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The aim of this research is to look into the roles of families’ social situation and cohesion in adolescent auto-aggres- siveness in Croatia. The research was conducted on a sample of Zagreb high school students which encompassed 701 pu- pils of both genders aged 14–19. The basic demographic data were obtained using the Structured Demographic and Family Data Questionnaire. Auto-aggressiveness was tested using a section of the Report on Youth Aged 11–18 and the Scale of Auto-destructiveness – SAD, whereas the family cohesion was tested with the Family Adaptability and Cohesion Evaluation Scales FACES III. The obtained results show differences according to the gender: girls are more prone to auto-aggressiveness than boys (t=–3.385, df=565, p=0.001) and girls more often show symptoms of destructiveness (t=–3.809, df=637, p<0.001) and anxiety (t=–6.562, df=640, p<0.001), while boys show pronounced aggressiveness (t=2.655, df=653, p=0.008). Significant family factors associated with auto-aggressiveness are parents’ marital status (c²=18.039, df=4, p=0.001), their financial situation (F(2.548)=4.604, p=0.010), alcoholic father (c²=9.270, df=2, p= 0.010), mentally ill mother (t=5.264, df=541, p<0.001), as well as mentally ill father (t=4.744, df=529, p<0.001), and corporal punishment by mother (F(2.542)=8.132, p<0.001) or father (F(2.530)=5.341, p=0.005). Adolescents from split families show more auto-aggressiveness. Family cohesion appears to be considerably associated with auto-aggressive- ness and the adolescents that see their families as less cohesive have more mental problems (c²=29.98, df=2, p<0.001). There is a connection between auto-destructive behavior in adolescents and family factors. Knowledge of family’s social situation and cohesion may help understand, prevent and treat auto-aggressiveness in adolescents.

Background: Along with primary traumatization, wives of PTSD-diagnosed war veterans often become victims of the altered and dysfunctional state of their partners, which adds to the severity of symptoms of primary traumatization and furthers the development of other mental disorders. The aim of this study was to compare the effects of primary and secondary traumatization in wives of PTSD-diagnosed war veterans and wives of war veterans without PTSD. Subjects and methods: The experimental group consisted of 154 wives whose veteran husbands had been treated in Mostar Clinical Hospital for psychotrauma-induced PTSD. The control group was formed of 77 wives of war veterans who do not suffer from PTSD. The research used a general demographic questionnaire, the Harvard Trauma Questionnaire (HTQ) and the MINI International Neuropsychiatric Interview. Results: Wives of veterans with chronic PTSD experienced a significantly greater number of traumatic events (t=2.66; p=0.008) and had higher scores of PTSD symptoms (t=8.93; p<0.001). A significantly larger number of these women reported chronic somatic diseases (χ²=4.553; p=0.033). Furthermore, wives of PTSD-affected veterans significantly more frequently met criteria for current depression episode (χ²=20.65; p<0.001), past depression episode (χ²=24.40; p<0.001), depression with melancholic features (χ²=19.20; p<0.001), dysthymia (χ²=7.15; p=0.007), panic disorder with agoraphobia (χ²=5.28; p=0.022), PTSD (χ²=18.39; ss=1; p<0.001) and generalized anxiety disorder (χ²=19.58; p<0.001). This group also showed a higher level of suicidality (χ²=8.95; p=0.003). Conclusion: The findings of this research show how mental difficulties experienced by wives of PTSD-diagnosed war veterans affect the interrelationship of their primary and secondary traumatization.

