PROPOSITION OF CHANGES TO THE MENTAL HEALTH CARE SYSTEM AIMED AT INCLUSION OF INDIVIDUALS WITH PSYCHICAL DISORDERS INTO SOCIETY

Prema rezultatima dosadašnjih istraživanja i spoznajama iz relevantne literature, a s ciljem inkluzije osoba s psihičkim poremećajima u društvo te smanjenja stope njihove rehospitalizacije i institucionalizma, predlažu se sljedeće intervencije u sustavu skrbi o mentalnom zdravlju: povećanje socijalnih kontakata osoba s psihičkim poremećajima (stjecanje i zadržavanje prijatelja i najboljeg prijatelja, razvijanje podržavajućih odnosa od strane bliskog člana obitelji), zapošljavanje ili održavanje zapošljavanja, postizanje boljeg razumijevanja i manje percepcije diskriminacije osobe od strane njegova/njezina bračnog druga/partnera, rano otkrivanje prvih znakova psihičkih poremećaja kako bi se osoba što ranije počela liječiti, rad na spremnosti osobe na suradnju u liječenju te edukaciju o bolesti kako bi osoba prihvatila svoju dijagnozu bez stigme. U prilogu se nalaze konstruirani dijagrami: početni dijagram koji prikazuje trenutačno stanje skrbi o osobama s psihičkim poremećajima u Hrvatskoj, međusobnu povezanost i utjecaj različitih podsustava kao i završni dijagram koji prikazuje mogućnosti djelovanja odnosno prijedlog intervencija u sustavu skrbi o mentalnom zdravlju.Based on the relevant literature review and current research results and with the aim of facilitating inclusion of people with a mental illness into society as well as decreasing the rate of their re-hospitalization and institutionalism, the following interventions in the health care and the social care system are suggested: increasing social contacts of people with a mental illness (acquiring and keeping friends and a best friend and developing supportive relations with a close family member), employment or keeping a job, achieving better comprehension and decreasing the occurrence of people with a mental illness being perceived as discriminated persons by their spouses/partners, early interventions in diagnosing and treatment of psychological disorders, increasing the level of cooperation during the treatment as well as education about the disorder so that the individual could accept his/her diagnosis without stigma. The appendix includes two constructed diagrams: the initial one presents the current state of care of persons with psychical disorders in Croatia, interrelation and influence of different sub-systems, and the closing one presents intervention possibilities, i.e. the intervention proposal within the mental health care syste

PROPOSITION OF CHANGES TO THE MENTAL HEALTH CARE SYSTEM AIMED AT INCLUSION OF INDIVIDUALS WITH PSYCHICAL DISORDERS INTO SOCIETY

Prema rezultatima dosadašnjih istraživanja i spoznajama iz relevantne literature, a s ciljem inkluzije osoba s psihičkim poremećajima u društvo te smanjenja stope njihove rehospitalizacije i institucionalizma, predlažu se sljedeće intervencije u sustavu skrbi o mentalnom zdravlju: povećanje socijalnih kontakata osoba s psihičkim poremećajima (stjecanje i zadržavanje prijatelja i najboljeg prijatelja, razvijanje podržavajućih odnosa od strane bliskog člana obitelji), zapošljavanje ili održavanje zapošljavanja, postizanje boljeg razumijevanja i manje percepcije diskriminacije osobe od strane njegova/njezina bračnog druga/partnera, rano otkrivanje prvih znakova psihičkih poremećaja kako bi se osoba što ranije počela liječiti, rad na spremnosti osobe na suradnju u liječenju te edukaciju o bolesti kako bi osoba prihvatila svoju dijagnozu bez stigme. U prilogu se nalaze konstruirani dijagrami: početni dijagram koji prikazuje trenutačno stanje skrbi o osobama s psihičkim poremećajima u Hrvatskoj, međusobnu povezanost i utjecaj različitih podsustava kao i završni dijagram koji prikazuje mogućnosti djelovanja odnosno prijedlog intervencija u sustavu skrbi o mentalnom zdravlju.Based on the relevant literature review and current research results and with the aim of facilitating inclusion of people with a mental illness into society as well as decreasing the rate of their re-hospitalization and institutionalism, the following interventions in the health care and the social care system are suggested: increasing social contacts of people with a mental illness (acquiring and keeping friends and a best friend and developing supportive relations with a close family member), employment or keeping a job, achieving better comprehension and decreasing the occurrence of people with a mental illness being perceived as discriminated persons by their spouses/partners, early interventions in diagnosing and treatment of psychological disorders, increasing the level of cooperation during the treatment as well as education about the disorder so that the individual could accept his/her diagnosis without stigma. The appendix includes two constructed diagrams: the initial one presents the current state of care of persons with psychical disorders in Croatia, interrelation and influence of different sub-systems, and the closing one presents intervention possibilities, i.e. the intervention proposal within the mental health care syste

