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Background: The International Labour Organization (ILO, 2000) has defined stress and exhaustion from working shifts and night work, and psychological and organizational stressors conditions that create health risks for surgical nurses. Among the OR nurses/ technicians 41.9% reported that causes of their stress included inadequate teamwork, ineffective communication, and especially surgeons’ negative attitudes. Subjects and methods: The stuudie has been held in Clinical Hospital Centre Split, the sample consists of a total of 62 out of 109 possible respondents participated in the study. A total of 23 (37%) anesthesiology technicians and 39 (63%) ICU nurses / technicians participated in the survey. In the empirical part of this research, the importance of selected stressors was tested using quantitative methods in biomedicine.The existence of stress was tested by the Wilcoxon test. Stress level in the ICU was tested by T-test The analysis was elaborated in the statistical software STATISTICA 12. Conclusions were made at a significance level of 5%. The research was conducted through the questionnaire taken from the paper Milan Miloševi􀃼 entitled: "Development of a measuring instrument of stress in the workplace hospital health professionals and an assessment of its use value” (2010). Results: Based on the empirical t value of 3.42 at 59 degrees of freedom the conclusion is that there was found a statistically significant difference in the level of stressors in the workplace between nurses / technicians in the ICU and anesthesiology technicians. The conclusion was reached at an empirical level of significance

Hematotoxicity od cyclin dependent kynases 4/6 (CDK4/6) inhibitors palbociclib and ribocyclib during first 2 cycles of treatment of metastatic breast cancer – a restropective analysis in single centre

Depression is one of the most frequent mood disorders. The spectrum of its meanings is very complex. Symptoms of depression can be felt at every stage of life. Depressed mood states can, as for intensity, show the clinical picture that varies from mood changes to psychotic states. In this presentation, it is described a case of the patient who since early childhood showed the symptoms of ADHD that was showing as a comorbidity feelings of depression, which have significantly hindered the emotional maturation of the person. This etiological clarification has led to effective treatment, including the psychopharmacological and psychotherapeutic approach.

The hereby presented guidelines for the use of psychodynamic psychotherapy are based on references and research in the field of individual and group therapy and they refer to psychotherapy for patients suffering from the first psychotic episode, schizophrenia, schizoaffective psychosis, bipolar disorder and paranoid psychosis. The aim was to provide an overview of present literature and to give recommendations based on current knowledge. Clinical experience and research of the outcomes of psychodynamic psychotherapy encourage positioning of such treatments among recommendations for treating various mental disorders, as well as in the field of psychotherapy of patients with psychotic disorders (PD).

In the end of every severe stress situation (like war, terrorist attack, earthquake, fire, etc.) there is a strong need for peace, reconciliation and renewal. But, life goes in a way that the space without conflict cannot be maintained. Thinking in accordance with kleinian concepts, a group in severe stress situation inevitably regresses from depressive (D) to paranoid-schizoid (PS) position. By leaving D position PS position becomes stronger, the borders between a group and an individual weaken, massive projective identifications penetrate into individuals and force them to share mental contents of a group. There is a strong pressure towards homogenization and cohesion among people. Concrete thinking overcomes symbolic thinking, so that the compulsion for action strenghtens at the expense of thinking. The ability to feel guilt and shame, and the processes of mourning fade away. The group in PS position does not have tolerance towards differences. Paranoid rule “with us or against us” makes permanent threat, so that those who are different are identified as enemies. In that situation it is difficult to observe subjects with autonomous psychic life. They are seen as completely negative partial objects, and those who belong to hostile groups can totally lose every similarity with other people around, so that the identification with them becomes not possible. A group in D position maintains border between group and an individual. It allows consciousness about mental life in others and identification with them as with people with whom empathic relationship can be established. After the severe stress situation, when D position strengthens, terrible traumas cannot be integrated without risk of falling into depression. It is not possible to integrate any amount of negative features of ourselves and guilt or shame feelings, if that amount seems relatively bigger that the amount of positive features of ourselves and our group. Reaching again D position is possible if still traumatic contents are dispatched into torn area where PS stances are dominant. Every group as well as every individual have limited ability to accept awareness of some painful mental content. One part of it will remain hidden from the Ego in order not to become overwhelmed by these contents. They will stay split off, not suppressed. This helps groups to maintain the space without conflict which should remain big enough to maintain life and groups wind up clock of illusions in which they wrap the picture of themselves, where wish for reconciliation and forgiveness loom again. But traumas remain stored somewhere and inseparable and during historic shakes they are ready to erupt when they find first opportunity.

