PRESCRIBING PATTERNS IN ADOLESCENT PSYCHIATRIC PRACTICE: AN IMPORTANT ROLE OF ANTIPSYCHOTICS

Background: Many adolescents affected by psychiatric disorders require pharmacological treatment. Knowing which medication is being used is of utmost importance. Our main objective was to gain insight into prescribing patterns at the Department of child and adolescent psychiatry, Clinical Hospital Centre Rijeka. In addition, we looked for potential differences between adolescents regarding their pharmacotherapy status. Subjects and methods: The data from medical charts of 227 adolescents (55% females), age 12-18 years (16.4±1.18) were analysed. All of them were treated as outpatients during one year period (2014/15). Medical charts were obtained from the computerized archive system of Clinical Hospital Centre. Prescribed drug patterns were taken into account if patients have been taking medication for at least one month. Results: Most of the patients, 162 (71.4%), were treated with psychiatric medication. In the pharmacologically treated group, adolescents were older (t=-4.678; p<0.001), predominately male (χ2=5.175, p=0.023) and hospitalized (χ2=20.612, p<0.0001). Accordingly, male (OR=2.09, P<0.05) and hospitalized (OR=15.32, P<0.001) adolescents were more disposed to be medicated. Psychotic disorder was the most commonly diagnosed disorder (51 patients). There were 454 different prescribing patterns, mostly prescribed antipsychotics, 36.6% of all prescriptions; followed by 31.5% anxiolytics’ and 23.7% antidepressants’ prescriptions. However, number of patients receiving antipsychotics, anxiolytics and antidepressants was quite similar (103: 110: 99). The highest number of patients was treated with sertraline (58), followed by those treated with risperidone (48). Majority of the patients (104/227) were treated with polytherapy. Conclusion: Prescribing psychiatric pharmacotherapy for adolescents is a common clinical practice. Adolescents that were prescribed pharmacotherapy were significantly older; hospitalized and male adolescents were more prone to be medicated. Antipsychotics were most frequently prescribed drugs. The prescribing patterns are generally consistent with international trends and guidelines; however caution regarding high proportion of polytherapy is necessary

PREGNANCY AND ATYPICAL ANTIPSYCHOTICS

Scientific research aiming at discovering new generations of effective medications is a common practice in medicine, and psychiatric research is no exception. Antipsychotics are used to treat chronic mental illnesses such as schizophrenia. The new generation of antipsychotics (atypicals) gradually reveal their advantages in comparison to the older generation of antipsychotics (conventional, typicals) and are increasingly applied to the everyday practice. Although there are no differences in the therapeutic effectiveness between the two groups mentioned, atypical antipsychotics have become the drugs of choice. A certain number of women in their reproductive age suffer from schizophrenia and other mental illnesses which demand antipsychotic treatment. Atypical antipsychotics have been available on the market since the mid 90’s so the experience in the application of these medicaments in treating pregnant women is relatively modest. This study will present our own experience in the treatment of a pregnant woman suffering from schizophrenia, who was treated with ziprasidone for the duration of her pregnancy. The psychotic symptoms remained in remission throughout the whole pregnancy period, during labour and after the birth. The pregnancy course remained normal all through to the birth, which was carried out naturally and normally. A healthy baby was born within the term expected

PREGNANCY AND ATYPICAL ANTIPSYCHOTICS

Scientific research aiming at discovering new generations of effective medications is a common practice in medicine, and psychiatric research is no exception. Antipsychotics are used to treat chronic mental illnesses such as schizophrenia. The new generation of antipsychotics (atypicals) gradually reveal their advantages in comparison to the older generation of antipsychotics (conventional, typicals) and are increasingly applied to the everyday practice. Although there are no differences in the therapeutic effectiveness between the two groups mentioned, atypical antipsychotics have become the drugs of choice. A certain number of women in their reproductive age suffer from schizophrenia and other mental illnesses which demand antipsychotic treatment. Atypical antipsychotics have been available on the market since the mid 90’s so the experience in the application of these medicaments in treating pregnant women is relatively modest. This study will present our own experience in the treatment of a pregnant woman suffering from schizophrenia, who was treated with ziprasidone for the duration of her pregnancy. The psychotic symptoms remained in remission throughout the whole pregnancy period, during labour and after the birth. The pregnancy course remained normal all through to the birth, which was carried out naturally and normally. A healthy baby was born within the term expected

HIGH DOSES ALPRAZOLAM INDUCED AMENORRHOEA AND GALACTORRHOEA

Alprazolam belongs in the group of anxiolytics, medicaments used for reducing anxiety. As most other drugs, it can cause various adverse events, including hormonal disturbances and imbalance. Prolactin elevation is one such hormonal adverse event that can lead to galactorrhoea, or abnormal milk discharge from the breast and amenorrhoea. In this case report we will present the case of a female patient that developed galactorrhoea while treated with alprazolam, after all physical factors that can also cause these symptoms were excluded

