CLINICALLY SIGNIFICANT DEPRESSIVE DISORDER IN ADOLESCENCE; CROSS-SECTIONAL STUDY OF TWO CROATIAN COUNTIES

Background: The aim of the study was to determine whether there is a difference in the intensity of depression, suicidality, and expression of clinical features among adolescents in two different regions of Krapina-Zagorje (KZ) and Split-Dalmatia (SD). Subjects and methods: The study was designed as a descriptive cross-sectional, the sample consisted of 200 adolescents, 100 from each region, aging 16-18 years, from various high schools. The research was conducted by psychiatrists in Split and Krapina, where school population of Split-Dalmatia County and Krapina-Zagorje County gravitates. For the assessment of depression, the Hamilton rating scale for depression with 21 items was used, which has proven in clinical practice. For the inclusion in the study, among other parameters, participants needed to satisfy the criterion that depression is clinically significant (19 or more points on the HAMD-21). Results: The data obtained points out to statistically significant difference in the intensity of depression between the two regions (p<0.001). There was no difference in suicidal impulses. For the most part, the expression of clinical features between adolescents in these regions showed no significant difference, except that guilt (p=0.001), failing in the work plan and activities (p=0.000) and paranoid ideas (p=0.013) were significantly more expressed in adolescents of Krapina-Zagorje County and sleep disorders (p<0.001) in adolescents of Split-Dalmatia County. Conclusions: It can be concluded that depression, suicidality and much of the clinical features depend on the developmental age, i.e. the turbulent adolescent development, rather than on regional differences, although, to a lesser extent, the expression of clinical features can be influenced by milieu, lifestyle, family dynamics and educational procedures, which can partially affect the expression of clinical features

DEPRESSION AND AUTO-AGGRESSIVENESS IN ADOLESCENTS IN ZAGREB

Background: The aim of the study was to explore the frequency of depression among the general population of adolescents who were high school students in the city of Zagreb. As depression is associated with increased suicidal risk we wanted to check to what extent depression, as an emotional problem among youth, is associated with auto-aggression in the general population of adolescents. Subjects and methods: The study was conducted on a sample of high school students in Zagreb and it included 701 students of both genders aged from 14-19 years of age. To test the depression a Beck Depression Inventory (BDI) was administered for youth between 11-18 years of age (Youth Self Report for ages 11-18). To test auto-aggression a Scale of Auto-destructiveness (SAD) was used. Results: Results obtained by this study show that about 20.7% of high school students have mild and borderline depressive disorders while moderate or severe depression shows about 5% of them, whereby depression is statistically significant among girls who, on average, report more symptoms of depression. It has also been proven a significant impact of depression levels (F (2,423)=35.860, p<0.001) on auto-aggression in subjects of both genders. In both genders, moderately depressed show more auto destructiveness than those without depression symptoms (p<0.01). In the group of heavily depressed (n=30), significantly higher self-destructiveness is shown by girls (p<0.01). Conclusions: The data suggest the importance of early recognition, understanding and treatment of depressive symptoms in adolescents in order to reduce the risk of subsequent chronic psychosocial damage

DEPRESSION AND AUTO-AGGRESSIVENESS IN ADOLESCENTS IN ZAGREB

Background: The aim of the study was to explore the frequency of depression among the general population of adolescents who were high school students in the city of Zagreb. As depression is associated with increased suicidal risk we wanted to check to what extent depression, as an emotional problem among youth, is associated with auto-aggression in the general population of adolescents. Subjects and methods: The study was conducted on a sample of high school students in Zagreb and it included 701 students of both genders aged from 14-19 years of age. To test the depression a Beck Depression Inventory (BDI) was administered for youth between 11-18 years of age (Youth Self Report for ages 11-18). To test auto-aggression a Scale of Auto-destructiveness (SAD) was used. Results: Results obtained by this study show that about 20.7% of high school students have mild and borderline depressive disorders while moderate or severe depression shows about 5% of them, whereby depression is statistically significant among girls who, on average, report more symptoms of depression. It has also been proven a significant impact of depression levels (F (2,423)=35.860, p<0.001) on auto-aggression in subjects of both genders. In both genders, moderately depressed show more auto destructiveness than those without depression symptoms (p<0.01). In the group of heavily depressed (n=30), significantly higher self-destructiveness is shown by girls (p<0.01). Conclusions: The data suggest the importance of early recognition, understanding and treatment of depressive symptoms in adolescents in order to reduce the risk of subsequent chronic psychosocial damage