Psihofarmakoterapija sulpiridom u bolesnika s ovisnošću o alkoholu i depresijom

Depression is quite common in the early stage of treatment for alcohol addiction. The patient\u27s awareness of his difficult situation may be one of the reasons for depression. Furthermore, depression can develop as the result of depressive disorders that are primarily or secondarily associated with alcohol addiction. Antidepressive therapy is usually initiated after a two-week detoxification procedure. Only exceptionally it may start earlier in case of severe depressive disorder. The administration of sulpiride from the very beginning of treatment yields favorable results because of the wide range of its action, especially antidepressive effects. The effect of sulpiride therapy was investigated in 20 alcoholics suffering from minor to moderate depressive disorders. The patients were administered 50 mg sulpiride capsules three times a day. Control group included 20 patients who received placebo. Both the study and control group patients underwent psychotherapeutic methods usually conducted in a sociotherapeutic community. The severity of depressive disorder was measured by use of Hamilton\u27s and Beck\u27s scale before, and then at 2, 4and 6 weeks from the beginning of treatment. Also, the patients were clinically observed during the psychotherapeutic procedures and other activities performed in the therapeutic community. Study results confirmed the efficacy of sulpiride in the management of depressive alcohol addiction in alcoholics. The sulpiride dose of 150 mg/day showed a rapid antidepressive effect. Accordingly, sulpiride was confirmed to play an important role in the rational use of psychopharmacotherapy in patients with alcohol addiction in a sociotherapeutic community.U početnoj fazi liječenja u alkoholičara se često očituje depresivno raspoloženje. Ono može biti posljedica uvida u problematičnu situaciju u kojoj se alkoholičar nalazi ili se radi o depresivnom poremećaju primarno ili sekundarno vezanom uz alkoholizam. Uvođenje ciljane antidepresivne terapije prakticira se nakon dvotjednog detoksikacijskog postupka, a iznimno kod jasno izraženih slika i ranije. Primjena sulpirida u početku liječenja alkoholizma daje pozitivne rezultate zbog njegovog širokog raspona, između ostalog i antidepresivnog, djelovanja. Ispitivalo se je djelovanje sulpirida u skupini od 20 bolesnika s lakšim i srednje teškim depresivnim poremećajem liječenih u Dnevnoj bolnici za alkoholizam na Klinici za psihijatriju, alkoholizam i druge ovisnosti Kliničke bolnice "Sestre milosrdnice" u Zagrebu. Ispitanici su primali 3x1 kapsulu od 50 miligrama sulpirida, dok je 20 bolesnika u kontrolnoj skupini primalo placebo. Obje su skupine podvrgnute individualnim i grupnim psihoterapijskim metodama u okviru socioterapijske zajednice. Razina depresivnog poremećaja ispitivana je Hamiltonovom i Beckovom ljestvicom koja je primijenjena pri dolasku na liječenje, te nakon dva, četiri i šest tjedana liječenja. Bolesnici su i klinički promatrani tijekom psihoterapijskih postupaka i ostalih aktivnosti koje se provode u terapijskoj zajednici. U radu je potvrđena djelotvornost sulpirida u dozi od 150 mg/dan u liječenju depresivnih poremećaja alkoholičara kroz njegov brz antidepresivni učinak, te je istaknuta njegova uloga u racionalnoj psihofarmakoterapiji alkoholičara u socioterapijskoj zajednici

