Difference of Symptoms Networks in Early and Late Phase Schizophrenia; A Cross-Sectional Network Analysis.

OBJECTIVE: The functional remission or recovery of schizophrenia patients is a challenging task which relies on pharmacotherapy but also on the timing of psychotherapy and other therapeutic interventions. The study aimed to assess the difference in strength and structure of symptoms networks between early and late phase schizophrenia. Our secondary objective was to check whether the overall, positive, negative, and general symptoms severity change over the course of treatment and disorder. METHODS: This nested cross-sectional analysis combined the samples from two studies performed during 2014-2016 at University Psychiatric Hospital Vrapce, Zagreb, Croatia on the consecutive sample of men 30-60 years old diagnosed with schizophrenia, 85 of them in the early (≤5 years from diagnosis), and 143 in the late phase of the illness. The study was funded by the project: "Biomarkers in schizophrenia - integration of complementary methods in longitudinal follow up of FEP patients". RESULTS: Median (IQR) age of the participant in the early phase was 36 (32-45) years and in the late phase 44 (38-49) years. Patients in the early phase had significantly higher odds for being in the symptomatic remission compared to the patients in the late-phase schizophrenia (OR=2.11; 95% CI 1.09-4.09) and had 10% less pronounced negative symptoms. The global strength, density, and structure of the symptoms network were not significantly different between the two study groups. CONCLUSIONS: Negative symptoms severity change with the course of illness and differ from the early to the late phase of schizophrenia. However, the overall network of psychotic symptoms is relatively stable, and overall strengths or density and the partial relationship between particular symptoms do not change significantly. The observed worsening of negative symptoms is probably at least partially caused by the lack of clear guidelines and effective treatment options aimed specifically toward negative symptoms.

Significantly lower right middle cerebral artery blood flow velocity in the first episode of psychosis during neurocognitive testing.

BACKGROUND: Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity (BFV) during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. SUBJECTS AND METHODS: We recruited 46 patients with the first episode of psychosis (FEP), admitted to the University Hospital Centre Zagreb during 2016-2017 and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. RESULTS: After the adjustment for age, sex and education by quantile regression, patients with FEP had significantly lower BFV in middle cerebral arteries during the 3rd (Δ-15, Δ%-28% p=0.023) and 4th task (Δ-15, Δ%-28% p=0.031) of the Stroop test and the 1st task of Foot tapping test (Δ -16, Δ% -30% p=0.034). We observed significantly lower changes of right middle cerebral artery BFV in FEP between two consecutive tests in all four tasks of the Phonemic verbal fluency test, 1st and 2nd task of the Stroop test and Trail making test, and the1st task of Foot tapping test; and of the left artery between first three tasks of the Phonemic verbal fluency test, the last one of the Phonemic verbal fluency test and all first three tasks of the Stroop test. CONCLUSIONS: Decreased middle BFV during the execution of particular neurocognitive tasks in patients with FEP, compared to control subjects might indicate impaired hemodynamic function in the prefrontal/parietal brain areas, and possibly provide an explanation of some of the observed neurocognitive deficits in patients with the first episode of psychosis.

Impact of a Nursing in Psychiatry Course on Students' Attitudes Toward Mental Health Disorders.

Negative attitudes toward patients with mental illnesses are not uncommon among health professionals, and lead to poorer quality and outcomes of care. Because attitudes are formed early in life, the current study aimed to investigate if teaching psychiatry in secondary school nursing students (i.e., adolescents) changes attitudes toward three prevalent psychiatric disorders: schizophrenia, posttraumatic stress disorder (PTSD), and depression. A pilot quasi-experimental study was conducted with 51 fourth-year students in secondary nursing school who completed a questionnaire regarding attitudes toward these disorders on the first and last day of their Nursing in Psychiatry course. Results show that the stigma attached to all three disorders was significantly reduced after students completed the course. Students attached greater stigma to schizophrenia than PTSD, and to PTSD than depression, before and after the course. The study indicates that education in psychiatry helps reduce negative attitudes toward PTSD, schizophrenia, and depression. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 45-51.].

Medical education changes students' attitudes on psychiatry: survey among medical students in Croatia.

In Croatia, psychiatric disorders are the leading group of disorders by days of hospitalization and they are in second place according to the number of hospitalizations in the period of working age. Nevertheless, psychiatry in Croatia, as well as in the world, is one of the least attractive specialties for medical students. In this paper we determined the impact of compulsory education in psychiatry on the attitudes of medical students of the fourth year of the Zagreb school of medicine and Osijek school of medicine. We tested attitudes toward psychiatry, psychiatric treatment and attitudes toward seeking professional psychological help using questionnaires that were filled out twice, at the beginning of psychiatry placement and at the end of psychiatry placement. Questionnaires were completed by 239 students from the Zagreb school of medicine and Faculty of medicine Osijek (response rate 78.4%). After the placement, students had significantly more positive attitudes about psychiatry and psychiatric treatment, as well as the attitudes toward seeking professional psychological help. Attitudes towards psychiatry, seeking psychological help and attitude towards psychiatric medication and psychotherapy correlated with the evaluation of the quality of psychiatric education. Additional forms of education in psychiatry should be offered, in order to maintain and increase the impact of education on students' attitudes.

Can medical students recognize depression? A survey at the Zagreb School of Medicine.

OBJECTIVE: The objective of this study was to investigate medical students' knowledge and attitudes towards depression. METHODS: Students attending their final year at Zagreb School of Medicine completed a set of standardized questionnaires, including attitudes towards psychiatric medication, attitudes towards depression, and personality inventory. RESULTS: In total, 199 students completed the questionnaire (response rate 77 %). Most medical students were only partially able to correctly identify major symptoms of depression, but did suggest referral to mental health specialists as the most appropriate course of action. They recognized social and biological causes of depression. Degree of correct identification of symptoms of depression correlated positively with non-stigmatizing attitudes towards depression and negatively with stigmatizing attitudes towards depression. CONCLUSION: Students' attitudes toward depression may influence their recognition of symptoms of depression. Incorporation of these findings in development of undergraduate medical curricula may improve students' recognition of depression.