Self-Regulation and Rumination as a Transdiagnostic Factors for Internalizing and Externalizing Disorders Among Adolescents.

Objective: Internalizing and externalizing disorders are developmentally complex entities with multifactorial pathogenesis. The findings from recent research on the transdiagnostic responsibility of self-regulation and rumination suggest that their deficits underlie all psychiatric disorders in adults, and yet only a small number of studies have been conducted on the population of adolescents. Method: The clinical study included 162 adolescents, divided into two clinical groups, treated in the Department of Child and Adolescent Psychiatry in Hospital. The first clinical group consisted of 91 adolescents with internalizing mental disorders, with the second clinical group consisting of 71 adolescents with externalizing mental disorders. They had been referred for psychodiagnostic assessment after their first psychiatric examination, and were diagnosed according to the International Classification of Diseases (ICD-)10 criteria, the diagnoses confirmed through structured clinical interviews. They additionally met the inclusion and exclusion criteria for participating in this study. Results: The results suggest that self-regulation significantly and negatively predicted symptoms of mental disorder in both clinical groups, and rumination significantly predicted symptoms of anxiety and depression in the group of adolescents suffering from internalizing disorders. Conclusions: The findings emphasize the importance of maladaptive self-regulation as a transdiagnostic factor underlying various forms of psychopathology in adolescents, and the importance of rumination as a unique transdiagnostic process related to different disorders in the internalizing dimension.

Scarcity of research on psychological or psychiatric states using validated questionnaires in low- and middle-income countries: A ChatGPT-assisted bibliometric analysis and national case study on some psychometric properties.

Background: It is vital to assess whether research on psychological or psychiatric states using validated questionnaires is still lagging in low- and middle-income countries and to what degree, and to continue to assess the psychometric properties of the most informative questionnaires. Methods: We performed a bibliometric analysis of Web of Science Core Collection for all years to determine the number of studies performed in each country that used an inventory or a questionnaire on aggression, anxiety, depression, borderline personality, narcissism, self-harm, shame, or childhood trauma. We conducted a simple observational analysis of distributions by countries to derive the main overall conclusions, assisted by ChatGPT to test its ability to summarise and interpret this type of information. We also carried out a study in Croatia to examine some psychometric properties of five commonly used questionnaires, using Cronbach's α coefficient and zero-order correlations. Results: We observed a concentration of research activity in a few high-income countries, primarily the United States and several European nations, suggesting a robust research infrastructure and a strong emphasis on studying psychological and psychiatric states within their population. In contrast, low- and middle-income countries were notably under-represented in research on psychological and psychiatric states, although the gap seems to be closing in some countries. Turkey, Iran, Brazil, South Africa, Mexico, India, Malaysia and Pakistan have been consistently contributing an increasing number of studies and catching up with the most research-intensive high-income countries. The national case study in Croatia confirmed adequate psychometric properties of the most frequently used questionnaires. Conclusions: Addressing research gaps in low- and middle-income countries is crucial, because relying solely on research from high-income countries may not fully capture the nuances of psychological and psychiatric states within diverse populations. To bridge this gap, it is essential to prioritise mental health research in low-resource settings, provide training and resources to local researchers, and establish international collaborations. Such efforts can lead to the development of culturally valid questionnaires, an improved understanding of psychological and psychiatric states in diverse contexts, and the creation of effective interventions to promote mental well-being on a global scale.

Alexithymia, Phosphorus Levels, and Sleep Disorders in Patients on Hemodialysis.