Psihofarmakoterapija sulpiridom u bolesnika s ovisnošću o alkoholu i depresijom

Depression is quite common in the early stage of treatment for alcohol addiction. The patient\u27s awareness of his difficult situation may be one of the reasons for depression. Furthermore, depression can develop as the result of depressive disorders that are primarily or secondarily associated with alcohol addiction. Antidepressive therapy is usually initiated after a two-week detoxification procedure. Only exceptionally it may start earlier in case of severe depressive disorder. The administration of sulpiride from the very beginning of treatment yields favorable results because of the wide range of its action, especially antidepressive effects. The effect of sulpiride therapy was investigated in 20 alcoholics suffering from minor to moderate depressive disorders. The patients were administered 50 mg sulpiride capsules three times a day. Control group included 20 patients who received placebo. Both the study and control group patients underwent psychotherapeutic methods usually conducted in a sociotherapeutic community. The severity of depressive disorder was measured by use of Hamilton\u27s and Beck\u27s scale before, and then at 2, 4and 6 weeks from the beginning of treatment. Also, the patients were clinically observed during the psychotherapeutic procedures and other activities performed in the therapeutic community. Study results confirmed the efficacy of sulpiride in the management of depressive alcohol addiction in alcoholics. The sulpiride dose of 150 mg/day showed a rapid antidepressive effect. Accordingly, sulpiride was confirmed to play an important role in the rational use of psychopharmacotherapy in patients with alcohol addiction in a sociotherapeutic community.U početnoj fazi liječenja u alkoholičara se često očituje depresivno raspoloženje. Ono može biti posljedica uvida u problematičnu situaciju u kojoj se alkoholičar nalazi ili se radi o depresivnom poremećaju primarno ili sekundarno vezanom uz alkoholizam. Uvođenje ciljane antidepresivne terapije prakticira se nakon dvotjednog detoksikacijskog postupka, a iznimno kod jasno izraženih slika i ranije. Primjena sulpirida u početku liječenja alkoholizma daje pozitivne rezultate zbog njegovog širokog raspona, između ostalog i antidepresivnog, djelovanja. Ispitivalo se je djelovanje sulpirida u skupini od 20 bolesnika s lakšim i srednje teškim depresivnim poremećajem liječenih u Dnevnoj bolnici za alkoholizam na Klinici za psihijatriju, alkoholizam i druge ovisnosti Kliničke bolnice "Sestre milosrdnice" u Zagrebu. Ispitanici su primali 3x1 kapsulu od 50 miligrama sulpirida, dok je 20 bolesnika u kontrolnoj skupini primalo placebo. Obje su skupine podvrgnute individualnim i grupnim psihoterapijskim metodama u okviru socioterapijske zajednice. Razina depresivnog poremećaja ispitivana je Hamiltonovom i Beckovom ljestvicom koja je primijenjena pri dolasku na liječenje, te nakon dva, četiri i šest tjedana liječenja. Bolesnici su i klinički promatrani tijekom psihoterapijskih postupaka i ostalih aktivnosti koje se provode u terapijskoj zajednici. U radu je potvrđena djelotvornost sulpirida u dozi od 150 mg/dan u liječenju depresivnih poremećaja alkoholičara kroz njegov brz antidepresivni učinak, te je istaknuta njegova uloga u racionalnoj psihofarmakoterapiji alkoholičara u socioterapijskoj zajednici

Bio-psycho-social model of treatment and rehabilitation of addicts during the conduction of safety measure of obligatory psychiatric treatment in prison hospital Zagreb

Addicts are a specific category of offenders or prisoners. Although some of them are primarily criminalized, the largest number of sentences for drug abuse crimes seem just as direct or indirect consequences of these disorders. Therefore, the application of a special program is needed for the treatment of addicts, lead by multi-disciplinary team of experts and focused on the prevention of future addiction behavior, and therefore criminal relapse. Authors are presenting the bio-psycho-social model of treatment and rehabilitation of addicts during the conduction of safety measure of obligatory psychiatric treatment at Department for forensic psychiatry in Prison hospital Zagreb. Each patient at the Department is involved in a structured treatment program as a part of a single program of imprisonment, which is, in this case specific and modified in a way that the basic psychiatric treatment program aimed to reduce psychopathology is combined with special program of addiction treatment, abstinence and rehabilitation. The program for drug addiction, alcoholism and gambling in co-morbidity with other mental disorders (primarily personality disorders and PTSP) is presented. It consists of use of pharmacotherapy and substitution therapy, individual and group psychotherapy work, therapeutic community, working occupational therapy, clubs for addicts, work with family and communication with the State Board of Parole and Post-Prison Supervision. It is lead by multi-disciplinary team of experts and it is focused on the rehabilitation process and the prevention of future addiction behavior which leads to the prevention of criminal relapse