Background: Workplace aggression constitutes a serious problem in individual, organizational and social cause-effect relations. The aim is to determine the prevalence of such aggression on the pilot sample to test the appropriateness of the research design for the further conduct of a national survey on the specified topic. Subjects and methods: The sample included 113 employees in the city of Split, deployed within the public, profit and non-profit sectors. The research was conducted through an online survey. The questionnaire consisted of pre-coded questions on the sociodemographic characteristics of the respondents and their perception of interrelations with colleagues and clients/customers of products and services, exposure to various forms of physical and verbal aggression and the frequency of somatic and psychical problems caused by the workplace conditions and interrelations in this context. Results: Although participants did not suffer direct physical assault from associates, and only two of them have experienced it from clients/customers, they emphasize the frequency of psychical workplace abuse through more subtle forms of physical and verbal aggression.The training of employees at all hierarchical levels is required for the better understanding of the roles of their associates and clients/customers. Its effects strengthen their mutual respect, tolerance and solidarity. In this way, the interrelations that many respondents do not see as good or excellent can be improved, hence improving the prevention of aggression. Conclusions: The study of aggression should include a broader social context. Aggression tends towards a quantitative and qualitative expansion in different environments. When individuals seek some benefit for themselves in a dubious way, while neglecting others, aggressive acts are foreseeable. Therefore, Croatian society has the foundation for aggressive behavior, as it is unable to make the consensual practice of a moral, political and economic recovery.

The rapid development of new technologies has led to significant changes in the work environment in general, as well as in seafaring, namely on board. Moreover, the daily life of the modern man is inextricably intertwined with technology. Its impact on personal and professional life leads to a series of changes that are reflected not only in the mode of business performance but also in the influence of private events during professional work. The significant and rapid progress of technology presents a challenge to our consciousness and conscience that has to be discussed over and over again, as both categories are exposed to the influence of personal experiences and environment. Originating from the interaction of one’s personality and his environment, our consciousness and conscience potentiate us to act in accordance with socially established rules and values. In addition, the lack of training after the official education, except by inertia with respect to the requirements of the work position, certainly increases the percentage of errors, ultimately leading to difficulties in performing vocation and even to disaster. The tragedy aboard Costa Concordia and other maritime accidents, involving passenger and cargo vessels with increasing harm to humans and the environment, point to the growing importance of the categories of human consciousness and conscience in performing the profession of seafarer’s profile.

In writing about the group setting in treatment of patients with psychosis the author is drawing from his long clinical practice and his writings on the subject. He underlines the value of group-analytic concepts, formulated by S.H.Foulkes, as well as needed modifications when patients with psychosis are in question. Through clinical examples he will explain his experiences and discuss some specific features concerning inpatients and outpatients group psychodynamic psychotherapy for patients with psychosis. A special attention will be directed towards the dynamics of the therapist's/therapeutic team's roles, and to the need of continuous supervision

Aim: To assess the effectiveness of the long-term group psychotherapy in the treatment of posttraumatic stress disorder (PTSD) in war veterans on the basis of clinical picture of PTSD, associated neurotic symptoms, and adopted models of psychological defense mechanisms. Methods: Prospective cohort study involved 59 war veterans who participated in dynamic-oriented supportive group psychotherapy for five years. The groups met once a week for 90 minutes. Forty-two veterans finished the program. The Clinician-Administered PTSD Scale structured interview was used to assess the intensity of PTSD. Crown-Crisp Index was used to evaluate other neurotic symptoms, and Life Style Questionnaire was used to assess the defense mechanisms. The assessments were done at the beginning of psychotherapy, after the second, and after the fifth year of treatment. Comorbid diagnoses, hospitalizations, and outpatient clinic treatments were also recorded. Results: Long-term group psychotherapy reduced the intensity of PTSD symptoms in our patients (the difference between Clinician-Administered PTSD Scale score at the beginning and the end of treatment, F = 9.103, P = 0.001). Other neurotic symptoms and the characteristic profile of defense mechanisms did not change significantly during the course of treatment. Predominant defense mechanisms were projection (M = 82.0 ± 14.4) and displacement (M = 69.0 ± 16.8). None of the symptoms or defense mechanisms present at the beginning of the treatment changed significantly after two or five years of treatment. The number of diagnosed major depressive episodes, which increased after the second year of psychotherapy, decreased by the end of treatment. Conclusion: Psychotherapy can reduce the intensity of PTSD symptoms, but the changes in the personality of veterans with PTSD are deeply rooted. Traumatic experiences lead to the formation of rigid defense mechanisms, which cannot be significantly changed by long-term group psychotherapy.

