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Promjene koje često dolaze u kasnijoj životnoj dobi, poput umirovljenja, smrti voljene osobe, povećanih izdvajanja, medicinskih problema mogu dovesti do depresije. Depresija sprječava osobe da uživaju u životu kao što su navikli. No, učinci depresije idu daleko van raspoloženja. Također utječe na energiju, spavanje, apetit i fizičko zdravlje. Međutim, depresija nije neizbježan dio starenja, a tu su i mnogi koraci koje možete poduzeti kako bi prevladali simptome, bez obzira na izazove s kojima se osoba suočava. Prepoznavanje depresije u starijih osoba počinje prepoznavanjem znakova i simptoma. Depresija u starijih odraslih osoba i starijih osoba često je povezan s fizičkim bolestima, što može povećati rizik za depresiju. Kronična bol i tjelesna invalidnost može razumljivopovući osobu put dna. Simptomi depresije također se mogu pojaviti kao dio zdravstvenih problema, kao što je demencija ili kao nuspojava lijekova na recept. Simptomi depresije su nuspojava mnogih najčešće propisanih lijekova. Osoba je posebno u opasnosti, ako uzima više lijekova. Dok su promjene raspoloženja nuspojave lijekova na recept koje mogu utjecati na svakoga, starije osobe su osjetljivije, jer, kako starimo, naša tijela postaju manje učinkovita da metaboliziraju i izluiče lijekove. Liječenje depresije je jednako učinkovito za starije odrasle osobe kao što je za mlađe ljude. Depresija u starijih odraslih osoba i starijih osoba često je rezultat teške životne situacije ili izazova, i svaki se pokušaj liječenja trebabazirati na tome. Ako je usamljenost temelj depresije, na primjer, sami lijekovi neće riješiti taj problem. Isto tako, bilo koji medicinski problemi kojem je komplikacija depresija treba rješavati. Sama narav depresije ometa sposobnost osobe da zatraži pomoć, iscrpljujući energiju i samopouzdanje. Za starije depresivne osobe, koji su odrasli u vrijeme kada su mentalne bolesti bile vrlo stigmatizirane i neshvaćene, liječenje i traženje pomoći može biti još teže -pogotovo ako oni ne vjeruju da je depresija stvarna bolest, previše su ponosni ili ih je sram pitati za pomoć, ili strah da postaju teret svojim obiteljima. Sestra ima veliku ulogu u pomaganju. The changes that often come in later life, like retirement, the death of loved ones, increased isolation, medical problems can lead to depression. Depression prevents person from enjoying life like you used to. But its effects go far beyond mood. It also impacts energy, sleep, appetite, and physical health. However, depression is not an inevitable part of aging, and there are many steps you can take to overcome the symptoms, no matter the challenges person face. Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression in older adults and the elderly is often linked to physical illness, which can increase the risk for depression. Chronic pain and physical disability can understandably get person down. Symptoms of depression can also occur as part of medical problems such as dementia or as a side effect of prescription drugs. Symptoms of depression are a side effect of many commonly prescribed drugs. Person's particularly at risk if he/she's taking multiple medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because, as we age, our bodies become less efficient at metabolizing and processing drugs. Depression treatment is just as effective for elderly adults as it is for younger people. Since depression in older adults and the elderly is often the result of a difficult life situation or challenge, any treatment plan should address that issue. If loneliness is at the root of somone's depression, for example, medication alone is not going to cure the problem. Also, any medical issues complicating the depression must be also be addressed. The very nature of depression interferes with a person's ability to seek help, draining energy and self-esteem. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult—especially if they don’t believe depression is a real illness, are too proud or ashamed to ask for assistance, or fear becoming a burden to their families. Nurse has a great part in helping.

Poremećaji raspoloženja spadaju u najučestalijima „velikim“ psihijatrijskim poremećajima“. Prevalencija BAP-a u populaciji iznosi 1%. Kao i većini ne znamo točan uzrok ali ih ipak možemo podjeliti u tri velike kategorije: biološka, psihološka socijalna. Bipolarni afektivni poremećaj su karakteristične izmjene: depresivnih hipomaničnih, maničnih i mješovitih epizoda. Osnovna terapija je farmakološka terapija koja se primarno provodi stabilizatorima raspoloženja. U slučaju neadekvatnog odgovora na prvi lijek izbora litij moguće su i druge alternativne kombinacije antipsihoticima novije generacije, antidepresivima i EST. Litij, valproat, karmazepin i antipsihotici su učikovitiji u liječenju manije dok lamotrigin je učikovitiji u liječenju depresije. Olanzepin je prvi antipsihotik odobren u liječenju bipolarnog afektivnog poremećaja. Monoterapijia antidepresivima se ne preporuča već u kombinaciji sa stabilizatorima raspoloženja. Osim farmakološke terapije liječenje bipolarnog afektivnog poremećaja se provodi kongitivno - biherviorarnom i individualnom terapijom. Bipolarni afektivni poremećaj spada u vodeće psihijatrijske poremećaje sa najviše suicida. Stigma je za neke pacijente gora nego sama bolest jer stigmatizacija pojačava osjećaj otuđenja, nerazumijevanje okoline te izazivanje krivnje kod pacijenata što utječe na tijek bolesti. U borbi stigmatizacije postoje antistigma programi koji educiraju kako stigmu treba zamijeniti tolerancijom i razumijevanjem. Važnu ulogu ima terapijski odnos medicinske sestre i pacijenta koji može imati lječidbeni učinak koji ne smijemo zanemariti. Mood disorders are the most common "major psychiatric disorders." Prevalence BAP in the population is 1%. Like most do not know the exact caused but we can still share into three major categories: biological, psychological and social. Bipolar affective disorder characterized by changes: depression, hypomania, manic and mixed episode. Basic pharmacological therapy is therapy that is primarily performed mood stabilisers. In case of inadequate response to the first drug of choice for lithium as well as some other alternative combinations of newer generation antipsychotics, antidepressants and EST. Lithium, valproic, carbamazepin, and antipsychotics are streamlined in treatment of mania while lamotrigine is streamlined treatment depression. Olazapine is the first antipsychotic approved for the treatment of bipolar affective disorder. Antidepressants monotherapy is not recommended, but in combination with mood stabilizers. Except pharmacological therapy treatment of bipolar affective disorder is implemented and cognitive-behavioral and individual treatment. Bipolar affective disorder is one of the leading psychiatric disorders with the most suicide. Stigmatization for some patients worse than the disease it self, because stigmatization reinforces the sense of alienation, lack of understanding of the environment and causing guilt in patients which affects the flow bolesti. In fight stigmatization are antistigmatization programs to educate that stigmatization must trumpet replaced by tolerance and understanding. An important role has therapeutic relationship nurse and a patient who can have iatrogenic effects that we can not ignore.

Shizofrenija je poremećaj koji ima nepoznati uzrok, obilježena psihotičkim simptomima koji oštećuju funkcioniranje i uzrokuju smetnje u mišljenju, ponašanju i osjećanju. Shizofrenija je kronična bolest kod koje izlječenje nije moguće međutim može se kontrolirati redovitim uzimanjem propisanih antipsihotika. Jedan od najozbiljnijih problema u liječenju shizofrenije je izostanak terapijske suradnje i neredovito uzimanje lijekova. Klasični antipsihotici su iziskivali svakodnevno konzumiranje, stalnu kontrolu te su imali puno više nuspojava, za razliku od suvremenih antipsihotika koji osiguravaju trajnu koncentraciju lijeka u dužem vremenskom periodu uz minimalne oscilacije. U terapiji novim antipsihoticima uloga medicinske sestre je od iznimne važnosti. Naime ona vodi dnevnik terapije te prati stanje i redovitost primanja terapije. Također daje terapiju, nadzire bolesnika, prati reakcije i prisustvo mogućih nuspojava te u slučaju nesuradljivosti kontaktira osobe nadležne za stanje bolesnika. Schizophrenia is a disorder with unknown cause, characterized by psychotic symptoms that damage the functioning and causes changes in thinking, feeling and behavior. Schizophrenia is a chronic disease with no cure, however, it can be controlled by usage of regular prescribed antipsychotics. One of the most serious problems in the treatment of schizophrenia is the lack of therapeutic cooperation and erratic drug taking. Classic antipsyhotics require daily consumption, constant control and they have more side effects, unlike modern antipsychotics that provide ongoing concentration of the drug over a longer period of time with minimal fluctuations. In the treatment with new antipsychotics role of nurses is big importance. Nurse keeps a journal of therapy and monitors the status and regularity of drug treatments. She also provides therapy, supervises patient reactions on drug and monitors possible side effects. In case of non-compliance she contacts the patient or persons responsible for the patients wealthbeing.

Alkoholizam kao jedan od najznačajnijih problema suvremene medicine i zbog svojih etioloških odrednica, terapijskih postupaka, nedovoljne senzibilizacije društva kada je u pitanju razumijevanje svih posljedica alkoholizma donosi ozbiljne posljedice pojedincu, obitelji te velike materijalne štete društvu u cjelini zbog toga svaki segment liječenja alkoholičara nužno je temeljito poznavati i uskladiti s drugim također važnim metodama i postupcima u liječenju alkoholizma. Vrlo važna metoda jest liječenje u okviru klubova liječenih alkoholičara, a vrijednosti takvog načina liječenja očituju se uspješnošću apstinencije, očuvanju psihičkog i fizičkog zdravlja pojedinca, očuvanju obitelji, kvalitetnijem odgoju djece, kvaliteti života bivšeg alkoholičara, kvalitetnijim međuljudskim odnosima općenito te ozbiljnim financijskim uštedama na osobnom i društvenom planu. U ovom završnom radu autor govori o aspektima upravo navedenog. Alcoholism as one of the most significant problems of modern medicine and because of its etiological determinants, therapeutic procedures, lack of sensitization of society when it comes to understanding all the consequences of alcoholism brings serious consequences for individuals, families and important material damage to society in general because each segment of treating alcoholics is necessary thoroughly know and comply with the other also important methods and procedures in the treatment in alcoholism. A very important method is treatment within clubs of treated alcoholics, and values of that kind of treatment are evident in the success of abstinence, preservation of mental and physical health of the individual, preservation of families, quality childcare, the quality of life of former alcoholics, better human relations in general and severe financial savings on personal and social areas. In this final thesis the author talks about the aspects just mentioned.