Alexithymia, or the inability to distinguish between bodily feelings and emotions, has been linked to poor sleep quality in some studies. Rare studies examined the associations between electrolyte phosphorus in patients on hemodialysis and their sleep quality, daytime sleepiness, and alexithymia with inflammatory factors. Hemodialysis is a treatment method for terminal renal patients that involves the diffusion of unwanted metabolic products through the dialyzer membrane. Our study aimed to examine whether there was a difference in phosphorus levels, inflammatory factors, and daytime sleepiness according to the hemodialysis patients' levels of alexithymia. The study involved 170 HD patients that had been treated with chronic dialysis for more than three months. Prior to the hemodialysis procedure, laboratory findings were sampled. Respondents completed the Pittsburgh Sleep Quality Index, the Toronto Alexithymia Scale 26, and the Epworth Sleepiness Scale, and were questioned about depression. The results showed that alexithymic HD patients exhibited significantly higher leukocyte counts, lower predialysis phosphorus values, and more pronounced daily sleepiness than the alexithymia-free group (Mann−Whitney U test, p = 0.02, p = 0.005, and p < 0.001, respectively). We concluded that alexithymia was an independent predictor of high daytime sleepiness in HD patients (OR = 1.05, 95% CI 1.02 to 1.09).

Systematic Review of Alexithymia in the Population of Hemodialysis Patients.

Alexithymia is a construct defined as the inability to differentiate between emotional experiences and bodily sensations. According to existing knowledge, alexithymia may have a major effect on the process of treatment and the outcome of the hemodialysis disease. The objective of this literature review was to determine the significance that alexithymia has for compliance and variables of clinical and mental health in the population of hemodialysis patients. For the above purpose, bibliographic databases "MEDLINE" and "Web of Science" were searched. The matrix method was used in analysis of articles. Searching both databases resulted in 248 articles. After applying exclusion and inclusion criteria, we included results of 13 articles in the literature review. The results of the search are findings regarding the prevalence and correlation of alexithymia with variables of clinical and mental health in hemodialysis patients. Alexithymia is significantly more common in the population of hemodialysis patients, and it has a negative effect on their mental and somatic health. Alexithymia levels in hemodialysis patients are more pronounced in cases where there is a greater number of comorbidities. Alexithymia is the predictor of high mortality rate in the population of hemodialysis patients, independent of other comorbidities.

FROM ERECTILE DYSFUNCTION TO BRAIN SUBEPENDYMOMA: A CASE REPORT.

Endocrinopathies are relatively rare causes of erectile dysfunction. Cases of hyperprolactinemia and pituitary adenomas have been previously reported. We present a clinical case of a 27-year-old male with suspected infertility and recent symptoms of erectile dysfunction. Additional radiological and endocrinologic workup revealed underlying subependymoma, which was expanding in the sellar and suprasellar regions, causing pressure against the pituitary gland. The resulting endocrine disorder caused problems that were subjectively at first manifested mainly as erectile dysfunction. The case is an educative example pointing to the need of taking possible intracranial lesions in consideration when starting workup in a patient presenting with erectile dysfunction. It may be of broad clinical interest not only for endocrinologists but also for practitioners in various fields.

Positive Effect of Breastfeeding on Child Development, Anxiety, and Postpartum Depression.

BACKGROUND: Postpartum depression is a psychiatric disorder that starts from the second to the sixth week after birth. Breastfeeding is considered a protective factor for postpartum mood swings. This paper aims to examine the effect of breastfeeding on postpartum depression and anxiety, and how it affects child development. METHODS: The study included 209 pregnant women, 197 puerperea, and 160 women at the end of the third month after delivery, followed through three time-points. The instruments used in the study were the Edinburgh Postpartum Depression Scale (EPDS), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI). RESULTS: Postpartum mothers with low risk of PPD breastfed their children more often than mothers with a mild or severe risk of perinatal depression. Mean values on the BDI scale three months after giving birth were higher in mothers who did not breastfeed their child (M = 3.53) than those who did breastfeed their child (M = 2.28). Postpartum anxiety measured by BAI was statistically negatively correlated (rs-, 430) with the duration of breastfeeding. CONCLUSION: Nonbreastfeeding mothers are more depressed and anxious compared to breastfeeding mothers.

Predictors of Mental Health Outcomes in Road Traffic Accident Survivors.

