Psychiatric Clinic Historic overview and projections for future

Psychiatric approach should be based on themodel of biological psychiatry andmodified therapeutic community, with fast and precise diagnostics, taking care of acute psychiatric patients in the frame of intensive monitoring, using the modern psychopharmacological and other medicamental therapy and all forms of individual, group and family psychotherapy. The activities and development of the out-patient Clinic and Day-hospital, with short-term hospital treatment should also be intensified, as well as the collaboration with teams of primary health care

Psihološki i psihijatrijski čimbenici temporomandibularnog poremećaja

Temporomandibular disorders (TMD) is an umbrella term covering a series of pathologic conditions which can have similar signs and symptoms and which lead to an imbalance in the normal functioning of stomatognatic system. Temporomandibular disorders are defined as a group of orofacial disorders with pain in the preauricular area, jaw joints (TMJ) or masticating muscles with limitations in range and deviations of lower jaw’s movement as well as TMJ sounds during mastication. When the pathophysiologic factor is known, the pain is conventionally classified as “specific” and when it is unknown it is called “nonspecific”, psychogenic, idiopathic, conversive or euphemistic atypical pain. Nonspecific pain of the TMD is very often a symptom of a psychiatric disorder, for example depression with somatic symptoms, hypochondria, psychosis or is classified in the group of somatoform psychiatric disorders according to contemporary classification systems, e.g. the American Psychiatric Association’s DSM-IV (7) and the International Classification of Diseases (ICD-10). TMD affects 12% of overall population. Psychological-psychiatric problems prevail among patients with TMD, anxious-depressive disorder is found in 50%, while depression in 32.1% of patients. Patients with psychiatric problems are 4.5 times more prone to TMD than individuals without psychiatric problems and vice versa. TMD is connected with numerous etiologic factors, which renders early and precise diagnosis as well as efficient therapy more difficult. Five main factors are usually listed as connected to TMD: trauma, occlusion, habits (parafunctional activities, such as chewing a piece of gum, chewing on one side, teeth clenching, bruxism), deep pain stimulus, psychological problems connected with emotional stress, and psychiatric disorders. Psychological and psychiatric factors of TMD are the focus of this paper. Treating nonspecific, psychogenic pain disorders is not possible without a holistic, integrative, interdisciplinary team approach of psychiatrists, psychologists, physiologists, neurologists and sometimes even neurosurgeons. Cognitive-behavioral psychotherapy is prevalent as well as techniques of alleviating anxiety and stress (autogenic training), physiologic therapy, EMG biofeedback methods and psychopharmacotherapy.Temporomandibularni poremećaj (TMP) skupni je naziv za niz patoloških stanja koja mogu imati slične znakove i simptome, a dovode do poremećaja normalne funkcije stomatognatog sustava. Temporomandibularni poremećaji definiraju se kao skupina orofacijalnih poremećaja s boli u preaurikularnom području, čeljusnim zglobovima (TMZ) ili žvačnim mišićima s ograničenjima u rasponu i devijacijama kretnji donje čeljusti te zvukovima TMZ-ova tijekom žvakanja. Kada je poznat patofiziološki uzročni čimbenik TMP-a s boli, konvencionalno se klasificira kao “specifičan”, a kada patofiziološki uzročni čimbenik nije poznat, kao “nespecifičan”, psihogen, idiopatski, konverzivan ili eufemistički atipičan. Nespecifična bol pri TMP-u često je simptom nekog psihijatrijskog poremećaja kao što je depresija sa somatskim simptomima, hipohondrija, psihoza ili se pak svrstava u skupinu somatoformnih psihijatrijskih poremećaja prema suvremenim klasifikacijskim sustavima kao što su Dijagnostički i statistički priručnik (DSM-IV) američkog psihijatrijskog društva i Međunarodna klasifikacija bolesti i srodnih zdravstvenih problema MKB-10. TMP zahvaća 12% cjelokupne populacije. Psihološko-psihijatrijski problemi prevladavaju među bolesnicima s TMP-om, anksiozno-depresivni poremećaj pronađen je u 50%, a depresija u 32.1% bolesnika. Pacijenti sa psihijatrijskim problemima skloniji su 4.5 puta TMP-u nego osobe bez psihičkih problema i obrnuto. TMP je povezan s brojnim etiološkim čimbenicima, što otežava ranu i preciznu dijagnostiku i učinkovitu terapiju. Obično se navodi pet glavnih čimbenika povezanih s TMP-om: trauma, okluzija, navike (parafunkcijske aktivnosti, kao što su žvakanje žvakaće gume, žvakanje na jednu stranu, stiskanje zubi, bruksizam), duboki bolni podražaj, psihološki problemi povezani s emocionalnim stresom i psihijatrijski poremećaji. U ovom radu pozornost je usmjerena na psihološke i psihijatrijske čimbenike TMP-a. Liječenje nespecifičnih, psihogenih bolnih poremećaja TMZ-a nije moguće bez holističkog, integrativnog, interdisciplinarnog, timskog pristupa psihijatra, psihologa, fizijatra, neurologa, a ponekad i neurokirurga. Prevladava kognitivno-bihevioralna psihoterapija, tehnike ublažavanja anksioznosti i stresa (autogeni trening), fizikalna terapija, EMG biofeedback metode i psihofarmakoterapija

