Dementia and Legal Competency

The legal competency or capability to exercise rights is level of judgment and decision-making ability needed to manage one\u27s own affairs and to sign official documents. With some exceptions, the person entitles this right in age of majority. It is acquired without legal procedures, however the annulment of legal capacity requires a juristic process. This resolution may not be final and could be revoked thorough the procedure of reverting legal capacity – fully or partially. Given the increasing number of persons with dementia, they are often subjects of legal expertise concerning their legal capacity. On the other part, emphasis on the civil rights of mentally ill also demands their maximal protection. Therefore such distinctive issue is approached with particular attention. The approach in determination of legal competency is more focused on gradation of it\u27s particular aspects instead of existing dual concept: legally capable – legally incapable. The main assumption represents how person with dementia is legally capable and should enjoy all the rights, privileges and obligations as other citizens do. The aspects of legal competency for which person with dementia is going to be deprived, due to protection of one\u27s rights and interests, are determined in legal procedure and then passed over to the guardian decided by court. Partial annulment of legal competency is measure applied when there is even one existing aspect of preserved legal capability (pension disposition, salary or pension disposition, ability of concluding contract, making testament, concluding marriage, divorce, choosing whereabouts, independent living, right to vote, right to decide course of treatment ect.). This measure is most often in favour of the patient and rarely for protection of other persons and their interests. Physicians are expected to precisely describe early dementia symptoms which may influence assessment of specific aspects involved in legal capacity (memory loss, impaired task execution, language difficulties, loosing perception of time and space, changes in mood and behaviour, personality alterations, loss of interests and initiative). Towards more accurate determination of legal competency the psychometric tests are being used. The appliance of these tests must be guided with basic question during evaluation: „For what is or is not he/she capable?« In prediction of possible dementia development, the modern diagnostic procedures are used as help for potentially demented individuals in order to plan own affairs and by oneself determine future guardian. This ensures the maximal respect and protection of rights among persons with dementia in order to independently manage life one step ahead of progressive illness. Finally, it is to be distinguished medical concept of legal capacity which is universal and judicial concept which is restricted by rules of national legal system differing from country to country

SUICIDALITY AND SIDE EFFECTS OF ANTIDEPRESSANTS AND ANTIPSYCHOTICS

Antidepressants and antipsychotics can cause side effects in various organs and organic systems, and some (and) in the central nervous system, which can also be clinically manifested by suicidal behavior as well. Tricyclic antidepressants particularly of imipramine and clomipramine can have pro-suicidal effect, which is believed to be the consequence of their own hypothetic asynchronous cognitive-psychomotor pharmacodynamic action. Antidepressants from the group of selective serotonin reuptake inhibitors can at the beginning of administration as monotherapy also have pro-suicidal effects in patients with hints of suicidality or suicidal behavior, by increasing the intensity of already present suicidal predictors, such as dysphoria, anxiety, impulsiveness, agitation etc. Antipsychotics can act stimulatingly upon predictors of suicidal behavior, that is, pro-suicidal in an indirect way through side effects they cause indirect pro-suicidal neurological and consecutive psychological impact, as it is called. It is particularly valid for classic antipsychotics causing primarily neurological, i.e. extrapyramidal side effects, along which consecutive psychological side effects can occur as well. However, new antipsychotics in comparison to classic ones, have less pronounced neurological, extrapyramidal symptoms and signs but more somatic-metabolic side effects, and thereby their action can be mostly manifested as indirect pro-suicidal neurological and somatic-metabolic as well as consecutive psychological activity

Dual Antidepressant for Dual Diagnosis - Venlafaxine Treatment of an Alcohol-Abusing PTSD Patient with a Depressive Disorder

Posttraumatski stresni poremećaj jedini je anksiozni poremećaj kod kojeg je poznata etiologija, uzrokovan je traumatskim događajem. Vrlo često ga prate drugi poremećaji, čime liječenje postaje složenije i dugotrajnije. Prikazan je tijek kliničke slike PTSP-a s obzirom na ambulantno i hospitalno liječenje. Ujedno je prikazan tijek liječenja dualnim inhibitorom ponovne pohrane serotonina i noradrenalina - venlafaksinom bolesnika oboljelog od PTSP-a u komorbiditetu s depresivnim poremećajem i zlouporabom alkohola. Biopsihosocijalni pristup doveo je do redukcije simptoma PTSP-a kod oboljeloga, normalizacije odgovora na stres te poboljšanja njegovih adaptacijskih mehanizama i više razine socijalnog funkcioniranja.Posttraumatic stress disorder (PTSD) is the only anxiety disorder of a known etiology, i.e. it is caused by a traumatic event. It is very often accompanied by other disorders which makes its treatment more complex and longer. The course of the PTSD clinical picture is presented through outpatient and hospital treatments. The article also presents the course of treatment with venlaflaxine, a dual serotonin and noradrenalin reuptake inhibitor, in a PTSD patient with co-morbidities: depressive disorder and alcohol abuse. A biopsychosocial approach reduced PTSD symptoms in the affected patient, normalized stress response, and improved adaptive mechanisms and social functioning

