Suicidal Behavior and Suicide among Children and Adolescents-Risk Factors and Epidemiological Characteristics

In last decade suicide attempts and suicides among youngsters are increasing greatly and are one of the leading causes of mortality in this age group. Epidemiological data are pointing on more frequent trend of self-destructive behavior among youngsters in the world as well as in our country. Risk factors which influence on increasing number of suicide attempts and suicides in this age are different in etiology: interference of genetic influences, family dynamics and external environment (school, friends, social environment, peers, television, video, and internet). Croatia as a country in transition is also following trends in the world according to epidemiological data, what is for sure great challenge for all who participate in dealing with youngsters, especially psychiatric services. In the planning of treatment is very important to include family with intention to accomplish optimal therapeutic effect. Also, it is very important to warn parents on their part of responsibility in upbringing and developing of their adolescent

Određivanje razina talija i urana u bunarskoj vodi i biološkim uzorcima stanovništva triju istočnohrvatskih sela

Using inductively-coupled plasma mass spectrometry (ICP-MS), we measured the concentrations of thallium and uranium in local water resources from three villages (Ćelije, Draž, and Potnjani) in eastern Croatia, with the aim to determine if they were associated with the levels of these same elements in the serum, urine, and hair collected from the residents of this area. The exposure of the local population to thallium and uranium through drinking water was generally low. ICP-MS was capable of measuring the levels of both of the elements in almost all of the analysed samples. Although there were differences in the concentrations of both elements in water samples and biological specimens taken from the residents, they did not reach the maximum contaminant level in any of the four sample types studied. Although hair was previously reported as an excellent indicator of occupational and environmental exposure to various elements, our study did not confirm it as a reliable biological material for tracing thallium and uranium levels, mainly due to the very low concentrations of these elements, often well below the detection limit. However, our results have shown that the concentration of thallium and uranium in drinking water can be effectively traced in urine samples.Koristeći masenu spektrometriju induktivno spregnute plazme (ICP-MS), izmjerili smo koncentracije talija i urana u lokalnim izvorima vode triju istočnohrvatskih sela (Ćelije, Draž i Potnjani) radi određivanja jesu i povezane s razinama obaju elemenata u serumu, urinu i kosi stanovnika tih triju sela. Izloženost lokalnog stanovništva taliju i uranu preko pitke vode općenito je bila niska. ICP-MS uspješno je izmjerio razine obaju elemenata u gotovo svim analiziranim uzorcima. Iako je bilo razlika u razinama obaju elemenata u uzorcima vode i biološkim uzorcima stanovnika, nijedan nije prešao maksimalnu dopuštenu granicu. Kosa je prethodno opisana kao izvrstan pokazatelj profesionalne ili okolišne izloženosti različitim elementima, no rezultati našeg ispitivanja nisu potvrdili njenu pouzdanost pri mjerenju talija i urana uslijed vrlo niskih koncentracija obaju elemenata, koje su često bile i ispod razine detekcije. Međutim, pokazali su kako uzorci urina mogu poslužiti kao vrlo dobri indikatori prisutnosti talija i urana u pitkoj vodi

The Case Report of Treatment Strategy for Anorexia nervosa with Psychotic Elements in Adolescent

Eating disorders in early childhood are the same frequency in boys and girls. During adolescence eating disorders are ten (10) times more frequent in girls than in boys. Worrying is the fact that eating disorders are the third chronic illness among adolescents after obesity and asthma. Depicting this adolescent we tried to show difficulty of treatment of this disorder, where in the beginning is important to stabilize body weight and prevent somatic damages such as: heart damage, amenorrhoea, changes in EKG (electrocardiogram) and electrolyte dysbalance that could endanger the life of patient. Simultaneously it is important to recognize and treat comorbid psychological disturbances such as in this case: depression, delusions with occasional psychotic reactions combined with unrealistic thinking about the layout of her own body. There is still no cure for the treatment of eating disorders which are in growing number of reports among male adolescents

Do regulatory guidelines for recommendation and prescription of medications affect off label treatment with atypical antipsychotics and anticonvulsants in Osijek-Baranja County?