Background: There are very little literature data available on the prevalence of personality disorder in parents of children and adolescents suffering from inflammatory bowel disease. The purpose of this study was to assess the rate of parents meeting the criteria for a particular personality disorder according to the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Methods: The study included 36 parents of children and adolescents (aged 7-18 years) with inflammatory bowel disease. Results: Half of the parents of children with inflammatory bowel disease scored at or above the threshold of diagnostic criteria for a particular DSM-IV disorder on Axis II, mainly obsessive-compulsive personality disorder. Overall, rigidity and inflexibility about morality were the most frequent obsessive-compulsive personality disorder criteria. Conclusion: Parental personality factors play an important role in the context of pediatric inflammatory bowel disease, although the question remains whether it is influencing or being influenced by the disease. As this study was cross-sectional, we cannot say with certainty if the obsessive-compulsive personality disorder features occur with a high prevalence in parents of children with inflammatory bowel disease as a result of carrying for a child with a chronic disease, or they are a maintaining or even precipitating factor in the frame of pediatric inflammatory bowel disease.

Background: The aim of the study was to explore the frequency of depression among the general population of adolescents who were high school students in the city of Zagreb. As depression is associated with increased suicidal risk we wanted to check to what extent depression, as an emotional problem among youth, is associated with auto-aggression in the general population of adolescents. Subjects and methods: The study was conducted on a sample of high school students in Zagreb and it included 701 students of both genders aged from 14-19 years of age. To test the depression a Beck Depression Inventory (BDI) was administered for youth between 11-18 years of age (Youth Self Report for ages 11-18). To test auto-aggression a Scale of Auto-destructiveness (SAD) was used. Results: Results obtained by this study show that about 20.7% of high school students have mild and borderline depressive disorders while moderate or severe depression shows about 5% of them, whereby depression is statistically significant among girls who, on average, report more symptoms of depression. It has also been proven a significant impact of depression levels (F (2,423)=35.860, p

Cilj istraživanja: Cilj ovoga istraživanja bio je pokazati postoji li povezanost između nenamjernih ozljeda u ranoj adolescenciji i depresivnosti . Materijali i metode: Istraživanje je provedeno na 803 djece iz šestih razdreda osnovnih škola na širem području Splita. Djeci je prije ispitivanja objašnjen razlog ispitivanja i način njegova provođenja. Popunjavali su ispitne listiće, koji su sadržavali pisanu uputu. Mjere ispitivanja bile su: - broj nenamjernih ozljeda u zadnju godinu dana; - depresivnosti sa pod-skalama depresivnosti; - suicidalnost. Rezultati: Analizom dobivenih podataka pokazali smo kako adolescenti oba spola podjednako razmišljaju o suicidalnosti i imaju podjednak broj nenamjernih ozljeda u godini dana. Adolescenti koji imaju veći broj nenamjernih ozljeda tijekom godine ostvarili su veće rezultate na testu depresivnosti i suicidalnosti izuzev na tvrdnju „Pokušao sam se ubiti“. Zaključak: Dobiveni rezultati pokazuju povezanost nenamjernih ozljeda i depresivnosti, međutim mehanizmi koji su uzrok tome nisu poznati. Bilo bi dobro staviti pod povećan nadzor sve one adolescente s većim brojem ozljeda tijekom godine i tražiti kod njih znakove depresivnosti., Objective: The aim of this study was to show whether there is a correlation between unintentional injury in early adolescence and depression. Materials and methods: The study was conducted on 803 children from the sixth grade primary schools in the area of Split. Reasons for testing was explained to children and the manner of its implementation. Children was filling out the test papers, which contained written instruction. Tests measures were: - The number of unintentional injuries in the last year; - Depression with sub-scales of depression; - Suicide. Results: Data analysis showed that adolescents of both sexes equally thinking about suicide and have an equal number of unintentional injuries per year. Adolescents who have a higher number of unintentional injuries during the year achieved higher scores on tests of depression and suicidality with the exception of the statement "I tried to kill myself." Conclusion: The results show a correlation unintentional injuries and depression, but the mechanisms that cause it are not known. It would be good to put under increased surveillance all those adolescents with a number of injuries during the year and look at their signs of depression.

Cilj: Istraživali smo učestalost sudjelovanja u fizičkim obračunima i vršnjačkom nasilju kod ranih adolescenata i njihovu povezanost s razvojem depresivnih simptoma. Tragali smo i za specifičnim spolnim razlikama. Metode: Presječna epidemiološka studija provedena je na 800 djece u dobi od 11 do 14 godina na području gradova Splita, Solina i Kaštela. Fizički obračuni te sudjelovanje u vršnjačkom zlostavljanju je procjenjivano korištenjem pitanja iz upitnika SZO Zdravstveno ponašanje u djece školske dobi (WHO-HBSC). Depresivnost je mjerena pomoću Inventara dječje depresivnosti (CDI). Rezultati: Pronađeno je 24,2% adolescenata koji često sudjeluju u fizičkim obračunima te 5,5% koji često sudjeluju u vršnjačkom nasilju. Hi-kvadrat test pokazuje da dječaci češće sudjeluju u fizičkim obračunima i vršnjačkom nasilju od djevojčica. Adolescenti koji često sudjeluju u fizičkim obračunima i vršnjačkom nasilju, pokazuju višu razinu depresivnih simptoma od adolescenata koji nikad nisu sudjelovali u fizičkim obračunima i vršnjačkom nasilju. Zaključak: Nasilje među djecom česta je pojava i u mnogim slučajevima traje godinama. Sada prepoznajemo da djeca koja često sudjeluju u fizičkim obračunima i vršnjačkom nasilju pod rizikom su razvoja depresivnih poremećaja. Nalazi ovog istraživanja mogu imati potencijalno važne kliničke i preventivne implikacije., Objective: The current study examined prevalence of physical fighting and involvement in bullying behaviour among early adolescents and its association with depression. We were looking for possible gender differences as well. Methods: A cross-sectional, questionnaire study was performed on 800 adolescents between ages 11 and 14 in the area of Split, Solin and Kaštela. Physical fighting and involvement in bullying behaviour were assessed using questions from thr World Health Organization survey Health Behaviour in School-aged Children. Depression was measured using Children Depression Inventory. Results: Twenty four point two percent adolescent reported involvement in physical fighting and five point five percent reports involvement in bullyinh behaviour. Chi-square test indicates more male than female physical fighting and involvement in bullying behaviour. Adolescents who are frequently involved in physical fighting and bullying behaviour manifest higher levels of depressive simptoms than students who were never involved in physical fighting and bullying behaviour. Conclusion: Bullying is common among children, and in many cases lasts for years. We now recognized that physical fighting and involvement in bullying behaviour are at risk of developing depressive disorders. These findings may have potentially important clinical and preventive implications.

Background: Aim of this study was to explore association between psychiatric disorders (PTSD and depression) and chronic medical illnesses in a group of Bosnian refugees followed up for three years (1996-1999). Subjects and methods: Study was conducted in refugee camps in Varaždin, Nbaseline = 534, Nendpoint = 376 (70.4%). The interviews were conducted in Bosnian, data on depression and PTSD were collected using the Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire, respectively. Medical conditions were self-reported. Results: Most important findings: 1) Half of the sample at both study points reported no psychiatric problems (N=294, 55% vs. N=225, 59%), others suffered from depression (N=99, 18.5% at both times), PTSD (N=30, 5.6% vs. N=15, 4%), and depression + PTSD (N=129, 24.2% vs. N=114, 30.3%) ; 2) A total of 15 medical conditions were identified, and most frequently present were high blood pressure (N=201, 37.6%) and heart disease (N=167, 31.3%) ; 3) Occurrence of medical conditions was related to the clinical group – they were more frequent in subjects diagnosed with depression and depression + PTSD, than in those who were asymptomatic or suffering from PTSD only. Conclusions: Our data indicate the persistence of both psychological and somatic health problems in Bosnian refugees involved in this study over time. Holistic approach and avoiding of mind-body dualism might be beneficial for the care and long-term prognosis of these people.

ObjectiveThe study explored factors to which people traumatized by war attribute their recovery from posttraumatic symptoms and from war experiences.MethodsIn-depth interviews were conducted with two groups of participants with mental sequelae of the war in the former Yugoslavia: 26 people who had recovered from posttraumatic stress disorder (PTSD) and 17 people with ongoing symptoms of PTSD. Participants could attribute their recovery to any event, person or process in their life. The material was subjected to thematic analysis.ResultsEight themes covered all factors to which participants attributed their recovery. Six themes described healing factors relevant for both groups of participants: social attachment and support, various strategies of coping with symptoms, personality hardiness, mental health treatment, received material support, and normalization of everyday life. In addition to the common factors, recovered participants reported community involvement as healing, and recovered refugees identified also feeling safe after resolving their civil status as helpful. Unique to the recovered group was that they maintained reciprocal relations in social attachment and support, employed future-oriented coping and emphasised their resilient personality style.ConclusionsThe reported factors of recovery are largely consistent with models of mental health protection, models of resilience and recommended interventions in the aftermath of massive trauma. Yet, they add the importance of a strong orientation towards the future, a reciprocity in receiving and giving social support and involvement in meaningful activities that ensure social recognition as a productive and valued individual. The findings can inform psychosocial interventions to facilitate recovery from posttraumatic symptoms of people affected by war and upheaval.

