Povezanost aleksitimije i dvije dimenzije velikog depresivnog poremećaja: kognitivne i somatsko-afektivne

Aim: To explore the association between alexithymia and two dimensions of major depressive disorder (MDD): cognitive and somatic-affective. Patients and methods. Unicentric, cross-sectional study included consecutive sample of 63 patients at the Department of Psychiatry (DoP), Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia. Target population included outpatients with diagnosed MDD (F32 and F33, according to ICD-10). Inclusion criteria were: confirmed MDD diagnosis, age between 18 and 65 years, both genders, outpatient treatment at the DoP. The main outcome was the association between alexithymia, measured by total score on 20-item Toronto-Alexithymia scale (TAS-20), with two dimensions of MDD, cognitive and somatic-affective, measured by Beck Depression Inventory-II (BDI-II). Results: Both dimensions of BDI-II and the total severity of MDD symptoms were statistically significantly, although low, associated with alexithymia, and the differences between these two correlations were not (statistically) significant. However, in the multivariable model, the cognitive dimension (b = 0.64; β = 0.48; p = 0.002; statistically significant at the false discovery rate of 0.05) was primarily associated with alexithymia, and the somatic-affective was not, after all cognitive aspects were controlled for (b = -0.19; β = 0-0.14; p = 0.491; not statistically significant, with the false discovery rate of 0.05). Conclusion: Alexithymia is primarily associated with a pure cognitive dimension of MDD after somatic-affective elements are excluded. Somatic-affective dimension of MDD is not associated with alexithymia after the cognitive elements were controlled for. Both dimensions, as well as the overall severity of MDD, are associated with alexithymia, but this association is relatively low.Cilj. Istražiti povezanost aleksitimije s dvije dimenzije velikog depresivnog poremećaja (VDP): kognitivnom i somatsko-afektivnom. Materijali i metode. Provedeno je unicentrično, presječno istraživanje na susljednom uzorku 63 ispitanika na Klinici za psihijatriju KBC Sestre Milosrdnice, Zagreb, Hrvatska. Ciljana populacija bili su ambulantno liječeni bolesnici s dijagnosticiranim VDP (MKB-10: F32 i F33). Kriteriji uključivanja bili su: potvrđena dijagnoza VDP, dob od 18 do 65 godina, oba spola, ambulantno liječenje na Klinici za psihijatriju. Glavni ishod bila je povezanost aleksitimije mjerene ukupnim rezultatom Toronto ljestvice aleksitimije-20 (TAS-20) s dvije dimenzije VDP mjerenog Beckovim inventarom depresije-II (BDI-II): kognitivnom i somatsko-afektivnom. Rezultati. Istraživanjem se pokazalo da su bivarijabilno obje dimenzije BDI-II, kao i ukupna težina simptoma VDP statistički značajno iako nisko povezane s aleksitimijom te da razlike između tih dviju korelacija nisu statistički značajne. Međutim, u multivarijabilnom modelu pokazalo se da je s aleksitimijom primarno povezana kognitivna dimenzija (b=0,64; β=0,48; p=0,002; statistički značajno uz stopu lažnih otkrića od 0,05), dok somatsko-afektivna to nije, nakon što se iz nje izluče svi kognitivni aspekti (b=-0,19; β=0-0,14; p=0,491; nije statistički značajno uz stopu lažnih otkrića od 0,05). Zaključak. Čini se da je aleksitimija primarno povezana s čistom kognitivnom dimenzijom VDP nakon što se iz nje izluče somatsko-afektivni elementi, odnosno da somatsko-afektivna dimenzija VDP nije povezana s aleksitimijom nakon što su izlučeni kognitivni elementi. Obje dimenzije, kao i ukupna težina VDP, povezani su s aleksitimijom, no ta je povezanost razmjerno niska

