Investigation of professional stress at emergency physicians and psychiatrists

Fenomen stresa je komplikovan i sadrži različite definicije. Prve studije o stresu su se zasnivale na fiziologiji, ali su se sredinom prošlog veka pojavili i mnogi psihološki modeli. Reakcija na stres može da nastane ne samo kao reakcija na stvarne psihološke i fizičke događaje, nego i u njihovom očekivanju. Ovaj tip stresa se naziva „psihološki“ i smatra se najvažnijim u današnjem društvu kao glavni razlog hroničnog stresa. Profesionalni, radni ili stres vezan za profesiju, ima relativno kratku istoriju u naučnom razmatranju. Određene teorije ističu interakciju osobe i sredine. U poslednjih nekoliko godina pritisak na lekare porastao je u mnogim zemljama, kao rezultat različitih reformi zdravstvene zaštite koji utiču na autonomiju lekara, prestiž i prihode, što dovodi do većeg stresa na radu. Radni stres može dovesti do hroničnih reakcija, kao što su loše zdravlje, iscrpljenost i depresija. Cilj ovog istraživanja bio je ispitivanje i utvrđivanje nivoa profesionalnog stresa kod lekara urgentne medicine i psihijatara, kao i faktora koji utiču na njegov nastanak, razvoj i ispoljavanja (koja se u savremenoj medicinskoj literaturi označavaju kao tzv. „sindroma izgaranja“ , odnosno „burnout sindrom“ ili jednostavno „burnout“, a „burnout“ na engleskom znači sagorevanje ili izgaranje i kod nas se kao termin često koristi u stručnim krugovima) Istraživanje je koncipirano kao studija preseka. Ispitanici su bili lekari psihijatri i lekari urgentne medicine (prosečan broj radnih sati kod svih je bio veći od 35 nedeljno), i podeljeno je 330 upitnika. Ukupan broj popunjenih testova je bio 302 (152 lekara urgentne medicine i 150 psihijatara), što daje veoma visok procenat odgovora od 91,8%. Ispitivanje je urađeno pomoću upitnika koji se sastojao od šest celina i to: Sociodemografski upitnik, Opšti zdravstveni upitnik (General Health Questionairre – GHQ), Masleč inventar izgaranja (Maslach Burnout Inventory – MBI), Kvalitet života (Quality Of Life – QOL), Upitnik o zadovoljstvu zaposlenih (UZZ) i Profil indeks emocija - PIE (Emotions Profile Index). ..The phenomenon of stress is complicated and it contains many different definitions. The first studies on stress have been based on physiology, but in the middle of the last century many psychological models emerged. Stress reaction can occur not only as a response to a real psychological and physical events, but also in their expectation. This type of stress is called the “psychological” and it is considered as the most important in today’s society as the main cause of chronic stress. Professional, work or stress related to the profession, has a relatively short history in the scientific discussion. Certain theories emphasize people and the environment interact. In recent years, the pressure on physicians has increased in many countries, as a result of various health care reform affecting the autonomy of doctors, prestige and income, leading to more stress at work. Work stress can lead to chronic reactions, such as poor health, burnout and depression. The objective of this study was to investigate and determine the level of job stress for emergency medicine physicians and psychiatrists, as well as factors affecting its emergence, development and manifestation (in the actual medical literature called “burnout syndrome”, i.e. “burnout”). The study was designed as a cross sectional study. Respondents were emergency medicine physicians and psychiatrists (the average number of working hours at all was more than 35 per week), and 330 questionnaires were distributed. The total number of completed tests was 302 (152 emergency medicine physicians and 150 psychiatrists), which gives a very high response rate of 91.8%. The research was conducted through a questionnaire, which consisted of six segments, namely: socio-demographic questionnaire, the General Health Questionnaire - GHQ, Maslach Burnout Inventory - MBI, Quality of Life - QOL, Questionnaire of employee satisfaction (UZZ) and emotions profile index - PIE..

CORRELATION OF PRE-MORBID ALCOHOLISM AND CHANGES IN THE LEVEL OF BIOGENIC AMINE METABOLITES IN CEREBROSPINAL FLUID OF ACCUTE BRAIN INFARCTION PATIENTS

