Physical health of individuals with psychosis - a mixed method study

People with psychosis have poorer physical health than the general population and this aspect of care delivery has largely been neglected. The IMPULSE trial (ISRCTN 11913964) investigated a psychosocial intervention prompting people with psychosis to discuss their physical health concerns with mental health clinicians. This mixed-method study explored a series of clinical meetings over 6 months to understand how physical health is discussed, what actions are taken, and if these translated into benefits for the participating individuals with psychosis. 221 individuals with psychosis were included, attending 847 clinical meetings over 6 months. Results show that, when prompted, most participants (54%) took up the opportunity to discuss their physical health at least once. These individuals were keen to make changes such as adopt healthy diet, stop smoking, lose weight, etc. Despite taking steps to achieve these goals, after 6 months no improvement was detected in subjective satisfaction with physical health, severity of physical health problems or satisfaction with services. Adopting healthier lifestyle behaviours is difficult even in motivated individuals. Future research is needed to determine innovative approaches to promote lifestyle change in individuals with psychosis

THE COMORBIDITY OF DIABETES MELLITUS AND PSYCHIATRIC DISORDERS

Diabetes mellitus is a chronic disease affecting approximately 6% of the general population. Depression and schizophrenia are often comorbid with diabetes. There are two main ways to explain this phenomenon. Firstly, patients with diabetes mellitus have higher incidence of psychiatric disorders and secondly, antidepressants and antipsychotics may cause metabolic abnormalities. Antidepressants with noradrenergic activity have the highest potential to cause metabolic abnormalities. In schizophrenia, the risk is highest with clozapine and olanzapine pose the highest risk, moderate for risperidone and quetiapine, while ziprasidone and sertindole have not been associated with diabetes. American Diabetes Association and American Psychiatric Association suggested that optimal management of patients with schizophrenia should include baseline assessment on their weight, waist circumference, blood pressure, blood glucose level and lipidogram and family history on obesity, diabetes, dyslipidemia, hypertension and cardiovascular illness. During the first three months, weight gain should be monitored on monthly basis, while biochemical analysis should be performed after the first three months, and then once a year. In patients with significant weight gain, increase of blood glucose level or dyslipidemia, the first intervention should be switch to another antipsychotic. If necessary, a patient should be referred to an endocrinologist and advised on changing their life style

Interventions for posttraumatic stress disorder in psychiatric practice across Europe: a trainees' perspective

BACKGROUND: With an annual prevalence of 0.9-2.6%, posttraumatic stress disorder (PTSD) is very common in clinical practice across Europe. Despite the fact that evidence-based interventions have been developed, there is no evidence on their implementation in clinical practice and in national psychiatric training programmes. ----- OBJECTIVE AND METHOD: The Early Career Psychiatrists Committee of the European Psychiatric Association conducted a survey in 23 European countries to explore implementation of evidence-based interventions for PTSD and training options. ----- RESULTS: The findings indicate that pharmacotherapy was available in the majority of the participating countries (n=19, 82.8%). However, psychological interventions were much less widespread. For example, psychoeducation was widely available in 52% of the countries (n=12), cognitive-behavioural therapy in 26.2% (n=6), and specific trauma-focused techniques were rarely available. Training on PTSD was part of the official training in 13 countries (56.5%), predominantly in the form of theoretical seminars. ----- CONCLUSIONS: Overall, this survey indicates that the treatment for PTSD is largely focused on pharmacotherapy, with psychological evidence-based interventions poorly available, especially outside specialized centres. Poor implementation is linked to the lack of official training in evidence-based interventions for psychiatric trainees across Europe

PHARMACOGENETICS AND INTERACTIONS OF ANTIDEPRESSANTS IN THE TREATMENT OF CO-MORBID ILLNESS

Patients who require long-term treatment for depression have an increased risk of experiencing drug interactions since they will take medications for and/or co-morbid illness. Antidepressants can be the object of drug interactions by other substances, or they can precipitate interactions by inhibiting enzyme pathways. There is an increasing agreement about the importance of polymorphisms in cytochrome P450 enzymes and the effects of drug-drug interactions in relation to the incidence of adverse effects. Genetic test suitable for the routine laboratory are now available for some important metabolizing enzymes (e.g. CY2D6, CY2C19) identifying those individuals who are slow or fast metabolizers of certain drugs. Specific antidepressants differ in the interactions with CYP450 isoenzymes and in their susceptibility to drug-drug interactions. The main focus of this article is pharmacokinetic drug interactions of antidepressants. With that specific knowledge, clinicians can improve outcomes of depressed patients, by considering the possibility of drug interactions both before prescribing a specific antidepressant and while monitoring for response, adverse effects and patient compliance