Aim. To assess the effectiveness of the long-term group psychotherapy in war veterans with posttraumatic stress disorder (PTSD) by evaluation of clinical picture of PTSD, associated neurotic symptoms and adopted models of psychological defense mechanisms. Methods. Prospective cohort study of 59 war veterans who participated in a five-year dynamic-oriented, supportive group psychotherapy. The groups met once a week for 90 minutes. Forty-two veterans finished the psychotherapy. The Clinician Administered PTSD Scale structured interview was used to assess the intensity of PTSD, Crown-Crisp Index was used to assess other neurotic symptoms, and Life Style Questionnaire was used to assess the defense mechanisms. The assessments were done at the beginning of psychotherapy, after the second, and after the fifth year of treatment. Comorbid diagnoses, hospitalizations, and treatments in a day hospital were observed. Results. Long term group psychotherapy reduced the intensity of PTSD symptoms (difference between CAPS score at the beginning and end of treatment F=9.103 P=0.001). Other neurotic symptoms and the characteristic profile of defense mechanisms did not change significantly during the course of treatment. Predominant defense mechanisms were projection (M=82.0± ; ; ; 14.4) and displacement (M=69.0± ; ; ; 16.8). No symptom or defense mechanism showed significant difference at the beginning of treatment, after two and after five years of treatment. After the second year of psychotherapy, the number of diagnosed major depressive episodes increased, and decreased at the end of treatment. Conclusion. Psychotherapy can reduce the intensity of PTSD symptoms, but the changes in the personality of veterans with PTSD are deeply rooted. Traumatic experiences lead to forming of a rigid model of defense functioning, which, unfortunately, can hardly be significantly influenced by long term group psychotherapy.

The aim of this research is to assess which therapeutic factors are of greatest importance to patients in group analytic psychotherapy, and whether the patients' characteristics and the phase of the group process influenced their evaluation of therapeutic factors. The Yalom's group therapeutic factors questionnaire was filled out by 66 patients, members of small groups conducted according to group analytic principles. The average scores for each therapeutic factor were subsequently ranked by importance to the patients and related to their age, sex, education, previous Psychotherapeutic experience, and Phase of group process. Self-understanding was. the highest-ranking therapeutic factor for the patients (average score 21.32 +/- 0.04 out of 25 maximum), whereas identification was the lowest ranking factor (15.88 +/- 0.06 in average). Group therapeutic factors were scored higher by women, patients up to 30 years of age, high-school graduates, and those with previous psychotherapeutic experience. Self-understanding seems to be the most important therapeutic factor in group analysis, emphasizing the importance of appropriate selection of patients for group analysis in order to utilize therapeutic factors the best.

The authors expose the assessment of therapeutic factors during group analytic treatment. In the methodology of research several measuring instruments were applied. In this study it will be exposed the results obtain by Yalom's questionnaire containing 60 items. Three smalt analytic groups were followed up, encompassing 20 group members. By self-evaluation they ranked the assessment of every of 12 therapeutic factors according to their importance. The variability of results was shown more inside then among groups. The highest-ranking therapeutic factors the group members sorted out were: self-understanding, family re-enactment, cohesiveness and universality. The factor of identification was the Lowest ranking in all groups.

The authors expose the assessment of therapeutic factors during group analytic treatment. In the methodology of research several measuring instruments were applied. In this study it will be exposed the results obtain by Yalom´s questionnaire containing 60 items. Three small analytic groups were followed up, encompassing 20 group members. By self- evaluation they ranked the assessment of every of 12 therapeutic factors according to their importance. The variability of results was shown more inside then among groups. The highest-ranking therapeutic factors the group members sorted out were: self- understanding, family re-enactment, cohesiveness and universality. The factor of identification was the lowest ranking in all groups.

