Logotherapy and the Psychological State in Crisis Situations

Kriza je vrlo teško stanje nakon kojeg se očekuje ili razrješenje ili katastrofa. U kriznoj se situaciji osoba susreće s opasnostima koje ne može razriješiti poznatim načinima rješavanja problema, što može izazvati poteškoće na kognitivnom, ponašajnom, emocionalnom i tjelesnom planu. U radu se prikazuje utjecaj kriznih situacija na psihičko stanje pojedinca, s naglaskom na krize koje su 2020. godine pogodile Hrvatsku (pandemija i potresi) kao i terapijske mogućnosti koje u kriznim situacijama pruža logoterapija. Hoće li krizna situacija dovesti do psihičkog oboljenja, ovisi o značajkama krize i osobinama pojedinca koji je krizi izložen. U društvu u kojem mnogi pate zbog osjećaja besmislenosti života, krizne situacije lako mogu dovesti do psihičkih bolesti. Logoterapija, psihoterapijska tehnika koja u svoje središte stavlja volju za smislom kao pokretačku snagu ljudskog života, pojedinca upućuje na prihvaćanje života kao zadatka, uz naglašavanje njegove duhovne dimenzije, može u vrijeme današnjih kriza biti od preventivne i kurativne važnosti.The crisis is a very difficult state after which either a resolution or catastrophe is expected. In a crisis situation, a person faces dangers that cannot be resolved in already familiar ways of solving problems and this can lead to difficulties on the cognitive, behavioral, emotional, and physiological levels. The article discusses the influence of crisis situations on the psychological state of individuals, with an emphasis on the crises that have hit Croatia (pandemics and earthquakes) in 2020, as well as therapeutical possibilities offered by logotherapy in crisis situations. Whether a crisis situation will lead to a psychological illness depends on the characteristics of a crisis and of an individual who has been exposed to that crisis. In a society in which many suffer from the feeling of meaninglessness of life, crisis situations can easily lead to a psychological illness. Logotherapy, a psycho‑therapeutic technique that focuses on the striving for meaning as the driving force of human life, encourages an individual to embrace life as a task and emphasizes its spiritual dimension. As such, it can be of preventive and curative importance in the current situation of crises

INFLUENCE OF HORMONAL STATUS AND MENSTRUAL CYCLE PHASE ON PSYCHOPATOLOGY IN ACUTE ADMITTED PATIENTS WITH SCHIZOPHRENIA

Background: The gender differences in onset, symptom severity, and outcome of schizophrenia are now thought to support the hypothesis that sex hormones may also have a role in etiology, as well as treatment, of schizophrenia. A number of reproductive hormones may be implicated, including testosterone, progesterone, or luteinising hormone, and thus it is important to acknowledge that there is a complex interplay of hormones occurring. This study was introduced to highlight the effect of the menstrual cycle, and sex hormones on female patients with schizophrenia. Subjects and methods: The sample consisted of 31 consecutively acute admitted women, aged 18 to 45 years with schizophrenia diagnosed by DSM-5 criteria. The sample consisted of women who were regulary menstruating and to be undergoing regular hormonal fluxes. Each subject was enrolled and received psychopathology and hormone (estradiole, progesterone, testosterone) assessments. Psychopathology was measured with Positive end Negative Syndrome Scale (PANSS). The subjects were divided into folicular (high estrogen) and luteal (low estrogen) phase admissions. Data were analyzed by regression analysis and t-test for independent samples. Values are given as means ±SD. Results: There were no differences between the folicular and luteal phase admission grups with regard to age, duration of illness and age at onset of illness. We found that significantly more women were admitted during the luteal (low estrogen) phase of menstrual cycle (68%) as compared to follicular (high estrogen) phase (32%). Conclusion: There was a significant increase in hospital admissions in the luteal phase of menstrual cycle in women suffering from exacerbation of schizophrenia. The influence of particulary sex hormones (estrogen, progesterone and testosterone) on admission rate and clinical psychopatology was found insignificant