Pseudoschwangerschaft und Männerkindbett

Pseudopregnancy is a condition in which there is a firm belief of a non-pregnant woman in her pregnancy. The disorder also occurs in men. Patients manifest the symptoms and signs of pregnancy. According to DSM IV it is a conversion disorder, under the category of "Somatoform disorders". Pseudopregnancy occurs in patients with determined organic cerebral or endocrinologic pathology, in patients with chronic mental disorders, but also in those who were previously diagnosed with neither organic nor psychic disorders. There is always a wish for pregnancy and a fear from pregnancy at the same time. In any case, the psychological changes are caused by the imbalance of the pituitary-ovarian function of neurotransmitters in the pituitary gland and/or hypothalamus. A combination of psychotherapy, pharmacotherapy with antidepressants or antipsychotics, hormonal therapy and uterine curettage, is effective in almost every patient. Treatment should always be done within a team of other specialists (for instance, gynecologist). The authors emphasize the importance of systematic family psychotherapeutic approach in the treatment of psychotic patients.Pseudotrudnoća je stanje u kojem postoji čvrsta uvjerenost netrudne žene u vlastitu trudnoću. Poremećaj se javlja i u muškaraca. Bolesnici manifestiraju simptome i znakove trudnoće. DSM IV je svrstava u konverzivne poremećaje, unutar kategorije "somatoformni". Pseudotrudnoća se susreće u pacijenata s utvrđenom organskom cerebralnom ili endokrinološkom patologijom, u pacijenata s kroničnim duševnim bolestima, ali i u onih koji u povijesti bolesti nemaju organske niti psihičke poremećaje. Uvijek se istodobno susreću želja za trudnoćom i strah od trudnoće. U svakom slučaju, psihološke promjene uzrokovane su neravnotež om pituitarno-ovarijalne funkcije neurotransmitera u hipofizi i/ili hipotalamusu. Kombinacija psihoterapije, farmakoterapije antidepresivima ili antipsihoticima, hormonalne terapije i uterine kiretaže učinkovita je u gotovo svih pacijenata. Tretman bi trebalo uvijek provoditi u ekipi s drugim specijalistom (npr. ginekologom). Ističe se važnost sustavnoga obiteljskog pishoterapijskog pristupa u tretmanu psihotičnih pacijenata.Die Pseudoschwangerschaft (Scheinschwangerschaft) wird definiert als ein Zustand, in dem eine nicht schwangere Frau fest davon überzeugt ist, schwanger zu sein. Dieses Phänomen kann auch bei Männern auftreten. Die erkrankten Personen zeigen alle Symptome und Anzeichen einer Schwangerschaft. Dieser Zustand wird nach offizieller Klassifizierung zu den konversiven Störungen innerhalb der Kategorie der "somatoformen" Erkrankungen gezählt. Pseudoschwangerschaften treten in Fällen auf, in denen das Bestehen eines organischen, zerebralen oder endokrinologischen pathologischen Zustands nachgewiesen werden konnte; ebenso bei Patienten mit chronischen seelischen Erkrankungen, aber auch bei Personen, die in der Vergangenheit keinerlei Beschwerden dieser Art hatten. In allen Fällen ist einerseits der Wunsch nach einer Schwangerschaft, andererseits aber auch die Angst davor anzutreffen. Die psychologischen Veränderungen gehen stets zurück auf Störungen der Neurotransmitter-Funktion in der Hypophyse und /oder dem Hypothalamus und infolgedessen auf Funktionsstörungen von Hypophyse und Eierstöcken. Eine kombinierte Behandlungsweise, bestehend aus Psychotherapie, Einsatz von Antidepressiva oder Antipsychotika, ferner Hormontherapie und Uterin-Curetage, hat sich bei fast allen Patienten als wirksam erwiesen. Die Behandlung müsste stets die Mitarbeit eines Spezialisten (Gynäkologen) mit einbeziehen. Die Verfasser betonen, dass in solchen Fällen die Teilnahme sämtlicher Familienmitglieder an einer psychotherapeutischen Behandlung äußerst wichtig ist

