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Background: Anxiolytics such as benzodiazepines are widely used in the treatment of anxiety disorders, although they are no longer recommended as first-line therapy for these conditions due to increased risk of dependence, as well as cognitive adverse effects, especially among the elderly. High prescribing rates of anxiolytics may be indicative of higher prevalence of anxiety-related phenomena in a given society, either in a form of an anxiety disorder or as pressure on physicians to keep prescribing them, against current guidelines. Subjects and methods: We inspected prescribing rates of anxiolytics in 21 European countries and compared them with six dimensions of Hofstede's cross-cultural framework, namely uncertainty avoidance (UAI), power distance (PD), individualism (IDV), masculinity (MAS), long-term orientation (LTO) and indulgence (IND). Results: According to our findings, anxiolytic prescribing patterns in selected European countries correlate positively with Hofstede's dimensions of UAI and PD and negatively with IDV. Conclusion: Differences in prescribing rates of anxiolytics and trends in their use may be affected by cross-cultural factors. More research is needed to shed light on these regional differences in anxiolytic prescribing.

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.

Ketamine, synthesized in 1962, approved in 1970, is considered safe for use in controlled conditions, mainly as an anesthetic, especially in pediatric populations and in people suffering from pulmonary diseases, as well as in emergency departments and in war situations. Dissociative states (derealization and depersonalization) produced by ketamine made it a popular recreational drug, which led to increased regulation in most countries. Intravenous application of ketamine has shown rapid, although transitory antidepressant and antisuicidal effects in patients with unipolar and bipolar depression. Esketamine, the S(+) enantiomer of ketamine, with better pharmacodynamic selectivity, has just been approved for treatment-resistant major depressive disorder, in the form of a nasal spray. Presently, the high cost of the spray not only limits its widespread use, but also makes it less prone to abuse and diversion. Additional measures are needed to hinder it from becoming a new "street drug".