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Cilj istraživanja: Cilj ovog istraživanja je ispitati zastupljenost opterećenja u neformalnih njegovatelja, najčešće članova obitelji oboljelih od shizofrenije te utvrditi povezanost s dobi ispitanika, spolom ispitanika, dobi oboljele osobe i godinama brige za oboljelu osobu. Utvrditi povezanost općih psihopatoloških poteškoća s opterećenjem ispitanika. Ispitanici i postupci: Istraživanje se provelo na uzorku od 30 članova obitelji, neformalnih njegovatelja osoba oboljelih od shizofrenije metodom prigodnog uzorka. Korišten je demografski upitnik te dva standardizirana upitnika: Zarit upitnik o opterećenju i Upitnik za ispitivanje općih psihopatoloških teškoća. Rezultati: Prosječni rezultat naših 30 ispitanika na ZBI iznosio je 36,73 što je rezultat koji odgovara blagom do umjerenom stupnju opterećenja. Rezultat ZBI se nije statistički značajno razlikovao između spolova. Nije utvrđena statistički značajna povezanost između dobi ispitanika te godina brige sa opterećenjem. Utvrđena je statistički značajna negativna povezanost (rs=-0,381, P=0,037) između dobi oboljele osobe i opterećenja, kao i statistički značajna pozitivna povezanost (rs=0,474, P=0,008) između dnevnih sati brige i opterećenja. Prosječni rezultat CORE-OM naših 30 ispitanika iznosio je 38,13 što je rezultat koji odgovara blagoj razini izraženosti psihopatoloških poteškoća. Od 30 ispitanika, njih 19 (63,33%) ima klinički značajnu razinu izraženosti općih psihopatoloških poteškoća. Utvrđena je statistički značajna pozitivna povezanost (rs=0,395, P=0,031) između domene gubitka kontrole nad vlastitim životom ZBI i ukupnog rezultata CORE-OM, kao i statistički značajna pozitivna povezanost (rs=0,431, P=0,017) između domene financije ZBI i ukupnog rezultata CORE-OM. Također je utvrđena statistički značajna pozitivna povezanost (rs=0,426, P=0,019) između domene simptomi CORE-OM i domene financije te statistički značajna pozitivna povezanost (rs=0,418, P=0,021) između domene simptomi CORE-OM i domene gubitak kontrole nad vlastitim životom. Zaključci: Ovo istraživanje je potvrdilo postojanje fenomena opterećenja među neformalnim njegovateljima, članovima obitelji oboljelih od shizofrenije. Uz stalne procjene opterećenja, razvoj strategije suočavanja sa bolešću, socijalnom i zdravstvenom podrškom, iskustvo pružanja skrbi može biti manje opterećujuće za neformalne njegovatelje., Research goal: The goal of this research is to examine the representation of burden in informal caregivers, most often family members of patients with schizophrenia, and to determine the relationship with the age of the subject, the gender of the subject, the age of the person with the disease and the years of care for the person with the disease. To determine the connection of general psychopathological difficulties with the workload of the respondents. Respondents and procedures: The research was conducted on a sample of 30 family members, informal caregivers of persons suffering from schizophrenia using the convenience sampling method. A demographic questionnaire and two standardized questionnaires were used: the Zarit questionnaire on workload and the Questionnaire for examining general psychopathological difficulties. Results: The average score of our 30 subjects on the ZBI was 36.73, which corresponds to a mild to moderate level of burden. The ZBI score was not statistically significantly different between the sexes. No statistically significant correlation was found between the age of the respondents and years of care with workload. A statistically significant negative correlation (rs=-0.381, P=0.037) was found between the age of the patient and burden, as well as a statistically significant positive correlation (rs=0.474, P=0.008) between daily hours of care and workload. The average CORE-OM score of our 30 subjects was 38.13, which corresponds to a mild level of psychopathological difficulties. Out of 30 subjects, 19 (63.33%) have a clinically significant level of expression of general psychopathological difficulties. A statistically significant positive correlation (rs=0.395, P=0.031) was found between the loss of control over one's own life domain of the ZBI and the total CORE-OM score, as well as a statistically significant positive correlation (rs=0.431, P=0.017) between the ZBI finance domain and of the total result of CORE-OM. There was also a statistically significant positive correlation (rs=0.426, P=0.019) between the CORE-OM symptoms domain and the finance domain, and a statistically significant positive correlation (rs=0.418, P=0.021) between the CORE-OM symptoms domain and the loss of control domain with his own life. Conclusions: This research confirmed the existence of the burden phenomenon among informal caregivers, family members of schizophrenia patients. With ongoing assessments of burden, development of coping strategies, social and health support, the caregiving experience can be less stressful for informal caregivers.

Ciljevi: Glavni cilj ovog istraživanja bio je ispitati kvalitetu života osoba oboljelih od posttraumatskog stresnog poremećaja i njihovo pridržavanje zdravom načinu života. Dodatni ciljevi bili su ispitati povezanost kvalitete života sa sociodemografskim, antropometrijskim i metaboličkim parametrima, varijablama vezanim uz ratno iskustvo te štetnim životnim navikama. Materijali i metode: Istraživanje je provedeno na 100 ispitanika, veterana iz Domovinskog rata s dijagnozom PTSP-a, koji se liječe u Centru za psihotraumu Kliničkog bolničkog centra u Splitu. Od ispitanika su prikupljeni anamnestički i sociodemografski podaci te su ispunili FANTASTIC Lifestyle upitnik o pridržavanju zdravom načinu života. Izvedena su antropometrijska mjerenja (tjelesna masa, visina, opseg struka i bokova) te mjerenja sastava tijela (postotak masti, razina visceralne masti i metabolička dob). Rezultati: Kvaliteta života osoba oboljelih od PTSP-a je niska, a prosječni broj postignutih bodova na upitniku za sve ispitanike iznosio je 52,7 (95% CI 50,4-55). Utvrđena je značajna povezanost između socioekonomskog statusa i kvalitete života (P=0,032), pri čemu ispitanici višeg statusa imaju višu kvalitetu života. Najvišu kvalitetu života su imali umirovljenici s rezultatom 56 (95% CI 52,2-59,7). Nije utvrđena značajna povezanost između bračnog statusa i roditeljstva s kvalitetom života (P=0,055, P=0,203). Pušenje je pokazalo negativan utjecaj na kvalitetu života, pri čemu su najviši zbir bodova na upitniku imali nepušači (57,1; 95% CI 53,9- 60,3), a najniži pušači (48,2; 95% CI 44,7-51,8). Konzumacija većeg broja alkoholnih pića na tjedan također snižava kvalitetu života (P=0,042). Kvaliteta života bila je niža kod ispitanika koji su sudjelovali u ratu u mlađoj životnoj dobi (Spearman ρ=0,213, P=0,034), ali nije pokazala povezanost s vremenom provedenim u ratu. Nijedan antropometrijski niti metabolički parametar nije pokazao povezanost s kvalitetom života, osim metaboličke dobi (Pearson r=0,200, P=0,048). Zaključci: Osobe oboljele od PTSP-a imaju nisku kvalitetu života. Kvaliteta života pokazala je značajnu povezanost sa socioekonomskim statusom i zaposlenošću, pušenjem i konzumacijom alkohola, dobi pri sudjelovanju u ratu te metaboličkom dobi ispitanika., Objectives: The main goal of this research was to determine the quality of life of persons with posttraumatic stress disorder and their adherence to healthy lifestyle. Additional goals were to examine the connection between the quality of life and sociodemographic, anthropometric and metabolic parameters, variables related to the war experience and unhealthy life habits. Materials and methods: This research was performed on 100 subjects, who are veterans of the Croatian War of Independence with the diagnosis of PTSD and are patients of the Psychotrauma Clinic of the University Hospital of Split. The sociodemographic and anamnestic data were collected and the subjects have filled out the FANTASTIC Lifestyle questionnaire about the quality of life (QoL). Anthropometric (body mass, height, waist and hip circumference) and body composition (body fat percentage, visceral fat level and metabolic age) measurements were performed. Results: The quality of life of persons with PTSD is low and the mean score of the questionnaire was 52.7 (95% CI 50.4-55). A significant correlation between the socioeconomic status and the QoL was determined (P=0.032), the subjects of a higher status having higher QoL. The retired had the highest QoL with the score of 56 (95% CI 52.5-59.7). There was no significant correlation between the marital status and parenthood with QoL (P=0.055, P=0.203). Smoking showed a negative influence on the QoL, non-smokers having the highest score (57.1; 95% CI 53.9-60.3) and smokers having the lowest score (48.2; 95% CI 44.7-51.8). Consumation of a higher number of alcoholic beverages a week also lowers QoL (P=0.042). QoL was lower in the subjects who participated in the war at a younger age (Spearman ρ=0.213, P=0.034), but there was no correlation with the time spent in the war. No anthropometric or metabolic parameters showed the correlation with QoL, except the metabolic age (Pearson r=0.200, P=0.048). Conclusions: Persons suffering from PTSD have a low QoL. QoL showed a significant correlation with some sociodemographic parameters, unhealthy life habits, the age at which the subjects participated in the war and the metabolic age of the subjects.

Cilj: Odrediti promjene kliničke slike posttraumatskog stresnog poremećaja (PTSP-a) i serumske koncentracije interleukina-1β (IL-1β) nakon provedene adjuvantne terapije ω-3 polinezasićenim masnim kiselinama (PUFA) u hrvatskih ratnih veterana. Odrediti udjele dokozaheksaenske (DHA, C22:6ω-3) i eikozapentaenske masne kiseline (EPA, C20:5ω-3) u ukupnom profilu masnih kiselina seruma te utvrditi njihovu povezanost s intenzitetom kliničke slike PTSP-a. Metode: U istraživanje je bilo uključeno 90 veterana Domovinskog rata oboljelih od PTSP-a koji su randomizirani u dvije skupine. Kontrolna skupina je dnevno uzimala 50 mg sertralina, a terapijska skupina 50 mg sertralina i dvije OMEGA-3 kapsule (a 300 mg ω-3PUFA). Za procjenu kliničke slike PTSP-a primijenjene su slijedeće kliničke psihometrijske skale: Klinička skala za posttraumatski stresni poremećaj (CAPS), Hamiltonova skala za anksioznost (HAM-A) i Hamiltonova skala za depresivnost (HAM-D-17). Samoocjenskim upitnikom su prikupljeni podatci o sociodemografskim karakteristikama i životnim navikama ispitanika. Sastav masnih kiselina u serumu analiziran je metodom plinske kromatografije. Određivanje IL-1β provedeno je ELISA metodom. Modeliranje strukturnim jednadžbama (engl. structural equation model, SEM) korišteno je da bi se procijenila uzročna povezanost varijabli. U model su uključene sve varijable za koje se zna ili pretpostavlja da su povezane s procesom promjene intenziteta PTSP-a. Rezultati: Terapijska skupina imala je značajniji pozitivan pomak u kliničkoj slici u odnosu na kontrolnu skupinu. Terapijska skupina je u odnosu na kontrolnu skupinu pokazala značajnije poboljšanje na psihometrijskim skalama CAPS (P = 0,021) i HAM-A (P < 0,001), dok za skalu HAM-D-17 nisu utvrđene značajne razlike u poboljšanju između skupina (P = 0,154). Nije utvrđena povezanost koncentracije IL-1β u serumu s rezultatima primijenjenih psihometrijskih skala (CAPS τ = -0,078, P = 0,499; HAM-A τ = -0,148, P = 0,213; HAM-D-17 τ = -0,068, P = 0,560). Nakon primjene adjuvantne terapije ω-3 PUFA nije došlo do promjene koncentracije IL-1β (P = 0,872). EPA je sačinjavala 0,1 %, a DHA 0,5 % udjela ukupnog sastava masnih kiselina u serumu ispitanika s kroničnim PTSP-om. Utvrđena je značajna negativna korelacija udjela EPA s intenzitetom kliničke slike PTSP-a (CAPS τ = -0,326, P < 0,001; HAM-A τ = -0.304, P = 0,001; HAM-D-17 τ = -0.345, P < 0,001). SEM modelom je pokazano kako na intenzitet simptoma kroničnog PTSP-a utječe razina EPA (Wilks’Λ = 0,763-0,805, P 0,006-0,018), AA/EPA (Wilks’Λ = 0,699-0,757, P = 0,004), i konzumacija mliječnih proizvoda (Wilks’Λ = 0,760-0,791, P 0,045- 0,088). Nije utvrđen utjecaj ostalih masnih kiselina ili prehrambenih/životnih navika na intenzitet simptoma PTSP-a (P 0,362-0,633). Zaključak: Primjena ω-3 PUFA se pokazala učinkovitom adjuvantnom terapijom kod oboljelih od PTSP-a. Razina EPA negativno korelira s intenzitetom simptoma kroničnog PTSP-a. Zbog određenih ograničenja istraživanja ovi nalazi se mogu smatrati preliminarnim i na razini indikativnosti. Nedvojbeno, potrebna su daljnja istraživanja s placebo skupinom, te longitudinala istraživanja na većem uzorku kako bi razjasnila moguću ulogu i utjecaj ω-3 PUFA kod PTSP-a., Aim: To explore the effect of adjuvant therapy with ω-3 polyunsaturated fatty acids (PUFA) on both, the severity of clinical symptoms and serum concentration of interleukin-1β (IL-1β) in Croatian war veterans diagnosed with post-traumatic stress disorder (PTSD). To determine the ratio of eicosapentaenoic acid (EPA, C20:5ω-3) and docosahexaenoic acid (DHA, C22:6ω-3) in the serum total fatty acid profile, and to determine their individual association with the severity of clinical symptoms of PTSD. Methods: The study included 90 male participants who were randomly assigned into the control group (50 mg of sertraline/day) or into the therapy group (50 mg of sertraline plus two OMEGA-3 capsules (300 mg ω-3 PUFA)/day). Clinician-Administered PTSD Scale (CAPS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale 17 (HAM-D-17) were used to assess the severity of PTSD symptoms. Fatty acid composition of the serum was analyzed by gas chromatography. Determination of IL-1β was conducted by the ELISA method. Data about life-style habits were collected by a structured interview. Structural equation modeling (SEM) was used to assess the causal relationship between variables. The model includes all the variables that are known or presumed to be associated with the process of change in the intensity of PTSD. Multivariate general linear models (GLM) were applied with the aim to evaluate association between plasma fatty acid levels and PTSD severity scales, while controlling for different confounders. Results: Compared to control group the therapy group demonstrated significantly greater improvement in CAPS (P = 0.021) and HAM-A (P < 0.001) clinician-rated scales, while there was no difference for HAM-D scale (P = 0.154). In contrast, there was no evidence of association between IL-1β levels and the severity of clinical symptoms of PTSD (CAPS τ = -0.078, P = 0.499; HAM-A τ = -0.148, P = 0.213; HAM-D τ = -0.068, P = 0.560). Also, no effect of ω-3 augmentation on concentration of IL-1β was noticed. There was no confirmation of effect of ω-3 augmentation on the concentration of IL-1β after the treatment (P = 0.872). EPA made up for 0.1%, and DHA made up for 0,5% of total fatty acids pool. Statistically significant negative correlation was established between EPA level and the severity of PTSD symptoms (CAPS τ = -0.326, P < 0.001; HAM-A τ = -0.304, P = 0.001; HAM-D τ = -0.345, P < 0.001). SEM confirmed that PTSD severity is affected by EPA (Wilks’Λ = 0.763-0.805, P from 0.006 to 0.018, AA/EPA (Wilks’Λ = 0.699-0.757, P = 0.004), and dairy products consumption (Wilks’Λ = 0.760-0.791, P from 0.045-0.088). No other fatty acid ratio or dietary/lifestyle variable was found to significantly affect the severity of PTSD symptoms (P from 0.362 - 0.633). Conclusion: Augmentation of sertraline with -3 PUFA was proved as an effective adjuvant therapy for chronic PTSD in war veterans. The EPA ratio negatively correlated with the intensity of clinical symptoms of chronic PTSD. The study confirmed that lower EPA levels are associated with the severity of clinical symptoms in a combat-related chronic PTSD. EPA level is inversely associated with intensity of PTSD symptoms. According to our findings the EPA serum levels could possibly be used as a categorization biomarker of the severity of combat-related PTSD symptoms. Regardin certain study limitations our results should be considered just on indicative level. Further placebo-controlled studies are necessary to determine effect of ω-PUFA as possible adjunctive therapy in sertraline treated PTSD patients. Cross-over studies will be preferred in order to reduce possible effect of different environmental factors on parameters observed in this study. Also, further well designed longitudinal studies on large sample are necessary to elucidate possible role of EPA in PTSD.

