From antisocial personality disorder to psychopathy

Antisocijalni poremećaj ličnosti spada u „cluster B“ poremećaje ličnosti. Karakteriziran je kriminalnim ponašanjem, egocentrizmom, deficitom empatije, manipulativnošću i dezinhibicijom, a obrazac ponašanja je stabilan tijekom vremena. Radi se o takvom poremećaju ličnosti koji, osim što je značajan problem za oboljelog pojedinca i njegovu užu okolinu, predstavlja i važan socijalni problem. Prevalencija nije zanemariva – 2 do 4 % u općoj populaciji, a praćen je nezaposlenošću, psihičkim i somatskim komorbiditetima i niskim životnim standardom. Psihopatiju je kao dijagnozu u psihijatriju uveo Cleckley još 1941. na temelju vlastitog kliničkog iskustva, a prvi dijagnostički alat je osmislio Robert Hare u obliku ček-liste za psihopate. Danas se koristi njena revidirana verzija iz 1991. godine. Karakteristike psihopatije se dijele na dva faktora. Prvi predstavlja afektivno-interpersonalnu dimenziju koja se odnosi na šarm, grandioznost, površan afekt, patološko laganje i nedostatak empatije. Drugi faktor psihopatije je socijalno-devijantna dimenzija koja zapravo nalikuje antisocijalnom poremećaju ličnosti: parazitski i kriminalni stil života te impulzivnost. Općenito se smatra da postoji takozvani kontinuum narcističnog spektra unutar kojeg se karakteristike ličnosti od malignog narcizma, preko različitih stupnjeva antisocijalnog i psihopatskog ponašanja do punog oblika antisocijalnog poremećaja ličnosti i psihopatije, promatraju kao različiti stupnjevi jednog te istog poremećaja ličnosti. Liječenje pacijenata s ovakvim crtama ličnosti je dugotrajno, sporo i sa, do sada, skromnim napretkom. Koristi se pretežno metoda razvijanja mentalizacije kroz terapijski savez i korektivno iskustvo. Jedino što preostaje kako bi se postigao dodatni uspjeh i razumijevanje je provođenje daljnjih istraživanja, evaluacija dosadašnjeg rada i angažiranje ne samo medicine već i ostalih segmenata društva – pravosudnih tijela i socijalnih službi.Antisocial personality disorder is classified in “cluster B“. Characteristics of this personality disorder are criminally deviant behavior, egocentrism, empathy deficit, manipulative behavior, and disinhibition. These characteristic behaviors are a long-term pattern of individual's functioning. The prevalence of antisocial personality disorder is 2 to 4 %, and many comorbidities (psychic and somatic) make it very important for the patient alone, but also for the society. In 1941, based on his clinical observations, Cleckley came up with the term of psychopathy. Later, Robert Hare made the first diagnostic tool used to rate an individual's psychopatic or antisocial tendencies. Nowaday, Psyhcopathy Checklist – Revised is used for these purposes. Characteristics of psychopathy are divided in two factors. First deals with affective component of individual's character and includes charm, pathological lying, and empathy deficit. Second factor deals with behavioral component of psychopathy and includes impulsiveness and criminally deviant behavior. It is considered that antisocial personality disorder, psychopathy, and narcissism are all together a part of the Narcissistic continuum. They are considered as different presentations of very similar personality disorders which can't be strictly separated. Treatnig these patients is considered to be complicated, long-term, and with high failure rates. Up to now, the best treatment method has been encouraging the development of mentalization. To acomplish further progress in treating antisocial personality disorder and psychopathy, it is necessary to conduct more research, reassess previous work, and engage not only medicine, but also judicial institutions and social services

