Depression and stress levels in patients with different psychiatric disorders during concurrent early-phase COVID-19 pandemic and earthquake in Croatia.

BACKGROUND: While Croatia shared COVID-19 pandemic with other countries, its capital area was also hit by a 5.6 magnitude earthquake. The simultaneous impact of these two disasters on psychiatric patients is largely unknown, and we addressed those knowledge gaps. METHODS: The cross-sectional study was conducted during the pandemic's first peak, in the aftermath of earthquake, by telephonic survey. Measurements included the Patient Health Questionnaire-9, the Perceived Stress Scale and the semi-structured interview to evaluate the impact of pandemic stress and earthquake. Overall 396 patients with depression and/or anxiety disorders (DAD), 229 participants with schizophrenia spectrum disorders (SSD) and 205 healthy controls were enrolled. RESULTS: Both patient groups had higher depression and stress levels than controls, independent of sex, age and the presence of somatic comorbidity. After controlling for the same covariates, patient groups had higher COVID-19- and earthquake-related fears than controls. In patients with DAD, both fears were greater than among SSD patients. When comparing the two fears, the fear from earthquake was higher in DAD and control groups, whereas in SSD patients there was no such difference. CONCLUSIONS: Patients with DAD were the most vulnerable group during disasters, while earthquake seems to be associated with more fear than the pandemics, at least in DAD patients and healthy individuals. Future longitudinal studies should determine if early psychological support might alleviate stress levels after disasters and prevent further worsening of mental health, particularly among DAD patients.

Phantom Earthquake Syndrome - A Pilot Study after Zagreb and Banovina 2020 Earthquake.

Impact of earthquake on mental health is well-documented globally. A number of earthquake survivors after Zagreb and Banovina earthquake in the year 2020 reported a phenomenon of phantom earthquake. Telephone pilot study on phantom earthquake symptoms was conducted with semi-structured interview in earthquake survivors. Phantom earthquake is manifested as a false sense of earthquake-motion, accompanied with vegetative and motor symptoms with psychological distress and behavioral change that interfere with expected daily functioning. We propose an operational model for the phantom earthquake syndrome and discuss possible underlying neurobiological mechanisms to be further investigated in studying of the phantom earthquake syndrome.

Chemical Characteristics of Croatian Traditional Istarski prsut (PDO) Produced from Two Different Pig Genotypes.

Chemical characteristics of raw and processed Istarski prsut (PDO) produced from two different pig genotypes were studied with special emphasis on amino and fatty acid composition and factors of lipid stability. Raw hams of Large White (LW)xLandrace (L), and (LWxL)xDuroc (D) pig genotypes were used in the study (20 hams of each genotype). All left raw hams from each carcass were processed in accordance with the PDO specification of Istarski prsut, and other half (the right ones) of LWxL)xD genotype were used for analyses of raw hams (fresh muscles). Istarski prsut was evaluated on the basis of the chemical parameters of the raw and matured lean ham. The process of dry curing significantly influenced the chemical properties of Istarski prsut. Despite the higher content of intramuscular fat and polyunsaturated fatty acids, the fat of (LWxL)xD ham was much more resistant to hydrolysis and oxidation, suggesting that fatty acid profile and other factors, also play a significant role. Significant differences between pig genotypes in the amino acid and fatty acid profiles were found. The analyzed Istarski prsut may be distinguished by prints of multivariate chemometric statistical analysis, based on their amino acid and fatty acid compositions.

Attitudes Towards Older People in Croatian and Slovenian Nursing Students.

BACKGROUND: Croatia and Slovenia are neighboring countries with marked differences in high school and undergraduate nursing curricula. The aim was to assess and compare attitudes toward the elderly among undergraduate nursing students in Croatia and Slovenia and identify factors associated with positive/negative attitudes. SUBJECTS AND METHODS: This was a cross-sectional survey conducted between September, 2017 and July, 2018 among undergraduate nursing students at five higher education institutions: three in Slovenia and two in Croatia. The following data were gathered: age, sex, year of study, previous education, employment status, previous education in gerontolgy, desired professional role after graduating, previous experience with the elderly. Kogan`s Attitude Towards Old People Scale (KATOPS) score was the primary outcome measure. Pairwise comparisons were conducted between Croatian and Slovenian students. KATOPS score was dichotomized with values above the 3rd quartile considered excellent - the dichotomized score was used as the dependent variable in a binary logistic regression model. RESULTS: Overall, 825 students completed the questionnaire, 85.5% were women, 417 from Slovenia, 408 from Croatia, and 80% were under 22 years of age (80%). The average score on the KATOPS was 127.4, 95% CI 126.6-128.2. Variables associated with excellent scores on the KATOPS, based on the binary regression were: studying in Slovenia (OR=2.05, 95% CI 1.39-3.03), age group 28-32 years (OR=3.9, 95% CI 1.53-9.98); previous education gerontic nursing (OR=2.45, 95% CI 1.34-4.47), and full-time study (OR=2.12, 95% CI 1.38-3.55). Variables not associated with excellent scores were: being married (OR=0.44, 95% CI 0.22-0.92) and having previous experience in working with the elderly (OR=0.5, 95% CI 0.3-0.86). CONCLUSION: Attitudes toward old age are mildly positive in Slovenian and Croatian nursing students. Slovenian students have significantly more positive attitudes toward old age and these differences are most probably due to marked differences in undergraduate nursing curricula between the two countries.