INFLUENCE OF SERUM TESTOSTERONE LEVEL ON AGGRESSION IN WOMEN WITH SCHIZOPHRENIA

Background: Unlike in female population, the effect of testosterone on aggression in men has been investigated countless times so far. A scarce number of studies have examined the effect of testosterone on aggression in women. The results obtained so far are inconsistent for some studies indicated a positive, whilst others showed a negative correlation. Since testosterone turned out to be an important factor related to aggression in men, the aim of our study was to investigate whether this correlation existed in aggressive female patients with schizophrenia. Subjects and methods: The sample consisted of 120 women, aged from 18 to 45 years, diagnosed with schizophrenia by DSM-5 criteria. Those who were breastfeeding or suffered from specific hormonal or other physical disorders were excluded from the study. They were divided into two groups of 60 - those with aggressive behavior and those with nonaggressive behavior. Psychopathology was measured by several tests (Positive and Negative Syndrome Scale - PANSS, Overt Aggression Scale - OAS and PANSS Extended Subscale for Aggression Assessment). Serum testosterone hormone assays were performed. Statistical data analysis was done by parametric statistical tests, Kolmogorov-Smirnov test, Student\u27s t-test and simple linear regression. All data were presented as mean values and corresponding standard deviations (SD). Results: Testosterone levels didn\u27t differ significantly between aggressive and nonaggressive subjects. There were no significant differences between testosterone levels in suicidal aggressive subjects compared to nonsuicidal aggressive respondents (t=0.616; p=0.540). The largest number of subjects in both groups had referent testosterone levels. Conclusions: Despite expecting a significant effect of testosterone levels on aggression in women with schizophrenia, conducted by previous studies, no correlation has been found testosterone levels

Dementia and Psychiatric Emergencies in the Elderly Population

S obzirom na kontinuirano povećanje broja starijih osoba u ukupnoj populaciji u Hrvatskoj, za očekivati je da će se broj starijih osoba s akutnim psihičkim smetnjama koje zahtijevaju hitno zbrinjavanje sve više povećavati. Najčešći psihički poremećaji kod starijih osoba su: depresivni poremećaji, kognitivni poremećaji, demencija, poremećaji vezani uz uzimanje alkohola, poremećaji vezani uz druga zdravstvena stanja i lijekovima izazvani poremećaji. Gerijatrijski bolesnici bi u pravilu prvo trebali biti pregledani od strane stručnjaka somatske medicine (internista, neurologa, kirurga) prije nego što se upućuju u hitnu psihijatrijsku službu, kako bi se ustanovilo da su primarne smetnje iz psihijatrijske domene. Izražena depresija, suicidalnost, agitacija, sklonosti lutanju i ostalim rizičnim ponašanjima kod kuće, izražena anksioznost i smanjena sposobnost brige o sebi, glavni su razlozi hospitalizacije kod ovih bolesnika.Related to the fact of the continuous increase in the number of elderly people in the total population of Croatia, it can be expected that the number of elderly people with acute psychiatric disorders that require emergency care will increase. The most common psychiatric disorders found in the elderly are depressive disorders, cognitive disorders, dementia, alcoholrelated disorders, disorders related to other health conditions and drug-induced disorders. Geriatric patients should, generally speaking, first be reviewed by a psychosomatic medical specialist (internist, neurologist, surgeon) before they are sent to psychiatric emergency services in order to establish that the primary complaint is connected with the psychiatric domain. Pronounced depression, suicidality, agitation, wandering tendencies and other home-based risk behaviours, with anxiousness and reduced self-care ability, are the main reasons for hospitalization

The Frequency and Causes of Physical Complications/ Adverse Events During the Hospitalization of Patients with Dementia

