Comorbidity of anxiety disorders and depression

IntroductionComorbidity of anxiety and depression is common and frequently poses diagnostic and treatment challenges in the clinical setting and are associated with significant morbidity.The aim of this study was to analyze the comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a clinical sample of a Bosnian population.MethodsRandomly selected subjects (aged between 18 and 64 years, N = 2202) which were hospitalized at the Psychiatric clinic in Sarajevo was analyzed. Subjects were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses.ResultsThe prevalence of generalized anxiety disorder, agoraphobia and social phobia was the highest among bipolar II patients (18.8, 32.5 and 18.7%), simple phobia was most prevalent in (nonbipolar) major depression (20.6%). The rate of panic disorder was almost the same in the (nonbipolar) major depressive and bipolar II subgroups (11.2 and 10.5%). Bipolar I patients showed a relatively low rate of comorbidity.ConclusionsThe findings support previous results on the particularly high rate of comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness, which has significant negative implications for both the course of these disorders and levels of dysfunction.</jats:sec

PTSD as risk factor for alcohol-related disorders

PTSD is highly correlated with alcohol and drug abuse.ObjectiveTo estimate impact of PTSD on frequency of various forms of alcohol induced disorder.MethodResearch conducted during 2006 at Psychiatric Clinic in Sarajevo. It included: first group (I) of 50 patients with PTSD and alcohol induced disorders and second (II) group of 50 patients with alcohol induced disorder without PTSD.ResultsComparing results these two groups, we found:Alcohol intoxication: I group 11 (22%) vs. II group 15 (30%)Alcohol withdrawal: 3 (7%) vs. 4 (8%)Psychotic disorder with hallucinations: 11 (22%) vs. 9 (18%)Psychotic disorder with delusions: 7 (14%) vs. 5 (10%)Delirium: 6 (12%) vs. 9 (18%)Amnesic disorder: 9 (18%) vs. 4 (8%)Blackouts: 1 (2%) vs. 1 (2%);Seizures: 2(4%) vs. 3(6%).ConclusionIt seems that PTSD frequently caused more severe clinical forms of alcohol disorders, which should be prove in larger sample. This could be considered in prevention alcohol and PTSD as well.</jats:sec

Combination of aripiprazole and olanzapine in first episode psychosis patient with metabolic syndrome: A case report

There are numerous factors that predispose patients with schizophrenia to develop metabolic syndrome and become overweight including: physical passivity, unhealthy diet and anti-psyhotic treatment. The prevalence of anti-psychotic-related metabolic disturbances has been reported to vary from 23% to 50% and clozapine and olanzapine had the most pronounced potential to cause metabolic syndrome. We present the case of 32-year-old male who has been diagnosed with first episode schizophrenia spectrum psychosis and has been treated for 3 months in the community mental health center. He was medication–compliant and was prescribed olanazapine 10 mg a day and had initial remission of symptoms. The reason behind referral to our department of psychiatry was development of metabolic syndrome. Immediately upon admission to our department basic panel blood tests (minerals, creatinin, glucose, tryglicerides and cholesterol) as well as complete blood count were done. Patient reported gaining weight of more than 5 kilograms since the initiation of the olanzapine treatment. Results of the performed metabolic tests in addition to abnormal BMI and slightly higher blood pressure have indicated presence of metabolic syndrome. In order to try to reverse metabolic syndrome aripiprazole was commenced adjunctive to olanzapine. During the first week the dosage of aripiprazole was 2.5 mg/day, second week 5 mg/day and then increased to 10 mg a day. Three weeks after adding aripiprazole to olanzapine lab values of holesterol, triglycerides, fasting glucose as well as BMI were significantly lowered and symptoms of the metabolic syndrome were mitigated. Treatment was well tolerated.Disclosure of interestThe authors have not supplied their declaration of competing interest.</jats:sec

Predictors of influenza vaccination uptake among elderly in Croatia

Abstract Background Influenza vaccination (IV) is recommended for elderly but vaccination coverage in this group remains unsatisfactory in Croatia. The aim of this study was to explore IV uptake among elderly from Eastern Croatia and predictors that influence this uptake. Methods This cross-sectional questionnaire study was conducted during 2018/2019 influenza season in convenient sample of older adults aged 65 years or more from Eastern Croatia at the primary health care setting. Results The study sample consisted of 816 subjects (48.0% males and 52.0% females). The median age of all subjects was 73.0 years (interquartile range (IQR) 69.5 - 79.0 years). The overall prevalence of IV uptake was 33.3%. The IV uptake was statistically more frequent among females (P &amp;lt; 0.001) and old-old subgroup (85 years and older) (P &amp;lt; 0.001). There was no statistically significant difference in IV uptake considering marital status of subjects (P &amp;gt; 0.999). The median number of positive attitudes towards IV was 4.0 (IQR 2.0 - 4.0) and the median number of correct answers was 6.0 (IQR 4.0 - 8.0). The study revealed fair positive correlation between attitudes and IV uptake (rho=0.477; P &amp;lt; 0.001) and poor positive correlation between knowledge and IV uptake (rho=0.242; P &amp;lt; 0.001). The study further showed poor positive correlation between presence of comorbidities and IV uptake (rho=0.187; P &amp;lt; 0.001) and moderate positive correlation between previous year vaccination history and IV uptake (rho=0.669; P &amp;lt; 0.001). Conclusions The study showed that observed IV uptake is far below EU target influenza vaccination coverage among elderly of 75%. The study revealed that fairly good predictors of IV uptake in study population were gender, older age group, and previous year vaccination history while attitudes, knowledge and presence of comorbidities were fairly poor predictors. The good predictors of IV uptake among elderly should be taken into account during influenza vaccination popularization strategies development. Key messages Understanding the factors that could improve the acceptance of vaccination is crucial to design effective public health interventions. The structured communication campaigns on influenza and influenza vaccines should be developed and directed specifically to elderly as one of target groups for vaccination. </jats:sec