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The paper deals with a case report of a 41-year-old man who in search of the meaning of life in a so-called “shamanic ritual” drank tea made from the San Pedro cactus as well as paste made of the same plant. The hallucinations were post poned and started after 9.5 hours caracterised by a psychotic reaction with symptoms of catatonia. He was admitted to our Department of Psychiatry where he was administered a second generation antipsychotic. The clinical presentation disappeared about 60 hours after the ingestion of mescaline mainly because of the antagonistic effect the antipsychotic has on the serotoninergic 5-HT2A receptors.

Prikazan je tijek bolesti 41-godišnjaka koji je u potrazi za smislom života u tzv.”šamansko seansi” popio 2 x 2 dcl čaja od kaktusa San Pedro i konzumirao 4 čajne žlice smjese od kaktusa po prvi put. Halucinacije su započele nakon 9, 5 sati i trajale su 40-ak sati do hospitalizacije, gdje je opserviran i liječen tijekom 10-ak sati. Primljen je u slici katatonije u Kliniku za psihijatriju oko 50-sati po konzumaciji, a klinička slika zbog akutnog otrovanja psihoaktivnom tvarima nestala je 60-ak sati nakon ingestije.

Psihopatologija je temeljna psihijatrijska disciplina koja se bavi proučavanjem psihičkih simptoma. Psihički simptomi detaljno se opisuju, klasificiraju i stavljaju u kontekst specifičnih poremećaja ili bolesti. Postoji više različitih podjela psihopatologije. 1. Opća psihopatologija, koja bilježi, opisuje i označava subjektivno iskustvo i promijenjeno ponašanje pojedinca. Za opću psihopatologiju važno je napomenuti kako je danas transkulturalna, tj. nije posebna niti za jednu „školu” 2. Specijalna psihopatologija razlikuje simptome i ponašanja prema kliničkoj prezentaciji, prirodi i razvitku simptoma, a sinonimi su joj: funkcionalna, fenomenološka, simptomatska, specifična ili klinička psihopatologija. 3. Etiopatogenetska psihopatologija izravno bi povezivala uzrok određenog poremećaja s njegovim specifičnim simptomima. 4. Teorijska psihopatologija bila bi interdisciplinarna poveznica s antropologijom, filozofijom i sl. Prikaz istraživanja kognitivnih funkcija u shizofreniji s nedavnom početkom te utjecaja dugodjelujućeg aripiprazola na kognitivne funkcije u korelaciji s polimorfizmoma COMT, MTHFR i SERTa. Tromjesečna primjena terapije povezana je s statistički značajnim smanjenjem PANSSa (p < 0.001) te s kognitivnim funkcijama odgođenog prisjećanja (p < 0, 03), pozornosti (p < 0.01), i izvršnih funkcija u smislu mnaje perseveracija (p < 0, 03). Postoji pozitivna korelacija između M/M COMT mutacije i pozornosti.

Delirij se prema DSM-V klasifikaciji dijagnosticira na temelju smetnji pažnje i svijesti uz prisutnost neke dodatne smetnje kognitivnog funkcioniranja koja nastaje tijekom kratkog vremenskog razdoblja. Delirij može nastati zbog intoksikacije psihoaktivnom tvari/lijekom, zatim zbog sindroma ustezanja od psihoaktivne tvari/lijeka ili zbog drugog zdravstvenog stanja, a smetnje koje ga karakteriziraju ne mogu se objasniti neurorazvojnim poremećajem koji je od ranije prisutan ili je u razvoju. Gama- hidroksibutirat (GHB) prirodna je tvar prisutna u središnjem živčanom sustavu i perifernim tkivima sisavaca. Sporedni je metabolit i prekursor inhibicijskog neurotransmitera gamaaminomaslačne kiseline (GABA) u metabolizmu glutaminske kiseline. Dobiven sintetskim putem, GHB je godinama korišten u medicinskim istraživanjima, kao i u kliničkoj praksi, sve do saznanja o izazivanju ovisnosti te brojnim nuspojavama koje su mu ograničile kliničku primjenu. Danas se zloupotrebljava zbog svojih euforičnih, sedativnih, anaboličkih i amnestičkih učinaka. U ovome je radu prikazan bolesnik koji je liječen na Odsjeku za intenzivno psihijatrijsko liječenje Klinike za psihijatriju KBC Sestre milosrdnice zbog delirija uzrokovanim gama-hidroksibutiratom. Bolesnik je pri dolasku u hitnu psihijatrijsku ambulantu bio vremenski i prostorno dezorijentiran, labilnog afekta, psihomotorno agitiran, inkoherentnog misaonog tijeka s persekutornim idejama u misaonom sadržaju. Na primjenu antipsihotika nije bilo terapijskog odgovora. Ubrzo je dobiven heteroanamnestički podatak o bolesnikovoj štetnoj uporabi GHB-a, a među njegovim su stvarima pronađeni i lijekovi za HIV infekciju. Somatskom je obradom isključena sistemna infekcija kao mogući uzrok stanja bolesnika. U terapiju su uvedene visoke doze benzodiazepina, uz baklofen. Nakon intenzivnog liječenja, u kojemu je primijenjeno ukupno 730 mg diazepama i 180 mg baklofena kroz deset dana, uz stalno praćenje psihofizičkog stanja bolesnika, došlo je do potpunog povlačenja simptoma kojima se bolesnik očitovao pri prijemu.