Cilj: Istražiti povezanost između ukupnog serumskog kolesterola i depresije, agresije i suicidalnih ideacija u bolesnika s kroničnim, ratnim PTSP-om bez psihijatrijskog premorbiditeta i komorbiditeta. Metode: Kod ukupno 203 muška bolesnika s kroničnim, ratnim PTSP-om procjenjivani su: depresija, agresija i suicidalnost, korištenjem: zbroja 17-čestične Hamilton Depression Rating Scale (HAM-D17), zbroja Corrigan Agitated Behavior Scale (CABS) i zbroja Scale for Suicide Ideation (SSI), nakon čega su određivani serumski lipidni parametri (ukupan kolesterol, HDL-kolesterol, LDL-kolesterol i trigliceridi). Teţina PTSP-a procjenjivana je korištenjem dviju ocjenskih ljestvica: Clinician-Administered PTSD Scale for DSM-IV, Current and Lifetime Diagnostic Version (CAPS-DX) i Clinical Global Impressions of Severity scale - (CGI-S), nakon prethodne primjene ocjenske ljestvice Mini International Neuropsychiatric Interview – (MINI) kojom je isključen psihijatrijski komorbiditet i premorbiditet. Rezultati: Nakon prilagodbi za težinu PTSP-a, dob, indeks tjelesne mase (engl. body mass index, BMI), bračni status, stručnu spremu, radni status, korištenje pojedinih antidepresiva i druge lipidne parametre (LDL- i HDL-kolesterol i triglyceride), viši ukupni kolesterol je bio značajno povezan s nižom vjerojatnošću/manjim rizikom za imati više suicidalne ideacije (SSI≥20) (odds ratio [OR] 0.09; 95% confidence interval [CI] 0.03-0.23), klinički značajnu agresiju (CABS≥22) (OR 0.28; 95% CI 0.14-0.59 i barem umjerene depresivne simptome (HAM-D17≥17) (OR 0.20; 95% CI 0.08-0.48). Povezanost ukupnog kolesterola i HAM-D17 zbrojeva je bila značajno moderirana težinom PTSP simptoma (P, Aim: To investigate the relationship between total serum cholesterol and levels of depression, aggression, and suicidal ideations in war veterans with posttraumatic stress disorder (PTSD) without psychiatric comorbidity. Methods: A total od 203 male PTSD outpatients were assessed for the presence of depression, aggression and suicidality using the 17-item Hamilton Depression Rating Scale (HAM-D17), Corrigan Agitated Behavior Scale (CABS), and Scale for Suicide Ideation (SSI), respectively, followed by plasma lipid parameters determination (total cholesterol, high density lipoprotein [HDL]-cholesterol, low density lipoprotein [LDL]-cholesterol, and triglycerides). PTSD severity was assessed using the Clinician-Administered PTSD Scale for DSM-IV, Current and Lifetime Diagnostic Version (CAPS-DX) and the Clinical Global Impressions of Severity Scale (CGI-S), before which Mini-International Neuropsychiatric Interview (MINI) was administered to exclude psychioatric comorbidity and premorbidity. Results: After adjustments for PTSD severity, age, body mass index, marital status, educational level, employment status, use of particular antidepressants, and other lipid parameters (LDL- and HDL- cholesterol and triglycerides), higher total cholesterol was significantly associated with lower odds for having higher suicidal ideations (SSI≥20) (odds ratio [OR] 0.09; 95% confidence interval [CI] 0.03-0.23), clinically significant aggression (CABS≥22) (OR 0.28; 95% CI 0.14-0.59, and at least moderate depressive symptoms (HAMD17≥ 17) (OR 0.20; 95% CI 0.08-0.48). Association of total cholesterol and HAM-D17 scores was significantly moderated by the severity of PTSD symptoms (P

Rezultati istraživanja o oštećenju u prepoznavanju emocija iz izraza lica (PEIL) u shizofreniji (SHI) su vrlo raznoliki. Naše smo istraživanje podijelili u dva dijela: presječno istraživanje s ciljem utvrđivanja razlika u PEIL između 80 pacijenata s prvom epizodom psihoze (PEP), 80 pacijenata sa SHI i 80 zdravih kontrola (ZK) i prospektivno praćenje 159 pacijenta s PEP s ciljem utvrđivanja promjena u PEIL između prve akutne epizode i nakon 18 mjeseci liječenja. Istraživali smo i povezanost PEIL s psihopatologijom, kvalitetom života i funkcioniranjem pacijenata. Potvrdili smo postojanje statistički značajnih oštećenja na općenitoj i na razini negativnih emocija u obje skupine pacijenata u odnosu na ZK, s najlošijim rezultatima u SHI. Iako je u skupini s PEP došlo do značajnog poboljšanja PEIL, ono je izostalo u prepoznavanju tuge. Pokazali smo da su psihopatologija, kvaliteta života i funkcioniranje povezani s PEIL, pogotovo u PEP. Zaključno, oštećenja PEIL su značajna već od početka bolesti, s naglaskom na negativne emocije koje ne pokazuju poboljšanje ni nakon 18 mjeseci standardnog liječenja. S obzirom na to, ali i na povezanost s psihopatologijom, kvalitetom života i funkcioniranjem, ova bi oštećenja trebala biti uključena u inicijalnu procjenu i plan liječenja već od prve epizode bolesti., Results of the previous studies regarding facial emotion recognition (FER) in schizophrenia (SCH) are very heterogeneous. Our study was divided in two parts: cross-sectional study aiming to investigate differences in FER between 80 patients with first-episode psychosis (FEP), 80 patients with SCH and 80 healthy controls (HC) and prospective study with 159 patients with FEP aiming to investigate changes in FAR between first acute episode and after 18 months of treatment. We analyzed correlations of FAR with psychopathology, quality of life and functioning. Our results showed statistically significant differences between HC and patients’ groups in overall recognition and recognition of negative emotions, with the worst results in SCH. After 18 months of treatment, FAR improved for all emotions except sadness. Also, we found significant correlations of psychopathology, quality of life and functioning with FAR, especially in FEP. In conclusion, FAR deficits are present since the beginning of the illness, with emphasis on negative emotions which do not show improvement even after 18 months of treatment. Taking this into account, along with the correlations with psychopathology, quality of life and functioning, FAR deficits should be included in the initial assessment and treatment plan since the first episode of the illness.

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

Aim: To report the clinical courses of four adolescent patients, who developed childhood-onset schizophrenia and where art had a vital role in diagnosing schizophrenia, monitoring their clinical state and progression. Case report: All of the patients had several diagnoses throughout childhood; however, the final diagnosis was made with the help of art therapy. Following the changes in the content of our patients’ drawings enabled us to notice the changes in their quality of life, functioning, and efficacy of therapy. Some of the patients specified that throughout the drawing process, they felt more satisfied, “better” and not „haunted„ by their hallucinations. This acknowledgment assured us that creative expression through art is an appropriate approach for them. It also strengthened the therapeutic relationship with our patients and encouraged us to understand their disease and make better decisions about their treatment. Conclusions: We propose art as an assistive method in diagnosing schizophrenia. Art can break down communication barriers and can also serve as follow-up method for children and adolescent patients with schizophrenia, Sažetak. Cilj: Prikazati klinički tijek četiriju adolescenata koji su u djetinjstvu oboljeli od shizofrenije, kod kojih je korištenje likovnog izražavanja imalo glavnu ulogu u dijagnosticiranju same bolesti, praćenju kliničkog stanja i progresije. Prikaz slučaja: Tijekom djetinjstva, svim pacijentima dijagnosticirane su brojne dijagnoze, no početkom razdoblja adolescencije, uz pomoć likovnih djela pacijenata, postavljena je konačna dijagnoza shizofrenije. Praćenje likovnih sadržaja crteža pacijenata omogućilo je uvid u promjene kvalitete njihovih života, funkcioniranja i djelotvornosti terapije. Pojedini su naveli kako su se tijekom čitavog procesa crtanja osjećali zadovoljno, „bolje“ i da ih „ne proganjaju“ toliko njihove halucinacije. Ovakvo nas je priznanje uvjerilo da je kreativno izražavanje, kroz artterapiju, odgovarajući pristup bolesti. Terapijski je odnos s našim pacijentima ojačao i potaknuo nas na razumijevanje njihove bolesti i stanja, a ujedno i na donošenje boljih budućih odluka o liječenju. Zaključci: Komunikacija kroz likovno izražavanje može poslužiti kao pomoćna metoda u dijagnosticiranju shizofrenije. Umjetnost može srušiti komunikacijske prepreke, a ujedno može poslužiti i kao metoda praćenja djece i adolescenata sa shizofrenijom

The main objective of this study was to assess behavioural changes in forensic patients (those assessed as not guilty by reason of insanity and sent for an involuntary forensic treatment) during the COVID-19 pandemic restrictions. There were 82 patients treated at the Department for Forensic Psychiatry of the University Psychiatric Hospital Vrapče in 2020, 45 of which stayed in the department for the whole year. Data were extracted from their charts and from the nurses’ reports about their body masses, additional therapy prescribed and incidents at the ward. During the lock-down due to the COVID-19 pandemic, the body masses of the forensic patients decreased signifi cantly in the first weeks of the lock-down and stayed low during the rest of 2020. Patients used fewer additional antipsychotics, benzodiazepines, hypnotics and pain killers in April 2020 as compared to February 2020. In June 2020, the use of these drugs returned to pre-pandemic levels, with the exception of antipsychotics. In August 2020, painkiller use increased to higher than pre-pandemic levels. The number of incidents during lock-down was lower compared to pre-pandemic levels., Glavni je cilj ovog istraživanja bio procijeniti promjene u ponašanju forenzičkih pacijenata (onih koji su ocijenjeni kao neubrojivi i upućeni na prisilno forenzičko liječenje) tijekom razdoblja COVID-19 epidemioloških mjera. Tijekom 2020. na Zavodu za forenzičku psihijatriju Klinike za psihijatriju Vrapče liječilo se 82 bolesnika, od kojih je 45 boravilo na Zavodu tijekom cijele godine. Podatci su dobiveni iz njihovih kartona i sestrinskih lista o njihovoj tjelesnoj težini, dodatno propisanoj terapiji i incidentima na Zavodu. Tijekom lockdowna zbog COVID-19 pandemije, tjelesna težina forenzičkih bolesnika uvelike se smanjila u prvim tjednima lockdowna i ostala takva do kraja 2020. Usporedno s veljačom u 2020., u travnju iste godine bolesnici su trošili manje dodatnih antipsihotika, benzodijazepina, hipnotika i analgetika. U lipnju 2020. potrošnja tih lijekova se vratila na prepandemijsku razinu, osim antipsihotika. U kolovozu 2020. potrošnja analgetika povećala se iznad prepandemijske potrošnje. Broj je incidenata tijekom lockdowna, u odnosu na prethodnu godinu, bio manji.

