Long-acting injectable antipsychotics in treatment of schizophrenia - attitudes of psychiatrists and patients

Shizofrenija je kronična mentalna bolest koja se liječi oralnim i intramuskularnim antipsihoticima. Dugodjelujući intramuskularni antipsihotici (LAIA), unatoč potencijalno mnogim prednostima, rijetko se propisuju te je njihova primjena uglavnom rezervirana za nesuradljive bolesnike. Cilj ovog preliminarnog istraživanja bio je ispitati stavove psihijatara i pacijenata kako bismo dobili uvid u prednosti, nedostatke i moguće razloge rijetkog propisivanja LAIA. Sastavljene su tri ankete te je ispitano ukupno 48 psihijatara, 50 pacijenata liječenih oralnom terapijom i 50 pacijenata liječenih s LAIA. Usporedbom pacijenata, veći broj njih liječenih s LAIA osjeća poboljšanje (82%). 84% pacijenata liječenih s LAIA i 46% pacijenata liječenih oralnom terapijom smatra jednostavnijim način primjene lijeka jednom u dva do četiri tjedna. Iako 78% psihijatara navodi da je sklono propisivanju LAIA, mali je broj njihovih pacijenata kojima je to i propisano (medijan=20%). Unatoč pozitivnim stavovima pacijenata o LAIA, većina psihijatara (68,08%) smatra da pacijenti radije odabiru oralnu terapiju. Upravo bi zbog toga buduća istraživanja trebalo usmjeriti u detaljnije ispitivanje stavova i pacijenata i psihijatara o terapiji.Schizophrenia is a chronic mental illness that can be treated with oral and intramuscular antipsychotics. Despite many potential benefits, long-acting injectable antipsychotics (LAIA) are rarely prescribed and their usage is mostly reserved for nonadherent patients. The aim of this preliminary research was to examinate attitudes of psychiatrists and patients to get a better insight into advantages, disadvantages and possible reasons for rarely prescribing of LAIA. Three different questionnaires were given to total of 48 psychiatrists, 50 patients treated with oral medication and 50 patients treated with LAIA. Comparison among patients shows that there is a larger number of patients treated with LAIA that feels better (82%). 84% of patients treated with LAIA and 46% of patients treated with oral medication consider the usage of LAIA more simple. Although 81,25% of psychiatrists state that they tend to prescribe LAIA, there is a small number of their patients that are using it (median=20%). Despite positive attitudes of patients toward LAIA, majority of psychiatrists (68,08%) think that patients would rather choose oral therapy. Precisely because of this, future researches should be focused on further examination of psychiatrists' and patients' attitudes toward therapy

ATTITUDES OF CROATIAN PSYCHIATRISTS TOWARDS LONG-ACTING INJECTABLE ANTIPSYCHOTICS

Background: Despite many advantages of long-acting injectable antipsychotics (LAIA), this type of therapy is still underused in routine practice. Since psychiatrists\u27 attitudes play an important role in prescription rate of LAIA, we found it valuable to examine their attitudes because, according to our knowledge, there hasn\u27t been similar research in Croatia so far. Subjects and methods: In this research, we included the total of 48 psychiatrists. For research purposes, we created a questionnaire modeled on standardized questionnaire. Results are described with descriptive statistics and Likert scale was used to measure respondents\u27 attitudes to statements. Results: The number of years of their experience in practice is expressed with median of 13.50 years with minimal value of 1.00 and maximum value of 36.00 years. Most of psychiatrists find that LAIA play an important role in treatment of schizophrenia (n=44, 93.62%) and that they tend to prescribe that type of therapy (n=39, 81.25%). Almost all of psychiatrists (n=45, 93.75%) agree or strongly agree that it is easier to control patients\u27 disease if they are treated with LAIA rather than with oral therapy and 32 of them (68.08%) think that doctor-patient relationship is more successful when patients are treated with LAIA than with oral antipsychotics. According to their experience (n=32, 68.08%) patients prefer to be treated with oral antipsychotics instead of LAIA. We expressed approximate percentage of their patients treated with LAIA with median of 20%, with minimum value of 0.00% and maximum value of 70.00%. Conclusion: According to the results of our research, attitudes of psychiatrists towards LAIA are mostly positive, but considering the fact that there is a small number of their patients who are treated with them, we emphasize that psychiatrists still prescribe oral antipsychotics much more often than LAIA. Despite positive attitudes of patients towards LAIA, majority of psychiatrists think that patients would rather choose oral therapy

Long-acting injectable antipsychotics in treatment of schizophrenia - attitudes of psychiatrists and patients

