The Relationship of Several Generations within a Family

Poznato je da se proporcije po broju stanovnika između prve i treće dobi skoro izjednačuju. Proces starenja neminovan je i različite su mogućnosti prilagodbe na starenje; neki prijevremeno odustaju od suočavanja s ulogom srednje dobi, drugi pokušavaju iskoristiti sve mogućnosti i odgoditi suočavanje s trećom dobi, dok treća skupina pokušava zaustaviti vrijeme i ostati “vječno mlad”. Autorice su dale presjek generacijskih odnosa u obitelji s posebnim naglaskom na uloge djedova i baka. Dana je slika odnosa unutar zdrave obitelji s naznakom različitosti u pojedinim specifičnim situacijama kao što su različitost u zauzimanju stavova i razmišljanja o životnim situacijama, razlike u odnosima unutar obitelji u kojima djedovi i bake imaju samo jednog ili više unuka i kada djeca uzimaju “pravdu u svoje ruke”. Ujedno je prezentirana slika obitelji pojavom degenerativnih bolesti koje nastaju postupno te se obitelj na neki način i privikne na sve manji kapacitet djedova i baka u svakodnevnom životu i uključuje u rješavanje njihovih životnih problema. Progresivne bolesti djedova i baka dovode najčešće do iznenadnih konfrontacija unutar obitelji, što znači da ih mogu izgubiti. To suočavanje s gubitkom budi u svim članovima separacijske strahove. Degenerativne i progresivne bolesti izravno utječu na obiteljske odnose. Gubitak jednog od roditelja djeda/bake dovodi do promjena ne samo unutar para, nego u većini slučajeva i unutar šire obiteljske zajednice.It is known that the proportions of first and third generation group are evening. The process of aging is inevitable and there are different possibilities of adjustment to the change; some prematurely give up from facing the roles of middle age, others try to use everything possible and available to postpone facing the third age, while others try to stop the time and stay for ever young. Authors have given cross-section view of the generational relations in a family with a particular emphasis on the role of grandmothers and grandfathers. A picture of the relation within a healthy family is given with an indication of the diversities in individual specific situations such as taking opposite stands on life situations, differences among families with one or more grandchildren, and when children take the justice in their own hands. Also, a picture of a family is presented in a phenomenon of degenerative and progressive illnesses of grandmothers and grandfathers, as well as their impact on the family relations where family must accustom to seizing capacities of grandparents to help in everyday living and solving problems. Progressive illnesses of grandparents lead to the confrontation with the idea of losing them. Anticipating the loss awakens the separation fears in other family members. Degenerative and progressive illnesses have a direct impact on family relations. Losing one of the grandparents not only leads to change inside the couple but inside the wider family unit as well

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study

Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991- 1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following selfassessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes

GROUP AFTER EXCLUSION OF A SUICIDAL MEMBER OR WHAT IS HIDDEN IN THE RUG

Grupna analiza (ili grupna analitička psihoterapija) je tehnika grupne psihoterapije. Uspješno liječenje u grupi za članove grupe povezano je i s terapeutovim pripremnim zadatcima vezanima uz pokretanje grupe, a to se prije svega odnosi na izbor članova te priprema tih istih članova. Razvoj grupe može se sagledati kroz određene faze grupnog razvoja. Svaka sljedeća faza grupnog razvoja oblikovana je i nadograđena na uspješno savladanu prethodnu fazu. Stoga će se rani razvojni neuspjesi pokazati kroz daljnji grupni život i grupnu dinamiku. Svrha ovog članka je prikazati tijek grupnog procesa i zbivanja u grupi vezano uz isključenje suicidalnog člana. Prvi dio prikaza odnosi se na isključenje člana, a drugi koji obuhvaća kasniji period grupe uz još uvijek prisutne posljedice koje se odnose na usporenu detronizaciju voditeljice i usporenu proradu negativnog kraka transfera te razvijanja fenomena žrtvenog jarca. Detronizacija voditelja, prorada agresivnog /negativnog kraka transfera te nalaženje žrtvenog jarca su karakteristike druge faze grupnog razvoja koja je u ovom primjeru bila prolongirana.Group analysis (or group analytic psychotherapy) is a group psychotherapy technique. For group members, successful treatment in a group is also connected with the therapist’s preparatory tasks relating to group development, which primarily refers to the selection of group members and their preparation. The development of a group can be viewed through various stages of group development. Each subsequent stage of group development is shaped and built upon the successfully mastered previous stage. Early developmental failures will, therefore, become visible through further group existence and group dynamics. The purpose of this paper is to present the course of a group process and events in the group in relation to the exclusion of a suicidal member. The first part of the presentation refers to the exclusion of the member, while the second part includes a later group period when consequences referring to the slow dethronement of the conductor and the slow working of the negative part of transference are still present, in addition to the development of the scapegoat phenomenon. The dethronement of the conductor, the working of the aggressive/negative part of transference and finding of a scapegoat are characteristics of the second phase of group development, which in this case was prolonged

