PSYCHO-ONCOLOGY AND SPIRITUALITY

Psycho-oncology is a branch of medicine which, combining psychiatry and oncology, studies the biological and psychological factors related to the onset and treatment of carcinoma. The struggle with this life-threatening disease requires an adaptation to a new life situation characterized by changed routines of everyday life and dynamics of personal relationships. The psycho-oncological approach is a multidisciplinary one, as modern medicine recognizes more and more the role of spirituality in the treatment and recovery from various pathological conditions. Spirituality is the adaptive capability of intelligent beings to retain the will for life in spite of adversities and awareness of the imminence of death. Faced with a challenge of malignant disease people are nevertheless able to react with positive personality changes, which leads them to a more meaningful and substantial life. The so-called posttraumatic growth is a feature which enables an individual to assume control over his own reactions to disease, which in turn can have a positive influence on the treatment outcome. An essential role in this process is played by the spiritual growth of an individual. Malignant disease can represent an opportunity for spiritual growth, a dimension often neglected by contemporary lifestyles. Religion, as an important constituent part of spirituality, can offer the believer a meaning of suffering and thus turn the disease into an opportunity for self-knowledge and development of a more mature spirituality. Christian spirituality can represent a path which helps an individual to cope with malignant disease. Modern medicine should be based on a multidisciplinary approach to the patient and encompass all the human dimensions (rational, emotional and spiritual), whereas treatment itself must be both personalized and participatory

POSTTRAUMATIC STRESS DISORDER AND DEPRESSION AS COMORBID DISORDERS

Introduction: Depression is the most frequent disorder of today. It is unique for the fact that it can become a comorbid illness with almost any other psychiatric disorder. Premorbid depression is also a risk factor for the development of PTSD, while at the same time traumatic experience is a risk factor for the development of depression. These facts show us that a close connection between these two diagnostic entities exists. Aim of this research was to analyze the levels of depressiveness in patients that were hospitalized and patients that were treated in the Day hospital. Also, to establish the connection of age, time spent in combat (war), length of treatment and number of hospitalizations with the results from the Beck’s depression inventory. Subjects and methods: Participants were divided into two groups, 36 patients that were treated for PTSD in a hospital setting and 64 patients that were treated in the Day hospital. Participants completed Beck’s self-evaluation inventory for depression, as it assesses the degree of depression. Results: Two groups did not differ regarding to age, time spent in combat (war), the length of treatment and level of depressiveness assessed by Beck’s depression inventory. Score on Beck’s depression inventory was significantly positively correlated with the age of participants and the number of hospitalizations. Older participants and participants that were hospitalized more often score higher on Beck’s depression inventory. Conclusion: Results show that there is no difference between the two groups of participants of differing levels of depressiveness, but depression most often presents as severe depression in both groups of participants. Older participants and participants that were hospitalized more often are more depressed. This research points to the fact that it is necessary to treat PTSD and depression at the same time, because parallel treatment of these comorbid disorders leads to a decrease of the rate of suicide, due to the fact that depression is often the leading cause of suicide

POSTTRAUMATIC STRESS DISORDER AND DEPRESSION AS COMORBID DISORDERS

Introduction: Depression is the most frequent disorder of today. It is unique for the fact that it can become a comorbid illness with almost any other psychiatric disorder. Premorbid depression is also a risk factor for the development of PTSD, while at the same time traumatic experience is a risk factor for the development of depression. These facts show us that a close connection between these two diagnostic entities exists. Aim of this research was to analyze the levels of depressiveness in patients that were hospitalized and patients that were treated in the Day hospital. Also, to establish the connection of age, time spent in combat (war), length of treatment and number of hospitalizations with the results from the Beck’s depression inventory. Subjects and methods: Participants were divided into two groups, 36 patients that were treated for PTSD in a hospital setting and 64 patients that were treated in the Day hospital. Participants completed Beck’s self-evaluation inventory for depression, as it assesses the degree of depression. Results: Two groups did not differ regarding to age, time spent in combat (war), the length of treatment and level of depressiveness assessed by Beck’s depression inventory. Score on Beck’s depression inventory was significantly positively correlated with the age of participants and the number of hospitalizations. Older participants and participants that were hospitalized more often score higher on Beck’s depression inventory. Conclusion: Results show that there is no difference between the two groups of participants of differing levels of depressiveness, but depression most often presents as severe depression in both groups of participants. Older participants and participants that were hospitalized more often are more depressed. This research points to the fact that it is necessary to treat PTSD and depression at the same time, because parallel treatment of these comorbid disorders leads to a decrease of the rate of suicide, due to the fact that depression is often the leading cause of suicide

