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Pathological gambling is the most widespread and severe form of non-chemical addiction. It is challenging to categorize pathological gambling into just one category, ie. into a disorder characterized by impulsivity or into behavioral addiction, since there are obvious overlaps. With the above in mind, the changes within the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh revision of the International Classification of Diseases (ICD-11) are not surprising. Although not listed in the diagnostic criteria, impulsivity and neuropsychological deficits are an integral part of gambling disorder. For this reason, they are essential for a more complete understanding of the profile of pathological gamblers. The strongest arguments in favor of the reclassification of pathological gambling under the category of addiction are: similarities with the diagnostic characteristics of addiction to psychoactive substances (PAS); high degree of comorbidity between these two disorders; their common features including aspects related to the reward system; findings that the same brain structures are involved in both disorders. There are similarities in the way gambling disorders are reclassified within DSM-5 and ICD-11. As in DSM-5, pathological gambling is recognized as a form of addiction. In ICD-11, it was renamed gambling disorder and classified as behavioral addictions. The latest revisions of both classifications (DSM and ICD) have the same development path and essentially the same foundations, and a change in the perception of gambling within diagnostics is clearly visible. Pathological gambling is a very complex disease that is accompanied by neuropsychological deficits and impulsive behavior, both characteristic of addicts and people with impulse control disorders. Reclassification is significant for several reasons. First, there are similarities with the diagnostic characteristics of chemical addiction. Second, there is a high degree of comorbidity between impulse control disorders and addiction. Third, both involve the reward system and activate the same parts of the brain. It is assumed that these similarities led to the reclassification in both DSM-5 and ICD-11. It is still not entirely clear how this change in the perception of gambling within diagnostics will affect the actual treatment of pathological gambling. [ABSTRACT FROM AUTHOR]

Introduction. Psychoactive drug addiction causes serious consequences in many countries, not only for the health of the nation, but also for the emergence of various social problems, such as high crime rates, delinquency and unemployment. Material and Methods. A retrospective-prospective study included data of 100 criminal offenders, drug addicts, gathered from forensic psychiatric records in the context of criminal offences committed by those persons. Results. Out of all the drug addicts who committed criminal offences, 98% were males and the average age was 30.44. Most of the offenders were unemployed and had a lower level of education. A total of 56% were previously convicted. The majority of them previously committed one felony. Compared to previous offences, new criminal offenses were against life and body in 70%. Comorbid mental disorders were diagnosed among 84% of examinees at the moment of committing a crime, and 60% had personality disorders. The largest number of subjects with alcohol addiction primarily make offenses against life and body, while those with substance addiction usually commit offenses against human health. Conclusion. In drug addicts who have committed criminal offences, it has been confirmed that gender, age, employment, history of committing criminal acts and comorbid mental disorders are criminogenic factors that are significant for the prediction of general criminality. The continuity in researching predictive factors, as well as crime prevention within the population with mental disorders is and needs to remain a priority. [ABSTRACT FROM AUTHOR]

Introduction. Atypical antipsychotics are the gold standard in the treatment of psychotic and other mental disorders due to their efficacy and tolerability. However, the relatively frequent occurrence of antipsychotic-induced metabolic syndrome has encouraged research into possible solutions to this problem, including the adjunctive use of metformin. The aim of this review article is to present a concise, comprehensive and critical overview of the aforementioned issue based on the analysis of available experimental research. Material and Methods. PubMed and Google Scholar databases were searched for relevant literature published in a fifteen-year period between 2008 and 2022. The following terms were used in the search: atypical antipsychotics, metformin, and weight gain. Only double-blind, placebo-controlled, randomized, and cohort studies were taken into consideration. Results. A total of 145 papers were analyzed, of which 10 papers with 852 subjects met the inclusion criteria. All the reviewed studies concluded that the adjunctive administration of metformin at a daily dose of 500 mg to 2,000 mg has significantly reduced atypical antipsychotic-induced weight gain, with a favorable effect on other metabolic parameters that were examined in the analyzed papers. Conclusion. Taking into account the increased cardiovascular morbidity and the consequent mortality among those who have been using atypical antipsychotics in the long term, it is necessary to assess the risks and benefits of introducing adjunctive metformin in every patient who is at risk of developing metabolic syndrome. In order to recommend the routine use of metformin in such indications, studies that would include a larger sample and a longer period of treatment are needed. [ABSTRACT FROM AUTHOR]