Epidemiology of hepatitis C in Croatia in the European context

We analyzed prevalence, risk factors and hepatitis C virus (HCV) genotype distribution in different population groups in Croatia in the context of HCV epidemiology in Europe, with the aim to gather all existing information on HCV infection in Croatia which will be used to advise upon preventive measures. It is estimated that 35000-45000 of the Croatian population is chronically infected with HCV. Like in other European countries, there have been changes in the HCV epidemiology in Croatia over the past few decades. In some risk groups (polytransfused and hemodialysis patients), a significant decrease in the HCV prevalence was observed after the introduction of routine HCV screening of blood/blood products in 1992. Injecting drug users (IDUs) still represent a group with the highest risk for HCV infection with prevalence ranging from 29% to 65%. Compared to the prevalence in the Croatian general population (0.9%), higher prevalence rates were found in prison populations (8.3%-44%), human immunodeficiency virus-infected patients (15%), persons with high-risk sexual behavior (4.6%) and alcohol abusers (2.4%). Low/very low prevalence was reported in children and adolescents (0.3%) as well as in blood donors (0%-0.009%). In addition, distribution of HCV genotypes has changed due to different routes of transmission. In the general population, genotypes 1 and 3 are most widely distributed (60.4%-79.8% and 12.9%-47.9%, respectively). The similar genotype distribution is found in groups with high-risk sexual behavior. Genotype 3 is predominant in Croatian IDUs (60.5%-83.9%) while in the prison population genotypes 3 and 1 are equally distributed (52.4% and 47.6%). Data on HCV prevalence and risk factors for transmission are useful for implementation of preventive measures and HCV screening

Association between total serum cholesterol and depression, aggression, and suicidal ideations in war veterans with posttraumatic stress disorder: a crosssectional study

Aim To investigate the relationship between total serum cholesterol and levels of depression, aggression, and suicidal ideations in war veterans with posttraumatic stress disorder (PTSD) without psychiatric comorbidity. Methods A total of 203 male PTSD outpatients were assessed for the presence of depression, aggression, and suicidality using the 17-item Hamilton Depression Rating Scale (HAM-D17), Corrigan Agitated Behavior Scale (CABS), and Scale for Suicide Ideation (SSI), respectively, followed by plasma lipid parameters determination (total cholesterol, high density lipoprotein [HDL]-cholesterol, low density lipoprotein [LDL]-cholesterol, and triglycerides). PTSD severity was assessed using the Clinician-Administered PTSD Scale for DSM-IV, Current and Lifetime Diagnostic Version (CAPS-DX) and the Clinical Global Impressions of Severity Scale (CGI-S), before which Mini-International Neuropsychiatric Interview (MINI) was administered to exclude psychiatric comorbidity and premorbidity. Results After adjustments for PTSD severity, age, body mass index, marital status, educational level, employment status, use of particular antidepressants, and other lipid parameters (LDL- and HDL- cholesterol and triglycerides), higher total cholesterol was significantly associated with lower odds for having higher suicidal ideation (SSI≥20) (odds ratio [OR] 0.09; 95% confidence interval [CI] 0.03- 0.23], clinically significant aggression (CABS≥22) (OR 0.28; 95% CI 0.14-0.59), and at least moderate depressive symptoms (HAM-D17≥17) (OR 0.20; 95% CI 0.08-0.48). Association of total cholesterol and HAM-D17 scores was significantly moderated by the severity of PTSD symptoms (P < 0.001). Conclusion Our results indicate that higher total serum cholesterol is associated with lower scores on HAM-D17, CABS, and SSI in patients with chronic PTSD

Low BDNF concentrations in schizophrenia may be caused by non-linearity of BDNF correlation with age caused by its interaction with sex