UVOD: Patološki procesi reduciraju sposobnost aklimatizacije ljudi što može dovesti do izbijanja ili pogoršanja spektra različitih bolesti. Hipoteza je da meteorološki parametri utječu na shizofreni spektar bolesti. CILJ ISTRAŽIVANJA: Ispitati utjecaj meteoroloških parametara na shizofrene pacijente. ISPITANICI I METODE: U radu su ispitivani meteorološki parametri i njihova povezanost s brojem hospitalizacija pacijenata koji boluju od bolesti iz shizofrenog spektra. Ovo je retrospektivno opservacijsko istraživanje koje obuhvaća 3317 ispitanika s dijagnozama F20 te F23 prema kriterijima MKB-10, zaprimljenih na bolničko liječenje u razdoblju od 1. siječnja 2006. do 31. prosinca 2010. godine. REZULTATI: Ustanovljen je sezonalitet s predominacijom pojavnosti u proljeće. Opažena je pozitivna korelacija broja prijama s povećanjem temperature. Vrijednosti atmosferskog tlaka i vlažnosti te količina naoblake ne pokazuju značajnu korelaciju s brojem hospitalizacija. Opaženo je povećanje broja prijama u razdobljima s ciklonalnom aktivnošću. Nije opažena razlika u razdobljima s burom ili jugom, uz pozitivnu korelaciju s ciklonalnom aktivnošću koja se povećava s jačinom vjetra. Dnevna temperatura istakla se kao značajni prediktivni čimbenik povećanja broja prijama (R2=0,006; F(1,1502)=9,264; P=0002). ZAKLJUČAK: Rezultati istraživanja potvrđuju da meteorološki parametri utječu na shizofreni spektar bolesti, odnosno potvrđuju hipotezu da je shizofrenija meteorotropna bolest poremećene aklimatizacije. INTRODUCTION: Pathological processes in human organism reduce the ability to acclimatize which can cause worsening or triggering diseases. The hypothesis is that meteorological parameters have impact on the schizophrenic spectrum of diseases. AIMS OF RESEARCH: To apply the influence of meteorological factors to schizophrenic patients, and that schizophrenia is meteorotropic disease with disturbance in acclimatization. EXAMINEES AND METHODS: The study deals with the metereological parameters and their connection with admission rates for patients suffering from the schizophrenic spectrum of diseases. This is a retrospective observational study which has involved 3317 examinees sufferning from F20 to F23 diagnoses according to the ICD-10 criteria. All the examinees were patients hospitalised from 1 January to 31 December 2010. RESULTS: Seasonal pattern was found with peak in spring. Results indicate that admission rates were greater in the period with higher temperature range. There was no significant difference between types of winds, with negative correlation with wind strength. Correlation with with cyclonic activity was observed but not with humidity, atmospheric pressure and cloudiness. Daily temperature features prominently as a predictive factor for the increase in admission rates (R2=0.006; F(1.1502)=9.264; P=0.002). CONCLUSION: Results of the study confirm the impact of meteorological parameters on schizophrenic spectrum of diseases, and the hypothesis that schizophrenia is meteorotropic disease with disturbance in acclimatization.

The aims of this study were to identify the aspects of family functioning which are associated with the course and remission of schizophrenia and to explore relations between aspects of family functioning and family history of schizophrenia. The subjects were 90 patients, treated at the Clinical hospital centre in Rijeka, Croatia, with diagnosed schizophrenia (F20.0 to F20.5) and without psychiatric comorbidity. The patients were organized into three groups depending on the treatment status during the calendar year that preceded the year in which the survey took place: patients with schizophrenia who received an outpatient care and were maintaining favourable remission, patients who were hospitalized once to twice and patients who were hospitalized at least three times in the precedent calendar year. The treatment status was used as an indicator of the course of the illness. A Family Functioning Scale was applied and the data on the absence/presence of schizophrenia in the family history were collected through the examination of previous medical records. The lowest prevalence of familial schizophrenia was found among the patients who were maintaining favourable remission. Among the three groups statistically significant differences were found regarding the following family functioning variables: expressiveness, family sociability, democratic family style. Also there were observed statistically significant differences in the family functioning depending on the presence/absence of the schizophrenia in the family history that included following domains: family cohesion, external locus of control and democratic family style. Our study gives support to the conclusion that family functioning of persons with schizophrenia differs depending on the course of the illness and presence/absence of schizophrenia in the family history.

Intenzivna psihijatrijska skrb jest vrsta psihijatrijskog liječenja bolesnika koja se provodi na zatvorenom psihijatrijskom odjelu i po mogućnosti u jedinici intenzivnog liječenja, a sadržaji su joj dijagnostika, liječenje i opservacija hitnih stanja, odnosno bolesnika u psihijatriji. Uključuje sveobuhvatnu razinu skrbi, 24-satnu opservaciju te mogućnost fizičkog sputavanja i odvajanja bolesnika u slučaju gubitka kapaciteta za samokontrolu. Najčešća hitna stanja koja zahtijevaju intenzivnu psihijatrijsku skrb jesu suicidalnost, auto i hetero agresivnost i krizna stanja. Pregled bolesnika uključuje anamnezu, heteroanamnezu, opis psihijatrijskog statusa, opći somatski i neurološki pregled, laboratorijske pretrage, a ponekad CT i MRI mozga. U liječenju hitnog psihijatrijskog bolesnika upotrebljavaju se psihofarmakoterapija, psihoterapija (kratka, individualna dinamski orijentirana, ventilacija, debriefing, suportivna psihoterapija i obiteljska), te ponekad fizičko sputavanje i odvajanje bolesnika u izolacijsku prostoriju zbog moguće opasnosti za sebe i/ili okolinu. Članovi medicinskog tima su psihijatri te medicinske sestre i tehničari koji su stručno i posebno educirani u kliničkoj hitnoj psihijatriji i koji će odmah po prijamu bolesnika odrediti prioritete postupaka, dijagnostike i liječenja. Vrijeme provedeno u jedinici za intenzivnu psihijatrijsku skrb različito je, ali najčešće je od 2 do 6 dana. Po smirivanju akutne kliničke slike koja je i bila razlogom prijama u takvu jedinicu, bolesnika se premješta na odgovarajući psihijatrijski odjel sukladno njegovom općem psihofizičkom stanju i psihijatrijskoj dijagnozi. Iako se općenito misli da su postupci intenzivne psihijatrijske skrbi ponekad naglašeno specifični ili izvan okvira kompetencija osoblja koje radi u tim jedinicama, one su nužne i medicinski opravdane., Intensive psychiatric care is a type of psychiatric treatment of patients conducted in a closed psychiatric ward, and engages the diagnosis and treatment of psychiatric emergencies. Includes a comprehensive level of care, 24-hour observation, and the possibility of physical restraint and isolation of patients in the event of loss of capacity for self-control. Psychiatric disorders treated in such departments are deteriorating mental state within the various mental disorders. The most common emergencies that require intensive psychiatric care are suicide, auto and hetero aggressiveness and states of crisis. Examination of the patient includes medical history, heteroanamnesis, description of psychiatric status, general and neurological examination, laboratory tests, and sometimes CT and MRI of the brain. In order to take care of urgent psychiatric patients in use is pharmacotherapy, psychotherapy (brief, individual dynamically oriented, ventilation, debriefing, supportive and family psychotherapy), and sometimes physical restraint and isolation of patients in isolation room because of possible danger to himself and / or the environment. The principal members of the medical team are psychiatrists, nurses and technicians who are highly qualified and trained in clinical psychiatry emergency and will immediately determine procedure, diagnosis and treatment of the patient. Time spent in psychiatric intensive care unit varies, but is usually from 2-6 days. By calming the acute clinical picture which is the reason for admission to such department, the patient is transferred to other psychiatric wards in accordance with its general mental and physical condition and psychiatric diagnosis. Although it is generally thought that the procedures for intensive psychiatric care is sometimes too hard or beyond the competence of personnel working in such departments, they are medically necessary and justified.

Depression has been implicated as a possible risk factor for low bone mineral density (BMD). However, there is still no solid evidence that could connect these two different illnesses. This research examined the association between self-reported depression and low BMD in perimenopausal and postmenopausal women. This research screened 130 female patients who were 44 to 72 years old and registered at the densitometry clinic of KBC Rijeka during a three month period. Densitometry was performed in order to establish their BMD and according to the results two groups of participants were formed: normal BMD - 38 participants with normal BMD at hip and spine and reduced BMD - 75 participants with lower BMD at hip and spine. Depression was assessed using Beck depression inventory. Both groups of participants were compared regarding their depression scores. There were no significant differences between the groups with normal and reduced BMD regarding mean age, age of menopause, length of menopause and number of births (p = 0.001). Difference regarding depressiveness between the two groups was not significant (t = 0.73; p = 0.468). Also, there were no differences between the groups regarding the frequency of certain levels of depression. (chi2 = 2.27; p = 0.52). Results of this research suggest that self-reported depression is not associated with low BMD in perimenopausal and postmenopausal women.

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.

Side effects arising on the grounds of antidepressant administration pose as a substantial obstacle hindering successful depressive disorder treatment. Side-effects, ecpecially those severe or those manifested through dramatic clinical presentations such as panic attacks, make the treatment far more difficult and shake patients trust in both the treatment and the treating physician. This case report deals with a patient experiencing a moderately severe depressive episode, who responded to duloxetine treatment administrated in the initial dose of 30 mg per day with as many as three panic attacks in two days. Upon duloxetine withdrawal, these panic attacks ceased as well. The patient continued tianeptine and alprazolam treatment during which no significant side-effects had been seen, so that she gradually recovered. Some of the available literature sources have suggested the possibility of duloxetine administration to the end of generalised anxiety disorder and panic attack treatment. However, they are outnumbered by the contributions reporting about duloxetine-related anxiety, aggressiveness and panic attacks. In line with the foregoing, furthet monitoring of each and every duloxetine-administrated patient group needs to be pursued so as to be able to evaluate treatment benefits and weigh them against risks of anxiety or panic attack onset.

Multipla skleroza je oboljenje koje zbog svojih karakteristika predstavlja znaćajno psihološko i socijalno opterećenje za oboljelog. S druge strane neke psihološke značajke poput osobnih resursa i strukture osobnosti pokazale su određeni etiološki potencijal. U članku su opisani mogući izvori psiholoških i emocionalnih poteškoća koje se učestalo nalaze kod oboljelih od MS, od onih koji imaju ulogu u javljanju oboljenja, psihički komorbiditet koji se u visokom postotku kod MS javlja, do reakcija na kroničnu i potencijalno onesposobljavajuću bolest koja značajno utječe na mnoge aspekte kvalitete života.