VILLAIN OR PROTECTOR OR WORKING THROUGH DREAMS IN GROUP PSYCHOANALYTIC THERAPY

U psihoterapiji je važno razumjeti značenje snova jer snovi otkrivaju nesvjesno. San ispričan u grupi može ukazivati na nesvjesnu refleksiju grupnih događaja. Terapeut se treba pitati što je ono što sanjač ili grupa ne mogu procesuirati te pokušavaju proradom donesenog sna. S obzirom na to da snovi mogu biti kontejneri individualnih i kolektivnih anksioznosti, ako ih se ne proradi, mogu voditi u acting out. Grupni analitičari smatraju da je vrlo važno doći do latentnih misli sna u grupi ako je i kad je to moguće, posebno onih koje imaju transferni predznak. U ovom radu bit će prikazani primjeri kako je grupa donošenjem snova koji imaju grupni karakter pokušavala proraditi grupni događaj koji je utjecao na evociranje strogih roditeljskih figura. Grupa je kroz snove prorađivala otpore, negativan krak transfera te u konačnici integraciju negativnog i pozitivnog kraka.Understanding the meaning of dreams is of great importance in psychotherapy, because dreams reveal the unconscious. A dream shared with a group can indicate an unconscious reflection of group events. The therapist should inquire into what the person who had the dream or the group itself cannot process, and trying to work through the shared dream. Since dreams could represent containers of individual and collective anxiety, failure to work them through may lead to acting out. Group analysts believe that, if and when this is possible, it is important to reach the latent dream thoughts, particularly those with a transference prefix. In this paper, we will present examples of how a group attempted to work through a group event that affected the evocation of strict parental figures by discussing dreams that have a group character. Through dreams, the group worked through resistance, the negative side of transference, and ultimately, the integration of the negative and positive sides of transference

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study

Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991- 1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following selfassessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes

Caregiver Burden and Burnout in Partners of War Veterans with Post-traumatic Stress Disorder

War veterans diagnosed with chronic post-traumatic stress disorder (PTSD) experience serious difficulties in social, professional and family life. Consequently, their wives often become indirect victims of their husbands’ dysfunction. The purpose of this study was to assess the caregiver burden and burnout level in partners of veterans suffering from PTSD, especially in cases where partners suffer from their own PTSD symptoms. The experimental group consisted of 154 wives or partners of war veterans treated for PTSD caused by the war trauma in University Hospital Mostar. The control group was made of 77 wives or partners of war veterans without PTSD. The study was based on the General Demographic Questionnaire, the Harvard Trauma Questionnaire, Bosnia-Herzegovina version, Caregiving and the Experience of Subjective and Objective Burden and the Maslach Burnout Inventory. The wives of PTSD affected veterans scored significantly higher in all subscales of the Caregiver Burden Questionnaire and the Burnout Inventory. The results indicated that subjective demand burden, subjective stress and burnout were significantly higher in relationships in which both partners suffer from PTSD compared to couples in which only the veteran suffers from PTSD and couples in which none of the partners has PTSD. Living with a veteran diagnosed with PTSD places a heavy burden on the wife and poses a serious risk of burnout, which has to be taken into account in treatment planning

CLINICAL EXPERIENCES IN TREATING PTSD PATIENTS BY COMBINIG INDIVIDUAL AND GROUP PSYCHOTERAPY

PTSD is a complex psychobiological disorder that couses disfunctionality in many areas. In treating PTSD different models have been applied, however, no general consensus on the method of treatment has yet been achieved. At the Clinic for Psychol.ogical Medicine we have developed the model of combined treatment for PTSD patients that involves outpatient individual psychoterapy, psychopharmacotherapy and group psyhoterapeutic techniques introduced within repeated day-hospital treatments. In this paper the efficiency of the above mentioned model has been explored. Three PTSD patients have been presented. We assessed changes in psychological functioning of our subjects on the basic of clinical observation and analasys of the session protocols. The model of combined and long-term treatment of PTSD in which the approach to traumatised patients has been mostly supportive, including supportive psychoterapeutic interventions and psychoaromatherapy, has proved to be efficient in achieving integration of traumatic experiences and consolidation of traumatised Self. Combination of individual and group approach facilitates the analisys of traumatic transference, whereas more mature defence patterns become stronger and integration of traumatic experiences improved. Consolidation of the Self leads to better socilization

CROATIAN WAR VETERANS IN PRINT MEDIA IN 1996 AND IN 2006

Introduction: The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006. Methods: The data were gathered by reviewing two daily papers, Novi list and Večernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports. Results: A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans\u27 rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006. Conclusion: During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatization

Personality changes in patients with combat related posttraumatic stress disorder