Aim To examine the role of perceived stressfulness of trauma exposure and economic, social, occupational, educational, and familial adaptation after trauma in posttraumatic stress disorder (PTSD) and depression in displaced war survivors. Methods A cross-sectional survey was conducted between March 2000 and July 2002 with a sample of 173 internally displaced persons or refugees and 167 matched controls in Croatia. Clinical measures included Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. Results Displaced war survivors reported the exposure to a mean ± standard deviation of 13.1 ± 8.3 war stressors, including combat, torture, serious injury, death of close persons, and loss of property. Compared to controls, they reported higher rates of marked to severe impact of war on family (16.2% vs 51.6%), social (7.2% vs 43.5%), economic (12.6% vs 55.4%), occupational (1.8% vs 15.9%), and educational (2.4% vs 8.8%) adaptation. In two logistic regression analyses, the strongest predictor of PTSD and depression was high level of perceived distress during trauma exposure. PTSD but not depression was associated with economic, social, occupational, educational, and familial adaptation after trauma. Conclusion Displaced survivors who experienced multiple war events perceived greater negative impact of war on their life domains compared to individuals who lived in a war setting but had no trauma exposure. The most important determinant of psychological outcomes was perceived stressfulness of war stressors. Although post-trauma adaptation in different life spheres had an impact, its effect was not robust and consistent across disorders. These findings suggest that it would be effective to use a trauma-focused approach in rehabilitation of war survivors.

Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991- 1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following selfassessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes.

The selection of antipsychotics as medications used primarily for treating schizophrenia and disorders similar to schizophrenia is an important aspect of the treatment of forensic patients. This study examines the effect of antipsychotics selection (typical or atipycal) on the level of aggressiveness, side effects and the hospitalisation length. The research is conducted on 98 psychiatric patients diagnosed with schizophrenia or similar disorders (F 20-F 29) in two forensic psychiatric institutions. The patients committed aggressive criminal offence in state of insanity. The patients are currently treated in inpatient psychiatric institutions. The research was conducted by using the Aggressiveness Questionnaire (AG-87), the Simpson-Angus Scale for the assessment of extrapyramidal side effects, the Barnes Akathisia Rating Scale for the assesment of akathisia and the Abnormal Involuntary Movement Scale. The results show no significant difference between the groups of patients treated with typical and atypical antipsychotics in all the variables.

Attachment is a point of interest in psychosomatic research since it influences a wide array of biopsychosocial phenomena. Data from literature highlights the role of this concept in the context of Inflammatory Bowel disease (IBD), still, there is a lack of data regarding attachment among parents of children with chronic gastrointestinal diseases. The main hypothesis for the current study is that parents of children with IBD will have a more insecure attachment than parents of children with celiac disease (CD) and parents of healthy children. The second hypothesis is that insecure attachment among parents of sick children will be associated with lower parental quality of life (QoL). 46 parents of children with IBD, 42 parents of children with CD and 43 parents of healthy children completed the validated modification of the Brennan’s Experiences in Close Relationship Inventory. Results were categorized as secure and insecure attachment. In order to assess parental QoL, the WHOQOL-BREF questionnaire was used. The Total QoL was calculated as a sum of all domain items. Secure attachment was found in 45.7% parents of children with IBD, in 35.7% parents of children with CD and in 32.6% parents of healthy children. Surprisingly, the lowest rate of secure attachment was found in parents of healthy children. However, significant differences among groups do not exist. For all groups of parents the attachment style is associated with Total QoL, although only among parents of children with IBD, the secure attachment independently and significantly predicts higher parental Total QoL. According to results, we might say that parental attachment style does not have a role that exclusively belongs in the context of paediatric chronic gastrointestinal diseases. However, parents of children with IBD who have insecure attachment represent target group for psychosocial support in order to improve their QoL.