Mental health outcomes of road traffic accidents (RTAs) are always investigated in assessments of those involved. The aim of this study was to investigate the psychological consequences and associated factors in all RTA survivors, irrelevant of their injury status. A cohort of 155 people was assessed one month after experiencing a RTA using self-reported measures for posttraumatic stress disorder (PTSD), depression, and anxiety. Associations between mental health outcomes and sociodemographic factors, pre-RTA health status, injury-related factors, and RTA details were analyzed. RTA survivors reported substantial rates of PTSD (32.3%) and depression (17.4%) symptoms, and low rates of anxiety (5.8%). Symptoms of depression were associated with below-average self-perceived economic status, irreligiousness, medication use, psychiatric medication use, and injury-related factors. PTSD symptoms were associated with female gender, below-average self-perceived economic status, previous psychiatric illness, medication use, psychiatric medication use, not being at fault in the relevant RTA, claiming compensation, and injury-related factors. Anxiety symptoms were associated with previous chronic or psychiatric illness, previous permanent pain, psychiatric medication use, and self-perceived threat to life, but not with sustaining injury. Along with the evaluation and treatment of RTA injuries, health care providers should evaluate the pre-RTA health status of all RTA victims. Psychological support to those at risk may prevent psychological disorders after RTAs.

Quality of Life and Female Sexual Dysfunction in Croatian Women with Stress-, Urgency- and Mixed Urinary Incontinence: Results of a Cross-Sectional Study.

Background and objectives: Urinary incontinence is defined as the involuntary leakage of urine. Studies have reported that the severity of urinary incontinence symptoms can cause decreased quality of life and female sexual dysfunction in women, but the association between the duration of the incontinence and the aforementioned disturbances has not been evaluated. The objective of this study was to evaluate the differences in the occurrence of decreased quality of life and female sexual dysfunction in Croatian women with urinary incontinence, with regard to the duration and subtype of urinary incontinence. Materials and Methods: We conducted a cross-sectional study from March 2017 to July 2018 at our neurourology and urodynamics outpatient clinic, among 120 women with urinary incontinence symptoms. Based on medical history, physical exam and urodynamic assessment, participants were divided into groups with stress-, urgency- and mixed urinary incontinence. Several quality of life and female sexual dysfunction questionnaires were used for evaluation. The differences between the three UI groups were tested by the Kruskal-Wallis test. All p values were two-sided. The level of significance was set to Alpha = 0.05. Results: The mixed urinary incontinence group had a significantly inferior quality of life (p = 0.003) and lower scores on the female sexual dysfunction questionnaires (p = 0.02). The longer the duration of incontinence King's Health Questionnaire total score was worse (p = 0.003) and Female Sexual Function Index total score was worse (p < 0.001). Conclusions: Our results showed that there was a statistically significant difference in the occurrence of decreased quality of life and female sexual dysfunction considering the duration and subtype of incontinence in Croatian women.

Schizophrenia and creativity.

Creativity is defined as an idea or product that is both novel or original and useful or adaptive. Despite the value of creativity at the personal and societal level, the tendency for creative individuals to suffer from what we would now call mental illness has been noted for thousands of years. In the mid-twentieth century, empirical evidence for the connection between creativity and psychopathology began to emerge. In this paper author brings literature review of the studies done about connection between creativity and psychopathology, as well as connection on schizofrenia and creativity. Author also point out that creating can be therapeutic for those who are already suffering from mental illness, and that creative art therapies applied in clinical and psychiatric settings report positive health-related outcomes.

Depression and Suicidality during Pregnancy.