Background: The disorder of biogenic amine metabolism (serotonin – 5-HT and dopamine – DA) is expected in the brain (neuron) damage caused by acute ischemia. It is known that long-term abuse of ethyl-alcohol damages the quality of neurons diffusely in the brain. Cerebrospinal fluid (CSF) and its biochemical content, 5-HT and DA, are reliable indicators of the vitality of neurons. The main objective of this research was to demonstrate that the elevated content of metabolites 5-HT and DA in the CSF in patients with acute brain infarction, who were pre-morbid alcohol-dependent patients, is additionally emphasized by diffusive damage of neuron vitality caused by alcoholism. Subjects and methods: Study sample consists of two groups - 50 alcohol-dependent patients with acute brain infarction under the age of 65 (group A) and 50 patients with acute brain infarction who were not alcohol-dependent (group B). All subjects underwent the same procedure - CSF was taken during admission to the hospital and history was obtained through anamnesis, heteroanamnesis and clinical examinations. Results: Metabolism of DA and metabolic turnover of DA (3, 4 dihydroxyphenylacetic acid + homovanilic acid; DOPAC + HVA) was elevated in the liquor of both patient groups. The statistically significant difference between the groups was found in metabolic turnover of 5-HT (p<0.05), and metabolic turnover of DA (p<0.001). Conclusions: The metabolic neuron disbalance, i.e. their pathophysiological-biochemical dysfunction as a result of acute brain infarction, is present in a higher degree in patients with pre-morbid long-term alcohol abuse

Professional stress in general practitioners and psychiatrists: The level of psycologic distress and burnout risk

Background/Aim. So far, studies of stress have shown that physicians are at a high risk of sickness from psychic and somatic disorders related to professional stress, that can lead to important disturbance of personal, familiar and professional functionating. The aim of this study was to investigate the doctors exposition level to professional stress, to compare stress level in general practitioners (GP) group with that in the group of psychiatrists and risk level for the apperance of burnout syndrome. Methods. This cross-section study included subjects recruited by a random sample method. Thirty General Practice doctors and 30 psychiatrists (totally 60 doctors) filled the set of 3 questionnaires: Sociodemographics features, General Health Questionnaire (GHQ; Goldberg D, 1991), and Maslach Burnout Inventory (MBI; Maslach C, 1996). Appropriate statistical procedures (Pearson test, t-test, variance analysis) in interpretation of the results were used. Results. A total level of psychic distress measured with the GHQ test in both groups of physicians was very low implying their good mental health. A difference in Burnout risk based on MBI test between the groups was statistically significant (χ2 = 4,286; p &lt; 0.05) only at subscale Personal Accomplishment (MBI-PA); it was a consequence of a higher number of GPs with medium burnout risk (13.3 : 0.0%). However, even 35 physicians from the sample were affected with a high burnout risk measured with subscales Emotional Ehausation (MBI-EE) and MBI-DP, showing that both groups of physicians had risk for the appearance of burnout syndrome. Conclusion. The obtained results showed a high burnout risk level in both, GPs and psychiatrists, groups. In both groups there was no presence of psychic disorders (anxiety, depression, insomnia), while there was a high level of emotional ehausation and overtension by job, and also a lower total personal accomplishment. Level of exposition to professional stress is higher in GPs than in psychiatrists, but the difference was not statistically significant

Attitudes of employees toward offenders sentenced to community service

Da li će alternativne sankcije koje osuđeni izvršavaju u društvenoj zajednici biti uspešne u značajnoj meri može zavisiti i od stavova populacije u radnoj sredini u kojoj osuđeni izvršava kaznu. Ova studija rađena u Beogradu (Srbija) imala je za cilj da utvrdi smer i faktorsku strukturu stavova prema osuđenim i bivšim osuđenim osobama i njihovu povezanost sa uzrastom i obrazovanjem ispitanika. Uzorak su činili muškarci iz opšte populacije (N=78) zaposleni u firmama u kojima osuđeni obavljaju kaznu rada u javnom interesu. U istraživanju je za ispitivanje stavova korišćena Skala stavova prema osuđenima (Scale for Attitudes Toward Prisoners and Ex-prisoners). Analiza rezultata istraživanja je pokazala da ispitanici imaju pozitivan stav prema osuđenim osobama. Na skali stavova najveću frekventnost imala je tvrdnja: „Družio bih se sa osobom koja je na uslovnom otpustu iz zatvora“ sa kojom se 44,90% ispitanika „uglavnom slaže“ (MOD=4). Kod većine negativno formulisanih tvrdnji frekvencije odgovora „potpuno se slažem“ su niske, kreću se od 7,70% do 15,60%. Faktorskom analizom skale stavova izdvojena su tri respektabilna faktora koja su nazvana: Odbacivanje, Poverenje i Percepcija kazne. Korelacija između demografskih varijabli uzrast i obrazovanje i stavova nije bila statistički značajna (p=0,93; p=0,86). Nalazi studije imaju značajne implikacije za praktična psihološka i sociološka pitanja, kao što su priprema društvene zajednice za prihvat osuđenih na alternativne sankcije, i teorijska pitanja u vezi sa poznavanjem strukture, uzroka, geneze, funkcija i formi stavova prema osuđenima.Whether alternative penalties served by offenders in the community will be successful can also largely depend on the general attitudes in the workplace where the offender will be serving his penalty. This study, conducted in Belgrade, Serbia, was aimed to determine the inclination and factor structure of attitudes towards offenders and ex-offenders, and their correlation with the respondents’ age and education. The sample consisted of men from the general population (N=78), employed in companies where offenders serve community sentence. The study also considers the association between attitudes and the age and education of the respondents. The Scale for Attitudes toward Prisoners and Ex- Prisoners was used in the study. Research results showed that the respondents in general had positive attitude toward offenders. On the Scale of Attitudes, a statement “I would socialize with a person who is on parole from prison” had the highest frequency, with which 44.90% of respondents “mostly agree” (MOD=4). With most negatively formulated statements, the frequency of statements “I strongly agree” is low, ranging from 7,70% to 15.60%. Factor analysis of the attitude scale indicated three respectable factors which were named: Rejection, Trust, and Perception of Penalty. The correlation between the demographic variables of age and education, and the expressed attitudes shows there was no significant correlation (p=0.93; p=0.86). The findings of the study have an important impact on practical psychosocial issues, such as that of preparing the community to accept offenders serving alternative punishments, as well as theoretical questions regarding the understanding of the structure, cause, origin, function, and form of attitudes toward offenders. Key words: attitudes, offenders, community