CAPSAICIN - POTENTIAL SOLUTION FOR CHRONIC PAIN TREATMENT

Chronic pain is a painful condition defined by its duration where pain persists three months or more. Pain is connected with the high price of health care, work inability and disability. Moreover, it has significant consequences for patients and their families, working organizations and the society as a whole. The prevalence of chronic pain can range between 11.0% and 51.3% in general population. Pain is usually coherent with distress and a range of psychological symptoms such as depression, anxiety, altered attention and cognition manifesting as fear. Comprehensive pain management should always include the treatment of associated psychological symptoms. Multidisciplinary approach in treating chronic pain and its comorbidities and proper education of primary care physicians and different specialists involved in the management of chronic pain are crucial for better clinical outcomes. Topical capsaicin acts as a highly selective agonist of transient receptor potential vanilloid 1 of C and A nociceptors. Repeated applications or high concentrations give rise to a long-lasting effect termed defunctionalisation. In addition, the reduction of central sensitization through reduced C-nociceptor input contributes to capsaicin\u27s indirect mechanism of action. Capsaicin provides effective durable pain relief and reduction of intensity and area of pain in adult patients with chronic pain with a faster onset of analgesia and considerably fewer systemic adverse effects than the conventional treatment. While offering high levels of pain relief, additional improvements in sleep, fatigue, depression and quality of life have been noticed. Topical administration avoids dangerous systemic adverse effects and enables the combination with other drugs and analgesics with limited drug-drug interactions. Adding capsaicin to the standard chronic pain treatment might improve, fasten and ease the challenging path of managing chronic pain consequently providing the patient and their society with better quality of life

Prevalence of Metabolic Syndrome among Patients with Major Depressive Disorder – Differences Between Newly Diagnosed First Episode and Recurrent Disease

The objective of the present study was to assess differences in prevalence of the metabolic syndrome among depressed patients in regard to the duration of the illness (first episode versus recurrent episodes). A total of 190 patients suffering from major depressive disorder were included in the study, diagnosed according to International classification of disor- ders, 10th revision 1 . The same criteria were used to divide participants into two groups: first episode major depressive disorder and major depressive disorder with recurrent episodes. The metabolic syndrome was defined according to the criteria of the American National Cholesterol Education Program-Treatment Panel III 2 . Results showed that metabolic syndrome is significantly more prevalent in patients with recurrent major depressive disorder (45.2%) compared to pa- tients with first episode of major depressive disorder (27.3%), mainly due to differences in plasma glucose, triglycerides and HDL-cholesterol levels. These findings indicate the importance of the duration of depression and the number of re- curring episodes as factors involved in etiopathogenesis of the associated metabolic syndrome

Correlation of Levels of Depressiveness and Choice of Elective Subjects in Medical Students

The aim of this research was to establish if a correlation exists between the choice of an elective subject, namely subjects »Depression« and »Diabetes«, and levels of depressiveness in medical students. Three groups of third year medical students attending School of medicine, Rijeka University, were tested for the level of depression using Beck’s self-evaluation scale. The groups consisted of 30 non-randomly selected students that had enrolled elective subject »Depression« and 29 non-randomly selected students that had enrolled elective subject »Diabetes«, and the third group of 30 randomly selected third year medical students that had enrolled none of the previously mentioned elective subjects. Median age of participants in this research was 25.24. The results showed no statistically significant difference in overall level of depressiveness among the groups. By testing for the difference between group pairs, there was a statistically significant difference between depressiveness in students attending »Depression« and »Diabetes«, the latter being significantly more depressed (M=8.30 in »Depression« group; M=11.41 in »Diabetes« group; p=0.04). In total there were 33 males and 56 females that participated in this research. Gender difference was also tested, and there was no statistically significant difference between sexes among groups. The difference was found only within the group of students attending »Depression« elective subject, where females scored significantly higher on Beck’s questionnaire (z=2.26; p=0.03). The analysis of difference between items of the Beck’s questionnaire showed statistically significant difference in the item »Feeling of rejection«, where students attending elective subjects other then »Depression« scored significantly higher; differences in the items »Urge for punishment« and »Suicidal tendencies« were also found between »Diabetes« and »other elective subjects« group, in favor of »Diabetes« group; in the item »Weight loss« students attending »Diabetes« elective subject scored significantly higher then their peers in both other groups. The results indicate the possibility of a protective role of psycho-educative component provided to the students attending elective subject on depression within medical school environment, that has repeatedly been shown to be stressful and demanding and is beneficial for the onset of depressive disorders

