TREATMENT OF RESISTANT AND ULTRA RESISTANT SCHIZOPHRENIA

Schizophrenia is a psychiatric disease which affects one percent of population. It is most common in young adults. It is primarily treated with typical and atypical antipsychotics. Resistant schizophrenia is a condition diagnosed after no response is noticed to two different antipsychotics of which one is atypical. The treatment has to be undertaken with adequate doses and duration of therapy. Clozapine is the golden standard in the treatment of therapy-resistant schizophrenia. It has shown its superiority among other antipsychotics in various studies. Aside from greater effectiveness, advantages include absence of extrapyramidal side effects. During clozapine treatment, regular blood tests should be performed as a screening method for agranulocytosis. Twenty to thirty percent od schizophrenia patients suffer from treatment resistant schizophrenia. Sixty percent of the latter ones show no therapeutic response to clozapine. In conclusion twelve to eighteen percent of all patients suffering from schizophrenia show no response to any form of treatment. Attempts to augment clozapine effectiveness are being made by increasing the dose of monotherapy, using antipsychotic polipharmacy or adding other types of drugs to clozapine. Unfortunately, these augmentation methods have not yet proven themselves to be effective enough to be added to standard therapy algorythms. On the other hand, electroconvulsive therapy is neuromodulatory method that shows promise in increasing therapeutic success. Although many methods of treatment are being researched, therapy-resistant schizophrenia remains a clinical challenge which affects a significant percentage of population and will require additional research

TREATMENT OF RESISTANT AND ULTRA RESISTANT SCHIZOPHRENIA

Schizophrenia is a psychiatric disease which affects one percent of population. It is most common in young adults. It is primarily treated with typical and atypical antipsychotics. Resistant schizophrenia is a condition diagnosed after no response is noticed to two different antipsychotics of which one is atypical. The treatment has to be undertaken with adequate doses and duration of therapy. Clozapine is the golden standard in the treatment of therapy-resistant schizophrenia. It has shown its superiority among other antipsychotics in various studies. Aside from greater effectiveness, advantages include absence of extrapyramidal side effects. During clozapine treatment, regular blood tests should be performed as a screening method for agranulocytosis. Twenty to thirty percent od schizophrenia patients suffer from treatment resistant schizophrenia. Sixty percent of the latter ones show no therapeutic response to clozapine. In conclusion twelve to eighteen percent of all patients suffering from schizophrenia show no response to any form of treatment. Attempts to augment clozapine effectiveness are being made by increasing the dose of monotherapy, using antipsychotic polipharmacy or adding other types of drugs to clozapine. Unfortunately, these augmentation methods have not yet proven themselves to be effective enough to be added to standard therapy algorythms. On the other hand, electroconvulsive therapy is neuromodulatory method that shows promise in increasing therapeutic success. Although many methods of treatment are being researched, therapy-resistant schizophrenia remains a clinical challenge which affects a significant percentage of population and will require additional research

INFLUENCE OF HORMONAL STATUS AND MENSTRUAL CYCLE PHASE ON PSYCHOPATOLOGY IN ACUTE ADMITTED PATIENTS WITH SCHIZOPHRENIA

Background: The gender differences in onset, symptom severity, and outcome of schizophrenia are now thought to support the hypothesis that sex hormones may also have a role in etiology, as well as treatment, of schizophrenia. A number of reproductive hormones may be implicated, including testosterone, progesterone, or luteinising hormone, and thus it is important to acknowledge that there is a complex interplay of hormones occurring. This study was introduced to highlight the effect of the menstrual cycle, and sex hormones on female patients with schizophrenia. Subjects and methods: The sample consisted of 31 consecutively acute admitted women, aged 18 to 45 years with schizophrenia diagnosed by DSM-5 criteria. The sample consisted of women who were regulary menstruating and to be undergoing regular hormonal fluxes. Each subject was enrolled and received psychopathology and hormone (estradiole, progesterone, testosterone) assessments. Psychopathology was measured with Positive end Negative Syndrome Scale (PANSS). The subjects were divided into folicular (high estrogen) and luteal (low estrogen) phase admissions. Data were analyzed by regression analysis and t-test for independent samples. Values are given as means ±SD. Results: There were no differences between the folicular and luteal phase admission grups with regard to age, duration of illness and age at onset of illness. We found that significantly more women were admitted during the luteal (low estrogen) phase of menstrual cycle (68%) as compared to follicular (high estrogen) phase (32%). Conclusion: There was a significant increase in hospital admissions in the luteal phase of menstrual cycle in women suffering from exacerbation of schizophrenia. The influence of particulary sex hormones (estrogen, progesterone and testosterone) on admission rate and clinical psychopatology was found insignificant