Psihodijagnostika je mjerenje i procjena obilježja neke osobe pomoću različitih psiholoških metoda, tehnika i mjernih instrumenata. Značajan dio psihodijagnostike odnosi se na procjenu kognitivnih funkcija. Adekvatna procjena kognitivnih funkcija omogućuje i primjeren terapijski tretman prilagođen potrebama i mogućnostima oboljele osobe. Wechslerov test inteligencije za odrasle, četvrto izdanje (WAIS- IV-HR) daje informacije o općem intelektualnom funkcioniranju i specifičnim kognitivnim sposobnostima odraslih i adolescenata, dok Wechslerov test pamćenja (WMS-IV-HR) mjeri različite sposobnosti pamćenja i radnog pamćenja. Oba testa daju detaljne informacije u kliničkoj procjeni osoba s psihičkim poremećajima. U ovom radu bit će predstavljene razlike i specifičnosti u postignućima na WAIS-IV-HR i WMS-IV-HR kod osoba s različitim psihičkim poremećajima (shizofreniji, depresiji, anksioznosti). Osim njihovog značaja u dijagnostici različitih poremećaja, njihovi rezultati važni su u planiranju i provedbi adekvatnog liječenja u smislu izbora primjerenih metoda liječenja i njihovoj prilagodbi pojedinoj osobi.

Liječenje psihofarmacima učinilo je veliki pomak u liječenju psihičkih poremećaja osobito u području težih duševnih bolesti. Međutim, u značajnom dijelu pacijenata simptomi se ne povlače u potpunosti. Smetnje koje najčešće zaostaju u ovih težih psihičkih poremećaja su smetnje u funkcioniranju koje su najčešće posljedica perzistirajućih kognitivnih i negativnih simptoma. Terapijsku rezistenciju u shizofreniji, podrazumijeva nepostizanje značajnog poboljšanja simptoma na ranije adekvatno primijenjena dva različita antipsihotika odnosno antidepresiva u adekvatnoj dozi i trajanju primjene. A slično je definirana i terapijska rezistencija u drugim poremećajima spektra shizofrenije i bipolarnom afektivnom poremećaju. Međutim, i u pacijenta koji odgovaraju na terapiju često zaostaju rezidualni simptomi. Naime, terapija antipsihoticima učinkovitija je u poboljšavanju pozitivnih nego negativnih i kognitivnih simptoma koji najčešće čine simptome koju pokazuju terapijsku rezistenciju. U ovom izlaganju nudi se pregled literature iz područja rezistencije u liječenju težih duševnih psihičkih poremećaja kao i metoda kojima se i u osoba koje su terapijski rezistentne, odnosno pokazuju rezidue poremećaja i/ili smetnje u funkcioniranju, može postići dodatno poboljšanje. U prikazu je naglasak na psihoterapijskim i socioterapijskim metodama koje zapravo čine koncept terapijske rehabilitacije liječenju ovih poremećaja. Nakon pregleda dostignuća znanosti u ovom području daje se kritički osvrt na suvremene mogućnosti u terapiji s obzirom na vlastita klinička iskustava. Ističe se važnost multidisciplinarnog pristupa te korištenje različitih farmakoterapijskih, psihoterapijskih te socioterapijskih metoda kao i potreba kontinuirane evaluacije stanja pacijenta. Terapijska rezistencija u psihičkim poremećajima izazov je za kliničare i zahtijeva multidisciplinarni pristup u procesu terapijske rehabilitacije.

Dosadašnja istraživanja pokazala su da pacijenti koji boluju od shizofrenije imaju lošiji uspjeh na testovima kognitivnih sposobnosti u odnosu na ostatak populacije. Taj rezultat se pogoršava s obzirom na trajanje bolesti, a neka istraživanja pokazala su da već i prije prve psihoze postoji kognitivna deterioracija. U većini istraživanja korišten je i uzorak osoba sa shizofrenijom koje su imale različito trajanje bolesti. U ovom istraživanju cilj je bio provjeriti razlike između kognitivnih funkcija, mjerenih 5-KOG-om, kliničkog i uparenog kontrolnog uzorka. Klinički uzorak čine osobe s prvom psihozom, s visokom vjerojatnošću da se radi o shizofreniji (N = 30), dok je upareni kontrolni uzorak (N = 30) sastavljen od osoba bez dijagnosticiranih psihičkih smetnji, koje su uparene na temelju dobi, spola i obrazovanja. Test 5-KOG, koji je korišten u ovom istraživanju, trijažni je instrument čija primjena traje otprilike 15 minuta. 5-KOG se sastoji od 5 subtestova koji mjere 5 kognitivnih funkcija. To su: kratkoročno pamćenje, radno pamćenje, brzina obrade informacija, verbalna fluentnost i izvršne funkcije. Rezultati statističke analize pokazali su da klinički uzorak postiže statistički značajno niže rezultate na svim mjerenim domenama. Niže postignuće kod kliničkog uzorka može biti valjan pokazatelj nižeg premorbidnog kognitivnog statusa koji je dobiven u nekim ranijim istraživanjima, ali postoji i alternativno objašnjenje s obzirom na to da se testiranje odvijalo tek nakon pojave prve psihoze.

