Impact of Childhood Cancer on Education, Professional and Social Life of Survivors in Croatia.

BACKGROUND: The aim of this study was to investigate the impact of childhood cancer and its treatment on the education, occupation, and social life of young adults in Croatia. There have been no comparable studies on this particular growing population group in Croatia to date. The study is the starting point for comparing and improving the quality of life of survivors of childhood cancer in Croatia and other countries that follow this population. SUBJECTS AND METHODS: The study was conducted using questionnaires distributed from October to November 2020. A total of 73 individuals were interviewed, including 40 survivors and 33 siblings as a control group. Data were collected on disease characteristics (for cancer survivors), school performance, occupational success, and quality of social life. The χ² test and Mann Whitney U test were used to compare differences between categorical and continuous variables, respectively. RESULTS: The type of childhood malignancy and the type of childhood malignancy treatment affected survivors' academic performance (p=0.140), but performance was not statistically significantly different from that of the control group (p=0.923). No difference was found in total monthly income (p=0.920). In social life, there were no differences in living with parents (p=0.002), married life (p=0.118), and offspring (p=0.196), although there was a tendency to lag behind their siblings. CONCLUSION: Treatment of childhood malignancy affected academic achievement and occupational success, while in social life there tended to be differences between survivors and controls, so further study is needed.

The Role of Psychological Factors in the Outcome of In Vitro Fertilization in Women with Primary Infertility.

INTRODUCTION: Infertility is a multidimensional developmental crisis of the individual, couple, family and the population as a whole. This study concentrates on the psychological aspects of infertility treatment by in vitro fertilization (IVF). The aim of this study was to examine a connection between certain psychological factors - anxiety, depression, motivation for parenthood, styles of coping with stress - and the outcome of IVF. SUBJECTS AND METHODS: The study included 100 primarily infertile women aged 23-38 years, who underwent IVF procedure for the first time, at the Department of Gynaecology and Obstetrics of University Hospital Centre Zagreb. Regarding the outcome of IVF, they were divided into two groups, those with positive outcome (N=50), and those with negative outcome of IVF (N=50). We have applied: general data questionnaire, Parenthood motivation scale, COPE Inventory, and Depression, Anxiety, Stress Scales - 21. RESULTS: The dimension of motivation for parenthood Relationship and the styles of coping with stress Seeking emotional support, Planning and Active coping proved to be statistically significant predictors of IVF outcome. By increasing the results on the relationship, seeking emotional support and planning subscales, the likelihood of negative outcome was increased. By increasing the results on the active coping subscale, the likelihood of positive outcome was increased. Anxiety and depression symptoms did not prove to be statistically significant predictors of the IVF outcome. CONCLUSION: The role of psychological factors is important for understanding the diagnosis and treatment of infertility. They also provide the basis for creating guidelines for specific preventive and educational programs and for special forms of psychological counselling for individuals facing infertility.

Social functioning of patients with psychotic disorders in long-term psychodynamic group psychotherapy: preliminary research.

BACKGROUND: In recent years, social functioning of patients has increasingly been used as a criterion for assessing therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. SUBJECT AND METHODS: The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. RESULTS: The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. CONCLUSION: Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders.

Psychotherapy in 21st century.

INTRODUCTION: Today, psychological processes and brain is no longer looked at as something less scientific in comparison with physical processes, so mental diseases will become equal as physical diseases very soon. Until recently, brain functioning could be observed only in patients with cerebral lesions, after surgery, and on animals, but it is possible today to observe it directly with modern imaging techniques. AIM: The aim of this presentation is to point out that optimal health and functioning, which are basic assumptions of both neuroscience and psychotherapy is related to increased level of integrity and neural networks growth. METHODS: Therefore, neurological development can be seen as development determined by experience. More neural networks will be developed during critical periods then, ultimately, will be used. Environment in which child lives and develops determines which networks are going to live through, and those that were not stimulated are susceptible for neural extinction (pruning). Quality of parental relationship has basic impact on brain development. Mother's capacity to regulate newborn's affects is directly linked to future child's capacity to regulate his/her own affects. RESULTS: Positive experiences from an early childhood, together with positive genetic heritage, ensure proper brain development. First years in human life are also a period of most turbulent brain development, and those early experiences have disproportionally large impact on human brain development. CONCLUSIONS: Brain growth and differentiation are not only determined genetically but also with constant interactions with environment. This epigenetic brain information doesn't end in an early childhood. There is a lifelong redistribution of cortical networks, depending on individual experience, including creation of de-novo generation of neurons in adult hippocampus, as recently proved, and neuroplasticity is precondition for any persisted behavioral change, behavior, cognition and emotion.