HYPERPROLACTINEMIA - SIDE EFFECT OR PART OF THE ILLNESS

Background: Hyperprolactinemia is associated with side effect of antipsychotics in people suffering from psychotic disorders. However, increased prolactin levels (mlU/L) were found in patients suffering from the first psychotic episode who were not receiving antipsychotic therapy. The assumption of this study is that the abnormality in the level of prolactin is associated with the effect and influence of the disease, not the therapy that is carried out. Subjects and methods: Study involved 54 female patients hospitalized in Psychiatric hospital "Sveti Ivan", whose average age was 33.9 years. All patients had been diagnosed with a psychotic disorder (according to MKB-10, F20-F29). 18 patients had their first psychotic episode, while 36 patients had relapses of psychotic disorder. The methods used were: PANSS scale and measurement of prolactin concentration (Immunoanalyzer ACCESS 2, CLIA method). Arithmetic mean, standard deviations, correlation coefficient, Mann Whitney U test and the chi-squared test were used. Results: 75.5% of patients had prolactin values above the reference values (min 121, max 4192 ml/L). In a sample of patients with first psychotic episode, 77.8% had elevated prolactin levels, while among re-hospitalized patients, elevated levels had 74.2%. Statistically significant results were obtained: patients with higher pronounced symptoms had higher prolactin values, especially particles on PANSS: P1 (delusions), N4 (Apathy), G15 (preoccupation) and G16 (active avoidance). Conclusion: Elevated prolactin in patients has been demonstrated regardless of antipsychotic therapy, therefore the question of etiology of hyperprolactinemia in psychotic disorders is questionable. The association of hyperprolactinemia with the severity of the clinical picture has also been demonstrated, higher prolactin values indicating a stronger clinical picture, which calls into question the protective role of prolactin in psychotic disorders

HYPERPROLACTINEMIA - SIDE EFFECT OR PART OF THE ILLNESS

Background: Hyperprolactinemia is associated with side effect of antipsychotics in people suffering from psychotic disorders. However, increased prolactin levels (mlU/L) were found in patients suffering from the first psychotic episode who were not receiving antipsychotic therapy. The assumption of this study is that the abnormality in the level of prolactin is associated with the effect and influence of the disease, not the therapy that is carried out. Subjects and methods: Study involved 54 female patients hospitalized in Psychiatric hospital "Sveti Ivan", whose average age was 33.9 years. All patients had been diagnosed with a psychotic disorder (according to MKB-10, F20-F29). 18 patients had their first psychotic episode, while 36 patients had relapses of psychotic disorder. The methods used were: PANSS scale and measurement of prolactin concentration (Immunoanalyzer ACCESS 2, CLIA method). Arithmetic mean, standard deviations, correlation coefficient, Mann Whitney U test and the chi-squared test were used. Results: 75.5% of patients had prolactin values above the reference values (min 121, max 4192 ml/L). In a sample of patients with first psychotic episode, 77.8% had elevated prolactin levels, while among re-hospitalized patients, elevated levels had 74.2%. Statistically significant results were obtained: patients with higher pronounced symptoms had higher prolactin values, especially particles on PANSS: P1 (delusions), N4 (Apathy), G15 (preoccupation) and G16 (active avoidance). Conclusion: Elevated prolactin in patients has been demonstrated regardless of antipsychotic therapy, therefore the question of etiology of hyperprolactinemia in psychotic disorders is questionable. The association of hyperprolactinemia with the severity of the clinical picture has also been demonstrated, higher prolactin values indicating a stronger clinical picture, which calls into question the protective role of prolactin in psychotic disorders

Malignant Diseases and Mental Disorders - Prevalence, Mortality, Therapeutic Challenge

