PERSONALIZED PHARMACOTHERAPY IN PSYCHIATRY

The hypothesis of each individual being special and different leading to heterogenity of diseases sets the ground for the concept of personalized medicine. Personalized psychiatry follows the principles of personalized medicine. A constituent part of an individually adapted approach towards the psychiatric patient presents itself thorough personalized psychiatry. The development of pharmacogenomics and pharmacogenetics as well as the nanotechnology based on them ensures implementation of personalized medicine principles in psychiatry to a greater extent than other medical disciplines. In the field of pharmacogenomics, the greatest advance was achieved by the study of genetic variability in drug metabolism. All the predispositions are now present for the implementation of pharmacogenetic tests in routine practice. Pharmacogenetic testing for medications which are metabolised thorough two polymorph cytochromes P 450: CYP2D6 and CYP2C19 is of special significance due to their involvement in most adverse and ultrafast metabolism of psychopharmacs. The potential application of personalized medicine in psychiatry, supported by pharmacogenetics and pharmacogenomics, are: personalized medication choice, personalized dosage, anticipation of possible side-effects individually and personalized follow-up treatment with rehabilitation. The authors conclude how the development of pharmacogenomics and pharmacogenetics as well as the nanotechnology based on them, presents a step forward in creating a personalized therapeutic approach in psychiatry. However, the burden of applying the most appropriate therapeutic agent and medication tapering remains based on clinician decision. Pharmacogenetics can only help by making therapeutic decisions with one less unknown element

Correlation of the personality traits and sociodemographic factors in patients with mood disorders and suicidal behavior