Correlation of sleep disturbances, anxiety and depression in Croatian war veterans with posttraumatic stress disorder.

The aim of the study was to examine the relationships between global sleep quality and its specific components and Posttraumatic Stress Disorder (PTSD) symptom severity questionnaire. We also researched whether sleep quality and sleep disturbances differed among groups of PTSD based on symptom severity categories. This study was conducted on the sample of 120 Croatian war veterans with PTSD. The following self-report instruments were used: Pittsburgh Sleep Quality Index, the Pittsburgh Sleep Quality Index Addendum for PTSD, the Mississippi Scale for Combat-Related PTSD, the Spielberger State and Trait Anxiety Inventory and the Beck Depression Inventory. There were statistically significant differences between the three PTSD severity groups on general nervousness (PSQI-A variable), where patients with extremely severe PTSD have more symptoms of general nervousness than groups with severe or moderate PTSD. Differences were found between PTSD severity groups in episodes of terror and acting-out dreams, where patients with extremely severe PTSD have more symptoms of episodes of terror and acting-out dreams than groups with severe or moderate PTSD. Sleep quality was significantly correlated with state anxiety, trait anxiety, and depression, indicating that with decrease of anxiety and depression, sleep quality improves. Sleep latency was positively correlated with both state and trait anxiety. There wasn't any significant correlation between sleep latency and depression. Study suggests that sleep disturbances are equally severe across groups of veterans based on PTSD severity and that the severity of sleep disturbances is significantly related to severity of anxiety and depression symptoms.

Life satisfaction in persons of the third age after retirement.

The aim of this research was to determine the role of gender, type of residence, living arrangement, self-rated health status, loneliness, and sense of humor in self-reported life satisfaction in elderly retirees. The study included 300 elderly retirees from Zagreb, Croatia. Demographic data were collected with a structured questionnaire, whereas data on self-reported health status, loneliness, and sense of humor were collected with the UCLA Loneliness Scale, Life Satisfaction Index, HOPA-86, and SF-36 Health Survey. Participants living in a retirement home showed higher life satisfaction than those who lived in their own households. Those who had children showed greater life satisfaction No differences in life satisfaction were found with respect to gender, marital status, or living arrangement. The investigated demographic variables, self-rated health status, self-rated loneliness, and a sense of humor explained 52.8% of variance in life satisfaction. An active sense of humor was the most significant predictor. Living in a retirement home, having children, and having an active sense of humor had a positive influence on self-reported life satisfaction, whereas poorer self-rated health and loneliness had a negative influence. Taking into account the predictors of life satisfaction in preventive activities may contribute to successful aging.

A quality of life in chronic combat related posttraumatic stress disorder--a study on Croatian War veterans.

The main objective of this study was to examine an association of various symptoms in chronic combat-related post traumatic stress disorder (PTSD) and the quality of life in this population. 248 Croatian male war veterans all diagnosed with chronic PTSD were consecutively enrolled in this study as they showed up at the routine check-up. They were given self report questionnaires Trauma Symptom Inventory (TSI-A) evaluating different PTSD symptoms and WHO Quality of Life-BREF assessing four different domains of the quality of life. After independent sample t- test was performed, the presence of each symptom defined by Trauma Symptom Inventory indicated the impairment of all four quality of life domains in a group of subject suffering from it, except of intrusive experience not being associated with the lesser quality in social domain. All quality of life domains were significantly correlated with various PTSD symptoms; however Pearson correlation factors ranged from small to medium value. As expected, PTSD symptoms are associated with lesser quality of life in the affected population. The further research is needed to show possible causal relationship between PTSD and, especially, physical health of these patients.

A multivariate analysis of clinical severity, psychological distress and psychopathological traits in psoriatic patients.