Kada se govori o kogniciji obično se u nju ubraja cijeli niz moždanih funkcija, uključujući sposobnost učenja i pamćenja, organiziranja, planiranja i rješavanja problema, ispravne percepcije okoline, razumijevanja i korištenja jezika, procesiranja novih informacija te usmjeravanja, zadržavanja i pomicanja pozornosti. Upravo se prema navedenim sposobnostima formiraju neurokognitivne domene koje predstavljaju okosnicu dijagnostike kognitivnih smetnji. Iz aspekta shizofrenije, kognitivni deficiti su prepoznati kao njena temeljna osobitost, no ta činjenica nije novijeg datuma. Noviji fokus istraživanja prema kogniciji je pogonjen identifikacijom kognitivne domene simptoma shizofrenije, relativnom neučinkovitošću trenutno dostupne psihofarmakoterapije u adekvatnom kupiranju kognitivnih smetnji te razvojem novih terapijskih modaliteta kako bi se adresiralo iste. U samoj procjeni kognitivnog oštećenja u kliničkom se radu mogu koristiti brojni testovi i upitnici, no isti većinom traže znatnu razinu poznavanja problematike, što je često praćeno specifičnim edukacijama, ali i nezanemarivim vremenskim angažmanom, uzevši kako provođenje nekih od njih traje i više sati. K tome, ukoliko je potrebno se usmjeriti na neku specifičnu domenu kognitivnog oštećenja, neki od testova neće dati adekvatne rezultate ili ju pak uopće ne moraju pokrivati, posebice jer nisu razvijeni za psihijatrijske poremećaje, do možda demencija. Stoga, opet s kliničkog gledišta, nužna je primjena pouzdanih i vremenski ograničenih alata, poput 5-KOG testa za kogniciju u psihijatriji. Tim više što smo upotrebom spomenutog alata u vlastitim kliničkim istraživanjima jasno mogli obuhvatiti kognitivne funkcije u kontekstu diferentne medicinske obrade koja je uključivala neurogenetska i psihofarmakološka istraživanja te evaluaciju regionalnog moždanog krvotoka.

Mthfr polymorphisms as possible markers of treatment response in first-episode psychosis

Introduction: According to previous literature, language abilities, attention and processing speed are often emphasized as the most impaired among different domains of neurocognitive functioning in schizophrenia. Our aim was to investigate the course of changes in these neurocognitive functions in patients with first-episode psychosis (FEP) during an 18-month follow-up. Methods: This study is a part of the prospective cohort study: “Biomarkers in schizophrenia-integration of complementary methods in longitudinal follow up of FEP”. We recruited 159 FEP at the acute phase of illness during their first hospital treatment at two Croatian psychiatric clinics. Patients were assessed with sociodemographic questionnaire, Positive and Negative Syndrome Scale and neurocognitive tests for language abilities (Phonetic and Semantic Fluency Test), attention and processing speed (Stroop Test, Trial Making Test A, Digit Symbol Test) at two time points: during the first-episode of illness and after 18 months of follow-up. Results: As 30 patients (19%) were lost to follow-up, we analyzed 129 patients. Relative improvement rates in particular tests for attention and processing speed ranged from 11% to 19%, and for language abilities were 7% for Phonetic and 8% for Semantic Fluency test. Results were statistically significant for all tests and subtests besides Phonetic Fluency (p=0.311). Conclusions: Although there was a slight improvement in language abilities after 18-months follow-up, it seems that impairment of these abilities needs more time to recover or that it remains relatively stable trait during the course of illness.

Introduction: Huge efforts have been made to identify a biological correlate of schizophrenia in order to confirm the diagnosis and predict the outcome, but there are still no reliable biological markers. Our aim was to investigate possible clinical, functional and structural biomarkers of schizophrenia which are present during the first episode and monitor their changes during time. Methods: We have conducted a longitudinal study in patients with first episode of psychosis (FEP) and healthy controls (HC). Assessment included clinical interview, sociodemographic questionnaire, psychiatric rating scales and questionnaires and specific additional assessments that were divided into three work packages (WP). The first WP included neurocognitive and facial emotional recognition assessment with adequate tests, the second WP assessment of cerebral blood flow velocity with transcranial Doppler ultrasound, and the third WP assessment of regional cerebral perfusion with single photon emission computed tomography. Patients were assessed at baseline and after 18-month follow-up and HC at one time point. Results: We shall: 1. analyse the differences between FEP and HC, 2. analyse the changes during the course of illness from baseline to the end of study, 3. perform an exploratory analysis combining the results of different tests in order to identify potential disease phenotypes and their impact on treatment outcome. Conclusion: Identifying possible biological markers could help us in better understanding of illness and its course, as well as to tailor its treatment on individual basis.

