Važnost procjenjivanja kvalitete života u ovisnika o alkoholu

Alcohol dependence has a strong impact on quality of life (QoL) and OoL assessment is considered as a valid measure in evaluating the success of the treatment of patients with alcohol dependence. The goal of the study was to investigate QoL and some sociodemographic characteristics of patients with alcohol dependence in comparison with healthy individuals. Cross-sectional study (which is part of larger study) included 312 patients with alcohol dependence and 329 healthy individuals of both sexes. Structured interview for sociodemographic and alcohol related data, the Croatian version of the 5.00 Mini International Neuropsychiatric Interview (MINI), and the short version of the World Health Organization Quality of Life (WHOQoLBREF) were used. The results have shown that alcohol dependent patients were significantly more frequently uneducated (p=0.006) and primary education (p<0.001), while healthy individuals were significantly more likely to have secondary (p=0.003) and tertiary education (p=0.013). Patients with alcohol dependence were significantly more likely to be single (p=0.005), divorced (p<0.001), and living as married (p=0.008) compared to healthy people, while healthy populations were more often married (p<0.001) in comparison to alcohol addicts. Alcohol dependent persons were more often unemployed (p<0.001) and retired (p=0.005). Patients with alcohol dependence were more likely to have a perceived a sense of illness (p<0.001) than healthy subjects. There were significant differences in all domains of QoL: general, physical, psychological, social, and environment between patients with dependence and healthy individuals (p<0.001). To conclude, alcohol dependence has been shown to be negatively correlated with overall QoL and domains of QoL: physical, psychological, social, and environmental. Education of patients with alcohol dependence was lower than in healthy people, who were more likely to live in marriage and were employed.Sažetak - Ovisnost o alkoholu ima jaki utjecaj na kvalitetu života i procjena kvalitete života se smatra validnom mjerom u procjeni uspješnosti tretmana osoba ovisnih o alkoholu. Cilj istraživanja je bio istražiti kvalitetu života i neke sociodemografske karakteristike osoba ovisnih o alkoholu u odnosu na zdrave osobe. Krossekcijsko istraživanje (koje je dio većeg istraživanja) uključilo je 207 osoba ovisnih o alkoholu i 329 zdravih osoba oba spola. Korišten je strukturirani intervju za sociodemografske i alkohološke podatke, hrvatska verzija 5.00. Mini internacionalnog neuropsihijatrijskog intervjua (MINI) i kratka verzija Upitnika o kvaliteti života Svjetske zdravstvene organizacije (WHOQoL-BREF). Rezultati su pokazali da su osobe ovisne o alkoholu bile značajno češće neobrazovane (p=0,006) i primarnog obrazovanja (p<0,001), dok su zdrave osobe bile značajno češće sekundarnog (p=0,003) i tercijarnog obrazovanja (p=0,013). Alkoholičari su bili značajno češće samci (p=0,005), rastavljeni (p<0,001) i žive u izvanbračnoj zajednici (p=0,008) u odnosu na zdrave osobe, dok je zdrava populacija bila češće oženjena/udana (p<0,001) u odnosu na osobe ovisne o alkoholu. Osobe ovisne o alkoholu su bile češće nezaposlene (p<0,001) i umirovljene (p=0,005). Osobe ovisne o alkoholu češće su imale percepciju osjećaja bolesti (p<0,001) u odnosu na zdrave osobe. Postojale su značajne razlike u svim domenama kvalitete života: općoj, fizičkoj, psihološkoj, socijalnoj i okruženju između osoba ovisnih o alkoholu i zdravih osoba (p < 0,001). Zaključno, alkoholna ovisnost se pokazala negativno povezana s općom kvalitetom života i domenama kvalitete života: fizičkom, psihološkom, socijalnom i okruženjem. Obrazovanje osoba ovisnih o alkoholu je bilo niže u odnosu na zdrave osobe, koji su češće živjeli u braku i bili su zaposleni

Association between problematic Internet use and specific Internet activities and COVID-19- and earthquake-related stress, anxiety, and depression symptoms among Croatian young adults