The treatment of dysthymia in itself poses a problem in the everyday psychiatric practice and it can be further hindered when accompanied by pronounced personality traits (which are indicative of disorder). Due to its pathology and duration dysthymia interferes with the patient’s quality of life and the ability to function in some segments of everyday life. These interferences enticed our patient to opt for psychiatric treatment. During a three-year period, despite all the efforts made by psychiatrists in this comprehensive and challenging dysthymia treatment (psychotherapy, group psychotherapy, psychopharmacotherapy), the expected outcomes of the treatment did not occur. The patient’s goals and expectations included lifestyle change, achieving life satisfaction and mood improvement. The patient was refusing suggested psychopharmaca until confronted, in psychotherapy, with the fact that she is the one prolonging her own helplessness and directing her passive agression at the members of the group. In the end the patent agreed to take psychopharmaca. Therefore, sertraline was introduced in the treatment, but the patient experienced a severe allergic reaction (Qiuncke’s oedema). After four months the second attempt was made and escitaloptam was introduced, which resulted in urticaria. Due to these allergic reactions to antidepressants, the patient decided not to pursue the psychopharmacological treatment.

Celijakija je upalna bolest tankog crijeva nastala zbog genetske preosjetljivosti osoba na gluten. Uz somatske kliničke manifestacije, u djece se često javljaju i emocionalne poteškoće uz značajno smanjenje kvalitete života. Osnova liječenja celijakije je doživotno provođenje dijete bez glutena. Pridržavanje dijetalnog režima rezultira povlačenjem kliničkih znakova i simptoma bolesti, te poboljšanjem kvalitete života oboljele djece. Suradljivost se, u potpunom pridržavanju bezglutenske dijete, nedovoljno postiže, a može biti povezana s brojnim psihosocijalnim i ekonomskim čimbenicima. U liječenju djeteta oboljelog od celijakije važnu ulogu imaju roditelji, stoga je podršku potrebno pružiti cijeloj obitelji., Celiac disease is an inflammatory disease of the small intestine caused by a genetic sensitivity to gluten. Along with somatic clinical manifestations, emotional difficulties are also common and are followed by significant reduce in quality of life. The basis of treatment is a lifelong gluten-free diet. Adherence to the diet regime results in the withdrawal of clinical signs and symptoms of the disease and improves the quality of life of ill children. In the treatment of children suffering from celiac disease the parents have an important role, so it is necessary to provide a support to the entire family.

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 99 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.

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.

Schizophrenia is a complex multifactorial disease with insufficiently known aetiology. There are many hypotheses on the etiology of SCH, but none of them can fully explain all of the properties of SCH. However, they offer numerous new therapeutic modalities. Biochemical theories find cause of the disease in unbalanced chemical substance in the brain. Dopamine, glutamate, serotonin and acetylcholine are the most important neurotransmitters for the development of schizophrenia. Currently available therapies are mostly based on dopaminergic and serotonergic theories. Majority of scientists nowadays believe in neurodevelopmental and neurodegenerative causes of SCH. Current hypotheses are focused on the study of membrane phospholipids and changes in the central protein synthesis. The theory that encompasses most of the properties of SCH is the hypothesis on reduced central protein synthesis, but it still requires many control studies. Clearly defining the aetiology of schizophrenia would result in significant progress in diagnosis and treatment.

Dual-action antidepressants serotonin-norepinephrine reuptake inhibitors (SRNIs) are widely used to treat depression. Owing to its efficiency and safety, venlafaxine holds a prominent place in this group of antidepressants. Abrupt venlafaxine discontinuation involves a high risk of withdrawal syndrome. Mechanism of its development is similar to that of selective serotonin reuptake inhibitors (SSRIs), but of higher intensity. Venlafaxine withdrawal symptoms may include several somatic symptoms as well as several psychiatric symptoms. In some cases, symptoms may look like a stroke. A treatment option is re-inclusion of venlafaxine or a SSRI antidepressant. The paper presents the case of a 70-year-old patient who discontinued of her own accord to take venlafaxine, which she had been taking regulary at a daily dose of 225 mg for more than a year. A few hours after taking the last dose, withdrawal syndrome occurred with severe symptoms resembling a stroke. The patient was examined by a neurologist and the CT and laboratory parameters showed no irregularities. Diagnosis was made after psychiatric observation. Venlafaxine, 150 mg per day, was prescribed, the symptoms disappeared relatively quickly, and the patient fully recovered. Withdrawal syndrome is a real risk for each venlafaxine treated patient. The possibility of its occurence should be always kept in mind and patients should be timely informed about it. In this way, the risk of venlafaxine withdraw syndrome could be reduced, unnecessary stress to patients prevented and the costs of medical treatment lowered.

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.

Psoriasis, as same as other skin diseases, has an influence on many spheres of patient's life. It influences the mental image the patients have of themselves and it indirectly shapes their personality traits as well as it defines the quality of their lives. The purpose of the study was to examine the impact of psoriasis on the quality of life and gender differences in the quality of life and explore presence of neurotic symptoms among persons suffering from psoriasis in comparison to general population. During the treatment of persons suffering from psoriasis at the special hospital Naftalan in Ivanić Grad personality questionnaire and Quality of life scale were administered to 61 participants (m = 25; f = 36). Our results showed few gender differences in the satisfaction with specific life domains, but only differences in the satisfaction with sexual life could be related to the different effects psoriasis has on the quality of life of men and women. Our participants experience more anxiety and depression symptoms as well phobic fears in comparison to general population. Found genders differences in the presence and intensity of anxiety symptoms closely resemble those documented in the general population therefore aren't typical for people suffering from psoriasis.

Epilepsies in the elderly are generally considered to be those occurring after the age of 60 or 65. Epilepsy that manifests for the first time in adult age is considered a late-onset epilepsy. The majority of seizures are partial with or without secondary generalization. The most important risk factors for epilepsy in the elderly are head traumas, strokes, tumour, Alzheimer's disease and other types of dementia, encephalitis, arterial hypertension and cardiac insufficiency, as well as alcohol and drug abuse. Depression is the most common psychiatric comorbidity in patients with epilepsy. The relationship between depression and epilepsy is bidirectional suggesting that common pathogenic mechanisms are shared by the two disorders. Symptoms of depression can manifest in preictal period, as actual seizures, and in postictal period. However, interictal depression is the most common presentation. Iatrogenic causes, especially treatment with some antiepileptics must be excluded. Although sometimes the diagnostic criteria of DSM-IV are not completely met, the patients generally present with symptoms of a chronic course depression interrupted by recurrent symptom-free periods lasting from several hours to several days. The negative impact of depression on patients’ life quality of is well known and causes various psychosocial problems. Therefore, its early detection is of paramount importance. The management of depression in elderly with epilepsy is very specific due to pharmacokinetic interactions between antidepressant drugs and antiepileptics. The aim of our work is to establish and present the differences in the use of the antiepileptic drugs (AEDs) in treatment of older patients with epilepsy and depression. Data on patient demographics, type of epilepsy, seizure frequency and drug therapy for epilepsy and mental disorders are also discussed herein.

Suvremena medicinska praksa suočena je s porastom broja oboljelih od kroničnih bolesti. Kronična bolest utječe na ustaljenu dinamiku obitelji. Obiteljska dinamika podrazumijeva tip i model obitelji, značenja, vjerovanja i rituale, fazu životnog ciklusa u kojoj se obitelj nalazi u trenutku suočavanja s kroničnom bolešću te osnovne aspekte funkcioniranja koji uključuju kohezivnost, prilagodljivost, komunikaciju i organizaciju obitelji. Kronični bolesnici, kao i članovi njihove obitelji, dotadašnji način života moraju prilagoditi zahtjevima bolesti, uključujući i psihološku prilagodbu. Kod članova obitelji suočenih s bolešću jednog svojeg člana u početku dominira negacija, slijedi depresivna faza i žalovanje te polako nastupa prihvaćanje, čime se dotadašnji odnosi zamjenjuju odnosima druge kvalitete. Funkcionalna obitelj je fleksibilna i u stanju je prilagoditi svoju dinamiku kako bi pronašla mjesta za bolest uz istovremeni rad na ciljevima, rutini i ritualima koje je imala i prije pojave bolesti. U proces liječenja kronične bolesti neophodno je aktivno uključiti članove obitelji. Studije su pokazale da liječenje kroničnih bolesti orijentirano obitelji predstavlja unaprjeđenje u liječenju u odnosu na tradicionalno liječenje orijentirano na bolest ili pojedinačnog bolesnika, kako po pitanju rezultata liječenja i ishoda bolesti tako i u odnosu na ekonomske kriterije., Modern medical practice is faced with increasing number of people with chronic diseases. Chronic illness affects standard family dynamics. Reaction of the family faced with a chronic illness of their member depends on the unique balance of family members and relations between them. Family dynamics refers to the type and model of the family, meanings, beliefs and rituals, life cycle stage in which the family is at the time of dealing with chronic disease as well as basic aspects of functioning including cohesiveness, adaptability, communication and organization of the family. Chronic patient, and his family members, have to adapt their former way of life to the demands of illness, including psychological adjustment. In a family which is faced with the disease of one of its members initially dominates negation, the next phase is depression and mourning, then they slowly accept the situation and it replaces the former relations with new quality relations. Functional family is flexible and is able to adapt their dynamics to find space for a disease with simultaneous work on the goals, routines and rituals that it had before the incidence of the disease. In the process of chronic diseases treatment, it’s necessary to actively involve family members. Studies showed that family-oriented treatment of chronic diseases is an improvement in treatment over traditional treatment of a disease-oriented or individual- oriented treatement, both regarding the results of treatment and outcome of disease and in relation to economic criteria.