Psychiatric Clinic Historic overview and projections for future

Psychiatric approach should be based on themodel of biological psychiatry andmodified therapeutic community, with fast and precise diagnostics, taking care of acute psychiatric patients in the frame of intensive monitoring, using the modern psychopharmacological and other medicamental therapy and all forms of individual, group and family psychotherapy. The activities and development of the out-patient Clinic and Day-hospital, with short-term hospital treatment should also be intensified, as well as the collaboration with teams of primary health care

Psihološki i psihijatrijski čimbenici kronične boli

Chronic pain syndrome is a major health and socioeconomic problem that is manifested by frequent asking of medical assistance, high price of health care, sick leave, work inability and disability as well as frequent compensation requests. Generally speaking, pain, especially chronic pain, significantly diminishes the patient and their family’s quality of life. Most people experience one or more pain disorders during their life. Chronic pain prevalence accounts for 15 to 22% in population. It occurs more frequently in women, in older age and persons of decreased socioeconomic status. Chronic pain can be causally linked to comorbid psychiatric disorders, such as fear of physical illness, constant worry, anxious disorders, depression and reaction to stress. Every pain, especially chronic, has psychological characteristics as well which are expressed to an extent. When the pathophysiologic factor is known, the pain is conventionally classified as “specific” and when it is unknown it is called “nonspecific”, psychogenic, idiopathic, conversive or euphemistic atypical pain. Nonspecific pain is very often a symptom of a psychiatric disorder or it is classified in the group of somatoform psychiatric disorders according to contemporary classification systems, e.g. the American Psychiatric Association’s DSM-IV and the International Classification of Diseases (ICD-10). Psychosomatic medicine studies the connection of psychological conditions and psychiatric disorders, psychosocial stress, family and occupational factors with somatic disorders. On the other hand, a painful somatic illness can cause anxiety, depression, social phobia and isolation. Treating nonspecific psychogenic pain disorder is not possible without a holistic, integrative, interdisciplinary team approach of psychiatrists, psychologists, physiologists, neurologists and sometimes even neurosurgeons. Cognitive-behavioral psychotherapy is prevalent as well as techniques of alleviating anxiety and stress (autogenic training), physiologic therapy, EMG biofeedback methods and psychopharmacotherapy.Kronični bolni sindrom je veliki zdravstveni i socioekonomski problem koji se očituje čestim traženjem liječničke pomoći, visokom cijenom zdravstvene skrbi, bolovanjem, radnom nesposobnošću i invaliditetom te čestim odštetnim zahtjevima. Bol općenito, a poglavito kronična bol značajno smanjuje kvalitetu života bolesnika i njegove obitelji. Većina ljudi iskusi jedan ili više bolnih poremećaja tijekom svog života. Prevalencija kronične boli u pučanstvu je 15 do 22%. Puno češće se javlja u žena, u starijoj dobi i u osoba slabijeg socioekonomskog statusa. Kronična bol se uzročno-posljedično povezuje sa komorbidnim psihijatrijskim poremećajima kao što su strah od tjelesne bolesti, stalna zabrinutost, anksiozni poremećaji, depresija, reakcija na stres. Svaka bol, a pogotovo kronična bol ima više ili manje izražene i psihološke osobine. Kada je poznat pato-fiziološki uzročni čimbenik bol se konvencionalno klasificira kao «specifična», a kada nije poznat patofiziološki uzročni čimbenik kao «nespecifična», psihogena, idiopatska, konverzivna ili eufemistički atipična bol. Nespecifična bol često je simptom nekog psihijatrijskog poremećaja ili se svrstava u skupinu somatoformnih psihijatrijskih poremećaja prema suvremenim klasifikacijskim sustavima kao što su Dijagnostički i statistički priručnik (DSM-IV) Američkog psihijatrijskog društva i Međunarodna klasifikacija bolesti i srodnih zdravstvenih problema MKB- 10. Psihosomatska medicina bavi se proučavanjem povezanosti psiholoških stanja i psihičkih poremećaja, psihosocijalnog stresa, obiteljskih i radno-okupacionih čimbenika sa somatskim poremećajima. Ponekad se bol javlja kao simptom hipohondrije, depresije ili psihotičnog poremećaja. S druge strane bolna somatska bolest može prouzročiti anksioznost, depresivnost, socijalnu fobiju i izoliranost. Liječenje nespecifičnog, psihogenog bolnog poremećaja nije moguće bez holističkog, integrativnog, interdisciplinarnog, timskog pristupa psihijatra, psihologa, fizijatra, neurologa, a ponekad i neurokirurga. Prevladava kognitivno-bihevioralna psihoterapija, tehnike ublažavanja anksioznosti i stresa (autogeni trening), fizikalna terapija, EMG biofidbek metode i psihofarmakoterapija