Psoriasis is a chronic skin disease associated with problems in body image and self-esteem and feelings of stigma and shame. The aim of this study was to analyse the clinical extent of psoriasis and its association with psychological distress, and to compare the psychopathological traits in early-onset (type I: age of onset < 40 years) vs. late-onset (type II: age of onset > 40 years) psoriasis. A total of 140 patients participated in the study; 70 patients with confirmed diagnosis of psoriasis vulgaris and 70 patients as a comparative group. A battery of psychological instruments was used together with an Inventory of life stress events. The severity of psoriasis was assessed by standardized Psoriasis Area and Severity Index measure. The Psoriasis Life Stress Inventory showed the significant correlation with clinical extent of psoriasis and other measures of psychological distress. Patients with late-onset psoriasis had more prominent symptoms of depression compared with the group with early-onset psoriasis and the comparative group. The results of the Minnesota Multiphasic Personality Inventory-201 for the patient group with late-onset psoriasis showed a specific configuration of neurotic triad.

Neurobiological and clinical relationship between psychiatric disorders and chronic pain.

Pain is one of the most ubiquitous problems of today's world, its impact being far-reaching. Current conceptualizations of pain medicine adopt a bio-psycho-social perspective. In this model, pain is best described as an interactive, psycho-physiological behavioral pattern that cannot be divided into independent psycho-social and physical components. Neurophysiologic substrates of the pain experience can be broken down into the pain transmission elements emanating from peripheral, spinal, and supra-spinal processes. There are many complex mechanisms involved in pain processing within the central nervous system, being influenced by genetics, interaction of neurotransmitters and their receptors, and pain- augmenting and pain-inhibiting neural circuits. The patient's emotional experiences, beliefs and expectations may determine the outcome of treatment, and are fully emphasized in the focus of treatment interventions. There are several common psychiatric disorders accompanying and complicating the experience of pain that warrant clinical attention and that can be the focus of psychiatric treatment. These include depression, anxiety, sleep disorders, somatoform disorders, substance-related disorders and personality disorders. Complex and disabling pain conditions often require comprehensive pain treatment programs, involving interdisciplinary and multimodal treatment approaches. There are many roles that the psychiatrist can perform in the assessment and treatment of the patients with pain, individually tailored to meet the specific needs of the patient. Rational poly-pharmacy is of a high importance in the treatment of patients with chronic pain, with antidepressants and anticonvulsants contributing as the important adjuvant analgesic agents.

Psychological problems of patients with cancer.

Psycho-oncology is a broad approach to cancer therapy which treats the emotional, social, and spiritual distress which often accompanies cancer patients. The development of psycho-oncology began in the second part of the 20th century reflecting the increased interest in the study of cancer patients' psychological reactions to their illness at all stages of its course, and the analysis of the emotional, spiritual, social, and behavioral factors which influence the risk of developing cancer and long-term aftercare treatment. Today the psycho-oncology has become an accepted part of cancer treatment, with departments of psycho-oncology established in most major cancer centers in Canada, the United States and many Western European countries. A key clinical challenge for the oncologist is differentiating the expected and transient distress associated with cancer from the excessive, disabling distress requiring psychiatric interventions. One third of patients with cancer will experience distress which requires evaluation and treatment, and the most common psychiatric disorders are depression, anxiety disorders and adjustment disorders. Psychiatrists should be involved in the multidisciplinary treatment team who work with the cancer patients. Further research is needed to determine the effectiveness of different psychological and psychopharmacological interventions in psycho-oncology and palliative medicine. Mental health issues should be included in the training of health care professionals in all areas of medicine, psychology and social work to meet the demands of cancer patients.

The connection between coping mechanisms, depression, anxiety and fatigue in multiple sclerosis.

The aim of this study was to show how different coping mechanisms influence the prevalence of anxiety and depression in people suffering from multiple sclerosis. We also aimed at showing how different coping mechanisms contribute to subjective prosperity of the patients emphasizing general health, cognitive functions and fatigue. A questionnaire was given to attendants of the VI Symposium of Patients Suffering From Multiple Sclerosis. Scales were taken from Multiple Sclerosis Quality of Life Inventory (MSQLI), Hospital Anxiety and Depression Scale (HADS) and COPE inventory. A total of 68 anonymous questionnaires were handed in. A total of 57.9% of examinees had symptoms of depression, and 63.2% suffered from symptoms of anxiety. However, majority of the examinees suffered from the combination of these entities. Hypothesis about impact of various coping factors on depression, anxiety, fatigue was validated except an impact on physical state was not proven significant. Predictors improving these states were positive reinterpretation, social emotional support and humor, Predictors worsening these states were planning, acceptance, focus on emotional ventilation and denial. Psychiatric comorbidity has a high prevalence in people suffering from MS. Different coping mechanisms can help in improvement of everyday life.