Introduction. The association between substance use and aggression derives from the fact that among violent crime offenders there is a large number of people with alcohol and drug abuse. The objective of the study was to determine the incidence of psychoactive substance addicts in the population of violent crime offenders, as well as to consider possible measures to reduce the crime rates in this population. Material and Methods. Forensic psychiatric reports were used to assess 94 violent offenders from 2001 to 2018. The expert reports were obtained from the Psychiatry Clinic in Novi Sad, Serbia, including court case files, medical records, and psychiatric and psychological records of all offenders. Results. We have found that of the total of 94 violent crime offenders, as many as 25% suffered from some form of mental disorder. More than half of those with mental disorders from this group suffered from disorders induced by psychoactive substances, which means that as many as 15% of all offenders had some form of addiction. On the other hand, as much as 50% of all the offenders were under the influence of psychoactive substances at the time of the offense, predominantly by alcohol. Conclusion. Further research is needed in order to develop specific programs for the prevention of violence in the population using psychoactive substances. [ABSTRACT FROM AUTHOR]

Introduction. It is known that it is possible to improve healthcare by paying more attention to psychological aspects of diagnosis and treatment of physical and mental conditions. The study and practice of such factors is called psychological medicine. The aim of this paper was to provide contemporary aspects of psychological medicine and to emphasize its contributions to clinical practice. Material and Methods. A review of the literature on psychological and psychosomatic medicine was performed using Medline and manual search. Results. The main goals of psychological medicine are comprehensive assessment of psychological factors affecting the etiology, course and outcome of illness, biopsychosocial consideration of patient care, as well as integration of specific interventions in prevention, treatment and rehabilitation of patients. We need to emphasize that due to clinical limitations, in terms of current separation of mental and physical healthcare, the treatment of many health conditions in which psychological factors are significant, is still insufficient. Conclusion. Because of its importance to patients’ well-being, psychological and psychosomatic medicine should to be an integral part of clinicians’ knowledge across all specialties. [ABSTRACT FROM AUTHOR]

Introduction. Parkinson's disease is the second most common neurodegenerative disease with as many as 50 - 70% of patients experiencing psychotic symptoms during the course of the illness. Our aim was to provide an evidence-based review on the etiology, prevalence and management of psychotic symptoms in Parkinson's disease. Material and Methods. We used references from the "Medline" database published from 1999 to 2019. Results. The most common psychotic symptoms in Parkinson's disease are visual hallucinations, which occur in 25 - 30% of patients, acoustic hallucinations in about 20%, and delusions in around 5% of these patients. The etiology of psychotic symptoms is not fully clarified, but researchers suggest a complex interrelationship of factors associated with the disease itself and the factors associated with antiparkinsonian medications. After exclusion of other etiologic causes of psychotic symptoms, it is necessary to revise the type and dose of antiparkinsonian drugs. Although pimavanserin has recently been approved by the United States Food and Drug Administration, the current treatment of choice for psychotic symptoms in Parkinson's disease is still quetiapine. Only patients who do not tolerate or do not respond to quetiapine are treated with clozapine, which has been proven more effective, but with significant side effects. Conclusion. Timely diagnosis and adequate treatment of psychotic symptoms in Parkinson's disease are essential, because they dramatically affect the quality of life of patients and their families. Therefore, it is necessary to establish more effective tools for screening and treatment of psychotic symptoms in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Uvod: Poremećaji raspoloženja su najzastupljeniji mentalni poremećaji. Dele se na unipolarne depresije i bipolarne afektivne poremećaje. Bipolarni afektivni poremećaji se manifestuju kao manija, hipomanija, mešovita epizoda i depresivna epizoda. Kod bipolarnog afektivnog poremećaja depresivne epizode se javljaju mnogo češće. Hipomanične/manične epizode ostaju neprepoznate kako od strane bolesnika i njegove porodice, tako i od strane lekara usled nedovoljno dostupnih heteroanamnestičkih podataka. Od velikog je značaja podizanje svesti o važnosti detaljno uzete anamneze jer se terapija umnogome razlikuje kod unipolarne depresije i kod bipolarnog afektivnog poremećaja. Cilj rada je prikazati značaj razlikovanja unipolarne depresije od depresivne epizode u bipolarnom afektivnom poremećaju i postavljanje odgovarajuće dijagnoze. Prikaz bolesnika: Radi se o bolesnici staroj 73 godine koja je u ambulantnom psihijatrijskom tretmanu poslednjih dvadesetak godina vođena pod dijagnozom rekurentne depresije. Prilikom poslednje hospitalizacije dolazi na Kliniku u pratnji dece koji iznose grublje izmene na planu emocija i ponašanja koji su bili praćeni paranoidno – interpretativnim sumanutim idejama. Sve zajedno bi po opisu odgovaralo maničnoj psihotičnoj epizodi u okviru bipolarnog afektivnog poremećaja. Detaljnijim heteroanamnestičkim podacima dobijamo uvid u dosadašnje funkcionisanje pacijentkinje pri čemu je bilo prisutno redovno javljanje lekaru kada bi osetila da je sniženog raspoloženja i otežanog funkcionisanja na svakodnevnom planu, dok bi epizode hipomanije koje su se ogledale eleviranim raspoloženjem, logoroičnošću, ubrzanošću i hiposomnijom uz izostanak pratećeg umora smatrala jednostavno svojim dobrim raspoloženjem. To su smatrali i najbliži članovi porodice i njeno ponašanje pripisivali osobinama njene ličnosti. To je dovelo do toga da je pacijentkinja shvaćena kao rekurentni depresivni poremećaj usled čega je prepisivana terapija samo antidepresivima, a zapravo je usled nedostatka podataka previđeno da se radi o bipolarnom afektivnom poremećaju. Zaključak: Iz priloženog prikaza slučaja, dolazimo do zaključka da je veoma značajna pravovremena distinkcija, kao i adekvatno dijagnostikovanje ova dva poremećaja zbog ordiniranja adekvatne terapije i preveniranja nastanka “switcha” u maniju. [ABSTRACT FROM AUTHOR]