Chronic gastrointestinal diseases, such as inflammatory bowel disease (IBD) and celiac disease (CD), might have impact not only on the affected child but also on their parents since inside the family framework, a change in each member may have influence on the whole system. The aim of this study was to test the hypothesis that parents whose children have IBD or CD will have a lower quality of life (QoL) compared to parents of healthy children, as well as that lower QoL will be found among parents who perceive lower health related quality of life (HRQOL) of their child. 55 parents of children with IBD, 49 of CD and 53 parents of healthy children were included in the study. Children were aged 7–18 years. In order to measure parental QoL, a Croatian version of the WHOQOL-BREF questionnaire was administered, with four domains: physical health, psychological health, social relationship and environment. The Total QoL was calculated as a sum of all domain items. The parent-proxy report of children’s HRQOL, PedsQLTM 4.0 Generic Core Scales was used.Main result shows that parents of children with IBD report a significantly lower psychological health, compared to parents of other children, and significantly lower physical health compared to parents of healthy children. Among parents of children with CD and parents of healthy children, better parental Total QoL was significantly correlated with better parental report of children’s HRQOL, while for parents of children with IBD those associations were not found. Results of study show association between presence of the disease in offspring with poorer parental QoL, thus highlight the importance of supporting not only children with chronic disease but also involving their parents in psychosocial interventions, as well as supporting the patient’s association groups which gather both children with chronic disease and their parents.

Introduction: The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006. Methods: The data were gathered by reviewing two daily papers, Novi list and Večernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports. Results: A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans' rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006. Conclusion: During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatizatio

Background: The aim of this study was to evaluate the efficacy of tianeptine, an antidepressant that acts by increasing serotonin reuptake, in the treatment of posttraumatic stress disorder and to compare the effects of tianeptine and fluoxetine, an antidepressant from the selective serotonin reuptake inhibitors class. Subjects and methods: 43 war veterans suffering from posttraumatic stress disorder were included in the study. During the 5.5 months of treatment 21 patients were receiving tianeptine and 22 were receiving fluoxetine. In addition, all patients took part in intensive trauma specific group psychotherapy. The effects of the two antidepressants on symptoms of PTSD, depression and anxiety after 5.5 months of treatment were assessed using the Harvard Trauma Questionnaire, Beck Depression Inventory, STAI and the List of Drug Use and Side Effects. Results: There was no significant difference between the two treatment groups regarding their effect on symptoms and severity of depression. The level of anxiety was the same in the first measurement but the difference became significant in other three measurements in favor of tianeptine. The anxiolytics and other co-prescribed drugs remain the same in both groups, the use of analgesics significantly increase in fluoxetine group during the course of treatment. Conclusion: The study demonstrated that tianeptine is as effective as fluoxetine in the treatment of PTSD, with even stronger effect on anxiety and equal tolerance.

Children and adolescents are being treated with antipsychotics more often than before, although the risk of adverse events in this age group still remains unclear. Because of increased use of antipsychotics in children and adolescents, their endocrine and metabolic side-effects (weight gain, obesity, and related metabolic deviations) are of particular worrying, especially within pediatric and adolescent population that appears to be at greater risk comparing with adults for antipsychotic-induced metabolic adverse events. In this work we will present the course of treatment of an adolescent girl with psychotic symptoms, within the clinical diagnosis of Organic delusional disorder, who had a considerable weight gain after one year of olanzapine treatment.

The aim of this research was to determine the possible differences in degrees of depression, somatization and anxiety between the acute and chronic female patients with temporomandibular disorders (TMD), and whether these differences exist in healthy female patients. Ninety female patients were involved in this research; 60 of them were TMD patients of the Dental Polyclinic, while other 30 females came for a rutine recall visit and had no problem related to TMD. Patients were aged 22 to 67 years, the average age being 38.5±12 years. All patients were asked to fill in the RDC/TMD protocol and three psychological tests (Emotions Profile Index, Somatization Scale and life Events Scale). Following the analysis of the RDC/TMD protocol and psychological tests, it was determined that the chronic female patients had higher depression and somatization scores in comparison with the acute patients (p<0.01); the acute patients self-perceive higher levels of anxiety in relation to the control group; furthermore, the patients reporting higher levels of depression were more inclined to somatization and had experienced a greater number of stress events in the past six months. It is beyond doubt that patients suffering from the TMD’s exhibit higher levels of depression, somatization and anxiety compared to the healthy ones, which proves that physiological factors may play a predisposing role in combination with reduced level of body tolerance to pain, and a decreased tolerance to stress.

