SCHIZOPHRENIA AND CREATIVITY

Creativity is defined as an idea or product that is both novel or original and useful or adaptive. Despite the value of creativity at the personal and societal level, the tendency for creative individuals to suffer from what we would now call mental illness has been noted for thousands of years. In the mid-twentieth century, empirical evidence for the connection between creativity and psychopathology began to emerge. In this paper author brings literature review of the studies done about connection between creativity and psychopathology, as well as connection on schizofrenia and creativity. Author also point out that creating can be therapeutic for those who are already suffering from mental illness, and that creative art therapies applied in clinical and psychiatric settings report positive health-related outcomes

Urinary Incontinence: Diagnostic Evaluation and First-line Treatment

Urinary incontinence is defined as involuntary leakage of any amount of urine that negatively affects the individual\u27s hygienic and social status. It is an important public health problem because it has a high prevalence and incidence. Due to various social prejudices, it is often neglected and unreported. It is also characterized by its chronic appearance and complications such as decreased quality of life, sexual dysfunction and symptoms of anxiety and depression. The financial burden for symptomatic, conservative and surgical treatment of urinary incontinence is high. Both women and men are reluctant to seek medical help, and they most often use coping strategies to deal with urinary incontinence symptoms, which include the use of incontinence aids such as adult diapers and pads. We conducted a systematic review of high-quality randomized controlled studies and of other review articles to compare circumstances surrounding the diagnostic evaluation and first-line treatment of urinary incontinence in women and men according to International Continence Society guidelines. Because urinary incontinence can occur during any stage of life, diagnostic and therapeutic approach is different in women and men. Social stigmatization created due to urinary incontinence may harm a person’s self-confidence and cause many negativities at a social level. Timely recognition of the type and severity of symptoms of urinary incontinence is necessary to reduce the occurrence of the aforementioned complications. (Radoja I, Degmečić* D. Urinary Incontinence: Diagnostic Evaluation and First-Line Treatment. SEEMEDJ 2020; 4(1); 63-73

Aggression and Suicidality in Psychotic Disorders

Agresivnost i suicidalnost ubrajaju se u hitna stanja u psihijatriji. Agresivno ponašanje može se javiti u sklopu brojnih različitih bolesnih stanja (psihoze, akutne intoksikacije, poremećaja ličnosti, organskih mentalnih poremećaja), a često se agresivnost može očitovati i posljedično u egzogenim frustrativnim situacijama. Zamjetan broj pacijenata s prvom psihotičnom epizodom uključen je u agresivne incidente. Studije pokazuju da oko 30 % bolesnika u prvoj psihotičnoj epizodi počini barem jedno nasilno djelo tijekom prve psihotične epizode. Agresivnost često dovodi do brojnih negativnih posljedica za bolesnika poput produženih hospitalizacija, socijalne izolacije ili pak uključivanja socijalne službe u daljnju skrb o bolesniku. Klinički rizični faktori za agresivno ili nasilno ponašanje psihotičnih bolesnika uključuju povijest o prethodno počinjenom nasilju, prisustvo maničnih simptoma, uporaba psihoaktivnih tvari, nesuradljivost u liječenju, uzbuđenje, impulzivnost, nedostatak uvida i pozitivne simptome. Suicidalnost u psihotičnim poremećajima izuzetno je važna tema. Naime, shizofrenija i drugi psihotični poremećaji prepoznati su kao nezavisan rizični faktor za suicidalne pokušaje i samoubojstvo, te suicidalnost u psihotičnih bolesnika predstavlja veliki izazov u kliničkoj praksi zbog nepredvidljivosti, naglosti postupka i brutalnih metoda koje mogu biti primijenjene. Životni rizik od počinjenja samoubojstva u shizofreniji i drugim psihotičnim poremećajima procijenjen je otprilike na 5 – 7 %, iako je prema nekim procjenama bliži 10 %. Najviši je rizik za počinjenje samoubojstva tijekom prve godine nakon početka bolesti kada bolesnici oboljeli od shizofrenije imaju 12 puta veći rizik za samoubojstvo u usporedbi s općom populacijom. U kliničkoj praksi važno je primijeniti adekvatne terapijske postupke pri liječenju agresivnih i suicidalnih simptoma u psihotičnih bolesnika. Terapijski postupci uključuju farmakološke i nefarmakološke postupke.Aggression and suicidality are emergency states in psychiatric practice. Aggressive behaviour can appear in different mental disorders (psychosis, acute intoxications, personality disorders, organic mental disorders), and also after different frustrative situations. A noticeable number of patients with a first psychotic episode have aggressive incidents. Studies show that around 30 percent of patients in a first psychotic episode committed at least one violent act. Aggression often leads to several negative consequences such as prolonged hospitalisation, social isolation, or inclusion of social services. Clinical risk factors for violent or aggressive behaviour in psychotic patients include history of violent acts, existence of manic symptoms, use of psychoactive substances, uncooperativeness, excitement, impulsivity, lack of insight and positive symptoms. Suicidality in psychotic disorders is also an important topic considering the fact that schizophrenia and psychotic disorders are recognised as independent risk factors for suicide and suicidal behaviour. Life risk for suicide in schizophrenia and other psychotic disorders is estimated around 5–7 percent, and up to 10% according to some authors. The suicide risk is higher during the first psychotic episode in the first year of the disease when it is even twelve times higher compared with the general population. These two symptoms in psychotic patients are challenging in clinical practice where pharmacological and nonpharmacological treatment procedures should be applied as standard therapeutic procedures