BackgroundDuring the COVID-19 pandemic and concomitant earthquakes in Croatia in 2020, increased Internet use (IU) and Internet-based addictive behaviors were associated with decreasing mental well-being. We determined the changes IU, problematic IU (PIU), and problematic specific Internet activities in young adults during the prolonged stress caused by the pandemic and earthquakes, age differences in PIU and differences in perceived source of stress (pandemic or earthquakes), and association between PIU and increase in specific Internet activities and stress, anxiety, and depression symptoms in young adults.MethodsA cross-sectional online survey conducted from September 30, 2021 to October 17, 2021 included 353 young adults aged 22.6 ± 2.1 years, 382 early adults aged 32.1 ± 4.4 years, and 371 middle-aged adults aged 49.0 ± 6.5 years. Data on sociodemographic characteristics, stressors (without perceived stressors, only pandemic-related stressor, only earthquake-related stressor, and both pandemic- and earthquake-related stressors), and IU were collected with a self-report questionnaire. The Impact of Event Scale and the Hospital Anxiety Depression Scale were used to evaluate mental symptoms. PIU was assessed using Tao et al.’s criteria. Data were anaylzed with paired-sample Wilcoxon test, McNemar’s and Pearson’s chi-square tests, and structural equation modeling.ResultsIn 17% of young adults, we found increased PIU (OR = 5.15, 95% CI [2.82, 10.18]), problematic social media use (OR = 2.77, 95% CI [1.56, 5.14]), and uncontrolled online shopping (OR = 5.75, 95% CI [1.97, 22.87]) (p &lt; 0.001 for all). PIU and problematic social media use were more common among young adults (60.8%), as well as problematic online gaming (25.9%). Problematic social media use was more frequent among young adults reporting pandemic stress than among those without perceived stress (69.9% vs. 43.2%). Increased online gaming predicted more severe avoidance symptoms (p = 0.041), increased social media use predicted more severe depression symptoms (p = 0.017), increased online shopping predicted more severe intrusion (p = 0.013) and anxiety symptoms (p = 0.001). PIU predicted more severe intrusion (p = 0.008), avoidance (p = 0.01), anxiety (p &lt; 0.001), and depression (p = 0.012) symptoms.ConclusionDifferent effects of the pandemic and earthquakes on IU could reflect a different effect of various stressors on Internet behavior of young adults. Type of problematic Internet behavior may predict for the type of mental health problem

Dynamics of Shame in Psychotherapy of Alcoholics

Cilj ovog članka je naglasiti psihodinamsku ulogu srama u alkoholizmu te njegovu važnost u procesu psihoterapijskog liječenja osoba s dijagnosticiranim sindromom ovisnosti o alkoholu. Velika većina osoba ovisnih o alkoholu emocionalno je nezrela, a sram je snažno utjecao na izgradnju njihovih ličnosti. Sram je odredio razvoj njihovih identiteta te je potaknuo nastanak duboko ukorijenjenih emocija nepovjerenja, krivnje, inferiornosti i izolacije. Grupna psihoterapija prva je linija psihoterapijskog liječenja alkoholizma. No, njezin pozitivan ishod ograničen je činjenicom da se, upravo zbog sustava scenarija zasnovanog na sramu te često popratne anksioznosti i emocionalne labilnosti, osobe ovisne o alkoholu nerado pridružuju grupi, a ako joj se i pridruže, najčešće je to kratkoročno. U ovom članku razmatramo stilove grupnih psihoterapija koji bi mogli imati pozitivniji ishod u liječenju osoba ovisnih o alkoholu. Analiza objavljene literature ukazala je na nedostatak integrativnog psihoterapijskog pristupa liječenju.The aim of this article is to highlight the psychodynamic role of shame in alcoholism and its importance in the psychotherapeutic treatment of alcoholics. Alcoholics are often emotionally immature and have a shame-based personality. Shame has strongly influenced the development of their identity and led to deeply ingrained feelings of mistrust, guilt, inferiority, and isolation. Group psychotherapy is the first line of psychotherapeutic treatment of alcoholism, but its successfulness is limited by the fact that alcoholics find joining and staying in a group quite difficult due to a shame-based script system and accompanying anxiety and emotional lability. We discuss the styles of psychotherapeutic groups that may be more effective with alcoholics. A review of published literature indicated the lack of integrative psychotherapeutic treatment

