A validation study of appropriate phonological verbal fluency stimulus letters for use with Croatian speaking individuals [Fonološka verbalna fluentnost na hrvatskom uzorku: primjena testa, izbor podražaja i norme]

The aim of this study is to determine the word frequency for all thirty letters of the Croatian alphabet and to collect normative data for the letter fluency task in Croatian speakers. Ninety two healthy participants were given each of the Croatian letters, and asked to generate as many words as possible in 60 seconds for each letter. Results suggested that participants generated most frequently words starting with the letters as follows: »K«, »P«, »S« and »M«

Older Age in Croatian Clinical Practice is not Discriminative Factor for Liver Transplantation

Transplantacija jetre je oblik terapije kod ireverzibilnog akutnog ili kroničnog zatajenja jetre. Bolje liječenje brojnih bolesti rezultiralo je produženjem životnog vijeka s posljedičnim starenjem populacije. Valja naglasiti da ne postoji dobna granica kako za primatelja tako ni za davatelja organa kod transplantacijskog liječenja, pa se sve češće radi o starijim primateljima/davateljima organa. Cilj ovog rada je utvrditi udio bolesnika starijih od 65 godina liječenih transplantacijom jetre u ukupnom broju jednako liječenih bolesnika, te prikazati vrstu i učestalost komplikacija ovakvog liječenja. Od 1. siječnja 2013 do 1. rujna 2019. godine u KB Merkur transplantacijom jetre liječeno je ukupno 746 bolesnika od kojih je 206 (27,6 %) bilo starije od 65 godina. U toj podskupini bolesnika najčešća indikacija za transplantaciju jetre bila je primarna neoplazma jetre (44,2 %), potom alkoholna bolest jetre (29,6 %), dok su ostale indikacije bile prisutne u 26,2 % bolesnika. Mortalitet tijekom zahvata ili u posttransplantacijskom praćenju u ovoj podskupini bolesnika iznosio je 31 %. Najčešći uzroci smrti bile su: infekcije, sepsa i multiorgansko zatajenje. Kao zaključak može se reći da životna dob bolesnika nije kontraindikacija za transplantacijsko liječenje, osobito kod bolesnika kojima je to jedina metoda liječenja bolesti u vitalnoj indikaciji. Psihijatrijska procjena je važan i sastavni dio pre- i posttransplantacijske faze praćenja bolesnika.Background: Liver transplantation is a method of treatment for irreversible end-stage liver insufficiency. Improved treatment of various diseases has led to the extension of life expectancy and consequently older world population. It must be pointed out that there is no age limit either for organ donation or organ transplantation. Since the population is getting older, today more and more patients who receive liver transplantation are elderly patients. The aim of this study was to show the percentage of elderly patients who received liver transplantation in our centre, as well as to analyse the rate and type of complications of the treatment. The study was retrospective, and included patients treated by liver transplantation in the period between January 1, 2013 and September 1, 2019 at the University Hospital Merkur. There were 746 treated patients, 206 of whom (27.6%) were elderly (>65 years) patients. The main indication for the treatment was primary liver neoplasm (44.2%), followed by alcohol liver disease (29.6%), and other indications (26.2%). The mortality rate during operation and in the post-transplantation follow up period was 31%. The most frequent cause of death were infections, sepsis, and multiorgan failure. Conclusion: Older age is not a contraindication for liver transplantation, especially if it is a lifesaving procedure. Psychiatric assessment is an important and integral part of the pre- and post-transplantation follow-up phase

Eicosapentaenoic acid in serum lipids could be inversely correlated with severity of clinical symptomatology in Croatian war veterans with posttraumatic stress disorder

Aim To explore the association between plasma fatty acids composition and the severity of clinical symptoms in Croatian war veterans with posttraumatic stress disorder (PTSD). Methods This cross-sectional study included 62 men diagnosed with PTSD caused by combat activities during the War in Croatia 1991-1995. Clinician-Administered PTSD Scale (CAPS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D-17) were used. Plasma fatty acids composition was determined by gas chromatography. Data about life-style habits were collected by a structured interview. To evaluate the association between plasma fatty acid levels and PTSD severity scales, multivariate general linear models (GLM) were applied while controlling for different confounders. Results Significant negative correlations were found between plasma eicosapentaenoic acid (EPA, 20:5n-3) level and the scores on psychological scales (τ = -0.326, P < 0.001 for CAPS; τ-0.304, P = 0.001 for HAM-A; and τ = -0.345, P < 0.001 for HAM-D-17). GLM confirmed that PTSD severity was affected by EPA (Wilks’Λ = 0.763-0.805, P = 0.006-0.018, ηp 0.195-0.237), arachidonic acid (AA)/EPA (Wilks’Λ = 0.699- 0.757, P = 0.004, ηp 0.243-0.301), and dairy products consumption (Wilks’Λ = 0.760-0.791, P = 0.045-0.088, ηp 0.128- 0.111). No other fatty acid or dietary/lifestyle variable was significant ( P = 0.362-0.633). Conclusion The study suggests that lower EPA levels are associated with the severity of clinical symptoms in PTSD