Rezultati dosadašnjih istraživanja o perifernoj koncentraciji moždanog neurotrofnog čimbenika rasta (engl. brain derived neurotrophic factor, BDNF) u shizofreniji (SCH) su pokazali određene nedosljednosti. Cilj ovog istraživanja bio je istražiti mogu li ove nedosljednosti biti objašnjene konfundirajućim učincima dobi i spola. U ovom presječnom istraživanju, provedenom tijekom 2017 na Klinici za psihijatriju, Kliničkog bolničkog centra Sestre milosrdnice, Zagreb, Hrvatska, uključen je uzorak od 41 bolesnika/ispitanika s dijagnosticiranom SCH. Glavni ishod bile su koncentracije BDNF-a u serumu. Nađena je načajna cross-over interakcija spola i dobi s koncentracijom BDNF-a (p=0.017). U muških bolesnika/ispitanika, koncentracija BNDF-a je značajno rasla s dobi. U ženskih bolesnica/ispitanica, korelacija između dobi i BDNF-a nije bila značajna. Na razini ovog uzorka, ona je bila negativna: starija dob bila je povezana s nižim koncentracijama BDNF-a u ženskih bolesnica/ispitanica. Koncentracije BDNF-a su se značajno razlikovale između ženskih i muških bolesnika dobi ispod 22 godine (ukupno 7% bolesnika), i dobi iznad 65 godina (ukupno 10% bolesnika). BDNF bi mogao biti obećavajući biomarker shizofrenije, ali bi različite norme trebale biti predložene za bolesnike različite dobi i spola.Considerable inconsistencies exist between results of the studies on brain-derived neurotrophic factor (BDNF) peripheral concentrations and schizophrenia (SCH). The objective of our study was to check whether these inconsistencies may be explained by confounding effects of age and sex. In this cross-sectional study performed during 2017 at Department of Psychiatry, University Hospital Center Sestre milosrdnice, Zagreb, Croatia, we included a sample of 41 patients diagnosed with SCH. The main outcome was BDNF serum concentrations. We have detected a significant cross-over interaction of sex and age on BDNF concentration (p=0.017). In male patients BNDF concentrations significantly increase with age. In female patients the correlation between age and BDNF was not significant. On this particular sample level, it was negative: aging was associated with the decrease of BDNF concentrations in female patients. BDNF concentrations were significantly different between female and male patients under the age of 22 years (total of 7% of patients), and above the age of 65 (total of 10% of patients). BDNF may be a promising schizophrenia biomarker, but different norms should be proposed for the patients of different age and sex

Uvid i samostigma kod oboljelih od shizofrenije

Poor insight and high level of self-stigma are often present among patients with schizophrenia and are related to poorer treatment adherence, poorer social function and rehabilitation, aggressive behavior, higher level of depression, social anxiety, lower quality of life and selfesteem. Reports on a relationship between insight and stigma are controversial. We examined the relationship of the level of insight and self-stigma in a sample of 149 patients with schizophrenia. Insight was measured with the Scale to assess Unawareness of Mental Disorder and self-stigma with the Internalized Stigma of Mental Illness. Results showed 88.6% of the patients to have high or moderate insight, with a mean value of 2.73. General insight showed the highest level (2.58) and insight in positive symptoms the lowest level (2.9). The self-stigma score in general was 2.13, with stereotype endorsement being lowest (1.98). According to study results, 77.1% of patients felt minimal or low self-stigma across all subscales, except for stigma resistance subscale. Statistically significant correlation was found between insight and four subscales of self-stigma, while no correlation was found for the stigma resistance subscale only. These results imply the need of individually tailored antistigma and insight promoting programs for patients with schizophrenia.Manjkav uvid i visoka razina samostigme često su prisutni kod oboljelih od shizofrenije, a povezani su sa slabijom suradljivošću, slabijim socijalnim funkcioniranjem, agresivnim ponašanjem, otežanom rehabilitacijom, višom razinom depresivnosti i socijalne tjeskobe, nižom kvalitetom života i manjkom samopouzdanja. Dosadašnja istraživanja utvrdila su kontradiktoran odnos uvida u bolest i samostigme. U ovom istraživanju ispitivali smo razinu uvida, samostigme i njihovu povezanost u uzorku od 149 bolesnika sa shizofrenijom. Prema dobivenim rezultatima, 88,6% bolesnika imalo je visok ili umjeren uvid, sa srednjom vrijednošću od 2.73. Opći uvid pokazao je najvišu razinu, s rezultatom od 2.58, a uvid u pozitivne simptome je bio najniži, s rezultatom od 2.9. Ukupna samostigma bila je 2.13, a prihvaćanje stigme najniže, 1.98. Prema rezultatima, gotovo dvije trećine svih bolesnika osjećali su minimalnu ili nisku samostigmu prema svim podljestvicama, osim u podljestvici otpora stigmatizaciji. Nađena je statistički značajna korelacija između uvida i četiri podljestvice samostigme, a korelacija nije pronađena samo kod podljestvice otpora stigmatizaciji. Ovi rezultati potvrđuju hipotezu i impliciraju potrebu individualnog programa za smanjenje samostigme i promociju uvida za bolesnike sa shizofrenijom