INFLUENCE OF SERUM TESTOSTERONE LEVEL ON AGGRESSION IN WOMEN WITH SCHIZOPHRENIA

Background: Unlike in female population, the effect of testosterone on aggression in men has been investigated countless times so far. A scarce number of studies have examined the effect of testosterone on aggression in women. The results obtained so far are inconsistent for some studies indicated a positive, whilst others showed a negative correlation. Since testosterone turned out to be an important factor related to aggression in men, the aim of our study was to investigate whether this correlation existed in aggressive female patients with schizophrenia. Subjects and methods: The sample consisted of 120 women, aged from 18 to 45 years, diagnosed with schizophrenia by DSM-5 criteria. Those who were breastfeeding or suffered from specific hormonal or other physical disorders were excluded from the study. They were divided into two groups of 60 - those with aggressive behavior and those with nonaggressive behavior. Psychopathology was measured by several tests (Positive and Negative Syndrome Scale - PANSS, Overt Aggression Scale - OAS and PANSS Extended Subscale for Aggression Assessment). Serum testosterone hormone assays were performed. Statistical data analysis was done by parametric statistical tests, Kolmogorov-Smirnov test, Student\u27s t-test and simple linear regression. All data were presented as mean values and corresponding standard deviations (SD). Results: Testosterone levels didn\u27t differ significantly between aggressive and nonaggressive subjects. There were no significant differences between testosterone levels in suicidal aggressive subjects compared to nonsuicidal aggressive respondents (t=0.616; p=0.540). The largest number of subjects in both groups had referent testosterone levels. Conclusions: Despite expecting a significant effect of testosterone levels on aggression in women with schizophrenia, conducted by previous studies, no correlation has been found testosterone levels

Psychiatric Patient and Obesity

Debele osobe i osobe s prekomjernom tjelesnom težinom imaju više psihičkih poremećaja u usporedbi s osobama normalne tjelesne težine. Debljina je jedan od najčešćih tjelesnih problema u osoba oboljelih od teških i dugotrajnih psihičkih bolesti i poremećaja. Dok je prevalencija debljine u općoj populaciji 20 – 30%, prevalencija debljine u populaciji oboljelih od shizofrenije jest između 40 – 60%. Debljina se kod osoba oboljelih od shizofrenije povezuje s karakteristikama i značajkama same bolesti kao što su loše i nezdrave prehrambene navike, sjedilački način života, socijalno povlačenje, psihomotorna usporenost i činjenica da mnogi psihotropni lijekovi (antipsihotici, stabilizatori raspoloženja i antidepresivi) koji se rabe u liječenju ove bolesti povećavaju tjelesnu težinu. U liječenju debljine kod psihijatrijskih bolesnika mogu se primjenjivati farmakološke i nefarmakološke metode.Mental disorders are more common among obese and overweight people than among people with normal body weight. Obesity is one of the most frequent physical health problems found in patients suNering from severe and chronic mental disorders. Obesity prevalence in general population ranges from 20% to 30%, while in patients with schizophrenia it ranges from 40% to 60%. Obesity in patients with schizophrenia is associated with the characteristics and nature of the disorder, such as bad eating habits, sedentary lifestyle, social withdrawal and psychomotor retardation. In addition, a number of psychotropic medications used to treat schizophrenia (antipsychotics, mood stabilizers and antidepressants) cause weight gain. Both pharmacological and non-pharmacological methods are available for the treatment of obesity in patients with mental disorders

Pharmacological therapy as a supplement to reduction diet and physical activity for weight reduction