Psihički poremećaji koji dolaze u komorbiditetu s karcinomom drastično smanjuju kvalitetu života i utječu na ishod bolesti, povećavaju mortalitet, a prema literaturi smatra se da se javljaju kod 50 % pacijenata s dijagnozom karcinoma. Rana detekcija psihičkih poremećaja, probir, odabir adekvatnih dijagnostičkih ljestvica i odabir adekvatne terapije preduvjet su poboljšanja kvalitete života takvih bolesnika i utjecaja na povoljniju prognozu. Cilj ovog preglednog rada bio je odgovoriti na pitanja: koji su to psihički poremećaji koji se javljaju, kakva je kvaliteta života, postoje li specifične ljestvice za procjenu, dobivaju li psihijatrijski pacijenti adekvatnu skrb, postoje li specifičnosti terapije kao i interakcija onkološke terapije te može li terapija onkološkog pacijenta inducirati nastanak psihičkog poremećaja. Pretraživali smo literaturu koristeći bazu podataka US National Center for Biotechnology Information (NCBI) Σ Medline/Pubmed sistem. Uzimali smo u obzir publikacije tijekom zadnjih deset godina. Psihološke reakcije i psihički poremećaji su brojni, a rezultat su same dijagnoze koja podrazumijeva doživotno liječenje, agresivnih medicinskih tretmana, promjena u načinu života, no i direktnog utjecaja tumora. Većina studija ukazuje na protektivnu ulogu shizofrenije i psihofarmaka, no neke nuspojave psihofarmaka dovode se u direktnu vezu s kancerogenim učinkom. Postoje specifične ljestvice za procjenu psihičkog stanja kod pacijenata koji boluju od malignih bolesti. Što se pak tiče skrbi, pacijenti koji boluju od karcinoma, a u komorbiditetu imaju psihičke poremećaje ili bolesti ne dobivaju adekvatan tretman važeći prema današnjim smjernicama za liječenje karcinoma. To znanje pak ukazuje na važnost timskog, multidisciplinskog pristupa koji jedini može pravovremeno, kvalitetno pomoći takvim bolesnicima.Mental disorders comorbid with carcinoma, which according to the literature occur in 50% of cases of cancer, drastically decrease the quality of life of patients, increase mortality rate, and affect the outcome of the disease. Early detection of mental disorders, screening, the use of adequate diagnostic scales, and therapy are a prerequisite to improving of the quality of life of such patients and achieving a better prognosis. The aim of this review paper is to find an answer to the following questions: which mental disorders can occur? What is the quality of life of these patients? Are there specific assessment scales? Do psychiatric patients receive adequate treatment? Are there any therapeutic specificities and interactions with the oncological therapy? Can an oncological patient’s therapy cause the occurrence of a mental disorder? We went through the literature with the help of the US National Centre for Biotechnology Information (NCBI) database Σ the Medline/Pubmed system Σ and we took into consideration publications from the past ten years. There are many psychological reactions and mental disorders that occur as a result of diagnoses that requires a lifetime of treatment, aggressive medical treatments, lifestyle changes, and of the influence of the tumour itself. Most studies indicate a protective role of schizophrenia and psychopharmacology but also that certain side-effects of drugs are directly linked with a cancerogenic effect. There are specific scales to assess the mental state of patients suffering from malignancies. According to current guiding principles, patients suffering from carcinoma in comorbidity with mental disorders or diseases do not receive adequate treatment. Our current knowledge, however, indicates the importance of team-work and an interdisciplinary approach as the only solution to effectively and adequately help patients

Serotonin and Cortisol as Suicidogenic Factors in Patients with PTSD

Post-traumatic Stress Disorder (PTSD) frequently occurs in commorbidity with different mental disorders, including suicidal behaviour. Group of biological factors, including serotonergic system, HPA axis and some genetic factors, are being studied as potential markers, able to differentiate suicidal and non-suicidal behaviour across the group of PTSD patients. This study is examining statistical relation between platelet serotonine concentration and serum cortisole concentration, within the group of PTSD patients with and without attempted suicide, treated at »Sveti Ivan« Psychiatric Hospital in Zagreb. The hypothesis of this study is that periferal biochemical markers are different accross the groups of PTSD patients with and without attempted suicide and the group of healthy controls. Our results have shown significantly lower platelet serotonine concentration in PTSD patients with and without suicide behaviour, compared to healthy controls. There are no statisticaly significant differences of the serum cortisole concentration accross observed groups. Our results correspond with those reported by other authors in this area of research, suggesting that platelet serotonine level might be used as potential periferal marker to detect risk of suicidal behaviour in PTSD patients