From antisocial personality disorder to psychopathy

Antisocijalni poremećaj ličnosti spada u „cluster B“ poremećaje ličnosti. Karakteriziran je kriminalnim ponašanjem, egocentrizmom, deficitom empatije, manipulativnošću i dezinhibicijom, a obrazac ponašanja je stabilan tijekom vremena. Radi se o takvom poremećaju ličnosti koji, osim što je značajan problem za oboljelog pojedinca i njegovu užu okolinu, predstavlja i važan socijalni problem. Prevalencija nije zanemariva – 2 do 4 % u općoj populaciji, a praćen je nezaposlenošću, psihičkim i somatskim komorbiditetima i niskim životnim standardom. Psihopatiju je kao dijagnozu u psihijatriju uveo Cleckley još 1941. na temelju vlastitog kliničkog iskustva, a prvi dijagnostički alat je osmislio Robert Hare u obliku ček-liste za psihopate. Danas se koristi njena revidirana verzija iz 1991. godine. Karakteristike psihopatije se dijele na dva faktora. Prvi predstavlja afektivno-interpersonalnu dimenziju koja se odnosi na šarm, grandioznost, površan afekt, patološko laganje i nedostatak empatije. Drugi faktor psihopatije je socijalno-devijantna dimenzija koja zapravo nalikuje antisocijalnom poremećaju ličnosti: parazitski i kriminalni stil života te impulzivnost. Općenito se smatra da postoji takozvani kontinuum narcističnog spektra unutar kojeg se karakteristike ličnosti od malignog narcizma, preko različitih stupnjeva antisocijalnog i psihopatskog ponašanja do punog oblika antisocijalnog poremećaja ličnosti i psihopatije, promatraju kao različiti stupnjevi jednog te istog poremećaja ličnosti. Liječenje pacijenata s ovakvim crtama ličnosti je dugotrajno, sporo i sa, do sada, skromnim napretkom. Koristi se pretežno metoda razvijanja mentalizacije kroz terapijski savez i korektivno iskustvo. Jedino što preostaje kako bi se postigao dodatni uspjeh i razumijevanje je provođenje daljnjih istraživanja, evaluacija dosadašnjeg rada i angažiranje ne samo medicine već i ostalih segmenata društva – pravosudnih tijela i socijalnih službi.Antisocial personality disorder is classified in “cluster B“. Characteristics of this personality disorder are criminally deviant behavior, egocentrism, empathy deficit, manipulative behavior, and disinhibition. These characteristic behaviors are a long-term pattern of individual's functioning. The prevalence of antisocial personality disorder is 2 to 4 %, and many comorbidities (psychic and somatic) make it very important for the patient alone, but also for the society. In 1941, based on his clinical observations, Cleckley came up with the term of psychopathy. Later, Robert Hare made the first diagnostic tool used to rate an individual's psychopatic or antisocial tendencies. Nowaday, Psyhcopathy Checklist – Revised is used for these purposes. Characteristics of psychopathy are divided in two factors. First deals with affective component of individual's character and includes charm, pathological lying, and empathy deficit. Second factor deals with behavioral component of psychopathy and includes impulsiveness and criminally deviant behavior. It is considered that antisocial personality disorder, psychopathy, and narcissism are all together a part of the Narcissistic continuum. They are considered as different presentations of very similar personality disorders which can't be strictly separated. Treatnig these patients is considered to be complicated, long-term, and with high failure rates. Up to now, the best treatment method has been encouraging the development of mentalization. To acomplish further progress in treating antisocial personality disorder and psychopathy, it is necessary to conduct more research, reassess previous work, and engage not only medicine, but also judicial institutions and social services

Kronične nezarazne bolesti kod hrvatskih branitelja u odnosu na opću populaciju: 25 godina nakon rata

Many published reports have documented an increased prevalence of chronic medical conditions among veterans, but there were only a few studies that compared these increases with the general population. The aim of this study was to determine differences in chronic medical conditions between Croatian war veterans and the general population. This study included two groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from the general population. Medical history, physical examination, laboratory tests and specific diagnostic procedures were taken during systematic physical examination in both groups. The prevalence of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis, smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary heart disease (4.3% vs. 1 %), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%), and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases among Croatian war veterans and emphasized the need of better control of their medical conditions.Povećana učestalost kroničnih bolesti među veteranima dokumentirana je kroz brojna istraživanja, no samo ih je nekoliko studija uspoređivalo s općom populacijom. Cilj ovog istraživanja bio je utvrditi razlike u pojavnosti kroničnih bolesti između hrvatskih branitelja i opće populacije. Ovo istraživanje obuhvatilo je dvije skupine ispitanika, 1453 hrvatskih branitelja i 1429 sudionika iz opće populacije. Anamneza, fizikalni pregled, laboratorijske pretrage i specifični dijagnostički postupci provedeni su tijekom sistematskog fizikalnog pregleda u obje skupine. Analizirana je učestalost hipertenzije, šećerne bolesti, hiperlipidemije, hipotireoze i hipertireoze, kronične opstruktivne plućne bolesti, koronarne bolesti, malignih bolesti, psihijatrijskih bolesti, kolelitijaze, nefrolitijaze, pušenja i konzumacije alkohola. Utvrđeno je da hrvatski branitelji imaju veću vjerojatnost za razvoj hipertenzije (29,5% prema 24,3%), dijabetesa (17,3% prema 3,8%), hiperlipidemije (56,4% prema 27,3%), hipertireoze (3,1% prema 0,8%), koronarne bolesti srca (4,3% naspram 1%), zloćudne bolesti (4,1% naspram 2,2%), psihijatrijske bolesti (15,4% naspram 1,1%) i češću konzumaciju alkohola (53% naspram 29%) nego pojedinci u općoj populaciji. Uočena je značajna razlika u korist opće populacije za hipotireozu (14,3% naspram 8%). Nije bilo razlika u učestalosti kronične opstruktivne plućne bolesti, kolelitijaze, nefrolitijaze i pušenja. Naši nalazi potvrdili su hipotezu o višoj učestalosti kardiovaskularnih bolesti, malignih i psihijatrijskih bolesti među hrvatskim braniteljima te naglasili potrebu bolje kontrole njihovog zdravstvenog stanja

