PERSONAL SPACE OF WAR VETERANS WITH PTSD – SOME CHARACTERISTICS AND COMPARISON WITH HEALTHY INDIVIDUALS

Background: The aim of this study was to determine the size of personal space among war veterans with PTSD, compared to healthy individuals, and to examine its associations with some sociodemographic and clinical characteristics. Subjects and Methods: Participants were 83 male war veterans with chronic PTSD and 85 healthy male employees of the medical institutions. Preferred interpersonal distances were assessed by using a stop-distance technique, where male and female research assistants approached the participants from four directions (front, behind, left, right). The patients filled out The Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD). Results: War veterans with PTSD preferred significantly larger interpersonal distances compared to healthy participants. Larger personal space size was preferred by those who had children, and the largest preferred distances were observed for the approaches from behind. Both samples preferred larger distances when approached by a male person. Conclusion: The findings of this study contribute to increased understanding of the personal space in patients with PTSD, and may be implemented into prevention of aggressive behavior during psychiatric treatment, and into development of more effective therapeutic strategies

PERSONALITY CHARACTERISTICS OF PSYCHOTIC PATIENTS AS POSSIBLE MOTIVATING FACTORS FOR PARTICIPATING IN GROUP PSYCHOTHERAPY

Background: This study aimed to examine the relationship between some personality characteristics of patients diagnosed with psychotic disorders and the quality of their engagement in psychodynamic group psychotherapy. Given that previous research has shown that self-stigma is significantly negatively associated with the engagement of patients, the measure of self-stigma was used as a correlate of patients’ motivation to participate in group psychotherapy. Subjects and methods: A total of 48 outpatients (52.1% women; mean age 35.30 years) attending group psychodynamic psychotherapy completed The Inventory of Personality Organization, The Pathological Narcissism Inventory, The Measure of Parental Style, The Relationship Questionnaire, and The Internalized Stigma of Mental Illness scale. Results: The findings showed that patients with higher levels of self-stigma have unhealthy attachments styles, perceived their mothers´ parental style as indifferent and achieved greater scores on narcissistic vulnerability scale. They are also are prone to primitive psychological defences, have poorly integrated identity, and achieved lower scores on reality testing dimension. Conclusion: Taking into account the limitations of this study, these findings may contribute to improved understanding of the quality of participation and engagement of psychotic patients in group psychotherapy, and may help to develop more effective therapeutic approaches

HYPERPROLACTINEMIA - SIDE EFFECT OR PART OF THE ILLNESS

Background: Hyperprolactinemia is associated with side effect of antipsychotics in people suffering from psychotic disorders. However, increased prolactin levels (mlU/L) were found in patients suffering from the first psychotic episode who were not receiving antipsychotic therapy. The assumption of this study is that the abnormality in the level of prolactin is associated with the effect and influence of the disease, not the therapy that is carried out. Subjects and methods: Study involved 54 female patients hospitalized in Psychiatric hospital "Sveti Ivan", whose average age was 33.9 years. All patients had been diagnosed with a psychotic disorder (according to MKB-10, F20-F29). 18 patients had their first psychotic episode, while 36 patients had relapses of psychotic disorder. The methods used were: PANSS scale and measurement of prolactin concentration (Immunoanalyzer ACCESS 2, CLIA method). Arithmetic mean, standard deviations, correlation coefficient, Mann Whitney U test and the chi-squared test were used. Results: 75.5% of patients had prolactin values above the reference values (min 121, max 4192 ml/L). In a sample of patients with first psychotic episode, 77.8% had elevated prolactin levels, while among re-hospitalized patients, elevated levels had 74.2%. Statistically significant results were obtained: patients with higher pronounced symptoms had higher prolactin values, especially particles on PANSS: P1 (delusions), N4 (Apathy), G15 (preoccupation) and G16 (active avoidance). Conclusion: Elevated prolactin in patients has been demonstrated regardless of antipsychotic therapy, therefore the question of etiology of hyperprolactinemia in psychotic disorders is questionable. The association of hyperprolactinemia with the severity of the clinical picture has also been demonstrated, higher prolactin values indicating a stronger clinical picture, which calls into question the protective role of prolactin in psychotic disorders

HYPERPROLACTINEMIA - SIDE EFFECT OR PART OF THE ILLNESS

Background: Hyperprolactinemia is associated with side effect of antipsychotics in people suffering from psychotic disorders. However, increased prolactin levels (mlU/L) were found in patients suffering from the first psychotic episode who were not receiving antipsychotic therapy. The assumption of this study is that the abnormality in the level of prolactin is associated with the effect and influence of the disease, not the therapy that is carried out. Subjects and methods: Study involved 54 female patients hospitalized in Psychiatric hospital "Sveti Ivan", whose average age was 33.9 years. All patients had been diagnosed with a psychotic disorder (according to MKB-10, F20-F29). 18 patients had their first psychotic episode, while 36 patients had relapses of psychotic disorder. The methods used were: PANSS scale and measurement of prolactin concentration (Immunoanalyzer ACCESS 2, CLIA method). Arithmetic mean, standard deviations, correlation coefficient, Mann Whitney U test and the chi-squared test were used. Results: 75.5% of patients had prolactin values above the reference values (min 121, max 4192 ml/L). In a sample of patients with first psychotic episode, 77.8% had elevated prolactin levels, while among re-hospitalized patients, elevated levels had 74.2%. Statistically significant results were obtained: patients with higher pronounced symptoms had higher prolactin values, especially particles on PANSS: P1 (delusions), N4 (Apathy), G15 (preoccupation) and G16 (active avoidance). Conclusion: Elevated prolactin in patients has been demonstrated regardless of antipsychotic therapy, therefore the question of etiology of hyperprolactinemia in psychotic disorders is questionable. The association of hyperprolactinemia with the severity of the clinical picture has also been demonstrated, higher prolactin values indicating a stronger clinical picture, which calls into question the protective role of prolactin in psychotic disorders

