alcohol to a greater extent were more physically aggressive and already had a degree of anger. Also, the obtained results showed that younger respondents are more prone to physical aggression than older ones. These results indicate the need to educate the population about the harmful effects of alcohol abuse from an early age, as well as with the possibility, process and goals of treatment when alcoholism occurs.

Ovaj završni rad govori o temi povezanosti depresije i moždanog udara u pacijenata. Prvi dio rada spominje i opisuje moždani udar, etiologiju, povezane pojmove, simptome, priča o anatomiji mozga i moždanog krvotoka, čimbenicima rizika te o liječenju i rehabilitaciji nakon moždanog udara. Govori se i o epidemiologiji moždanog udara i aktualnom stanju u hrvatskoj. Drugi dio rada opisuje depresiju, epidemiologiju te aktualno stanje u svijetu i hrvatskoj, etiologiju depresije te oblike depresivnog poremećaja. Zadnji dio rada govori o depresiji kao čimbeniku za pojavu moždanog udara, depresiji nakon moždanog udara, čimbenicima rizika za razvoj depresije nakon moždanog udara i o liječenju depresije nakon moždanog udara., This final paper discusses the connection between depression and stroke in patients. The first part of the paper mentions and describes stroke, etiology, related concepts, symptoms, talks about the anatomy of the brain and cerebral blood flow, risk factors, and treatment and rehabilitation after stroke. There is also talk about the epidemiology of stroke and the current situation in Croatia. The second part of the paper describes depression, epidemiology and the current situation in the world and in Croatia, the etiology of depression and forms of depressive disorders. The last part of the paper discusses depression as a factor in the occurrence of stroke, depression after stroke, risk factors for the development of depression after stroke and the treatment of depression after stroke.