STIGMA AND SUICIDE

Suicide is one of the major mental health problems in the world. It is estimated that one million suicide are committed per year and that after every suicide six people from the surrounding suffer or develop major life changes. After suicide survivors are at higher risk of developing major psychological changes and suicidal ideations as well. They go through the complicated process of grief which is specifically characterized by the felling of guilt, shame, denial and anger. The griefing process, more often than in other causes of death, doesn’t integrate but is complicated with prolonged grief. This represents a very favorable state for perceiving stigma. Stigma is most often defined as a mark of disgrace or infamy; a stain or reproach, as on one’s reputation. In suicide we talk about public and self stigma. Both forms of stigma can separately cause social isolation, demoralization, the felling of hopelessness and other consequences that interfere with the previous functioning. Because of the high incidence of psychological changes after stigma it is crucial for the bereaved to have close mental health services. But stigma is a barrier to treatment seeking. After suicide most survivors fell stigmatized but it is not yet known which factors modify the perception of stigma. Other causes of death like natural death are less related to stigma. On the other side traumatic death like an accident or homicide seem to be related to perception of stigma in the same way survivors perceive after suicide. Suicide and stigma are related in a two way direction meaning that suicide can cause stigma but stigma can lead to suicidal thoughts as well. Even suicide attempters fell stigmatized by colleagues, medical staff and their closest surrounding. There is a need for interventions. The effect of broad anti-stigma campaigns and targeted programs still have to be examines. In clinical settings, interventions that reduce self stigma, stigma-stress and shame might successfully reduce suicidality

STIGMA AND SUICIDE

Suicide is one of the major mental health problems in the world. It is estimated that one million suicide are committed per year and that after every suicide six people from the surrounding suffer or develop major life changes. After suicide survivors are at higher risk of developing major psychological changes and suicidal ideations as well. They go through the complicated process of grief which is specifically characterized by the felling of guilt, shame, denial and anger. The griefing process, more often than in other causes of death, doesn’t integrate but is complicated with prolonged grief. This represents a very favorable state for perceiving stigma. Stigma is most often defined as a mark of disgrace or infamy; a stain or reproach, as on one’s reputation. In suicide we talk about public and self stigma. Both forms of stigma can separately cause social isolation, demoralization, the felling of hopelessness and other consequences that interfere with the previous functioning. Because of the high incidence of psychological changes after stigma it is crucial for the bereaved to have close mental health services. But stigma is a barrier to treatment seeking. After suicide most survivors fell stigmatized but it is not yet known which factors modify the perception of stigma. Other causes of death like natural death are less related to stigma. On the other side traumatic death like an accident or homicide seem to be related to perception of stigma in the same way survivors perceive after suicide. Suicide and stigma are related in a two way direction meaning that suicide can cause stigma but stigma can lead to suicidal thoughts as well. Even suicide attempters fell stigmatized by colleagues, medical staff and their closest surrounding. There is a need for interventions. The effect of broad anti-stigma campaigns and targeted programs still have to be examines. In clinical settings, interventions that reduce self stigma, stigma-stress and shame might successfully reduce suicidality

STIGMA OF PSYCHIATRIC DISEASES AND PSYCHIATRY

The aim of this review is evaluate stigma seen among people suffering from psychiatric disorders. We will show the negative effects of stigma on psychiatric services and evaluate the importance of continiuous anti-stigma programs. It is encouraging that new anit-stigma programmes are developed. The aim of this program is the restoration of dignity to patients and institutions. Media play an important role in shaping the view of an average person on psychiatric patients and most programms use media as a mediator to promote a positive attitude to psychiatric disorders. Apart from ignorance, fear and hostility they have to deal with self-stigma, as well. Through anti-stigma programs, psychoeducation of patients and families about the disorder and treatment options we can give them an acitve role in the treatment, restore dignity, self-confidence, quality of life and reintegrate them into the society

STIGMA OF PSYCHIATRIC DISEASES AND PSYCHIATRY

The aim of this review is evaluate stigma seen among people suffering from psychiatric disorders. We will show the negative effects of stigma on psychiatric services and evaluate the importance of continiuous anti-stigma programs. It is encouraging that new anit-stigma programmes are developed. The aim of this program is the restoration of dignity to patients and institutions. Media play an important role in shaping the view of an average person on psychiatric patients and most programms use media as a mediator to promote a positive attitude to psychiatric disorders. Apart from ignorance, fear and hostility they have to deal with self-stigma, as well. Through anti-stigma programs, psychoeducation of patients and families about the disorder and treatment options we can give them an acitve role in the treatment, restore dignity, self-confidence, quality of life and reintegrate them into the society