Mental illnesses have a complicated genetic basis, and it is very difficult to explain their biology using only a genetic approach. In collaboration with international partners, we have started to develop a complementary strategy focusing on proteins of the central nervous system. This approach is based on the fact that in chronic neurodegenerative diseases such as Alzheimer's, Parkinson's, and Huntington's disease, the pathology is manifested by the detection of insoluble protein aggregates in the brain. Based on the observed abnormal protein homeostasis in postmitotic neurons in patients with these diseases, we drew the parallel and hypothesised that proteins may similarly accumulate in the form of smaller aggregates and occur in chronic mental illness. Initial studies show that such proteins are present in the brains of patients, but their practical diagnostic value is limited. The proteins observed to date were: DISC1, TRIOBP, NPAS3, CRMP1, and dysbinidin-1. Therefore, we hypothesised that the abnormal proteostasis observed in the brain of patients with chronic mental illness might correspond to abnormal expression of serum proteins. In this study, we focused on five proteins previously identified as potentially aggregating proteins in the brains of patients with mental illness. A total of 150 subjects, 50 subjects with schizophrenia, 50 subjects with major depressive disorder, and 50 healthy controls were enrolled in the study. All subjects were informed of the planned testing method prior to their voluntary consent. Blood samples were collected at the Rijeka Clinical Hospital Centre and subsequently analysed as part of a doctoral thesis at the Department of Biotechnology, University of Rijeka. A new protocol for blood serum was therefore developed, adapted from previously published protocols performed on cells and brain samples. The insoluble protein fraction is purified from each serum sample of the blood. Western blotting was used to determine the presence of the above five proteins. In this study, DISC1, CRMP1, and NPAS3 were not detectable in the insoluble fraction of the blood serum of the studied individuals. TRIOBP-1, TRIOBP-5/6, and dysbindin-1 were detected in a subset of samples, indicating possible abnormal proteostasis in the blood manifested as aggregate formation. Dysbindin-1 was detected in two schizophrenia patients, but neither in a control sample nor in patients with major depressive disorder, whereas the detected TRIOBP isomers were not specific for either mental illness diagnosis. Surprisingly, high NPAS3 concentrations were detected in whole blood serum. Higher than average NPAS3 levels was shown to correlate significantly with a diagnosis of schizophrenia. These patients also had a higher proportion of first-degree relatives with other mental illnesses. Considering all patient samples of those who had proteostasis disorder, 11 patients who had one or more of these pathologies (NPAS3, dysbindin-1, TRIOBP-1, and/or TRIOBP-5/6) showed a slight but significant increase in PANSS total score (p = 0.031), primarily due to higher scores on the general psychopathology scale. Other proteins have also been detected by mass spectrometry in insoluble fractions of blood serum, such as vinculin, ANKRD proteins, including POTEF and PDE4IP in individuals diagnosed with major depressive disorder. In summary, most of the proteins that accumulate in the brains of patients with severe mental disorders are not clearly detectable and do not clearly correspond to a particular diagnosis. Two interesting exceptions are dysbindin-1 and NPAS3, which may be associated with schizophrenia and deserve further investigation. Mass spectrometry revealed additional proteins that may form protein aggregates in the blood, particularly in patients with major depressive disorder, and that have not previously been studied in the brain. Despite a limited number of patients, this study provides preliminary evidence that the severity of schizophrenia symptoms may be associated with impaired protein proteostasis that accumulates in the brain of patients with schizophrenia. These findings warrant further studies with larger groups or specific subject populations to confirm the role of abnormal proteostasis in serum blood in patients with chronic mental disorders. Keywords: blood serum, protein aggregates; schizophrenia; major depressive disorder. Psihičke bolesti imaju kompliciranu genetsku osnovu i vrlo je teško objasniti njihovu biologiju koristeći samo genetički pristup. U suradnji s međunarodnim partnerima započeli smo razvijati komplementarnu strategiju usmjerenu na proteine središnjeg živčanog sustava. Ovaj pristup temelji se na činjenici da se kod kroničnih neurodegenerativnih bolesti kao što su Alzheimerova, Parkinsonova i Huntingtonova bolest patologija očituje detekcijom netopljivih proteinskih agregata u mozgu. Na temelju uočene abnormalne homeostaze proteina u postmitotskim neuronima u ovih bolesnika, povukli smo paralelu i pretpostavili da se proteini mogu slično akumulirati u obliku manjih agregata i pojaviti se u kroničnoj mentalnoj bolesti. Početna ispitivanja pokazala su da su takvi proteini prisutni u mozgu bolesnika, ali njihova praktična dijagnostička vrijednost je ograničena. Dosad istraživani proteini su: DISC1, TRIOBP, NPAS3, CRMP1 i dysbinidin-1. Dakle, pretpostavili smo da abnormalna proteostaza uočena u mozgu bolesnika s kroničnom mentalnim bolestima može korelirati s abnormalnom ekspresijom serumskih proteina. U ovom smo se istraživanju usredotočili na pet proteina koji su prethodno identificirani kao potencijalno agregirajući proteini u mozgu bolesnika s mentalnom bolešću. U ispitivanje je uključeno ukupno 150 ispitanika, 50 ispitanika sa shizofrenijom, 50 ispitanika s velikim depresivnim poremećajem i 50 zdravih pojedinaca. Svi su ispitanici obaviješteni o planiranoj ispitnoj metodi prije potpisivanja dobrovoljnog pristanka. Uzorci krvi prikupljeni su u Kliničko bolničkom centru Rijeka, a potom su analizirani u sklopu doktorskog rada na Odjel za biotehnologiju Sveučilišta u Rijeci. Primarno je utvrđen novi protokol za purifikaciju krvnog seruma, baziran na prethodno objavljenim protokolima na staničnim linijama i uzorcima mozga. Netopljiva proteinska frakcija pročišćena je iz svakog serumskog uzorka. Western blotting je korišten za određivanje prisutnosti gore navedenih pet proteina. U ovom ispitivanju DISC1, CRMP1 i NPAS3 nisu bili vidljivi u netopljivoj frakciji krvnog seruma ispitivanih pojedinaca. TRIOBP-1, TRIOBP-5/6 i dysbindin-1 otkriveni su u podskupini uzoraka, što ukazuje na moguću abnormalnu proteostazu u krvi koja se očituje kao stvaranje agregata. Diybindin-1 otkriven je u dva bolesnika sa shizofrenijom, ali ni u jednom kontrolnom uzorku niti u bolesnika s velikim depresivnim poremećajem, dok otkriveni izomeri TRIOBP nisu bili specifični ni za jednu dijagnozu mentalne bolesti. Iznenađujuće, visoke koncentracije NPAS3 otkrivene su u serumu pune krvi. Pokazalo se da više razine NPAS3 značajno koreliraju s dijagnozom shizofrenije. Ovi bolesnici također su imali veći udio bliskih rođaka s drugim psihičkim bolestima. S obzirom na sve uzorke bolesnika, uzorci koji su imali poremećaj proteostaze, 11 bolesnika koji su imali jednu ili više ovih patologija (NPAS3, dysbindin-1, TRIOBP-1 i/ili TRIOBP-5/6) pokazalo je blago, ali značajno povećanje ukupnog PANSS rezultata (p = 0,031), prvenstveno zbog više ocjene na općoj psihopatološkoj skali. Drugi proteini također su detektirani masenom spektrometrijom u netopljivim frakcijama krvnog seruma, kao što su vinculin, ANKRDN proteini, uključujući POTEF i PDE4IP i to u osoba kojima je dijagnosticiran veliki depresivni poremećaj. Ukratko, većina proteina koji se akumuliraju u mozgu bolesnika s teškim mentalnim poremećajima nisu jasno detektirani i ne odgovaraju određenoj dijagnozi. Dvije zanimljive iznimke su dysbindin-1 i NPAS3, koji mogu biti povezani sa shizofrenijom i zaslužuju daljnja istraživanja. Masena spektrometrija otkrila je dodatne proteine koji mogu stvarati proteinske agregate u krvi, osobito u bolesnika s velikim depresivnim poremećajem, a koji nisu prethodno ispitivani u mozgu. Unatoč ograničenom broju bolesnika, ovo ispitivanje pruža preliminarne dokaze da ozbiljnost simptoma shizofrenije može biti povezana s oštećenom proteostatazom proteina koji se nakupljaju u mozgu bolesnika sa shizofrenijom. Ovi nalazi zahtijevaju daljnja ispitivanja s većim grupama ili specifičnim populacijama ispitanika kako bi se potvrdila uloga abnormalne proteostaze u krvnom serumu u bolesnika s kroničnim mentalnim poremećajima.

Kod pacijenata s PEP i shizofrenijom postoje oštećenja neurokognitivnog funkcioniranja. Međutim, postoje neusuglašenosti oko prevalencije i težine oštećenja specifičnih neurokognitivnih funkcija i domena te oko njihovih odnosa. Te nekonzistencije moguće je dijelom objasniti i heterogenošću ciljanih uzorka, odnosno postojanjem podskupina s različitim neurokognitivnim profilima i njihovim različitim povezanostima s drugim parametrima poremećaja te ishodima liječenja. Stoga smo u ovom istraživanju provjerili hipotezu o heterogenosti uzorka pacijenata s PEP i shizofrenijom s obzirom na latentne neurokognitivne profile, istražili razlike PEP i shizofrenije te istražili povezanost tih profila s psihopatologijom i svakodnevnim funkcioniranjem. Potvrdili smo postojanje tri razmjerno homogena profila kod pacijenata s PEP i shizofrenijom. Pokazali smo da se oni strukturalno ne razlikuju, ali da postoji značajna statistička mogućnost pripadanju određenome profilu. Pokazali smo i povezanost psihopatologije, negativnih simptoma sa neurokognitivnim profilima u PEP. Zaključno, svrstavanje pacijenata sa PEP i shizofrenijom u određene profile na temelju kognitivnog funkcioniranja moglo bi biti od važnosti u određivanju fenotipa, specifičnih bioloških mehanizama u pozadini bolesti te određivanju individualiziranog terapijskog pristupa s ciljem boljeg ishoda liječenja., Patients with first episode psychosis (FEP) and schizophrenia have impaired neurocognitive functioning. However, there are inconsistencies about the prevalence and severity of impairment of specific neurocognitive functions and domains and relationships between this two groups. These inconsistencies can be partly explained by the heterogeneity of this populations, ie the existence of subgroups with different domains of neurocognitive functions and their different relationships with other parameters of the disorder and treatment outcomes. Therefore, in this study, we tested the hypothesis of heterogeneity of populations of patients with FEP and schizophrenia with respect to latent domain profiles of neurocognitive functions. We investigated the differences between FEP and schizophrenia, and investigated the association of these profiles with psychopathology and everyday functioning. We confirmed the existence of three relatively homogeneous profiles in patients with FEP and schizophrenia. We have shown that they do not differ structurally, but that there is a significant statistical possibility of belonging to a certain profile. We also showed the association of psychopathology, more precise negative symptoms with neurocognitive profiles in FEP. In conclusion, classifying patients with FEP and schizophrenia into specific profiles based on cognitive functioning could be important in determining phenotype, specific biological mechanisms underlying the disease, and tailoring an individualized therapeutic approach for better treatment outcome.

Pathogenic changes in γ-secretase activity, along with its response to different drugs, can be affected by changes in the saturation of γ-secretase with its substrate. We analyze the saturation of γ-secretase with its substrate using multiscale molecular dynamics studies. We found that an increase in the saturation of γ-secretase with its substrate could result in the parallel binding of different substrate molecules at the docking site and the active site. The C-terminal domain of the substrate bound at the docking site can interact with the most dynamic presenilin sites at the cytosolic end of the active site tunnel. Such interactions can inhibit the ongoing catalytic activity and increase the production of the longer, more hydrophobic, and more toxic Aβ proteins. Similar disruptions in dynamic presenilin structures can be observed with different drugs and disease-causing mutations. Both, C99-βCTF-APP substrate and its different Aβ products, can support the toxic aggregation. The aggregation depends on the substrate N-terminal domain. Thus, the C99-βCTF-APP substrate and β-secretase path can be more toxic than the C83-αCTF-APP substrate and α-secretase path. Nicastrin can control the toxic aggregation in the closed conformation. The binding of the C99-βCTF-APP substrate to γ-secretase can be controlled by substrate channeling between the nicastrin and β-secretase. We conclude that the presented two-substrate mechanism could explain the pathogenic changes in γ-secretase activity and Aβ metabolism in different sporadic and familial cases of Alzheimer’s disease. Future drug-development efforts should target different cellular mechanisms that regulate the optimal balance between γ-secretase activity and amyloid metabolism.

We investigated whether a functional insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) influenced antipsychotic treatment. At baseline, and after 8 weeks of treatment with various antipsychotic medications, we assessed patients’ Positive and Negative Syndrome Scale (PANSS) scores, PANSS factors, and metabolic syndrome-related parameters (fasting plasma lipid and glucose levels, and body mass index). A total of 186 antipsychotic-naïve first-episode psychosis patients or nonadherent chronic psychosis individuals (99 males and 87 females) were genotyped by polymerase chain reaction analysis. The ACE-I/D polymorphism was significantly associated with changes in PANSS psychopathology only (p < 0.05). Compared to ACE-II homozygous males, ACE-DD homozygous and ACE-ID heterozygous males manifested significantly greater decreases in PANSS positive score, PANSS excitement factor, and PANSS cognitive factor. ACE-DD homozygous females manifested higher decreases in PANSS depression factor compared to ACE-II homozygous and ACE-ID heterozygous females. The polymorphism’s effect size was estimated as moderate to strong, while its contribution to the PANSS psychopathology ranged from ~5.4–8.7%, with the lowest contribution observed for PANSS positive score changes and the highest for PANSS depressive factor changes. Our results indicated that ACE-I/D polymorphism had a statistically significant but weak gender-specific impact on psychopathology data and showed no association between ACE-I/D polymorphism and metabolic syndrome-related parameters.

Depresija je bolest karakterizirana promjenama u raspoloženju, poput dugotrajne tuge i nesposobnosti uživanja u stvarima i aktivnostima koje su pojedincu do tada bile izvor sreće i zadovoljstva. Uz osnovne simptome još se pojavljuju i simptomi poput promjene apetita, nesanice, nemira, nemogućnost koncentracije, problemi s pamćenjem, osjećaj krivnje i bezvrijednosti, manjak energije. Bolest utječe na obavljanje svakodnevnih, najvažnijih aktivnosti jer narušava mogućnost normalnog funkcioniranja pacijenta. Također, depresija dovodi do razaranja obiteljskih, prijateljskih i poslovnih odnosa. Ukoliko depresija potraje duže vrijeme bez provedenog adekvatnog liječenja kod oboljele osobe dolazi do pojave suicidalnih misli i pokušaja samoubojstava kod pojedinih osoba. Depresija je veliki javnozdravstveni problem jer je u posljednje vrijeme broj oboljelih sve veći i stope smrtnosti su u porastu zbog pojave drugih tjelesnih bolesti i počinjenja samoubojstva. Važno je potražiti pomoć stručnjaka prilikom pojave prvih simptoma koji upućuju na depresiju zbog što ranijeg postavljanja dijagnoze i provođenja sigurnog i učinkovitog liječenja koje će biti prilagođeno svakom pojedincu. Istraživanje je provedeno sa ciljem provjere znanja studenata sestrinstva o depresiji i saznati koliki je rizik za razvoj depresije u njihovoj populaciji. U anketi su sudjelovala 102 studenta sestrinstva od prve do treće godine. 73 (71,6%) sudionika istraživanja bila su ženskog spola, a ostalih 29 (28,4%) muškog spola. Najviše sudionika bilo je iz treće godine sestrinstva, njih 44%. Velika većina sudionika nije zaposlena u struci. Analizom dobivenih podataka možemo zaključiti kako studenti sestrinstva nemaju negativne stavove ili stereotipe o oboljelima od depresije. 30% sudionika istraživanja je u trenutku ispunjavanja ankete osjećala prisutnost simptoma depresije. Dobiveni podaci pokazuju visoku stopu pojave simptoma depresije kod mladih ljudi, u ovom slučaju studenata sestrinstva. Kod većine sudionika do pojave simptoma depresije došlo je upravo prilikom studiranja zbog svakodnevne izloženosti visokim razinama stresa. Zbog neadekvatnih načina suočavanja sa stresom pojedini sudionici istraživanja često se osjećaju bezvrijedno i iskazuju nezadovoljstvo svojim životom te smatraju da su ostali ljudi zadovoljniji od njih. Na temelju brojnih provedenih istraživanja zaključuje se da je depresija bolest koja je sve više prisutna i razvoju bolesti jednako su skloni svi ljudi, neovisno o spolu, dobi i stupnju obrazovanja. Depresija je postala veliki javnozdravstveni problem i potrebno je provoditi edukaciju već od najranije dobi kako bi se prevenirao nastanak bolesti u kasnijoj životnoj dobi. Depression is a disease characterized by changes in mood, such as prolonged sadness and the inability to enjoy things and activities that were previously a source of happiness and satisfaction for the individual. In addition to the basic symptoms, symptoms such as changes in appetite, insomnia, restlessness, inability to concentrate, memory problems, feelings of guilt and worthlessness, lack of energy also appear. The disease affects the performance of everyday, most important activities because it impairs the patient's ability to function normally. Also, depression leads to the destruction of family, friendship and business relationships. If depression lasts for a long time without adequate treatment, suicidal thoughts and suicide attempts occur in some individuals. Depression is a major public health problem because recently the number of patients is increasing and the death rate is increasing due to the appearance of other physical diseases and suicide. It is important to seek the help of a specialist when the first symptoms suggestive of depression appear, in order to establish a diagnosis as early as possible and implement a safe and effective treatment that will be adapted to each individual. The research was conducted with the aim of checking the knowledge of nursing students about depression and finding out the risk of developing depression in their population. 102 nursing students from the first to the third year participated in the survey. 73 (71.6%) research participants were female, and the other 29 (28.4%) were male. Most of the participants were from the third year of nursing, 44% of them. The vast majority of participants are not employed in the profession. By analyzing the obtained data, we can conclude that nursing students do not have negative attitudes or stereotypes about depression patients. 30% of the research participants felt the presence of symptoms of depression at the time of filling out the survey. The obtained data show a high rate of depression symptoms in young people, in this case nursing students. In the case of most of the participants, the symptoms of depression occurred during their studies due to daily exposure to high levels of stress. Due to inadequate ways of coping with stress, some research participants often feel worthless and express dissatisfaction with their lives and think that other people are more satisfied than them. Based on numerous researches, it is concluded that depression is a disease that is increasingly present and that all people are equally prone to the development of the disease, regardless of gender, age and level of education. Depression has become a major public health problem and it is necessary to carry out education from an early age in order to prevent the onset of the disease in later life.