Cilj: Kronična upalna bolest crijeva (KUBC) spada među najteže kronične bolesti dječje i adolescentne dobi. KUBC je zajednički naziv za Crohnovu bolest (CB), ulcerozni kolitis (UK) i nediferencirani kolitis. Točan uzrok nije poznat, ali se smatra da su u nastanak kronične upalne crijevne reakcije uključeni i funkcionalno integrirani utjecaji okoline, bolesnikovo genetsko nasljeđe, bolesnikova crijevna mikrobiološka flora te imunološki sustav. Obilježena nepredvidljivim egzarcebacijama neujednačene jačine, bolest se najčešće manifestira probavnim smetnjama, ali nisu rijetke ni izvancrijevne tegobe. Izvancrijevne smetnje puno su izrazitije u CB. Psihičke smetnje u te su djece brojne, a učestalije su u aktivnim fazama bolesti. Prikaz slučaja: U prikazu je opisan dječak obolio od ulceroznog kolitisa s pridruženim psihičkim smetnjama. Osobita pažnja posvećena je obiteljskim odnosima. Rasprava: Iako su psihološki i tjelesni čimbenici povezani, prihvaćenije je mišljenje da su psihički poremećaji u KUBC posljedica, a ne uzrok bolesti. Uobičajeno funkcioniranje i kvaliteta života obitelji djece s KUBC mogu biti ozbiljno narušeni. Reakcija obitelji na bolest djeteta ovisi o dobi djeteta, prirodi, težini i prognozi bolesti. Cijela obitelj mora se udruženo suočiti s bolesti te na taj način ostaje zajedno. Otvoreno obiteljsko komuniciranje o simptomima i liječenju KUBC mora biti prilagođeno dobi bolesnika. Time se osnažuje bolesnikova percepcija o mogućnostima savladavanja svakodnevnih problema. Zaključak: Osnova liječenja KUBC mora biti holistički pristup kojim se uvažavaju sve posebnosti djetetova stanja., Aim: Inflammatory bowel diseases are considered to be amongst the most severe chronic diseases in childhood and adolescence. They are marked by unpredictable relaps with uneven intensity. The most recognizable are gastrointestinal disturbances, but extraintestinal ones are numerous as well. It’s not rare that those affected develop psychological disturbances which then can lead to further complications to the diseases course and treatment. Case report: We described a case of a boy with colitis ulcerosa and psychological disturbances. Special attention was paid to relationship with closed family. Discussion: Normal functioning and the quality of life of families with children with IBD can be seriously disturbed. Coping with the disease of the child depends on the child’s age, nature, severity and prognosis of the illness. Both, the individual and the whole family should face the disease united and in that way they remain together. Open family communication about symptoms and treatment of IBD must be adapted to the patient’s age. This reinforces the patient’s perception of the possibilities of overcoming everyday problems. Conclusion: The basis of treating IBD must be a holistic approach that takes into consideration all the specifics of the child’s condition.

Adolescencija je razvojni period nakon kojeg ulazimo u odraslu dob. Obitelj u kojoj djeca dostižu fazu adolescencije u vrlo je specifičnoj fazi životnog ciklusa što i pred adolescenta i pred obitelj s adolescentom postavlja nove zadatke i ciljeve. Imati adolescenta u obitelji za cijelu obitelj zasigurno znači biti u fiziološki kriznom periodu razvojnih ciklusa u obitelji. Biti roditelj adolescentu drugačija je pozicija roditeljstva u odnosu na ranije razvojne faze djeteta. U vrijeme adolescencije mnogo se toga događa prvi put i adolescentima i njihovim roditeljima. U procesima odrastanja i odvajanja od roditelja na obzoru adolescenata pojavljuju se novi problemi. Ove nove objektne relacije i novi odnosi stvaraju vrlo sklizak teren za sukobe na relaciji adolescent – roditelji. Generacijski jaz između roditelja i adolescenata je neizbježan, no adolescencija se ne događa samo adolescentima, ona se na specifičan način događa i njihovim roditeljima. Razvojne zadaće i razvojni procesi u adolescenciji traže i od adolescenata i od njihovih roditelja kapacitete za prilagodbu i razvoj odnosa na drugačijoj, zrelijoj razini. Usporedo s adolescentom koji odrasta i njegova obitelj doživljava promjene. Roditelji adolescenta moraju, kao što to mora i majka malom djetetu, uvijek biti tu da bi se adolescent od njih mogao odvojiti i odrasti. Emocionalna klima u obiteljskom okruženju u kojemu dijete ili adolescent živi i odrasta najznačajniji je čimbenik zdravog razvoja., Adolescence ia a developmental phase after which we enter the adulthood. Family phase where offprings reach adolescence is a specific phase in the life of a family and places new tasks and goals not only infront of adolescent but also infront of the family as a whole. Having an adolescent in the family certainly, for every member of that family, includes being in a physiologically critical, demanding period of developmental processes. To be a parent to an adolescent is a different position in the parenthood than being a parent in the earlier phases. There are many things that happend to the child and to the parents for the first time in their lives. During the process of growing up and separation from parents new significant others begin to appear. These new object relations and new connections create a very slippery field between the adolescent and his or her parents. The generational gap among parents and adolescent is inevitable. However, adolescence does not happen only to adolescents, it also affects parents in a different, specific way. Developmental tasks and developmental processes in adolescence require, both from adolescents and their parents, high capacities for adjustment and maturation of their relationship. Along with the adolescent growing up, his or her family also experiences changes. Parents of the adolescent, just like a mother for a little baby, have to be present so that their adolescent could separate from them and develop, grow up. Emotional climate in which a child or a adolscent enters adulthood is one of the most important factor of mental health.

Život svakog čovjeka u suvremenom svijetu prepun je čimbenika koji izazivaju frustraciju. Stres kojemu smo neminovno izloženi poti če sve veći broj psihosomatskih oboljenja koja su evidentno u porastu. Zbog navedenih oboljenja sve su veće potrebe i za psihijatrijskim intervencijama, pa s ti me u vezi postoji porast potreba za konzultati vnom (suradnom, liaison) psihijatrijom. Ovaj se trend uočava i u našoj sredini. Suradna (liaison) psihijatrija proučava psihičke odnosno emocionalne odgovore pojedinca na adaptaciju, implikaciju i posljedice somatske bolesti . Interdisciplinarni način liječenja omogućuje da i psihijatar bude uključen u liječenje primarno tjelesnih bolesti . Takav način liječenja dovodi do bržeg uspostavljanja remisije bolesti , te potvrđuje da se duša i ti jelo ipak ne mogu promatrati odvojeno. U članku su opisana iskustva suradnje liječnika primarne zašti te i psihijatra u specijalisti čkoj ambulanti u sklopu primarne zašti te, kako je to organizirano u Domu zdravlja Primorsko-goranske županije u Rijeci., Lives of many people living in the modern world of today are marked by a large number of factors which cause a lot of frustrati on. Stress to which we’re exposed to facilitates the emergence of psychosomati c illnesses whose incidence is evidently growing. This increase is demanding a greater number of psychiatric interventi ons, relati ng to an increase of the need for a consultati ve (liaison) psychiatry. This trend is also observed and evident in our urban environment. Liaison psychiatry explores and analyzes the psychic or emoti onal responses of the individual to the adaptati on, implicati on and consequences of a somati c illness. An interdisciplinary model of treatment enables the psychiatrist to be involved in the treatment of the primarily physical illnesses. This way of treatment facilitates a faster remission achievement, confi rming the need for an inseparable perspecti ve of the body and mind, which needs to be viewed as a whole. In this arti cle we describe the experience of cooperati on between primary care physicians and psychiatrists in specialist ambulate within primary care that is organized in the PGŽ Rijeka.

Background: A body of biochemical evidence suggests that abnormal phospholipid metabolism may play a role in the etiology of schizophrenia, and possibly, other psychiatric and neurological diseases. Niacin, a B-complex vitamin, induces prostaglandin synthesis, vasodilatation, and skin flushing when applied as a solution on the skin or taken orally. In schizophrenia, diminished or absent skin response to niacin represents a robust finding. Results: Attenuated niacin skin-flush response has been analysed as a potential biochemical marker of impaired prostaglandin signaling in schizophrenia. Diminished skin redness after topical application of niacin might be caused by a reduced level of the precursor arachidonic acid in the peripheral membranes, increased activity of the enzyme phospholipase A2, abnormal expression of niacin or prostaglandin receptors, or poor vasomotor activity of cutaneous capillary walls. Heritability estimates established in several studies support niacin skin flush response as a vulnerability trait for the development of psychosis. However, the exact mechanism of a reduced skin flush, the possible influence of the long-term use of antipsychotics, and the usefulness of the test for diagnostic purpose are not clear yet. Conclusions: Niacin skin flush test is a simple, non-invasive and easily replicable method in the research of schizophrenia. The studies investigating niacin flushing in schizophrenia are numerous but incoherent regarding methods of niacin application and valuation of the results. New studies, controlling adequately for age, sex, drug abuse, diet, as well as genetic factors that may influence the ntensity and reaction time, are necessary to clarify the usefulness of niacin testing in psychiatry.