DIMENSIONS OF HUMAN SPIRITUALITY, LAYMAN UNDERSTANDINGS OF HEALTH AND LIMITS OF MEDICINE

The essence of human uniqueness and what is special about humans is spirituality. What is unique to every human being is his: language, sociability, politic, science, art, technical and working attitudes, playing games, fun and laughter, as well as religiosity and ethical attitudes. All of these dimensions are based upon spirituality or even the human spirit. This paper aims to relate all these dimensions of human spirituality to the sick person and establish to what extent that person is imbued with them and whether he can rely on them. Furthermore, this paper attempts to shed some light on the limits of medicine, especially as seen by Ivan Illich. In the end we are left with a series of questions, and possibly with an indisputable fact that the person who is suffering physically or mentally is "saved" by his most amazing unique trait – his religiosity

Utjecaj polimorfizma gena serotoninskog sustava na izraženost dentalne anksioznosti

The aim of the study was to test the correlation between 5-HTTLPR polymorphism and dental anxiety. Research hypothesis was that positive relation between the expression of dental anxiety and the S allele exists in the population of healthy Caucasians. We conducted a prospective study on 159 subjects, volunteers made up of medical and non-medical staff of the Sestre milosrdnice University Hospital Centre. Both genders were included, age range 19 to 59, mentally and physically healthy (according to DSM-5 classification of mental disorders). For the purpose of this research, we used a sociodemographic questionnaire containing the following information: age, gender, education level, work status, marital status and residence. Corah’s Dental Anxiety Scale-Revised (DAS-R) was used to measure dental anxiety. Data distribution was tested by Kolmogorov-Smirnov test, difference between the groups by χ2-test and one-way analysis of variance, and correlation of variables by logistic regression. In the study population, we found positive correlation between S-allele and total result in DAS-R questionnaire. The presence of S allele suggests that the person will have a higher result in DAS-R questionnaire, i.e. higher expression of dental anxiety.Cilj studije bio je ispitati povezanost polimorfizma 5-HTTLPR i dentalne anksioznosti. Naša hipoteza pretpostavlja pozitivnu povezanost izraženosti dentalne anksioznosti s S alelom u populaciji zdravih bijelaca. Provedena je prospektivna studija na 159 ispitanika, dobrovoljaca koje je sačinjavalo medicinsko i nemedicinsko osoblje KBC-a “Sestre milosrdnice”. U istraživanje su uključeni ispitanici obaju spolova, dobnog raspona od 19 do 59 godina, tjelesno i psihički zdravi (bez poremećaja prema klasifikaciji DSM-5). U istraživanju smo rabili sociodemografski upitnik sa sljedećim podacima: dob, spol, stupanj naobrazbe, radni status, bračno stanje, mjesto stanovanja. U svrhu mjerenja dentalne anksioznosti primijenjen je Corahov upitnik o dentalnoj anksioznosti (Corah Dental Anxiety Scale-Revised, DAS-R). Raspodjela podataka testirana je Kolmogorov-Smirnovljevim testom. Za testiranje razlike među skupinama primijenjen je χ2-test i jednosmjerna analiza varijance. Za utvrđivanje povezanosti među varijablama primijenjena je logistička regresija. U ispitivanoj populaciji našli smo pozitivnu povezanost S alela i ukupnog rezultata na upitniku DAS-R. Prisutnost S alela ukazuje na to da će osoba imati veći rezultat na upitniku DAS-R, odnosno veću izraženost dentalne anksioznosti