ASSOCIATION OF NEUROPEPTIDE S RECEPTOR 1 AND GLUTAMATE DECARBOXYLASE 1 GENE POLYMORPHISMS WITH POSTTRAUMATIC STRESS DISORDER

Background: Posttraumatic stress disorder (PTSD) is an anxiety disorder caused by highly traumatic experiences. The aim of this study was to investigate the influence of single nucleotide polymorphisms (SNPs) in the neuropeptide S receptor 1 (NPSR1) and the glutamate decarboxylase 1(GAD1) gene on PTSD and its psychopathological aspects among individuals affected by the Balkan wars during the 90s. Subjects and methods: This study was conducted as part of the South Eastern Europe (SEE) study on molecular mechanisms of PTSD. It comprised 719 participants (539 males), including those with current PTSD, remitted PTSD and healthy volunteers. Psychometric evaluation was performed using the Mini International Neuropsychiatric Interview (M.I.N.I.), the Clinician Administrated PTSD Scale (CAPS) andthe Brief Symptom Inventory (BSI). We examined NPSR1 single nucleotide polymorphism (SNP) rs324981 and GAD1 variant rs3749034 genotypes. Case-control analyses were carried out using logistical regression to determine genotype differences between all patients that had either current or remitted PTSD and control individuals. To analyse the influence of the analysed SNPs on PTSD severity, we performed linear regression analyses with CAPS and BSI within each of the two patient groups separately. All of the calculations were performed for additive allelic, recessive, dominant and genotypic models. Results: We observed a nominally significant association for the major allele (G) of GAD1 rs3749034 with an increased risk to develop PTSD in a case control analysis in the recessive model (P=0.0315, odds ratio=0.47, SE=0.35). In contrast, a nominally significant association of the minor allele (A) with higher CAPS scores was identified within the patient group with lifetime PTSD in the dominant model (P=0.0372, ????=6.29, SE=2.99). None of these results did withstand correction for multiple tests. No nominal significant results of GAD1 rs3749034 were found with regard to the intensity of psychological BSI symptoms. Case control analyses of NPSR1 rs324981 revealed a nominally significant higher risk for homozygous T allele carriers to develop PTSD (P=0.0452) in the recessive model. On the other hand, the T allele showed a nominally significant association with higher BSI scores in patients suffering from lifetime PTSD in the recessive model (P=0.0434). Again, these results were not significant anymore after correction for multiple tests. No associations of NPSR1 rs324981 and CAPS score was identified. Conclusion: The findings of this study provide some evidence that the NPSR1 and GAD1 polymorphisms might play a role in the development of war-related PTSD and its related psychological expressions. Further research is needed to elucidate the interactions of specific gene variants and environmental factors in the development of PTSD

ASSOCIATIONS OF GENE VARIATIONS IN NEUROPEPTIDE Y AND BRAIN DERIVED NEUROTROPHIC FACTOR GENES WITH POSTTRAUMATIC STRESS DISORDER

Background: Individuals who are exposed to traumatic events are at an increased risk of developing posttraumatic stress disorder (PTSD), a condition during which an individual\u27s ability to function is impaired by emotional responses to memories of those events. The gene coding for neuropeptide Y (NPY) and the gene coding for brain-derived neurotrophic factor (BDNF) are among the number of candidate gene variants that have been identified as potential contributors to PTSD. The aim of this study was to investigate the association between NPY and BDNF and PTSD in individuals who experienced war-related trauma in the South Eastern Europe (SEE) conflicts (1991-1999). Subjects and methods: This study included participants with current and remitted PTSD and healthy volunteers (N=719, 232 females, 487 males), who were recruited between 2013 and 2015 within the framework of the South Eastern Europe (SEE) - PTSD Study. Psychometric methods comprised the Mini International Neuropsychiatric Interview (M.I.N.I.), the Clinician Administered PTSD Scale (CAPS), and the Brief Symptom Inventory (BSI). DNA was isolated from whole blood and genotyped for NPY rs5574 via PCR - RFLP and NPY rs16147 and BDNF rs6265 using the KASP assay. Results: Tests for deviation from Hardy-Weinberg equilibrium showed no significant results. Analyses at the categorical level yielded no associations between the affected individuals and all three SNPs when compared to controls. Within lifetime PTSD patients, the major alleles of both NPY variants showed a nominally significant association with higher CAPS scores (p=0.007 and p=0.02, respectively). Also, the major allele of rs5574C>T was associated with higher BSI scores with a nominal significance among current PTSD patients (p=0.047). The results did not withstand a Bonferroni adjustment (????=0.002). Conclusion: Nominally significant associations between NPY polymorphisms and PTSD susceptibility were found that did not withstand Bonferroni correction