Five years study on impact of anxiety on quality of life in patients treated with bone marrow transplantation.

OBJECTIVE: This longitudinal research is to follow the changes in quality of life and in anxiety level of patients treated with bone marrow transplantation (BMT). SUBJECTS AND METHODS: Patients selected in period from 1990 to 2000 were treated with bone marrow transplantation and were invited to participate in the study. In ten years period 299 patients were treated with BMT. 109 patients were included in this study (58 male and 51 female) after their informed consent was obtained. 42 of 109 patients were successfully monitored during a five year period and they successfully returned completed questionnaires. RESULTS: The level of Karnofsky scores show statistically significant difference related to time that passed since BMT. Average value of Karnofsky scores in a group of patients 3 months after BMT was 82.22, and in group five years after BMT was 91.76. There is statistically significant difference between these values (p=0.003). Results of anxiety as a trait and as a state also show statistically significant decrease between measuring after leaving the hospital and five years after BMT. CONCLUSIONS: There is statistically significant correlation between anxiety and quality of life, that is, with decrease of anxiety quality of life level increases.

Serum cholesterol concentrations in suicidal and non-suicidal male patients suffering from persistent delusional disorder.

Suicidal behavior is a major health risk in psychiatric disorders, especially in affective and psychotic disorders. The neurobiology of suicidal behavior is still unclear. Suicidality has been related to a reduced cholesterol levels. The aim of this study was to evaluate serum cholesterol concentrations in suicidal and non-suicidal men suffering from persistent delusional disorder and in healthy volunteers. Results showed that serum cholesterol concentrations were significantly lower in suicidal than in non-suicidal patients and healthy controls. Also, level of psychopathology (measured by Brief Psychiatric Rating Scale) is significantly marked in the group of suicidal patients, which indicates the importance of detecting some clinical symptoms in patients with persistent delusional disorder in order to prevent suicidal behavior.

Relationship between combat related posttraumatic stress disorder (PTSD) and multiple sclerosis (MS).

The interrelation between chronic stress and multiple sclerosis (MS) has always been known, but the biological foundation for this phenomenon has not yet been proven. Our case-study of 5 patients, both diagnosed with multiple sclerosis and PTSD, attempts to demonstrate various dimensions of interrelation between these two diseases. We have also tried to point out the problems and possible complications doctors might encounter during the treatment of an MS patient who is suffering from chronic stress. Our findings show the need for a multidisciplinary approach in the treatment of patients with chronic PTSD and co morbid multiple sclerosis, which will optimize treatment and result in more cost-effective care. Appropriate identification and optimal pharmacological interventions for both disorders might modify further chronicity of these disorders and thus achieve better outcome.

Smaller right hippocampus in war veterans with posttraumatic stress disorder.

Chronic stress can putatively cause damage in the human hippocampus, but evidence of damage has not been consistently shown in studies on hippocampal morphology in posttraumatic stress disorder (PTSD). We compared hippocampal volumes in PTSD patients and normal subjects. Using a 3D T1-weighted GRE magnetic resonance imaging sequence, we measured hippocampal volumes in 15 war veterans with combat-related chronic PTSD and 15 case-matched normal controls. Although war veterans, our PTSD subjects were not professional soldiers and were mobilized shortly before they were exposed to a very specific combat-related trauma over a 3-day period. In our study, the period between traumatic exposure and imaging was considerably shorter, on average, 9 years, compared with at least two decades in previous studies on subjects with combat-related PTSD. Moreover, our subjects were free of any comorbidity, treatment or medication. The right hippocampus was significantly smaller in PTSD subjects than in healthy controls. The left hippocampus was also smaller in PTSD subjects than in controls, but the difference was not significant. In all PTSD subjects, the right hippocampus was smaller than the left (on average, 7.88%). Our results show smaller volume of the right hippocampus in PTSD patients than in normal subjects.

Coping with severe burns in the early stage after burn injury.

