The influence of 5-HT(2C) and MDR1 genetic polymorphisms on antipsychotic-induced weight gain in female schizophrenic patients

We investigated the relationships between functional genetic variants of the 5-HT(2C) receptor and multidrug-resistant protein (MDR1), coding for P-glycoprotein, and second generation antipsychotic (SDA)-induced weight gain among 108 female schizophrenic patients treated with olanzapine or risperidone for up to 4 months. No significant differences in -759C/T allelic and genotype variants of 5-HT(2C) were found between patients who gained more than 7% of their initial weight compared with those who gained less. Haplotype-based analysis of two MDR1 loci, exon 21 G2677T and exon 26 C3435T, revealed a slightly lower representation of the G2677/C3435 haplotype in the >/=7% group. In the subgroup of patients treated with risperidone, we found borderline overrepresentation of 2677T, significant overrepresentation of 3435T variant and borderline overrepresentation of 2677T/3435T haplotype the >/=7% group, whereas G2677/C3435 haplotype was found to be less represented in the >/=7% group. Our data indicate a nonsignificant role of 759C/T 5-HT(2C) in SDA-induced weight gain, and a stronger influence of the MDR1 G2677T and C3435T polymorphisms on risperidone-induced weight gain in female schizophrenic patients. 3435T and 2677T MDR1 variants, both associated with lower P-gp function, might predispose to higher risperidone accessibility to the brain that would lead to stronger effects, including weight gain

New Antipsychotics

Antipsihotici, što su se pojavili na tržištu nakon klozapina, a sintetizirani su na temelju opaženog kliničkog učinka i farmakološkog profila djelovanja klozapina, nazivani su različito: „noviji antipsihotici“, „novi antipsihotici“, „atipični antipsihotici“ i „antipsihotici druge generacije“. Naziv antipsihotici druge generacije (ADG) po svemu sudeći najprikladniji je pa je uglavnom i prihvačen kad se govori o ovoj heterogenoj skupini lijekova što se klinički rabe za gotovo iste indikacije. Razlozi za takav stav leže u činjenicama da je, prvo, upitno je li razlikovanje tipičnih i atipičnih antipsihotika znanstveno opravdano. Nadalje, ni svi ovi lijekovi nisu više novi (ili noviji), niti farmakološki ili klinički identični, već imaju različite farmakološke i kliničke učinke. Međutim, ostaje činjenica da su svi oni pripadnici druge generacije antipsihotičkih lijekova. Ovdje će se opisati: amisulprid, klozapin, olanzapin, kvetiapin, risperidon, sertindol, ziprasidon, zotepin i aripiprazol koji su do sada licencirani u bar jednoj zemlji Europske unije ili u Sjedinjenim Američkim Državama, i iloperidon koji je u zadnjoj fazi kliničkog ispitivanja.Antipsychotics that emerged on the market after clozapine, synthesized on the basis of observed clinical efficacy and pharmacological profile of clozapine activity, have got various names: “newer antipsychotics”, “new antipsychotics”, “atypical antipsychoitics” and “second generation antipsychotics”. The name “second generation antipsychotics” (SGA) is, according to all data, the most appropriate, so it has become generally accepted when speaking about this heterogeneous group of medications, which is clinically used for almost identical indications. Reasons for such attitude lie in the facts that it is questionable whether the distinction between typical and atypical antipsychotics is scientifically justified. Furthermore, all these drugs are not new (or newer) any more, and are not pharmacologically and clinically identical, but have different pharmacological and clinical efficacy. However, the fact remains that they all belong to the second generation of antipsychotic drugs. Here are described: amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone, zotepine and aripiprazole, up to now licensed in at least one country of the European Union or in the USA, as well as iloperidone, which is in the final phase of clinical research