Poremećaji prehrane su skupina poremećaja koje karakterizira ozbiljno i trajno odstupanje povezano s hranjenjem i tjelesnom težinom. Njihova incidencija je zadnja dva desetljeća u porastu. Uvriježeno je mišljenje da su životni izbor, a ne bolest. Radi toga često ostaju neprepoznati i liječe se kada se bolest u potpunosti razvije. Najučestaliji poremećaji prehrane su anoreksija nervoza, bulimija nervoza i poremećaj prejedanja. Karakterizira ih restrikcija unosa hrane, preskakanje obroka, uporaba laksativa i diuretika, povraćanje te brojna druga kompenzatorna ponašanja. Dovode do brojnih medicinskih komplikacija, najčešće zbog kasnog postavljanja dijagnoze. Liječenje bi trebalo biti individualno te uključivati psihoterapiju te farmakoterapiju ukoliko je potrebna., Eating disorders are a group of disorders characterized by severe and persistent deviations related to eating and body weight. Their incidence has been increasing for the last two decades. It is widely believed that they are a lifestyle choice, not a disease. Because of this, they often go unrecognized and are treated when the disease is fully developed. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder. They are characterized by restriction of food intake, skipping meals, use of laxatives and diuretics, vomiting and numerous other compensatory behaviours. They lead to many medical complications, most often due to late diagnosis. Treatment should be individual and include psychotherapy and pharmackotherapy if necessary.

Cilj istraživanja: Cilj ovog istraživanja je ispitati zastupljenost simptoma sindroma sagorijevanja u medicinskih sestara i tehničara te utvrditi povezanost s duljinom izravne izloženosti radu s pacijentima oboljelima od bolesti COVID-19 i psihološkom fleksibilnosti. Utvrditi postoji li povezanost sindroma sagorijevanja i psihološke fleksibilnosti sa spolom, obrazovanjem, dobi i duljinom radnog staža. Ispitanici i postupci: Istraživanje se provelo na uzorku od oko 211 medicinskih sestara i tehničara zdravstvenih ustanova diljem Republike Hrvatske pri čemu su se upitnici ispunjavali putem elektronske verzije. Korišten je demografski upitnik i upitnik o radu s COVID-19 pacijentima te dva standardizirana upitnika: Upitnik intenziteta sagorijevanja na poslu i Upitnik prihvaćanja i akcije (AAQ-II). Statistička analiza je učinjena u programu IBM SPSS Statistics 20. Rezultati: Prosječni rezultat naših 211 ispitanika na Upitniku sagorijevanja iznosio je 27,25 što znači da u prosjeku imaju početne simptome sagorijevanja na poslu. Rezultat na Upitniku sagorijevanja se nije statistički značajno razlikovao između osoba koje su bile raspoređene za rad na COVID-19 odjelu i onih koji to nisu te nije ovisio o duljini rada na odjelu. Rezultati na Upitniku prihvaćanja i akcije (AAQ-II) pozitivno koreliraju s ukupnim rezultatom na Upitniku sagorijevanja, tj. medicinske sestre i tehničari koji imaju veću psihološku fleksibilnost imaju nižu razinu sindroma sagorijevanja. Stupanj stresa na odjelu s COVID-19 bolesnicima pozitivno korelira s ukupnim rezultatom na Upitniku sagorijevanja i na Upitniku prihvaćanja i akcije (AAQ-II). Osobe koje su stupanj stresa proglasile višim imale su i više sagorijevanja na poslu te veću psihološku nefleksibilnost. Nismo dobili statistički značajne razlike između demografskih skupina (spol, obrazovanje, dob, duljina radnog staža) na Upitniku sagorijevanja i Upitniku akcije i prihvaćanja (AAQ-II). Zaključci: Dobiveno pokazuje kako su, neovisno o iskustvu i duljini rada s COVID-19 pacijentima, medicinske sestre i tehničari generalno u riziku za sagorijevanje na radnom mjestu i psihičke smetnje. Ove spoznaje ističu važnost brige za mentalno zdravlje zdravstvenih djelatnika kao vulnerabilne skupine za razvoj psihičkih smetnji te otvaraju prostor za razvoj pravovremenih preventivnih i intervencijskih aktivnosti s posebnim naglaskom na one koje za cilj imaju poboljšati psihološku fleksibilnost., Objectives: The aim of this research is to examine the prevalence of symptoms of burnout syndrome in nurses and to determine the relationship with the length of direct exposure to work with patients suffering from the disease COVID-19 and psychological flexibility. We also wanted to determine whether there is an association between burnout syndrome and psychological flexibility with gender, education, age and length of service. Subjects and Methods: The research was conducted on a sample of about 211 nurses of health institutions throughout the Republic of Croatia, where the questionnaires were filled out via the electronic version. A demographic questionnaire and a questionnaire on working with COVID-19 patients and two standardized questionnaires were used: the Burnout Intensity Questionnaire and the Acceptance and Action Questionnaire (AAQ-II). Statistical analysis was performed in the IBM SPSS Statistics 20 program. Results: The average score of our 211 respondents on the Burnout Questionnaire was 27.25, which means that in general they have initial symptoms of burnout at work. The result on the Burnout Questionnaire was not statistically significantly different between people who were assigned to work in the COVID-19 ward and those who were not, and it did not depend on the length of work in the ward. The results on the Acceptance and Action Questionnaire (AAQ-II) positively correlate with the total score on the Burnout Questionnaire, meaning nurses and technicians who have higher psychological flexibility have a lower level of burnout syndrome. The degree of stress in the ward with COVID-19 patients positively correlates with the total score on the Burnout Questionnaire and the Acceptance and Action Questionnaire (AAQ-II). People who declared the level of stress to be higher had more burnout at work and greater psychological inflexibility. We did not obtain statistically significant differences between demographic groups (gender, education, age, length of work experience) on the Burnout Questionnaire and the Action and Acceptance Questionnaire (AAQ-II). Conclusions: The findings show that, regardless of experience and length of work with COVID-19 patients, nurses are generally at risk for workplace burnout and psychological distress. These findings highlight the importance of caring for the mental health of health workers as a vulnerable group for the development of psychological disorders.

Poremećaji autističnog spektra skupina su neurorazvojnih poremećaja koji se javljaju u ranoj dobi, a glavne osobine su poremećaj socijalnih vještina, govora i komunikacije te ograničeni interesi i radnje. COVID-19 pandemija zahvaća većinu svjetske populacije, pa tako i djecu i mlade s poremećajima autističnog spektra i njihove obitelji. Tipični simptomi navedene dijagnoze dodatno im otežavaju suočavanje s pandemijom. Gubitak dnevne rutine, otežan pristup primarnoj zdravstvenoj zaštiti, zabrinuti i tjeskobni roditelj vežu se uz pogoršanje psihičkog zdravlja djece i veće probleme u ponašanju., Autism spectrum disorders are groups of neurodevelopmental disorders that occur at an early age and the main features are impaired social skills, speech and communication, and limited interests and actions. The COVID-19 pandemic affects the majority of the world's population, including children and young people with autism spectrum disorders and their families. The typical symptoms of this diagnosis make it even more difficult for them to cope with a pandemic. Loss of daily routine, difficult access to primary health care, and anxious parents are associated with deteriorating mental health of children and greater behavioral problems.

Raspravna sposobnost predstavlja sposobnost okrivljenika da shvati svrhu kaznenog postupka koji mu se stavlja na teret, razumije pojedine radnje u sudskom procesu i posljedice istih, sporazumijeva se s braniteljem i daje mu upute koje su potrebne u svrhu obrane. Raspravno je sposoban onaj ispitanik koji je psihički i fizički sposoban razumjeti optužbe protiv sebe, pratiti tijek kaznenog postupka i koristiti se svojim zakonskim pravima. Kako bi se ove prethodno spomenute stavke poštovale u kaznenom postupku, sudovi nerijetko traže pomoć vještaka koji svojim iskustvom i stručnim znanjem pomažu sudu u kvalificiranju medicinskih značajki koje utječu na raspravnu sposobnost ispitivane osobe. Prilikom svih vještačenja uvijek se utvrđuje činjenično stanje, a ne pravna pitanja Competency to stand trial is the ability of the defendant to understand the purpose of the criminal proceedings against him, to understand certain actions in the trial and their consequences, to communicate with the defense counsel and to give him the instructions necessary for the purpose of defense. A defendant is capable of a court hearing if he is mentally and physically capable of understanding the charges against him, following the course of the criminal proceedings, and exercising his legal rights. In order to respect these aforementioned items in criminal proceedings, courts often seek the assistance of experts who, with their experience and expertise, assist the court in qualifying medical features that affect the subject's ability to competency to stand trial. During all expert examinations, the factual situation is always determined, and not legal issues

Digitalna demencija je sintagma koja u međusobnu vezu dovodi niz simptoma i znakova koji upućuju na deficite u kognitivnim funkcijama sličnim onima u demenciji, a javljaju uslijed pretjeranog i neadekvatnog korištenja digitalnih tehnologija poput mobitela, tableta i računala itd. Cilj ovog rada je izložiti utjecaj digitalnih tehnologija i medija na kognitivni razvoj djece i mentalno zdravlje odraslih pregledom dostupne literature i provedenih istraživanja. Mnogobrojna dosadađnja istraživanja ukazuju na negativne promjene u vezi sa digitalnim tehnologijama koje se, za razliku od demencije, bilježe već u najranijoj životnoj dobi u smislu utjecaja na pažnju i proces učenja. U odrasloj dobi mogu biti uzrokom niza poremećaja kao što su negativan utjecaj na pažnju i pamćenje, emocionalna otupljenost i manjak empatije, socijalna izolacija, manjak sna i nemogućnost zadržavanja koncentracije. Psihijatrijska struka danas se susreće s novim oblicima neuropsihijatrijskih poremećaja svih uzrasta, a čiji kriteriji za dijagnostiku još nisu definirani u Međunarodnoj klasifikaciji bolesti (MKB-11) i Dijagnostičkom i statističkom priručniku za duševne poremećaje (DSM-V). Budući da su psihički poremećaji povezani sa digitalnim tehnologijama u porastu, dužnost je psihijatrije kao grane medicine senzibilizacija, pravovremeno prepoznavanje simptoma i pružanje adekvatne skrbi., Digital dementia is a phrase that brings together a number of symptoms and signs which indicate deficits in cognitive functions similar to those in dementia, and occur due to excessive and inadequate use of digital technologies such as mobile phones, tablets and computers, etc. The aim of this paper is to present the impact of digital technologies on children's cognitive development and mental health of adults by reviewing the available research literature. Numerous studies indicate negative changes associated with digital technologies that, unlike dementia, are registered from an early age in terms of negative impact on attention and the learning process. In adulthood, they can be the cause of a number of disorders such as a decline of attention and memory, emotional numbness and lack of empathy, social isolation, lack of sleep and inability to maintain concentration. Today, the psychiatric profession encounters new forms of neuropsychiatric disorders of all ages, and whose diagnostic criteria have not yet been defined in the International Classification of Diseases (ICD-11) and The Diagnostic and Statistical Manual of Mental Disorders (DSM-V). As mental disorders associated with digital technologies are on the rise, the duty of psychiatry, as a medical field, is to sensitize, recognize symptoms in a timely manner, and provide adequate care.

Psihotični poremećaji čine jednu od skupina duševnih poremećaja, a karakteriziraju ih smetnje ponašanja, mišljenja, osjećaja. Mogu biti prolazni ili trajni, a mogu ih osim neuralnih promjena uzrokovati traume mozga, uzimanje psihoaktivnih tvari, poremećaji raspoloženja i drugo. Pritom se ne smije zanemariti utjecaj okoline, genetika, utjecaj osoba, okolina odrastanja. Najčešći psihotični poremećaj je shizofrenija. Shizofrenija je poremećaj kod kojega osoba gubi vezu s realnošću te se javljaju sumanutosti i halucinacije. Najčešće vrste halucinacija su glasovi, od sumanutosti sumanutost proganjanja. Tijekom postavljanja dijagnoze važno je postojanje i intenzitet pozitivnih i negativnih simptoma. Shizofreni bolesnici teško funkcioniraju u svakodnevnom životu, najčešće su nezaposleni, što ima utjecaj na njihove bližnje te su skloni samoozlijeđivanju. Stoga je bitno što ranije prepoznati bolest, kako od strane oboljele osobe, njihovih bližnjih te liječnika kako bi se pravovremeno krenulo s odgovarajućom terapijom. Temelj liječenja shizofrenije je primarno farmakoterapija (antipsihotici), no ne smije izostati psihosocijalno liječenje (obiteljska, skupna, bihevioralna, individualna terapija)., Psychotic disorders make up one of the groups of mental disorders and they are characterized by disorders of behavior, thinking, feelings. They can be transient or permanent, and in addition to neural changes, they can be caused by brain trauma, taking psychoactive substances, mood disorders and more. The influence of the environment, genetics, the influence of people, the environment of growing up must not be neglected. The most common psychotic disorder is schizophrenia. Schizophrenia is a disorder in which a person loses touch with reality and insanity and hallucinations occur. The most common types of hallucinations are voices, and insanity is the insanity of persecution. The existence and intensity of positive and negative symptoms are important during diagnosis. Schizophrenic person finds it difficult to function in everyday life, they are most often unemployed, which has an impact on their loved ones and they are prone to self-harm. Therefore, it is important to recognize the disease as early as possible, both on the part of the sick person, their family/relatives and the doctor in order to start the appropriate therapy in a timely manner. The basis of schizophrenia treatment is primarily pharmacotherapy (antipsychotics), but psychosocial treatment must not be absent.