The Problem of Informed Consent of Persons with Neurocognitive Disorders in Clinical Investigations

Podatci s početka milenija ukazivali su na prevalenciju Alzheimerove bolesti od 24,3 milijuna oboljelih u svijetu, ali i na očekivani značajni godišnji porast broja novih slučajeva demencije, koji sada iznosi već 4,6 milijuna. Što se tiče najnovijih globalnih procjena možemo se osloniti na procjenu ADI-a (Alzheimer Disease International), krovne udruge koja okuplja 80 nacionalnih Alzheimer organizacija, iz koje je razvidno da danas u svijetu ima više od 47 milijuna osoba s demencijom. No, zabrinjava tvrdnja da će broj oboljelih i nadalje progresivno rasti. Biomedicinska istraživanja su neprocjenjiv (i jedini) izvor novih spoznaja i znanja zahvaljujući kojima je postignut značajan napredak u području medicine u prošlom stoljeću (a što traje i danas). U području kliničkih istraživanja osobe s demencijom su vulnerabilna skupina. Zakonska odredba prema kojoj se onemogućava davanje pristanka za sudjelovanje u istraživanjima od strane zakonskog zastupnika je potencijalno ograničavajući faktor u kontekstu istraživanja koja uključuju osobe s demencijom. U području psihijatrije nužna je procjena pacijentove sposobnosti za davanje informiranog pristanka. S obzirom na specifičnosti mentalnih poremećaja ova procjena je nužna u cilju zaštite bolesnika i njegova prava na izbor medicinskog postupka kao i u cilju izbjegavanja zloporaba u svakodnevnoj kliničkoj praksi.From the beginning of the millennium showed that the prevalence of Alzheimer’s disease was at 24.3 million of patients globally, but also anticipated a significant increase of the number of new cases of dementia, which are currently at 4.6 million. Currently, based on estimates from the ADI (Alzheimer Disease International), a head association that aggregates data 80 national Alzheimer organizations, it is apparent that there are more than 47 million persons with dementia in the world today. However, what is concerning is the statement that this number will continue to grow progressively. Biomedical investigations are an invaluable (and the only) source of new knowledge, thanks to which significant progress has been achieved in medicine during previous century and continues to be achieved today. In the field of clinical investigations, persons with dementia represent a vulnerable group. The legal representative of the person with dementia cannot give consent for participation in clinical investigation, which represents a potentially limiting factor for clinical investigations that include persons with dementia. In psychiatry, the evaluation of patient competence for giving informed consent is necessary. Given the specificity of mental disorders, this evaluation is necessary in order to protect the patient and their choice of medical procedure as well as to avoid misuse in everyday clinical practice

Neurocognitive Disorders – How Can We Reduce the Risk

Demencija spada u bolesti s najvećom prevalencijom poslije kardiovaskularnih, cerebrovaskularnih bolesti te malignih bolesti. Smatra se da u svijetu ima oko 50 milijuna osoba s demencijom, a procjenjuje se da će ih 2050. godine biti čak 115 milijuna. U smanjenju razvoja demencije, kada je riječ o osobama treće dobi, od ključnog je značenja nastavak njihove mentalne aktivnosti (tzv. mentalni fitnes). Vrlo je korisno kada se (stariji) ljudi redovito bave nekim društvenim igrama, različitim mozgalicama, križaljkama, sudokuom, rebusima i slično, jer sve to služi i kao svojevrstan kognitivni trening.Dementia is one of diseases with highest prevalence after cardiovascular and cerebrovacular diseases, and malignant diseases. There are an estimated 50 million people with dementia in the world, with an estimated 2050 year to be as much as 115 million. In reducing the development of dementia, when it comes to older people, it is crucial meanings the continuation of their mental activity (so-called mental fitness). It is very useful when (older) people get on a regular basis engage in some board games, different puzzles, crossword puzzles, sudoku, rebuses and the like, because it all serves as a kind of cognitive training

Treatment of People With Neurocognitive Disorder – How to Improve Treatment Conditions