Poremećaj pažnje s hiperaktivnošću (attention deficit hyperactivity disorder, u daljem nastavku teksta - ADHD) je najrasprostranjeniji neurorazvojni poremećaj kod dece i adolescenata, s procenjenom globalnom učestalošću između 5% i 12%. Učestalost ADHD-a zajedno s tikovima je značajno veća nego što bi se očekivalo. Deca koja su dijagnostikovana s ADHD-om znatno češće imaju i hronične tikove (chronic tic disoreder, u daljem nastavku teksta - CTD) u poređenju s onima koji nemaju ADHD. Kada se ADHD javlja zajedno s poremećajem tikova, lečenje može biti izazovno. Kroz ovaj prikaz, nadamo se osvetljavanju jedinstvenih izazova i potencijalnih strategija lečenja ove komorbidnosti. Devetogodišnji dečak primljen na Kliniku za psihijatariju zbog hiperaktivnosti, slabe koncentracije i pažnje, kao i motornih tikova u vidu izraženog treptanja, plaženja i klimanja glavom. Primljen radi dopunskih dijagnostičkih procedura i eventualnog uvođenja diferentne psihofarmakoterapije. Psihološkim testiranjem dobijeno da je globalno intelektualno postignuće u kategoriji proseka, međutim registrovan nesklad između verbalnih i manipulativnih sposobnosti. Tokom hospitalizacije na osnovu opservacije i psihološkog celokupnog testiranja, kao i korišćenjem testova (SNAP – IV granične vrednosti) nije semoglo direktno ukazati na postojanje hiperkinetskog poremećaja, te preporučeno šestomesečno praćenje i nastavak logopedsko-defektološkog tretmana. U međuvremenu praćen od strane nadležnog psihijatra tokom kojeg se na osnovu psihodijagnostičkih procena zaključuje da postoji deficit pažnje sa hiperaktivnošću. Po isključenju kontraindikacija, uvedena psihostimulativna terapija metilfenidatom u dozi od 18mg. Doza titrirana nakon dva meseca do 36mg kada se postiže zadovoljavajući terapijski odgovor. Uvođenje metilfenidata nije imalo značajnijeg uticaja na tikove, ali nije dolazilo ni do pogoršanja te vrste tegoba. Poremećaj ponašanja i funkcionalni poremećaji povezani s ADHD-om imaju negativne uticaje na akademske, socijalne i porodične aspekte. Za razliku od osoba koje se samo suočavaju sa Turetovim sindromom (TS), oni koji imaju i TS i ADHD imaju izraženije teškoće u oblastima poput planiranja, radne memorije, inhibicione funkcije i vizualne pažnje. Kliničari koji leče pacijente sa tikovima i ADHD-om mogu razmotriti korišćenje metilfenidata za rešavanje simptoma ADHD-a. Međutim, važno je da kliničari razgovaraju o ovom pitanju sa starateljima prilikom propisivanja leka i pažljivo prate pacijente zbog opreza navedenog u informacijama o leku. [ABSTRACT FROM AUTHOR]