Povijest razvoja koncepta shvaćanja shizofrenija zapravo je povijest shvaćanja psihotičnih poremećaja uopće. U pisanim tragovima koji datiraju i do dvije tisuće godina prije Krista, opisuju se stanja i ponašanja koja bi se danas vjerojatno dijagnosticirala kao shizofrenija. Thomas Crow kaže da je shizofrenija ono što definira ljudsku vrstu te da postoji otkad postoji ljudska vrsta kao takva. S druge strane, Fuller Torrey tvrdi da je shizofrenija do unazad 200 godina bila izrazito rijetka ili da uopće nije postojala te da se pojavljuje zajedno s industrijskom revolucijom. Današnji konsenzus jest da je shizofrenija stara bolest nepoznatog uzroka te da se s vremenom neke njene značajke mijenjaju. U mnogim udžbenicima povijest shizofrenije počinje s Emilom Kraepelinom koji je sindromu koji mi danas nazivamo shizofrenija dao ime dementia preaecox, ili Eugenom Bleulerom, koji je dementiju preacox preimenovao u shizofreniju. U antičkom periodu također nalazimo terminologiju koja bi mogla opisivati shizofrenog bolesnika. U antičkom Rimu koristio se termin demencija, koji se upotrebljavao za osobe koje su bile do određenog trenutka normalnog, uobičajenog ponašanja da bi kasnije postale drugačije/abnormalne. Krajem 14. i početkom 15. stoljeća opisuje se francuski kralj Karlo VI. Ludi (le Fol ili le Fou). Krajem 18. stoljeća pojavljuju se detaljni opisi tzv. “opsjednutosti” osoba, koje bi danas vjerojatno bile dijagnosticirane kao shizofrenija. Kasnije, sve do 19. stoljeća bolesnicima koje bismo danas dijagnosticirali kao shizofrene, razni su autori pripisivali demencije, paranoju, monomanije, amencije, morije, versaniu tipica itd., ovisno o kliničkoj slici. Početkom 19. stoljeća Phillipe Pinel koristi pojam demencija kao sinonim za ludilo. Belgijski psihijatar Benedict Augustin Morel uvodi 1845. godine termin démence précoce. Karl Ludwig Kahlbaum sličan poremećaj naziva versania tipica od 1874. godine i posebno opisuje simptome katatonije. Koncepciju shizofrenije treba shvatiti kao radnu dijagnozu koja je podložna trenutačnim trendovima i mogućim korekcijama u budućnosti.

Objectives: The mPIVAS study is designed to assess efficacy of Android smart-phone application PsyLOG in monitoring and controlling side-effects of antipsychotics (SEA). Background and aims: Monitoring of SEA is often subjective, depending on ad-hoc reporting from patients (and their care- givers) and frequently leads to prolonged duration of SEA and possible therapy discontinuation. We constructed this randomized control trial aiming to test the use of mobile technology in improvement of monitoring of SEA. Materials and methods: Patients diagnosed with schizophrenia spectrum disorder treated with antipsychotics for up to five years will be recruited from five Croatian psychiatric hospitals and randomized to three groups differentiated by SEA monitoring method: PsyLOG application, GASS questionnaire and standard monitoring. Additional assessment will include questionnaires for therapeutic alliance and quality of life. During the three-month follow-up period, participants will be assessed after one and after three months from baseline. Results: We plan to recruit 65 patients per group (80% power with expected ≤15% of drop out and missing data). We plan to analyze the differences between three groups in the proportion of patients whose antipsychotic treatment was modified in any way due to side effects and the median time for it, changes in therapeutic alliance and patients’ quality of life. Conclusions: Identifying effective measures for monitoring of SEA could contribute to patients’ health, quality of life and adherence by improving their knowledge about pharmacotherapy, recognition of side-effects and involvement in their treatment, as well as to help clinicians in choosing more appropriate medications.