Postupak za prisilne hospitalizacije propisan je ZZODS-om i namijenjen osobama s težim duševnim smetnjama koje predstavljaju rizik za sebe ili okolinu. Povećan rizik za prisilnu hospitalizaciju prema mnogobrojnim studijama imaju pacijenti s kroničnim mentalnim poremećajima kao što je shizofrenija i druge psihoze. Cilj ovoga rada bio je uočiti utjecaj pandemije COVID-19 na prisilne hospitalizacije, a time i na mentalno zdravlje u populaciji. Brojne studije su promatrale utjecaj socijalne izolacije i straha oko vlastite sigurnosti tijekom pandemije na mentalno zdravlje, čime su zaključili da osim što na različite načine negativno utječe na mentalno zdravlje žena, muškaraca, djece, mladih i kronično bolesnih, da osobito snažan utjecaj ima na pacijente s psihijatrijskim poremećajima. Ovo istraživanje obuhvaća 201 pacijenata prisilno hospitaliziranih na Klinici za psihijatriju KBC-a Rijeka u razdoblju od 2018. do 2021. godine. Pacijenti su podijeljeni u dvije veće skupine prema datumu hospitalizacije (prije covid pandemije ili tijekom covid pandemije) te uspoređivani na temelju spola, dobi, dijagnostičkih kategorija, broja prethodnih hospitalizacija na Klinici za psihijatriju, duljine boravka, i mjesta otpusta (kući ili u psihijatrijsku bolnicu). Također, analizirala se razlika u broju pacijenata prije i tijekom covid pandemije, kao i razdoblje „lockdown-a“ u RH. Rezultati istraživanja ukazuju na porast dijagnoza poremećaja raspoloženja i perzistentnih sumanutih stanja, a pad dijagnoza poremećaja ličnosti tijekom pandemije. U usporedbi s razdobljem prije pandemije, za vrijeme njezinog trajanja ukupno je hospitaliziran manji broj pacijenata, povećava se udio pacijenata ženskog spola, te je veći broj otpusta kući, a manji u PB Lopača. „Lockdown“ je karakteriziran padom broja prisilnih hospitalizacija., The procedure for involuntary hospitalizations is prescribed by the ZZODS and is intended for people with severe mental disorders that pose a risk to themselves or other people. According to numerous studies, patients with chronic mental disorders such as schizophrenia and other psychoses have an increased risk of involuntary hospitalization. The aim of this study was to observe the impact of the COVID-19 pandemic on involuntary hospitalizations and thus on mental health of the population. Numerous studies have analyzed the impact of social isolation during the pandemic on mental health, concluding that in addition to negatively affecting the mental health of women, men, children, young people and the chronically ill, it has a particularly strong impact on patients with psychiatric disorders. The research includes 201 patients involuntarily hospitalized at the Psychiatric Clinic of the University Hospital Centre Rijeka in the period from 2018 to 2021. Patients were divided into two larger groups according to the date of hospitalization (before the covid pandemic or during the covid pandemic) and compared based on gender, age, diagnostic categories, number of previous hospitalizations at the Psychiatric Clinic, length of stay, and place of discharge. Also, the difference in the number of patients before and during the covid pandemic was analyzed, as well as the period of lockdown in the Republic of Croatia. The results of the study indicate an increase in diagnoses of mood disorders and delusional disorders, and a decrease in diagnoses of personality disorders during the pandemic. Compared to the period before the pandemic, a smaller number of patients were hospitalized during its duration, the share of female patients increased, as well as the number of discharges home, while the number of discharges in Psychiatric hospital Lopača decreased. The lockdown period is characterized by a decline in the number of involuntary hospitalizations.

Aim To compare the severity of posttraumatic stress disorder (PTSD) symptoms and of particular PTSD clusters among help-seeking veterans before and during the COVID-19 lockdown. The second aim was to identify the main coping strategies used. Methods Male war veterans (N = 176) receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (12-18 months before the pandemic declaration in March 2020) and during the COVID-19 pandemic lockdown (March-June 2020). The Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, and The Brief COPE were used. Results Direct exposure to the virus in our sample was low, and the majority of participants followed the preventive measures. The severity of the overall PTSD symptoms and of clusters of symptoms significantly decreased compared with the first assessment. At the second assessment, all participants still fulfilled the PTSD diagnosis criteria. During the lockdown, the participants used emotion-focused and problem-focused coping rather than dysfunctional coping. Conclusion The severity of PTSD symptoms decreased during the lockdown. Further research is needed to study the trajectories of long-term psychopathology. © 2021 Medicinska Naklada Zagreb. All rights reserved.

Background and Objectives: Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background. Design: Cross-sectional study. Methods: LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist. Results: Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R 2 =.24; F2,3823 = 619.01; p

Cilj: Prikazati slučaj trudnice oboljele od bipolarnog afektivnog poremećaja (BAP) te terapijske izazove u njezinu liječenju. Prikaz slučaja: Trudnica u dobi od 35 godina hospitalizirana je na Klinici za psihijatriju zbog psihotične dekompenzacije od ranije dijagnosticiranog BAP-a. Pacijentica se u više navrata bolnički liječila zbog BAP-a. Prvi put je bila hospitalizirana u 25. godini života. Od tada je, unatoč redovitim kontrolama i medikaciji, došlo do nekoliko pogoršanja psihičkog stanja i to u vidu maničnih epizoda. U 35. godini života kod pacijentice je ustanovljena trudnoća te se ambulantno korigirala prethodno preporučena terapija. Ukinuo se litij i uveo se natrijev valproat. Nakon četiri tjedna pacijentica je hospitalizirana radi manične epizode s psihotičnim elementima. Hospitalno se terapija korigirala u skladu sa svjetskim iskustvima u liječenju BAP-a tijekom trudnoće. Tako se tijekom hospitalizacije kod ove pacijentice doza natrijeva valproata reducirala, a u terapiju se uveo antipsihotik kvetiapin, čija se doza titrirala do ukidanja simptoma bolesti. Pacijentica je na termin, carskim rezom, rodila zdravu djevojčicu. Do danas više nije bila hospitalno liječena, a podaci pedijatra ukazuju na uredan psihofizički razvoj djevojčice. Zaključak: Duševna bolest i njeno liječenje prije i/ili tijekom trudnoće predstavljaju rizične faktore za majku i za novorođenče. Stoga pojačani nadzor ovog tipa rizične trudnoće te propisivanje adekvatne psihofarmakoterapije s najmanjim mogućim posljedicama za majku i dijete predstavlja poseban izazov, ali i dužnost liječnika., Aim: To report a case of a pregnant woman with bipolar affective disorder (BAD) and therapeutic challenges in her treatment. Case report: A 35-year-old pregnant woman was hospitalized at the psychiatric clinic due to psychotic decompensation from a previously diagnosed BAD. The patient was hospitalized several times due to BAD. She was first hospitalized at the age of 25. Since than, despite regular check-ups and medication, there have been several deteriorations in mental health, mostly manic episodes. At the age of 35 the patient got pregnant and the previously recommended therapy was corrected. Lithium was abolished and sodium valproate was introduced. After four weeks, the patient was hospitalized due to manic episode with psychotic elements. The therapy was adjusted in accordance with world experience in the treatment of BAD during pregnancy. During hospitalization the dose of sodium valproate was reduced and the antipsychotic quetiapine was introduced into the therapy. The dose of quetiapine was titrated until the symptoms of the disease disappeared. The patient gave birth to a healthy baby girl by C-section. So far she has not been hospitalized. The pediatrician`s data indicate normal psychophysical development of the girl. Conclusion: Mental illness before and during pregnancy is a risk factor both for the mother and her newborn. Therefore, careful monitoring of pregnancy, as well as prescribing adequate psychopharmacotherapy with the least possible consequences for the mother and her child is a special challenge, but also a doctor`s duty.

Background: The aim of this study was to examine post-traumatic stress disorder (PTSD) symptom levels and coping strategies during the COVID-19 pandemic among treatment-seeking veterans with pre-existing PTSD. Method: A cohort of 176 male treatment-seeking veterans with pre-existing PTSD during the first COVID-19 pandemic lockdown (T1) and 132 participants from the same cohort one year after the onset of the pandemic (T2) participated in a longitudinal study. All participants responded to a COVID-19-related questionnaire and the following measures: the Life Events Checklist for DSM-5 (LEC-5), PTSD Checklist for DSM-5 (PCL-5) and the Brief COPE. Results: The intensity of overall PTSD symptoms, avoidance symptoms and negative alterations in cognitions and mood was lower at T2. PTSD symptoms were not significantly correlated with SARS-CoV-2 potentially traumatic events (PTE) at T2. Veterans scored higher on emotion-focused and problem-focused coping than on dysfunctional coping. Conclusions: Veterans with pre-existing PTSD who were receiving long-term treatment coped with COVID-19 stressors without the effects of retraumatization and a consequent worsening of PTSD symptoms.

Objective The primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples. Methods The scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample. Results Main findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic. Discussion The COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre-existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues.

Objectives Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes. Methods This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families. Trial registration: ISRCTN 11913964

Background and objectives: Psychological and psychosocial interventions proved to be effective in treatment of depression. The main objective of this study is to examine the effects of psychosocial day care program on the quality of life and clinical symptoms of persons with depression. Methods: In a controlled trial, 114 participants aged 20 or older with ICD-10 major depression were recruited after they being discharged from in- patient treatment. The intervention group (n = 59) received a 4-month group psychosocial program consisting of psychoeducation, social skills training and therapeutic community, and the control group (n = 55) received the usual care. Participants were assessed three times: at baseline, at the end-of-treatment and at 6- months follow-up. The outcome measures were the Montgomery- Åsberg Depression Rating Scale and Manchester Short Assessment of Quality of Life. Results: The intervention group had significantly larger symptom reduction compared to control group (F (1, 98) = 15.11, p < 0.01), at both second assessment (−8.31 ± 0.78, p < 0.01) and third assessment (−10.7 ± 0.69, p < 0.01). Both groups showed significant reduction in depressive symptoms over study time (F (1.53, 150.28) = 228.01, p < 0.01). The psychosocial intervention program had no statistically significant effect on subjective quality of life. Conclusion: The psychosocial intervention program led to significant reduction of depressive symptoms but had no effect on patients’ subjective quality of life.

Pandemija koronavirusne bolesti 2019. (COVID-19) u značajnom je obimu onemogućila provođenje uobičajenih edukacijskih aktivnosti što je, izmedu ostalog, rezultiralo i primjenom novih modela učenja. Međutim, promjene koje su uslijedile često su implementirane bez detaljne prethodne analize i temeljitog, sustavnog planiranja njihovog provođenja. Ovaj kratki pregled literature ima za cilj identificirati neke od glavnih pedagoških izazova u edukaciji specijalizanata psihijatrije tijekom aktualne pandemije. Rezultati ovog preglednog članka mogu pomoći pri razvoju dodatnih pedagoških tehnika i inovativnih alata za korištenje u budućim obrazovnim aktivnostima te pridonijeti planiranju organizacije specijalističkog obrazovanja iz psihijatrije., The coronavirus disease 2019 (COVID-19) pandemic has challenged and almost completely disrupted the previous teaching system, based mainly on teachers’ and learners’ physical presence. This impact has forced educators to identify alternative learning models and begin utilizing new approaches, often without detailed analysis or thorough, systematic planning. The current literature review aims to reveal some of the greatest pedagogical challenges in remotely teaching psychiatry residents during the pandemic. This mini-review’s results may help in developing additional pedagogical techniques and key applications for educational activities to teach psychiatry residents, as well as to suggest directions for future psychiatry resident education.

There is a small body of research about mental and physical comorbidity in post-traumatic stress disorder (PTSD) patients despite the fact that some psychiatric disorders and physical conditions are commonly comorbid with PTSD. In this study, we researched the relationship between PTSD and its mental and physical comorbidities by comparing the number of patient hospitalizations across two ten-year periods. Our sample consisted of 2761 patients with warfare PTSD hospitalized during the 20-year period (1999-2018). The results confirmed a higher number of hospitalizations in the 2009-2018 period than in the 1999-2008 period for the group of PTSD patients with both mental and physical comorbidity. Furthermore, no significant difference was found in the number of hospitalizations between the two ten-year periods for the group of PTSD patients with mental comorbidity. We argued that both mental and physical comorbidities along with PTSD are needed to induce a significantly higher level of distress in patients, resulting in a higher number of hospitalizations after a longer period of time. Patients with the most severe conditions and comorbidity have a greater need to seek help from mental health professionals as their mental and physical state deteriorates to a higher degree when not in the treatment of any kind., Postoji relativno manji broj istraživanja o mentalnim i tjelesnim subolestima kod bolesnika s posttraumatskim stresnim poremećajem (PTSP) unatoč činjenici da su određeni psihijatrijski poremećaji i tjelesna stanja učestali komorbiditeti PTSP-a. U ovom istraživanju ispitan je odnos između PTSP-a i njegovih mentalnih i fizičkih subolesti usporedbom broja hospitalizacija bolesnika u dva desetogodišnja razdoblja. Uzorak je činio 2761 bolesnik s ratnim PTSP-om koji su bili hospitalizirani tijekom 20-godišnjeg razdoblja (1999.-2018.). Rezultati su potvrdili statistički značajno veći broj hospitalizacija u razdoblju 2009.-2018. nego u razdoblju 1999.-2008. kod skupine bolesnika koji boluju od PTSP-a istodobno s mentalnim i tjelesnim subolestima. Nadalje, nije nađena značajna razlika u broju hospitalizacija između dva desetogodišnja razdoblja za skupinu bolesnika s PTSP-om i mentalnim subolestima. Moguće je objašnjenje da su i psihičke i tjelesne subolesti s PTSPom potrebne za stvaranje značajno veće razine tegoba kod bolesnika, što rezultira većim brojem hospitalizacija nakon duljeg razdoblja. Također, moguće je da bolesnici s najtežim stanjima i subolestima imaju veću potrebu tražiti pomoć stručnjaka za mentalno zdravlje, jer se njihovo mentalno i tjelesno stanje u većoj mjeri stalno pogoršava kada ne primaju neki oblik liječenja.

Granični poremećaj ličnosti spada u skupinu B poremećaja ličnosti. To je najčešći poremećaj ličnosti, a karakteriziran je emocionalnom nestabilnošću, odnosno nemogućnošću regulacije afekta, poremećenim obrascima mišljenja i ponašanja, impulzivnim ponašanjima, te intenzivnim ali nestabilnim odnosima sa drugima. Granični poremećaj ličnosti nerijetko je povezan s različitim komorbidnim psihijatrijskim entitetima, koji su često glavni otežavajući faktor u terapiji graničnog poremećaja ličnosti. Najčešća komorbidna stanja koja se susreću u bolesnika s graničnim poremećajem ličnosti su poremećaji raspoloženja, od kojih je najčešća depresija, zatim anksiozni poremećaji, bolesti ovisnosti, te psihotični poremećaji., Borderline personality disorder is one of the personality disorders from cluster B. It is the most common personality disorder, and is characterized by emotional instability, inability to regulate affect, disturbed patterns of thinking and behavior, impulsive behavior, and intense but unstable relationships with others. Borderline personality disorder is often associated with various comorbid psychiatric entities, which are often the main problem when treating borderline personality disorder. The most common comorbid conditions that can be seen in patients with borderline personality disorder are mood disorders, mostly depression, followed by anxiety disorders and addiction.

Ovaj rad refleksija je na tekst pod naslovom „Psychosis Neurosis“. Ovaj tekst je svom terapeutu, u vidu e-pošte napisao, za mene anoniman pacijent. Čitajući spomenuti tekst asocijacije su me vodile u smjeru patologije selfa, odnosno zastoja u razvoju zbog nezadovoljenih self-objekt potreba. Budući da, osim pacijentova teksta, nije bilo dostupnih drugih podataka o pacijentu, sa sigurnošću se ne može tvrditi, već samo pretpostavljati o pacijentu, njegovoj dijagnozi, uzrocima njegova stanja ili tijeka i ishoda terapije. Budući da me pacijentov tekst asocijativno vodio u područje self-psihologije, u ovom radu posvetila sam se zrcaljenju, pitanju narcizma i narcističnih poremećaja ličnosti, pitanju selfa, self-objekt potreba te terapijskim mogućnostima narcističnih poremećaja s posebnim osvrtom na inačice transfera i važnost empatije. Spomenuti su i psihijatrijski poremećaji koji često dolaze u komorbiditetu s narcističnim poremećajima., This paper is a commentary on the Psychosis Neurosis story written by a patient to his therapist in an email form. The clues in the text have led me towards the pathology of the self, i.e towards the developmental arrest due to the unsatisfied self-object needs. Since no additional information was available about the patient, save for the email, we can only speculate about the patient’s diagnosis, the causes of his state, and the course and outcome of his therapy sessions. Due to the fact of me being led, associatively, towards self-psychology, in this work I focused on mirroring, narcissism and narcissistic personality disorders, the self, self-object needs, and therapeutic options for narcissistic personality disorders with special attention paid to the versions of transfer and the importance of empathy. I also mentioned some psychiatric disorders that often appear in comorbidity with narcissistic disorders.