Introduction Bipolar disorder has been continuously studied due to its high prevalence and incidence. The aim of this study was to explore the influence of duration of the first episode of bipolar disorder on the further course of this disorder. Material and Methods The research was conducted as a retrospective-prospective, naturalistic study, which included 65 bipolar patients admitted to the hospital. We used Student's t-test in addition to descriptive parameters, mean, median and standard deviation. We followed the 5-year course of the disorder after the first episode. Results Having examined the medical records of the first episode and five-year follow-up of the course of the disease we found a statistically significant difference (2 vs 1.54; df=120; p<0.05) in the number of episodes following the first episode between the patients whose first episode was longer than 2 months and the patients whose first episode was shorter than 2 months. In addition, we found a statistically significant difference (55.42 vs 42.3; df=120; p<0.05) in duration of episodes that followed the first episode between the patients whose first episode was longer than 2 months and the patients whose first episode was shorter than 2 months. Discussion Since these results are in accordance with the literature, we ought to point out the possibility of developing chronic syndromes in patients with longer first episodes. Conclusion This study is a modest contribution to the trend of studying bipolar disorder. Better knowledge of the course would enable better treatment, prognosis and outcome of this disorder. [ABSTRACT FROM AUTHOR]

Introduction. The coronavirus pandemic caused a restructuring of mental health services, marked by a decrease of hospital work capacity and increased reliance on telemedicine. Children and adolescents are a particularly vulnerable group that has been affected by the newly arisen corona virus-19 pandemic. The objective was to evaluate the correlation between the coronavirus pandemic and alternations in hospitalization rates, seasonal distribution, and sociodemographic characteristics of patients admitted to the Department of Child and Adolescent Psychiatry. Material and Methods. The study was conducted at the Psychiatry Clinic of the Department of Child and Adolescent Psychiatry at the University Clinical Center of Vojvodina in the period from March 6, 2017 to March 5, 2021. The sample comprised 1114 inpatients and individuals undergoing partial hospitalizations, diagnosed with mental disorders classified according to the International Classification of Diseases. Participants were categorized into two groups: one treated before the onset of the pandemic (March 2017-March 2020) and another treated during the pandemic (March 2020-March 2021). Statistical analysis was performed on the collected data, with the results presented in tables and graphs. Results. During the pandemic, an overall reduction in admissions (-32.34%) was observed, accompanied by a noticeable decrease in admissions during the spring compared to the pre-coronavirus period (p=0.011). The most prevalent diagnoses were F9 and F4, respectively (p<0.01). A higher number of hospitalizations were noted in middle adolescence (p<0.001), among females (p=0.006) and those residing in urban areas (p=0.009). Conclusion. The coronavirus pandemic led to alternations in the functioning and dynamics on Department of Child and Adolescent Psychiatry. The sociodemographic characteristics of the youth changed during the pandemic. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the frequency of various forms of maltreatment in adolescents without parental care, their mental health problems and treatment needs. Sixty examinees of both genders, aged 12-18, were divided in two groups: abused group (adolescent without parental care in an institutional setting) and control group (general population). The presence/absence of registered abuse/neglect by official social services were the criterion for classifying respondents into groups. The general questionnaire, Childhood Trauma Questionnaire and Youth Self Report were used. 46.67% of adolescents were neglected, 40% of them suffered several types of abuse, 10% were physically abused, 3.33% were emotionally abused, and no adolescent was sexually abused. 16.6% of cases of sexual abuse in the abused group as well as milder forms of maltreatment in the control group were registered by self-reported retrospective measures, which are not part of official registers. Delinquency, aggressive behavior and somatic complaints are significantly more prominent in the abused group compared to the control group. 86% of adolescents used some form of support and counseling from professionals, 56.6% were included in psychiatric treatment, and only 36.6% in psychotherapy. Mental health problems in abused adolescents without parental care indicates the specific needs for psychotherapy and psychiatric treatment. [ABSTRACT FROM AUTHOR]

Lithium therapy remains the gold standard in the treatment of bipolar disorder and clinical guidelines recommend it as the first choice for maintenance treatment of bipolar disorder. However, the use of lithium has decreased over the years, mainly due to the fear of its adverse effects. The aim of this paper was to review current literature data for the monitoring and overcoming side effects of lithium therapy in order to provide contemporary evidence for adequate lithium use. Material and Methods. A literature review of lithium therapy in bipolar disorder, using both Medline and manual searches, was performed. Classification of studies, in relation to their quality, was performed using the guidelines established by the American Academy of Neurology. Results. Despite methodological limitations of recent studies, there is irrefutable evidence that lithium therapy can cause toxicity and side effects related to renal, thyroid and parathyroid function, as well as weight gain. Conclusion. There is clear evidence that lithium can cause various side effects, but clinically significant conditions in this regard are rare and successfully treated. Literature data confirm strong efficacy of lithium and suggest its wider use in bipolar disorder. By following clinical recommendations and careful monitoring during lithium treatment, the risk of serious side effects is low compared to its efficacy. [ABSTRACT FROM AUTHOR]