Shizofrenija je kronična mentalna bolest koja se liječi oralnim i intramuskularnim antipsihoticima. Dugodjelujući intramuskularni antipsihotici (LAIA), unatoč potencijalno mnogim prednostima, rijetko se propisuju te je njihova primjena uglavnom rezervirana za nesuradljive bolesnike. Cilj ovog preliminarnog istraživanja bio je ispitati stavove psihijatara i pacijenata kako bismo dobili uvid u prednosti, nedostatke i moguće razloge rijetkog propisivanja LAIA. Sastavljene su tri ankete te je ispitano ukupno 48 psihijatara, 50 pacijenata liječenih oralnom terapijom i 50 pacijenata liječenih s LAIA. Usporedbom pacijenata, veći broj njih liječenih s LAIA osjeća poboljšanje (82%). 84% pacijenata liječenih s LAIA i 46% pacijenata liječenih oralnom terapijom smatra jednostavnijim način primjene lijeka jednom u dva do četiri tjedna. Iako 78% psihijatara navodi da je sklono propisivanju LAIA, mali je broj njihovih pacijenata kojima je to i propisano (medijan=20%). Unatoč pozitivnim stavovima pacijenata o LAIA, većina psihijatara (68,08%) smatra da pacijenti radije odabiru oralnu terapiju. Upravo bi zbog toga buduća istraživanja trebalo usmjeriti u detaljnije ispitivanje stavova i pacijenata i psihijatara o terapiji.Schizophrenia is a chronic mental illness that can be treated with oral and intramuscular antipsychotics. Despite many potential benefits, long-acting injectable antipsychotics (LAIA) are rarely prescribed and their usage is mostly reserved for nonadherent patients. The aim of this preliminary research was to examinate attitudes of psychiatrists and patients to get a better insight into advantages, disadvantages and possible reasons for rarely prescribing of LAIA. Three different questionnaires were given to total of 48 psychiatrists, 50 patients treated with oral medication and 50 patients treated with LAIA. Comparison among patients shows that there is a larger number of patients treated with LAIA that feels better (82%). 84% of patients treated with LAIA and 46% of patients treated with oral medication consider the usage of LAIA more simple. Although 81,25% of psychiatrists state that they tend to prescribe LAIA, there is a small number of their patients that are using it (median=20%). Despite positive attitudes of patients toward LAIA, majority of psychiatrists (68,08%) think that patients would rather choose oral therapy. Precisely because of this, future researches should be focused on further examination of psychiatrists' and patients' attitudes toward therapy

PSYCHIATRY FOR BETTER WORLD: COVID-19 AND BLAME GAMES PEOPLE PLAY FROM PUBLIC AND GLOBAL MENTAL HEALTH PERSPECTIVE

Blame games tend to follow crisis, be they at local, national or international level related to political, financial or health issues. COVID-19 crisis from the very beginning has been followed by divisive and disruptive psychosocial and political blame games. Active or passive blaming is an inherent feature of human beings in order to shift responsibilities onto others, single out a culprit, find a scapegoat and pinpoint a target. Finger pointing, blame games and scapegoating are associated with creation of binaries that identify agency as good or bad, right or wrong, moral or immoral. The scapegoat is expectedly always bad, wrong and immoral, commonly black evil. The detrimental effects of the COVID-19 blame games are seen in a lack of cohesion and coherence in the anti-COVID-19 solving strategies. Fighting the COVID 19 crisis all countries and nations need to join efforts on defeating it and to shift from a destructive blaming and zero-sum type of thinking to a much more creative, systemic and humanistic type. Effective response to COVID-19 is related to sowing the seeds for humanistic self and empathic civilization, rather than blaming, scapegoating and xenophobia

COVID-19 PANDEMIA AND PUBLIC AND GLOBAL MENTAL HEALTH FROM THE PERSPECTIVE OF GLOBAL HEALTH SECURITY

The Coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China and has spread all over the world and has caused huge threats to health and lives. It has affected different frontiers of lives and induced many psychiatric individual and collective problems such as panic, anxiety, depression, post-traumatic stress disorders, suspiciousness, infodemia, cacophony, xenophobia, racisms, etc. The COVID-19 outbreak has induced public and global mental health crisis as well as a huge psychosocial experiment. Psychiatry and other mental health sciences can play very useful role in supporting the well-being of COVID-19 patients and their families, healthcare personnel and the society. For successful fighting with present and future pandemics we have to learn more about psychiatric and psychological aspects of COVID-19 from the perspectives of public and global mental health

COVID-19 INFODEMIC AND PUBLIC TRUST FROM THE PERSPECTIVE OF PUBLIC AND GLOBAL MENTAL HEALTH

Crisis usually involves participants who trust and distrust each other, commonly in the same time. COVID-19 infodemic induced confidence crisis and distrust in authorities, science communities, governments and institutions can lead to harmful health behaviors and ill mental health and become a serious threat to public and global mental health as another kind of virus. Distrust mentality, conspiracy thinking and blame games may have detrimental effects not just on the individual level, but on the level of the whole groups, communities and global world. Public distrust and mistrust are related to the crisis in the domain of social and political relations, not only on the same country level, but also between different countries at regional or global level. Dynamics between public trust and mental health is a complex and bidirectional, ill mental health is causing and enhancing the inclination to confidence crisis, distrust, conspiracy theories and blame games and vice versa confidence crisis, distrust, conspiracy thinking and blame games are leading to ill mental health. It is important to have a holistic transdisciplinary integrative understanding of these dynamics and science-based treatment and prevention