From antisocial personality disorder to psychopathy

Antisocijalni poremećaj ličnosti spada u „cluster B“ poremećaje ličnosti. Karakteriziran je kriminalnim ponašanjem, egocentrizmom, deficitom empatije, manipulativnošću i dezinhibicijom, a obrazac ponašanja je stabilan tijekom vremena. Radi se o takvom poremećaju ličnosti koji, osim što je značajan problem za oboljelog pojedinca i njegovu užu okolinu, predstavlja i važan socijalni problem. Prevalencija nije zanemariva – 2 do 4 % u općoj populaciji, a praćen je nezaposlenošću, psihičkim i somatskim komorbiditetima i niskim životnim standardom. Psihopatiju je kao dijagnozu u psihijatriju uveo Cleckley još 1941. na temelju vlastitog kliničkog iskustva, a prvi dijagnostički alat je osmislio Robert Hare u obliku ček-liste za psihopate. Danas se koristi njena revidirana verzija iz 1991. godine. Karakteristike psihopatije se dijele na dva faktora. Prvi predstavlja afektivno-interpersonalnu dimenziju koja se odnosi na šarm, grandioznost, površan afekt, patološko laganje i nedostatak empatije. Drugi faktor psihopatije je socijalno-devijantna dimenzija koja zapravo nalikuje antisocijalnom poremećaju ličnosti: parazitski i kriminalni stil života te impulzivnost. Općenito se smatra da postoji takozvani kontinuum narcističnog spektra unutar kojeg se karakteristike ličnosti od malignog narcizma, preko različitih stupnjeva antisocijalnog i psihopatskog ponašanja do punog oblika antisocijalnog poremećaja ličnosti i psihopatije, promatraju kao različiti stupnjevi jednog te istog poremećaja ličnosti. Liječenje pacijenata s ovakvim crtama ličnosti je dugotrajno, sporo i sa, do sada, skromnim napretkom. Koristi se pretežno metoda razvijanja mentalizacije kroz terapijski savez i korektivno iskustvo. Jedino što preostaje kako bi se postigao dodatni uspjeh i razumijevanje je provođenje daljnjih istraživanja, evaluacija dosadašnjeg rada i angažiranje ne samo medicine već i ostalih segmenata društva – pravosudnih tijela i socijalnih službi.Antisocial personality disorder is classified in “cluster B“. Characteristics of this personality disorder are criminally deviant behavior, egocentrism, empathy deficit, manipulative behavior, and disinhibition. These characteristic behaviors are a long-term pattern of individual's functioning. The prevalence of antisocial personality disorder is 2 to 4 %, and many comorbidities (psychic and somatic) make it very important for the patient alone, but also for the society. In 1941, based on his clinical observations, Cleckley came up with the term of psychopathy. Later, Robert Hare made the first diagnostic tool used to rate an individual's psychopatic or antisocial tendencies. Nowaday, Psyhcopathy Checklist – Revised is used for these purposes. Characteristics of psychopathy are divided in two factors. First deals with affective component of individual's character and includes charm, pathological lying, and empathy deficit. Second factor deals with behavioral component of psychopathy and includes impulsiveness and criminally deviant behavior. It is considered that antisocial personality disorder, psychopathy, and narcissism are all together a part of the Narcissistic continuum. They are considered as different presentations of very similar personality disorders which can't be strictly separated. Treatnig these patients is considered to be complicated, long-term, and with high failure rates. Up to now, the best treatment method has been encouraging the development of mentalization. To acomplish further progress in treating antisocial personality disorder and psychopathy, it is necessary to conduct more research, reassess previous work, and engage not only medicine, but also judicial institutions and social services

Access site complications following cardiac catheterization assessed by duplex ultrasonography