PHARMACOGENETICS AND INTERACTIONS OF ANTIDEPRESSANTS IN THE TREATMENT OF CO-MORBID ILLNESS

Patients who require long-term treatment for depression have an increased risk of experiencing drug interactions since they will take medications for and/or co-morbid illness. Antidepressants can be the object of drug interactions by other substances, or they can precipitate interactions by inhibiting enzyme pathways. There is an increasing agreement about the importance of polymorphisms in cytochrome P450 enzymes and the effects of drug-drug interactions in relation to the incidence of adverse effects. Genetic test suitable for the routine laboratory are now available for some important metabolizing enzymes (e.g. CY2D6, CY2C19) identifying those individuals who are slow or fast metabolizers of certain drugs. Specific antidepressants differ in the interactions with CYP450 isoenzymes and in their susceptibility to drug-drug interactions. The main focus of this article is pharmacokinetic drug interactions of antidepressants. With that specific knowledge, clinicians can improve outcomes of depressed patients, by considering the possibility of drug interactions both before prescribing a specific antidepressant and while monitoring for response, adverse effects and patient compliance

PSYCHOLOGICAL AND SOMATIC HEALTH PROBLEMS IN BOSNIAN REFUGEES: A THREE YEAR FOLLOW-UP

Background: Aim of this study was to explore association between psychiatric disorders (PTSD and depression) and chronic medical illnesses in a group of Bosnian refugees followed up for three years (1996-1999). Subjects and methods: Study was conducted in refugee camps in Varaždin, Nbaseline=534, Nendpoint=376 (70.4%). The interviews were conducted in Bosnian, data on depression and PTSD were collected using the Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire, respectively. Medical conditions were self-reported. Results: Most important findings: 1) Half of the sample at both study points reported no psychiatric problems (N=294, 55% vs. N=225, 59%), others suffered from depression (N=99, 18.5% at both times), PTSD (N=30, 5.6% vs. N=15, 4%), and depression + PTSD (N=129, 24.2% vs. N=114, 30.3%); 2) A total of 15 medical conditions were identified, and most frequently present were high blood pressure (N=201, 37.6%) and heart disease (N=167, 31.3%); 3) Occurrence of medical conditions was related to the clinical group – they were more frequent in subjects diagnosed with depression and depression + PTSD, than in those who were asymptomatic or suffering from PTSD only. Conclusions: Our data indicate the persistence of both psychological and somatic health problems in Bosnian refugees involved in this study over time. Holistic approach and avoiding of mind-body dualism might be beneficial for the care and long-term prognosis of these people

PHARMACOGENETICS AND ANTIPSYCHOTICS IN THE LIGHT OF PERSONALIZED PHARMACOTHERAPY

The concept of personalized drug therapy on the basis of genetic investigations has become a major issue in psychopharmacology. Pharmacogenetic studies have focused on polymorphisms in liver cytochrome P450 isoenzymes that metabolize many antidepressant and antipsychotic medications. The most significant results are the association between drug metabolic polymorphisms of cytochrome P450 with variations in drug metabolic rates and side effects. Additionally, polymorphisms in dopamine and serotonin receptor genes are repeatedly found associated with response phenotypes, probably reflecting the strong affinities that most antipsychotics display for these receptors. The contribution of kinetic factors to the clinical outcome of antipsychotic treatment has a strong evidence base. Genetic tests for the pretreatment prediction of antipsychotic response have obvious implications for the selection of most appropriate drug and dose and contribute for the optimization of antipsychotic treatment. The pretreatment determination of individual’s drug metabolic rates by CYP genotyping is the leading field. This review summarizes the present knowledge of associations between cytochrome P450 isoenzymes and the efficacy and side effects of antipsychotics

Utjecaj gnojidbe i sorte na komponente prinosa salate (Lactuca sativa L.)