War veterans diagnosed with chronic post-traumatic stress disorder (PTSD) experience serious difficulties in social, professional and family life. Consequently, their wives often become indirect victims of their husbands’ dysfunction. The purpose of this study was to assess the caregiver burden and burnout level in partners of veterans suffering from PTSD, especially in cases where partners suffer from their own PTSD symptoms. The experimental group consisted of 154 wives or partners of war veterans treated for PTSD caused by the war trauma in University Hospital Mostar. The control group was made of 77 wives or partners of war veterans without PTSD. The study was based on the General Demographic Questionnaire, the Harvard Trauma Questionnaire, Bosnia-Herzegovina version, Caregiving and the Experience of Subjective and Objective Burden and the Maslach Burnout Inventory. The wives of PTSD affected veterans scored significantly higher in all subscales of the Caregiver Burden Questionnaire and the Burnout Inventory. The results indicated that subjective demand burden, subjective stress and burnout were significantly higher in relationships in which both partners suffer from PTSD compared to couples in which only the veteran suffers from PTSD and couples in which none of the partners has PTSD. Living with a veteran diagnosed with PTSD places a heavy burden on the wife and poses a serious risk of burnout, which has to be taken into account in treatment planning.

Recent studies have shown that greater social support after combat stress is associated with better psychological posttraumatic outcomes. By comparison of a group of veterans (n=71) who sought psychiatric help and were diagnosed with PTSD (clinical group) and a group of veterans (n=43) without PTSD (control group) we examined various components of structural and functional social support in war veterans in Croatia. The measures of social support were assessed for two time periods: a) immediately after the war, and b) at the present time. Results of two-way analysis of variance indicate that veterans without PTSD tend to report significantly higher number of persons who provide them different forms of social support than veterans with PTSD. Perceived family and friends support is higher in veterans without PTSD than in veterans with PTSD. Support received from friends and fellow soldiers decreases over time in both groups, whereas for the clinical group support of friends decreases significantly more.

Introduction: Depression is one of the five most frequent disorders in primary care practice and often remains unrecognized. One of the reasons why depression often passes unnoticed is comorbidity – a number of different chronic diseases coexist with depression, especially in elderly patients. Aim: The aim of this research was to assess the difference between depressed and non-depressed patients regarding somatic and mental comorbidity. The differences in drug use were also examined. Subjects and Methods: Five hundred successive adult patients visiting family physicians in Rijeka, Croatia, were polled using the Beck Depression Inventory and a general questionnaire which was created for the purpose of the study. The existing medical records were also used. Results: Elevated depression level was determined in 48.1% of the examinees. These patients were suffering from larger number of chronic diseases (X=1.23) than non-depressed patients (X=0.70; t=5.07; p<0.001; z=4.93; p<0.001), especially cardiac, mental, renal and osteomuscular diseases. Depressed persons used significantly more drugs (X=1.28) than non-depressed patients (X=0.58; t=6.10; p<0.001; z=5.78; p<0.001), especially antirheumatics, analgesics, sedatives, antidepressants, antiallergics and diuretics. Conclusion: The research results point to a necessity of routine screening and early treatment of depression in patients with chronic diseases in primary care practice.

In clinical practice with adolescents we often come across with prepsychotic and psychotic disorders. When an adolescent patient has a positive hereditary burden for psychiatric illnesses in both parents, then the qualification of adolescent’s mental disorder seems closer to psychotic. We must have in mind that hereditary burden is only one of many etiological factors that contribute to mental decompensations in adolescent age, that can, but don’t have to be the prodrome of psychosis in the future. Whether is characterised as psychotic or not, the treatment of an adolescent in critical situation must be personalised, considering biological, social and individual factors of a patient. We believe that clinician’s experience in treating psychotic adolescent patients and personalised and integrative approach to a patient is of great importance. In this article we will present the therapeutical process of a 19-year old female adolescent, with psychotic symptoms, whose both parents are psychiatric patients. A personalised and integrative approach in treatment of this patient made possible the overcome of crisis, termination of high school education and an employment. These achievements, no matter what the future can bring to this patient, create better conditions for her functioning in life.

