Contemporary Classification of Psychotic Disorders

Revizija DSM-5 i poglavlje o mentalnim poremećajima ICD-11 utemeljeni su na ranijim konceptima mentalnih poremećaja, pa tako i psihotičnih poremećaja, te tako ističu zajedničke značajke, ali i razlike. Oba klasifikacijska sustava obilježava nozološki pristup i temelje klasifikaciju svih mentalnih poremećaja na psihopatologiji istih. Tako je klinička prosudba još uvijek presudna za klasifikacije duševnih poremećaja. Glavna je razlika uloga funkcionalnih oštećenja koja su obavezna u DSM-5, ali ne i u ICD-11. Usklađeni su kriteriji vremenskog tijeka i uvedeno je ocjenjivanje dimenzija u oba sustava. Razlike u kriterijima trajanja dovode do različitih pristupa u pogledu kratkotrajnih psihotičnih poremećaja. Oslabljeni psihotični simptomi nisu dobili puni dijagnostički status. Niti DSM-5 niti ICD-11 nisu uveli neurobiološke ili genetske čimbenike u klasifikaciju psihotičnih poremećaja. Oba sustava poduzimaju korake prema dimenzionalnim procjenama simptoma pojedinih poremećaja. Neke razlike prevladavaju u pogledu kriterija vremenskog tijeka i postupanja s kratkotrajnim psihotičnim poremećajima, što može ukazivati na različite koncepte kroničnosti na kojima se temelje te odluke. Konsenzus grupa za izradu novih klasifikacijskih sustava ipak nije uključila sindrom oslabljenih psihotičnih simptoma među mentalne poremećaje, što ukazuje da je granica prema normalnosti još uvijek dvojbena u oba klasifikacijska sustava i otvorena za buduće rasprave o konceptima subkliničkih ili drugih dimenzionalnih ocjena te subdijagnostičkih simptoma u općoj populaciji.The revision of the DSM-5 and the chapter on mental disorders of the ICD-11 are based on earlier concepts of mental disorders, including psychotic disorders, and thus emphasize common features as well as differences. Both classification systems feature a nosological approach and base the classification of all mental disorders on their psychopathology. Thus, clinical judgment is still crucial for classifications of mental disorders. The main difference is the role of functional impairments, which are mandatory in DSM-5 but not in ICD-11. The time course criteria were harmonized and dimension evaluation was introduced in both systems. Differences in duration criteria lead to different approaches regarding short-term psychotic disorders. Attenuated psychotic symptoms were not given full diagnostic status. Neither DSM-5 nor ICD-11 introduced neurobiological or genetic factors into the classification of psychotic disorders. Both systems take steps towards dimensional assessments of the symptoms of each disorder. Some differences prevail with regard to the criteria of time course and treatment of short-term psychotic disorders, which may indicate different concepts of chronicity on which these decisions are based. The consensus group for the creation of new classification systems did not include the syndrome of attenuated psychotic symptoms among mental disorders, indicating that the borderline towards normality is still doubtful in both classification systems and open to future discussions on the concepts of subclinical or other dimensional ratings of subdiagnostic symptoms in the general population

Treatment of bipolar affective disorder during pregnancy: case report

Cilj: Prikazati slučaj trudnice oboljele od bipolarnog afektivnog poremećaja (BAP) te terapijske izazove u njezinu liječenju. Prikaz slučaja: Trudnica u dobi od 35 godina hospitalizirana je na Klinici za psihijatriju zbog psihotične dekompenzacije od ranije dijagnosticiranog BAP-a. Pacijentica se u više navrata bolnički liječila zbog BAP-a. Prvi put je bila hospitalizirana u 25. godini života. Od tada je, unatoč redovitim kontrolama i medikaciji, došlo do nekoliko pogoršanja psihičkog stanja i to u vidu maničnih epizoda. U 35. godini života kod pacijentice je ustanovljena trudnoća te se ambulantno korigirala prethodno preporučena terapija. Ukinuo se litij i uveo se natrijev valproat. Nakon četiri tjedna pacijentica je hospitalizirana radi manične epizode s psihotičnim elementima. Hospitalno se terapija korigirala u skladu sa svjetskim iskustvima u liječenju BAP-a tijekom trudnoće. Tako se tijekom hospitalizacije kod ove pacijentice doza natrijeva valproata reducirala, a u terapiju se uveo antipsihotik kvetiapin, čija se doza titrirala do ukidanja simptoma bolesti. Pacijentica je na termin, carskim rezom, rodila zdravu djevojčicu. Do danas više nije bila hospitalno liječena, a podaci pedijatra ukazuju na uredan psihofizički razvoj djevojčice. Zaključak: Duševna bolest i njeno liječenje prije i/ili tijekom trudnoće predstavljaju rizične faktore za majku i za novorođenče. Stoga pojačani nadzor ovog tipa rizične trudnoće te propisivanje adekvatne psihofarmakoterapije s najmanjim mogućim posljedicama za majku i dijete predstavlja poseban izazov, ali i dužnost liječnika.Aim: To report a case of a pregnant woman with bipolar affective disorder (BAD) and therapeutic challenges in her treatment. Case report: A 35-year-old pregnant woman was hospitalized at the psychiatric clinic due to psychotic decompensation from a previously diagnosed BAD. The patient was hospitalized several times due to BAD. She was first hospitalized at the age of 25. Since than, despite regular check-ups and medication, there have been several deteriorations in mental health, mostly manic episodes. At the age of 35 the patient got pregnant and the previously recommended therapy was corrected. Lithium was abolished and sodium valproate was introduced. After four weeks, the patient was hospitalized due to manic episode with psychotic elements. The therapy was adjusted in accordance with world experience in the treatment of BAD during pregnancy. During hospitalization the dose of sodium valproate was reduced and the antipsychotic quetiapine was introduced into the therapy. The dose of quetiapine was titrated until the symptoms of the disease disappeared. The patient gave birth to a healthy baby girl by C-section. So far she has not been hospitalized. The pediatrician`s data indicate normal psychophysical development of the girl. Conclusion: Mental illness before and during pregnancy is a risk factor both for the mother and her newborn. Therefore, careful monitoring of pregnancy, as well as prescribing adequate psychopharmacotherapy with the least possible consequences for the mother and her child is a special challenge, but also a doctor`s duty

