How can we improve clinical outcome by understanding the inseparability of mind and body ?

We have experienced that very often the medical outcome does not depend exclusively on laboratory results or clinical findings, but also on the invisible part of every human - his mind. We focused on reviewing previous studies on the inseparability of mind and body in different medical specialties, improvement of communication skills and understanding human psychology in everyday clinical practice. The psychosomatic effects in cardiology, gastroenterology, diabetology and dermatology that we adduced in our review article requires a comprehensive personalized assessment that takes into consideration the interaction of the mind, body, and social environment. Mentioning many medical specialties, we can conclude that a psychosomatic approach and given solutions should not be only restricted to psychiatry, medical psychology and psychosomatic medicine, but rather involved into almost any clinical practice

THE RELATIONSHIP BETWEEN ALEXITHYMIA AND MORBIDITY

Aleksitimija je sindrom definiran kao nesposobnost prepoznavanja i izražavanja emocija. To je česta odlika u pacijenata s problemom ovisnosti, posttraumatskim stresnim poremećajem i psihosomatskim poremećajima kao što su gastrointestinalne bolesti, migrena, dermatološki simptomi i sindrom iritabilnog kolona. Aleksitimija je usko povezana s poremećajem regulacije afekta kao što je modulacija uzbuđenja, odgovarajućom ekspresijom i supresijom emocija, tolerancijom bolnih emocija i kognitivnom asimilacijom. Pretpostavlja se da aleksitimija ima vrlo važnu ulogu i u patogenezi medicinski neobjašnjenih tjelesnih simptoma i faktor je rizika od nekih psihosomatskih stanja. Klinički je važna činjenica da je većina pacijenata s medicinski neobjašnjenim tjelesnim simptomima sposobna prepoznati da njihovi tjelesni simptomi mogu biti povezani s depresijom ili anksioznim poremećajem kao najčešćim psihičkim poremećajima.Alexithymia is a tendency to experience psychological distress in the form of somatic symptoms. Alexithymia is a syndrome that is defined by the inability to recognize and express emotions. It is a common feature in patients with psychoactive abuse disorders, post-traumatic stress disorder, and psychosomatic disorders such as gastrointestinal complaints, migraine, dermatological symptoms, and irritable bowel syndrome. Alexithymia is associated with a failure to use adaptive affect regulation such as modulating arousal, appropriately expressing or suppressing emotions, tolerating painful emotions and cognitive assimilation. Alexithymia is presumed to play a very important role in the pathogenesis of medically unexplained physical symptoms and it is a risk factor for a psychosomatic condition. It is of clinical importance that the majority of patients with medically unexplained physical symptoms are able to recognize that their physical symptoms may be related to their depression or anxiety disorder which are the most common mental disorders

Upotreba likovnog izričaja u analitički orijentiranoj psihoterapiji djece i adolescenata

U psihoterapiji djece i adolescenata često je nemoguće ostvariti dostatnu i u dijagnostičkom i terapijskom smislu zadovoljavajuću verbalnu komunikaciju s pacijentom, stoga je potrebno poznavati određene alate kojima se ona može nadomjestiti. Najbolji primjer takvog alata je upotreba likovnosti, koju vrlo često koristimo, ne samo kao dijagnostičko, već i kao psihoterapijsko sredstvo. Upotrebom, npr. slike i crteža omogućujemo ventilaciju, tj. smanjenje tjeskobe, sublimaciju, uvid u nesvjesno funkcioniranje i dana nam je mogućnost praćenja terapije i razumijevanja terapijskog analitičkog procesa. Interpretacija crteža nikad nije jednosmjeran proces, već zahtijeva dijalog terapeuta i pacijenta, te izvrsno poznavanje pacijenta. Tehnika je upotrebljiva za široki raspon psihopatologije kako u djece i adolescenata, tako i u odraslih. Ovim radom želimo ukazati, kako na aktualnu prisutnost upotrebe crteža i slike kao dijela psihoanalitički orijentiranog psihoterapijskog procesa liječenja djece i adolescenata na našim prostorima, tako i na nezaobilazno značenje i nužnost upotrebe ove tehnike u dijagnostičkom i terapijskom smislu u dječjoj i adolescentnoj psihijatriji

ALEXITHYMIA AND PSYCHOLOGICAL DISTRESS AMONG WOMEN UNDERGOING IN VITRO FERTILIZATION

Background: The aim of the current study was to analyze the relationship between alexithymia, anxiety, physical problems, trauma, and psychological distress in women undergoing in vitro fertilization. Subjects and methods: The study was based on 78 women (mean age = 34.4 ys) who were referred to a fertility treatment with in vitro fertilization. The questionnaires (socio-demographic questionnaire, Toronto Alexithymia Scale, and Clinical Outcomes in Routine Evaluation – Outcome Measure) were administered by the investigators. Results: Our results suggest that alexithymia was significantly correlated to anxiety (r=0.506, p=0.00), depression (r=0.591, p=0.00), physical problems (r=0.477, p=0.00), trauma (r=0.512, p=0.00), and psychological distress (r=0.598, p=0.00). Furthermore, high alexithymia group showed significantly higher levels of anxiety (F=4.65, p=0.00), depression (F=2.30, p=0.00), trauma (F=1.80, p=0.00) and general psychological distress (F=2.85, p=0.04) than the low alexithymia group. Conclusions: Results of the present study point out that alexithymia could be considered a potential risk factor for high levels of anxiety, depression and general psychological distress. It may also be used as an indicator of a need for further psychological support aimed at women undergoing in vitro fertilization