The use of antipsychotics in treatment of children and adolescents requires good knowledge of psychopathology, psychofarmacotherapy, developmental processes and family relations. It is necessary to have parental consent for the use of a medication in this age, with previous explanation of therapeutic goals, limitations and possible side effects of antipsychotics. The number of antipsychotics registered for use in children and adolescents is quite limited. The combination of clinical experience of those working with psychotic adolescents and a good collaboration with parents, creates a therapeutic space where good results in treatment can be achieved. Side effects, though rarely, can bring in question the course of treatment and disorder follow up. In this work we will present a 14-year old girl adolescent with psychotic symptoms, in which case the course of treatment and discontinuance of therapy was caused by a side effect - an oculogyric crisis.

Aim To assess long-term mental health outcomes in people who suffer from war-related posttraumatic stress disorder (PTSD) but do not receive appropriate treatment. Methods We interviewed 264 subjects from former Yugoslavia, who lived in Croatia, Serbia, Germany, and the United Kingdom. All of them had suffered from PTSD at some point following the war, but never received psychiatric or psychological treatment. The interviews took place on average 10.7 ± 3.0 years after the war-related trauma. Outcomes were current PTSD on the Clinician Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders-IV, subjective quality of life (SQOL) on the Manchester Short Assessment of Quality of Life, and care costs. Socio-demographic characteristics, the level of traumatic war-events, and aspects of the post-war situation were tested for association with outcomes. Results Current PTSD was diagnosed in 83.7% of participants, the mean SQOL score was 4.0 ± 0.9, and mean care costs in the last 3 months exceeded €1100 in each center. Older age, more traumatic war-events, lower education, and living in post-conflict countries were associated with higher rates of current PTSD. Older age, combat experience, more traumatic war-events, being unemployed, living alone, being housed in collective accommodation, and current PTSD were independently associated with lower SQOL. Older age and living in Germany were linked to higher costs of formal care. Conclusion People with untreated war-related PTSD have a high risk of still having PTSD a decade after the traumatic event. Their SQOL is relatively low, and they generate considerable care costs. Factors that have been reported as influencing the occurrence of PTSD also appear relevant for recovery from PTSD. Current PTSD may impair SQOL independently of social factors.

Depression and anxiety are prevailing mental problem in patients on chronic hemodialysis and they have great influence on outcome of illness. Additionally, these disorders are rarely identified in that population of patients and they are insufficiently treated. The aim of this study was to assess the prevalence of depression and anxiety in patients on chronic hemodialysis in University Clinical Hospital Mostar and to examine the correlation between the demographic variables and the time spent on dialysis with depression and anxiety levels. The experimental group consisted of 56 patients on chronic hemodialysis in Mostar Clinical Hospital. The control group 1 consisted of 53 patients diagnosed with a chronic illness and treated for at least a year, while the control group 2 consisted of 51 persons who were not diagnosed with any chronic somatic or mental illness. Demographic data were collected using the constructed questionnaire. The Beck Depression Inventory-BDI was used to determine depression, while the Spielberger State-Trait Anxiety Inventory-STAI was used to determine anxiety. We recorded significantly higher prevalence of depression in patients on chronic dialysis (51.8%) than in patients with a chronic illness (41.5%) and persons without chronic illnesses (9.8%; p<0.001). Trait anxiety level was significantly higher in hemodialysed patients compared to the other two groups (p=0.006) but there were no significant differences in state anxiety level. The study has not shown any significant difference in the prevalence of depression and anxiety level regarding the differences in sex, gender and education level, apart from a higher level of state anxiety in patients with a lower education level (p=0.032). These results indicate that patients on hemodialysis have a significantly higher level of depression and a higher level of trait anxiety compared to patients with chronic illnesses and especially compared to general population.