Psihološki i psihijatrijski čimbenici kronične boli

Chronic pain syndrome is a major health and socioeconomic problem that is manifested by frequent asking of medical assistance, high price of health care, sick leave, work inability and disability as well as frequent compensation requests. Generally speaking, pain, especially chronic pain, significantly diminishes the patient and their family’s quality of life. Most people experience one or more pain disorders during their life. Chronic pain prevalence accounts for 15 to 22% in population. It occurs more frequently in women, in older age and persons of decreased socioeconomic status. Chronic pain can be causally linked to comorbid psychiatric disorders, such as fear of physical illness, constant worry, anxious disorders, depression and reaction to stress. Every pain, especially chronic, has psychological characteristics as well which are expressed to an extent. When the pathophysiologic factor is known, the pain is conventionally classified as “specific” and when it is unknown it is called “nonspecific”, psychogenic, idiopathic, conversive or euphemistic atypical pain. Nonspecific pain is very often a symptom of a psychiatric disorder or it is classified in the group of somatoform psychiatric disorders according to contemporary classification systems, e.g. the American Psychiatric Association’s DSM-IV and the International Classification of Diseases (ICD-10). Psychosomatic medicine studies the connection of psychological conditions and psychiatric disorders, psychosocial stress, family and occupational factors with somatic disorders. On the other hand, a painful somatic illness can cause anxiety, depression, social phobia and isolation. Treating nonspecific psychogenic pain disorder is not possible without a holistic, integrative, interdisciplinary team approach of psychiatrists, psychologists, physiologists, neurologists and sometimes even neurosurgeons. Cognitive-behavioral psychotherapy is prevalent as well as techniques of alleviating anxiety and stress (autogenic training), physiologic therapy, EMG biofeedback methods and psychopharmacotherapy.Kronični bolni sindrom je veliki zdravstveni i socioekonomski problem koji se očituje čestim traženjem liječničke pomoći, visokom cijenom zdravstvene skrbi, bolovanjem, radnom nesposobnošću i invaliditetom te čestim odštetnim zahtjevima. Bol općenito, a poglavito kronična bol značajno smanjuje kvalitetu života bolesnika i njegove obitelji. Većina ljudi iskusi jedan ili više bolnih poremećaja tijekom svog života. Prevalencija kronične boli u pučanstvu je 15 do 22%. Puno češće se javlja u žena, u starijoj dobi i u osoba slabijeg socioekonomskog statusa. Kronična bol se uzročno-posljedično povezuje sa komorbidnim psihijatrijskim poremećajima kao što su strah od tjelesne bolesti, stalna zabrinutost, anksiozni poremećaji, depresija, reakcija na stres. Svaka bol, a pogotovo kronična bol ima više ili manje izražene i psihološke osobine. Kada je poznat pato-fiziološki uzročni čimbenik bol se konvencionalno klasificira kao «specifična», a kada nije poznat patofiziološki uzročni čimbenik kao «nespecifična», psihogena, idiopatska, konverzivna ili eufemistički atipična bol. Nespecifična bol često je simptom nekog psihijatrijskog poremećaja ili se svrstava u skupinu somatoformnih psihijatrijskih poremećaja prema suvremenim klasifikacijskim sustavima kao što su Dijagnostički i statistički priručnik (DSM-IV) Američkog psihijatrijskog društva i Međunarodna klasifikacija bolesti i srodnih zdravstvenih problema MKB- 10. Psihosomatska medicina bavi se proučavanjem povezanosti psiholoških stanja i psihičkih poremećaja, psihosocijalnog stresa, obiteljskih i radno-okupacionih čimbenika sa somatskim poremećajima. Ponekad se bol javlja kao simptom hipohondrije, depresije ili psihotičnog poremećaja. S druge strane bolna somatska bolest može prouzročiti anksioznost, depresivnost, socijalnu fobiju i izoliranost. Liječenje nespecifičnog, psihogenog bolnog poremećaja nije moguće bez holističkog, integrativnog, interdisciplinarnog, timskog pristupa psihijatra, psihologa, fizijatra, neurologa, a ponekad i neurokirurga. Prevladava kognitivno-bihevioralna psihoterapija, tehnike ublažavanja anksioznosti i stresa (autogeni trening), fizikalna terapija, EMG biofidbek metode i psihofarmakoterapija

