Marital loss, gender and their association with mental health and physical health outcomes in Bosnian refugees: lesson reminder in a time of war.

INTRODUCTION: Mental health disorders and chronic health diseases are highly prevalent and impactful consequences of distressful experiences among refugees, yet a comprehensive conceptual model encompassing biopsychosocial factors is lacking. This study aims to assess the relevance of widowhood to PTSD and major depression maintenance as well as to adverse health outcomes in a cohort of Bosnian refugees. METHODS: This longitudinal study included 526 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varazdin, Croatia, in the Bosnian language. Data were collected using the Harvard Trauma Questionnaire and Hopkins Checklist-25, respectively. Physical health disorders were self-reported. RESULTS: Both at baseline and endpoint female gender and marital loss are associated with a statistically significant higher burden of psychological and physical health outcomes. This group showed higher rates of PTSD and major depression disorders, as high comorbidity with hypertension, cardiovascular diseases, asthma and arthritis. DISCUSSION: The results of the present study align with a wealth of literature studies linking marital loss to shifts in mental health and impaired physical health. A conceptual framework is provided for understanding how both mental health and physical health outcomes are highly dependent on social phenomena. CONCLUSIONS: This investigation reinforces the hypothesis of the role of social bonds and marital support in recovery from trauma experiences. Further studies are, however, needed for a better understanding of the consequences of adverse events on trauma-exposed subjects from a holistic bio-psycho-social point of view.

Predictors of Chronic Combat-Related Post-Traumatic Stress Disorder Group Psychotherapy Favorable Outcomes; A Prospective Cohort Study in Croatia.

BACKGROUND: Combat-related chronic post-traumatic stress disorder (PTSD) is a therapeutically resistant disorder of the fluctuating course. The success of a group psychotherapy is partial. The aim of this paper is to determine baseline characteristics of veterans for whom a group psychotherapy will be the effective psychotherapeutic treatment. SUBJECTS AND METHODS: We performed this prospective cohort study in two geographically distant institutions: Regional Psychotrauma Center at the Psychiatric Clinic Split, and the Daily Hospital of the Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia. We selected a consecutive sample of 86 veterans with combat-related chronic PTSD admitted to the group psychotherapy during 2009-2012. The primary outcome was ≥5% improvement in PTSD symptoms severity measured by Mississippi Scale for Combat-Related PTSD and adjusted for the baseline Mississippi scale score. Predictors were participants' 17 baseline sociodemographic and clinical characteristics and psychological features like personality traits, stress-coping mechanisms, and depression. RESULTS: We identified two patients' segments with significantly higher likelihood for the favorable treatment outcome. The first one were patients with the low score (≤8) on the phobia scale and high score (≥7) on the hysterical personality scale. In this segment 100% of patients experienced a favorable treatment outcome. The second one were the patiens with a higher score (>8) on the phobia scale, the low score (≤12) on the free-floating anxiety scale and the high score ≥8) on the obsession scale. In this segment, 64% experienced the favorable treatment outcome. CONCLUSION: The favorable outcome of the group psychotherapy of PTSD symptoms severity in patients with combat-related chronic PTSD can be predicted before the start of the treatment. The favorable outcome should be expected in patients with the low phobia and pronounced hysteria personality traits, or in patients with higher phobia, but with low free-floating anxiety and low obsession.

Psychosocial effects of the quarantine during the first wave of the COVID-19 pandemic on the residents of the island of Brac.

BACKGROUND: An unprecedented health and economic crisis in small island communities during the COVID-19 pandemic indicated the importance of studying its harmful effects on residents' mental health. OBJECTIVES: To examine the differences in negative affectivity, perceived stressors, and social support both on the quarantined and not quarantined islands. METHODS: A web-based survey and correlational cross-sectional research design were used, based on a nonprobabilistic convenience sampling method to select 613 Croatian islands' residents during May 2020. The participants completed the Depression, Anxiety and Stress Scale (DASS-21) and the General Information Questionnaire, data on their exposures to stressors during the COVID-19 pandemic and the perceived social support. RESULTS: Compared with the nonquarantined residents of other islands, the island of Brac residents scored significantly higher on the symptoms of depression (M = 11.61; t = 2.13, P < 0.05) and stress (M = 13.06; t = 3.21, P = 0.001) subscales, receiving more support from religious communities (t = 2.34, P = 0.02) and less from the physicians (t = -2.68, P = 0.01). Lower sociodemographic status was associated with higher levels of depression, anxiety, and stress. CONCLUSION: The COVID-19 pandemic highlighted the urgent need to protect mental health in isolated island areas specially for singles and people of low socioeconomic status.

BACKGROUND: This study contributed to the recognition and understanding of the pandemic's impact on the mental health of the isolated island population. The aim was to examine the differences in perceived stressors, perceived social support, and negative affectivity (symptoms of depression, anxiety, and stress) between residents of Brac directly affected by the COVID-19 pandemic and residents of other islands not directly exposed to the pandemic. METHODS AND EXAMINEES: A total of 613 inhabitants of the Croatian islands were included in the analysis during pandemic in May 2020. All participants answered web-based survey about perceived stressors, social support, and psychological symptoms. RESULTS: Staying on the quarantined island during the pandemic significantly contributed to the levels of depressive, anxiety, and stress symptoms. It also highlighted the positive impact of connections with family members and the religious community as well as the negative impact of lower socioeconomic status on adaptation in times of pandemic. CONCLUSION: Despite the short duration, the psychological effects of a pandemic were more visible in residents of an island affected by a pandemic compared with residents of other islands not exposed to COVID-19 pandemic.

Peritraumatic Distress and Posttraumatic Stress Symptoms During the COVID-19 Pandemic: The Contributions of Psychosocial Factors and Pandemic-Related Stressors.