The care for mental health in Croatia before war was highly institutionalized. By the beginning of the war it could not saturate new needs. Rigid hierachy structure with poor possibilities of movements in a new condition could not adapt itself. In this group the first who rwacted were psychotherapists and psychologists. New group of clients-numerous psychotraumatised-demanded new approach and new organisation of the institutions for the old system was not able to give apprpriate help. In the article there is presented the dynamic of changes and present ways of the development of the mantal health protection service in Croatia.

Our research included sample of 60 soldiers. They were roughly divided into true groups: (1) experimental group (N = 30) consisted of soldiers temporarily disabled for military service. They were put on a two week group programme of psychotherapy: (2)Control group (N = 30)consisted of soldiers temporarily disabled for military service, who, however, were not included in any psychotherapeutic programme. patients of both groups were approximately the sam age, sex, education background, were administrated the same type of psychotropic medication, and the time laps of trauma occured at about the same time. Their emotional state and psychosomatic scales were taken before and after treatment. The third control teas made after a year: The obtained results show a statistical significance in scales: -selfevaluation of the experience of the possibility of self-control of existing psychic difficulties (F=4, 66 (0, 035 ; p

The aim of this workshop is to present new findings about the psychological genesis of autism and the new perspectives in the psychoanalytic approach to psychotherapy of autism built on these findings that occurred during the eighteen years of psychotherapeutic work with eight autistic children. The starting point of this presentation are the leading psychoanalytic concepts of autism (Mahler, Tustin, Meltzer, Alvarez) in which autism is understood as a result of the failure of development of the early object relations and the emphasis is given to the importance of early trauma coping with the stimuli of the outside world and the failure of mothers to protect children from them. Within these concepts of autism we meet with psychotherapeutic approach in which the emphasis is on the reconstruction of these early traumatic experiences constructed within the first forms of relationship with the autistic child. In these approaches the therapeutic role is passive collection of contents that serve as the basis for interpretation and reconstruction of early traumatic experiences. In this approach, the least attention is given to the specific construction of a primary relationship with the autistic child and to the development of verbal communication that is necessary in psychoanalytic psychotherapy approach. Just through the recognition of the important role of early narcissistic development, in which the integration of early sensor-motor experiences comes to building primary narcissistic structures necessary for the development of object relations, new perspectives in understanding and psychotherapeutic approach to autism are opened. These new findings in relation to existing psychoanalytic concepts of autism make major changes in psychotherapeutic approach from the tasks of reconstruction early traumatic experience of separation in the psychotherapeutic milieu established primary relationships (traumatic psychotherapeutic model) to the construction of these primary mental structures necessary for coping with the content of separation and construction of object relations (developmental psychotherapeutic model).

The primary narcissism as a specific period of early child development (Freud, 1910-15) is today a neglected and abandoned concept. The problem of primary narcissism is determined by different definitions of this term with regard to its description and time of occurrence (Laplanche-Pontalis). A special role in that problem have made theorists of British school of object relations putting the meaning of narcissism as opposed to the object relation and in this way put into question the validity of the concept of primary narcissism and its existence. Psychotherapeutic experience with autistic children threw new light on understanding the role of early development in the genesis of autism and particularly on the development of primary (archaic) narcissistic structure in the autistic development. Just a failure in the development of primary narcissistic structures, which represent the basis for the child's vitality and activity, has been recognized as basic deficiency in the process of differentiation and the development of object relations of autistic children. By these findings early aspects of narcissistic development were given particular importance in the development of object relations and they gave new emphasis to process of sensor-motor integration (Winnicott) and also the development of primary narcissistic structures (Kohut) especially in the initial phase of psychotherapy of autistic children. Primary narcissism in this paper is understood as an early stage of development in which the initial mental (primary narcissistic) structure are formed. These initial mental structures represent necessary condition for the development of object relations, especially in the developmental experience of 'crisis differentiation' (Mahler). To that extent the development of primary narcissism and object relations are not perceived as two independent lines of development, but quite the opposite as mutually dependent and intertwined lines of development which has a certificate in results of early child development’s investigations (Piaget, Stern, Hobson).