DAY HOSPITAL TREATMENT AS A MISSING LINK FOR SINGLE PATIENTS WITH POSTTRAUMATIC STRESS DISORDER (PTSD): A PRELIMINARY STUDY

Background: The aim of this study was to examine the day hospital treatment outcome on severity of clinical manifestations, general neuroticism and coping mechanisms in patients suffering from chronic combat-related PTSD. Subjects and methods: The sample consisted of 38 consecutive patients admitted to the Day Hospital treatment of PTSD during one year observation period. The average age of the sample was 46.03 years. The patients completed 3 self-report measures upon admission to the hospital and upon discharge: The Mississippi scale for combat-related PTSD (M-PTSD), The Crown-Crisp experiential index (CCEI), and The COPE inventory. Results: There was no significant change in the severity of clinical manifestations of PTSD, general neuroticism and coping mechanisms among the whole sample. However, compared to married participants and participants with children, single participants and those without children reported higher levels of anxiety when admitted to the hospital, but lower levels at discharge. In addition, patients without children reduced their avoidance behavior during the treatment. Conclusion: This preliminary study showed that single patients and those without children may benefit more from the day hospital treatment program. Our findings emphasize the importance of social support in the recovery process of severely traumatized persons, and may assist with the development of more effective therapeutic approaches

IMPROVING THE QUALITY OF LIFE DURING TREATMENT IN THE DAY HOSPITAL FOR EARLY INTERVENTION IN PSYCHIATRIC HOSPITAL "SVETI IVAN"

Background: The Day hospital for early intervention is a time-limited structured therapeutic program based on different psychotherapy and socio-therapy techniques. The aim of this study was to examine the outcomes of the Day hospital treatment for early intervention on self-esteem, and quality of life, and to determine which patients benefit the most from the program. Subjects and methods: The study was conducted on 124 patients with an early phase of psychosis who were treated at the Day hospital. They filled out Rosenberg Self-Esteem Scale, and WHOQOL-BREF upon the admission and again after three months of the treatment. Interaction effects were examined between their sociodemographic characteristics (gender, age, employment status), clinical features (first episode of psychosis or longer duration of illness), and results on applied questionnaires. Results: After three months of the treatment, patients evaluated their self-esteem, overall quality of life and satisfaction with different QoL domains (physical and psychological health, environment) as significantly improved. Younger patients had greater increase in estimated self-esteem compared to older patients. No other significant interactions were found. Conclusion: Notwithstanding the limitations of this study, we may conclude that the findings are encouraging and may assist with development of more effective therapeutic approaches

IMPROVING THE QUALITY OF LIFE DURING TREATMENT IN THE DAY HOSPITAL FOR EARLY INTERVENTION IN PSYCHIATRIC HOSPITAL "SVETI IVAN"

Background: The Day hospital for early intervention is a time-limited structured therapeutic program based on different psychotherapy and socio-therapy techniques. The aim of this study was to examine the outcomes of the Day hospital treatment for early intervention on self-esteem, and quality of life, and to determine which patients benefit the most from the program. Subjects and methods: The study was conducted on 124 patients with an early phase of psychosis who were treated at the Day hospital. They filled out Rosenberg Self-Esteem Scale, and WHOQOL-BREF upon the admission and again after three months of the treatment. Interaction effects were examined between their sociodemographic characteristics (gender, age, employment status), clinical features (first episode of psychosis or longer duration of illness), and results on applied questionnaires. Results: After three months of the treatment, patients evaluated their self-esteem, overall quality of life and satisfaction with different QoL domains (physical and psychological health, environment) as significantly improved. Younger patients had greater increase in estimated self-esteem compared to older patients. No other significant interactions were found. Conclusion: Notwithstanding the limitations of this study, we may conclude that the findings are encouraging and may assist with development of more effective therapeutic approaches

SOCIAL FUNCTIONING OF PATIENTS WITH PSYCHOTIC DISORDERS IN LONG-TERM PSYCHODYNAMIC GROUP PSYCHOTHERAPY: PRELIMINARY RESEARCH

Background: In recent years, social functioning of patients has increasingly been used as a criterion for assessing therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. Subject and methods: The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. Results: The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. Conclusion: Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders

EFFICACY AND SAFETY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION USING AN H1-COIL OR FIGURE-8-COIL IN THE TREATMENT OF UNIPOLAR MAJOR DEPRESSIVE DISORDER: A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique with few side effects that has been reported to be effective in the treatment of major depressive disorder (MDD). At present, no randomized controlled trials (RCT) have compared the efficacy and safety of rTMS delivered by the figure-8-coil and the H1-coil. We describe an industry-independent, randomized, controlled, single-blinded, single-center study protocol assessing the differences in efficacy and safety of rTMS for patients diagnosed with MDD with the H1-coil and figure-8-coil as an add-on to stable pharmacotherapy or pharmacotherapy alone. Stimulation protocols follow those that led to the FDA clearance of these treatments for MDD. The sample of 76 patents in each of the three groups will be enrolled and assessed with clinical and neuropsychological tests. The primary outcome is remission rate defined as Hamilton depression rating scale (HAM-D17) score ≤7 at the end of week-4. This clinical trial will address the efficacy and safety of rTMS modalities for MDD. The evaluation of biological markers will also help to elucidate the pathophysiology of MDD and the mechanisms of action of rTMS