Potrebe i zahtjevi naših bolesnika su primarna briga svih liječnika i medicinskog osoblja te svih zaposlenika u zdravstvenom sustavu. Vrsna medicinska pomoć više je od samog pružanja medicinskih vještina. Humano ponašanje i brižna njega važni su elementi u liječenju naših bolesnika. Daljnji razvoj klinika i bolnica u kojima se liječe osobe s neurokognitivnim poremećajima trebao bi se razvijati u kontekstu cjelokupnog razvoja zdravstvene zaštite osoba s duševnim smetnjama koji se temelji na deinstitucionalizaciji, jačanju zaštite mentalnog zdravlja u zajednici, ali i osuvremenjivanju potrebnih bolničkih kapaciteta i razvoju Referentnog centra kao centra izvrsnosti.The needs and requirements of our patients are the primary concern of all physicians and medical staff, and of all employees in the healthcare system. Good medical care is more than just providing medical skills. Human behaviour and care are important elements in the treatment of our patients. Further development clinics and hospitals that treat people with neurocognitive disorders should develop in the context of the overall development of health care for people with mental disabilities which is based on deinstitutionalization and strengthening mental health care in the community but also updating the necessary hospital capacity and the development of the Referral Centre as a center of excellence

Depresivni poremećaj kod osoba starije dobi smještenih u domu i kod kuće Depressive disorder of older people at retirement and family home

Cilj: Utvrditi učestalost pojave depresivnog poremećaja kod osoba starije dobi ovisno o životnom okružju (Dom za starije i nemoćne osobe ili obitelj ispitanika) te utvrditi stupanj depresivnog poremećaja kod osoba starije dobi koji žive u krugu svoje obitelji i osoba koje su smješteni u Domu. Ispitanici i metode: U istraživanje je uključeno 100 ispitanika starijih od 70 godina. Ispitanici su bili podijeljeni u dvije skupine: osobe smještene u Domu i osobe koje žive sa svojim obiteljima, od kojih svaka ima po 50 ispitanika. Podaci su prikupljeni putem općeg upitnika i dvije ocjenske skale (Skala za procjenu težine bolesti i Gerijatrijska skala depresije). Opći upitnik je dizajniran za potrebe ovog istraživanja i prikupljanje demografskih podataka ispitanika. Rezultati: Rezultati t-testa pokazuju da postoji statistički značajna razlika (p<0,05) u ozbiljnosti depresije kod ispitanika koji žive u Domu u odnosu na one koji žive kod kuće s obitelji. Zaključak: Stariji ljudi koji žive u krugu svoje obitelji imali su manje izražene simptome depresije u odnosu na osobe koje žive u Domu

The Frequency and Causes of Physical Complications/ Adverse Events During the Hospitalization of Patients with Dementia

Uvod: Osobe s demencijom osjetljivije su na razvoj različitih komplikacija/neželjenih događaja u odnosu na osobe iste dobne skupine bez demencije. Češće se zaprimaju u bolnicu, gdje imaju veću prevalenciju komplikacija i povećanu smrtnost. Cilj: ispitati učestalost hitnih premještaja bolesnika s demencijom zbog tjelesnih komplikacija iz Klinike za psihijatriju Vrapče na somatske odjele drugih bolnica. Metode: U ovom retrospektivnom istraživanju analizirali smo podatke bolesnika s demencijom koji su liječeni od 1. siječnja do 31. kolovoza 2019. godine na Odjelu psihogerijatrije u Klinici za psihijatriju Vrapče s naglaskom na vrijeme trajanja hospitalizacije i razloge otpusta koji su doveli do premještaja s Odjela. Rezultati: Od siječnja do kraja kolovoza 2019. godine na Odjel psihogerijatrije u Klinici zaprimljeno je ukupno 256 bolesnika (67,97 % žena i 32,03 % muškaraca). Prosječna dob žena bila je 80,5, a muškaraca 76,4 godina. Premješteno na somatski odjel (bolnicu) bilo je 28 % bolesnika (40,24 % muškaraca, 23 % žena), a od toga 39 % u prvih sedam dana od dolaska u bolnicu. Pneumonija je bila vodeća somatska dijagnoza kod 19 % premještenih. Prosječno trajanje hospitalizacije među svim ispitanicima bilo je kod muškaraca 33,08 dana, a kod žena 36,47 dana. U istom je razdoblju na Odjelu preminulo 10,93 % bolesnika (12,2 % muškaraca i 10,34 % žena), od toga 25 % unutar pet dana od dolaska u bolnicu. Zbog neujednačenosti pisanja redoslijeda otpusnih dijagnoza, za detaljniju analizu razloga premještaja, bit će potrebno podrobnije ispitivanje. Zaključak: Najteža tjelesna pogoršanja i smrtni ishodi javljali su se u prvih tjedan dana od dolaska u bolnicu. Rezultati ukazuju na nužnost somatske obrade i liječenja bolesnika s demencijom prije nego budu hospitalizirani na psihijatrijskom odjelu.Introduction: Patients with dementia are more susceptible to the development of various complications/adverse events than people of the same age group without dementia. They are more often admitted to hospitals, where they have a higher prevalence of complications and higher mortality. Aim: To examine the frequency of physical complications that require emergency transfers of patients with dementia from the psychogeriatric ward of the University Psychiatric Hospital Vrapče (UPHV) to somatic wards of other hospitals. Patients and methods: In this retrospective study we analysed the data of patients with dementia who received medical treatment at the psychogeriatric ward of the University Psychiatric Hospital Vrapče between 1 January and 31 August 2019, with special emphasis on the treatment length and reasons for discharge due to compromised medical condition. Results: 256 patients (67.97% female, 32.03% male) were admitted to the psychogeriatric ward of the UPHV. The average age was 80.5 years for female and 76.4 years for male patients. 28% of patients (23% of all female and 40.24% of all male patients) were transferred to somatic wards of other hospitals. 39% of all transferred patients were transferred within the first seven days after the admission to the UPHV. Pneumonia was the main somatic diagnosis among 19% of all transferred patients. The mean duration of hospitalization was 36.47 days for female patients and 33.08 days for male patients. 10.93% of all admitted patients (10.34% of all female and 12.2% of all male patients) died at the psychogeriatric ward, 25% of whom died within the first five days after the admission to the UPHV. Due to a lack of uniform order of registering diagnoses, a more detailed examination of reasons for transfers will be required. Conclusion: The most severe deteriorations in the physical condition and fatal outcomes occurred within the first week after the admission to the UPHV. The results indicate the necessity of somatic treatment of dementia patients before admission to a psychiatric ward