Farmakološka terapija može biti korisna kao dodatak redukcijskoj prehrani i tjelesnoj aktivnosti u smanjenju tjelesne mase. Međutim, treba imati na umu da farmakološka terapija ne bi smjela biti jedini način za smanjenje tjelesne mase. Redukcijska prehrana i tjelesna aktivnost su ključni za zdrav i održiv gubitak tjelesne mase. Farmakološka terapija treba biti korištena samo pod nadzorom stručnjaka i u slučajevima kada druge strategije za gubitak tjelesne mase nisu uspješne. Pandemija pretilosti i povećanja tjelesne mase nastavlja rasti alarmantnom brzinom. Trenutni dokazi za preporuku specifičnih dijeta i kombinacija dijete i lijekova za mršavljenje te kombinacija lijekova i tjelesnih aktivnosti i dijeta i dalje slabi, što se djelomično može pripisati razlikama u prehrambenim protokolima, razlikama u praćenju tjelesne aktivnosti i različitim vremenima praćenja u dostupnim ispitivanjima. Budući da su modifikacije stila i načina života ograničene u svom uspjehu u održavanju gubitka tjelesne mase, farmakoterapija igra važnu ulogu u postizanju klinički značajnog gubitka tjelesne mase. Farmakoterapija za smanjenje tjelesne mase indicirana je kao dodatak dijeti sa smanjenim unosom kalorija i povećanoj tjelesnoj aktivnosti u odraslih osoba s ITM ≥30 kg/m², ali i u osoba s preuhranjenošću s ITM-om ≥27 do 35 kg/m² s komorbiditetima ili ITM >40 kg/m2 s komorbiditetima ili bez njih. Farmakoterapija pretilosti značajno se razvila u posljednjih 60 godina. Federalna uprava za lijekove (FDA) je za sada odobrila šest lijekova za dugotrajno liječenje pretilosti. Malo je vjerojatno da će jedno farmakološko sredstvo biti učinkovito u liječenju pretilosti. Stoga će buduće strategije za liječenje pretilosti morati potaknuti učinkovit gubitak težine i vjerojatno će zahtijevati istodobnu primjenu lijekova koji djeluju kroz različite mehanizme. Ciljevi kontrole tjelesne mase naglašavaju važnost realističnog pristupa mršavljenju kako bi se postiglo smanjenje zdravstvenih rizika, a uključuju promicanje gubitka tjelesne mase, održavanje postignute niže tjelesne mase i prevenciju ponovnog debljanja. Ako se želi smanjiti tjelesnu masu, potrebno je pristupiti tome s više različitih strategija, uključujući i farmakološku terapiju.Pharmacological therapy can be useful as an adjunct to a reduction diet and physical activity in reducing body weight. However, it is important to note that pharmacological therapy should not be the only way to reduce body weight. Diet and physical activity are key to healthy and sustainable weight loss. Pharmacological therapy should only be used under expert supervision and in cases where other strategies for weight loss are unsuccessful. The obesity and weight gain pandemic continues to grow at an alarming rate. Current evidence to recommend specific diets and combinations of diet and medication for weight loss and combination of medication and physical activity and diet remains weak, which may be partially attributable to differences in dietary protocols, differences in monitoring of physical activity, and different follow-up times in the available trials. Because lifestyle modifications are limited in their success in maintaining weight loss, pharmacotherapy plays an important role in achieving clinically significant weight loss. Pharmacotherapy for weight loss is indicated as an addition to a diet with reduced calorie intake and increased physical activity in adults with BMI ≥30 kg/m², but also in obese individuals with BMI ≥27 to 35 kg/m² with comorbidities or BMI > 40 kg/m2 with or without comorbidities. Pharmacotherapy of obesity has developed significantly in the last 60 years. The Federal Drug Administration (FDA) has so far approved six drugs for the long-term treatment of obesity. It is unlikely that a single pharmacological agent will be effective in the treatment of obesity. Therefore, future strategies for the treatment of obesity will need to promote effective weight loss and will likely require the simultaneous use of drugs that work through different mechanisms. Weight control goals emphasize the importance of a realistic approach to weight loss to reduce health risks, and include promoting weight loss, maintaining weight loss, and preventing weight gain. If one wants to reduce body weight, it is necessary to approach with several different strategies, including pharmacological therapy

Pharmacological therapy as a supplement to reduction diet and physical activity for weight reduction