Background: To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine and non-benzodiazepine hypnotic adjuvant treatment as well as to first- generation antipsychotic add-on treatment. Subjects and methods: Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine, were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10 and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuro psychiatric Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the assessment period were used as efficacy measures. Results: All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one hour (p

Cilj: Osvijestiti mogućnost postojanja ekscitirajućeg delirantnog sindroma u psihotičnog pacijenta s povišenom tjelesnom temperaturom. Prikaz slučaja: Pacijent u dobi od 32 godine prisilno je hospitaliziran pet puta u posljednjih 11 godina na Klinici za psihijatriju KBC-a Rijeka. Unazad 14 godina u psihijatrijskom je tretmanu pod dijagnozom paranoidne shizofrenije, a ekscitirajući delirantni sindrom javio se tri godine od početka liječenja. U posljednje dvije prisilne hospitalizacije prezentirao se uz kliničku sliku psihotičnosti i poremećene svijesti (po opisu delirantnu), psihomotorne agitiranosti, nesuradljivosti, uz simptome autonomne hiperreaktivnosti (tahikardija, tahipneja, znojenje, povišenje krvnog tlaka) te zakočene muskulature. Osim toga, pacijent ima stalnu potrebu za razodijevanjem i izraženu privučenost ogledalima. Trećeg dana posljednje hospitalizacije razvila se povišena tjelesna temperatura koja se poklapa s primjenom veće doze antipsihotika. Najprije je postavljena sumnja na maligni neuroleptični sindrom i ukinuta je antipsihotična terapija, ali bez značajnijeg učinka na psihičko i tjelesno stanje. Dijagnostička obrada nije pokazala značajno povišenje razine kreatin fosfokinaza niti nalaz mioglobina u urinu. S obzirom na to, ponovno su primijenjeni antipsihotici u liječenju te postupno dolazi do poboljšanja i psihičkog i tjelesnog stanja bolesnika te se tada počinje sumnjati da se radi o jedinstvenom ekscitiranom delirantnom sindromu. Zaključak: Pojava vrućice u psihijatrijskih bolesnika dijagnostički je i terapijski izazovna. Rano razmatranje sindroma hipertermije povezanih s liječenjem od vitalne je važnosti. Dijagnostička dvojba između malignog neuroleptičkog sindroma i ekscitirajućeg delirantnog sindroma značajna je jer su uključeni različiti terapijski pristupi, a radi se o dvama potencijalno letalnim sindromima., Aim: To raise awareness about the existence of excitated delirium syndrome in a psychotic patient with fever. Case report: A 32-year-old patient was forcibly hospitalized five times in the last 11 years at the Clinic for Psychiatry at the University Hospital Center Rijeka. For the past 14 years, he has undergone sychiatric treatment with the diagnosis of paranoid schizophrenia, and the excitatory delirium syndrome occurred three years after the beginning of the treatment. In the last two involuntary hospitalizations, the patient was presented with a clinical picture of psychosis and impaired consciousness (delirious by description), psychomotor agitation, non-cooperation with symptoms of autonomic hyperreactivity (tachycardia, tachypnea, sweating, increased blood pressure) muscle rigidity. In addition, the patient had a constant need for undressing and a pronounced attraction to mirrors. On the third day of the last hospitalization, there was elevated body temperature which coincided with the administration of a higher dose of antipsychotics. Malignant neuroleptic syndrome was first suspected and antipsychotic therapy was discontinued, but without a significant effect on mental and physical condition. Diagnostic processing did not show a significant increase in creatine phosphokinase levels or the finding of myoglobin in the urine. Taking this into account, antipsychotics were reintroduced in the treatment, and the mental and physical condition of the patient gradually improved, and then a unique excited delirium syndrome was suspected. Conclusion: The occurrence of fever in psychiatric patients is diagnostically and therapeutically challenging. Early consideration of treatment-related hyperthermia syndromes is vital. The diagnostic dilemma between malignant neuroleptic syndrome and excitatory delirium syndrome is significant because different therapeutic approaches are involved, and these are two potentially lethal syndromes.

Ciljevi istraživanja su bili istražiti zadovoljstvo općom kvalitetom života i općim zdravljem, specifična područja kvalitete života (tjelesno i psihičko zdravlje, socijalni odnosi i okruženje) kod veterana s PTSP-om u odnosu na zdravu kontrolu te njihovu kvalitetu života u odnosu na psihijatrijske i tjelesne komorbiditete, težinu kliničke slike, sociodemografske karakteristike, neka ratna i poslijeratna iskustva. Istraživanjem je bilo obuhvaćeno 164 veterana s PTSP-om i komorbidnim psihijatrijskim i tjelesnim poremećajima i 213 zdravih ispitanika (75 % s ratnim iskustvom). Primijenjeni su strukturirani anamnestički upitnik, M.I.N.I, CAPS, HAMA, HAMD, PANSS, WHOQOLBREF. Tjelesne su bolesti dijagnosticirane MKB-10 klasifikacijom. Statistička analiza provedena je deskriptivnom statistikom, ANOVOM, t-test-om, Pearsonovim koeficijentom korelacije i višestrukom regresijskom analizom. Opća kvaliteta života i sva njezina područja oboljelih ratnih veterana bile su lošije u odnosu na zdravu kontrolu. Psihijatrijski komorbiditet imalo je 85 %, a tjelesni 71 % veterana. Prediktori su kvalitete života veterana bili dužina ratnog iskustva koja je predviđala bolju opću kvalitetu života, veći broj tjelesnih bolesti koji je predviđao lošiju procjenu tjelesnog zdravlja i niža osobna primanja te veći broj djece koji su predviđali lošije socijalne odnose. Niti jedno sociodemografsko obilježje, ratno i poslijeratno iskustvo veterana nije se pokazalo značajnim prediktorom za predviđanje zadovoljstva općom percepcijom zdravlja, psihičkim zdravljem i okruženjem. Pokazao se snažan negativan utjecaj samog PTSP-a sa psihijatrijskim komorbiditetom i bez psihijatrijskog komorbiditeta na kvalitetu života ratnih veterana koji se dodatno pojačava prisutnošću tjelesnog komorbiditeta., The study aimed to investigate overall Quality of Life (QoL) and satisfaction with health, as well as the specific QoL aspects (physical and mental health, social relationships, and environment) and QoL in relation to psychiatric and physical comorbidities, the severity of clinical picture, sociodemographic characteristics, particular war and post-war experiences in veterans with PTSD compared to healthy control. The study included 164 veterans with PTSD and comorbid psychiatric and physical disorders and 213 healthy subjects (75 % with war experience). The following instruments were applied: structured anamnestic questionnaire, M.I.N.I, CAPS, HAMA, HAMD, PANSS, WHOQOLBREF. The ICD-10 diagnostic manual was used for physical diseases, and descriptive statistics, ANOVA, t-test, Pearson correlation coefficient, and multiple regression analysis for statistical data analysis. Overall satisfaction with the QoL and health and all areas of QoL was worse in sick veterans than in healthy control. 85 % of veterans had psychiatric and 71 % physical comorbidity. Predictors of veterans' QoL were: length of war experience that predicted better overall QoL, a higher number of physical illnesses that predicted poorer physical health assessment. Furthermore, lower personal income and a higher number of children predicted poorer social relations. None of the veterans' socio-demographic characteristics and war and post-war experiences proved to significantly predict satisfaction with the general perception of health, mental health, and environment. A negative affect of PTSD on the QoL, regardless of the presence of psychiatric comorbidity, was significant in war veterans. Furthermore, it was intensified by physical comorbidity.

Repetitivna transkranijska magnetska stimulacija (rTMS) neinvazivna je tehnika stimulacije mozga koja je učinkovita u liječenju velikoga depresivnoga poremećaja (VDP-a). Prevalencija depresije veća je kod žena nego kod muškaraca. Razlike između spolova u farmakoterapijskom antidepresivnom učinku teško je generalizirati. Uočena je vjerojatna povezanost kratkotrajnih učinaka rTMS-a sa spolom, ali u većini studija učinak spola nije bio zasebno analiziran, pa nije bilo moguće donijeti konkluzivne zaključke. Cilj je ovog istraživanja ispitati spolne razlike u učinkovitosti terapije VDP-a rTMS-om upotrebom zavojnice oblika osmice. Proveli smo industrijski neovisnu, unicentričnu, randomiziranu, kontroliranu, jednostruko zaslijepljenu studiju od svibnja 2020. do listopada 2020. u Psihijatrijskoj bolnici "Sveti Ivan", Zagreb, Hrvatska. Pacijenti su randomizirani u dvije skupine: jednu liječenu rTMS-om sa zavojnicom oblika osmice i standardnom farmakoterapijom (47 pacijenata) i drugu liječenu samo standardnom farmakoterapijom (43 pacijenta). Koristili smo stratificiranu (za dob, spol i težinu depresije) blok randomizaciju sa slučajnom veličinom blokova od 4, 6 i 8 sudionica i sudionika. Primarni ishod bila je promjena na Hamiltonovoj ljestvici ocjene depresije-17 (HAM-D17) nakon četiri tjedna liječenja. Varijable čiji smo mogući zbunjujući učinak kontrolirali multivarijabilnom statističkom analizom bile su dob, dob početka VDP-a, dijagnoza, liječenje SIPPS-om, SIPPSN-om i ostalim antidepresivima. Nakon prilagodbe za planirane zbunjujuće varijable snižavanje rezultata HAM-D17 bilo je statistički značajno više u skupini liječenoj rTMS-om + standardnom farmakoterapijom nego u kontrolnoj skupini liječenoj samo standardnom farmakoterapijom. Kod žena je snižavanje rezultata HAM-D17 tijekom četiri tjedna liječenja bilo statistički značajno i klinički relevantno veće u pokusnoj skupini liječenoj rTMS-om i standardnom farmakoterapijom nego u kontrolnoj skupini liječenoj samo standardnom farmakoterapijom. Interakcija ispitivane skupine, dakle liječenje rTMS-om i standardnom farmakoterapijom ili samo standardnom farmakoterapijom i spola na promjenu rezultata HAM-D17 od uključivanja do nakon četiri tjedna liječenja nije bila statistički značajna nakon prilagodbe na varijable s mogućim zbunjujućim učinkom. Nije moguće prihvatljivo pouzdano tvrditi kako između muškaraca i žena postoje razlike u učinku rTMS-a pomoću zavojnice oblika osmice, ali rezultati ukazuju na potrebu za daljnjim istraživanjima. Introduction Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that is effective in treatment of major depressive disorder (MDD). The prevalence of depression is higher in women than in men. It has been observed that women respond better to selective serotonin reuptake inhibitors (SSRIs) than men, but not all studies confirm these findings, so it is difficult to generalize gender differences in pharmacotherapeutic antidepressant effect. A probable association of short-term antidepressant properties of rTMS with gender has been observed. Meta-analysis published in 2019. showed that rTMS MDD studies with higher proportion of women participants observed a higher response rates at 3rd and 6th months, but since the gender-related effects were not specifically analyzed it was not possible to draw conclusive conclusions. Men respond more strongly to placebo treatment but the placebo (sham) response to repetitive transcranial magnetic stimulation (rTMS) in MDD is not associated with gender. Objective To investigate gender differences in the efficacy of 8-coil rTMS on major depressive disorder (MDD). Methods We performed an industry-independent, unicentric, randomized, controlled, single-blinded study from May 2020 to October 2020 in Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia. Patients were randomized into two groups: one treated with 8-coil rTMS and standard pharmacotherapy (47 patients) and the other treated with the standard pharmacotherapy alone (43 patients). We used a stratified (for age, gender and depression severity), permuted blocks randomization with the randomized block sizes of 4, 6 and 8 participants. The primary outcome was Hamilton Depression Rating Scale-17 (HDRS). Variables whose possible confounding effect we controlled by multivariable statistical analysis were: age, diagnosis, duration of illness, treatment with selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other antidepressants. Results After the adjustment for all preplanned possible confounding variables, the lowering of HAMD17 score after 4-weeks treatment was statistically significantly different between patients treated with 8-coil rTMS + standard pharmacotherapy, and patients treated with standard pharmacotherapy alone. In women, the lowering of HAM-D17 score over four weeks of treatment was statistically significantly and clinically relevantly larger in the experimental group treated with rTMS and standard pharmacotherapy than in the control group treated with standard pharmacotherapy alone (F (1, 26) = 7.49; p = 0.011; ω2 = 0.08; false discovery rate; FDR

ACCEPTED ABSTRACT: Introduction: Studies consistently report that patients with schizophrenia exhibit qualitative abnormalities on language production tasks. These abnormalities are possibly associated with the severity of psychotic symptoms. Despite this, some studies have conflictingly suggested that patients with schizophrenia exhibit similar word frequency (WF) effects on lexical tasks compared to healthy subjects. Given that previous studies calculated WFs from language corpora, we aimed to investigate the relationship between WF and psychotic symptoms using a novel, simple method for calculating WF. Methods: Thirty-six patients with schizophrenia were included in the study. The severity of positive symptoms was measured using the Scale for the Assessment of Positive Symptoms (SAPS). One semantic and one letter fluency task were administered with the patients instructed to produce as many animal anmes and words beginning with the letter p in 60 s, respectively. Every response in the output was assigned (1) a corpus-based WF, extracted from the German-language lexical database dlexDB, and (2) a within-sample WF. The within-sample WF was calculated as the raw number of participants who produced the word. Spearman���s correlations were computed between the WF variables and symptoms. Results: Corpus-based WF exhibited skewed, kurtic, and/or non-normal distribution. Contrastingly, within-sample WF displayed normal, non-skewed, and non-kurtic distribution. There were no significant correlations between corpus-based WF and symptoms on both tasks. Conversely, within-sample WF on semantic fluency was significantly negatively and weakly correlated with the global SAPS score, as well as subscales measuring delusions and bizarre behavior. Further, within-sample WF on letter fluency was significantly positively and weakly correlated with the subscale measuring bizarre behavior of the SAPS scale. Conclusion: The differences in the data distribution patterns between corpus-based WF and within-sample WF indicate that different methodological frameworks may have better use of one or the other variable type. Further, significant correlations with positive symptoms were observed only for within-sample WF. It can be concluded that within-sample WF may be more appropriate for analyzing verbal fluency output in psychiatric research compared to corpus-based WF., Pre-recorded presentation video: https://doi.org/10.5281/zenodo.5619891 ........................................................................................................................................................................................................................... Preprint: https://doi.org/10.31234/osf.io/7tndz, {"references": ["Allen, H.A., Liddle, P.F., Frith, C.D., 1993. Negative features, retrieval processes and verbal fluency in schizophrenia. Br. J. 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Semantic memory deficits based on category fluency performance in schizophrenia: similar impairment patterns of semantic organization across Turkish and Japanese patients. Psychiatry Res. 167(1\u20132), 47\u201357. https://doi.org/10.1016/j.psychres.2007.12.009", "Sung, K., Gordon, B., Vannorsdall, T.D., Ledoux, K., Pickett, E.J., Pearlson, G.D., Schretlen, D.J., 2012. Semantic clustering of category fluency in schizophrenia examined with singular value decomposition. J. Int. Neuropsychol. Soc. 18, 565\u2013575. https://doi.org/10.1017/S1355617712000136", "Tan, E.J., Yelland, G.W., Rossell, S.L., 2016. Characterising receptive language processing in schizophrenia using word and sentence tasks. Cogn. Neuropsychiatry 21(1), 14\u201331. https://doi.org/10.1080/13546805.2015.1121866", "Tan, E.J., Wagner, G.A., Rossell, S.L., 2016. Examining lexical processing with two word tasks using the schizotypy analogue. 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Background: The Covid-19 pandemic is associated with adverse mental health outcomes for people worldwide. Objective: The study aimed to assess mental health during the Covid-19 pandemic and the key risk factors from the human ecology perspective in Croatia’s adult population. Method: An online panel survey with 1, 201 adult participants (50.1% women) was done with a nationally representative sample in terms of gender, age, and country region four months after the nation lockdown began and two months after most of the restrictions were lifted. Indicators of mental health included symptoms of adjustment disorder (ADNM-8) ; depression, anxiety, and stress (DASS-21) ; symptoms of post- traumatic stress disorder (PC-PTSD-5) ; and well-being (WHO-5). Results: In the entire sample, 9.8% (95% confidence interval [CI]: 7.9%, 14.0%) of the participants were at risk of adjustment disorder, 7.7% (95% CI: 6.7%, 11.9%) were at risk of depression disorder, and 7.8% (95% CI: 5.3%, 10.3%) were at risk of anxiety disorder. In addition, 7.2% (95% CI: 5.3%, 10.2%) were experiencing high levels of stress. The average well-being score was 56.5 (SD = 21.91) on a scale from 0 to 100. Among the participants who have lifetime traumatic experience (n = 429), 14% (95% CI: 10.6%, 17.2%) were at risk for PTSD. Key risk factors for specific mental health outcomes differed, but the common ones included: current health status, previous mental health diagnosis, and psychological resilience. Being younger, having a below-average income, and excessively following news about Covid-19 were predictive for some of the mental health problems. Conclusions: Together, the key risk factors identified in this study indicate the need for public health interventions addressing the general population’s mental health, but also for specific risk groups. Lower rates of mental health symptoms assessed soon after lifting quarantine measures that have been found in other studies may indicate human resilience capacity.

