Dual Antidepressant for Dual Diagnosis - Venlafaxine Treatment of an Alcohol-Abusing PTSD Patient with a Depressive Disorder

Posttraumatski stresni poremećaj jedini je anksiozni poremećaj kod kojeg je poznata etiologija, uzrokovan je traumatskim događajem. Vrlo često ga prate drugi poremećaji, čime liječenje postaje složenije i dugotrajnije. Prikazan je tijek kliničke slike PTSP-a s obzirom na ambulantno i hospitalno liječenje. Ujedno je prikazan tijek liječenja dualnim inhibitorom ponovne pohrane serotonina i noradrenalina - venlafaksinom bolesnika oboljelog od PTSP-a u komorbiditetu s depresivnim poremećajem i zlouporabom alkohola. Biopsihosocijalni pristup doveo je do redukcije simptoma PTSP-a kod oboljeloga, normalizacije odgovora na stres te poboljšanja njegovih adaptacijskih mehanizama i više razine socijalnog funkcioniranja.Posttraumatic stress disorder (PTSD) is the only anxiety disorder of a known etiology, i.e. it is caused by a traumatic event. It is very often accompanied by other disorders which makes its treatment more complex and longer. The course of the PTSD clinical picture is presented through outpatient and hospital treatments. The article also presents the course of treatment with venlaflaxine, a dual serotonin and noradrenalin reuptake inhibitor, in a PTSD patient with co-morbidities: depressive disorder and alcohol abuse. A biopsychosocial approach reduced PTSD symptoms in the affected patient, normalized stress response, and improved adaptive mechanisms and social functioning

The change in perception of illness monitored by group psychotherapy of family members of patients with psychotic disorder

Cilj: Opisati promjene odnosa prema bolesti kroz četverogodišnji rad grupne psihoterapije članova obitelji. U sklopu Programa rane intervencije kod prvih epizoda psihotičnih poremećaja (RIPEPP) roditelji bolesnika oboljelih od psihotičnih poremećaja uključeni su, uz psihoedukacijske radionice, i u psihodinamsku grupnu psihoterapiju. Metode: Praćenje protokola seansi koje se bilježe po sjećanju nakon održanih grupa. Rezultati: Tijekom četverogodišnjeg rada s članovima obitelji opazili smo da je postupno došlo do promjene stava prema bolesti. U početku grupnog rada uočeno je neprihvaćanje bolesti, negacija te pomak problema prema van (npr. uzimanje droga). U drugoj fazi prorađuju se osjećaji srama (bolest kao narcistička povreda) i krivnje (bolest kao kazna) te teškoće suočavanja s ozbiljnošću i dugotrajnošću bolesti. Prepoznata je i treća faza rada u kojoj članovi grupe (roditelji) fokus pomiču s djece i njihovih poteškoća na sebe (počinje prorada tugovanja). Zaključak: Grupna klima koja se tijekom četverogodišnjeg rada u grupi stvorila pridonijela je postupnom prihvaćanju bolesti te time i promjeni odnosa prema djeci. Bolja uspostava granica stvara uvjete za separaciju najprije od grupe, a kasnije i od oboljelog člana.Aim: This paper gives the description of changes in the perception of illness during the four-year involvement of the patients’ family members in group psychotherapy. Within the program of early intervention in the first episodes of psychotic disorder, parents of patients with psychotic disorder take part in psycho-educational workshops as well as in psychodynamic group psychotherapy. Methods: The method of work is based on the monitoring of session protocols noted from memory after the group therapies have been finished. Results: Unacceptance of illness, denials and outer transfer of the problem (such as drug abuse) were noticed in the beginning of the group work. In the second phase, the feelings of shame were dealt with (illness as a narcissistic injury) and guilt (illness as punishment) as well as difficulties in facing the severity and long duration of illness. The third phase was also recognized in which we noticed that the group members (parents) focused their attention from their children’s difficulties to themselves (the period of grieving process started). Conclusion: The group atmosphere which developed during the four- year period of work in the group contributed to the gradual acceptance of illness and so changed the relationship with children. Better setting of boundaries allowed separation, first from the group, and also from the inflicted family member later on

Serotonin and Cortisol as Suicidogenic Factors in Patients with PTSD

Post-traumatic Stress Disorder (PTSD) frequently occurs in commorbidity with different mental disorders, including suicidal behaviour. Group of biological factors, including serotonergic system, HPA axis and some genetic factors, are being studied as potential markers, able to differentiate suicidal and non-suicidal behaviour across the group of PTSD patients. This study is examining statistical relation between platelet serotonine concentration and serum cortisole concentration, within the group of PTSD patients with and without attempted suicide, treated at »Sveti Ivan« Psychiatric Hospital in Zagreb. The hypothesis of this study is that periferal biochemical markers are different accross the groups of PTSD patients with and without attempted suicide and the group of healthy controls. Our results have shown significantly lower platelet serotonine concentration in PTSD patients with and without suicide behaviour, compared to healthy controls. There are no statisticaly significant differences of the serum cortisole concentration accross observed groups. Our results correspond with those reported by other authors in this area of research, suggesting that platelet serotonine level might be used as potential periferal marker to detect risk of suicidal behaviour in PTSD patients

EARLY INTERVENTION PROGRAM FOR PSYCHOTIC DISORDERS AT THE PSYCHIATRIC HOSPITAL \u27\u27SVETI IVAN

The Early intervention program for the first episodes of psychotic disorders (RIPEPP) at the Psychiatric Hospital “Sveti Ivan“ in Zagreb encompasses patients hospitalized due to various psychoses (acute psychotic disorder, schizophrenia, schizoaffective and delusional disorder, bipolar affective disorder with psychotic symptoms) in the “critical period“ of illness, i.e. within five years after the occurrence of the first symptoms. The RIPEPP Program consists of an in- and out-patient part, and includes psychotherapeutic and psychoeducative components as well as the administration of antipsychotics. The Psychotherapeutic part, conducted by psychotherapists – group analysts, comprises psychodynamic group psychotherapy for patients and for family members. The Psychoeducative part, led by cognitive-behavioral therapists, is carried out through educative interactive workshops for both patients and their family members. The paper describes the theoretical framework, as well as the professional, personnel, educative and organizational basis of the Program, the principles of evaluation and some experiences after five years of implementation