Dementia is More Frequent in Women

Demencija je sindrom globalnog i progresivnog oštećenja stečenih kognitivnih sposobnosti pri očuvanoj svijesti prouzročen organskom bolešću središnjeg živčanog sustava u kojem su posebno oštećene sposobnosti pamćenja, učenja, apstraktnog mišljenja, orijentacije te poimanja vidno‐prostornih odnosa. Prevalencija i incidencija Alzheimerove bolesti (AB), najčešćeg uzroka demencije, znatno je veća kod žena nego kod muškaraca, a ta se razlika s dobi povećava. Dvostruko veća učestalost AB kod žena u odnosu na muškarce djelomično se može objasniti time što žene imaju očekivano dulji životni vijek. Žene imaju lošiju kognitivnu izvedbu na mnogim neuropsihologijskim testovima u odnosu na muškarce u istom stadiju bolesti, odnosno višestruke kognitivne funkcije kod žena teže su i šire zahvaćene nego kod muškaraca. Mogući razlozi za ovakvu nepovoljnost naspram žena su redukcija estrogena u postmenopauzi, veće kognitivne rezerve muškaraca te utjecaj apolipoproteina E. Određeni biološki čimbenici također bi mogli objasniti različite kliničke manifestacije AB s obzirom na spol. Osim što prema prezentiranim podatcima žene češće obolijevaju od AB, žene su također te koje u bitno većoj mjeri pružaju neformalnu njegu ljudima s demencijom, te su oko dvije trećine neformalnih njegovatelja žene. Zaključno, u daljnjem istraživačkom i kliničkom radu s AB svakako bi trebalo obratiti pozornost na spoznaje o spolnim razlikama u razvoju i progresiji ove bolesti.Dementia is a syndrome of global and progressive impairment of acquired cognitive abilities with preserved consciousness caused by an organic illness of the central nervous system with especially pronounced damage to the ability to memorise, learn, think abstractly, orientate, and perceive spatial relations. The prevalence and incidence of Alzheimer’s Disease (AD), the most common cause of dementia, is considerably greater in women than in men, and that difference increases with age. The fact that AD occurs twice as often in women than in men may be partially explained by a longer life expectancy among women. Women show worse cognitive performance on numerous neuropsychological tests in comparison to men during the same stage of the disease, meaning that multiple cognitive functions are more widely and severely impaired in women than in men. Possible reasons for such unfavourable results among women are a reduction of oestrogen during post-menopause, larger cognitive reserves in men, and the influence of apolipoprotein E. Certain biological factors may also explain various clinical manifestations of AD regarding sex. Apart from the fact that, according to presented data, women develop AD more often than men, women are also those who offer informal care to people with dementia in much greater numbers, and almost two thirds of informal caregivers are women. In conclusion, further research and clinical work with AD should certainly pay attention to insights about sex differences in the development and progression of this disease