Somatization as a Defence from Narcissistic Injury

Somatizacijski poremećaj je poremećaj u kojem se psihički problemi i emocionalni konflikti izražavaju tjelesnim simptomima, a somatizacija je psihološki mehanizam u kojem se psihički problemi i emocionalni konflikti manifestiraju tjelesnim simptomima za koje se ne nalazi organska podloga. Može se javiti kao zasebni ili komorbidni poremećaj, osobito s poremećajima raspoloženja, anksioznim poremećajima, poremećajima ličnosti (najčešće histrionski poremećaj ličnosti i opsesivno-kompulzivni poremećaj ličnosti). Ovakve osobe primarno se javljaju u ambulante opće medicine ili tjelesne ambulante i tek kasnije i na psihijatrijska liječenja. Liječenje osoba s tzv. somatoformnim poremećajima je kompleksno, vrlo dugo i zahtjevno te je potrebna cijela lepeza psihijatrijskih vještina, često bez pozitivnih rezultata. U ovom radu prikazana je pacijentica kod koje je traumatska i konfliktna situacija na poslu doživljena kao narcistička povreda koja je dovela do razvoja dramatične kliničke slike u oblku somatizacija i somatizacijskog poremećaja kod osobe s histronskim poremećajem ličnosti. Nemogućnost suočavanja s povredom selfa kod histrionskog poremećaja ličnosti može dovesti do somatizacije kao načinom rješavanja problema. Prigodom liječenja je važno identificirati točan uzrok, tj. okidač (engl. trigger) koji je doveo do nastanka poremećaja te suočiti pacijenta s psihološkom i emocionalnom etiologijom tegoba, što uvelike doprinosi boljem terapijskom ishodu. Važnost pravovremenog prepoznavanja somatizacija je između ostaloga nužna i zbog izbjegavanja nepotrebnih tjelesnih dijagnostičkih postupaka, kao i zbog socijalne i radne disfunkcionalnosti takvih osoba.Somatization disorder is characterized by a tendency of a person to communicate psychological distress and emotional conflicts through physical symptoms, while somatization is a psychological mechanism manifesting psychological distress and emotional conflicts as physical symptoms that lack an organic basis. It can develop as a single disorder or a mental disorder comorbid with other disorders, especially co-occurring with mood disorders, anxiety disorders, and personality disorders (most commonly, histrionic and obsessive-compulsive personality disorders). In most cases, people suffering from such disorders seek help from general practitioners or at healthcare facilities specialized for physical disorders. It is only after this that they seek psychiatric assistance. The treatment of people suffering from so-called somatoform disorders is complex, time-consuming and demanding and it requires a broad spectrum of psychiatric skills. However, it rarely yields positive outcomes. This research paper focuses on a case study of a patient with histrionic behaviour who experienced a conflict situation at work as a narcissistic injury. The narcissistic injury triggered the development of a dramatic clinical picture in the form of somatization and, consequently, the development of the somatization disorder. The inability of a person with a histrionic personality disorder to confront an injury of self can trigger somatization as a defence mechanism. The treatment requires careful identification of the root cause, the so-called trigger that initiated the development of the disorder, and the confrontation of a patient with the psychological and emotional etiology of his/her symptoms. Such an approach has a profound impact on a more positive outcome of the therapy. However, timely detection of somatization is important, among other things, to avoid unnecessary physical diagnostic procedures and to enable the normal performance of social and occupational roles of a patient

Elderly Victims of Domestic Violence in Croatia: A Cross-sectional Study of a Single Counseling Center