Svrha rada. Istražiti poštivanje pravnog uređenja preporučivanja i propisivanja lijekova te učestalost liječenja atipičnim antipsihoticima i antikonvulzivima izvan odobrenih indikacije u Osječko-baranjskoj županiji. Materijal i metode. Na 27.361 recepata za atipične antipsihotike propisanih za 2.928 pacijenata i 3.265 recepata za antikonvulzive propisanih za 392 pacijenta, uspoređivane su MKB šifre bolesti s popisom bolesti na odobrenju Hrvatske agencije za lijekove i medicinske proizvode. Recepti na kojima je utvrđen nesklad dijagnoza označeni su oznakom izvan odobrenih indikacija. Rezultati. Liječenju atipičnim antipsihoticima izvan odobrenih indikacija bilo je izloženo 1.086 (37,1 %) pacijenata, a od toga 1.085 (99,97 %) na pravno nedozvoljen način. Liječenju antikonvulzivima izvan odobrenih indikacija bilo je izloženo 226 (57,7 %) pacijenata, a od toga 226 (100 %) na pravno nedozvoljen način. Zaključak. Učestalost liječenja atipičnim antipsihoticima i antikonvulzivima izvan odobrenih indikacija u Osječko-baranjskoj županiji slična je zemljama u kojoj je dozvoljeno propisivanje lijekova izvan odobrenih indikacija.Purpose: This paper explores the relationship between regulatory guidelines for recommen-dation and prescription of medications and off label treatment with atypical antipsychotics and anticonvulsants in Osijek-Baranja County. Methods: 27,361 prescriptions for atypical antipsychotics and 3,265 prescriptions for anti-convulsants were obtained from the Croatian Health Insurance Fund’s electronic data base on the usage of atypical antipsychotics and anticonvulsants recommended by Osijek-Baranja County psychiatrists in 2015. For each patient, medical diagnosis was compared with the diagnoses in Agency for Medicinal Products and Medical Devices of Croatia. Prescriptions for which diagnosis did correspond with registered diagnoses were marked as on label, while prescriptions for which diagnosis did not correspond to registered diagnoses were marked off label. Results: During 2015 in Osijek-Baranja County 1,086 (37.1%) of 2,928 patients treated with atypical antipsychotics were subjected to off label treatment; among which 1,085 (99.97%) patients were treated with disregard for legal regulations. Two hundred and twenty six (57.7%) of 392 patients treated with anticonvulsants were subjected to off label treatment; 226 (100%) of which were treated with disregard for legal regulations. All prescriptions for off label treatments were prescribed with disregard for legal regulations. Conclusion: The frequency of off label treatment with atypical antipsychotics and anticonvulsants in Osijek-Baranja County is similar to that of countries in which off label prescribing is permitted. Psychiatrists and primary care physicians in Osijek-Baranja County disregard legal guidelines for recommending and prescribing medications when treating patients with atypical antipsychotics and anticonvulsants

The Treatment of Autistic Children with Risperidone

Autism is a pervasive developmental disorder characterised by impairment in social interaction and communication, with unusual behavior. In some cases the pharmacotherapy is prescribed and the most studied antipshychotic drugs include haloperidol and risperidone. In this paper we displayed the treatment of two cases of autism in boy and girl with risperidone. With the use of risperidone in girl, we have achieved reduction of psychomotor symptoms and reduction of hetero-aggressive and self-destructive behavior, and in boy we have also achieved reduction of psychomotoric symptoms, with improvement in contact with his surrounding, he had less learning problems and he has felt familiar not only with his mother, but with other persons. Research on the use of risperidone in the treatment of autistic disorders among children in Croatia are rare, given the limited use of risperidone in children younger than 15 years, the question arises about the need to expand the scope of application of risperidone in younger age groups

THE TEMPERAMENT AND CHARACTER TRAITS IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER AND BIPOLAR AFFECTIVE DISORDER WITH AND WITHOUT SUICIDE ATTEMPT

Background: Suicide and mood disorders (especially major depressive disorder (MDD) and bipolar affective disorder (BD)) represent a significant global health burden. Major depressive disorder and bipolar affective disorder have been associated with increased risk for suicide. Some specific suicide risk factors might be found in underlying individual personality traits. Specific personality features may predispose an individual to mood disorders (MDD or BD) hence increased suicide risk. The specificity of this research is in the assessment of personality features during the acute phase of illness immediately after suicide attempt which resulted in psychiatric inpatient treatment. Subjects and methods: The study included 119 unrelated Caucasian participants with MDD-severe depressive episode without psychotic symptoms (MDD) and BD-severe depressive episode without psychotic symptoms (BD-sDE). Both groups of patients with MDD and BD-sDE were divided into the suicide attempters and non-suicidal group. The diagnoses of the severe depressive episode without psychotic symptoms in major depressive disorder (MDD; F32.2) and bipolar disorder (BD-sDE; F31.4) were made according to ICD-10 (WHO 1992) diagnostic criteria. Methods of suicide attempts were also assessed according to ICD-10 and a self-report questionnaire, the Temperament and Character Inventory (TCI) was applied. Results: The participants who exhibited suicide attempt had significantly higher scores on harm-avoidance (HA) (p<0.001), significantly lower score on persistence (PS) (p=0.037) and lower score, however not statistically significant, on novelty-seeking (NS) (p=0.319) regarding temperament dimensions. In character dimensions, the patients with suicidal attempt had significantly lower scores on self-directedness (SD) (p<0.001) and significantly lower scores on cooperativeness (CO) (p=0.001). Conclusion: Patients who had suicide attempt may have some significantly different personality traits than non-suicidal patients with mood disorders. The combination of high harm-avoidance (HA) and low self-directedness (SD) may be specific for depressive episode while the combination of high HA, novelty-seeking (NS), and self-transcendence (ST) with low SD may be related to suicide attempts during the depressive episode in bipolar disorder. The novelty-seeking (NS), self-transcendence (ST) and self-directedness (SD) may be specific for suicidal group of bipolar patients