Schizophrenia is one of the most demanding psychiatric disorders due to heterogeneity of clinical presentations and difficulties in posing diagnosis, prediciting prognosis and developing treatment plan treatment. Up to this date, possible biomarkers that could help to objectify the diagnosis and the course of treatment of schizophrenia are still not identified. In this project, we recruited a sample of 150 patients with first-episode of psychosis (of schizophrenia type) (FEP)and 100 healthy controls and assessed changes between the acute psychosis and subsequent remission among patients over an 18-month follow- up. The assessments included several methods performed through four work packages. In this report, we present the results of assessment with psychopathological scales, battery of neurocognitive tests and test for facial emotional recognition, as well as of salivatory cortisol measurement during a stress paradigm and cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT)) and during stress conditions using the transcranial doppler ultrasound. Overall, we found multiple deficits in various functions including neurocognitive deficits, hypoperfusion in several brain areas in SPECT, as well as deficits in functional aspects (sensitivity to stress) that differentiated healthy controls from FEP. Some of these deficits were still present after 18- month follow-up. These results confirm that the deficits seen in schizophrenia are present from the first presentation of illness and some do not respond well to the treatment. This finding supports the concept of early detection and early intervention with multi-layered treatment approaches from the first-episode of psychosis.

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

Introduction: Language disturbances, usually seen as loosening of associations, have featured prominently among „characteristic" signs and symptoms of schizophrenia from the earliest conceptualizations. There is an open question of the nature of language disturbances, as indicators of underlying cognitive disturbances or core symptoms of the disorder. Aims: The aim of the collaboration between University of Zagreb linguists and psychiatrists was to describe lexical-semantic deficits in schizophrenia-spectrum disorders and to determine correlations between executive functions and lexical-semantic deficits. Finally, the aim was to link these changes with specific symptom clusters and evaluate their possible value in indicating/predicting particular illness phases/courses. Participants and methods: First-episode psychosis (FEP) patients and those early in the course of schizophrenia-spectrum psychotic disorder will be recruited and evaluated clinically to determine symptom clusters profile/severity. Earlier collaboration focused on verbal fluency task and categorization, while in the present study participants were tested on both lexical- semantic processing as well as cognitive functioning. Psycholinguistic tests were developed to determine different aspects of lexical-semantic deficits. Results: Comparison of FEP and healthy individuals showed deficits in hypernymy/ hyponymy processing and the processing of semantic-pragmatic structures, in both production and reception. Results also confirm previous research with regards to significant differences in clustering mechanisms in verbal fluency tasks and relativity of lexical-semantic category boundaries. Additionally, we found that neural noise during lexical recall in FEP depends on the given lexical-semantic category. Data collection is ongoing in the current project on psycholinguistic parameters in lexical-semantic deficits. Conclusion: There are clear changes in lexical-semantic processing in FEP patients. Clinical linguistics creates an arena for multidisciplinary efforts of linguists and psychiatrists (but related fields as well) in an attempt to elucidate processes underlying schizophrenia-spectrum disorders and potentially come up with new diagnostic/prognostic instruments.

Background: An emergency in psychiatric setting is any disorder in thought process, feelings and/or behavior of the patient that requires urgent therapeutic intervention. In general, we can observe an increase in numbers of psychiatric emergencies throughout the world and in Croatia as well. Agitation and aggression are one of the most common causes of emergency in psychiatry. Agitation is common and frequent in patients suffering from schizophrenia. Patient can be agitated in various levels such as: mild, moderate or severe and can alternate between these levels in the same presentation. Agitated patients often require hospitalization that includes pharmacotherapy and sometimes physical restraining, in order to treat the cause of agitation and prevent auto and/or heterodestructive behavior. Subjects and methods: In this paper we focus on patients suffering from schizophrenia that were admitted in University Hospital "Vrapþe" in 2017, and assess the numbers through the criteria of voluntary vs. involuntary admissions and physical restraint usage. Results: Out of total observations, 130 (35.6%) were patients admitted for the first time and 179 (49%) were patients later diagnosed with schizophrenia spectrum and other psychotic disorders. Court ordered involuntary hospitalization was ordered for 35 (2.8%) patients out of total admitted patients, and 68.6% (N24) of them were diagnosed with schizophrenia spectrum and other psychotic disorders. Physical restraint was used for 122 patients out of total admissions and 28.7% (N35) of restrained patients were diagnosed with schizophrenia spectrum and other psychotic disorders. Conclusions: Emergencies in patient suffering from schizophrenia are extremely delicate and demanding situations in every-day clinical practice of psychiatrist. There is an increased risk involved for the patient but for the staff as well. All interventions should be individualized and patients should carefully monitored throughout the entire process. All professionals involved in care for a patient should be up to date with medical and legal issues.