Psihološko-psihijatrijski čimbenici kronične vrtoglavice

Investigations demonstrated a correlation between oto-neurological illnesses manifested subjectively by instability and dizziness and anxiety and other psychiatric disorders. The concept of chronic vertigo offered a systematic approach to patients with a lasting dizziness not caused by an evident patophysiological vestibular damage. According to newer neurobiological investigations, there are three subtypes of chronic dizziness: otogenic, psychogenic and interactive. Nowadays there is a greater diagnostic accuracy and insight into the basic pathophysiological processes of the vestibular migraene, post-concussional syndrom and dysautonomias that can cause chronic dizziness. Selective serotonin reuptake inhibitors, rehabilitation therapy for restoring the balance, and cognitive- behavioural therapy can be effective in treatment, but this effectiveness is limited.Istraživanja su pokazala da postoji povezanost između nekoliko neuro-otoloških kliničkih stanja koja se javljaju subjektivnim osjećajem nestabilnosti i vrtoglavice uz anksioznost i druge psihijatrijske simptome. Pojam kronične subjektivne vrtoglavice ponudio je sustavni pristup bolesnicima sa ustrajnom vrtoglavicom koja nije uzrokovana očitim patofiziološkim vestibularnim oštećenjem. Sukladno sa novim neurobiološkim istraživanjima postoje tri podtipa kronične subjektivne vrtoglavice (otogeni, psihogeni, interaktivni) koje čine fizički i psihološki simptomi. Danas postoji veća dijagnostička točnost i uvid u temeljne patofiziološke procese vestibularne migrene, postkontuzijskog sindroma mozga i distonije autonomnog živčanog sustava, koji mogu prouzročiti simptome nalik kroničnoj subjektivnoj vrtoglavici. Selektivni inhibitori ponovne pohrane serotonina-SIPPSa, rehabilitacijska terapija ravnoteže i kognitivno-bihevioralna terapija pokazuju ograničenu, ali korisnu učinkovitost u liječenju kronične subjektivne vrtoglavice

Psihološko-psihijatrijski čimbenici kronične vrtoglavice

Investigations demonstrated a correlation between oto-neurological illnesses manifested subjectively by instability and dizziness and anxiety and other psychiatric disorders. The concept of chronic vertigo offered a systematic approach to patients with a lasting dizziness not caused by an evident patophysiological vestibular damage. According to newer neurobiological investigations, there are three subtypes of chronic dizziness: otogenic, psychogenic and interactive. Nowadays there is a greater diagnostic accuracy and insight into the basic pathophysiological processes of the vestibular migraene, post-concussional syndrom and dysautonomias that can cause chronic dizziness. Selective serotonin reuptake inhibitors, rehabilitation therapy for restoring the balance, and cognitive- behavioural therapy can be effective in treatment, but this effectiveness is limited.Istraživanja su pokazala da postoji povezanost između nekoliko neuro-otoloških kliničkih stanja koja se javljaju subjektivnim osjećajem nestabilnosti i vrtoglavice uz anksioznost i druge psihijatrijske simptome. Pojam kronične subjektivne vrtoglavice ponudio je sustavni pristup bolesnicima sa ustrajnom vrtoglavicom koja nije uzrokovana očitim patofiziološkim vestibularnim oštećenjem. Sukladno sa novim neurobiološkim istraživanjima postoje tri podtipa kronične subjektivne vrtoglavice (otogeni, psihogeni, interaktivni) koje čine fizički i psihološki simptomi. Danas postoji veća dijagnostička točnost i uvid u temeljne patofiziološke procese vestibularne migrene, postkontuzijskog sindroma mozga i distonije autonomnog živčanog sustava, koji mogu prouzročiti simptome nalik kroničnoj subjektivnoj vrtoglavici. Selektivni inhibitori ponovne pohrane serotonina-SIPPSa, rehabilitacijska terapija ravnoteže i kognitivno-bihevioralna terapija pokazuju ograničenu, ali korisnu učinkovitost u liječenju kronične subjektivne vrtoglavice

