Anxiety and Defense Styles in Eating Disorders

This study investigates anxiety and defense styles in eating disorders. Seventy eating disorder (ED) patients and fifty-one female matched control subjects completed State and Trait Anxiety Inventory (STAI) and 88-items Defense Style Questionnaire (DSQ). ED patients were more anxious in actual situations and more anxiety prone in general. They relied on maladaptive action and Image distorting defense style. Bulimic anorexic (BAN) patients and bulimia nervosa (BN) patients differed in defense styles from restrictive anorexic (RAN) patients who displayed no significant difference in either state and trait anxiety or in defense styles when compared to healthy patients. Different levels of anxiety and ego defense maturity are present in ED patients. The almost normal ego functioning of RAN patients could be explained by pseudomaturity, tendency to control external and internal environment and the unconscious efforts to imitate normality to avoid conflicts

The Role of Croatia in the Management of the Humanitarian Crisis in Bosnia and Herzegovina

Croatia played a crucial role in the management and termination of the humanitarian crisis caused by the aggression of the Yugoslav Army and Serbian paramilitary forces in Bosnia and Herzegovina. Between 1992 and 1995, Croatia accepted three waves of refugees and cared for more than 500,000 refugees from B&H; it thus secured the basic precondition for the survival of B&H as a state. Croatia invested more than 1,000,000.000 U.S. dollars from its State budget just for the care of refugees from B&H. Even today about 130,000 Bosnian refugees are still accomodated in Croatia, for most are still unable to return to their homes. The European Community and the UN were unable to protect the lives of civilians or to prevent grave breaches of international humanitarian law. At the some time, the Croatian military operation "Storm" in 1995 saved the lives of thousands of civilians in the Bihać area. A careful analysis of the Croatian contribution to the achievement of the Dayton agreements and the resolution of the humanitarian crisis in B&H clearly reveals that the positive role of Croatia has been seriously underestimated and down-played by the international community

Pharmacotherapy of Suicidality in Schizophrenic Patients

Suicidalnost je vrlo važna i česta pojava u shizofrenih bolesnika i javlja se kod do 50 % bolesnika tijekom života. Do 20 % shizofrenih bolesnika život završi suicidom. Suicidi shizofrenih bolesnika uz neka zajednička obilježja sa suicidima opće populacije imaju i specifična obilježja upravo za tu dijagnostičku skupinu. Rizični čimbenici za suicid shizofrenih bolesnika su primarno klinički (sumnjičavost, persekutornost, dezorganiziranost, imperativne halucinacije, impulzivnost, depresivnost) ali i posljedični nepovoljni socioekonomski, maritalni, radni, emocionalni, degradirajući, stigmatizirajući i slični čimbenici. Potrebno je voditi računa o mogućem nastanku nepoželjnih nuspojava, kako o njihovom direktnom djelovanju na suicidalnost tako i o mogućem djelovanju na smanjenje komplajnsa a time i na smanjenje učinkovitosti ordiniranog lijeka. S tim u svezi potrebno je provoditi adekvatnu i individualno specifičnu vrstu terapije. To u prvom redu znači provoditi adekvatnu psihofarmakoterapiju u smislu povlačenja navedenih simptoma bolesti. Terapiju treba započeti što je moguće ranije i u adekvatnoj dozi, kako se ne bi razvili nepovoljni posljedični (sekundarni) čimbenici (gubitak emocionalnih i socijalnih veza, gubitak posla, spuštanje na socijalnoj ljestvici i slično). U sprečavanju tih sekundarnih pojava važna je dakle i adekvatna farmakoterapija i brojne psihosocijalne metode i akcije.Suicidality is a very important and frequent event in schizophrenic patients, occurring in up to 50% of patients during lifetime. Suicides in schizophrenic patients, although sharing some characteristics with suicides in general population, have also specific features for this particular diagnostic group. Risk factors for suicide in schizophrenic patients are primarily clinical (suspiciousness, persecutory delusions, disorganization, imperative hallucinations, depression), but also consequent untoward socio-economic, marital, work, emotional, degrading, stigmatizing and similar factors. It is necessary to pay attention to possible occurrence of adverse side effects, both in their direct action upon suicidality and in possible action in decreasing compliance, thus lessening the efficacy of a prescribed drug. In this regard, it is necessary to perform adequate and individually specific type of therapy. That primarily means implementation of adequate psychopharmacotherapy in the sense of reducing the mentioned symptoms. Therapy should be commenced as early as possible and in corresponding dose, in order to avoid development of adverse secondary factors (loss of emotional and social relationships, loss of workplace, lowering on social scale, etc).In preventing these secondary events adequate pharmacotherapy and numerous psychosocial methods and actions are important as well