Cilj ovoga istraživanja je procjena i prepoznavanje specifičnih osobina ličnosti kod suicidalnih bolesnika sa poremećajem raspoloženja (povratni depresivni poremećaj i bipolarno afektivni poremećaj) i kod nesuicidalnih bolesnika sa navedenim poremećajem raspoloženja. Ispitanici i metode: Ovo istraživanje obuhvatilo je ukupno 119 bolesnika sa dijagnozom povratnog depresivnog poremećaja - depresivna epizoda bez psihotičnih simptoma i dijagnozom bipolarno afektivnog poremećaja - depresivna epizoda bez psihotičnih simptoma, prema dijagnostičkim kriterijima MKB-10. Provođeno je od studenog 2012. godine do rujna 2015. godine na Klinici za psihijatriju pri KBC Osijek. Bolesnici su podijeljeni u dvije skupine - eksperimentalnu (suicidalni bolesnici s poremećajem raspoloženja) i kontrolnu (nesuicidalni bolesnici sa poremećajem raspoloženja). Dimenzije ličnosti, težine poremećaja i suicidalnosti su procjenjivane 1. dan (unutar 72h od prijema) i 21. dan liječenja. Procjenski intrumenti primjenjivani u obje skupine su bili: „Temperament and Character Inventory“(TCI) za procjenu dimenzija ličnosti 1. i 21.dan; „Columbia-Suicide Severity Rating Scale“(C-SSRS) u skupini suicidalnih bolesnika 1. i 21. dan; „Reason for Living Inventory“(RFL) u obje skupine 1. dan; „Hamilton Depression Rating Scale“(HAM-D) u obje skupine 1. i 21. dan, te polu-strukturirani sociodemografski upitnik. Rezultati: U skupini bolesnika sa suicidalnim idejama (neovisno o poremećaju raspoloženja), kod prijema, dobili smo značajno više vrijednosti u dimenziji temperamenta i karaktera izbjegavanje štete (HA) (Mann Whitney U Test, P<0,001), a značajno niže vrijednosti za dimenziju upornost (P) (Mann Whitney U Test, P=0,04), samo-vođenja (SD) (Mann Whitney 130 U Test; P<0,001) te kod suradnje (C) (Mann Whitney U Test, P=0,001). Kod otpusta suicidalni bolesnici zadržavaju značajno više vrijednosti u dimenziji HA (Mann Whitney U Test, P<0,001), značajno niže vrijednosti dimenzije SD (Mann Whitney U Test, P<0,001) i dimenzije C (Mann Whitney U Test, P=0,002). Navedeni rezultati potvrđeni su detaljnom analizom suicidalnih bolesnika prema nesuicidalnima u odnosu na karakteristike ličnosti i intenzitet suicidalnog ponašanja. U skupini suicidalnih bolesnika, naspram skupine nesuicidalnih, dobili smo značajno niže vrijednosti na cijelom instrumentu procjene razloga za život (RFL) (Mann Whitney U Test, P<0,001). Na našem uzorku nismo dokazali utjecaj sociodemografskih čimbenika na suicidalno ponašanje.Suicide and mood disorders represent a major global public health problem. Depressive disorder and bipolar disorder are associated with increased risk for suicide. Beside the existing disorder, underlaying personality traits may be the factor which could influence the appearance of specific mood disorder and suicidal behavior. Aim of the research: The aim of this research was to evaluate and recognize the specific personality traits in patients with mood disorders (recurrent depressive disorder and bipolar disorder) who had suicidal ideation and attempt in comparison to non-suicidal patients with respective mood disorders. Participants and Methods: Our sample consisted of 119 unrelated patients (both male and female) who were suffering form recurrent depressive disorder - depressive episode without psychotic symptoms and bipolar disorder - depressive episode without psychotic symptoms, according to ICD-10 diagnostic criteria. The research was conducted from November 2012 to September 2015 on Deparment of Psychiatry, University Hospital Centre Osijek. The patients were divided in two groups, experimental (patients with mood disorder and suicide ideation/attempt) and control group (non-suicidal patients with mood disorder). Personality traits, severity of depression and suicidal ideation were assessed on the first day (within 72h upon addmittion) and on the 21st day of treatment. The battery of instruments used for assessment was: „Temperament and Character Inventory“(TCI) for personality traits on the 1st and 21st day; „Columbia-Suicide Severity Rating Scale“(C-SSRS) in the group od suicidal patients on the 1st and 21st day; „Reason for Living Inventory“(RFL) in both groups on the 1st day; „Hamilton Depression Rating Scale“(HAM-D) in both groups on 1st and 21st day and semi-structured sociodemographic questionnaire. 132 Results: In the group of suicidal patients (regradless the mood disorder), upon admittion, we found significantly higher scores on the harm-avoidance (HA) temperament dimension (Mann Whitney U Test, P<0,001) and significantly lower scores on persistence (P) (Mann Whitney U Test, P=0,04), self-directedness (SD) (Mann Whitney U Test; P<0,001) and on cooperativeness (C) (Mann Whitney U Test; P=0,001). On the 21st day in the group of suicidal patients there were stil significantly higher scores on HA dimension (Mann Whitney U Test, P<0,001) and significantly lower scores on SD dimension (Mann Whitney U Test, P<0,001) and C dimension (Mann Whitney U Test, P=0,002). These results were confirmed with detailed analysis of the suicidal and non-suicidal group in relation to personality traits and intensity of suicidal behavior. When compared to non-suicidal group, the group of patients with suicidal attempt had significantly lower scores on the complete RFL assessment instrument (Mann Whitney U Test, P<0,001). On our sample we did not confirm the influence of sociodemographic factors on suicidal behavior. Conclusion: High score in harm-avoidance (HA) dimension with low scores in self-directedness (SD), cooperativeness (CO) and persistence (P) were present in the group of suicidal patients with mood disorders upon addmittance and discharge. We assume that the presence of these specific personality traits may determine possible future risk for suicidal behavior in the mentioned group of patients. The results on our sample, confirmed and corroborated relatively new hypothesis for existance stable (not state-dependent) personality traits which could affect individual vulnerability for development of depressive disorder and suicidal behavior