ASSOCIATION ANALYSIS OF MAOA AND SLC6A4 GENE VARIATION IN SOUTH EAST EUROPEAN WAR RELATED POSTTRAUMATIC STRESS DISORDER

Background: The aim of this study is to investigate the association of gene variations of the monoamine oxidase A (MAOA) and the serotonin transporter solute carrier family 6 member 4 (SLC6A4) gene with posttraumatic stress disorder (PTSD) severity and coping strategies in patients with war related PTSD. Subjects and methods: The study included 747 individuals who had experienced war trauma in the South Eastern Europe conflicts between 1991 and 1999. Genotyping of the MAOA VNTR and SLC6A4 tandem repeat polymorphism in combination with rs25531 was done in 719 participants: 232 females and 487 males. Among them, 369 have had current or lifetime PTSD and 350 have had no PTSD symptoms. For psychometric approach we used the Clinician Administrated PTSD Scale (CAPS), the Brief Symptom Inventory (BSI), the adapted Hoffman Lazarus Coping scale and a basic socio-demographic data questionnaire. Results: There were no significant intergroup (PTSD versus non PTSD) differences in the genotype distribution of MAOA and SLC6A4 gene polymorphisms. The primary finding of our study was that the MAOA short allele (MAOA-S) was nominally significantly associated with the severity of PTSD symptoms in the total subgroup of participants with lifetime PTSD; males for symptoms of hyperarrousal and females with symptoms of re-experience and hyperarousal. In our research the male subsample with current PTSD and MAOA-S genotype had nominally significantly higher scores for some positive coping strategies compared to those carrying the long allele genotype (MAOA-L). There was no significant association between the severity of PTSD symptoms, BSI phenotype, coping scores and the SLC6A4 genotype. Conclusion: The present results support the notion that MAOA VNTR gene variation modulates development and recovery of posttraumatic stress disorder in a war traumatised population, but did not support a connection between SLC6A4 gene variations and war related PTSD

GENETIC SUSCEPTIBILITY TO POSTTRAUMATIC STRESS DISORDER: ANALYSES OF THE OXYTOCIN RECEPTOR, RETINOIC ACID RECEPTOR-RELATED ORPHAN RECEPTOR A AND CANNABINOID RECEPTOR 1 GENES

Background: Exposure to life-threatening events is common and everyone will most likely experience this type of trauma during their ifetime. Reactions to these events are highly heterogeneous and seems to be influenced by genes as well. Some individuals will develop posttraumatic stress disorder (PTSD), while others will not. In this study, our aim was to analyze the correlation between single nucleotide polymorphisms (SNPs) within the oxytocin receptor (OXTR) gene (rs53576 and rs2254298), the RAR-related orphan receptor A (RORA) gene (rs8042149) and the cannabinoid receptor 1 (CNR1) gene (rs1049353) and PTSD. All candidate genes have been previously associated with stress related disorders and the reaction to traumatic events. Subjects and methods: Participants (N=719) have been exposed to war-related trauma during the war in South-Eastern Europe (Bosnia and Herzegovina, Croatia and Kosovo). We correlated the presence and absence of current and lifetime PTSD as well as PTSD severity (Clinician Administered PTSD scale (CAPS)) and current psychopathology (Brief Symptom Inventory (BSI) score) with the mentioned SNPs. DNA was isolated from whole blood and genotyped for OXTR rs2254298 and rs53576 following previously published protocols, for RORA rs8042149 via PCR-RFLP and CNR1 rs1049353 via KASP. Results: Nominally significant results were found for OXTR rs53576 in connection with the CAPS and BSI scores within lifetime PTSD patients. The additive allelic model indicated that G allele carriers achieved lower CAPS (p=0.0090) and BSI (p=0.0408) scores than participants carrying one or two copies of the A allele. These results did not withstand correction for multiple tests. No significant results were observed for OXTR rs2254298, RORA rs8042149 and CNR1 rs1049353 although the results for RORA showed a slight tendency that rs8042149 may influence the level of BSI scores in current PTSD patients. Conclusions: This study points to a role of the OXTR gene in PTSD and the related psychopathology following war related trauma