Background: An emergency in psychiatric setting is any disorder in thought process, feelings and/or behavior of the patient that requires urgent therapeutic intervention. In general, we can observe an increase in numbers of psychiatric emergencies throughout the world and in Croatia as well. Agitation and aggression are one of the most common causes of emergency in psychiatry. Agitation is common and frequent in patients suffering from schizophrenia. Patient can be agitated in various levels such as: mild, moderate or evere and can alternate between these levels in the same presentation. Agitated patients often require hospitalization that includes pharmacotherapy and sometimes physical restraining, in order to treat the cause of agitation and prevent auto and/or heterodestructive behavior. Subjects and methods: In this paper we focus on patients suffering from schizophrenia that were admitted in University Hospital "Vrapče" in 2017, and assess the numbers through the criteria of voluntary vs. involuntary admissions and physical restraint usage. Results: Out of total observations, 130 (35.6%) were patients admitted for the first time and 179 (49%) were patients later diagnosed with schizophrenia spectrum and other psychotic disorders. Court ordered involuntary hospitalization was ordered for 35 (2.8%) patients out of total admitted patients, and 68.6% (N24) of them were diagnosed with schizophrenia spectrum and other psychotic disorders. Physical restraint was used for 122 patients out of total admissions and 28.7% (N35) of restrained patients were diagnosed with schizophrenia spectrum and other psychotic disorders. Conclusions: Emergencies in patient suffering from schizophrenia are extremely delicate and demanding situations in every-day clinical practice of psychiatrist. There is an increased risk involved for the patient but for the staff as well. All interventions should be individualized and patient should carefully monitored throughout the entire process. All professionals involved in care for a patient should be up to date with medical and legal issues.

Predstavljanje projekta Klinička lingvistika: psiholingvistički parametri u leksičko- semantičkoj obradi i izvršnim funkcijama kod osoba oboljelih od shizofrenije

Introduction: According to previous literature, neurocognitive deficits in schizophrenia are present since the begining of the illness. While some report relative stability of impairment, others mention domain specific differences (e.g. verbal fluency) that vary during time. Objectives: To analyze the neurocognitive profile and its differences between patients with first episode psychosis and schizophrenia. Methods: We conducted a cross- sectional study including patients with first episode psychosis (N= 100) and schizophrenia (N= 100) recruited from three croatian hospitals during acute phase of their illness. Assessment included battery of various neurocognitive tests representing five domains of neurocognition. Results: Our results showed that three structurally equivalent neurocognitive profiles fitted the data the best for both patient groups. Profiles differed in the successfulness in domain specific tests, with Profile 1 being „The best“ and Profile 3 „The worst“. Differences between patient groups were more of a quantitative than of qualitative nature, with “The best” profile being more prevalent in the first episode patients’ group (40.2%), who also had better performace in all neurocognitive tasks. Conclusions: When presented in profile model, it seems that neurocognitive impairment in schizophrenia is a specific trait of illness that does not change in its nature, but it deteriorates lineraly whith the progression of illness.

Pravodobno otkrivanje i liječenje oboljelih od prvih psihotičnih poremećaja jedan je od najvećih izazova suvremene psihijatrije. Suvremeni pristupi liječenju psihotičnih poremećaja naglasak stavljaju na funkcionalni ishod bolesti. Osnova i temelj liječenja shizofrenije i drugih psihotičnih poremećaja iz spektra shizofrenije jest primjena antipsihotika. Antipsihotici se rabe i u liječenju svih ostalih psihotičnih poremećaja. Ovisno o indikaciji, može se razlikovati preporučena duljina primjene antipsihotika. Zbog specifičnosti farmakoterapije u prvoj psihotičnoj epizodi potrebni su uvođenje antipsihotika druge ili treće generacije kao prve linije terapije, započinjanje niskom dozom te pažljivo i polako titriranje radi postizanja minimalne učinkovite doze lijeka. Psihosocijalne intervencije (u biopsihosocijalnom kontekstu) sastavni su dio liječenja prve psihotične epizode i tijekom akutnog liječenja i u fazi postizanja i održavanja remisije.

Kao kronična psihička bolest, depresija je oduvijek predstavljala terapijski izazov za svakog psihijatra. Često se uz depresivni poremećaj javljaju različiti somatski komorbiditeti koji dodatno kompliciraju odabir adekvatne psihofarmakoterapije. Prikazati ćemo pacijenticu koja je po drugi put hospitalizirana u Klinici za psihijatriju Vrapče pod kliničkom slikom povratnog depresivnog poremećaja, uz komorbiditet arterijske hipertenzije i glaukoma lijevog oka. Glaukom, ili kako ga još nazivaju „tihim ubojicom vida“, progresivna je i često asimptomatska bolest oka koja dovodi do propadanja vidnog živca te znatnog ili trajnog gubitka vida. Kod naše bolesnice nakon nekoliko tjedana primjene venlafaksina dolazi do pogoršanja od ranije dijagnosticiranog i liječenog glaukoma lijevog oka te je pacijentica hitno pregledana i zbrinuta u nadležnoj oftalmološkoj ambulanti. Po povratku na odjel, postepeno se ukida venlafaksin i uvodi agomelatin. Kod pacijentice ubrzo dolazi do poboljšanja psihičkog stanja, uz normalizaciju očnog tlaka. Iako upotreba antidepresiva iz SNRI skupine nije apsolutno kontraindicirana kod glaukoma, navedeno je da je potrebna veća pažnja kod njihovog uvođenja jer pogoršanja glaukoma spada u moguće nuspojave ovih lijekova, što se kod naše pacijentice i dogodilo. Pretraživanjem dostupne literature, odlučili smo umjesto venlafaksina uvesti upravo aglomelatin jer smo došli do saznanja da osim antidepresivnog učinka, u dozi od 25 mg ima i pozitivan utjecaj na smanjenje očnog tlaka. U nekim istraživanjima je zabilježeno smanjenje očnog tlaka do 30% , uz podatak da je učinkovit kao terapija i kod pacijenata kod kojih klasična medikacija više nije djelotvorna.