Hrvatska je europska zemlja s jednom od najviših stopa obiteljskog nasilja a bez nacionalne strategije zlostavljanja starijih osoba. Cilj ovog istraživanja je odrediti razlike između žrtava obiteljskog nasilja starijih od 60 godina i žrtava mlađih od 60 godina. Od ukupno 3164 odrasle osobe koje su zatražile pomoć u Savjetovalištu za žrtve nasilja u obitelji u Zagrebu, 200 su bile starije od 60 godina. Istraživanje je uključilo izravne strukturirane intervjue s ciljem prikupljanja sociodemografskih podataka, podataka o vrsti nasilja, počiniteljima nasilja, prijavama nasilja nadležnim institucijama te vrsti intervencija. Primijenjen je Pearsonov koeficijent korelacije i z-test s Bonferronijevom korekcijom za utvrđivanje razlika između žrtava obiteljskog nasilja starijih od 60 godina i žrtava mlađih od 60 godina s obzirom na sociodemografska obilježja, vrstu nasilja i intervencije. Snaga povezanosti kategorijskih varijabli određena je Cramerovim V. Binarna logistička regresija utvrdila je neovisne doprinose sociodemografskih obilježja, obilježja obiteljskog nasilja i s njime povezanih intervencija za predviđanje vrste nasilja kojemu su bile izložene žrtve obiteljskog nasilja starije od 60 godina. Starije su žrtve češće imale niži stupanj obrazovanja, bile su udovci/udovice, umirovljenici, a počinitelji nasilja bila su njihova djeca, braća i sestre i drugi članovi obitelji, tijekom dužeg razdoblja, a najčešće vrste zlostavljanja bili su ekonomsko zlostavljanje ili kombinacija fizičkog i ekonomskog nasilja u usporedbi s mlađim žrtvama obiteljskog nasilja. Starije žrtve rjeđe prijavljuju obiteljsko nasilje nadležnim institucijama zbog njihove ekonomske ovisnosti ili ovisnosti povezane s čimbenicima zdravlja o članovima obitelji koji su često i počinitelji. Posljedično, prevencija i intervencija stručnih i nadležnih institucija su ograničene.Croatia is one of the European countries with the highest prevalence of domestic violence (DV) and without a national policy on elder abuse. The aim of the study was to determine the differences between elderly victims (EV) of DV aged 60+ in comparison with younger DV victims (aged <60). A total out of 3164 adults who visited the Counseling Center for DV in Zagreb, 200 of them were aged 60+. Structured face-to-face interviews to collect socio-demographic data, types of abuse, perpetrators and reporting of abuse, and types of interventions were applied. To identify differences between the elderly (60+) and younger (<60) DV victims regarding the socio-demographic characteristics, characteristics of abuse, and related interventions Pearson’s χ2 test and z-test with the Bonferroni’s correction were applied. Strength of association between categorical variables was determined by Cramer’s V. Binary logistic regression determined independent contributions of socio-demographic characteristics, characteristics of DV, and related interventions in predicting types of abuse experienced by elder DV victims (60+). EV were more likely lower educated, widowed, retired, abused by their children, siblings, and other family members, experienced longer DV, financial and a combination of physical and financial abuse compared to younger DV victims. EV rarely report DV to the authorities due to financial or health-related dependency on family members who are often the perpetrators. Consequently, prevention and intervention by competent authorities are limited

THE ASSOCIATION BETWEEN SEROTONIN TRANSPORTER POLYMORPHISM, PLATELET SEROTONIN CONCENTRATION AND INSOMNIA IN NON-DEPRESSED VETERANS WITH POSTTRAUMATIC STRESS DISORDER

Background: The role of serotonin transporter and its functional gene polymorphism (5-HTTLPR, serotonin transporter linked polymorphic region) was investigated in sleep disturbances in various mental disorders, with conflicting findings. Here, the association of particular sleep disturbances with 5-HTTLPR genotypes and platelet serotonin (5 HT) concentration was determined simultaneously in veterans with posttraumatic stress disorder (PTSD), who were subdivided into those with or without comorbid depression. Subjects and methods: Croatian male, medication-free war veterans with PTSD (N=325), subdivided into those with or without comorbid depression, and subdivided further according to the various sleep disturbances, were evaluated using the Structured Clinical Interview, the Hamilton Rating Scale for Depression and the Clinician Administered PTSD Scale. Genotyping and platelet 5-HT concentration measurements were conducted using PCR and spectrofluorimetric methods, respectively. Results: Nominally higher frequency of the 5-HTTLPR LL genotype compared to S carriers (p=0.026; ????² test) and significantly higher platelet 5-HT concentration (p=0.001; one-way ANOVA) were detected in non-depressed veterans with PTSD with early insomnia, compared to matched veterans without early insomnia. Conclusions: Over-representation of the LL genotype of the 5-HTTLPR and higher platelet 5-HT concentrations were detected in veterans with PTSD who did not develop comorbid depression but had severe early insomnia. These results suggest that 5- HTTLPR genotypes and platelet 5-HT concentration are associated with early insomnia in non-depressed veterans with PTSD. Limitations of the study were the cross-sectional nature of the study, biallelic assessment of the 5-HTTLPR, and a lack of use of the specific sleep measurement scales. These results should be replicated in larger samples, validated on different populations, using specific sleep measurement scales and triallelic 5-HTTLPR assessment