Aim To assess psychological problems in children as reported by their veteran fathers with war-related posttraumatic stress disorder (PTSD). Method The study group consisted of 154 veterans with war-related PTSD who were treated at the Mostar University Hospital. The control group consisted of 77 veterans without war-related PTSD who were selected from veteran associations by the snowball method. General Demographic Questionnaire, the first and fourth module of the Harvard Trauma Questionnaire–Bosnia and Herzegovina version, and the Questionnaire on Developmental, Emotional, and Behavioral Problems in Children, created specifically for the needs of this study, were used to collect data on veterans’ perception of psychological problems in their children. Results In comparison with veterans without PTSD, veterans with PTSD reported significantly more developmental (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.51-3.73), behavioral (OR, 3.92; 95% CI, 1.53-10.03), and emotional problems (OR, 17.74; 95% CI, 2.40-131.10) in their children. Conclusion Veterans with war-related PTSD more often reported developmental problems in their children. Father’s PTSD may have long-term and long-lasting consequences on the child’s personality.

Aim To explore the use of health care and community-based services in war-affected regions of Croatia and its relation to mental health. Methods A sample of 719 adults exposed to at least one war-related traumatic event were selected by random-walk technique from three Croatian counties and interviewed for socio-demographic data, mental health status (Mini International Neuropsychiatric Interview), and service use (Matrix for the Assessment of Community and Healthcare Services) in the period from 1991 to 2006. Descriptive analysis of service use was performed. Relations between service use, current mental health, and recovery from posttraumatic stress disorder (PTSD) were analyzed using logistic regression models. Results The traumatized population used a wide range of health care and community-based services. Health care was the most frequently used service category, especially primary health care (92.5%), followed by accommodation support (57.9%), financial support (57.7%), and employment support (32.5%). Compared with participants without mental disorders, participants with current PTSD were more likely to use only legal support (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.15-3.99), while participants with other mental disorders were more likely to use social support and contacts (OR, 1.72; 95% CI, 1.08-2.75). Receiving accommodation support (OR, 2.05; 95% CI, 1.03-4.06) was the only significant predictor of recovery from PTSD, while seeking legal support (OR, 0.28; 95% CI, 0.08-0.92) was elated to slower recovery. Conclusion Although a wide range of services were organized to help the traumatized population in Croatia, only the solution of housing issue significantly predicted recovery. The organization of help services should take into consideration the existing infrastructure and local specificities, and respect the needs of people in war-affected areas.

Aggressiveness is a frequent and problematic aspect of the treatment of forensic patients. This study examines the correlation of aggressiveness and its subtypes with quality of life enjoyment and satisfaction, personality dimensions and family functioning. The research is conducted on 99 psychiatric patients diagnosed with schizophrenia or psychotic disorder similar to schizophrenia (F 20 – F 29) in two forensic psychiatry institutions. The patients committed criminal offence in state of insanity. These offences had signs of aggressive acts and the patients were therefore admitted to inpatient psychiatric forensic institutions. The research was conducted by using the Aggressiveness Questionnaire (AG-87), the Eysenck Personality Questionnaire, the Quality of Life Enjoyment and Satisfaction Questionnaire and the Family Functioning Scale. The results show that aggressiveness has a negative correlation with the quality of life enjoyment and satisfaction. Regression analyses indicate that bad family relations and psychoticism are significant predictors of aggressiveness and its subtypes. We can conclude that forensic patients who committed aggressive offence in psychotic state, who at the same time score higher values on psychoticism scale and report negative family relations, are more likely to express aggressiveness also during their stay in forensic psychiatric hospital.