An emerging phenomenon in our understanding of the pathophysiology of mental illness is the idea that specific proteins may form insoluble aggregates in the brains of patients, in partial analogy to similar proteinopathies in neurodegenerative diseases. Several proteins have now been detected as forming such aggregates in the brains of patients, including DISC1, dysbindin-1 and TRIOBP-1. Recently, neuronal PAS domain protein 3 (NPAS3), a known genetic risk factor for schizophrenia, was implicated through a V304I point mutation in a family with major mental illness. Investigation of the mutation revealed that it may lead to aggregation of NPAS3. Here we investigated NPAS3 aggregation in insular cortex samples from 40 individuals, by purifying the insoluble fraction of these samples and testing them by Western blotting. Strikingly, full-length NPAS3 was found in the insoluble fraction of 70% of these samples, implying that aggregation is far more widely spread than can be accounted for by this rare mutation. We investigated the possible mechanism of aggregation further in neuroblastoma cells, finding that oxidative stress plays a larger role than the V304I mutation. Finally, we tested to see if NPAS3 aggregation could also be seen in blood serum, as a more accessible tissue than the human brain for future diagnosis. While no indication of NPAS3 aggregation was seen in the serum, soluble NPAS3 was detected, and was more prevalent in patients with schizophrenia than in those with major depressive disorder or controls. Aggregation of NPAS3 therefore appears to be a widespread and multifactorial phenomenon. Further research is now needed to determine whether it is specifically enhanced in schizophrenia or other mental illnesses.

Background The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder. Objective This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic. Methods Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression. Results The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions. Conclusions We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder., HIGHLIGHTS We examined symptoms of adjustment disorder in 15,563 adults during the COVID-19 pandemic.The prevalence of probable adjustment disorder was 18.2%.We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.

Socijalna fobija se definira kao perzistentni strah osobe da će je drugi ljudi pomno promatrati i negativno prosuđivati. Kao posljedica toga, osoba koja ima socijalnu fobiju izbjegava socijalne situacije kojih se boji ili ih doživljava sa intenzivnom anksioznosti. Kada je osoba prisiljena ući u fobičnu situaciju ili u nju uđe ne očekujući je, doživljava snažnu anksioznost sa pojavom različitih somatskih simptoma, kao što su crvenjenje, drhtanje ruku, mučnina, palpitacije, nagla potreba za mokrenjem i druge. Etiologija poremećaja je nepoznata, ali se smatra da u nastanku poremećaja postoji umjereni utjecaj genetskih čimbenika. Socijalna fobija najčešće započinje u ranoj adolescenciji i ima kroničan tijek koji dovodi do značajnih oštećenja u obrazovnom i radnom funkcioniranju, životnom ostvarenju te dovodi do osjećaja smanjene kvalitete života. Čest je komorbiditet sa drugim psihijatrijskim poremećajima. U liječenju se koriste psihoterapijski postupci i različiti lijekovi, od kojih su najznačajniji inhibitori ponovnog povrata serotonina i kognitivno-bihevioralna terapija. Social phobia is defined as a persistent fear of a person that other people will observe him or her closely and judge him or her negatively. As a result, a person who has a social phobia avoids social situations that he fears or experiences them with intense anxiety. When a person is forced to enter a phobic situation or enters it without expecting it, he experiences strong anxiety with the appearance of various somatic symptoms, such as redness, trembling hands, nausea, palpitations, sudden need to urinate and others. The etiology of the disorder is unknown, but it is believed that there is a moderate influence of genetic factors in the development of the disorder. Social phobia most often begins in early adolescence and has a chronic course that leads to significant impairment in educational and work functioning, life achievement, and leads to feelings of reduced quality of life. Comorbidity with other psychiatric disorders is common. Psychotherapeutic procedures and various medications are used in the treatment, the most important of which are serotonin reuptake inhibitors and cognitive behavioral therapy.

Cilj: Cilj ovog istraživanja bio je ispitati postoje li razlike između skupine bolesnika koji boluju od depresije i bolesti ovisnosti te skupine koja uz depresiju i bolest ovisnosti ima i druge psihijatrijske komorbiditete. Materijali i metode: Retrospektivno je analizirana medicinska dokumentacija pacijenata oboljelih od depresije i bolesti ovisnosti koji su liječeni na Klinici za psihijatriju Kliničkog bolničkog centra Split od 1. siječnja 2018. do 1. siječnja 2020. Prikupljeni su podatci za: spol, dob, broj hospitalizacija, heterodestruktivnost, autodestruktivnost, dob pri prvom kontaktu sa psihijatrom, trajanje konzumacije psihofarmaka, socioekonomski status te somatske i psihijatrijske komorbiditete. Rezultati: Istraživanje je obuhvatilo 47 bolesnika. 17 ih boluje od depresije i bolesti ovisnosti i oni čine kontrolnu skupinu, a 30 uz navedeno dvoje ima i druge psihijatrijske komorbiditete i oni čine testnu skupinu. U obje skupine najviše ima ispitanika muškog spola srednje životne dobi. Dokazan je značajno veći broj pokušaja samoubojstva u bolesnika kontrolne skupine gdje ih je 64,71 % pokušalo izvršiti samoubojstvo nego u testnoj skupini gdje je njih 26,67 % pokušalo izvršiti samoubojstvo. Nije utvrđena statistički značajna razlika između skupina u broju pokušaja samoubojstva s obzirom na bračni status. Postoji razlika u broju pokušaja samoubojstva s obzirom na radni status između skupina. Najveći broj pokušaja samoubojstva je utvrđen u nezaposlenih osoba kontrolne skupine, dok je najmanji broj pokušaja samoubojstva utvrđen u zaposlenih osoba testne skupine. Nije utvrđena statistički značajna razlika u broju hospitalizacija između skupina s obzirom na postojanje somatskog komorbiditeta. Srednja vrijednost broja hospitalizacija u obje skupine je 3. Zaključci: U ovom radu smo ukazali na problematiku samoubojstva među ovom skupinom bolesnika i na rizične čimbenike kao što je nezaposlenost i samački život. Potrebni su daljnji napori medicinskog osoblja kako bi se što prije prepoznala depresija i zlouporaba sredstava ovisnosti. Pravovremenim prepoznavanjem i liječenjem mogu se izbjeći daljnje komplikacije i pogoršanje stanja bolesnika. Potrebna su daljnja istraživanja da bi se utvrdile dodatne razlike između navedenih skupina duševnih bolesnika., Diploma thesis title: Depression and addiction diseases Objective: The aim of this study was to examine whether there are differences between the group of patients suffering from depression and addiction and the group that has other psychiatric comorbidities in addition to depression and addiction. Materials and methods: We retrospectively analyzed medical records of patients suffering from depression and addiction treated at the Department of Psychiatry, University Hospital of Split from January 1ˢᵗ 2018 to January 1ˢᵗ 2020. Data were collected for: gender, age, number of hospitalizations, heterodestructiveness, self-destructiveness, age at first contact with psychiatrist, duration of drug consumption, socioeconomic status as well as somatic and psychiatric comorbidities. Results: The study included 47 patients. 17 of them suffer from depression and addiction and they form a control group, and 30 in addition to the above two have other psychiatric comorbidities and they form a test group. In both groups, the majority of respondents are middle-aged males. A significantly higher number of suicide attempts was proven in patients of the control group where 64.71 % tried to commit suicide than in the test group where 26.67 % of them tried to commit suicide. No statistically significant difference was found between the groups in the number of suicide attempts in relation to marital status. There is a difference in the number of suicide attempts in relation to the working status between the groups. The highest number of suicide attempts was found in the unemployed patients of the control group, while the lowest number of suicide attempts was found in the employed patients of the test group. There was no statistically significant difference in the number of hospitalizations between groups in relation to the existence of somatic comorbidity. The mean number of hospitalizations in both groups was 3. Conclusions: In this paper, we have pointed out the problem of suicide among this group of patients and the risk factors such as unemployment and single life. Further efforts by medical staff are needed to identify depression and substance abuse as soon as possible. Early recognition and treatment can avoid further complications and worsening of the patient's condition. Further research is needed to determine additional differences between these groups of mental patients.

Cilj: Cilj ovog istraživanja bio je istražiti učinke pandemije COVID-19 na studentskoj populaciji kroz dimenzije depresivnosti, anksioznosti i stresa, procijeniti njihove stilove privrženosti, a zatim ih usporediti između skupina studenata medicinskih i nemedicinskih usmjerenja. Materijali i metode: Istraživanje je provedeno „online“ putem na uzorku od 1348 studenata (1084 žena i 257 muškaraca) u dobi od 18 do 42 godine. Korišteni su Upitnik depresivnosti, anksioznosti i stresa (DASS) i Upitnik stila privrženosti (ASQ) koji su prikupljeni metodom snježne grude. Rezultati: Istraživanje je da je ukupan rezultat na DASS upitniku značajno veći od normativnih vrijednosti, kao i da su na ukupnom rezultatu na DASS upitniku i podljestvicama depresivnosti i anksioznosti nemedicinari imali značajno veći rezultat od medicinara (p, Aim: The aim of this study was to investigate the effects of the COVID-19 pandemic on the student population through the dimensions of depression, anxiety, and stress, assess their attachment styles, and then compare them between groups of medical and nonmedical students. Materials and methods: The research was conducted "online" on a sample of 1348 students (1084 women and 257 men) aged 18 to 42 years. The Depression, Anxiety and Stress Questionnaire (DASS) and the Attachment Style Questionnaire (ASQ) were used and collected by the snowball method. Results: The study showed that the total score on the DASS questionnaire was significantly higher than the normative values, and that on the overall score on the DASS questionnaire and the scales of depression and anxiety, non-medical students had a significantly higher score than medical students (p

Čovječanstvo još od davnih vremena upotrebljava glazbu za zabavu, druženje, opuštanje, ali i kao lijek. Stare generacije vjerovale su da glazba ima moć izliječenja te istu primjenjivali u bolesnim stanjima. Razvojem društva, razvila se i medicina i glazba te se danas formirala znanost o glazbi u medicini. Terapija glazbom ili muzikoterapija označava pojam koji objedinjuje profesionalnu praksu u zdravstvu u kojoj muzikoterapeut, posebno educirana osoba, primjenjuje elemente glazbe kao terapeutski agens u poboljšanju tjelesnog i duševnog aspekta osobe. Kao nadopuna standardnim obrascima liječenja u pedijatriji, sve se više koristi muzikoterapija za sve dobne skupine. Vidljivi su pozitivni učinci u raznim područjima poput neonatologije, onkologije i neurorehabilitacije. Glazba kao terapija aktivno sudjeluje u prilagodbi djece na bolest i hospitalizaciju. Koristeći roditeljski glas te uporabom zvukova sličnih onim intrauterino vidljiv je opuštajući učinak na prematuruse te utjecaj na frekvenciju srca i disanja, san, dobivanje na težini te neurorazvoj. Muzikoterapeuti u pedijatrijskoj onkologiji fokusiraju se na liječenje boli, anksioznosti i depresije glazbom, no time pružaju i emocionalnu potporu i motivaciju oboljelome i njegovoj obitelji. Terapija glazbom je prilika za socijalnu interakciju, osobno izražavanje te pomaže djeci u učenju, proširivanju i korištenju novih vještina suočavanja. Pozitivni učinci glazbe vidljivi su u neurorehabilitaciji gdje se koristi neurološka muzikoterapija, orijentirana na senzoričku, motornu i kognitivnu rehabilitaciju. Uporabom ritma poboljšava se usklađenost pokreta, obrasci kretanja i aktivacija mišića. Sudjelovanjem u neurološkoj muzikoterapiji djeca s poteškoćama u razvoju stječu pozitivna iskustva socijalizacije, komunikacije, samoizražavanja te emocionalnu podršku i povezanost s vršnjacima i obitelji. Mankind have been using music for entertainment, socializing, relaxation, but also as a medicine. Older generations believed that music had the power to heal and applied it to the sick. With the development of society, medicine and music also developed and the science of music in medicine was formed. Music therapy is a term that describes professional practice in health care in which a music therapist, a specially educated person, applies elements of music as a therapeutic agent in improving the physical and mental aspect of a person. As a complement to standard pediatric treatment, music therapy is used increasingly for all ages. Positive effects are visible in various fields such as neonatology, oncology and neurorehabilitation. Music as a therapy actively participates in the adaptation of children to illness and hospitalization. Using the parent's voice and using sounds similar to those intrauterine, there is a visible relaxing effect on infants and also an impact on heart rate and respiration, sleep, weight gain and neurodevelopment. Music therapists in pediatric oncology focus on treating pain, anxiety and depression with music, while providing emotional support and motivation to the patient and his family. Music therapy is an opportunity for social interaction, personal expression and also as help for learning, expanding and using new coping skills. The positive effects of music are visible in neurorehabilitation where neurological music therapy is used, oriented towards sensory, motor and cognitive rehabilitation. Using rhythm improves movement coordination, movement patterns and muscle activation. By participating in neurological music therapy, children with developmental disabilities gain positive experiences of socialization, communication, self-expression, but also emotional support and connection with peers and their family.