BACKGROUND: Pregnant women experience a set of biological and psychological disturbances. The aim of this study was to assess the appearance of depressive symptoms and suicidal thoughts in pregnant women during the third trimester of pregnancy. SUBJECTS AND METHODS: A total of 110 pregnant women were included in the study. All of them filled out an anonymous questionnaire about sociodemographic data, Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Study participants were between 18-46 years of age. 45.45% of the pregnant women were between 37 and 39 weeks pregnant. According to the EPDS, the risk for perinatal depression was observed in 29 (23.36%) pregnant women: 15 (13.64%) of them had a total score on EPDS from 10-12, and 14 (12.72%) had a total score of 13-20. A higher score on both Beck scales was characteristic for pregnant women with a higher risk for the development of perinatal depression based on the results on EPDS. The prevalence of suicidal thoughts was 2.73%. CONCLUSIONS: Perinatal depression is a state which should be given more attention. The recognition of perinatal depression during pregnancy allows health medical workers to observe pregnant women at risk and then to make preventive and clinical interventions. The risk for perinatal depression is higher in pregnant women with more expressed depressive and anxiety symptoms. Pregnant women with suicidal thoughts are more anxious and depressed.

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.

Observing Electroconvulsive Therapy Changes Students' Attitudes: A Survey of Croatian Medical Students.

AIM: To assess the impact of education and direct observation of electroconvulsive therapy (ECT) on medical students' attitudes toward ECT in particular and psychiatric treatment in general in Croatia. METHOD: Two self-administered questionnaires were completed by year 4 medical students twice, at the beginning and the end of the psychiatry clerkship. Students were divided into 2 groups: those who observed an ECT session (47.9%) and those who did not (52.1%). RESULTS: The survey was completed by 190 students yielding a response rate of 79.8%. Students' attitudes toward ECT and other methods of psychiatric treatment and psychiatry in general changed in positive direction after the clerkship in both groups. However, the attitudes toward ECT of students who observed a live ECT session became more positive than those who did not. Likewise, students who observed ECT were more likely to agree to receive ECT and had better knowledge about ECT compared with the other group. CONCLUSIONS: Having watched a live ECT session had a positive effect on students' attitudes toward ECT and other types of psychiatric treatment. Watching live ECT sessions should be mandatory during the psychiatric clerkship.

Emotional profile and risk behaviours among tattooed and non-tattooed students.

AIM: To determine differences in emotional profile and frequencies of certain risk behaviours between tattooed and non-tattooed students. METHODS: One hundred students fulfilled personality assessment (trust, timid, depressive, distrust, aggressive, gregarious, controlled, uncontrolled) and questionnaire of socio-demographic data that also included some questions about possession of tattoo (time, place, motive) and about certain risk behaviours (court punishment, consummation of alcohol, psychoactive substances and cigarettes). RESULTS: The total number of 35 (out of 100) students had a tattoo, and 67 wished to have a tattoo. There was no statistically significant difference in emotional profile between tattooed and non-tattooed individuals, yet the differences were detected when the group of subjects who wanted a tattoo and those who did not want a tattoo were compared. Higher result on the aggression scale of and lower on control scale was gained by those with the wish for tattooing. Students with bigger tattoos (23) showed higher score on depression scale. Students in the tattooed group more frequently abused drugs and committed traffic offences compared to the students in non-tattooed group. CONCLUSION: Results of this research as well as previous research show that the presence of a tattoo could be a rough indicator for possible emotional problems and risk behaviour, which could have significant implications in preventing these behaviours. Future studies are required on a larger and more representative sample as well as to clarify why young people decide to be tattooed.

From Postpartum Metastatic Cancer to Parathyroid Adenoma: A Case Report.

We present a 36 year old female patient with suspected postpartum advanced metastatic cancer and multiple osteolytic lesions due to which she was referred to the Internal medicine clinic for further diagnostic evaluation. After extensive investigation, it was discovered that the underlying condition was a parathyroid gland adenoma and the patient was treated surgically. Clinicians should note that parathyroid adenoma can mimic metastatic malignant disease, and should make appropriate diagnostic tests that will lead to the correct diagnosis.

Depression, anxiety and cognitive dysfunction in patients with type 2 diabetes mellitus--a study of adult patients with type 2 diabetes mellitus in Osijek, Croatia.