NEUBROJIVA OSOBA U PROCESU OD ISTRAŽNOG ZATVORA DO REALIZACIJE PRISILNOG SMJEŠTAJA

Autori ovim radom žele prikazati činjenično stanje i postupke prema neubrojivim osobama koje su hospitalizirane na Odjelu psihijatrije Zatvorske bolnice temeljem čl. 551. ZKP-a do upućivanja u psihijatrijsku ustanovu radi realizacije prisilnog smještaja po čl. 44. ZZODS-a. U razdoblju od pet godina na Odjelu psihijatrije boravilo je od 89 osoba u 2006. godini do 71 osobe u 2011. godini, prosječne dobi od 41 godine, u 60% slučajeva sa završenom srednjom stručnom spremom, a u više od 60% slučajeva osobe su samci ili razvedeni. Kod velike većine (81%) dijagnosticirana je prava, trajna i teška duševna bolest iz kruga shizofrenije i drugih psihotičnih poremećaja, a kod 16% osoba postavljene su dvije i više dijagnoza. Osobe s najučestalijim dijagnozama, shizofrenijom, shizotipnim i sumanutim poremećajima, u čak 60% slučajeva čine kaznena djela protiv života i tijela, u manjem postotku čine kaznena djela protiv slobode i prava čovjeka (prijetnja), zatim slijede kaznena djela nasilja u obitelji, a u najmanjem postotku čine kaznena djela protiv spolne slobode i spolnog ćudoređa te protiv opće sigurnosti. Uočeno je nadalje da se istražni zatvor po čl. 551. ZKP-a izdržava bez iznimke u Zatvorskoj bolnici, iako je ZKP dao mogućnost da se izdržava i u drugoj odgovarajućoj psihijatrijskoj ustanovi. Na pravomoćno rješenje o prisilnom smještaju sukladno čl. 44. ZZODS-a neubrojiva osoba unutar zatvorskog sustava čeka i do 555 dana. Županijskom sudu nadležnom za određivanje prisilnog smještaja po čl. 44. ZZODS-a, po pravomoćnosti rješenja o prisilnom smještaju, treba i do 105 dana da Ministarstvu zdravlja dostavi dokumentaciju o pokretanju prisilnog smještaja, iako Zakon kaže: bez odgode. Ministarstvu zdravlja treba i do 157 dana da odabere u kojoj će se zdravstvenoj ustanovi provoditi prisilni smještaj, unatoč zakonskom roku od tri dana. Dakle, unatoč važećim propisima ZKP-a, KZ-a i ZZODS-a, neubrojive osobe neopravdano dugo borave unutar zatvorskog sustava, a to je jedan od najtežih oblika kršenja ljudskih prava budući da te osobe po KZ-u nisu krive jer u vrijeme ostvarenja zakonskih obilježja kaznenog djela ili prekršaja nisu bile u mogućnosti shvatiti značenje svojeg postupanja ili nisu mogle vladati svojom voljom zbog duševne bolesti, privremene duševne poremećenosti, nedovoljnoga dušev-nog razvitka ili druge teže duševne smetnje. Država bi trebala pronaći financijska sredstva za izgradnju forenzičnog odjela/centra koji bi ispunjavao uvjete za smještaj forenzičnih bolesnika (od izdržavanja istražnog zatvora do provođenja prisilnog smještaja) budući da aktualni kapaciteti, razina sigurnosti i opremljenost forenzičnih institucija za prisilni smještaj neubrojivih osoba očito ne zadovoljava. Potrebna je dodatna edukacija suca pojedinaca i sudova nadležnih za realizaciju mjera po čl. 44. ZZODS-a radi ubrzanja čitavog postupka upućivanja neubrojive osobe na liječenje