Farmakološka terapija može biti korisna kao dodatak redukcijskoj prehrani i tjelesnoj aktivnosti u smanjenju tjelesne mase. Međutim, treba imati na umu da farmakološka terapija ne bi smjela biti jedini način za smanjenje tjelesne mase. Redukcijska prehrana i tjelesna aktivnost su ključni za zdrav i održiv gubitak tjelesne mase. Farmakološka terapija treba biti korištena samo pod nadzorom stručnjaka i u slučajevima kada druge strategije za gubitak tjelesne mase nisu uspješne. Pandemija pretilosti i povećanja tjelesne mase nastavlja rasti alarmantnom brzinom. Trenutni dokazi za preporuku specifičnih dijeta i kombinacija dijete i lijekova za mršavljenje te kombinacija lijekova i tjelesnih aktivnosti i dijeta i dalje slabi, što se djelomično može pripisati razlikama u prehrambenim protokolima, razlikama u praćenju tjelesne aktivnosti i različitim vremenima praćenja u dostupnim ispitivanjima. Budući da su modifikacije stila i načina života ograničene u svom uspjehu u održavanju gubitka tjelesne mase, farmakoterapija igra važnu ulogu u postizanju klinički značajnog gubitka tjelesne mase. Farmakoterapija za smanjenje tjelesne mase indicirana je kao dodatak dijeti sa smanjenim unosom kalorija i povećanoj tjelesnoj aktivnosti u odraslih osoba s ITM ≥30 kg/m², ali i u osoba s preuhranjenošću s ITM-om ≥27 do 35 kg/m² s komorbiditetima ili ITM >40 kg/m2 s komorbiditetima ili bez njih. Farmakoterapija pretilosti značajno se razvila u posljednjih 60 godina. Federalna uprava za lijekove (FDA) je za sada odobrila šest lijekova za dugotrajno liječenje pretilosti. Malo je vjerojatno da će jedno farmakološko sredstvo biti učinkovito u liječenju pretilosti. Stoga će buduće strategije za liječenje pretilosti morati potaknuti učinkovit gubitak težine i vjerojatno će zahtijevati istodobnu primjenu lijekova koji djeluju kroz različite mehanizme. Ciljevi kontrole tjelesne mase naglašavaju važnost realističnog pristupa mršavljenju kako bi se postiglo smanjenje zdravstvenih rizika, a uključuju promicanje gubitka tjelesne mase, održavanje postignute niže tjelesne mase i prevenciju ponovnog debljanja. Ako se želi smanjiti tjelesnu masu, potrebno je pristupiti tome s više različitih strategija, uključujući i farmakološku terapiju.Pharmacological therapy can be useful as an adjunct to a reduction diet and physical activity in reducing body weight. However, it is important to note that pharmacological therapy should not be the only way to reduce body weight. Diet and physical activity are key to healthy and sustainable weight loss. Pharmacological therapy should only be used under expert supervision and in cases where other strategies for weight loss are unsuccessful. The obesity and weight gain pandemic continues to grow at an alarming rate. Current evidence to recommend specific diets and combinations of diet and medication for weight loss and combination of medication and physical activity and diet remains weak, which may be partially attributable to differences in dietary protocols, differences in monitoring of physical activity, and different follow-up times in the available trials. Because lifestyle modifications are limited in their success in maintaining weight loss, pharmacotherapy plays an important role in achieving clinically significant weight loss. Pharmacotherapy for weight loss is indicated as an addition to a diet with reduced calorie intake and increased physical activity in adults with BMI ≥30 kg/m², but also in obese individuals with BMI ≥27 to 35 kg/m² with comorbidities or BMI > 40 kg/m2 with or without comorbidities. Pharmacotherapy of obesity has developed significantly in the last 60 years. The Federal Drug Administration (FDA) has so far approved six drugs for the long-term treatment of obesity. It is unlikely that a single pharmacological agent will be effective in the treatment of obesity. Therefore, future strategies for the treatment of obesity will need to promote effective weight loss and will likely require the simultaneous use of drugs that work through different mechanisms. Weight control goals emphasize the importance of a realistic approach to weight loss to reduce health risks, and include promoting weight loss, maintaining weight loss, and preventing weight gain. If one wants to reduce body weight, it is necessary to approach with several different strategies, including pharmacological therapy

Dementia and Psychiatric Emergencies in the Elderly Population

S obzirom na kontinuirano povećanje broja starijih osoba u ukupnoj populaciji u Hrvatskoj, za očekivati je da će se broj starijih osoba s akutnim psihičkim smetnjama koje zahtijevaju hitno zbrinjavanje sve više povećavati. Najčešći psihički poremećaji kod starijih osoba su: depresivni poremećaji, kognitivni poremećaji, demencija, poremećaji vezani uz uzimanje alkohola, poremećaji vezani uz druga zdravstvena stanja i lijekovima izazvani poremećaji. Gerijatrijski bolesnici bi u pravilu prvo trebali biti pregledani od strane stručnjaka somatske medicine (internista, neurologa, kirurga) prije nego što se upućuju u hitnu psihijatrijsku službu, kako bi se ustanovilo da su primarne smetnje iz psihijatrijske domene. Izražena depresija, suicidalnost, agitacija, sklonosti lutanju i ostalim rizičnim ponašanjima kod kuće, izražena anksioznost i smanjena sposobnost brige o sebi, glavni su razlozi hospitalizacije kod ovih bolesnika.Related to the fact of the continuous increase in the number of elderly people in the total population of Croatia, it can be expected that the number of elderly people with acute psychiatric disorders that require emergency care will increase. The most common psychiatric disorders found in the elderly are depressive disorders, cognitive disorders, dementia, alcoholrelated disorders, disorders related to other health conditions and drug-induced disorders. Geriatric patients should, generally speaking, first be reviewed by a psychosomatic medical specialist (internist, neurologist, surgeon) before they are sent to psychiatric emergency services in order to establish that the primary complaint is connected with the psychiatric domain. Pronounced depression, suicidality, agitation, wandering tendencies and other home-based risk behaviours, with anxiousness and reduced self-care ability, are the main reasons for hospitalization