Akutna bolest jednog od članova obitelji predstavlja značajni stresni životni događaj ili situaciju unutar obitelji. Iznenadna bolest stvara previranja na koja obitelj često ne može adekvatno odgovoriti ili se nositi s promjenama u zahtjevima funkcioniranja. Bez obzira o kojoj akutnoj bolesti ili stradavanju se radi, primjerice srčanom udaru, moždanom udaru, prometnoj nesreći, iznenadnoj bolesti i sl., ono predstavlja akutni životni događaj vezan uz prekid uobičajenog tijeka života unutar svakodnevice obitelji (Holmes-Raheova ljestvica stresnih događaja stavlja povredu ili bolest na šesto mjesto bodovanja stresnosti). Stres zbog bolesti člana obitelji uvijek je nasljednik dotadašnjih iskustava obiteljskog života i njene povijesti funkcioniranja i pokretač je promjena, kako u strategijama suočavanja, tako i u značenju bolesti koje obitelj pridodaje stresnom zbivanju. Bolest mijenja aktualnu obiteljsku situaciju samom činjenicom da se jedan član obitelji razbolio. Ozbiljnija tjelesna bolest najčešće je komplicirana neugodnim emocijama svih članova obitelji – anksioznošću i depresijom, prilagodbenim teškoćama i nesnalaženjem u promjeni i preraspodjeli uloga koje se nameću i pojavljuju unutar obitelji nakon razbolijevanja jednog od članova. Radi se zapravo o seriji stresova koji mogu izazvati psihološke i fiziološke stresne odgovore unutar obitelji kao cjeline. Svaka obitelj reagira adaptirajući se koliko je god to moguće iz njenih resursa u teškoj situaciji. Strategije suočavanja mogu biti različite: od aktivnog suočavanja, distanciranja, traženja socijalne podrške i prihvaćanja odgovornosti do izbjegavanja i negiranja problema. Liječnici koji neposredno liječe bolesnika najvažniji su u pružanju informacija obitelji jer time znatno smanjuju stresnost akutnih zbivanja i omogućavaju prevladavanje nesigurne i uzdrmane obiteljske situacije., Acute illness of a family member represents an important stressful event for the whole family. Usually, the family confronted with a sudden illness, cannot adequatly cope with new demands for change in functioning. No matter which acute illness or injuries are involved – heart attack, stroke or traffic accident, sudden illness is an acute life event associated with the termination of the usual course of everyday life within the family (Holmes – Rahe Scale of stressfull events puts the injury or disease to sixth place scoring stressfulness). Stress due to illness of a family member always is the succesor of the previous family life experiences and its history of driving changes, as well as the meaning of illness which family adds to new stressors. The fact that one family member became ill, changes the whole current family situation. Serious physical illness is often complicated by unpleasent emotion of all family members – anxiety, depression, adaptive difficulties and disorientation, as well as with a change in redistribution of roles that occurs within the family. It is actually a series of stresses that can cause psychological and physiological responses in most family members. Each family will react according to their specific resources. Coping mechanisms are various – from active coping, distancing, getting social support and taking responsability to avoidance or denial of the problem. Doctors who treat patients directly, are the most important in providing information to family members, reducing their anxieties and in such way helping them to overcome the unsafe and shaken family situation.

Dok se kroz prošlo stoljeće izravan učinak psihološke traume široko proučavao, sekundarni utjecaj života s pojedincem koji pati od posttraumatskog stresnog poremećaja ostao je daleko manje razvijeno polje istraživanja. Posljednjih godina istraživači i kliničari ipak su počeli ispitivati kako individualno izlaganje traumatskim događajima pogađa supružnike ili partnere, djecu, osobe koje profesionalno pomažu psihotraumatiziranima, te ostale koji dolaze u izravni kontakt sa žrtvama prirodnih i ljudskih katastrofa. Proučavanje traume unutar obitelji dio je onoga što se u suvremenoj literaturi naziva sistemskom traumatologijom, studijom skupina, institucija i ostalih ljudskih sustava koji pokazuju stresne reakcije koje su izravni rezultat traumatskog događaja ili niza događaja. Utjecaj traumatskog stresa pojedinca na članove njegove obitelji i osobe u bliskom kontaktu konceptualiziran je kao sekundarna traumatizacija. U užem smislu izraz sekundarna traumatizacija odnosi se na prijenos noćnih mora, intruzivnih misli, bljeskova prisjećanja i ostalih simptoma posttraumatskog stresnog poremećaja koje tipično doživljavaju traumatizirani pojedinci, na osobe u njihovoj blizini. U širem smislu izraz sekundarne traumatizacije odnosi se na bilo koji prijenos distresa s nekoga tko je doživio traumu na one u njegovoj blizini i uključuje širok spektar manifestacija distresa, pored onih koje sliče posttraumatskom stresnom poremećaju. Nalazi istraživanja posttraumatskog stresnog poremećaja u kontekstu obitelji uvjerljivi su u svojim otkrićima da život u obitelji u kojoj netko pati od posttraumatskog stresnog poremećaja ima duboke učinke na druge članove obitelji, obiteljsku dinamiku i obiteljski sustav u cijelosti. Ova saznanja upućuju na potrebu stvaranja i razvijanja učinkovitijih programa u liječenju oboljelih od posttraumatskog stresnog poremećaja u kojima bi točka intervencije bila upravo obitelj., While in the last century the studies of direct effects of psychological trauma were widely spread, the secondary influence of living with PTSD sufferer remained far less developed field of study. But in the recent years, the researchers and clinicians started examining the way individuals’ traumatic stress exposure influences the spouses or partners, children, people who professionally assist traumatized persons, and others who come into direct contact with victims of natural and human disasters. The study of trauma within the family is part of what modern literature calls systemic trauma, study of groups, institutions and other human systems that show stress reactions that are a direct result of a traumatic event or series of events. Effect of traumatic stress on individual family members and people in close contact is conceptualized as secondary traumatization. In the narrow sense the term of secondary traumatization refers to the transfer of nightmares, intrusive thoughts, flashbacks and other symptoms of posttraumatic stress disorder typically experienced by traumatized individuals, onto the people in their vicinity. In a broader sense of the term, secondary traumatization refers to any transfer of distress from someone who had experienced trauma to those in his/hers vicinity, and includes a wide range of distress manifestations in addition to those similar to posttraumatic stress disorder. The findings of post-traumatic stress disorder in the family context are convincing in their discovery that living in families where someone suffers from post-traumatic stress disorder has profound effects on other family members, family dynamics and overall family system. These findings suggest the need for creating and developing effective programs to treat those suffering from posttraumatic stress disorder in which the point of intervention would be focused on the family.

Cilj: Neurorazvojna hipoteza shizofrenije implicira abnormalnu regulaciju metaboličke kaskade arahidonske kiseline (AA), a minor anomalije (MA) navode se kao potencijalni markeri abnormalnog razvoja mozga. U radu je istražena moguća povezanost varijacija u trima genima iz superobitelji fosfolipaza (PLA2) čiji su produkti uključeni u signalni put AA s pojavom MA glave i lica u shizofrenih bolesnika. Metode: U istraživanje su uključena 63 ispitanika (32 žene i 31 muškarac) Klinike za psihijatriju KBC-a Rijeka s potvrđenom dijagnozom shizofrenije prema DMS-IV kriterijima. Procijenjeno je 30 varijabli koje opisuju varijacije lica, očiju, nosa, usnica, nepca, jezika i ušiju, te određen ukupan broj MA u svakog ispitanika. Polimorfi zme gena PLA2G4A (rs10798059, G/A ili BanI polimorfi zam), PLA2G6A (rs4375, C/T) i PLA2G4C (rs1549637, A/T) analizirali smo PCRRFLP metodom. Rezultati : Pronađena je stati sti čki značajna povezanost između zbroja MA i PLA2G4C genoti pa (tauPLA2G4C = 0,214; P = 0,014) pri čemu je medijan zbroja MA bio najviši u TT homozigota i iznosio 13 (raspon od 10 do 16). Također smo utvrdili stati sti čki rubno značajnu interakciju PLA2G4A i PLA2G6A genoti pova, pri čemu je najviši medijan zbroja MA nađen u homozigota GG/CC (14; raspon od 10 do 22), odnosno u odsutnosti PLA2G4A-A ili PLA2G6A-T alela (P = 0,058). Zaključak: Rezultati upućuju na moguću povezanost varijacija u genima uključenim u rani razvoj živčanog sustava s pojavom MA glave i lica u shizofrenih bolesnika., Aim: The neurodevelopmental hypothesis of schizophrenia implicates abnormal regulati on of the arachidonic acid (AA) metabolic cascade while minor physical anomalies (MPAs) are indicated as a potenti al markers of abnormal brain development in pati ents with schizophrenia. We tested whether risk for MPAs was associated with variati ons in three genes of phospholipase A2 (PLA2) superfamily as PLA2s play an important role in signaling pathway of AA. Methods: 63 pati ents (32 females and 31 males) from the Psychiatry Clinic, Clinical Medical Centre Rijeka, were recruited for this study; the diagnosis of schizophrenia was confi rmed using DSM-IV criteria. We investi gated 30 MPAs of the head and face regions, and correlated their total number with genotype and allelic variants of polymorphisms in genes PLA2G4A (rs10798059, G/A or BanI polymorphism), PLA2G6A (rs4375, C/T variation) and PLA2G4C (rs1549637, A/T variation). Genotyping was performed by PCR-RFLP method. Results: Significant correlati on was found between MPA total score and PLA2G4C genotype (tauPLA2G4C=0,214; P=0,014); the highest median was found in TT homozygotes (13; range=10-16). A trend for synergisti c eff ect of two polymorphisms, each one in PLA2G4A and PLA2G6A genotypes, was also detected. The highest MPA score median was found in GG/CC homozygotes (14; range=10-22; P=0,058) or in the absence of PLA2G4A-A and PLA-2G6A-T alleles. Conclusions: The results suggested possible associati on between parti cular variati ons in the genes crucial during early development of central nervous system (genes of the PLA2 superfamily) with higher total number of MPAs of the head and face.

U uvodniku su navedeni motivi i povod za tematski broj na ovu temu te je skrenuta pažnja na važnost i interakciju obitelji u svim segmentima ljudskog života.