Cognitive deficit in schizophrenia: an overview.

Depressive mood, anxiety, delusions, hallucinations and behavioral disturbances have been traditionally recognized as leading symptoms of mental disorders. However, cognitive symptoms went under-recognized or declined. Today there is robust evidence that cognitive dysfunction is present in the majority of mental disorders and is also related to impairments in the functioning of the persons with mental illness. It is proposed that aberrant brain neuronal network connectivity, arising from interplay of genetic, epigenetic, developmental and environmental factors, is responsible for cognitive decline. In schizophrenia, dysfunctions in working memory, attention, processing speed, visual and verbal learning with substantial deficit in reasoning, planning, abstract thinking and problem solving have been extensively documented. Social cognition - the ability to correctly process information and use it to generate appropriate response in situations, is also impaired. The correlation of cognitive impairment with functional outcome and employment, independent living and social functioning has emphasized the need for development of the treatments specific to cognition. It is considered that brain neuroplasticity allows for re-modulating and compensating the impairment process which could give opportunity to improve cognitive functions. Therefore, there is a need for comprehensive clinical assessment and follow-up of cognitive decline in mental illness. Implementation of specific treatment strategies addressing cognitive decline in mental illness, like new drugs, distinct cognitive-behavioural therapy, psychoeducation, social skills training and remediation strategies should be strongly indorsed targeting recovery and reduction of disability due to mental illness.

Electroconvulsive therapy - general considerations and experience in Croatia.

Despite controversy, ECT has been recognized as significantly effective for the treatment of mental disorders since 1938, when Cerletti and Bini introduced ECT in clinical psychiatric practice for treatment of schizophrenia. In the next period, indication for ECT switched more toward depression and catatonia. ECT was even banned from psychiatric training in 1960's, due to the anti-psychiatric movement, which were fortified by Oscar winning movie "One Flew over the Cuckoo's Nest". Due to its robust effectiveness, ECT revived in the early 1980's and today holds its position in clinical psychiatric practices around the world. Mechanism of ECT on brain and psychopathology is still not fully understood. Main theories have been neurotransmitter, post-receptor, neurophysiological and neuroendocrine theory. Regarding best clinical practices and evidence reported in the literature, ECT today is considered a treatment option for, traditionally, depression, suicidality and catatonia, and also schizophrenia, schizoaffective disorder, bipolar disorder, malignant neuroleptic syndrome, postpartal depression and psychosis, obsessive compulsive disorder, post-traumatic stress disorder, dementia, etc. Recent evidence of ECT efficacy is growing stronger also in the treatment resistant cases, for depression and psychosis. Great advantage of ECT is lack of absolute contraindications. ECT in Croatia was introduced in clinical psychiatric practice in 1960's in four institutions. Mainly due to stigma, but also a tendency for shifting toward hypothesized action mechanism, ECT in Croatia has been re-named to electrostimulative therapy or electroneuromodulatory treatment. In recent decades, the Department of psychiatry in the University Hospital Centre Zagreb (KBC Zagreb), has continuously been practicing ECT. Our department is considered a regional leader, regarding number of patient cases and overall experience in homeland and neighbouring countries. In the 2016, Croatian expert group, selected by the Croatian Psychiatric Association, proposed national guidelines for the ECT. Research in ECT at our department has shown predominance of the treatment for therapy resistance in depression and psychosis. The other research at our department also showed improvement in several cognitive functions of patients after ECT application.

No change in N-acetyl aspartate in first episode of moderate depression after antidepressant treatment: (1)H magnetic spectroscopy study of left amygdala and left dorsolateral prefrontal cortex.

BACKGROUND: The role of brain metabolites as biological correlates of the intensity, symptoms, and course of major depression has not been determined. It has also been inconclusive whether the change in brain metabolites, measured with proton magnetic spectroscopy, could be correlated with the treatment outcome. METHODS: Proton magnetic spectroscopy was performed in 29 participants with a first episode of moderate depression occurring in the left dorsolateral prefrontal cortex and left amygdala at baseline and after 8 weeks of antidepressant treatment with escitalopram. The Montgomery-Asberg Depression Rating Scale, the Hamilton Rating Scale for Depression, and the Beck Depression Inventory were used to assess the intensity of depression at baseline and at the endpoint of the study. At endpoint, the participants were identified as responders (n=17) or nonresponders (n=12) to the antidepressant therapy. RESULTS: There was no significant change in the N-acetyl aspartate/creatine ratio (NAA/Cr) after treatment with antidepressant medication. The baseline and endpoint NAA/Cr ratios were not significantly different between the responder and nonresponder groups. The correlation between NAA/Cr and changes in the scores of clinical scales were not significant in either group. CONCLUSION: This study could not confirm any significant changes in NAA after antidepressant treatment in the first episode of moderate depression, or in regard to therapy response in the left dorsolateral prefrontal cortex or left amygdala. Further research is necessary to conclude whether NAA alterations in the first episode of depression could possibly be different from chronic or late-onset depression, and whether NAA alterations in stress-induced (reactive) depression are different from endogenous depression. The potential role of NAA as a biomarker of a treatment effect has yet to be established.