Changes in brain metabolites measured with magnetic resonance spectroscopy in antidepressant responders with comorbid major depression and posttraumatic stress disorder [Promjene razina moždanih metabolita mjerenih magnetskom rezonantnom spektroskopijom u ispitanika s komorbiditetom depresije i posttraumatskog stresnog poremećaja koji su odgovorili na antidepresivno liječenje]

In a present pilot study, performed on 11 subjects, we studied proton magnetic resonance spectroscopy (1H-MRS) changes in early to intermediate (3-6 weeks) responders to antidepressant treatment with selective serotonin reuptake inhibitors (SSRIs). All subjects had diagnosis of major recurrent depression comorbid to posttraumatic stress disorder (PTSD). Magnetic spectroscopy was done in the region of dorsolateral prefrontal cortex on a 3T MRI-unit. Participants were selected out of the larger sample due to an early response to antidepressant treatment within 3–6 weeks, measured with Beck Depression Inventory (BDI). We measured levels of neuronal marker N-acetyl-aspartate (NAA), choline (CHO) and creatine (Cr). There was no difference in NAA/Cr ratios between the first and the second spectroscopic scans (p=0.751). However, CHO/Cr ratios showed increasing trend with mean value at the first scan of 1.09 (SD=0.22) while mean value at second scan was 1.25 (SD=0.24), displaying statically significant difference (p=0.015). In conclusion, significant increase in choline to creatine ratio from the first to the second spectroscopic scan during the antidepressant treatment, compared to almost identical values of NAA to creatine ratio, suggests increased turnover of cell membranes as a mechanism of the early response to the antidepressant drug therapy

Pharmacogenetics of Depressions

Farmakogenetika, a posebno farmakogenomika, nove su znanstvene discipline čiji početni rezultati daju nadu da će se među bolesnicima koji boluju od depresije uspjeti prepoznati homogene skupine s obzirom na očekivani terapijski odgovor i na taj način omogućiti učinkovitije liječenje depresije. Sasvim je jasno da je terapijski odgovor rezultat složenih genskih učinaka, a ne samo jednoga gena. Na njega utječu ne samo genski polimorfizmi nego i varijacije u ekspresiji gena i posttranslacijske modifikacije proteina pod utjecajem brojnih čimbenika kao što su doza lijeka, prehrana te interakcije s drugim tvarima unijetim u organizam. Ne valja očekivati da bi se samim farmakogenetičkim ili čak farmakogenomskim istraživanjima mogla objasniti većina varijabiliteta u terapijskom odgovoru, no ustanovljavanje uzroka čak i dijela njegova varijabiliteta koji je pod izravnim genskim utjecajem znatno bi pridonijelo pouzdanijoj procjeni očekivanog terapijskog učinka i značajnije povisilo sada nizak udio bolesnika koji povoljno odgovaraju na antidepresivnu terapiju. Veći dio varijabiliteta terapijskog odgovora bit će moguće objasniti tek daljnjim razvojem transkriptomskih i proteomskih istraživanja koja su, za sada, ipak još u fazi ranog razvoja.Pharmacogenetics, and particularly pharmacogenomics, are new scientific disciplines whose initial results hold promise that the homogeneous groups with respect to the expected therapeutic response will be recognized among people suffering from depression, which would enable its more efficient treatment. It is clear that the therapeutic response is a result of complex genetic effects, and not only of one gene. Therapeutic response is affected not only by genetic polymorphisms, but also by variations in gene expression and post-translational modifications of proteins under the influence of numerous factors, e.g. dose, food, interactions with other substances. Although pharmacogenetic or even pharmacogenomic studies alone are not expected to completely elucidate the variability in the therapeutic response, the establishment of at least some causes of this variability, which is under a direct genetic influence, would significantly contribute to a more reliable assessment of expected therapeutic response and considerably increase a currently low share of patients responding to antidepressant therapies. For the most part, the variability in the therapeutic response can be explained only by further transcriptomic and proteomic research that is, currently, in the early phase of development

Häufigkeit und Dauer von Krankenhausaufenthalten schizophrener Patienten: eine Analyse gemäß ICD-10