Poznato je da se proporcije po broju stanovnika između prve i treće dobi skoro izjednačuju. Proces starenja neminovan je i različite su mogućnosti prilagodbe na starenje; neki prijevremeno odustaju od suočavanja s ulogom srednje dobi, drugi pokušavaju iskoristiti sve mogućnosti i odgoditi suočavanje s trećom dobi, dok treća skupina pokušava zaustaviti vrijeme i ostati “vječno mlad”. Autorice su dale presjek generacijskih odnosa u obitelji s posebnim naglaskom na uloge djedova i baka. Dana je slika odnosa unutar zdrave obitelji s naznakom različitosti u pojedinim specifičnim situacijama kao što su različitost u zauzimanju stavova i razmišljanja o životnim situacijama, razlike u odnosima unutar obitelji u kojima djedovi i bake imaju samo jednog ili više unuka i kada djeca uzimaju “pravdu u svoje ruke”. Ujedno je prezentirana slika obitelji pojavom degenerativnih bolesti koje nastaju postupno te se obitelj na neki način i privikne na sve manji kapacitet djedova i baka u svakodnevnom životu i uključuje u rješavanje njihovih životnih problema. Progresivne bolesti djedova i baka dovode najčešće do iznenadnih konfrontacija unutar obitelji, što znači da ih mogu izgubiti. To suočavanje s gubitkom budi u svim članovima separacijske strahove. Degenerativne i progresivne bolesti izravno utječu na obiteljske odnose. Gubitak jednog od roditelja djeda/bake dovodi do promjena ne samo unutar para, nego u većini slučajeva i unutar šire obiteljske zajednice., It is known that the proportions of first and third generation group are evening. The process of aging is inevitable and there are different possibilities of adjustment to the change; some prematurely give up from facing the roles of middle age, others try to use everything possible and available to postpone facing the third age, while others try to stop the time and stay for ever young. Authors have given cross-section view of the generational relations in a family with a particular emphasis on the role of grandmothers and grandfathers. A picture of the relation within a healthy family is given with an indication of the diversities in individual specific situations such as taking opposite stands on life situations, differences among families with one or more grandchildren, and when children take the justice in their own hands. Also, a picture of a family is presented in a phenomenon of degenerative and progressive illnesses of grandmothers and grandfathers, as well as their impact on the family relations where family must accustom to seizing capacities of grandparents to help in everyday living and solving problems. Progressive illnesses of grandparents lead to the confrontation with the idea of losing them. Anticipating the loss awakens the separation fears in other family members. Degenerative and progressive illnesses have a direct impact on family relations. Losing one of the grandparents not only leads to change inside the couple but inside the wider family unit as well.

Cilj: U radu je istražena moguća povezanost minor anomalija glave i lica i pojedinih simptoma u bolesnika s potvrđenom dijagnozom shizofrenije. Metode: U 40 bolesnika i 46 kontrolnih psihički zdravih ispitanika procijenjeno je 30 minor anomalija podijeljenih u sedam skupina (skupine karakteriziraju opću simetriju/asimetriju lica, anomalije oka, usnica, nosa, nepca, jezika i uha). Za svako analizirano područje izračunat je zbroj anomalija te ukupan zbroj anomalija svih dijelova glave i lica u svakog ispitanika. Pojedini zbrojevi minor anomalija analizirani su s obzirom na dob, spol, dob nastupa bolesti, trajanje bolesti i zbrojeve triju podljestvica (pozitivne, negativne i opće psihopatologije) PANSS-a (od engl. Positive and Negative Syndrome Scale). Rezultati: Statistički značajne korelacije pronađene su između zbroja minor anomalija nepca i zbroja intenziteta simptoma opće psihopatologije na PANSS-u (r=0,357; P, Aim: The aim of the research was to investigate possible correlations between minor physical anomalies (MPAs) scores and clinical features of patients with schizophrenia: age at disease onset, duration of illness, and the severity of symptoms (evaluation of PANSS scores). Methods: We investigated 30 minor anomalies of the head and face in 40 patients and 46 non-psychiatric controls. Variables were grouped into seven head and face regions, and we calculated regional scores, as well as total MPA score for each individual. Results: Significant correlations were found between palatal score and PANSS general psychopathology scale score (r=0,357; P

Rehabilitacija psihijatrijskog bolesnika sveobuhvatan je i složen proces koji teži vođenju zdravog života, unatoč postojanja simptoma bolesti ili poremećaja. Rehabilitacija se sastoji od organoterapije (psihofarmakoterapije), psihoterapije i socioterapije. Socioterapija je, prema tome, dio rehabilitacije u kojoj u terapijske svrhe koristimo dimenzije grupe. Socioterapijski postupci su različiti, no svi imaju zajednički cilj: poboljšati funkcioniranje bolesnika i ojačati njegove sposobnosti socijalne prilagodbe. Konačni cilj socioterapije i cjelokupne rehabilitacije je resocijalizacija i reintegracija psihijatrijskog bolesnika u zajednicu, Rehabilitation of the psychiatric patient is a comprehensive and a complex process, aiming at a healthy lifestyle despite the existence of the symptoms of the illness or a disorder. The rehabilitation comprises of organotherapy (psychopharmacotherapy), psychotherapy and sociotherapy. Therefore, sociotherapy is defined as a segment within rehabilitation, with a group dimension applied for therapeutic purposes. The effects of sociotherapy are various, nevertheless, they are all aiming towards a single goal: improving the patient’s functioning, strenghtening their social adaptation skills. The final sociotherapy’s goal and the goal of the rehabilitation as a whole is re-socialisation and re-integration of the psychiatric patient in the community.

Objective: To review the feasibility and effectiveness of single daily dosing of lithium in patients with affective disorder and to discuss advantages and disadvantages of this schedule of administration. Method: A comprehensive search of the literature was conducted using a combination of electronic databases and a search of reference lists and relevant journals. English-language articles were selected for the review if they discussed the issues comparing multiple and single daily dosing schedules of lithium. Results: We found 9 comparative studies. Single daily dosing of lithium causes transient higher peak lithium concentrations; however, no comparative study revealed a significant difference in side effects between multiple and single daily dosing groups. Numerous reports concluded that taking lithium in a single dose prevents, or at least limits, the increase in urine output (and the reduction of osmolality) and subsequent thirst. There is no evidence that a single lithium dosing schedule preserves glomerular function. Conclusion: According to the presented data, it could be reasonable to use lithium as a single evening dose in patients who can tolerate this schedule because no studies have suggested any benefit from administration of multiple daily doses. Possible advantages of single daily dosing, especially in improved compliance, could not be veiled by disadvantages of transient and mild postabsorptive side effects.

U životu Zvonimira Sušića – neurologa, psihijatra, sudskoga vještaka, edukatora, nastavnika, prevoditelja i erudita enciklopedijskoga općeg i stručnog znanja – razabiru se tri jasna razdoblja: zagrebačko, riječko i zadarsko razdoblje. U Zagrebu (1926.– 1946.) promoviran je za liječnika (1932.), bio je demonstrator, potom asistent Fiziološkog instituta Medicinskoga fakulteta, volonter, sekundarni liječnik (specijalizirao je 1938.), asistent i primarni liječnik Bolnice za duševne bolesti u Vrapču te docent (1941.) na Neuropsihijatrijskoj katedri Zagrebačkoga sveučilišta. U Rijeci (1947.– 1959.) reorganizirao je Psihijatrijski odjel te osnovao Neurološki odjel Opće bolnice » Braće dr. Sobol« . Bio je najprije honorarni nastavnik, potom docent te izvanredni profesor neurologije i psihijatrije na riječkome Medicinskome fakultetu. U Zadru (1960.– 1968.) bio je ravnatelj bolnice u Ugljanu. Objavio je približno 100 radova iz područja kliničke neurologije, neuropatologije, psihijatrije i sudske psihijatrije. Radovi o predstavljanju sheme tijela u moždanoj kori, obmanama osjetila, tuberoznoj sklerozi, trudnoći i multiploj sklerozi, patohistologiji demijelinizacije, toksičnim neuritisima, epilepsijama, živčanim manifestacijama bruceloze, herpetičkim infekcijama, patogenezi konvulzivnoga sindroma, psihijatrijskoj terminologiji, terapiji Parkinsonove bolesti i shizofrenije, sposobnosti sastavljanja oporuke, organizaciji psihijatrijske službe, objavljeni su u domaćim i prestižnim europskim časopisima te često bili citirani. Obrađivao je zasebna poglavlja u udžbenicima iz psihijatrije i posebne natuknice u enciklopedijskim izdanjima. Začetnik je (uza Stanislava Župića) psihodrame u Hrvatskoj. Među pionirima je neuropatologije u Hrvatskoj, jer je davne godine 1936. u Bolnici u Vrapču razvio Neuropatološki laboratorij. Odlikovao se čudesnom preciznošću i pedantnošću u ispitivanju bolesnika. Bio je čest i dosjetljiv predavač u raznim sekcijama Zbora liječnika Hrvatske i u drugim javnim institucijama. Obdareni poliglot, nakon umirovljenja bavio se pre¬ vodilačkim radom. U naše medicinsko okruženje, do tada pretežno srednjoeuropske medicinske kulture, unio je vrijednosti i obrasce rada francuske neurološke i njemačke neuropatološke škole.

Posttraumatic stress disorder (PTSD) in one family member can negatively influence other family members and affect entire family dynamics (1-3). For many reasons, children in such families are especially vulnerable (4). Many studies have established that, in comparison with children of combat veterans without PTSD, the children of combat veterans with PTSD have more frequent and more serious developmental, behavioral, and emotional problems (2,5-10). Some of them also have specific psychiatric problems (11). Interviews with spouses and partners of combat veterans revealed that children of veterans with PTSD have more behavioral problems (5) and more frequent problems with authority, depression, anger, hyperactivity, and personal relationships (6-10) than children of veterans without PTSD. They are also more aggressive, use opiate drugs more often (6), and have learning difficulties and problems with diadic relations and emotional regulation (8). However, Harkness (8,12) did not find a significant association between the intensity of PTSD symptoms in veteran fathers and behavior of their children. On the other hand, it seems that the children of Vietnam War veterans did have behavioral problems, with veterans’ PTSD being a possible indirect factor in this association (13). It is assumed that direct war experience may disrupt the later capability of veterans to function as parents, leading to difficulties in the development and behavior of their children (12,13). With respect to the degree of individual and social traumatization caused by war trauma and post-war social situation in Bosnia and Herzegovina (BH), we assumed that war-related PTSD in veterans would have noticeable effect on the development of their children and that children of veterans with PTSD would have more psychological problems than children of veterans without PTSD. The aim of our study was to determine developmental, behavioral, and emotional problems of children in BH as reported by their veteran fathers with combat-related PTSD.