Ciljevi istraživanja: Glavni ciljevi ovoga istraživanja bili su usporediti intenzitet depresije, kao i rezultat na pojedinačne tvrdnje Beck Depression Inventory-II (BDI-II) upitnika među pacijentima liječenim supstitucijskom terapijom metadonom i onima liječenim supstitucijskom terapijom buprenorfinom. Materijali i metode: U Službi za mentalno zdravlje na Nastavnom zavodu za javno zdravstvo Splitsko-dalmatinske županije u razdoblju od 18. ožujka 2021. do 29. travnja 2021. godine. ispitanici liječeni supstitucijskom terapijom buprenorfinom ili metadonom ispunili su Beck Depression Inventory-II ( BDI-II) upitnik. Također, iz Pompidou obrazaca prikupljeni su podaci o pacijentovim općim socio-demografskim podacima, podacima o liječenju, rizičnom ponašanju i sudskim problemima. Rezultati: U navedenom razdoblju istraživanje je obuhvatilo 103 ispitanika, od kojih je njih 84 (81,6%) bilo muškog spola te 19 (18,4%) ženskog spola. 47 ispitanika (45,6%) liječeni su supstitucijskom terapijom buprenorfinom, dok je ostalih 56 (54,4%) bilo liječeno supstitucijskom terapijom metadonom. Zbrajanjem rezultata koje su postigli rješavajući Beck Depression Inventory-II ( BDI-II) upitnik, 50 ispitanika (48,6%) imalo je minimalnu depresiju, njih 21 (20,4%) blagu, 16 (15,5)% umjerenu, a isti broj, njih 16, imao je težak oblik depresije, bez statistički značajnih razlika među istraživanim grupama. Pokazana je statistički značajna (P, Diploma thesis title: Difference in the intensity of depression in patients treated with methadone replacement therapy compared to patients treated with buprenorphine replacement therapy. Objectives: The main objectives of this study were to compare the intensity of depression and scores on individual claims of the Beck Depression Inventory-II (BDI-II) questionnaire among patients treated with methadone replacement therapy and those treated with buprenorphine replacement therapy. Materials and methods: In the Mental Health Services at the Teaching Institute for Public Health of the Split-Dalmatia County in the period from March 18, 2021. to April 29, 2021. subjects treated with buprenorphine or methadone replacement therapy completed the Beck Depression Inventory-II (BDI-II) questionnaire. Also, data on patient general socio-demographic data, treatment data, risky behavior, and court problems were collected from Pompidou forms. Results: In this period, the study included 103 respondents, of whom 84 (81.6%) were male and 19 (18.4%) female. 47 subjects (45.6%) were treated with buprenorphine replacement therapy, while the remaining 56 (54.4%) were treated with methadone replacement therapy. Summarizing the results achieved by solving the Beck Depression Inventory-II (BDI-II) questionnaire, 50 respondents (48.5%) had minimal depression, 21 of them (20.4%) had mild depression, 16 (15.5%) had moderate depression, and the same number, 16 of them, had a severe form of depression., with no statistically significant differences among the study groups. There was a statistically significant (P

Koža je najveći, a ujedno i najvidljiviji organ ljudskog tijela. Još početkom prošlog stoljeća opisana je kao organ ekspresije. Znanost koja pokriva sve aspekte međuodnosa psihološkog statusa i kože u pogledu uzroka, početka, razvoja, dijagnostike i liječenja različitih kožnih bolesti naziva se psihodermatologija. Danas se, iz praktičnih razloga, koristi klasifikacija u kojoj se psihodermatološki poremećaji dijele na psihosomatske, primarno psihijatrijske ili psihogene i sekundarno psihijatrijske. U skupinu psihosomatskih bolesti ubrajamo atopijski dermatitis, psorijazu, akne, alopeciju areatu, psihogenu purpuru, seboroični dermatitis, rozaceu, urtikariju, psihogene ekskorijacije, lokalizirani pruritus analnog područja i vulve te hiperhidrozu. U skupinu primarnih psihijatrijskih bolesti spadaju trihotilomanija, artefaktni dermatitis, neurotske ekskorijacije, onihotilomanija i kronični lihen simpleks, kao i funkcionalni poremećaji kože i sluznica te sumanuti poremećaji. Sekundarni psihijatrijski poremećaji javljaju se kod pacijenata s kroničnim kožnim bolestima koje narušavaju fizički izgled. Kod bolesnika s takvom dermatološkom patologijom dolazi do razvoja anksioznosti, depresivnosti, gubitka samopouzdanja i socijalne fobije. Poznata je i dokazana praksa liječenja dermatoloških bolesnika psihijatrijskim metodama. Koriste se i psihofarmaci i psihoterapija, ali i kombinacija tih dviju metoda, ovisno o indikaciji. The skin is the largest and the most visible organ of the human body. As early as the beginning of the last century, it was described as an organ of expression. The science that covers all aspects of the relationship between psychological status and skin in terms of the cause, onset, development, diagnosis, and treatment of various skin diseases is called psychodermatology. For practical reason, a classification that is used today is the one which psychodermatological disorders are divided into psychosomatic, primarily psychiatric or psychogenic, and secondarily psychiatric. The group of psychosomatic diseases includes atopic dermatitis, psoriasis, acne, alopecia areata, psychogenic purpura, seborrheic dermatitis, rosacea, urticaria, psychogenic excoriations, localized pruritus of the anal area and vulva, and hyperhidrosis. The group of primary psychiatric diseases includes trichotillomania, artifact dermatitis, neurotic excoriations, onychotylomania and chronic lichen simplex, as well as functional disorders of the skin and mucous membranes and delusional disorders. Secondary psychiatric disorders occur in patients with chronic skin diseases that impair physical appearance. Patients with such dermatological pathology develop anxiety, depression, loss of self-confidence and social phobia. The practice of treating dermatological patients with psychiatric methods is well known and proven. Psychopharmaceuticals and psychotherapy are also used, but also a combination of these two methods, depending on the indication.

Objectives: The main objective of this research was to investigate the relationship between early childhood trauma, PTSD, and complex PTSD in war veterans. Materials and methods: Research participants were 88 male war veterans, 40 diagnosed with PTSD and 48 diagnosed with CPTSD. This research was conducted at the Department of Psychiatry, University Hospital Split, and the Regional Center for Psychotrauma. The measurement instruments were four questionnaires: the Clinician-Administered PTSD Scale for DSM-V (CAPS-V) used to confirm the diagnosis of PTSD, the International Trauma Questionnaire (ITQ) used to establish the diagnosis of CPTSD, the Stress and Adversity Inventory (STRAIN) used to gain information on early childhood trauma, and a sociodemographic questionnaire used for demographic variable analysis and exclusion/inclusion criteria. Results: Veterans with CPTSD reported a somewhat greater count and severity of chronic traumatic childhood experiences than veterans with PTSD, but the difference was not statistically significant (P= 0.14 and P=0.2, respectively). Veterans with CPTSD and PTSD did not differ significantly in sociodemographic characteristics. Veterans with CPTSD reported significantly greater symptoms of avoidance, cognitive symptoms, arousal/irritability symptoms, social functioning problems, and subjective disturbance than veterans with PTSD. Conclusions: Although veterans with CPTSD and PTSD did not show a statistically significant difference in early childhood trauma, veterans with CPTSD did report a somewhat greater count and severity of chronic childhood adversities, which is in accordance with the literature. Veterans with CPTSD showed significantly greater symptoms of avoidance, cognitive symptoms, arousal/irritability symptoms, social functioning problems, and subjective disturbance compared to veterans with CPTSD. There was no statistically significant difference in the sociodemographic variables of veterans with CPTSD and PTSD., Ciljevi: Glavni cilj ovog istraživanja je bio ispitati povezanost rane traumatizacije i nastanka posttraumatskog stresnog poremećaja i kompleks posttraumatskog stresnog poremećaja u ratnih veterana. Materijali i metode: Ispitanici su bili 88 ratnih veterana, 40 njih dijagnosticirano s PTSP-om i 48 s kompleks PTSP-om. Istraživanje je provedeno pri Klinici za psihijatriju KBC-a Split i Regionalnom centru za psihotraumu. U ovom istraživanju su kao mjerni instrumenti korištena četiri upitnika: Clinician-Administered PTSD Scale for DSM-V (CAPS-V) korišten za dijagnosticiranje PTSP-a, International Trauma Questionnaire (ITQ) korišten za dijagnosticiranje kompleks PTSP-a, Stress and Adversity Inventory (STRAIN) korišten za prikupljanje informacija o ranoj životnoj traumi i sociodemografski upitnik koji je korišten za analizu demografskih varijabli te kao mjerilo kriterija uključivanja i isključivanja. Rezultati: Veterani s kompleks PTSP-om su iskazivali donekle veći broj i težinu kroničnih traumatskih iskustava u djetinjstvu od veterana s PTSP-om, iako razlika nije statistički značajna (P=0.14 i P=0.2). Nije bilo statistički značajne razlike između sociodemografskih karakteristika veterana s PTSP-om i kompleks PTSP-om. Veterani s kompleks PTSP-om su iskazali značajno više simptoma izbjegavanja, kognitivnih simptoma, simptoma iritabilnosti, problema sa socijalnim funkcioniranjem i subjektivne procjene uznemirenosti od veterana s PTSP-om. Zaključak: Iako veterani s kompleks PTSP-om nisu pokazali statistički značajnu razliku u ranoj traumatizaciji od veterana s PTSP-om, iskazali su donekle veći broj i težinu kroničnih traumatskih iskustava u djetinjstvu, što je u skladu s dosadašnjom literaturom. Veterani s kompleks PTSP-om su pokazali statistički više simptoma izbjegavanja, kognitivnih simptoma, simptoma iritabilnosti, problema sa socijalnim funkcioniranjem i subjektivne procjene uznemirenosti od veterana s PTSP-om. Nije bilo statistički značajne razlike u sociodemografskim karakteristikama između veterana s PTSP-om i kompleks PTSP-om.

Shizofrenija je psihijatrijski poremećaj nedovoljno razjašnjene etiologije. Neurodegenerativna teorija temelji se na činjenici da je shizofrenija karakterizirana kroničnim i progresivnim procesima u živčanom sustavu koji su obilježeni biokemijskim promjenama, alteriranim histopatološkim nalazom, opadanjem moždanih funkcija te deterioracijom u ponašanju. Glavni dokaz ove teorije pružaju morfološke analize kojima se može dokazati redukcija volumena korteksa u brojnim regijama, te povećanje volumena ventrikula mozga. Što se tiče bijele tvari, uočena je redukcija u živčanim putevima koji spajaju prefrontalni i temporalni režanj. Mjerenja metodom fMRI ustanovila su slabiju globalnu povezanost moždanih struktura u pacijenata sa shizofrenijom u odnosu na zdrave kontrole. Neurodegenerativna teorija često se povezuje s povišenim razinama dopamina koje dovode do inhibicije respiratornih enzima u mitohondrijima i time do staničnog oštećenja i smrti. Pored toga, također se povezuje s hipofunkcijom NMDA receptora i posljedičnom povišenom razinom glutamata koji djeluje egzotoksično i tako posreduje daljnjoj neurodegeneraciji. Kao najznačajnija kritika ove teorije uzimaju se rezultati brojnih istraživanja kognitivnih funkcija koji potvrđuju izostanak neurokognitivnoga pogoršanja, pa čak i poboljšanje u fazama remisije. Druga velika kritika je glioza kao glavni marker neurodegeneracije, a nikada zapravo nije sa sigurnošću potvrđena u pacijenata sa shizofrenijom. U konačnici, neurodegenerativna teorija je povezana sa većinom drugih teorija u etiologiji shizofrenije. Važno je još istaknuti da povezanost neurorazvojne i neurodegenerativna teorije otvaraju novi progresivni razvojni model., Schizophrenia is a psychiatric disorder of insufficiently clarified etiology. Neurodegenerative theory is based on the fact that schizophrenia is characterized by chronic and progressive processes in nervous system which are marked by the biochemical changes, altered histopathologic results, decline in brain functions and behavioral deterioration. Principal evidence of this theory is demonstrated by the morphometric analyses, which can prove volume reduction of cortex in many different brain regions, as well as enlargement of brain ventricles. As for the white matter changes, reduction in trajectories connecting prefrontal and temporal lobes has been observed. Measurements with the fMRI method have identified weaker global connectivity in patients with schizophrenia compared to healthy controls. Neurodegenerative theory is often connected with elevated levels of dopamine which in turn lead to inhibition of respiratory enzymes in mitochondria finally causing cell damage and death. This theory is also linked with hypofunction of NMDA receptors and consequentially raised levels of glutamate, a neurotransmitter which has an exotoxic effect and thus mediates further neurodegeneration. Results of numerous studies of cognitive function are taken as the most prominent critique of this theory. These studies confirm the absence of neurocognitive decline, even improvement in remission phase. Another significant critique is gliosis as the most important indicator of neurodegeneration, which has never been confirmed with certainty in patients with schizophrenia. Finally, neurodegenerative theory is connected with the majority of other theories in etiology of schizophrenia. It is also important to emphasize that connection of nerodevelopmental and neurodegenerative theories opens up a new progressive model.

Prema definiciji svjetske zdravstvene organizacije zdravlje je stanje potpunog fizičkog, psihičkog i socijalnog blagostanja. Briga o mentalnom zdravlju od iznimne je važnosti, a pogotovo u osjetljivim skupinama pacijenata kao što su terminalno oboljeli. Terminalna faza bolesti je medicinski izraz za stadij bolesti koji se ne može izliječiti. U tom stadiju bolesti izvor velikih emocionalnih previranja je strah od smrti. Pacijenti se boje fizičke i psihičke patnje, poniženja, prekida postignuća ciljeva, posljedica koje će njegova smrt ostaviti na članove obitelji i onoga što dolazi nakon smrti. Ponekad je strah od smrti toliko intenzivan da može uzrokovati anksioznost, depresiju, delirij i poremećaje spavanja. U tim teškim trenutcima oboljelim pacijentima najveću podršku pružaju članovi obitelji. Ponekad se terminalno oboljeli pacijenti previše povuku u sebe te je ostvarivanje komunikacije s njima izrazito teško. Tada je dobrodošla pomoć stručne osobe, koja uz razgovor i psihoterapiju pokušava pacijentu umanjiti mentalnu patnju. U slučajevima kada to nije dovoljno u liječenju se mogu koristiti i lijekovi poput antidepresiva i anksiolitika. Psihološku potporu potrebno je pružiti i članovima obitelji oboljelog pacijenta kako bi se prolazak kroz ovo teško razdoblje olakšao. Umiranje je proces koji je potrebno prihvatiti., According to World Healt Organization`s definition of health, health is the state of complete physical, psychological and social well-being. Mental health care is extremely important, especially in vulnerable groups of patients such as terminally ill. The terminal stage of the disease is a medical term for a stage of the disease that cannot be cured. At this stage of the disease, the source of great emotional turmoil is the fear of death. Patients are afraid of physical and mental suffering, humiliation, interruption of the achievement of goals, the consequences that his death will leave on family members and what comes after death. Sometimes the fear from death can be so intensive that it can cause anxiety, depression, delirium and disorders with sleep. In these difficult times, family members provide the greatest support to sick patients. Sometimes terminally ill patients clam up themselves and the communication with them is extremely difficult. Then the help of a professional person is welcome, who helps with conversation and psychotherapy In cases where even that is not enough antidepressants and anxiolytics may also be used in treatment. Psychological support should also be provided to the family members of the ill patient in order to facilitate the passage through this difficult period. Dying is a process that needs to be accepted.