Humani koronavirusi u kontekstu ‘Jednog zdravlja’

Seven human coronaviruses have been identified so far: four seasonal coronaviruses (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1) and three novel coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2). While seasonal coronaviruses cause only mild symptoms, novel coronaviruses cause severe and potentially fatal infections. All known coronaviruses originated in animals. Bats are considered as an origin for the majority of coronaviruses capable of infecting humans; however, rodents are proposed as natural hosts for HCoV-OC43 and HCoV-HKU1. Different animal species could serve as intermediate hosts including alpacas (HCoV-229E), livestock (HCoV-OC43), civet cats (SARS-CoV), camels (MERS-CoV), and pangolins (SARS-CoV-2). In Croatia, SARS-CoV-2 was detected in humans, pet animals, wildlife, and the environment. The COVID-19 pandemic has highlighted the role of the ‘One Health’ approach in the surveillance of zoonotic diseases.Do sada je otkriveno sedam humanih koronavirusa: četiri sezonska koronavirusa (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1) i tri nova koronavirusa (SARS-CoV, MERS-CoV, SARS-CoV-2). Dok sezonski koronavirusi uzrokuju tek blage infekcije, novi koronavirusi su uzročnici teških i potencijalno smrtonosnih infekcija. Svi poznati koronavirusi su podrijetlom od životinja. Šišmiši se smatraju izvorom većine koronavirusa koji uzrokuju infekcije u ljudi, međutim prirodnim rezervoarima HCoV-OC43 i HCoV-HKU1 se smatraju glodavci. Različite životinjske vrste predstavljaju prijelazne domaćine uključujući alpake (HCoV-229E), stoku (HCoV-OC43), cibetke (SARS-CoV), deve (MERS-CoV) te ljuskaše (SARS-CoV-2). Na području Hrvatske SARS-CoV-2 je dokazan u ljudi, kućnih ljubimaca, divljih životinja te okolišu. Pandemija COVID-19 naglašava ulogu pristupa ‘Jedno zdravlje’ u nadzoru zoonoza