ZIPRASIDONE AS A POSSIBLE CAUSE OF CLEFT PALATE IN A NEWBORN

Use of antipsychotic medication during the entire course of pregnancy in patients suffering from schizophrenia is frequently necessary as discontinuation of therapy can lead to relapse of the illness which can be far more severe for the mother, but also for the fetus. That is the case why third generation antipsychotics, so called atypical antipsychotics, are also being used during the pregnancy, but their effects are not fully researched. Use of ziprasidone as a third generation antipsychotic, and its effects during the pregnancy in patients suffering from various mental illnesses is very rarely described in scientific literature. There is even fewer information regarding eventual adverse events of ziprasidone in newborn babies of mothers that have been treated with ziprasidone during the entire course of pregnancy. This paper will be based around a case report of a female patient suffering from schizophrenia who has been treated with ziprasidone during the entire course of her pregnancy and whose newborn baby was diagnosed with a cleft palate (palatoschisis) at the time of birth

PSYCHODYNAMIC GROUP PSYCHOTHERAPY IN THE TREATMENT OF BORDERLINE PERSONALITY DISORDER

Granični poremećaj osobnosti karakteriziran je pervazivnim simptomima nestabilnosti u međuljudskim odnosima, self-imageu i afektu, uz impulzivnost i znatne probleme s identitetom. Socijalno ponašanje tih bolesnika nestabilno je, kaotično i kontradiktorno. Liječenje graničnog poremećaja osobnosti predstavlja terapijski izazov budući da navedena obilježja osobnosti tih bolesnika znatno utječu na odnos prema psihoterapeutu kao i na odnose u grupnom settingu. U vrijeme kada su postavljeni dijagnostički kriteriji za granični poremećaj smatralo se da je riječ o poremećaju koji je neizlječiv. U međuvremenu je došlo do promjene u konceptu, stajalištima i psihoterapijskom pristupu. Istraživanja evaluacije psihoterapijskih postupaka za taj poremećaj dokazala su učinkovitost mnogih od njih. Među njima je i grupna psihodinamička psihoterapija. U odnosu na klasični psihoanalitički pristup u radu s tim bolesnicima danas se preferira veći angažman psihoterapeuta, ohrabrivanje, validacija i savjetovanje, tj. potiče se intersubjektivnost i enactment, osobito na početku liječenja kad je anksioznost preplavljujuća i postoji opasnost od preranog prekida terapije. Nakon što se postigne kohezija u grupi i razvije grupni matriks dolaze u obzir ekspresivne ili interpretativne intervencije. Budući da je riječ o bolesnicima koji psihoterapeuta ne ostavljaju indiferentnim te mogu pobuditi snažne kontratransferne odgovore, potrebna je redovita supervizija. Cilj ovog rada jest teoretsko razmatranje i razumijevanje uloge grupne psihodinamičke psihoterapije u liječenju graničnog poremećaja osobnosti.Borderline personality disorder (BPD) is characterized by pervasive symptoms of instability in interpersonal relations, self-image, and affect, accompanied by impulsive behavior and major identity issues. Social behavior of such patients is unstable, chaotic, and contradictory. The treatment of BPD is a challenge from the therapeutic point of view since the patient personality traits mentioned above affect the relationship with both the psychotherapist and the group, if treated in such setting. At the time when the diagnostic criteria were being set, BPD was considered to be an incurable disorder. In the meantime, there have been changes made to the concept of BPD, to the attitudes toward it, as well as to the therapeutic approach. Evaluations of psychotherapeutic methods showed that many were effective, including group psychodynamic psychotherapy, for BPD treatment. In contrast to the classical psychoanalytic approach, greater psychotherapist involvement is advised, as well as encouragement, validation, and counseling. The BPD patients are being motivated to use intersubjectivity and enactment, especially in the initial sessions when anxiety can be overwhelming and there is a risk of premature termination of the therapy. After the group cohesion has been achieved and the group matrix developed, expressive or interpretative interventions can be employed. Due to the risk of strong countertransference, regular supervision must be practiced. The aim of this paper is to present some theoretical considerations and deepen the understanding of the role of psychodynamic group psychotherapy in the treatment of BPD patients