Correlation of cognitive functions with some aspects of illness, treatment and social functioning in recurrently hospitalized schizophrenic patients.

Cognitive deficits are found to be contributors to poorer psychosocial functioning, rehabilitation outcome and lack of treatment success in schizophrenia. Aim of the study was to examine correlation of cognitive functions with some aspects of illness, treatment and social functioning in a group of recurrently hospitalized schizophrenic patients (N=60). Deficient results on psychomotor processing speed, verbal fluency and verbal learning correlated with the longer duration of illness, higher number of hospitalizations and shorter duration of regular antipsychotic treatment. Deficient results on verbal fluency correlated with the younger age of onset, poor functional autonomy and organizational skills, whereas deficient results on psychomotor processing and verbal learning correlated with poor organizational skills alone. Score on verbal fluency was predictive of social skills impairment, whereas score on psychomotor processing was predictive of functional autonomy and organizational skills impairment. Functioning of different cognitive domains could be predictive of functioning in different social domains. Interplay of specific cognitive deficit and social functioning could be responsible for recurrent hospitalizations and unfavorable treatment choices.

[Capacity to consent to research in patients with mental illness]. / Sposobnost osoba s mentalnim poremecajem za davanje informiranog pristanka u biomedicinskim istrazivanjima.

Informed consent is a legal procedure when including a person in the treatment, diagnostics or research which includes information, voluntarism and capacity to consent of the participant. Capacity to consent is related to decision-making process and could be influenced by various factors. Assessment of capacity to consent is still clinical, because there are no widely accepted standards and assessment instruments. Persons with mental disorders could have some deficits in capacity for decision-making that could be temporary or permanent. Ethical considerations in the research with participants not able to consent are related to benefit vs. non-benefit studies and risk assessment. Finding of the better methods for capacity assessment and capacity enhancement could improve selection of the research participants. Legal recommendations, including international declarations and conventions, as well as the related Croatian laws are important mechanisms for safeguards of the persons with mental illness in biomedical research.

[Psychiatric comorbidity in veterans with chronic PTSD treated at Center for Crisis Intervention, Zagreb University Hospital Center]. / Psihjatrijski komorbiditet branitelja lijecenih zbog kronicnog PTSP-a u Centru za krizna stanja KBC-a Zagreb.

UNLABELLED: Epidemiological and clinical studies provide evidence that veterans with chronic PTSD can be at risk of relapse with respect to a number of high-risk behaviors, including attempted suicide, violence, and misuse of alcohol and drugs. AIM, PATIENTS AND METHODS: The aim of our study was to assess the prevalence of psychiatric comorbidity in veterans with chronic PTSD treated at Center for Crisis Intervention, Zagreb University Hospital Center, for 4 years. The diagnosis of PTSD and comorbid psychiatric diagnosis were confirmed according to DSM-IV criteria. RESULTS AND DISCUSSION: Study results showed PTSD without comorbid psychiatric diagnosis to persist in 25.3%, and PTSD with comorbid psychiatric diagnosis in 74.7% of study subjects. The most common psychiatric disorders were depression, personality disorders, and alcoholism. CONCLUSION: It is important to recognize other comorbid disorders because of the increased risk of suicidal behavior. Accordingly, therapeutic intervention should be adjusted to each individual case.

Cognitive functions in the involuntary hospitalized schizophrenic patients.

OBJECTIVE: Objective of the study was to investigate differences in some important cognitive functions in the schizophrenic patients that were either involuntary or voluntary hospitalized in psychiatric hospital. METHOD: 30 involuntary hospitalized patients with schizophrenia were evaluated with neurocognitive battery and compared with a group of 30 voluntary hospitalized patients with schizophrenia. Demographic and medical data were also analyzed RESULTS: Involuntary hospitalized patients showed significantly poorer performance in some cognitive tests and no difference in the other cognitive tests in comparison with voluntary hospitalized patients. Involuntary hospitalized patients also had earlier onset of illness, higher number of psychiatric hospitalizations and involuntary psychiatric hospitalizations, and less regular psychiatric treatment. More often the reason for involuntary hospitalization was aggressive behavior. CONCLUSION: Deficit of cognitive functioning could influence treatment decisions in schizophrenic patients, leading to poorer compliance and coping with illness and resulting in less favorable treatment options, like involuntary hospitalization.