ANXIETY IN EPILEPTIC PATIENTS

Background: Anxiety may occur as ictal, postictal or interictal symptom in patients with epilepsy. The main aim of this research was to explore the intensity and frequency of anxiety in patients with generalized, temporal and extratemporal epilepsy. Subjects and methods: This is a cross-sectional study of three groups of patients with epilepsy (30 patients per group) - recently diagnosed with generalized epilepsy, temporal epilepsy and extratemporal epilepsy, and a healthy control group (N=30). The Beck Anxiety Inventory (BAI) was used for quantitative assessment of anxiety. Results: Patients with temporal and extratemporal epilepsies had a significantly higher mean total scores on the BAI than the patients with generalized forms of epilepsies (ANOVA: F=6.323, p<0.01). There were no statistically significant differences between the temporal and extratemporal epilepsy groups according to the levels of anxiety on BAI (t-test: t=1.68, p>0.05). For the first three symptoms - numbness, wobbling in the legs and the fear of the worst happening - the group of patients with extratemporal epilepsies had significantly higher average levels of intensity and frequency of symptoms (ANOVA: F1=5.591, F2= 6.555, F3=5.906; p<0.01) Conclusions: Patients with partial epilepsy have more frequent and prominent anxiety symptoms than patients with generalized epilepsy, and also more than the control group. All these findings clearly indicate the necessity to modify treatment strategies accordingly in order to include both the antiepileptic therapy and treatment for anxiety disorders

Uloga krvno-moždane barijere u psihijatrijskim oboljenjima

The blood-brain barrier (BBB) is formed by continuous, closely connected endothelial cells, enveloped in the basal lamina, pericytes, and foot extensions of astrocytes. BBB has a vital role in brain metabolism and protects the brain parenchyma from harmful agents present in the systemic circulation. Damage to the BBB and an increase in its permeability have an important role in many neurodegenerative diseases. This paper aims to review the literature on the impact of the BBB damage on psychiatric illness, a largely neglected and under researched area. Links between BBB impairment and specific neuropsychiatric disorders are described including schizophrenia, affective disorders, dementias with behavioral disorders, and alcohol use disorder, with comparison to typical hereditary small vessel diseases affecting the BBB such as cerebral autosomal dominant arteriopathy with subcortical infarction and leukoencephalopathy (CADASIL) and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). The authors critically summarize possible pathogenic mechanisms linking BBB damage and these common disorders.Крвно-мождана баријера (КМБ) се састоји од континураних, тесно спојених ендотелних ћелија омотаних базалном ламином, перицитима и сто-паластим продужецима астроцита. КМБ има виталну функцију и можданом метаболизму и штити мождани паренхим од штетних фактора присутних у системској циркулацији. Показано је да оштећење КМБ и повећање њене пропустљи-вости има значајну улогу у многим неуродегене-ративним обољењима. Циљ овога рада је преглед литературе о значају оштећења КМБ код психијатријских обољења, до сада занемареној и недовољно истраженој облас-ти. Повезаност измедју поремећаја КМБ и неуро-психијатријских поремећаја је посебно анализи-рана за схизофренију, афективне поремећаје, де-менције са бихевиоралним изменама, поремећај употребе алкохола, са посебним освртом на на-следне болести малих крвних судова мозга са оштећењем КМБ као што су церебрална аутозо-мално доминантна артериопатија са супкортика-ним инфарктима и леукоенцефалопатијом (CADASIL) и митохондријска енцефаломиопатија са лактатном ацидозом и епизодама налик можда-ном удару (MELAS). Аутори критички сумирају могуће патогенетске механизме који повезују оштећења КМБ са овим честим обољењима