Povezanost upalnih biljega, antidepresiva i depresije

The aim of this study was to explore the role of inflammatory markers in the occurrence of depression. The concentrations of inflammatory markers were analyzed in the groups of healthy subjects and subjects with major depressive disorder (MDD ) initially and after one-month antidepressant therapy in the latter. The intention was to demonstrate the role of inflammatory markers in the development of MDD by differences in their concentrations and to explain the mechanism of depression development. This would help us expand our understanding of the occurrence of depression and enable introduction of some new methods in the treatment and diagnosis of depression. Study results showed a statistically significant difference in the concentrations of inflammatory markers (C-reactive protein (CRP), interleukin-6 and tumor necrosis factor alpha) between the group of MDD subjects and control group of healthy subjects. These concentrations were higher in MDD subjects. A statistically significant difference was also found in CRP concentration before and after antidepressant therapy administered to MDD patients, i.e. it was lower after antidepressant therapy. Study results pointed to the efficacy of antidepressant therapy for depression by reducing the concentration of this inflammatory marker.Cilj ovoga istraživanja bio je ispitati ulogu upalnih faktora u mehanizmu nastanka depresije. Analizirane su koncentracije upalnih čimbenika između skupina zdravih ispitanika i ispitanika oboljelih od depresije pri dolasku i mjesec dana od početka liječenja antidepresivima u potonjoj skupini. Temeljem razlika u koncentracijama navedenih čimbenika željelo se potvrditi njihovu ulogu u nastanku depresije i objasniti mehanizam nastanka depresije. Time bi se uz proširivanje spoznaje o uzroku nastanka depresije mogle primijeniti i nove metode liječenja i dijagnostike depresije. Ovim radom pokazano je postojanje statistički značajne razlike u koncentracijama upalnih faktora (CRP, IL -6 i TNF -α) između zdravih ispitanika i onih oboljelih od depresije. Navedene koncentracije su bile više kod depresivnih ispitanika. Nadalje, nakon terapije antidepresivima zabilježena je statistički značajna razlika u koncentraciji CRP u odnosu na početak liječenja, tj. CRP je bio niži nakon terapije antidepresivima. Dobiveni rezultati govore u prilog učinkovitosti terapijskog djelovanja antidepresiva u liječenju depresije kroz snižavanje koncentracije ovoga upalnog čimbenika

Povezanost upalnih biljega, antidepresiva i depresije

The aim of this study was to explore the role of inflammatory markers in the occurrence of depression. The concentrations of inflammatory markers were analyzed in the groups of healthy subjects and subjects with major depressive disorder (MDD ) initially and after one-month antidepressant therapy in the latter. The intention was to demonstrate the role of inflammatory markers in the development of MDD by differences in their concentrations and to explain the mechanism of depression development. This would help us expand our understanding of the occurrence of depression and enable introduction of some new methods in the treatment and diagnosis of depression. Study results showed a statistically significant difference in the concentrations of inflammatory markers (C-reactive protein (CRP), interleukin-6 and tumor necrosis factor alpha) between the group of MDD subjects and control group of healthy subjects. These concentrations were higher in MDD subjects. A statistically significant difference was also found in CRP concentration before and after antidepressant therapy administered to MDD patients, i.e. it was lower after antidepressant therapy. Study results pointed to the efficacy of antidepressant therapy for depression by reducing the concentration of this inflammatory marker.Cilj ovoga istraživanja bio je ispitati ulogu upalnih faktora u mehanizmu nastanka depresije. Analizirane su koncentracije upalnih čimbenika između skupina zdravih ispitanika i ispitanika oboljelih od depresije pri dolasku i mjesec dana od početka liječenja antidepresivima u potonjoj skupini. Temeljem razlika u koncentracijama navedenih čimbenika željelo se potvrditi njihovu ulogu u nastanku depresije i objasniti mehanizam nastanka depresije. Time bi se uz proširivanje spoznaje o uzroku nastanka depresije mogle primijeniti i nove metode liječenja i dijagnostike depresije. Ovim radom pokazano je postojanje statistički značajne razlike u koncentracijama upalnih faktora (CRP, IL -6 i TNF -α) između zdravih ispitanika i onih oboljelih od depresije. Navedene koncentracije su bile više kod depresivnih ispitanika. Nadalje, nakon terapije antidepresivima zabilježena je statistički značajna razlika u koncentraciji CRP u odnosu na početak liječenja, tj. CRP je bio niži nakon terapije antidepresivima. Dobiveni rezultati govore u prilog učinkovitosti terapijskog djelovanja antidepresiva u liječenju depresije kroz snižavanje koncentracije ovoga upalnog čimbenika