Background: Depressive symptoms seem to be frequent in schizophrenia, but so far have received less attention than other symptom domains. Impaired serotonergic neurotransmission has been implicated in the pathogenesis of depression and schizophrenia. The objectives of this study were to investigate platelet serotonin concentrations in schizophrenic patients with and without depressive symptoms, as well as to investigate the association of platelet serotonin concentrations with symptoms of schizophrenia, mostly depressive symptoms. Methods: A total of 364 patients were included in the study. Significant depressive symptoms were defined by the cut-off score of 7 or more on Calgary Depression Rating Scale (CDSS). Platelet serotonin concentrations were assessed by the enzyme-linked immunosorbent assay (ELISA). Results: Prevalence of depression in patients with schizophrenia was 65.1%. Schizophrenic patients with depressive symptoms showed lower platelet serotonin concentrations compared to schizophrenic patients without depressive symptoms. An inverse correlation was found between platelet serotonin and depressive symptoms, with those symptoms being associated with lower platelet serotonin concentrations in patients with depressive symptoms compared to patients without depressive symptoms. Discussion: Depressive symptoms in schizophrenic patients may be associated with reduced concentrations of platelet serotonin.

Poster prezentira liječenje u Dnevnoj bolnici Klinike za psihijatriju Vrapče i rad s pacijentima s prvom psihotičnom epizodom nakon završetka hospitalizacije.

Objective: Brain tumors are often associated with neurological as well as with psychiatric symptoms. Cotard's syndrome is a rare condition characterized with monothematic nihilistic delusions concerning one's own body. It is not listed as a specific disorder in the DSM-IV or in ICD-X, as it is typically viewed as a part of other underlying disorders. Delusions are most commonly related to a loss of specific body part or a body as a whole. Syndrome was described for the first time by Jules Cotard in 1880.g as a new form of agitated melancholy. Although most commonly described as a part of schizophrenia, bipolar disorder or psychotic depression it is also associated with numerous neurological conditions such as encephalitis, Parkinson's disease, migraine, brain tumors, a-v malformations or traumas. Methods:In this poster we describe 37 years old patient diagnosed with glioblastoma which developed Cotard's syndrome in postoperative care. Patient was operated twice, and treated in post-op care with chemo and radiotherapy. Results:Our patient manifested Cotard's syndrome as negative delusions, stating total absence of his heart and right arm. According to our data search we found Cotard's syndrome rarely associated to glioblastoma. His pharmacotherapy included fluvoxamine, promazine, diazepam, phenobarbital and dexamethasone. His discharge diagnoses (ICD-XI) were: F06.7 ; F91 because of C71.2 and 3 ; Brain tumor of right parietooccipital region (PHD glioblastoma multiforme) ; St. post op and reop ; St post radiotherapy ; St post chemotherapy, Sensomotoric dysphasia ; Right sided hemiparesis. Conclusion: It remains important to recognize the syndrome because specific underlying mechanisms are present, and prognostic and therapeutic consequences have to be taken into account.

Objective: Postpartum psychosis [PPP] is rare disorder with an estimated prevalence in the general population of 1-2 per 1, 000 childbirths. PPP is a psychiatric emergency that requires inpatient psychiatric treatment because it can have negative consequences for the mother, infant, and entire family. Methods: We present five patients diagnosed with first onset PPP treated with olanzapine during the last year (2013th) in our Intensive care unit. All of our patients experienced clear phenomenological predominance of psychotic symptoms with no evidence of neither manic nor depressive symptoms. Results: Median age of our patients was 31 years(range 27-40 ; interquartile range [IQR] 10), all of them were primiparous, and experienced some of the obstetrical complications during delivery. None of our patient had previous history of psychiatric illnesses, and only one had positive family history. The median onset of psychotic symptoms that led to hospitalization occurred at 12 days postpartum (range 8-25 ; IQR 10, 5). Median duration of hospitalization was 11 days (range 6-38, IQR 20.5). One patient was discharged prior to achieving full remission because of the infectious complications, although she showed clear response to treatment prior to demission. We treated all patients with olanzapine, and we used bromocriptine for every patient to achieve ablactation. Supplementary therapy was used according to symptomatology and the progress of treatment, namely low doses of typical antipsychotics (n = 3), and benzodiazepines (n = 4). Two of our patients had a typical antipsychotic still included in discharge therapy, and three of them had benzodiazepines. Conclusion: According to out database search there are no clear guidelines regarding the treatment of first onset PPP in the patients with no prior history of psychiatric illnesses. According to our data, olanzapine proved itself as a valuable first line treatment. At this point there is a definite need for further investigations of preferably prospective design for the full understanding and possibly developing clear guidelines for PPP.