Depression and Suicidality in the Adolescents in Osijek, Croatia

Mood disorders in children and adolescents and their treatments have received increasing attention and clinical investigation over the last few decades. The core features of mood disorders are essentially the same across the life span. Developmental level, however, appears to influence the expression of certain mood symptoms with greater frequency than other within the framework of depressive disorders. Suicide is the fourth leading cause of death in children between the ages of 10 and 15 years and the third leading cause of death among the adolescents and young adults 15–25 years. In this article the authors presents cross-sectional study done on the sample of 286 adolescents. Adolescents fulfilled selfrating scale Beck Depression Inventory for the screening of the depression and suicidality. In our sample 3.85% of the adolescents fulfilled the criteria for severe depressive episode and the 5.94% of the adolescents fulfilled criteria for moderate depressive episode. Also on the item of suicidality (Item 9) 0.7 % of the adolescents had very high score, while 8.4 had significant score for the suicidal risk. Our results are in concordance with similar epidemiological studies done world while

Connection between Mental Disorders and Hypertension In Patients Treated at the Psychiatric Clinic, Clinical Hospital Centre Osijek

Background: The objective of this study was to assess the type and frequency of psychiatric disorders associated with hypertension and to identify sociodemographic specifics and other comorbid diseases. Materials and Methods: This was retrospective study to establish if there was a relationship between mental disorders and hypertension in patients hospitalized at the Department of Psychiatry from January 1, 2020 to August 15, 2021. Different mental disorders were correlated with hypertension comorbidity, with the emphasis on disease duration, mental disorder characteristics, diagnostic category such as age and gender, and other comorbidities. Results: The study included data from 800 patients hospitalized at the Department of Acute and Biological Psychiatry and the Department of Integrative Psychiatry at the Psychiatry Clinic of the University Hospital Center Osijek. All of them were treated for various mental disorders in the period from January 1, 2020 to August 15, 2021. Special emphasis was placed on the patients who had been diagnosed with a mental disorder and hypertension in order to determine how many patients treated for a mental disorder also suffer from hypertension. The research shows that 230 (28.75%) out of 800 patients suffer from both a mental disorder and hypertension. Conclusions: The study has shown that almost one third of the respondents treated at the Psychiatry Clinic for a certain period of time suffer from hypertension. The majority of hypertensive patients were treated for recurrent depressive disorder, alcohol addiction and posttraumatic stress disorder

Emergency Psychiatry

Stanje ugroženog ili neugroženoga tjelesnog zdravlja koje snažno remeti njegovu psihosocijalnu egzistenciju i nalaže hitnu terapijsku intervenciju hitno je stanje u psihijatriji. Hitno stanje karakteriziraju akutni poremećaji mišljenja, raspoloženja, ponašanja ili socijalnih odnosa. Najčešće se radi o stanjima suicidalnosti, akutne psihotične epizode, akutne anksioznosti, nasilnog ili impulzivnog ponašanja, psihomotorne agitacije ili uzbuđenosti, delirija, intoksikacije psihoaktivnim tvarima te o malignome neuroleptičkom sindromu. U radu je opisano svako od navedenih hitnih stanja pojedinačno uz preporuke za terapijski pristup u specifičnim situacijama. Cilj je psihofarmakologije hitnih stanja u psihijatriji u što kraćem vremenu postići smirivanje bolesnika te sniziti rizik od ozljeđivanja i njega i okoline. Najčešće se primjenjuju kombinacije antipsihotika i benzodiazepina.Emergency conditions in psychiatry are characterized by acute disorders of cognition, affectivity, behaviour and interpersonal functioning. Symptoms and conditions behind psychiatric emergencies require immediate psychiatric interventions. Emergency conditions requiring psychiatric interventions may include attempted suicide, acute psychotic episodes, acute anxiety attacks, violence or other rapid changes in behaviour, psychomotoric agitation or aggression, delirium, drug intoxication and malignant neuroleptic syndrome. In this paper, the mentioned emergency conditions as well as the treatment recommendations are explained in detail. The therapeutic aim in emergency psychiatry encompasses crisis stabilization and prevention of potentially life-threatening conditions in a shortest time possible. The mostly used emergency medication consists of a combination of antipsychotics and benzodiazepines

UMIŠLJENI POREMEĆAJI

Umišljene poremećaje karakterizira svjesno i namjerno kreiranje, preuveličavanje i/ili izazivanje fizičkih ili psihičkih znakova i simptoma bolesti. Cilj takvog ponašanja je zauzimanje uloge bolesnika te hospitalizacija kojom bolesnik namjerava izazvati pažnju, sažaljenje i simpatije kod drugih. Poremećaj treba razlikovati od simuliranja pri čemu pacijenti nemaju namjeru ostvariti praktičnu korist. Umišljeni poremećaj se razlikuje i od somatoformnih poremećaja kod kojih pacijenti vjeruju u postojanje bolesti i nemaju namjeru zavaravati. Takvi poremećaji imaju kompulzivnu kvalitetu, ali je ponašanje pacijenata dobrovoljno i namjerno, iako se ne može kontrolirati. Uzrok takvog ponašanja nije poznat, iako neka istraživanja u razvoju poremećaja opisuju moguće biološke kao i psihološke čimbenike. Dijagnoza se temelji na kombinaciji dvojbenih laboratorijskih i drugih dijagnostičkih nalaza isključenjem drugih mogućih bolesti, nedoslijednošću i promjenjivošću simptomatologije oboljeloga te dobivenih podataka o pacijentu od obitelji i prijatelja. Standardna terapija za poremećaj nije nađena, ali kombinacija psihofarmaka s intenzivnom psihoterapijom kao kognitivno-bihevioralnom i obiteljskom terapijom može polučiti rezultate. U literaturi se ti poremećaji često zamjenjuju pojmom Münchausenov sindrom, iako se taj pojam odnosi samo na jedan tip poremećaja