The Influence of Risperidone on Cognitive Functions in Schizophrenia

Introduction of the antipsychotics of the second generation (SGA) into the therapy of schizophrenia roused expectations that, finally, the cognitive dysfunction in schizophrenia could be eliminated by psychopharmacological therapy. The purpose of the study was to verify the effect of atypical antipsychotic risperidone on cognitive functions in schizophrenic patients. The study was carried out upon 48 male schizophrenic patients aged 21–47 years who were switched from the antipsychotics of the first generation (FGA) to the antipsychotic risperidone, due to intolerance, during the treatment. Intelligence, abstract and concrete thinking and mental speed, attention, and short-term nonverbal memory prior to the switch, one month after the switch, and three months after the switch to risperidone, were evaluated. One month after the switch the number of subjects with severe impairment of intellectual abilities decreased significantly from 62% to 15% and after three months the number was even lower–8%. The impairement of concrete and abstract thinking and mental speed also showed the same tendencies of decrease. The improvement of the cognitive functioning after the switch from the antipsychotics of the first generation to the antipsychotic risperidone is explained by removal of the antipsychotics of the first generation from the therapy and the consequential disinhibition of secondary cognitive impairments and by decreased average dose of anticholinergic and decreased number of patients who need anticholinergic therapy beside risperidone. The possibility of clear pro-cognitive effect of risperidone is suggested and its verification is proposed with strict control of other factors that improve cognitive functioning of schizophrenic patients during the treatment

Obuzeto-prisilni poremećaj

U radu su prikazane najnovije spoznaje o epidemiologiji, dijagnostici i liječenje obuzeto-prisilnog poremećaja (OPP). Prikazani rezultati pokazuju da je OPP znatno češći no što se ranije mislilo, a dijagnostika je obogaćena nizom novih neuroslikovnih istraživanja što pobuđuju nadu u bolje poznavanje etiologije poremećaja. Dat je pregled genetskih istraživanja, kao i načini liječenja poremećaja, kako psihofarmakološki, psihoterapijski tako i transkranijskom magnetskom stimulacijom, dubokom stimulacijom mozga i neurokirurškim metodama

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

Premenstrual dysphoric disorder: a neglected diagnosis? Preliminary study on a sample of Croatian students

The aims of this study were to assess prevalence and symptom profile of premenstrual dysphoric disorder (PMDD) in a sample of Croatian students and young university graduates. We obtained data for 87 healthy women, aged 18-30, at their regular gynecologic outpatient visits over the period of 2003 to 2004. The severity of premenstrual symptoms were assessed daily, during two cycles, with the Daily Record of Severity of Problems (DRSP) and criteria for PMDD according to DSM-IV were applied. Fifteen out of 87 women fulfilled PMDD criteria and reported statistically significantly higher prevalence of co morbid disorders in their medical history compared to non-PMDD group. The most common symptoms in the PMDD group were psychological, while in non-PMDD group were vegetative. Overall, relatively high prevalence of PMDD in studied group indicates the need to continue the study

Posttraumatic stress disorder in women - experiences form the Psychiatric Clinic, University Hospital Center Zagreb, Croatia [Posttraumatski stresni poremećaj u žena - iskustva Klinike za psihijatriju Kliničkog bolničkog centra Zagreb, Hrvatska]

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

Screening for depression disorders in patients with chronic somatic illness

Depression is one of the most common complications in patients with chronic somatic illnesses. Comorbidity of depression with physical illness often remains unrecognized and untreated, additionally aggravating the somatic illness itself, its treatment and prognosis. The aim of this study was to investigate the prevalence of depression in chronic somatic patients suffering from diabetes, epilepsy, asthma, chronic obstructive pulmonary disease (COPD) and hypothyroidism. Patients, who were regularly attending control examinations in neurological and internal medicine out-patient departments, were tested for the presence of depression with Beck Depression Inventory. The sample comprised 2153 chronic somatic patients aged between 18 and 80 years. Out of this total, 228 patients (10.6%) did not complete the study, (5.12%) refused to participate, and (5.5%) of the patients were technical failures. 1925 patients completed the study, and 1383 of them were not depressive. In 542 patients (28.5%) depression was confirmed, being almost twice more frequent in women, 346 (64%) vs. 196 (36%) male. Among these depressed examinees, mild depression was found in 284 (52.4%), major in 186 (34.3%) and severe in 72 (13.3%) chronic somatic patients. The majority of patients were aged over 55 yrs (49%). This population contained the largest number of depressed examinees (49.9%). The prevalence of depression with regard to subgroups shows that (25.6%) of asthma patients were depressed, as well as (26.6%) of those with COPD. These two groups did not present statistically significant differences regarding gender. The depression level of (32.2%) was found in patients with diabetes, of (29.6%) in patients with epilepsy and of (24.2%) among those with hypothyroidism. As for gender, statistically significant difference was found in the last three groups of patients (p < 0.001)