Depresija i umor uzrokovani opstrukcijskom apnejom tijekom spavanja u multiploj sklerozi

To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS.Sukladno našim saznanjima nema studije koja je istraživala nastaju li umor i depresija kao najučestaliji simptomi kod bolesnika s multiplom sklerozom (MS) i opstrukcijskom apnejom tijekom spavanja (OSA) primarnim mehanizmima MS ili iz sekundarnih povezanih stanja kao što je OSA kod bolesnika s MS. Cilj naše anketne studije bio je utvrditi jesu li depresija i umor u bolesnika s MS povezani s kliničkim obilježjima OSA ili MS. Proveli smo anketu pomoću četiri validirana upitnika (STOP-BANG, Epworthova ljestvica pospanosti, ljestvica težine umora i revidirana ljestvica depresije Centra za epidemiološke studije) u 28 uzastopnih ambulantnih bolesnika s klinički i paraklinički dokazanom MS. Učestalost bolesnika s MS s povećanim rizikom od nastanka OSA bila je 29%, a dob je bila u pozitivnoj korelaciji s tim rizikom (p=0,019). Nijedna od kliničkih značajka bolesnika s MS (podtip, status invaliditeta, trajanje bolesti, modificirajuća terapija, drugi lijekovi) nije bila u korelaciji s depresijom i umorom. Naprotiv, pretjerana pospanost tijekom dana kao obilježje OSA bila je značajno i pozitivno povezana s razinom simptoma depresije (p=0,004) i razinom umora (p=0,015). Također, depresija je značajno i pozitivno korelirala s povećanim rizikom od OSA (p=0,015) i dobi bolesnika s MS (p=0,016). Konačno, utvrđena je značajna pozitivna korelacija između težine umora i simptoma depresije (p=0,003). OSA je čest poremećaj kod bolesnika s MS. Kliničke značajke i čimbenici rizika za OSA u bolesnika s MS povezani su s dva najčešće prijavljivana simptoma depresije i umora, podupirući tako hipotezu da su oba simptoma posljedica sekundarnog stanja u MS

PROPHYLAXIS OF MIGRAINE – A REVIEW OF LITERATURE

Cilj ovog prikaza literature je procijeniti mogućnosti profi lakse migrene. Prema preporukama International Headache Society (IHS) profi laksa migrene provodi se u bolesnika koji imaju ≥4 dana migrensku glavobolju na mjesec bilo da se radi o epizodičnoj ili kroničnoj migreni. Učinkovitim liječenjem smatra se smanjenje učestalosti migrenskih ataka za ≥50 %. Učinkovitima su se pokazali β-blokatori, kalcijski antagonisti, antiepileptici kao što su topiramat i valproat kao i gabapentin i pregabalin, te fl unarizin i antidepresivi. Učinkovitost levatiracetama, cervikalne miofascijalne anestezije te kožne elektrostimulacije i muskularne stimulacije još je u ispitivanju. Dvojben je učinak botulinum toksina. Istražuje se moguća primjena histamina, zatvaranje foramena ovale te primjena akupunkture, supraorbitalne i vagalne nervne stimulacije te transkranijske magnetske stimulacije. Istražuje se utjecaj kateholamina i melatonina te kontraceptiva, ribofl avina, dekstrometorfi na u nastanku migrenskih glavobolja. Potrebna je adekvatna procjena mogućih učinaka u profi laksi primjenom probiotika, koenzima Q10 i magnezija. Klinička istraživanja su pokazala da primjena humanih monoklonskih protutijela erenumaba, fremanezumaba i galkanezumaba pokazuju statistički značajnu učinkovitost (≥50 % učinkovitosti) u profi laksi migrene što je potrebno potvrditi u kliničkoj praksi.This literature review is aimed at assessing the possibilities of migraine prophylaxis. The International Headache Society (IHS) recommends performing migraine prophylaxis in patients suffering ≥4 migraine headaches per month, either episodic or chronic. The treatment is deemed successful when the migraine attacks are decreased by ≥50%. Effi ciency has been demonstrated for β-blockers, calcium antagonists, antiepileptics such as topiramate and valproate, as well as gabapentin, pregabalin, fl unarizine and antidepressants. The effi ciency of levetiracetam, cervical myofascial anesthesia, skin electrostimulation and muscular stimulation is still being tested. The effects of botulinum toxin are dubious. There is ongoing research of the possibility of using histamines, closing foramen ovale, acupuncture, supraorbital and vagal nerve stimulation and transcranial magnetic stimulation. Effects of catecholamine, melatonin, contraceptives, ribofl avin, dextromethorphan and melatonin in persisting migraine headaches are being researched as well. Required is an appropriate assessment of the possible effects of probiotics, coenzyme q10 and magnesium in migraine prophylaxis. Clinical researches have shown the use of human monoclonal antibodies erenumab, fremanezumab and galcanezumab to demonstrate a statistically signifi cant effi ciency (≥50%) in migraine prophylaxis, yet requiring further confi rmation in clinical practice