Aggression in Children and Adolescents

U suvremenom društvu s evidentno povećanom incidencijom agresivnog ponašanja, razvidan je tome pridružen porast agresivnog ponašanja i poremećaja u vezi s agresijom kod djece i adolescenata. Zbog ovog rastućeg problema koji opterećuje obitelji, škole, socijalne i medicinske radnike i društvo u cjelini, intenzivno se traga za sredstvima njegovog učinkovitog prepoznavanja, prevencije, dijagnoze i liječenja. Ovaj članak dopunjuje već poznate teorije nedavnim studijama i novootkrivenim saznanjima i pokušava ponuditi potpuni pregled ove složene teme. Pokazuje odnos između naslijeđa, roditeljskih kvaliteta, odgoja, utjecaja vršnjaka i društvenih normi te način na koji oni postaju rizični za razvoj problematičnog ponašanja. Članak ističe i mogućnosti prevencije i liječenja, posebice kod izdvojenih, visokorizičnih skupina, ali naglašava i napredak primijećen u školama u kojima su se provodili neki od preventivnih programa agresivnosti djece i adolescenata.In a modern society with an evidently increased incidence of aggressive behaviour, it is noticeable that aggressive behaviour and disorders related to aggression in children and adolescents are rising accordingly. Due to this growing problem which burdens families, schools, social and medical workers and society as a whole, there is an intensive search is underway for means of its efficient detection, prevention, diagnosis and treatment. This article combines previously established theories with recent studies and new findings and tries to offer a complete overview of this complex subject. It shows the relationship between heredity, parental qualities, upbringing, peer influence and social norms, indicating which of these are risk factors for developing such problematic behaviour and in what manner. The article points out prevention and treatment possibilities, especially of selected high-risk groups, but also emphasizes the progress observed in schools where some of the prevention programmes on this subject have been implemented

THE ROLE OF RELIGIOSITY IN COPING WITH INFERTILITY TREATMENT

Background: To analyze relationship between religiosity and psychological distress in woman undergoing in vitro fertilization. Subjects and methods: The study was based on 103 woman engaged in a fertility treatment with in vitro fertilization. The questionnaires (Religiosity Questionnaire, Clinical Outcomes in Routine Evaluation Outcome Measure, and socio-demographic questionnaire) were administered by investigators. Results: The results suggest that the level of religiosity significantly differs participants in terms of problems (F=1.92, p=0.01), functioning (F=1.79, p=0.03), risk behaviors (F=3.02, p=0.00), anxiety (F=1.72, p=0.03) and physical problems (F=1.82, p=0.02). There were no significant differences in subjective wellbeing, depression and traumatization according to religiosity. Conclusion: Results of a present study point out that religiosity could be considered as a protective factor for psychological distress

Aggression in Children and Adolescents

U suvremenom društvu s evidentno povećanom incidencijom agresivnog ponašanja, razvidan je tome pridružen porast agresivnog ponašanja i poremećaja u vezi s agresijom kod djece i adolescenata. Zbog ovog rastućeg problema koji opterećuje obitelji, škole, socijalne i medicinske radnike i društvo u cjelini, intenzivno se traga za sredstvima njegovog učinkovitog prepoznavanja, prevencije, dijagnoze i liječenja. Ovaj članak dopunjuje već poznate teorije nedavnim studijama i novootkrivenim saznanjima i pokušava ponuditi potpuni pregled ove složene teme. Pokazuje odnos između naslijeđa, roditeljskih kvaliteta, odgoja, utjecaja vršnjaka i društvenih normi te način na koji oni postaju rizični za razvoj problematičnog ponašanja. Članak ističe i mogućnosti prevencije i liječenja, posebice kod izdvojenih, visokorizičnih skupina, ali naglašava i napredak primijećen u školama u kojima su se provodili neki od preventivnih programa agresivnosti djece i adolescenata.In a modern society with an evidently increased incidence of aggressive behaviour, it is noticeable that aggressive behaviour and disorders related to aggression in children and adolescents are rising accordingly. Due to this growing problem which burdens families, schools, social and medical workers and society as a whole, there is an intensive search is underway for means of its efficient detection, prevention, diagnosis and treatment. This article combines previously established theories with recent studies and new findings and tries to offer a complete overview of this complex subject. It shows the relationship between heredity, parental qualities, upbringing, peer influence and social norms, indicating which of these are risk factors for developing such problematic behaviour and in what manner. The article points out prevention and treatment possibilities, especially of selected high-risk groups, but also emphasizes the progress observed in schools where some of the prevention programmes on this subject have been implemented