Objective: To determine the correlation between social support and PTSD symptoms in women traumatized by the war and postwar social insecurity in Herzegovina. Subjects and methods: The experimental group consisted of 187 randomly selected women living in Mostar, who were exposed to a wide spectrum of traumatic events during the war. The control group included 180 women living in the area surrounding Mostar who were not directly exposed to war destruction. Demographic data were obtained and a battery of psychological tests was used to measure the level of war traumatization and PTSD symptoms, along with the perception of social support. Results: Women in the experimental group had significantly lower levels of perceived social support from friends (t=2.91; p<0.05) and coworkers (t=2.30; p<0.05). However, its protective significance for all levels of posttraumatic symptoms was strong, even stronger than social support from the family. Of all the sources of emotional social support, low level of perceived support from friends is the only significant predictor of PTSD. Conclusion: The sources of social support which the traumatized women drew from family, friends and coworkers change their significance depending on their availability. These sources are a strong predictive factor of PTSD development.

Aim: To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD). Method: The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders. Results: Out of 56 veterans’ wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms. Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (mean ± standard deviation, 19.1 ± 9.1 vs 13.2 ± 7.8 years, respectively; P = 0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (P = 0.05). Conclusion: As more than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family.

Aim To assess treatment outcomes of psychotherapy for war veterans suffering from posttraumatic stress disorder (PTSD) and to investigate self-perceived social acknowledgment. Methods In this prospective cohort study, a set of psychological instruments was used to assess the level of posttraumatic stress symptoms (Clinician-administered PTSD Scale, Impact of Event Scale – Revised), symptoms of general psychopathology (Brief Symptom Inventory), quality of life (The Manchester Short Assessment of Quality of Life), and perceived social acknowledgment on a sample of 152 Croatian war veterans participating in group psychotherapy. All participants were interviewed at baseline and followed up after 3 and 12 months. We analyzed the changes in symptom levels over the course of one year, as well as the correlations between symptoms (both at baseline and after therapy) and perceived social acknowledgment. Results The analysis of symptom levels at the beginning of group therapy and after 12 months showed minimal or no changes in their intensity. Only the symptoms of intrusion (ANOVA, F-value = 7.09, P<0.001) were significantly reduced after a period of 12 months. Levels of hostility (ANOVA, F-value = 7.85, P<0.001) and psychoticism were significantly increased (ANOVA, F-value = 7.80, P<0.001) at the end of the treatment. Other categories of posttraumatic symptoms and the level of general psychopathology did not change significantly during the course of treatment. The results showed that war veterans perceive extremely low levels of social acknowledgment, especially from their wider social environment: 92.9% perceived a lack of acknowledgment from governmental institutions and 95.4% from the state in general. Conclusion Despite some methodological constraints, our results showed that even 10 years after the traumatization, PTSD symptoms among war veterans remained intense and that undergoing therapy over a year did not produce significant improvements, except on the dimension of

Self-esteem involves the evaluative and affective dimensions of self-concept. It could be influenced by stress situations such as diseases or injuries, especially in the period of puberty and adolescence. The aim of this study was to establish the influence of isolated long tubular bone limbs’ fractures in children and adolescents and type of its treatment (conservative or active surgical treatment-various techniques) on self-esteem of patients, as well as to establish relationships between self-esteem, depression, anxiety and perception of the social support in the mentioned patients. This prospective clinical trial comprehends 135 patients, 94 male and 41 female, aged 10 to 18, treated for the mentioned fractures in the period from October 2003 until March 2005 in Departments for Pediatric Surgery of three hospitals: the Clinical Hospital Center in Rijeka (88.8% patients), the Clinical Children’s Hospital in Zagreb (9.7%), 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 of work were self-reported questionnaires: Rosenberg Self-esteem Scale (RSS), to establish the degree of self-esteem; Children Depression Inventory (CDI), to establish existence and degree of depression; Spielberg State Trait Anxiety Inventory (STAI)- form STAI2, to establish general anxiety; and Test of Perception of Social Support (TPSS). RSS, CDI and STAI2 were administered twice to the patients: at baseline and after 6 months of the trauma, whereas TPSS once, after 1 month of the trauma. Our results point at an decreased self-esteem followed by increased depression and increased general anxiety indicators in all patients within 1 week of experienced trauma, especially i