Access site complications are major source of morbidity following cardiac catheterization. Their incidence varies in the literature because of multiple definitions and methods of determining the presence of particular complication. The aim of this prospective study was to determine the incidence of access site complications following cardiac catheterization using arterial duplex ultrasonography. A total of 319 consecutive patients, who had cardiac catheterization underwent femoral artery duplex study 24 to 48 hours following manual hemostasis. Diagnostic angiogram had 232 (71.8%) while 87 (28.2%) had percutaneous coronary intervention (PCI). Femoral artery duplex ultrasound was normal in 247 (77.4%). Haematoma was found in 48 (15.1%), pseudoaneurysm in 17 (5.3%), AV fistula in 2 (0.6%) and dissection of the femoral artery in 5 (1.6%) patients. Baseline demografic characteristics were similar in group with normal duplex study and group with detected complication. Pseudoaneurysm and AV fistula were more commonly observed in patients following PCI than diagnostic angiogram (9.2% vs. 4.7%, p<0.001). Patients with documented complications more frequently had concomitant administration of antiplatelet and anticoagulant medication compared to the patients without complications (p=0.003). Hemodynamic disturbances (hypotension and bradycardia) during manual compression were more frequent in patients with complication (11% vs. 4.5%, p=0.047). Low threshold for use of duplex ultrasound should be exercised in patients following cardiac catheterization to establish the presence of access site complications. Special attention is needed in the setting of aggressive antiplatelet and anticoagulant therapy, interventional procedures and hemodynamic disturbances during manual hemostas

Chronic Medical Conditions in Croatian War Veterans Compared to the General Population: 25 Years after the War

Many published reports have documented an increased prevalence of chronic medical conditions among veterans, but there were only a few studies that compared these increases with the general population. The aim of this study was to determine differences in chronic medical conditions between Croatian war veterans and the general population. This study included two groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from the general population. Medical history, physical examination, laboratory tests and specific diagnostic procedures were taken during systematic physical examination in both groups. The prevalence of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis, smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary heart disease (4.3% vs. 1 %), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%), and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases among Croatian war veterans and emphasized the need of better control of their medical conditions

Izvještaj Hrvatskog registra biopsija nativnih bubrega za 2019. godinu

Background: This report describes data collected by the Croatian Registry of Renal Biopsies (CRRB) for the year 2019. Patients and methods: nine centers (82%) provided data for 255 native kidney biopsies. We assessed the anthropometric data, data on serum creatinine concentration (sCr), 24 h proteinuria, haematuria, serum albumin level, arterial hypertension, histological diagnosis, and complications after renal biopsy. Results: examined group consisted of 58% males, median age 58 y (18-80 y) and 42% women, median age 57 y (20-86 y). Males had a more impaired renal function at the time of renal biopsy, nephrotic syndrome, and hypertension. The most prevalent clinical presentation were urinary abnormalities (34.9%). Among all biopsy cases, primary glomerular diseases were the most often found histology group (41.5%), and IgA nephropathy was the most frequent diagnosis( 47.1%). Among secondary glomerular diseases, pauci-immune glomerulonephritis (PIGN) was most often found (30.9%). The highest proteinuria was observed in minimal change disease and diabetic nephropathy (DN). The highest sCR values were found in membranoproliferative glomerulonephritis (MPGN) and necrotizing vasculitis. Patients with MPGN and DN had the highest blood pressure levels. Conclusion: CRRB provides important data on the epidemiology of biopsy-proven kidney diseases from the whole territory of CroatiaUvod: izvještaj opisuje podatke Hrvatskog registra biopsija nativnih bubrega za 2019.godinu. Ispitanici i metode: poslani su podaci za 255 biopsija nativnih bubrega. Evidentirana je dob, spol, antropometrijski podaci, serumski kreatinin, 24h proteinurija, eGFR, prisutnost eritrociturije, arterijski tlak, klinička prezentacija, histološka slika i komplikacije biopsije bubrega. Rezultati: ispitivanu grupu činilo je 58% muškaraca, medijan dobi 58 g (18-80 g) i 42% žena, medijan dobi 57 g(20-86 g). Muškarci su se češće prezentirali azotemijom u času biopsije (67,5 %), nefrotskim sindromom (55,7 %) i hipertenzijom (62,5 %). Najčešće klinička prezentacija zbog koje je učinjena biopsija bubrega bio je sindrom eritrociturije i proteinurije (34,9 %). Najčešća skupina bubrežnih bolesti su bile primarne glomerulopatije (41,5 %). Među primarnim glomerularnim bolestima najučestalija je IgA nefropatija (IgAN)(47,1 %), a među sekundarnim glomerulonefritisima pauci imuni glomerulonefritis (PIGN) (30,9 %). Najvišom proteinurijom manifestirali su se od primarnih glomerularnih bolesti bolest minimalnih promjena a od sekundarnih formi dijabetička nefropatija (DN). Najvišim vrijednostima kreatinina u času biopsije manifestirali su se MPGN i PIGN. Hipertenzija je bila najviša kod MPGN i DN. Učestalost ozbiljnih komplikacija zabilježena je u 14 bolesnika (5,8 %). Zaključak: rezultati ukazuju na važne epidemiološke podatke prikupljene iz reprezentativnog broja nefroloških centara s cijelog teritorija Republike Hrvatske