Antipsychotics-induced hyperprolactinemia and screening for macroprolactin

Introduction: High prolactin (PRL) concentrations are found in laboratory test results of patients on majority of antipsychotic drugs. Prevalence rates and degrees of severity of hyperprolactinemia (HPRL) based on PRL concentration may depend on the presence of macroprolactin in the serum. The aim of the study was to investigate the difference between PRL concentrations before and after precipitation of macroprolactin and to examine if there were any changes in the categorization of HPRL between samples prior and after precipitation. Materials and methods: Total of 98 female patients (median age 33; range 19-47 years) diagnosed with a psychotic disorder, proscribed antipsychotic drugs, and with HPRL were included. Total PRL concentration and PRL concentration after macroprolactin precipitation with polyethylene glycol (postPEG-PRL) were determined by the chemiluminometric method on the Beckman Coulter Access2 analyser. Results: Total PRL concentrations (median 1471; IQC: 1064-2016 mlU/L) and postPEG-PRL concentrations (median 1453; IQC: 979-1955 mlU/L) were significantly correlated using intraclass correlation coefficient for single measurements (mean estimation 0.96; 95%CI 0.93-0.97) and average measurement (mean estimation 0.98; 95%CI 0.96-0.99), and all investigated female patient had HPRL according to PRL and postPEG-PRL concentration. The median PRL recovery following PEG precipitation was 95; IQC: 90-100%. There was substantial agreement (kappa test = 0.859, 95% CI: 0.764- 0.953) between the categories of HPRL severity based on total PRL concentrations and postPEG-PRL concentrations. Conclusion: The study demonstrated that HPRL was present in all subjects using the reference interval for total PRL concentration and postPEG-PRL concentration with no significant impact of macroprolactin presence in the serum on the categorization of patients according to severity of HPRL

TRACE ELEMENTS CONCENTRATIONS ASSOCIATION WITH SCHIZOPHRENIA SYMPTOMS; A CROSS-SECTIONAL STUDY IN CROATIA

Background: Significant inconsistencies exist in findings on association of bio-elements (BE) concentrations and schizophrenia. Hypothesis of this research was that different concentrations of BE are associated with different psychopathological schizophrenia symptoms. Subjects and methods: This cross-sectional study was performed from 2014 to 2016 at Psychiatric Hospital “Sveti Ivan” and University Psychiatric Hospital “Vra

EARLY INTERVENTION SERVICES FOR EARLY-PHASE PSYCHOSIS - CENTRE FOR INTEGRATIVE PSYCHIATRY IN PSYCHIATRIC HOSPITAL “SVETI IVAN”, CROATIA

Background: There is a growing body of evidence suggesting that early and effective management in the critical early years of schizophrenia can improve long-term outcomes. The objective of this study was to evaluate time to relapse of the patients with earlyphase psychosis treated in the Centre for integrative psychiatry (CIP). Subject and methods: We performed a retrospective cohort study on the sample of 373 early-phase psychosis patients admitted to Psychiatric Hospital “Sveti Ivan”, Zagreb Croatia: from January 1, 2015 to December 31, 2017. The primary outcome was time to relapse. Results: Patients who were admitted to group psychotherapeutic program after the end of acute treatment had 70% lower hazard for relapse (HR=0.30; 95% CI 0.16-0.58). Patients who were included first in the psychotherapeutic program and then treated and controlled in the daily hospital had 74% lower hazard for relapse (HR=0.26; 95% CI 0.10-0.67). Conclusions: In early-phase psychosis, integrative early intervention service has relevant beneficial effects compare to treatment as usual. These results justified the implementation of multimodal early intervention services in treatment of patients with earlyphasen psychosis