Breast cancer epidemiology in young women

Breast cancer is the most common malignancy in the population of women. Among young women, breast cancer incidence is 5-18% throughout different countries of the world. Young age for the appearance of breast cancer in woman is considered to be under 40 years of age. We wanted to research the epidemiologic data and incidence of breast cancer in a population of young women. This was a retrospective study. Data were gathered from medical documentation in the Department of Surgery of Clinical Hospital Centre Osijek. The total number of patients operated with breast cancer was (N = 1654) in period 2004-2011. Out of this number 71 (4.29 %) were < 40 years and 1583 (95.71%) were ≥ 40 years. The incidence trend in young women seems to be stable. Breast cancer incidence in the general population is increasing according to the National mammographic screening program

Pharmacotherapy of Suicidal Behaviour in Major Depression, Schizophrenia and Bipolar Disorder

The psychopathological dynamics in suicidality overcomes actual diagnostic distribution therefore pharmacotherapy has restricted role in overall prevention of suicidal behaviour among mentally ill and is demanding for clinician. This role is achieved through reduction and alleviation of suicidal risk with rational and individual pharmacotherapeutic approach emphasising effective, safe and tolerable treatment. The genetic and epigenetic factors, dysfunction of neuro- transmitter, neuroendocrine system and stress response system has been determining for neurobiology of suicidality. Therefore, pharmacotherapeutic approach should be focused, not only on prevention and reduction of suicidality, but ad- justed for general and diagnosis-specific risk factors. Suicidality represents trans-diagnostic issue, however making the correct diagnosis is of great importance. Identical group of psychiatric medications or even the same drug, could be palli- ating for suicidal behaviour in one diagnostic category and in other aggravating concerning suicidal ideations. Clini- cian should be reserved towards epidemiological studies about reducing suicidal rate due to increased consumption of antidepressants. Detailed data analysis showed there is no relevancy which antidepressants were given to specific pa- tient, in what age and phase of illness. The FDA has issued warnings about possible increased risk of suicidal behaviour in children and adolescents when given antidepressant therapy. In general, serotoninergic drugs have neutral or mildly protective effect on potential suicidal behaviour while noradrenergic drugs may have activating effect or could even worsen suicidal ideation in certain phase of the illness. When given in appropriate dose and the right time, dual or noradrenergic antidepressants, could also have good protective impact on specific patient. In patients with bipolar disor- der, antidepressive drug could be trigger for suicidal behaviour. Greater susceptibility when diagnosing bipolar disorder and broader usage of mood stablizing medications, alone or combined with other psychopharmacotherapy, has the sig- nificant role in suppression and elimination of suicidal behaviour. The lithium and sodium valproate are found to be particularly suitable for prevention and elimination of suicidal behaviour along with some other mood stabilizers. Phar- macohterapy of suicidality in patients with schizophrenia represents specific problem. Confirmed drug with anti-suici- dal effect, clozapine, is not first choice medication and does not represent general solution for suicidality in schizophrenia. For clinician, the pharmacotherapy of suicidal behaviour consists of skilled individual and rational drug administration accompanied with appropriate psychotherapeutic support