Uvod: Osobe s demencijom osjetljivije su na razvoj različitih komplikacija/neželjenih događaja u odnosu na osobe iste dobne skupine bez demencije. Češće se zaprimaju u bolnicu, gdje imaju veću prevalenciju komplikacija i povećanu smrtnost. Cilj: ispitati učestalost hitnih premještaja bolesnika s demencijom zbog tjelesnih komplikacija iz Klinike za psihijatriju Vrapče na somatske odjele drugih bolnica. Metode: U ovom retrospektivnom istraživanju analizirali smo podatke bolesnika s demencijom koji su liječeni od 1. siječnja do 31. kolovoza 2019. godine na Odjelu psihogerijatrije u Klinici za psihijatriju Vrapče s naglaskom na vrijeme trajanja hospitalizacije i razloge otpusta koji su doveli do premještaja s Odjela. Rezultati: Od siječnja do kraja kolovoza 2019. godine na Odjel psihogerijatrije u Klinici zaprimljeno je ukupno 256 bolesnika (67,97 % žena i 32,03 % muškaraca). Prosječna dob žena bila je 80,5, a muškaraca 76,4 godina. Premješteno na somatski odjel (bolnicu) bilo je 28 % bolesnika (40,24 % muškaraca, 23 % žena), a od toga 39 % u prvih sedam dana od dolaska u bolnicu. Pneumonija je bila vodeća somatska dijagnoza kod 19 % premještenih. Prosječno trajanje hospitalizacije među svim ispitanicima bilo je kod muškaraca 33,08 dana, a kod žena 36,47 dana. U istom je razdoblju na Odjelu preminulo 10,93 % bolesnika (12,2 % muškaraca i 10,34 % žena), od toga 25 % unutar pet dana od dolaska u bolnicu. Zbog neujednačenosti pisanja redoslijeda otpusnih dijagnoza, za detaljniju analizu razloga premještaja, bit će potrebno podrobnije ispitivanje. Zaključak: Najteža tjelesna pogoršanja i smrtni ishodi javljali su se u prvih tjedan dana od dolaska u bolnicu. Rezultati ukazuju na nužnost somatske obrade i liječenja bolesnika s demencijom prije nego budu hospitalizirani na psihijatrijskom odjelu.Introduction: Patients with dementia are more susceptible to the development of various complications/adverse events than people of the same age group without dementia. They are more often admitted to hospitals, where they have a higher prevalence of complications and higher mortality. Aim: To examine the frequency of physical complications that require emergency transfers of patients with dementia from the psychogeriatric ward of the University Psychiatric Hospital Vrapče (UPHV) to somatic wards of other hospitals. Patients and methods: In this retrospective study we analysed the data of patients with dementia who received medical treatment at the psychogeriatric ward of the University Psychiatric Hospital Vrapče between 1 January and 31 August 2019, with special emphasis on the treatment length and reasons for discharge due to compromised medical condition. Results: 256 patients (67.97% female, 32.03% male) were admitted to the psychogeriatric ward of the UPHV. The average age was 80.5 years for female and 76.4 years for male patients. 28% of patients (23% of all female and 40.24% of all male patients) were transferred to somatic wards of other hospitals. 39% of all transferred patients were transferred within the first seven days after the admission to the UPHV. Pneumonia was the main somatic diagnosis among 19% of all transferred patients. The mean duration of hospitalization was 36.47 days for female patients and 33.08 days for male patients. 10.93% of all admitted patients (10.34% of all female and 12.2% of all male patients) died at the psychogeriatric ward, 25% of whom died within the first five days after the admission to the UPHV. Due to a lack of uniform order of registering diagnoses, a more detailed examination of reasons for transfers will be required. Conclusion: The most severe deteriorations in the physical condition and fatal outcomes occurred within the first week after the admission to the UPHV. The results indicate the necessity of somatic treatment of dementia patients before admission to a psychiatric ward

KLINIČKA SLIKA KAO MOGUĆI PREDIKTOR AGRESIVNOSTI BOLESNIKA SA SHIZOFRENIJOM

Vodeći čimbenici rizika za agresivno ponašanje bolesnika sa shizofrenijom su antisocijalne osobine ličnosti, pozitivni simptomi u kliničkoj slici te ovisnost ili zlouporaba psihoaktivnih tvari. S ciljem analiziranja utjecaja i povezanosti kliničke slike i pojedinih simptoma shizofrenije na agresivno ponašanje uspoređivali smo skupinu agresivnih (N=60) i neagresivnih (N=60) muškaraca sa shizofrenijom. S obzirom da se u literaturi raspravlja o mogućoj zajedničkoj osnovi hetero- i autoagresivnosti, agresivni su ispitanici razdvojeni na heteroagresivnu (N=32) i suicidalnu skupinu (N=28). Prisutnost i intenzitet pojedinih simptoma shizofrenije ocijenili smo PANSS-om, stupanj heteroagresivnosti OAS (Overt Aggression Scale), a suicidalnosti C-SSRS (Columbia-Suicide Severity Rating Scale) i InterSePT (International Suicide Prevention Trial) ljestvicama. U heteroagresivnoj skupini značajno je viši ukupni PANSS te njegova pozitivna i opća podljestvica. Stupanj heteroagresivnosti u pozitivnoj je korelaciji s ukupnim PANSS-om i impulzivnošću, a u negativnoj korelaciji s depresivnošću i imperativnim halucinacijama. Stupanj suicidalnosti u pozitivnoj je korelaciji s depresivnošću i imperativnim halucinacijama, a u negativnoj s ukupnim PANSS-om, stupnjem heteroagresivnosti i impulzivnošću. Jedini je značajni prediktor izrazitog agresivnog ponašanja viši rezultat pozitivne podljestvice PANSS-a. Ovi rezultati upućuju na nužnost prepoznavanja pozitivnih simptoma shizofrenije kao značajnog čimbenika za pojavu agresivnosti s ciljem što ranijeg terapijskog djelovanja i sprečavanja agresivnih incidenata

Logotherapy as a Psychotherapeutic Technique in Psychogeriatric Palliative Care Wards