Prekomjerno zijevanje uzrokovano Sertralinom

Background: Even though there is a growing interest in the neurophysiology of yawning, it still remains somewhat of a scientific mystery due to the fact that we still do not know the exact mechanisms behind it. Apart from physiological yawning, abnormal and excessive yawning has been observed in numerous pathologies, mostly in neurological and psychiatric disorders, as well as side effects of various medicaments. Subject: We will present the case of a 42 year old woman who developed excessive yawning as a side effect of treatment with sertraline. Discussion: Although we still do not know the exact mechanism behind yawning, several neurotransmitters and neuropeptides are thought to be involved in the neurophysiology of yawning, especially serotonin and dopamine. Subsequently, excessive yawning has been observed in some patients treated with the majority of novel serotonergic antidepressants. Conclusion: Excessive yawning requires the same clinical attention as other side effects of antidepressant treatment and therefore should be carefully considered and managed. Intolerance to antidepressant treatment is a significant cause of treatment failure and that is why psychiatrists should keep in mind that sertraline could cause such a disabling side effect as excessive yawning.Pozadina: Iako postoji sve veći znanstveni interes za istraživanjem neurofiziologije zijevanja, ono i dalje predstavlja znanstvenu zagonetku jer je točan mehanizam nastanka još uvijek nepoznat. Abnormalno i prekomjerno zijevanje se javlja u brojnih bolesti i poremećaja, no posebice u psihijatrijskih i neuroloških poremećaja, te kao nuspojava raznih medikamenata. Ispitanici: Prikazat ćemo slučaj četrdesetdvogodišnje žene kod koje je došlo do razvoja prekomjernog zijevanja kao nuspojave liječenja sertralinom. Rasprava: Iako su točni mehanizmi nastanka zijevanja još uvijek nepoznati, za nekoliko neurotransmitera i neuropeptida se smatra da igraju važnu ulogu u neurofiziologiji zijevanja, posebice monoamini serotonin i dopamin. U skladu s time, prekomjerno zijevanje je zabilježeno kao nuspojava u određenom broju bolesnika liječenih većinom novijih serotonergički aktivnih antidepresiva. Zaključak: Sam fenomen zijevanja, a posebice zijevanje kao posljedica nuspojave liječenja antidepresivima, treba dobiti na značenju kao i druge nuspojave, te može biti predmetom proučavanja kako patofiziologije bolesti, tako i djelovanja drugih lijekova u ljudi

Virus Etiology of Schizophrenia: The Characteristics of the »Little Ice Age« and its Consequences

The data of the »Little Ice Age« (1500–1850) in Croatia and those which applied to human health were especially emphasized were analyzed. They are some which stand out like: importance of the sort of soil and relief, the infl uence of cutting down of woods and cattle-breeding and especially the war which lasted for 250 years in the territory of Croatia. The important interactions between those parameters were defi ned. The important correlations were also defi ned between freezing and long winters as well as wet springs and summers which caused starvation, malnutrition and the increase of infant mortality and also epidemics with enormous psychological stress among people in that period. The result was witch-hunting and burning (which was also advocated in the other parts of Europe) and they sometimes reached the levels of madness. Considering that such events were unknown in the earlier periods (in such proportions) and that (even today) the infl uence of the slow virus is emphasized in connection to the etiology of schizophrenia so why should’t it be supposed that the »Litlle Ace Age» could be the cause of the larger prevalence of schizophrenia in the teritory of Croatia

Defense Mechanisms in Alcohol Dependent Patients with Oral and Oropharinegal Cancer

The effects of psychological factors in alcoholics with malignant tumor of the oral cavity and oropharynx are scarcely explored. The aim of the research was to examine early family relations and investigate differences in the use of defense mechanisms in alcohol dependent patients suffering from malignant tumor of the oral cavity and oropharynx compared to alcohol dependent persons without malignant tumors and healthy controls. The research included 51 alcohol dependent patients treated for malignant tumor of the oral cavity and oropharynx at the University Hospital Center Rijeka from 2005 to 2009. The control groups corresponded to the experimental group in age, sex and education level. The research used a general demographic questionnaire, the Mini International Neuropsychiatric Interview and the Revised Questionnaire of Life Style and Defense Mechanisms. The research groups showed significant differences in difficult childhood (p<0.001) including abuse (p=0.004). The alcohol dependent persons suffering from malignant tumors of the oral cavity and oropharynx significantly less frequently used primitive defense mechanisms of regression (p=0.004) and displacement (p=0.013) compared to alcoholics without malignant tumors who significantly more often used neurotic defense mechanisms – compensation (p=0.005) and intellectualization (p<0.001). The earliest emotional experiences and quality of family relations affect the development of defense mechanisms. These are the psychological factors in the development of oropharyngeal cancer in alcohol addicts

Changes of Adolescents\u27 Defence Mechanisms during the First Year of High School Education

The goal of this study was to analyse the defence mechanisms\u27s changes during adolescent_s adaptation to the new schooling terms at the first year in high school. Sample of 266 students, mean age 15, have been included in the research. Kellerman_s Life Style Questionnaire (LSQ) was administred for measuring defence mechanisms at the beginning and at the end of the scool year. Results show that regression and reactive formation are changing at most; regression raises (p<0.005) while reactive formation decreases (p<0.000). Boys used repression, while girls reactive formation more frequently in both measuring. Displacement was »male» defence in the first measuring; but at repeated measuring this difference in sex vanished.The sources of anxiety can be found partly in new school environment and in adolescent_s effort to »solve the problem» with sexual impulses and aggression using different sets of defences