The frequency and length of admissions over 50 years were analyzed in a sample of 10.268 schizophrenic patients according to ICD-10 subtypes of schizophrenia. The lowest yearly hospitalization frequencies during the risk period were observed in simple, catatonic, unspecified and hebephrenic schizophrenia. When the total sample was analyzed, unspecified schizophrenia exhibited a significantly higher length of hospitalization than paranoid and undifferentiated/other schizophrenia. However, after the exclusion of continuous hospitalizations, unspecified schizophrenia, in severe contrast, was identified as the subtype with lowest admission length. This indicates the need for further research in order to explore the homogeneity of that diagnostic category, i.e. whether unspecified schizophrenia encompasses two subgroups with significantly different courses. Despite the fact that paranoid schizophrenia is generally considered as having the best course and prognosis, this subtype did not have the lowest frequency, nor length of hospitalization. A weak, but significant, negative correlation was observed between admission rate and the length of hospitalization for the total sample, and particularly in the paranoid and residual schizophrenia subtypes. In conclusion, subtypes of schizophrenia differ both in hospitalization rate and length of admission. The introduction of additional factors such as age at onset, gender, subtype presented at initial course of disorder or subtype stability during further analyses could help to identify groups that are more homogenous in their course, prognosis, and, possibly, etiology.Učestalost i trajanje hospitalizacija kroz 50 godina analizirani su na uzorku od 10 268 shizofrenih bolesnika s obzirom na podtip shizofrenije prema MKB-10. Najmanja učestalost hospitalizacija po godini rizika opažena je kod jednostavne, katatone, nespecificirane i hebefrene shizofrenije. U ukupnom uzorku, kod nespecificirane se shizofrenije uočava značajno veće trajanje hospitalizacija nego kod paranoidne te nediferencirane i druge shizofrenije. Nakon isključenja iz analize onih ispitanika kod kojih postoji trajna hospitalizacija tijekom promatranih godina, nespecificirana shizofrenija se, potpuno obratno, izdvaja kao podtip s najmanjim trajanjem hospitalizacije, što upućuje na potrebu daljnjih istraživanja s ciljem ustanovaljavanja prave homogenosti te dijagnostičke kategorije, odnosno obuhvaća li taj podtip dvije skupine potpuno suprotnog tijeka bolesti. Usprkos tome što se paranoidna shizofrenija načelno smatra podtipom s najpovoljnijim tijekom i prognozom bolesti, u ovom se istraživanju on ne pokazuje niti kao onaj s najmanjom učestalosti hospitalizacija, a niti kao onaj s njihovim najmanjim trajanjem. Slaba, ali statistički značajna negativna korelacija uočava se između učestalosti hospitalizacija i njihova trajanja kada su svi shizofreni ispitanici analizirani zajedno, a kod pojedinih podtipova takva se korelacija opaža kod paranoidne i rezidualne shizofrenije. Zaključno, podtipovi shizofrenije razlikuju se i po učestalosti hospitalizacija i po njihovu prosječnom trajanju, a uključivanje dodatnih čimbenika u budućim analizama (kao što su dob nastupa poremećaja, spol, podtip koji se očitovao u početku bolesti, ili promjenjivost dijagnostičke kategorije) može pridonijeti prepoznavanju podskupina koje su u većoj mjeri homogene s obzirom na tijek i prognozu, a, moguće, i na svoju etiologiju.Zum Zweck der vorliegenden Untersuchung wurden 10.268 Fälle schizophrener Patienten analysiert, die im Laufe der letzten 50 Jahre wiederholt hospitalisiert worden waren. Die Häufigkeit und Dauer von Krankenhausaufenthalten wurde bei solchen Patienten ausgewertet, bei denen gemäß den unter ICD-10 aufgelisteten Kriterien ein spezifischer Untertypus von Schizophrenie vorliegt. Die geringste Zahl von Krankenhausaufenthalten je Risikojahr war bei Fällen von katatonischer, nichtspezifizierter und hebephrener Schizophrenie zu beobachten, wohingegen es bei undifferenzierter sowie einigen anderen Arten von Schizophrenie zu weitaus häufigeren Hospitalisierungen kam. Nachdem jene Patienten, die sich zu Dauerbehandlungen in Krankenhäusern befinden, aus der Analyse ausgesondert worden waren, stellte sich heraus, dass im Gegensatz dazu nichtspezifizierte Schizophrenie jene Erkrankungsform darstellt, die mit den kürzesten Hospitalisierungen verbunden ist. Dieser Umstand erfordert weitere Untersuchungen, um das wahre Homogenitätsniveau dieser diagnostischen Kategorie zu ermitteln und eine Antwort auf die Frage zu finden, ob dieser Untertypus von Schizophrenie zwei völlig voneinander abweichende Manifestationsformen umfasst. Obwohl wiederum paranoide Schizophrenie generell als die Erkrankungsform mit dem günstigsten Verlauf und den günstigsten Besserungsaussichten gilt, zeigte sie in dieser Untersuchung weder die geringsten Krankenhausaufenthalte, noch waren diese von der kürzesten Dauer. Ein schwacher, aber statistisch dennoch relevanter negativer Bezug war zwischen der Häufigkeit von Hospitalisierungen und ihrer Dauer zu beobachten, nachdem sämtliche schizophrene Patienten analysiert worden waren; dies galt insbesondere für die diagnostischen Kategorien der paranoiden und residualen Schizophrenie. Abschließend kann gesagt werden, dass sich die verschiedenen Erkrankungsformen sowohl in der Häufigkeit von Krankenhausaufenthalten als auch in deren Dauer unterscheiden. Zukünftige Analysen sollten zusätzliche Faktoren mit einschließen, so etwa das Alter, in dem eine Erkrankung zum ersten Mal auftrat; das Geschlecht des/der Erkrankten; die bei Krankheitsbeginn erstellte Diagnose; die Veränderlichkeit der diagnostischen Kategorie. Auf diese Weise können die einzelnen Manifestationsformen von Schizophrenie, die hinsichtlich Krankheitsverlauf und Aussichten, aber vermutlich auch hinsichtlich der Ätiologie eine größere Homogenität aufweisen, besser erkannt werden