Uvod: Depresivni poremećaj i metabolički sindrom veliki su i rastući javnozdravstveni problemi. Sve je više istraživanja koja nastoje pronaći povezanost između ova dva sindroma. Njihova povezanost je složena te uključuje brojne patofiziološke mehanizme. Depresivni poremećaj se povezuje s pretilosti, upalom i inzulinskom rezistencijom koji su svi zajedno etiološki mehanizmi za razvoj metaboličkog sindroma. Nadalje, depresivni poremećaj ima i neuroendokrinološku komponentu koja utječe na metabolički sindrom. S druge strane, metabolički sindrom karakteriziraju povišeni upalni citokini koji mogu uzrokovati depresivno raspoloženje. Cilj ove disertacije bio je istražiti međusobnu povezanost metaboličkog sindroma i njegovih sastavnica, koncentracije trombocitnog serotonina, upalnih čimbenika i kortizola u bolesnika s depresivnim poremećajem u usporedbi s fenotipski zdravom kontrolnom skupinom. Također cilj je istražiti povezanost navedenih parametara s kliničkim obilježjima depresivnog poremećaja. Nakraju cilj je biološka tipizacija depresivnog poremećaja na temelju ispitivanih kliničkih, laboratorijskih i antropometrijskih varijabli. ----- Metode: Provedena je presječna studija na uzorku od 293 ispitanika od kojih je 145 bilo s depresivnim poremećajem i 148 zdravih ispitanika. Za dijagnozu depresije koristio se MINI upitnik i Hamiltonova ocjenska skala za depresiju. Metabolički sindrom dijagnosticiran je prema ATP III kriterijima. Svim ispitanicima se mjerio tlak krvi i opseg struka te su se određivale koncentracije glukoze, kolesterola, HDL-kolesterola, triglicerida, kortizola, IL-6, CRP-a i trombocitnog serotonina. Rezultati su obrađeni multivarijantnim statističkim metodama te klaster i diskriminacijskom analizom. ----- Rezultati: Pojavnost MS u depresivnih bolesnika bila je 41,4%. Nađene su statistički značajne razlike u tlakovima, opsegu struka, CRP-u, trigliceridima, glukozi, kortizolu i trombocitnom serotoninu između ispitanika s depresijom bez obzira imaju li metabolički sindrom ili ne u odnosu na kontrolnu skupinu. Da bismo učinili tipizaciju depresivnog poremećaja na temelju laboratorijskih, antropometrijskih i kliničkih karakteristika učinili smo klaster analizu kojom smo klasificirali bolesnika s depresivnim poremećajem u grupe koje su relativno homogene između sebe te heterogene jedna od druge. Tako smo dobili podtip bolesnika s depresivnim poremećajem definiran niskom koncentracijom trombocitnog serotonina, visokom koncentracijom kortizola, visokom koncentracijom glukoze, visokim trigliceridima, visokom koncentracijom CRPa, visokim HAMD skorom, visokim vrijednostima opsega struka i većim brojem dosadašnjih epizoda depresivnog poremećaja, te taj klaster možemo nazvati kombiniranim (metaboličkim) depresivnim poremećajem. Upalni podtip obilježen je koncentracijom trombocitnog serotonina koja je u granicama referentnih vrijednosti, normalnim koncentracijama kortizola i svim ostalim ispitivanim varijablama, osim povišenih vrijednosti IL-6, te ga možemo nazvati upalnim depresivnim poremećajem. Serotoninski podtip depresivnog poremećaja je karakteriziran izrazito niskom koncentracijom trombocitnog serotonina, a sve ostale ispitivane varijable su u referentnim vrijednostima. Dakle, temeljem našeg istraživanja (korištenjem lako dostupnih laboratorijskih, antropometrijskih, kliničkih vrijednosti i karakteristika depresivnog poremećaja), depresivni je poremećaj moguće podijeliti na tri biološka podtipa: • Kombinirani (metabolički) depresivni poremećaj • Upalni depresivni poremećaj i • Serotoninski depresivni poremećaj. ----- Zaključak: Biološki gledano, depresivni poremećaj nije jednoznačan, tj. postoje različiti biološki entiteti koji mogu rezultirati kliničkim slikama koje danas fenomenološki klasificiramo kao depresivni poremećaj. Vrlo je vjerojatno i kaskadno, vremensko preklapanje ovako definiranih podtipova depresivnog poremećaja, te postoji mogućnost „kompliciranja“ npr.upalnog depresivnog poremećaja u kombinirani, isto kao i serotoninskog u kombinirani (metabolički) tip depresivnog poremećaja. Tako mogući patofiziološki mehanizmi koji objašnjavaju prisustvo metaboličkog sindroma u depresivnom poremećaju (serotoninsko-upalni kontinuum depresivnog poremećaja), zapravo predstavljaju krug u kojem su isprepleteni te se uzajamno induciraju serotonin, kortizol i upalni citokini.

Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia