Percepcija različitih psihičkih bolesti kod oboljelih i članova njihovih obitelji

Najpoznatija teorija koja nastoji objasniti bolesnikov doživljaj bolesti je Leventhalov model samoregulacije, vodeći se tom teorijskom podlogom, ovo istraživanje nastoji ispitati kako određene psihičke bolesti percipiraju sami oboljeli i članovi njihovih obitelji te u kojoj mjeri je ta njihova percepcija povezana s prilagodbom određenoj bolesti. U ispitivanju je sudjelovalo ukupno 160 sudionika oboljelih od depresije, shizofrenije i PTSP-a te 80 članova njihovih obitelji. Primjenom Upitnika doživljaja bolesti (IPQ-R) ispitala se kvantitativna procjena doživljaja bolesti uzimajući u obzir komponente Leventhalovog modela samoregulacije. Kako bi se dobio detaljniji uvid u doživljaj bolesti oboljelih, provedene su po dvije fokusne grupe s oboljelima od depresije, shizofrenije i PTSP-a. Obrada rezultata ukazala je kako sve tri skupine oboljelih od psihičkih bolesti opisuju bolest kao kroničnu s naglaskom na farmakoterapiju. Izraženija depresivna slika pokazala se vezana za percepciju manjeg broja simptoma, slabije mogućnosti kontrole putem tretmana te percepcije bolesti kao dugotrajnije. Oboljeli od depresije percipiraju mogućnost osobne kontrole i kontrole putem tretmana u manjoj mjeri nego oboljeli od shizofrenije, no u nešto većoj mjeri nego oboljeli od PTSP-a. Dobiveno ukazuje da oboljeli od shizofrenije naglašavaju značajno veći broj simptoma, te percipiraju u značajnoj mjeri mogućnost kontrole putem tretmana i mogućnost osobne kontrole nad bolesti. Oboljeli od PTSP-a u odnosu na druge oboljele, u značajnoj mjeri percipiraju posljedice bolesti te pokazuju značajno niži rezultat kada je u pitanju mogućnost kontrole bolesti (i tretmanom i osobno). Općenito se kod oboljelih pokazalo da, što je veća percepcija kontrole putem tretmana, to je i bolje razumijevanje bolesti te bolja emocionalna prilagođenost bolesti, dok, što je veća percepcija posljedica, to je lošija emocionalna prilagođenost. Članovi obitelji percipiraju značajno veći broj posljedica u odnosu na oboljele te su se pokazali u manjoj mjeri emocionalno pogođeni bolešću. Kao prediktor emocionalne prilagođenosti kod članova obitelji, značajnim se pokazalo trajanje bolesti (percepcija bolesti kao kronične rezultira lošijom emocionalnom prilagodbom). Uz to se pokazalo da članovi obitelji oboljelih od PTSP-a imaju veću percepciju osobne kontrole i kontrole putem tretmana te slabije razumijevanje bolesti, a članovi obitelji oboljelih od shizofrenije puno bolje razumijevanje bolesti. Rezultati ovog istraživanja ukazuju na različitost percepcije bolesti među oboljelima, ali i članovima njihovih obitelji. Navedene razlike mogu u značajnoj mjeri pomoći pri planiranju budućih psihoedukacija te grupa podrške i za oboljele i za članove njihovih obitelji.The most famous theory which explains the patient's illness is Leventhal's model of self-regulation. Using this model, aim of this study is to examine how certain mental illnesses are perceived by the patients and members of their families and to what extent their perception is related to adaptation to a particular disease. A total of 160 patients with a diagnosis of depression, schizophrenia and PTSD and 80 members of their families participated in this study. Using the Illness Perception Questionnaire-Revised (IPQ-R) a quantitative assessment of the disease experience was considered; taking into account the Leventhal model of self-regulation. In order to obtain a more detailed insight into the illness experience, two focus groups with each group of patients (depresion, schizophrenia, PTSP) were included. The results indicated that all three groups of patients described their disease as chronic with an emphasis on pharmacotherapy. A larger number of depressive symptoms was associated with perception of smaller number of symptoms, less controllability by treatment and chronic timeline of depression. Patients with depression perceived depression as more controllable by treatment and in person then patients with PTSD, but less then patients with schizophrenia. In this study, sch patients emphasize significantly more symptoms and perceive higher possibility of control through treatment and the possibility of personal control of the disease. Patients with PTSD compared to other two groups are prone to perceive significantly more consequences of the disease and show the lowest outcome when it comes to the possibility of controlling the disease (both in treatment and in person). Our study has shown, in case of patients, that greater perception of treatment control leads to better understanding of the disease and better emotional adaptation to the disease. Also, greater perception of consequences leads to poor emotional adaptation. Family members recognized significantly more consequences of the disease in relation to the patients and were less emotionally affected by the disease. In family members as a predictor of a emotional adaptation to the disease significant factor was duration of the disease (poorer emotional adaptation is associated with perception of the disease as chronic). Also, higher perception of personal and treatment control was detected in family members of PTSD patients, while family members of sch patients had shown better understanding of the disease. The results of this study point to the difference in perception of illness among the patients and their family members. These differences can significantly contribute to further planning of psychoeducation, support groups for patients and their family members

NEGLECTED RUPTURE OF PERONEAL TENDON THAT PRESENTED AS TUMOR FORMATION

Uvod: Svrha ovog rada je prikazati slučaj bolesnika kojemu je kirurško liječenje bilo indicirano s ciljem odstranjenja tumorske tvorbe smještene ispred fi bularnog maleola, a za koju se s obzirom na lokalizaciju i izgled na magnetnoj rezonanciji (MR) smatralo da je gigantocelularni tumor (GCT) ovojnice peronealne tetive. Prikaz bolesnika: Bolesnik u dobi od 57 godina došao je na pregled zbog pojave jasno ograničene tvorbe smještene ispred fi bularnog maleola desnog stopala. Dvije godine ranije je tijekom rekreacijskog igranja košarke zadobio udarac u području lateralnog dijela stopala. Nakon toga je primijetio oteklinu tog područja koja je vremenom otvrdnula, ali je uvijek bila bezbolna i dobro ograničena. Na pregled je bolesnik došao s već učinjenim MR-om desnog stopala na osnovi kojeg se postavila sumnja na GCT ovojnice peronealnih tetiva pa je indicirano kirurško odstranjenje tvorbe. Tijekom operacije uočena je longitudinalna ruptura tetive peroneus brevisa (PB) zbog koje je ona bila podijeljena na dva dijela i to na način da je veći dio nalikovao tumorskom tkivu. Učinjena je resekcija tetive PB-a s tvorbom nakon čega su preostali dijelovi tetive tenodezirani za tetivu peroneus longusa (PL). Resecirani dio tetive zajedno s tvorbom poslan je na patohistološku analizu prema kojoj u preparatu nema tumorskog tkiva već je riječ o pseudocističnoj degeneraciji tetive. Bolesnik se u potpunosti oporavio te je na zadnjem kontrolnom pregledu, 36 mjeseci nakon operacije bio bez tegoba s operiranim gležnjem. Rasprava: Ako nakon čišćenja mjesta rupture peronealne tetive preostali dio tetive ima više od 50 % poprečnog presjeka peronealne tetive, može se ili tako ostaviti ili se tetiva može tubularizirati. Ako nakon čišćenja mjesta rupture peronealne tetive preostane manje od 50 % poprečnog presjeka peronealne tetive, potrebno je odstraniti i taj dio tetive u potpunosti. Potom se u slučaju rupture PB-a preostali dijelovi tetive PB-a prišiju za tetivu PL-a i to proksimalni dio tetive bar 3 do 4 cm iznad vrška lateralnog maleola, a distalni dio bar 5 do 6 cm distalnije od vrška fi bule. Zaključak: Ovaj prikaz bolesnika ukazuje da se ruptura degenerativno promijenjene peronealne tetive može prikazati kao bezbolna tvorba koja može nalikovati nekom tumorskom procesu. Zbog toga se ispravna dijagnoza ponekad može postaviti tek tijekom zahvata i potom potvrditi patohistološkom analizom. Osim toga, želimo istaknuti da prikaz slučaja našeg bolesnika potvrđuje navode iz literature da se nakon resekcije jedne peronealne tetive može uspješno učiniti tenodeza za drugu, zdravu tetivu, jer se time postiže dobar poslijeoperacijski rezultat.Introduction: The goal of this article is to present a case in which surgical treatment was indicated to remove a soft tissue mass adjacent to the fi bular malleolus. The mass was supposed to be a giant cell tumor (GCT) of the peroneal tendon sheath, based on the magnetic resonance imaging (MRI) fi ndings and its localization. Case report: A 57-year-old male came to our outpatient clinic complaining of a soft tissue mass adjacent to the fi bular malleolus of the right foot. He fi rst noticed the mass 2 years before, after sustaining a blunt injury of the lateral part of the right foot while playing basketball. Initially, the patient noticed a swelling in this area, which later hardened but was always painless and with well-defi ned borders. At the time of the examination, the patient had already undergone MRI of the right foot and ankle, which was suspicious of GCT of the peroneal tendon sheath. Surgery was indicated to remove the supposed tumor. At surgery, a longitudinal rupture of the peroneus brevis (PB) tendon was found, splitting the tendon in two parts, with the larger part being formed in a way that it mimicked a tumorous mass. Excision of the ruptured part of the PB tendon was done, followed by tenodesis to the peroneus longus tendon. Histopathologic diagnosis of the excised ruptured tendon showed pseudocystic degeneration of the tendon and no signs of tumorous tissue. The patient recovered fully and was symptom-free at the fi nal follow-up, 36 months after the surgery. Discussion: When rupture of peroneal tendon occurs, debridement of the ruptured part is always suggested. If, following debridement, the remaining part of the tendon is larger than 50% of the initial diameter, the surgeon can decide either to leave the tendon as it is, or to perform tendon tubularization. If, following debridement, the remaining part of the tendon is smaller than 50% of the initial diameter, resection of the remaining tendon is suggested. Afterwards, in cases of PB tendon rupture, the remaining parts of the PB tendon are sutured to the peroneus longus tendon. The proximal part of the PB tendon is sutured 3 to 4 cm proximal to the tip of the fi bula, while the distal part of the PB tendon is sutured 5 to 6 cm distal to the tip of the fi bula. Conclusion: This report shows that the rupture of peroneal tendon with degeneration may present as a painless mass mimicking a tumorous tissue on MRI images and during clinical examination. Thus, the defi nitive and correct diagnosis can sometimes be made only during surgery and confi rmed later by histopathologic analysis. Furthermore, treatment of our patient confi rmed the results from the literature, which suggest tenodesis of peroneal tendons as a viable treatment option in cases where a single tendon is completely ruptured or otherwise unusable

EARLY INTERVENTION PROGRAMME FOR PATIENTS WITH PSYCHOTIC DISORDERS IN “SVETI IVAN”. PSYCHIATRIC HOSPITAL (RIPEPP) - SOCIODEMOGRAPHIC AND BASELINE CHARACTERISTICS OF THE PARTICIPANTS

Background: Psychiatric hospital "Sveti Ivan" in Zagreb, Croatia, offers an outpatient Early intervention programme for patients with psychotic disorders (RIPEPP), consisting of psychoeducational workshops and group psychodynamic psychotherapy. The aim of this study was to describe sociodemographic and baseline characteristics of the participants, in order to provide better understanding of this population, and to assist with the development of more effective therapeutic approaches. Subjects and methods: Since 2008, a total of 245 patients with first episodes of psychosis and their family members participated in the programme. They filled out several questionnaires within the framework of the programme evaluation, but for the purposes of this study, only data collected on sociodemographic questionnaire and the Health of the Nation Outcome Scales (HoNOS) are presented. Results: Majority of the participants were male (66%), at the average age of 28 (SD=6.6), living with their parents (73.5%). Most of them finished secondary school (45.7%) but almost a quarter of the sample (23.7%) is currently studying at university. The average duration of untreated period was 101.60 days, with a median of 30 days. According to results of HONOS questionnaire, upon entry into the programme, the patients most often listed cognitive functioning (attention, concentration, memory) and professional issues (performance of work tasks and activities tied to work) as the most problematic areas. Conclusion: The findings of this study provide more detailed description of the beneficiaries of the RIPEPP programme, which can contribute to forming future programmes for the prevention of psychotic disorders