An association between minor physical anomalies in schizophrenia and polymorphisms in phospholipase A2 genes

Cilj: Neurorazvojna hipoteza shizofrenije implicira abnormalnu regulaciju metaboličke kaskade arahidonske kiseline (AA), a minor anomalije (MA) navode se kao potencijalni markeri abnormalnog razvoja mozga. U radu je istražena moguća povezanost varijacija u trima genima iz superobitelji fosfolipaza (PLA2) čiji su produkti uključeni u signalni put AA s pojavom MA glave i lica u shizofrenih bolesnika. Metode: U istraživanje su uključena 63 ispitanika (32 žene i 31 muškarac) Klinike za psihijatriju KBC-a Rijeka s potvrđenom dijagnozom shizofrenije prema DMS-IV kriterijima. Procijenjeno je 30 varijabli koje opisuju varijacije lica, očiju, nosa, usnica, nepca, jezika i ušiju, te određen ukupan broj MA u svakog ispitanika. Polimorfi zme gena PLA2G4A (rs10798059, G/A ili BanI polimorfi zam), PLA2G6A (rs4375, C/T) i PLA2G4C (rs1549637, A/T) analizirali smo PCRRFLP metodom. Rezultati : Pronađena je stati sti čki značajna povezanost između zbroja MA i PLA2G4C genoti pa (tauPLA2G4C = 0,214; P = 0,014) pri čemu je medijan zbroja MA bio najviši u TT homozigota i iznosio 13 (raspon od 10 do 16). Također smo utvrdili stati sti čki rubno značajnu interakciju PLA2G4A i PLA2G6A genoti pova, pri čemu je najviši medijan zbroja MA nađen u homozigota GG/CC (14; raspon od 10 do 22), odnosno u odsutnosti PLA2G4A-A ili PLA2G6A-T alela (P = 0,058). Zaključak: Rezultati upućuju na moguću povezanost varijacija u genima uključenim u rani razvoj živčanog sustava s pojavom MA glave i lica u shizofrenih bolesnika.Aim: The neurodevelopmental hypothesis of schizophrenia implicates abnormal regulati on of the arachidonic acid (AA) metabolic cascade while minor physical anomalies (MPAs) are indicated as a potenti al markers of abnormal brain development in pati ents with schizophrenia. We tested whether risk for MPAs was associated with variati ons in three genes of phospholipase A2 (PLA2) superfamily as PLA2s play an important role in signaling pathway of AA. Methods: 63 pati ents (32 females and 31 males) from the Psychiatry Clinic, Clinical Medical Centre Rijeka, were recruited for this study; the diagnosis of schizophrenia was confi rmed using DSM-IV criteria. We investi gated 30 MPAs of the head and face regions, and correlated their total number with genotype and allelic variants of polymorphisms in genes PLA2G4A (rs10798059, G/A or BanI polymorphism), PLA2G6A (rs4375, C/T variation) and PLA2G4C (rs1549637, A/T variation). Genotyping was performed by PCR-RFLP method. Results: Significant correlati on was found between MPA total score and PLA2G4C genotype (tauPLA2G4C=0,214; P=0,014); the highest median was found in TT homozygotes (13; range=10-16). A trend for synergisti c eff ect of two polymorphisms, each one in PLA2G4A and PLA2G6A genotypes, was also detected. The highest MPA score median was found in GG/CC homozygotes (14; range=10-22; P=0,058) or in the absence of PLA2G4A-A and PLA-2G6A-T alleles. Conclusions: The results suggested possible associati on between parti cular variati ons in the genes crucial during early development of central nervous system (genes of the PLA2 superfamily) with higher total number of MPAs of the head and face