Seroprevalencija na viruse iz herpes grupe u bolesnika na hemodijalizi

Herpes group viruses (herpes simplex virus, HSV; varicella-zoster virus, VZV; cytomegalovirus, CMV; and Epstein-Barr virus, EBV) remain an important cause of morbidity in immunocompromised persons. The aim of the study was to analyze the prevalence of HSV-1, HSV-2, VZV, CMV and EBV in patients undergoing hemodialysis. During a three-year period (2013-2015), 152 consecutive serum samples from hemodialysis patients and 150 healthy subjects (control group) were tested for the presence of IgM/IgG antibodies to herpes group viruses. Serologic tests were performed using a commercial enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunofluorescent assay (ELFA). Hemodialysis patients showed significantly higher CMV IgG seropositivity compared to controls (88.2% vs. 78.7%, p=0.011). In addition, seroprevalence rates of HSV-1 and VZV were higher in hemodialysis patients; however, these differences did not reach statistical significance (85.5% vs. 80.0%, p=0.054 and 99.3% vs. 96.0%, p=0.051, respectively). The prevalence of HSV-2 and EBV was similar in both groups (12.5% vs. 12.7%, p=0.137 and 98.0% vs. 95.3%, p=0.113, respectively). There was no difference in IgG seropositivity according to gender and place of residence. Logistic regression showed that older age was a significant predictor for CMV and EBV IgG seropositivity (increase in age by one year: CMV OR=1.055; 95%CI=1.030-1.080 and EBV OR=1.075, 95%CI=1.023-1.130).Virusi iz herpes grupe (herpes simpleks virus, HSV; varičela-zoster virus, VZV; citomegalovirus, CMV; Epstein-Barrov virus, EBV) su značajan uzrok smrtnosti u imunokompromitiranih osoba. Cilj rada bio je analizirati učestalost HSV-1, HSV-2, VZV, CMV i EBV u bolesnika koji se liječe hemodijalizom. Tijekom trogodišnjeg razdoblja (2013.-2015.) ispitano je ukupno 152 uzastopno pristiglih uzoraka seruma bolesnika na hemodijalizi te 150 uzoraka seruma zdravih osoba (kontrolna skupina) na prisutnost herpes virusnih IgM/IgG protutijela. Serološko testiranje učinjeno je pomoću komercijalnog dijagnostičkog imunoenzimnog testa (ELISA) ili imunoenzimnog testa s fluorescentnom detekcijom (ELFA). Bolesnici na hemodijalizi bili su značajno češće CMV IgG seropozitivni u odnosu na kontrolnu skupinu (88,2% prema 78,7%, p=0,011). Nadalje, seroprevalencija HSV-1 i VZV također je bila viša u bolesnika na hemodijalizi, no statistička značajnost nije dostignuta (85,5% prema 80,0%, p=0,054; 99,3% prema 96,0%, p=0,051). Učestalost HSV-2 i EBV protutijela nije se razlikovala između skupina (12,5% prema 12,7%, p=0,137, odnosno 98,0% prema 95,3%, p=0,113). IgG seroprevalencija nije se razlikovala u odnosu na spol i mjesto prebivališta. Rezultati logističke regresije pokazali su da je starija životna dob značajan čimbenik rizika za CMV i EBV seropozitivnost (porastom dobi za jednu godinu CMV OR=1,055; 95%CI=1,030-1,080; EBV OR=1,075, 95%CI=1,023-1,130)

The relationship among psychopathology, religiosity, and nicotine dependence in Croatian war veterans with posttraumatic stress disorder

Aim To examine relationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, suicidality, nicotine dependence, and religiosity in Croatian veterans. Methods This cross-sectional study used Combat Exposure Scale (CES) to quantify the stressor severity, PTSD Checklist 5 (PCL) to quantify PTSD severity, Duke University Religion Index to quantify religiosity, Montgomery Asberg (MADRS) and Hamilton Depression (HAM-D) rating scales to measure depression/suicidality, and Fagerstrom Test for Nicotine Dependence to assess nicotine dependence. Zero- order correlations, cluster analysis, multivariate regression, and mediation models were used for data analysis. Results Of 69 patients included, 71% met “high religiosity” criteria and 29% had moderate/high nicotine dependence. PTSD was severe (median PCL 71), depression was mild/moderate (median MADRS 19, HAM-D 14), while suicidality was mild. A subset of patients was identified with more severe PTSD/depression/suicidality and nicotine dependence (all P < 0.001). Two “chains” of direct and indirect independent associations were detected. Higher CES was associated with higher level of re-experiencing and, through re-experiencing, with higher negativity and hyperarousal. It also showed “downstream” division into two arms, one including a direct and indirect association with higher depression and lower probability of high religiosity, and the other including associations with higher suicidality and lower probability of high nicotine dependence. Conclusions Psychopathology, religiosity, and nicotine dependence are intertwined in a complex way not detectable by simple direct associations. Heavy smoking might be a marker of severe PTSD psychopathology, while spirituality might be targeted in attempts of its alleviation

Cognitive Screening Instruments, A Practical Approach, Second Edition Delirium in Elderly Patients Inflammation associated Depression: Evidence, Mechanism and Implications Psycho-Oncology Medical Management of Psychotropic Side Effects Dementia, 5th edition

Book review