Pharmacoeconomics Investigation of Psychofarmacs

Gospodarske procjene posljedica narušenja mentalnog zdravlja i istraživanja u kojima se terapijski ishod uspoređuje s uloženim sredstvima sve se češće susreću u stručnoj i znanstvenoj literaturi, usporedno s porastom broja raspoloživih mogućnosti u farmakoterapiji psihijatrijskih poremećaja. U ovom je prikazu dan osvrt na važnija istraživanja ekonomskih posljedica psihijatrijskih poremećaja, kretanja u potrošnji psihofarmaka, načela provođenja farmakoekonomskih istraživanja te na mogućnost njihove primjene u praksi.Economic estimation of consequences of disturbed mental health and of research in which therapeutic outcome is compared with invested funds has often been met in professional and scientific literature, along with the increase of available possibilities in pharmacotherapy of psychiatric disorders. This review presents more important research work in economic sequelae of psychiatric disorders, trends in use of psychopharmaca, principles of conducting pharmacoeconomic investigations, and the possibilities of their practical application

Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy in a Patient with Amyotrophic Lateral Sclerosis and Frontotemporal Dementia

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) have been investigated in a single neurodegenerative disease manifesting as either amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD) alone, but have not been examined in combined disorders such as ALS with FTD (ALS-FTD). To our knowledge, this study is the first attempt to demonstrate relationship between MRI abnormalities and MR spectroscopic metabolite changes of the motor cortex, frontal white matter and corticospinal tract in a patient with the diagnosis of ALS with probable upper motor neuron signs (ALS-PUMNS) and FTD. Patient presented underwent MRI of the brain and MRS. The ratio of N-acetylaspartate (NAA) to creatine (Cr), choline to Cr, myo-inositol (mI) to Cr and glutamate-glutamine (Glx) to Cr were derived from peak area measurement. Spectra from the right motor cortex, frontal white matter and corticospinal tract were obtained. MR images were evaluated for sulcus centralis enlargement, corticospinal tract hyperintensity and frontal lobes atrophy. Spectra showed reduced NAA/Cr and Glx/Cr ratio, yet the ratio of Cho/Cr exhibited significant elevation. MR images revealed sulcus centralis enlargement, high signal intensity of corticospinal tract and atrophy of both frontal lobes. Proton spectroscopic metabolic changes in a current patient fully correlate with previously reported MRS metabolic changes in ALS alone. Surprisingly, normal mI (glial marker) values have been found in almost all measured voxels of interest except in the frontal white matter. These findings differ from the previous findings in ALS or FTD alone. In conclusion, these findings support the concept that ALS, FTD and ALS-FTD may represent different manifestations of a single pathological continuum