ETIOLOGY OF SCHIZOPHRENIA AND THERAPEUTIC OPTIONS

Schizophrenia is a complex multifactorial disease with insufficiently known aetiology. There are many hypotheses on the etiology of SCH, but none of them can fully explain all of the properties of SCH. However, they offer numerous new therapeutic modalities. Biochemical theories find cause of the disease in unbalanced chemical substance in the brain. Dopamine, glutamate, serotonin and acetylcholine are the most important neurotransmitters for the development of schizophrenia. Currently available therapies are mostly based on dopaminergic and serotonergic theories. Majority of scientists nowadays believe in neurodevelopmental and neurodegenerative causes of SCH. Current hypotheses are focused on the study of membrane phospholipids and changes in the central protein synthesis. The theory that encompasses most of the properties of SCH is the hypothesis on reduced central protein synthesis, but it still requires many control studies. Clearly defining the aetiology of schizophrenia would result in significant progress in diagnosis and treatment

SYMPTOM SEVERITY IN SCHIZOPHRENIA PATIENTS WITH NPAS3, DYSBINDIN-1 AND/OR TRIOBP PROTEIN PATHOLOGY IN THEIR BLOOD SERUM: A PANSS-BASED FOLLOW UP STUDY

Background: It has been proposed that aggregation of specific proteins in the brain may be a pathological element in schizophrenia and other chronic disorders. Multiple such aggregating proteins have now been implicated through post mortem investigation, including NPAS3 (Neuronal PAS domain protein 3), dysbindin-1 (encoded by the DTNBP1, Dystrobrevin Binding Protein 1, gene) and TRIOBP (Trio-Binding Protein, multiple isoforms). While the presence of protein aggregates in the brain is interesting in terms of understanding pathology, it is impractical as a biomarker. These proteins were therefore investigated recently in blood serum of schizophrenia patients and controls, showing patients to have higher levels of NPAS3 in their serum generally. TRIOBP-1 and dysbindin-1 were also found in an insoluble state, implying aggregation, but did not clearly corresponding to disease state. Subject and methods: We revisit 47 of the originally recruited 50 patients with schizophrenia, all of whom are Croatian and aged between 18 and 72. We assessed their symptom specificity and severity using PANSS (the Positive and Negative Symptoms Scale), comparing those with NPAS3, insoluble dysbindin-1 and/or insoluble TRIOBP-1 in their blood serum to those lacking any such protein dysregulation. Results: The frequency of each individual potential protein pathology among these patients was too low for meaningful statistical analysis, however the 11 patients that displayed one or more of these pathologies (NPAS3, dysbindin-1, TRIOBP-1 and/or TRIOBP- 5/6) showed a subtle but significant increase in total PANSS scores compared to the 36 patients displaying none of the pathologies (p = 0.031), seemingly driven principally by increased scores on the general psychopathology scale. Conclusion: While the numbers of patients involved do not allow firm conclusions to be drawn at this time, this provides the first indication that disturbed proteostasis in blood serum, of proteins that aggregate in the brains of schizophrenia patients, may correlate with the severity of schizophrenia symptoms

SATISFACTION WITH LIFE AND COPING SKILLS IN THE ACUTE AND CHRONIC URTICARIA

Background: The purpose of this study was to examine the differences in satisfaction with life and coping strategies between patients with acute and chronic urticaria. Subjects and methods: Sixty patients with urticaria were divided into 2 groups after 6 weeks of standardized dermatology treatment (33 patients with acute and 27 patients with chronic urticaria). At baseline, all patients answered the following questionnaires: Satisfaction with Life Scale (SWLS), Personal Wellbeing Index (PWI-A), The Multidimensional Coping Inventory (COPE) and General questionnaire (age, gender, education, employment, marital status). After six weeks all the participants were re-tested with 2 questionnaires: SWLS and PWI-A. Results: Six weeks after the initial testing there was a statistically significant difference in satisfaction with life between patients with acute and chronic urticaria. Patients with acute urticaria were more satisfied with their lives than patients with chronic urticaria. Also, there was a statistically significant difference in the use of emotion-focused coping, seeking social support for emotional reasons and seeking social support for instrumental reasons. Patients with acute urticaria used emotion-focused coping and sought social support for emotional and instrumental reasons to a greater degree than patients with chronic urticaria. Conclusion: Patients with acute urticaria were more satisfied with their lives than patients with chronic urticaria. Patients with acute urticaria used emotion-focused coping and sought social support for emotional and instrumental reasons to a greater degree than patients with chronic urticaria