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

COMORBIDITY – A TROUBLESOME FACTOR IN PTSD TREATMENT

Posttraumatic stress syndrome (PTSD) is a disorder which emerges after the patient has experienced one or more psychotraumatic events, which equally include neurobiological deregulation and psychological dysfunction. Comorbidity is present in more than 80% of the diagnosed cases of PTSD, which makes treatment of the primary disorder very difficult. It has been identified that PTSD can be found in comorbidity with other psychiatric disorders as well as with physical illnesses. This study presents aged 42, who has been psychiatrically treated for the past 12 years, with a diagnose of chronic PTSD and who subsequently developed depression. The patient has been treated for psoriasis for the past seven years, and two years ago, had to undergo surgery due to bladder carcinoma, followed by a radiotherapy course. Multiple comorbidity significantly makes the treatment of the primary illness very difficult and it limits the choice of pharmacotherapy in ambulatory conditions

VALID GROUNDS FOR THE SWITCH OF ORIGINAL ANTIPSYCHOTICS WITH GENERICS

Patients\u27 non-compliance in treatments, such as irregular taking of medication, represents an enormous problem with psychiatric patients in general. This difficulty occurs especially in patients suffering from chronic mental illnesses such as schizophrenia. There are not any significant differences in the efficacy of reducing the positive symptoms in schizophrenia between the conventional and the atypical antipsychotics. However, the effects which are manifested in negative schizophrenia symptoms or in the patients\u27 cognitive functioning, favour the atypical antipsychotics. When it comes to adding the subjective well-being of the patients and their improvement of the quality of life, then, the advantages of atypical antipsychotics are unquestionable. New trends in medicine are increasingly impinge on the pharmacoeconomy, which aims at reducing treatment cost. This trend is getting progressively stronger in the world and as such, it certainly will not bypass Croatia. Pharmacists and General Practice doctors (GP) are permitted, by the law, to replace the original medicament prescribed by a specialist doctor, with a cheaper one from the same generic group of medicaments, with a purpose of cutting down the treatment costs. Is there always a valid justification for such practice, and should it become a rule for all the patients out there? This is a case report of a patient who suffers from paranoid schizophrenia. He has been on a treatment with atypical antipsychotics and has kept in a good and stable remission for the past seven years. His therapy consisted of olanzapine in a dose of 15 mg in the evening, throughout the whole period of his 7-year remission. A month ago, his GP doctor self- initially prescribed a generic olanzapine. The impact of this decision on to the mental state of the patient as well as his trust in the treatment itself is described in this report

ANTIPSYCHOTIC SIDE-EFFECT – POTENTIAL RISK OF PATIENTS REJECTING THEIR TREATMENTS

Antipsychotics side-effects pose an enormous problem in psychiatric treatment. The choice of antipsychotics is a crucial issue in the treatment as both patients\u27 cooperation and compliance often depend upon it. Severe side-effects might sometimes cause the treatment interruption, to which each patient is entitled. Schizotypal personality disorder (SPD) features include social and interpersonal deficits, discomfort with close relationships, as well as cognitive and perceptual distortions and eccentricities of behaviour. Dominant symptoms often determine psycho pharmacotherapy and therefore antipsychotic treatment is possible. A 23 year-old man was treated for 4 months due to disturbances typical for SPD. Since the patient did not respond well to haloperidol, zuclopenthixol was advised. The latter medication produced severe, life-threatening side-effects which caused urgent hospitalisation. Althouth zuclopenthixol was instantly retracted from the therapy, the patient and his family rejected any further psychiatric treatment. In spite the fact that hetero-data obtained from his mother a few months later, revealed disturbances which greatly affected the patient’s live, the patient showed resistance to further psychiatric treatment because of his negative experience with this medication

HYPERPROLACTINAEMIA – A RISPERIDONE SIDE-EFFECT

A 47 year old patient has been treated for psychotic depression for the last 5 years. The illness began manifesting through the symptoms of depressive thoughts, intrapsychic tension, projectivity, derealisation phenomena and pre-psychotic fears. She was treated with a combination of antidepressives, anxiolitics and hypnotics in ambulatory conditions. The therapy applied did not obtain the effects expected due to which an atypical antipsychotic was administered subsequently – risperidone, a 2 mg dose in the evening. After commencing the antipsychotic treatment, the symptoms started to weaken and a steady remission was obtained. Two years after a regular risperidone administration (in combination with fluoxetine, alprazolam and flurazepam) the patient reported some „bleeding“ in October 2006. Hormonal blood tests were performed and high prolactin values were registered (2567.0 mIJ/L),due to which a gradual risperidone retractement was indicated. Medicamentous hyperprolactinaemia is a well known side effect of risperidone. A gradual risperidone retractement lead to a lowered and normal prolactin level within a month

Liaison psychiatry in the ambulatory conditions – six years experience in Rijeka

Život svakog čovjeka u suvremenom svijetu prepun je čimbenika koji izazivaju frustraciju. Stres kojemu smo neminovno izloženi poti če sve veći broj psihosomatskih oboljenja koja su evidentno u porastu. Zbog navedenih oboljenja sve su veće potrebe i za psihijatrijskim intervencijama, pa s ti me u vezi postoji porast potreba za konzultati vnom (suradnom, liaison) psihijatrijom. Ovaj se trend uočava i u našoj sredini. Suradna (liaison) psihijatrija proučava psihičke odnosno emocionalne odgovore pojedinca na adaptaciju, implikaciju i posljedice somatske bolesti . Interdisciplinarni način liječenja omogućuje da i psihijatar bude uključen u liječenje primarno tjelesnih bolesti . Takav način liječenja dovodi do bržeg uspostavljanja remisije bolesti , te potvrđuje da se duša i ti jelo ipak ne mogu promatrati odvojeno. U članku su opisana iskustva suradnje liječnika primarne zašti te i psihijatra u specijalisti čkoj ambulanti u sklopu primarne zašti te, kako je to organizirano u Domu zdravlja Primorsko-goranske županije u Rijeci.Lives of many people living in the modern world of today are marked by a large number of factors which cause a lot of frustrati on. Stress to which we’re exposed to facilitates the emergence of psychosomati c illnesses whose incidence is evidently growing. This increase is demanding a greater number of psychiatric interventi ons, relati ng to an increase of the need for a consultati ve (liaison) psychiatry. This trend is also observed and evident in our urban environment. Liaison psychiatry explores and analyzes the psychic or emoti onal responses of the individual to the adaptati on, implicati on and consequences of a somati c illness. An interdisciplinary model of treatment enables the psychiatrist to be involved in the treatment of the primarily physical illnesses. This way of treatment facilitates a faster remission achievement, confi rming the need for an inseparable perspecti ve of the body and mind, which needs to be viewed as a whole. In this arti cle we describe the experience of cooperati on between primary care physicians and psychiatrists in specialist ambulate within primary care that is organized in the PGŽ Rijeka