This study examined the relationship between coping strategies, anxiety and depression levels and burn injury characteristics in the early phase of the treatment in burn-injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. Coping strategies were measured by the coping with burns questionnaire (CBQ). Anxiety and depression levels were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. There were no statistically significant gender differences in various coping strategies. Avoidance was associated with higher levels of anxiety, depression and hopelessness. The percentage of total body surface area (TBSA) and localization of burns were not associated with coping patterns. Implications for the assessment and management of burn injured patients were discussed.

Self-inflicted burns in patients with chronic combat-related post-traumatic stress disorder.

This study examined self-inflicted burns in case series of four patients with chronic combat-related post-traumatic stress disorder (PTSD). Those patients were hospitalized in the Burn Unit of the University Hospital of Traumatology in Zagreb because of severe burns and had a premorbid psychiatric history of PTSD. Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of these patients were collected. The authors have analyzed possible impacts of the sensationalistic way in which media present cases of self-inflicted burning that induce other, new cases of this suicide type, known in the literature as "Werther's syndrome". The importance of multidisciplinary approach in the treatment of burn patients is stressed with emphasis on the important role of liaison psychiatrist in treating these patients. It is necessary to educate media people to avoid sensational reporting on this kind of events. Continuous psychiatric treatment of vulnerable individuals could be useful in prevention of self-inflicted burns.

[Psychotherapeutic effect on cerebral blood flow--case report]. / Utjecaj psihoterapije na mozdanu cirkulaciju--prikaz bolesnika.

This is a case report on a 36-year-old Croatian war veteran who was seeking psychiatric treatment because of disturbances which were manifesting in: difficult impulse control, aggressive acting out reactions, continuous conflict with surroundings, and in traumatic and repeating nightmares. Posttraumatic stress disorder (PTSD) was diagnosed according to MKB-10 criteria and comorbid diagnoses were not found. After detailed psychiatric, psychological and neurological testing, brain SPECT was performed while the patient was medication free. Brain imaging was done twice within two-week period to avoid possible artefacts and to enhance statistical significance of possible pathological findings. SPECT results showed significant unilateral increase of regional cerebral blood flow (over 20% increased brain activity in dominant hemisphere, analyzed semiquantitatively using region-of-interest based method, and normalized to the mean brain activity) relative to opposite hemisphere in projection area of amygdala/nucleus accumbens. After the completion of all testing the patient started intense group psychotherapy of one year duration which was focused on interpersonal and social relations. After one year symptoms diminished, his impulse control became more adequate and he had no more aggressive acting out reactions, all of which was also objectified with information from patient family. Brain SPECT imaging was then repeated, twice within two-week period, and it showed normalization of findings and no significant differences in regional cerebral blood flow between cerebral hemispheres.

Characteristics of the Group Process in Long-Term Psychodynamic Group Psychotherapy for Patients with Psychosis.

This study aimed to investigate the development of the group process through group climate parameter dynamics during long-term psychodynamic group psychotherapy for 30 outpatients with psychosis. The group process in four groups was monitored using MacKenzie's Group Climate Questionnaire-Short Form (GCQ-S) that was completed by the therapist after each session over the two-year period. The trends of engagement, avoidance and conflict parameters differed between groups, and no clear indicators of the development phases were found. The results suggested that these groups remained in the first developmental phase during the observation period, and highlighted the characteristics of resistance and difficulties in establishing social relations in patients with psychosis.

[Diagnostic and therapeutic guidelines for posttraumatic stress disorders]. / Dijagnosticke i terapijske smjernice za posttraumatski stresni poremecaj.

Posttraumatic stress disorder (PTSD) presents an important medical and social problem in the Republic of Croatia with prevalence of 10-30% depending on the population. On the basis of our 8-year clinical experience in treating PTSD and detailed analysis of related literature a special team of the Department of Psychological Medicine, Zagreb University Hospital, compiled the proposed guidelines for diagnostics and treatment of PTSD. The established guidelines are independently developed, clinically proven at our Clinic and in terms of custom made procedure world wide unique. Their essential feature is psychoanalytic comprehension and approach to etiopathogenesis of PTSD, although it also applies to other psychotherapeutic techniques (cognitive-behavioral, relaxation, existential). The diagnostic model is based upon structured clinical interview (DSM-IV, ICD-10), but it also complies with the principles of psychotherapeutic interview. Therapeutic interventions as proposed are divided according to therapeutic goal into symptomatic and etiological.