Psychological Consequences of Rape on Women in 1991-1995 War in Croatia and Bosnia and Herzegovina

Aim: To explore the short- and long-term psychological consequences of rape on women victims of rape during the 1992-1995 war against Croatia and Bosnia and Herzegovina. Methods: The study included 68 women victims of rape and was conducted at the Medical Center for Human Rights, Zagreb, Croatia, from 1992 to 1995. Testimony method and a questionnaire were used to retrospectively obtain the description of rapes and symptoms women suffered immediately after rape and at the time of the study, ie, 11.9 ± 2.4 months after the trauma. Structured clinical interviews were conducted to diagnose psychiatric disorders that were present at the time of study, according to the third edition of Diagnostic and Statistical Manual of Mental Disorders. Results: The raped women were Croatian and Muslim (Bosniak) women, residents of Croatia and Bosnia and Herzegovina. Forty-four of them were raped more than once, 21 were raped every day during their captivity, and 18 were forced to witness rapes. Most of the rapes (n = 65) were accompanied by physical torture. The most frequent psychological symptoms felt immediately after the rape were depressiveness (n = 58), avoidance of thoughts or conversations associated with the trauma (n = 40), and suicidal ideas (n = 25). Although none of the women had a psychiatric history before the rape, at the time of study 52 suffered from depression, 51 from social phobia, 21 from posttraumatic stress disorder (PTSD), and 17 had sexual dysfunctions. These disorders were often comorbid. Out of 29 women who got pregnant after rape, 17 had artificial abortion. The decision to have an abortion was strongly predicted by suicidal thoughts and impulses (odds ratio, 25.8; 95% confidence interval, 2.53-263.2). Conclusion: War-time rapes had deep immediate and long-term consequences on the mental health of women victims of rapes and their social and interpersonal functioning

Psychological Consequences of Rape on Women in 1991-1995 War in Croatia and Bosnia and Herzegovina

Aim: To explore the short- and long-term psychological consequences of rape on women victims of rape during the 1992-1995 war against Croatia and Bosnia and Herzegovina. Methods: The study included 68 women victims of rape and was conducted at the Medical Center for Human Rights, Zagreb, Croatia, from 1992 to 1995. Testimony method and a questionnaire were used to retrospectively obtain the description of rapes and symptoms women suffered immediately after rape and at the time of the study, ie, 11.9 ± 2.4 months after the trauma. Structured clinical interviews were conducted to diagnose psychiatric disorders that were present at the time of study, according to the third edition of Diagnostic and Statistical Manual of Mental Disorders. Results: The raped women were Croatian and Muslim (Bosniak) women, residents of Croatia and Bosnia and Herzegovina. Forty-four of them were raped more than once, 21 were raped every day during their captivity, and 18 were forced to witness rapes. Most of the rapes (n = 65) were accompanied by physical torture. The most frequent psychological symptoms felt immediately after the rape were depressiveness (n = 58), avoidance of thoughts or conversations associated with the trauma (n = 40), and suicidal ideas (n = 25). Although none of the women had a psychiatric history before the rape, at the time of study 52 suffered from depression, 51 from social phobia, 21 from posttraumatic stress disorder (PTSD), and 17 had sexual dysfunctions. These disorders were often comorbid. Out of 29 women who got pregnant after rape, 17 had artificial abortion. The decision to have an abortion was strongly predicted by suicidal thoughts and impulses (odds ratio, 25.8; 95% confidence interval, 2.53-263.2). Conclusion: War-time rapes had deep immediate and long-term consequences on the mental health of women victims of rapes and their social and interpersonal functioning