Depression in patients with psoriasis

Depresija je česti psihički poremećaj kod oboljelih od psorijaze. Komorbiditet depresije i psorijaze iznosi do 30% i viši je od učestalosti među pacijentima u ambulantama opće prakse, gdje iznosi 22%. Autori su si postavili za cilj potvrditi povezanost u obilježjima oboljelih od depresije i psorijaze temeljem pregleda recentne literature dostupne u elektronskim bazama podataka. Rezultati pretraživanja su pokazali kako i oboljeli od depresije i oboljeli od psorijaze imaju promijenjene pokazatelje imunološkog odgovora i povišene pokazatelje sistemske upale. Autori zaključuju kako prisutnost upalnih promjena kod ovih poremećaja govori da su upalni procesi ključni za razvoj barem dijela depresivnih poremećaja i psorijaze. Zato farmakoterapijski pristup u kombiniranom liječenju psorijaze s pridruženom depresijom treba temeljiti na suvremenim spoznajama o uključenosti hipotalamično-hipofizno-adrenalne osi, proinflamatomih posrednika imunološkog odgovora (IL-1, IL-6, TNF-") i proteina akutne faze upale (C-reaktivni protein) u patogenezu oba poremećaja. Ključ terapijskog uspjeha je u timskom pristupu takvom bolesniku pod okriljem konzultativno-suradne (liaison) psihijatrije koja pruža okvir za učinkovitu suradnju dermatologa i psihijatra.Depression is a frequent psychiatric disorder in patients suffering from psoriasis. The depression and psoriasis comorbidity amounts up to 30 % and is higher than among patients in outpatient clinics of general practice, where it amounts to 22%. Authors have set a goal to prove a connection between characteristics of patients suffering from the depression and psoriasis, based on the latest literature, accessible through electronic data bases. Research results showed that patients suffering from depression and patients suffering from psoriasis have altered indicators of immunological response and higher indicators of systemic inflammation. Authors conclude that the presence ot inflammatory changes in these disorders shows that inflammatory processes are pivotal for the development of at least a part of depressive disorders and psoriasis. This is why pharmacotherapeutic approach in a combine treatment of psoriasis with a joint depression should be based on modem ideas about inclusion of hypothalamic-hypophyseal-adrenal axis, proinflammatory mediators of immunological response (IL-1, IL-6, TNF-") and acute inflammation phase proteins (C-reactive protein) into pathogenesis of both disorders. The key for successful treatment lies in team approach to such patient under the scope of liaison psychiatry, which provides a frame for successful cooperation between a dermatologist and a psychiatrist

Rak dojke u mladih žena: patološka i imunohistokemijska obilježja

A young woman with breast cancer is considered to be a woman younger than 40. According to the literature, breast cancer in the population of young women usually is of a higher histologic grade, unfavorable hormonal status, and overall higher mortality rate when compared with breast cancer occurring in older population. We compared pathologic and immunohistochemical features of breast carcinoma in women under 40 years of age with the respective features in women over 60 years of age. The following parameters were observed in these two groups: tumor size, lymph node status, histologic grade, hormonal receptor status, Ki-67 prognostic index, Her2/neu status, and histologic type of the tumor. Early onset breast carcinoma was found to have a higher frequency of tumor grade 3 (29% vs. 17%) and estrogen receptor negativity (45% vs. 23%). In the group of young women, breast carcinoma was mostly multicentric (23% vs. 5%), triple-negative (32% vs. 10%), and was found to have higher proliferation index Ki-67 (25% vs. 10%). Our results confirmed differences between the young and older groups of patients. In the group of young women, we found predominantly unfavorable prognostic parameters of the disease.Mladom ženom s rakom dojke smatra se žena mlađa od 40 godina. Prema literaturi rak dojke u populaciji mladih žena ima obično viši histološki stupanj i nepovoljan hormonski status. Puno je veći postotak smrtnosti u mladoj populaciji nego kada se karcinom javlja u starijoj životnoj dobi. Usporedili smo patološka i imunohistokemijska obilježja karcinoma dojke kod žena ispod 40 godina s odgovarajućim obilježjima među ženama iznad 60 godina. Sljedeći parametri su promatrani kod ove dvije skupine: veličina tumora, stanje limfnih čvorova, histološki gradus, status hormonskih receptora, prognostički indeks Ki-67, status Her2/neu i histološki tip tumora. Za karcinom dojke kod mladih žena utvrđeno je da ima veću učestalost tumora histološkog gradusa 3 (29% prema 17%) i negativnog statusa estrogenskih receptora (45% prema 23%). U skupini mladih žena rak dojke je uglavnom multicentričan (23% prema 5%), trostruko negativan (32% prema 10%) i ustanovljeno je da ima veći proliferacijski indeks Ki-67 (25% prema 10%). Naši rezultati potvrđuju razlike između mlade i starije skupine bolesnica. U skupini mladih žena utvrđeni su pretežito nepovoljni prognostički parametri bolesti