Cilj ovoga rada je prikazati sociodemografske karakteristike ovisnika o alkoholu lijecenih na Psihijatrijskom odjelu Opce bolnice Dubrovnik. Istraživanjem su obuhvaceni svi alkoholni ovisnici, a lijeceni tijekom 1992., 2000. i 2005. god. Podaci su prikupljeni iz bolnickog registra i povijesti bolesti, a obuhvaceni su sljedeci parametri: spol, dob, bracno stanje, školska sprema i radni status. Rezultati ukazuju da bolesnici lijeceni zbog ovisnosti o alkoholu još uvijek zauzimaju veliki dio psihijatrijskih kreveta, iako se kroz godine vidi tendencija smanjenja hospitalizacija. Takoder je vidljivo da je veci broj muških pacijenata. Vecinom su to osobe srednje životne dobi, a i kod žena i kod muškaraca radi se prvenstveno o oženjenim i zaposlenim ljudima. Dobivenim podacima dobiva se uvid u sociodemografske karakteristike lijecenih ovisnika o alkoholu na podrucju Dubrovacko-neretvanske županije s ciljem planiranja što kvalitetnije psihijatrijske skrbi ovih bolesnika., The purpose of this research was to examine the sociodemographic characteristics of alcohol addicts treated at the Department of Psychiatry of Dubrovnik General Hospital. All patients hospitalized because of alcohol addiction at the Department of Psychiatry of Dubrovnik General Hospital during 1992, 2000 and 2005 were included in this research. Data used in order to perform this research was gathered from hospital records and patients' case histories. Criteria assessed were: gender, age, marital status, employment and level of education. Results show that alcohol addicts still account for a great deal of psychiatric hospitalizations, although there is a noticeable tendency of decreasing the number of alcohol related hospitalizations. Furthermore, the majority of patients hospitalized because of alcohol addiction are male. Patients hospitalized are mostly middle-aged, married and employed. Acquired research data gives us a valuable insight into the sociodemographic characteristics of alcohol addicts in Dubrovacko-neretvanska County and enables further planning of quality psychiatric care of alcohol addicts.

The goal of this study was to analyse the defence mechanisms's changes during adolescent_s adaptation to the new schooling terms at the first year in high school. Sample of 266 students, mean age 15, have been included in the research. Kellerman_s Life Style Questionnaire (LSQ) was administred for measuring defence mechanisms at the beginning and at the end of the scool year. Results show that regression and reactive formation are changing at most; regression raises (p

Provedeno je istraživanje učestalosti simptoma poremećaja hranjenja meðu studentima Medicinskog fakulteta Sveučilišta u Rijeci. Novim, nestandardiziranim anonimnim upitnikom ispitano je 255 studentica i 155 studenata. Rezultati pokazuju da studentice mnogo češće od studenata drže dijetu i uzimaju laksative te namjerno izazivaju povraćanje kao mehanizme za održavanje željene težine. Većina studentica nije zadovoljno svojom trenutačnom težinom, a 3,5% ima znakove pothranjenosti · indeks tjelesne teæine ispod granične vrijednosti 18. Studentice su pod većim utjecajem kulta mršavosti, Češće imaju osjećaj krivnje nakon jela i više su zaokupljene vlastitim izgledom, a sve to moæe dovesti do najteæih oblika poremećaj hranjenja · anoreksije nervoze i bulimije nervoze., We carried out a survey about symptoms of Eating disorders among students of Medical Faculty University of Rijeka. A 405 students (255 female, 150 male, average age of 22) were asked to fill in a new non-standard, anonymous survey. We found that 52,9% female and 18% male students went dieting some time in their lives. 3,5% of female students have BMI lower than 18 meaning they are underweight. We have found that 5,5% of female students used self-induced vomiting, 5,9% abused laxatives and 1,2% used both, self-induced vomiting and laxatives. Statements of various student groups were compared (male-female; students who used vomiting, laxative and both-control group). Female students are in average thinner then their male colloquies. They are under larger influence of thin cult and more preoccupied with their bodyweight. We found that a certain number of students used self-induced vomiting, abused laxatives or both in controlling their weight. They were all female which leads us to conclusion that the female population is at the higher risk of developing eating disorders and progressing toward the most difficult forms such as Anorexia nervosa and Bulimia nervosa.

Longitudinalnim smo praćenjem obuhvatili 12 pacjentica oboljelih od anoreksije nervoze s ciljem evaluacije postupaka dijagnostike i liječenja. Prateći promjene u dijagnostičkim kriterijima (Dijagnostički i statistički priručnik duševnih bolesti · DSM IV) uočili smo da je u naših pacijentica najprije došlo do oporavka na planu fizičkih kriterija bolesti (povećanje težine i pojava menstruacije), ali da psihički kriteriji (strah od debljanja i poremećaj percepcije vlastita tijela) perzistiraju znatno duže. Anoreksija nervoza izrazito je dugotrajna bolest s tendencijom ka kroničnosti. Liječenje treba nastaviti i nakon tjelesnog oporavka (tjelesna teæina, menstruacija). Budući da smo našli i dosljedno predugo vrijeme (prosječno 14 mjeseci) od pojave prvih simptoma bolesti do pronalaženja dijagnoze, ističemo važnost ranog otkrivanja i dugotrajnog tretmana ove bolesti., Twelve patients with diagnosis anorexia nervosa have been prospectively follow-up with respect to evaluated the treatment regarding differences in diagnostic criteria (Diagnostic and statistical manual of mental diseases · DSM IV), academic, family and social functioning. Anorexia nervosa is a long treating disease with tendency toward chronicity. We recommend that treatment must go on after improvement in physical symptoms (body weight, period) because psychological criteria of illness (fear of becoming fat and disturbance in perception of own body) still persist. We found that the time from first signs of disease until the clear diagnose was to long (mean time is 14 months). We point out the importance of early diagnose and long-term treatment.

Povećanje učestalosti poremećaja hranjenja i potreba za višegodi¹njim liječenjem zavreðuju pojačanu pažnju kliničara. Klasifikacija poremećaja hranjenja sadrži: anoreksiju nervozu, bulimiju nervozu, prejedanje te atipičnu anoreksiju nervozu i atipičnu bulimiju nervozu. Anoreksija nervoza težak je i dugotrajan poremećaj hranjenja sa znatnim potencijalom za letalni ishod. U ovom je članku dan kratak pregled dijagnostičkih kriterija, kliničke slike, epidemioloških podataka, etiologije, mogućih ishoda i timski pristup u tretmanu anoreksije nervoze., Eating disorders are relatively common and potentially life - treating conditions experienced with increasing frequency by older children and adolescents mostly female. The diagnostic classification of eating disorders includes: anorexia nervosa, bulimia nervosa, binge eating, atypically anorexia and atypically bulimia nervosa. Anorexia nervosa is a very serious, long · term and potentially lethal eating disorder. This paper reviews the recent research literature on diagnostic criteria, clinical picture, epidemiological and etiological features related to anorexia nervosa. We have also discussed outcome and suggested team treatment

The aims of the present work are to introduce to the field of communication between the cancer patient and the professionals, to remark the positive influence communication may have on the patient, and to present the EORTC communication questionnaire. Communication between patient and professional is a key element in the support that is offered to cancer patients. It is important to consider different professionals communicate with cancer patients. There is a need of research in communication between patients and professionals. Two main models of patient care are presented: Paternalistic and Patient-Centered Cancer Care. Patient-Centered Care includes Patient- Centered Communication - PCC. The relation between communication and other PROs - Quality of Life, Information and Satisfaction with Care - is presented. There are cross-cultural differences in communication that could be related to the model of patient care. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is developing a questionnaire to assess communication between cancer patient and the professionals. This Communication questionnaire mainly assesses professionals’ behaviors. Cultural aspects have a key role in the development of the EORTC questionnaire. This instrument is based on the Patient- Centered Communication – PCC model. The EORTC QLQ-COMU26 is presented. It includes six scales and four individual items. The three phases of the questionnaire development process are described. At the present moment the EORTC QLQ-COMU26 is being field-tested in a larger international study (phase IV), to ensure it is an appropriate and psychometrically valid instrument., Este trabajo pretende introducir el área de la comunicación entre el paciente oncológico y los profesionales, y destacar el impacto que tiene en el paciente. Además, se presenta el cuestionario de comunicación de la EORTC. La comunicación entre el paciente y los profesionales es uno de los elementos claves del soporte que se ofrece a dichos pacientes. En dicha comunicación participan un rango importante de profesionales. Hay una necesidad de realizar más investigación sobre la comunicación. Se presentan dos modelos principales de atención al paciente: el Paternalista y el de Atención Centrada en el Paciente con cáncer. Este último lleva asociada la Comunicación Centrada en el Paciente - CCP. Se revisa la relación entre comunicación y otros PRO: Calidad de Vida, información, y Satisfacción con los Cuidados. Existen diferencias culturales en comunicación que pueden estar relacionadas con el modelo de atención al paciente. El Grupo de Calidad de Vida de la Organización Europea para la Investigación y Tratamiento del Cáncer-EORTC está desarrollando una escala de comunicación entre el paciente oncológico y los profesionales. La mayoría del contenido de dicho cuestionario se centra en las conductas de los profesionales. Los aspectos culturales tienen un papel fundamental en el desarrollo del instrumento. El cuestionario se basa en el modelo de Comunicación Centrada en el Paciente – CCP. Se presenta el cuestionario EORTC QLQ-COMU26, que consta de seis escalas y cuatro ítems individuales. Se describen las tres primeras fases que se han dado en su creación. En la actualidad su funcionamiento psicométrico se está valorando en un estudio internacional.

Autori žele upozoriti na problem psihoneurotičnih pacijenata, koji se javljaju u sve većem broju tražeći stomatološku zaštitu, kao i na način postupanja s njima. Zalažu se za stručni pristup psihoneurotičnom pacijentu, koji bi bez sumnje olakšao rad stomatologa., The authors wish to emphasize the problem of the growing number of psychoneurotic pationts who are appearying for stomatological treatment and the manner or methods for their acceptance. They are interceding for professional approach towards psychoneurotic patients which would undoubtedly be of great help to dental surgeons., Die Autoren wollen die Problematik der psychoneurotischen Patienten, die in immer grosserer Zahl stomatologischen Schutz suchen, hervorheben und gleichzeitig auf die entsprechende Behandlungsweise hinweisen. Sie treten fur eine fachmannische Zuwendung zum psychoneurotischen Patienten ein, was die Arbeit des Stomatologen ohne Zweifel erleichtert.

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.