SAŽETAK Pozadina istraživanja: U svjetlu strukturiranja novih izdanja klasifikacija bolesti, propituju se kriteriji za neke kliničke entitete. Među njima je i trajna promjena osobnosti uslijed traume/DESNOS koji se definira kao psihološka posljedica psihotraumatizacije, a njegovo postojanje isključuje postojanje PTSP-a. Svakodnevna klinička praksa ovu stavku dovodi u pitanje. Cilj: Utvrditi moguću prisutnost Disorder of extreme stress not otherwise classified (DESNOS) kod veterana Domovinskog rata s borbom uzrokovanim posttraumatskim stresnim poremećajem (PTSP). Metode: Istraživanje je uključilo 355 ispitanika u četiri centra u Hrvatskoj. Primijenjeni su upitnici: Structured Interview for Disorder of Extreme Stress (SIDES- SR), te Međunarodni neuropsihijatrijski intervju (MINI), Upitnik za poremećaj osobnosti DIP-Q, upitnik o kvaliteti života MANSA, Upitnik traumatskih događanja – TAQ, Harvard Trauma Questionnaire (HTQ): Croatian Version te opći demografski upitnik. Rezultati: U ispitivanoj populaciji 43% veterana Domovinskog rata koji boluju od PTSP-a zadovoljavaju sve kriterije i za DESNOS. Na kliničkoj razini, ispitivani veterani zadovoljili su kriterije za sljedeće poremećaje osobnosti: paranoidni, shizotipni, granični, izbjegavajući i opsesivno kompulzivni. Ispitanici s izraženijim DESNOS-om imaju i izraženije simptome poremećaja osobnosti i to: granični, paranoidni, opsesivno-kompulzivni, izbjegavajući i shizotipni. A ispitanici koji u potpunosti zadovoljavaju kriterije za DESNOS, na kliničkoj razini zadovoljavaju, uz navedene poremećaje i shizoidni poremećaj osobnosti. Na izraženost poremećaja osobnosti najviše utječu posttraumatski simptomi, odnosno što su izraženiji posttraumatski simptomi to je više prisutno simptoma poremećaja osobnosti. Simptomi trajne promjene osobnosti su jače izraženi u osoba koje su bile više traumatizirane. Ispitanici, koji uz PTSP imaju i DESNOS dva puta češće imaju u komorbiditetu: depresiju i/ ili socijalnu fobiju. Dijagnoza trenutnog paničnog poremećaja kod osoba s DESNOS-om se javlja gotovo tri puta češće nego kod osoba koje imaju samo PTSP. Također, što je kod ispitanika veći broj komorbidnih poremećaja uz PTSP, veća je i izraženost trajnih promjena osobnosti uslijed traume. Manje zadovoljstva s kvalitetom života može se predvidjeti kod ispitanika s ranom traumatizacijom i s jače izraženim simptomima bilo PTSP-a bilo DESNOS-a. Zaključak: Suprotno kriterijima postavljenima u ICD-10, rezultati ovog istraživanja govore da se PTSD i DESNOS mogu javljati u komorbiditetu. Veći intenzitet simptoma te češći komorbiditet s drugim psihijatrijskim poremećajima posebice depresijom, paničnim poremećajem i socijalnom fobijom zahtjeva dodatne terapijske intervencije u procesu liječenja veterana s DESNOS-om.Background: In light of new editions of the DSM and ICD classifications of diseases being prepared, certain clinical entities are being reassessed. Among others, clinical entities under reexamination are Disorder of Extreme Stress Not Otherwise Specified (DESNOS) or Complex PTSD according to the classification of the American Psychiatric Association. The corresponding diagnostic entity of the ICD would be Enduring Personality Change After Catastrophic Experience, which, according to definitions, occurs as a psychological effect of psychotraumatization and excludes the presence of PTSD. Day-to-day clinical practice casts doubts as to the view that PTSD and DESNOS/EPCACE symptoms are mutually exclusive. Aim: To determine possible presence of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) in Croatian war veterans who suffer from combat-related Posttraumatic Stress Disorder (PTSD). Methods: The research included 355 participants in four clinical centers in Croatia. It was based on the following instruments: Structured Interview for Disorder of Extreme Stress (SIDES-SR) and International Neuropsychiatric Interview (MINI), Questionnaire for personality disorders DIP-Q, Quality of Life questionaire (MANSA), Traumatic Antecedents Questionnaire TAQ, Harvard Trauma Questionnaire (HTQ): Croatian Version and General Demographic Questionnaire. Results: Forty three percent of veterans of the Homeland War in Croatia who suffer from PTSD met criteria for DESNOS. At the clinical level, tested veterans met the criteria for the following personality disorders: paranoid, schizotypal, borderline, and obsessive-compulsive and avoidant. Veterans with pronounced DESNOS have more often expressed symptoms of personality disorder as follows: borderline, paranoid, and obsessive-compulsive, avoidant and schizotypal. The veterans who fully meet the criteria for DESNOS, at the clinical level meet - with listed personality disorders - criteria for schizotypal personality disorder. Posttraumatic symptoms affect mostly the expressiveness of personality disorders. Enduring personality change symptoms are more pronounced in subjects who were more traumatized. Persons, who suffer from both, PTSD and DESNOS, twice more frequently suffer from comorbid depression with melancholic features or social phobia. DESNOS patients are almost three times more likely to have the diagnosis of current panic disorder. Furthermore, veterans who have more comorbid disorders with PTSD, have more pronaunced permanent changes in personality due to trauma. Less satisfaction with quality of life can be predicted in subjects with early trauma and more pronounced symptoms of PTSD or DESNOS. Conclusion: The research results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A higher intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder and social phobia require additional therapy interventions in treatment processes for DESNOS veterans