Comparative Study on Gene Tags of the Neurotransmission System in Schizophrenic and Suicidal Subjects

Schizophrenia and suicidal behaviour are sever and complex mental disorders, largely determined by factors of inheritance. Both disorders present pathological changes in the catecholamine neurotransmitter system. The study was conducted on three groups; a group of subjects suffering from schizophrenia, a second compounded by individuals who attempted suicide and a third group of phenotypically healthy examinees. The blood samples of schizophrenic patients as of those who attempted suicide were obtained at the Psychiatric Hospital »Sveti Ivan« in Zagreb in the year 2004. Tests were conducted on the statistic relation between a total of 18 SNPs within three candidate-genes of the dopamine and adrenergic system (DRD4, SLC6A3 and ADRA2B) and the manifestation of schzophrenia and suicidal behaviour. Cases were genotyped by use of SNPlex system. Statistically significant differences were determined in the allelic frequency between the mentioned groups. Findings show a siginficant connection between 4 SNPs (ADRA2B rs749457, SLC6A3 rs464094, DRD4 rs11246226 and rs4331145) and schizophrenia, and 2 SNPs with suicidal attempt (ADRA2B rs1018351 i SLC6A3 rs403636). In addition, this is the first study that highlights the potential role/effect of polymorphisms in ADRA2B on the manifestation of schizophrenia, as on suicidal behaviour

EARLY INTERVENTION PROGRAMME FOR PATIENTS WITH PSYCHOTIC DISORDERS IN “SVETI IVAN”. PSYCHIATRIC HOSPITAL (RIPEPP) - SOCIODEMOGRAPHIC AND BASELINE CHARACTERISTICS OF THE PARTICIPANTS

Background: Psychiatric hospital "Sveti Ivan" in Zagreb, Croatia, offers an outpatient Early intervention programme for patients with psychotic disorders (RIPEPP), consisting of psychoeducational workshops and group psychodynamic psychotherapy. The aim of this study was to describe sociodemographic and baseline characteristics of the participants, in order to provide better understanding of this population, and to assist with the development of more effective therapeutic approaches. Subjects and methods: Since 2008, a total of 245 patients with first episodes of psychosis and their family members participated in the programme. They filled out several questionnaires within the framework of the programme evaluation, but for the purposes of this study, only data collected on sociodemographic questionnaire and the Health of the Nation Outcome Scales (HoNOS) are presented. Results: Majority of the participants were male (66%), at the average age of 28 (SD=6.6), living with their parents (73.5%). Most of them finished secondary school (45.7%) but almost a quarter of the sample (23.7%) is currently studying at university. The average duration of untreated period was 101.60 days, with a median of 30 days. According to results of HONOS questionnaire, upon entry into the programme, the patients most often listed cognitive functioning (attention, concentration, memory) and professional issues (performance of work tasks and activities tied to work) as the most problematic areas. Conclusion: The findings of this study provide more detailed description of the beneficiaries of the RIPEPP programme, which can contribute to forming future programmes for the prevention of psychotic disorders

Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial - study protocol

Introduction: Optic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of recovery but does not prevent neurodegeneration and persistent visual impairment. In a phase II trial performed in preparation of this study, we have shown that erythropoietin protects global retinal nerve fibre layer thickness (RNFLT-G) in acute optic neuritis; however, the preparatory trial was not powered to show effects on visual function. Methods and analysis: Treatment of Optic Neuritis with Erythropoietin (TONE) is a national, randomised, double-blind, placebo-controlled, multicentre trial with two parallel arms. The primary objective is to determine the efficacy of erythropoietin compared to placebo given add-on to methylprednisolone as assessed by measurements of RNFLT-G and low-contrast visual acuity in the affected eye 6 months after randomisation. Inclusion criteria are a first episode of optic neuritis with decreased visual acuity to ≤0.5 (decimal system) and an onset of symptoms within 10 days prior to inclusion. The most important exclusion criteria are history of optic neuritis or multiple sclerosis or any ocular disease (affected or non-affected eye), significant hyperopia, myopia or astigmatism, elevated blood pressure, thrombotic events or malignancy. After randomisation, patients either receive 33 000 international units human recombinant erythropoietin intravenously for 3 consecutive days or placebo (0.9% saline) administered intravenously. With an estimated power of 80%, the calculated sample size is 100 patients. The trial started in September 2014 with a planned recruitment period of 30 months. Ethics and dissemination: TONE has been approved by the Central Ethics Commission in Freiburg (194/14) and the German Federal Institute for Drugs and Medical Devices (61-3910-4039831). It complies with the Declaration of Helsinki, local laws and ICH-GCP. Trial registration number: NCT01962571