Aim of the study was to determine the rate of depression and anxiety in the patients with diagnosed Type 2 Diabetes mellitus (DM), and also to determine the state of the congnitive functions in patients with Type 2 Diabetes mellitus compared with the control group. Study was designed as a epidemiological cross sectional study, sample consisted of 108 patients, 66 of the patients were diagnosed with Type 2 Diabetes mellitus, and 42 were control group. All of them were interviewed by psychiatrist and tested through clinical interview with Hamilton depression rating scale, Hamilton Anxiety rating scale, Mini mental state examination and questionnaire about sociodemografic data. Results show that group of patients with DM were statistically significant more depressed than the control group of the patients (p = 0.035). Pathological anxiety measured by Hamilton Anxiety Rating Scale (HAM-A) appeared in 34 DM patients and 7 of the patients in control group, which is also statistically significant difference (p = 0.002). Evaluation of the cognitive status done with Mini Mental State Examination (MMSE showed us the patients with DM presented more cognitive dysfunctions compared with the control group. We can conclude that the high prevalence of psychiatric disorders in diabetic patients points to the need for greater investment in appropriate diagnostic evaluation of patients that consider mental issues.

Placebo and nocebo effect: a mini-review.

It is well-known that placebo is a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective and that the nocebo is defined as a substance without medical effects but which worsenes the health status of the person taking it by the negative beliefs and expectations of the patient. Starting with the history of the placebo effect and giving a review of the most significant studies reporting about the placebo effect from 1939-2013 it was our intention to give the all-around look on this phenomena discussing the neurobiological and other theories of its origin and concentrating especially on the field of psychiatry and finally coming to conclusions regarding the conductance of clinical trials and ethics. Regarding psychiatry, the placebo effect has a substantial role in most of psychiatric conditions including depression, anxiety, addictions, and contrary to what may have been expected, schizophrenia. Likewise, the nocebo effect is not to be neglected as the studies are being conducted to identify the factors causing it so it could be prevented.

From hypoglycemia to right heart infarction: treatment of hypoglycemia in type 1 diabetes.

This case report presents a young 30-year old male patient with type 1 diabetes mellitus, who was treated for hypoglycemia and a general bad feeling. He was somnolent, pale, sweaty, hypotensive (65/40 mmHg) with bradycardia (40 beats per min) and additional workup revealed right myocardial infarction. Since diabetes causes neuropathy, it is important to keep in mind that chest pain in acute coronary syndrome can be absent in diabetic patients suggesting that if a patient with hypoglycemia has additional symptoms or if the general condition does not improve after glycemic control, additional investigation should always be performed.

The case report of treatment strategy for Anorexia nervosa with psychotic elements in adolescent.

Eating disorders in early childhood are the same frequency in boys and girls. During adolescence eating disorders are ten (10) times more frequent in girls than in boys. Worrying is the fact that eating disorders are the third chronic illness among adolescents after obesity and asthma. Depicting this adolescent we tried to show difficulty of treatment of this disorder, where in the beginning is important to stabilize body weight and prevent somatic damages such as: heart damage, amenorrhoea, changes in EKG (electrocardiogram) and electrolyte dysbalance that could endanger the life of patient. Simultaneously it is important to recognize and treat comorbid psychological disturbances such as in this case: depression, delusions with occasional psychotic reactions combined with unrealistic thinking about the layout of her own body. There is still no cure for the treatment of eating disorders which are in growing number of reports among male adolescents.

Suicidal behavior and suicide among children and adolescents-risk factors and epidemiological characteristics.

In last decade suicide attempts and suicides among youngsters are increasing greatly and are one of the leading causes of mortality in this age group. Epidemiological data are pointing on more frequent trend of self-destructive behavior among youngsters in the world as well as in our country. Risk factors which influence on increasing number of suicide attempts and suicides in this age are different in etiology: interference of genetic influences, family dynamics and external environment (school, friends, social environment, peers, television, video, and internet). Croatia as a country in transition is also following trends in the world according to epidemiological data, what is for sure great challenge for all who participate in dealing with youngsters, especially psychiatric services. In the planning of treatment is very important to include family with intention to accomplish optimal therapeutic effect. Also, it is very important to warn parents on their part of responsibility in upbringing and developing of their adolescent.