Salata (Lactuca sativa L.) je veoma važna i široko rasprostranjena povrtna kultura. Zbog brojnih nutritivnih i ljekovitih karakteristika, salata ima značajnu ulogu u prevenciji bolesti. Biološke karakteristike salate i njen specifičan rast i razvoj predstavljaju osnovu za uspostavljanje optimalnog načina uzgoja. U cilju da se postignu odgovarajući visoki prinosi, vrši se prihrana različitim organskim, mineralnim i mikrobiološkim gnojivima. Ona imaju veliki značaj prilikom rasta i razvoja salate, a osim toga utječu i na njene kvalitativne karakteristike. Cilj istraživanja je bio utvrditi učinak primjene različitih gnojiva na kvalitetu i kvantitetu različitih sorti salate u proljetnoj proizvodnji. Postavljen je dvofaktorijalni pokus (gnojivo x sorta) po slučajnom blok sustavu u plasteniku bez grijanja, na privatnoj parceli, na lokalitetu Lukavica, područje grada Istočno Sarajevo. Tijekom istraživanja ispitivan je utjecaj gnojiva (kontrola, Slavol, Fitofert hemisuper) na dvije sorte salate (Santoro RZ i Kiribati RZ) i to na: dužinu korjena (cm), broj listova, masu nadzemnog dijela biljke (g) i prinos (kg/m2). Najveća dužina korjena zabilježena je na varijanti gnojiva s fitofertom (10,02 cm) i u usporedbi s kontrolnom varijantom (8,55 cm) razlika je bila statistički značajna. Najveći prinos (509,5 kg/100m2) ostvaren je na varijanti gnojidbe s mikrobiološkim gnojivom, a najmanji na kontrolnoj varijanti (250 kg/100 m2). Razlike u ostvarenom prinosu unutar sorti nisu bile statistički opravdane

Parental adherence to Mediterranean diet is associated with their adolescents´ cereals intake

The Mediterranean diet (MD), abundant in whole grains, is known to be one of the healthiest dietary patterns. Given the health benefits of whole grain cereals as a rich source of nutrients and phytochemicals, this study examined parental adherence to MD and its association with their adolescents’ cereals intake, in 203 parent-adolescent dyads. Adherence to MD was evaluated using the Mediterranean Diet Quality Index for adolescents (13.5±1.2y) and the Short Mediterranean Diet Questionnaire for parents (41.53±5.99y). Although the level of the parents’ adherence to MD did not significantly influence the adolescents´ weekly consumption frequency of pasta and rice, adolescents whose parents had higher adherence to MD (44.3%) more often ate cereals or grains for breakfast (p=0.045) and less frequently, commercially baked goods or pastries (p=0.043). Adolescents of parents who had lower adherence to MD (55.7%) stated that they would eat more whole grain bakery products (p=0.049) and more breakfast cereals (p=0.039) if those foods were more often available at home. Adolescents with parents who had higher adherence to MD stated that they were more often encouraged by their parents to eat whole grain bakery products (p=0.030), compared with their counterparts whose parents had lower adherence to MD. With this study, we revealed that food environment and parental eating behaviour are notable factors that influence adolescents’ dietary intake. Disease prevention health programs should focus more strongly on encouraging parents to adopt MD features in their family food environment

Posttraumatic Stress Disorder in Women – Experiences form the Psychiatric Clinic, University Hospital Center Zagreb, Croatia

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops after a severe traumatic event or experience. Lifetime prevalence rate in the European population is 1.9 % and it is higher for women (2.9%) then for men (0.9 %). The aim of this study was to examine rates and sociodemographic and clinical characteristics of women with PTSD who were hospitalized at the Psychiatric clinic of University Hospital Center in Croatia over the years 1990–2007. Data were gathered retrospectively from the medical charts. We found that 67 women were diagnosed with PTSD which is 0.58% of all admissions over these years. Majority suffered from comorbid depression (N=51) and various somatic conditions, especially malignant gynecological tumors (N=23). No significant differences were found in distribution of PTSD symptoms in relation to the combat vs. civilian trauma. We found that patients with combat trauma often suffer from comorbid depression, while those with civilian traumas more often reported somatic conditions, especially malignant gynecological tumors. Our institution is a speciality clinic at a tertiary care medical center which tends to accumulate patients with serious forms of the disorder, and therefore our results can not be generalized to other settings involved in working with women with PTSD. Our results indicate that psychiatrists’ assessment of female patients should inevitably include lifetime traumatic experiences, and among those with PTSD, special attention should be paid to comorbid depression and malignant tumors