NEGLECTED RUPTURE OF PERONEAL TENDON THAT PRESENTED AS TUMOR FORMATION

Uvod: Svrha ovog rada je prikazati slučaj bolesnika kojemu je kirurško liječenje bilo indicirano s ciljem odstranjenja tumorske tvorbe smještene ispred fi bularnog maleola, a za koju se s obzirom na lokalizaciju i izgled na magnetnoj rezonanciji (MR) smatralo da je gigantocelularni tumor (GCT) ovojnice peronealne tetive. Prikaz bolesnika: Bolesnik u dobi od 57 godina došao je na pregled zbog pojave jasno ograničene tvorbe smještene ispred fi bularnog maleola desnog stopala. Dvije godine ranije je tijekom rekreacijskog igranja košarke zadobio udarac u području lateralnog dijela stopala. Nakon toga je primijetio oteklinu tog područja koja je vremenom otvrdnula, ali je uvijek bila bezbolna i dobro ograničena. Na pregled je bolesnik došao s već učinjenim MR-om desnog stopala na osnovi kojeg se postavila sumnja na GCT ovojnice peronealnih tetiva pa je indicirano kirurško odstranjenje tvorbe. Tijekom operacije uočena je longitudinalna ruptura tetive peroneus brevisa (PB) zbog koje je ona bila podijeljena na dva dijela i to na način da je veći dio nalikovao tumorskom tkivu. Učinjena je resekcija tetive PB-a s tvorbom nakon čega su preostali dijelovi tetive tenodezirani za tetivu peroneus longusa (PL). Resecirani dio tetive zajedno s tvorbom poslan je na patohistološku analizu prema kojoj u preparatu nema tumorskog tkiva već je riječ o pseudocističnoj degeneraciji tetive. Bolesnik se u potpunosti oporavio te je na zadnjem kontrolnom pregledu, 36 mjeseci nakon operacije bio bez tegoba s operiranim gležnjem. Rasprava: Ako nakon čišćenja mjesta rupture peronealne tetive preostali dio tetive ima više od 50 % poprečnog presjeka peronealne tetive, može se ili tako ostaviti ili se tetiva može tubularizirati. Ako nakon čišćenja mjesta rupture peronealne tetive preostane manje od 50 % poprečnog presjeka peronealne tetive, potrebno je odstraniti i taj dio tetive u potpunosti. Potom se u slučaju rupture PB-a preostali dijelovi tetive PB-a prišiju za tetivu PL-a i to proksimalni dio tetive bar 3 do 4 cm iznad vrška lateralnog maleola, a distalni dio bar 5 do 6 cm distalnije od vrška fi bule. Zaključak: Ovaj prikaz bolesnika ukazuje da se ruptura degenerativno promijenjene peronealne tetive može prikazati kao bezbolna tvorba koja može nalikovati nekom tumorskom procesu. Zbog toga se ispravna dijagnoza ponekad može postaviti tek tijekom zahvata i potom potvrditi patohistološkom analizom. Osim toga, želimo istaknuti da prikaz slučaja našeg bolesnika potvrđuje navode iz literature da se nakon resekcije jedne peronealne tetive može uspješno učiniti tenodeza za drugu, zdravu tetivu, jer se time postiže dobar poslijeoperacijski rezultat.Introduction: The goal of this article is to present a case in which surgical treatment was indicated to remove a soft tissue mass adjacent to the fi bular malleolus. The mass was supposed to be a giant cell tumor (GCT) of the peroneal tendon sheath, based on the magnetic resonance imaging (MRI) fi ndings and its localization. Case report: A 57-year-old male came to our outpatient clinic complaining of a soft tissue mass adjacent to the fi bular malleolus of the right foot. He fi rst noticed the mass 2 years before, after sustaining a blunt injury of the lateral part of the right foot while playing basketball. Initially, the patient noticed a swelling in this area, which later hardened but was always painless and with well-defi ned borders. At the time of the examination, the patient had already undergone MRI of the right foot and ankle, which was suspicious of GCT of the peroneal tendon sheath. Surgery was indicated to remove the supposed tumor. At surgery, a longitudinal rupture of the peroneus brevis (PB) tendon was found, splitting the tendon in two parts, with the larger part being formed in a way that it mimicked a tumorous mass. Excision of the ruptured part of the PB tendon was done, followed by tenodesis to the peroneus longus tendon. Histopathologic diagnosis of the excised ruptured tendon showed pseudocystic degeneration of the tendon and no signs of tumorous tissue. The patient recovered fully and was symptom-free at the fi nal follow-up, 36 months after the surgery. Discussion: When rupture of peroneal tendon occurs, debridement of the ruptured part is always suggested. If, following debridement, the remaining part of the tendon is larger than 50% of the initial diameter, the surgeon can decide either to leave the tendon as it is, or to perform tendon tubularization. If, following debridement, the remaining part of the tendon is smaller than 50% of the initial diameter, resection of the remaining tendon is suggested. Afterwards, in cases of PB tendon rupture, the remaining parts of the PB tendon are sutured to the peroneus longus tendon. The proximal part of the PB tendon is sutured 3 to 4 cm proximal to the tip of the fi bula, while the distal part of the PB tendon is sutured 5 to 6 cm distal to the tip of the fi bula. Conclusion: This report shows that the rupture of peroneal tendon with degeneration may present as a painless mass mimicking a tumorous tissue on MRI images and during clinical examination. Thus, the defi nitive and correct diagnosis can sometimes be made only during surgery and confi rmed later by histopathologic analysis. Furthermore, treatment of our patient confi rmed the results from the literature, which suggest tenodesis of peroneal tendons as a viable treatment option in cases where a single tendon is completely ruptured or otherwise unusable