Kod svakog bolesnika, a osobito onog s neizlječivom bolesti kao što je demencija, neophodan je holistički pristup. Posljednjih godina se razvojem palijativne medicine nastoji ublažiti tjelesna bol i psihološka patnja, kako bi se bolesniku poboljšala preostala kvaliteta života i omogućilo dostojanstveno umiranje. Patnja kroz koju prolazi bolesnik utječe na članove njegove obitelji, ali i na medicinsko osoblje - članove palijativnog tima. Postavlja se pitanje kako pomoći kada je kurativna medicina svojim dijagnostičkim i terapijskim pristupom iscrpila svoje mogućnosti. Budući da je jedan od principa djelovanja u palijativnoj medicini integralna medicinska skrb na fizičkoj, psihičkoj i duhovnoj razini, najprihvatljivija psihoterapijska metoda kod ovih bolesnika je logoterapija, koja osobu doživljava kroz sve ove dimenzije, a posebno naglašava važnost duhovne. Logoterapija se uspješno koristi i kod članova obitelji bolesnika, a njeni principi pomažu i članovima palijativnog tima da se nose s različitim izazovima svakodnevnog posla. U središtu logoterapije je spoznaja da je čovjek, prema svojoj prirodi, usmjeren prema traženju smisla, u čemu treba osluškivati svoju savjest. Logoterapija ukazuje na prepoznavanje sudbinskog i slobodnog prostora i potiče na aktivno djelovanje u slobodnom prostoru. Čak i kada se sudbina ne može promijeniti (bolest, smrt), čovjek je slobodan prema njoj zauzeti stav. Naša najjača motivacija je tražiti smisao izvan sebe, u nekome ili nečemu, na način da nadiđemo svoje „ja“. Imati smislenu životnu zadaću, znači imati zdravi život.With each patient, especially those with an incurable disease such as dementia, a holistic approach is essential. In recent years, through the development of palliative medicine, medical professionals have been trying to reduce physical pain and psychological suffering in order to improve the patient’s quality of life and to enable a dignified death. The patient’s suffering affects their family members, as well as medical staff - the palliative care professionals. The question is how to help when curative medicine has exhausted all its options with its diagnostic and therapy treatments. Since integral medical care on a physical, psychological, and spiritual level is one of the principles of action in palliative medicine, the best psychotherapeutic method for treating such patients is logotherapy, which considers a person through all these dimensions, with special focus on the spiritual. Logotherapy is successfully used with the patient’s family members, and its principles help palliative care professionals deal with the different challenges of their daily work. Logotherapy is based on the understanding that it is in the human nature to search for meaning while guided by conscience. Logotherapy points at recognizing human fate and freedom and encourages actively exercising that freedom. Even when fate cannot be changed (death, illness), a person is free to choose the attitude they have toward it. Our strongest motivation is to search for meaning outside ourselves, in someone or something, by transcending our “self”. To have a meaningful purpose in life is to have a healthy life

QTc and psychopharmacs: are there any differences between monotherapy and polytherapy

<p>Abstract</p> <p>Background</p> <p>Some psychotropic drugs are connected with prolongation of QT interval, increased risk of cardiac arrhythmias and greater incidence of sudden death, especially when used in combination. Concomitant use of antipsychotics and antidepressants is not rare in our clinical practice. The study compares the length of QT interval in patients on monotherapy with an antipsychotic or an antidepressant and patients taking polytherapy (an antipsychotic agent combined with an antidepressant).</p> <p>Methods</p> <p>Sixty-one hospitalized women who met the ICD-10 criteria for schizophrenia, schizoaffective psychosis, delusional disorder and mood disorder were included in the study. The monotherapy group was consisted of thirty-two women treated with an antipsychotic or an antidepressant while the polytherapy group was composed of twenty-nine women treated with an antipsychotic agent plus an antidepressant. Two electrocardiograms (ECGs) were obtained for each patient: the first was carried out before the treatment and the second after two weeks of treatment.</p> <p>Statistical analysis was carried out by SPSS program and included unpaired and paired t test and Fisher's exact test.</p> <p>Results</p> <p>Mean baseline QTc values did not differ between the groups (439 ± 22 ms was the same value found in the both groups; unpaired t test, p > 0.5). Mean QTc intervals after two weeks of treatment were also similar (439 ± 24 ms in the monotherapy group and 440 ± 20 ms in the polytherapy group; unpaired t test, p > 0.5). Fisher's exact test did not reveal significant difference in the number of patients with borderline (451–470 ms) or prolonged (> 470 ms) QTc between groups, neither before treatment nor after two weeks of treatment. Twenty two women of the total of sixty one patients (36%) had QTc > 450 ms before applying therapy.</p> <p>Conclusion</p> <p>We did not find significant QT prolongation in our patients after two weeks of treatment with antipsychotics and/or antidepressants. The QTc interval length did not differ significantly in the monotherapy and the polytherapy group. More than one third of included women exceeded the threshold value of borderline QTc interval (450 ms) before starting treatment. This finding calls for caution when prescribing drugs to female psychiatric patients, especially if they have other health problems.</p