EFFECTS OF EMPLOYMENT STATUS, EDUCATION AND SOCIAL CONTACTS ON THE EMPOWERMENT OF MENTALLY ILL PERSONS

U ovome radu analizirana je povezanost između razine samoosnaživanja u osoba s psihičkim poremećajima i njihova radnog statusa, obrazovanja te socijalnih kontakata. Istraživanje je provedeno upitnikom za mjerenje samoosnaživanja (Rogers empowerment skala) koji je adaptiran za hrvatski uzorak. Od ukupno 248 ispitanika (93 % response rata) polovica ispitanika bila je u radnom odnosu, a polovica nezaposlena ili radno nesposobna (umirovljena/invalidi). Većinom su ispitanici imali srednjoškolsko obrazovanje, a 11 % ih je imalo fakultet. Ispitanici su u većini slučajeva imali prijatelja, najboljeg prijatelja i bliskog člana obitelji, a polovica ih ima i bračnog druga/partnera. Gotovo sve sociodemografske kategorije ispitanih iskazuju umjerene razine samoosnaživanja. Iznimku čine fakultetski obrazovani ispitanici koji iskazuju visoku razinu samoosnaživanja, dok osobe koje u trenutku ispitivanja nisu imale ni prijatelja niti najboljeg prijatelja iskazuju nisku razinu samoosnaživanja. No, ispitanici koji u trenutku ispitivanja nisu imali partnera/bračnog druga, osnaženiji su od onih ispitanika koji su ga u trenutku ispitivanja imali. Nezaposlene osobe iskazuju veće samoosnaživanje od radno nesposobnih osoba. Prediktori više razine samoosnaživanja obuhvaćaju socijalne kontakte u obliku prijatelja i najboljeg prijatelja, radni status/zaposlenost, fakultetsko obrazovanje te nedostatak bračnog partnera. Preporuča se da težište tijekom liječenja, a posebno u rehabilitaciji osobe s psihičkim poremećajem bude na intervencijama za održavanje zaposlenja, odnosno zapošljavanju, obrazovanju, tj. doškolovanju, te održavanju ili ojačavanju socijalne mreže prijatelja uz posebnu pozornost na poboljšanje partnerskih odnosa.Under analysis is the correlation between the level of empowerment in mentally ill and their employment status, education and socio-cultural contacts. Rogers\u27s empowerment scale was adapted to suit the Croatian sample. Out of 248 mentally ill persons (93% response rate), one half was employed and the remaining half was either unemployed or disabled/retired. The majority of the persons in the sample had high school level education and 11% held a university degree. In most cases the subjects had a friend, best friend or close family members and a half had a partner/spouse. Almost all socio-demographic categories questioned exhibited a moderate level of empowerment while persons with a college degree exhibited high empowerment. Persons without friends or a best friend exhibited a low level of empowerment. However, persons without a partner or spouse were more empowered than those married or in a relationship. Unemployed persons exhibited a higher level of empowerment than those incapable of employment. The predictors of higher level of empowerment included social contacts in the form of a friend or best friend, employment, university degree and lack of partner/spouse. It is recommended that during treatment and especially during rehabilitation of a mentally ill person the focus should be on maintaining employment or procuring employment, on continuing education, on maintaining and improving social networks with special focus on partner/spouse relationship and couples therapy

Bio-psycho-social model of treatment and rehabilitation of addicts during the conduction of safety measure of obligatory psychiatric treatment in prison hospital Zagreb

Addicts are a specific category of offenders or prisoners. Although some of them are primarily criminalized, the largest number of sentences for drug abuse crimes seem just as direct or indirect consequences of these disorders. Therefore, the application of a special program is needed for the treatment of addicts, lead by multi-disciplinary team of experts and focused on the prevention of future addiction behavior, and therefore criminal relapse. Authors are presenting the bio-psycho-social model of treatment and rehabilitation of addicts during the conduction of safety measure of obligatory psychiatric treatment at Department for forensic psychiatry in Prison hospital Zagreb. Each patient at the Department is involved in a structured treatment program as a part of a single program of imprisonment, which is, in this case specific and modified in a way that the basic psychiatric treatment program aimed to reduce psychopathology is combined with special program of addiction treatment, abstinence and rehabilitation. The program for drug addiction, alcoholism and gambling in co-morbidity with other mental disorders (primarily personality disorders and PTSP) is presented. It consists of use of pharmacotherapy and substitution therapy, individual and group psychotherapy work, therapeutic community, working occupational therapy, clubs for addicts, work with family and communication with the State Board of Parole and Post-Prison Supervision. It is lead by multi-disciplinary team of experts and it is focused on the rehabilitation process and the prevention of future addiction behavior which leads to the prevention of criminal relapse