THE IMPORTANCE OF PSYCHODYNAMIC APPROACH DURING COVID-19 PANDEMIC

The coronavirus (COVID-19) outbreak was labeled a global pandemic by the WHO in March of 2020. Understanding how crisis influence an individual’s reactions to stressful events (and vice versa) is important in order to create meaningful and effective interventions. Our literature search have revealed lack of the papers related to psychodynamic approach to recent crisis. Psychodynamic places a large emphasis on defense mechanisms and unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for us to directly look at are housed. Even though these painful feelings and thoughts are outside of our awareness, they still influence our behavior in many ways. Optimal application of psychodynamic approach offers the frame for acceptance of psychological stress in a more positive way and benefits psychological growth. We believe that including psychodynamic approach in the national public and mental health emergency system will empower Croatia and the world during (and after) COVID-19 pandemic crisis

Reconstruction of the thumb defect following subungual melanoma resection using Foucher’s flap

No abstract availabl

PATHOLOGICAL NARCISSISM, NEGATIVE PARENTING STYLES AND INTERPERSONAL FORGIVENESS AMONG PSYCHIATRIC OUTPATIENTS

Background: Pathological narcissism has previously been investigated with regard to negative parenting and interpersonal forgiveness, but inconsistent findings have been obtained in relation to its two phenotypic forms - grandiosity and vulnerability. Moreover, the role of negative parenting in the lack of forgiveness within narcissistic pathology has not been explored thus far. The aim of the current research was to investigate the complex relations among pathological narcissism, negative parenting, and interpersonal forgiveness in psychiatric outpatients. Subjects and methods: A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were enrolled in this study. The participants filled out the Pathological Narcissism Inventory (PNI), the Tendency to Forgive Scale (TTF), the Measure of Parental Styles (MOPS), and the Depression, Anxiety, Stress Scales (DASS21). Results: Narcissistic grandiosity and narcissistic vulnerability were positively correlated with mothers’ and fathers’ negative parenting, but this association was significantly stronger in the case of narcissistic vulnerability. Only narcissistic vulnerability was related to interpersonal forgiveness. In the mediation analysis, negative parenting was not directly related to interpersonal forgiveness, however, this association became significant after introducing narcissistic vulnerability. Narcissistic vulnerability served as a full mediator of the mothers’ and fathers’ negative parenting - interpersonal forgiveness relationships. Conclusions: Narcissistic vulnerability seems to be more strongly related to negative parenting and interpersonal forgiveness than narcissistic grandiosity, while it also represents one of the underlying mechanisms of the negative parenting - interpersonal forgiveness relationship. The clinical implications of these findings are discussed in relation to pathological narcissism and lack of forgiveness

Mesenchymal tumour or amniotic band syndrome in a newborn – a diagnostic dilemma

Kod novorođenčeta sa sindromom amnijskih brazda postavljena je sumnja na mezenhimni tumor desnog stopala. Dobro ograničena kuglasta tumorska tvorba zauzimala je čitav dorzum stopala, bez prisutnog edema ostatka stopala distalno od amnijske brazde. Ultrazvučnim pregledom tvorba je opisana kao čvrsta, lokalizirana i dobro vaskularizirana, dok je magnetskom rezonancijom opisana kao limfedem uz mogućnost druge etiologije. Histološki nalaz biopsije CORE nije bio specifičan za maligno tumorsko tkivo, ali nije isključio mezenhimni tumor. Definitivna histološka dijagnoza postavljena nakon ekstirpacije tvorbe i Z-plastike potvrdila je dijagnozu limfedema. Korekcijom strangulacijske brazde i ekstirpacijom tumorozne tvorbe postignut je odličan funkcionalni i estetski rezultat. Ovakav atipičan izgled limfedema nastalog zbog strangulacijske brazde može pobuditi sumnju na mezenhimni solidni tumor.A suspicion of mesenchymal tumour of the right foot dorsum was raised in a newborn with amniotic band syndrome. A well defined spheric tumour occupied the entire foot dorsum, without edema of the rest of the foot distal to the constriction ring. An ultrasound scan defined the tumour as firm, localized and well vascularized, while the MR scan described the tissue as lymphedematous, although allowing other etiologies. CORE biopsy histology report did not reveal malignant cells, but still did not rule out mesenchymal tumour. A definite hystological analysis performed after tumour removal and Z-plasty confirmed the diagnosis of lymphedema. Correction of the constricting ring and tumour removal resulted in an excellent functional and aesthetic result. Such atypical lymphedema presentation resulting from amniotic constriction ring can raise suspicion of a solid mesenchymal tumor