The present study aimed to identify the contributions of sociodemographic factors, psychological hardiness, and pandemic-related stressors to the development of peritraumatic distress and posttraumatic stress symptoms (PTSS) during the peak of the COVID-19 pandemic. We also examined the mediating contribution of peritraumatic distress with respect to the associations between PTSS and (a) individual characteristics and (b) pandemic-related stressors. A total of 1,238 participants (82.1% women, 17.9% men) aged 18-75 years were included in the study. Participants completed the Dispositional Resilience Scale, Peritraumatic Distress Inventory, and Posttraumatic Stress Disorder (PTSD) Checklist. The results showed that 11.5% of participants scored above the clinical cutoff for peritraumatic distress, and 12.8% of participants scored above the clinical cutoff for PTSS. Regression models showed that higher levels of peritraumatic distress were statistically predicted by female gender, ß = -.12, p < .001; exposure to more than one stressor, ß = .21, p < .001; lower levels of commitment to people and activities, ß = -.12, p = .002; and resistance to challenges, ß = -.17, p < .001. Additionally, male gender, ß = .05, p = .007; younger age, ß = -.05, p = .005; lower levels of commitment to people and activities, ß = -.11, p < .001; lower ratings of hardiness with regard to challenge, ß = -.04, p = .043; and more severe peritraumatic distress, ß = .75, p < .001, predicted more severe PTSS during the pandemic. Peritraumatic distress mediated the associations between PTSS and both the number of experienced stressors and psychological hardiness.

Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees.

BACKGROUND: Little is known about gender differences among people exposed to war related trauma. Aim of this study is to explore gender differences in health status and comorbidity of mental and physical disorders in a cohort of Bosnian refugees followed up for 3 years (1996-1999). METHODS: This longitudinal study included 534 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varazdin, Croatia in Bosnian language. Data were collected using Harvard Trauma Questionnaire (Bosnian version) and Hopkins Checklist-25, respectively. Physical health disorders were self-reported. RESULTS: In both assessments there was a statistically significant difference between men and women in the number of physical health disorders, even when results were controlled for educational status. Although there was no difference in total number of symptoms in both assessments (F = 0.32; df = 1; p > 0.05 and F = 1.15; df = 1; p > 0.05), important physical health disorders were significantly more frequent among women than in men in different educational groups, namely high blood pressure and cardiovascular diseases, arthritis, and anaemia. Asthma, tuberculosis, cirrhosis of the liver, ulcer and epilepsy were more frequent in men than in women. There were no differences in frequencies of psychiatric disorders at baseline, but frequency of psychiatric disorders in women was higher at endpoint for uneducated respondents. There was significant difference compared to men in group of respondents without formal education, but only in comorbidity of PTSD and depression which was more often present in females (22.1%) than in males (3.6%). CONCLUSION: Our findings indicate the importance of gender and education on mental and physical health of people exposed to warrelated trauma. Long term health monitoring and programs, especially related to women's health are needed in order to avoid lasting consequences.

Emotional Competence and Coping Mechanisms in Croatian Women with Borderline Personality Disorder: the Role of Attachment.

BACKGROUND: The purpose of this study was to examine differences in attachment, emotional competence and coping strategies among women with BPD and a control group, and the contribution of the attachment dimensions to the emotional competence and coping styles. SUBJECTS AND METHODS: The group of women with BPD (N=30) and control group of hospital employees (N=47) participated in this cross-sectional study. Attachment, emotional competence and coping were determined by using self-evaluation questionnaires. RESULTS: The results showed that subjects with BPD more often had insecure attachment, lower emotional competence and ineffective coping strategies compared to controls. Higher levels of insecure attachment predicted lower levels of emotional competence and majority of ineffective coping strategies. CONCLUSION: The main findings of this study indicated the importance of insecure attachment to the maintaining of stress intolerance and, particularly, emotional incompetence, which has not been previously studied in the context of BDP. By improving emotional competence and developing more effective coping strategies during therapy, it is possible to contribute to better functionality across different life situations in women with BDP.

Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study.

BACKGROUND: Early exposure to trauma is a known risk factor for personality disorder (PD), but evidence for late-onset personality pathology following trauma in adults is much less clear. We set out to investigate whether exposure to war trauma can lead to lasting personality pathology in adults and to compare the mental health and social functioning of people with late-onset personality problems with those with PD. METHODS: We recruited patients who scored positively on the International Personality Disorder Examination (IPDE) in southern Croatia 15 years after the Croatian war of independence and used a semi-structured interview to establish when the person's personality-related problems arose. All participants also completed Harvard Trauma Questionnaire, and measures of mental health and social functioning. RESULTS: Among 182 participants with probable personality disorder, 65 (35.7%) reported that these problems started after exposure to war-trauma as adults. The most prevalent personality problems among those with late-onset pathology were borderline, avoidant, schizotypal, schizoid and paranoid. Participants with late-onset personality pathology were more likely to have schizotypal (75.4% vs. 47.3%) and schizoid traits (73.8% vs. 41.1%) compared to those with PD. Participants with late-onset personality pathology were three times more likely to have complex personality pathology across all three DSM-IV clusters compared to those with PD (OR = 2.96, 95% CI 1.54 to 5.67) after adjusted for gender and marital status. The prevalence of depression and social dysfunction were as high among those with late-onset personality pathology as among those with personality disorder. CONCLUSION: Retrospective accounts of people with significant personality pathology indicate that some develop these problems following exposure to severe trauma in adulthood. Personality-related problems which start in adulthood may be as severe as those that have an earlier onset. These findings highlight the long term impact of war trauma on the mental health and have implications for the way that personality pathology is classified and treated.

Severe war-related trauma and personality pathology: a case-control study.

BACKGROUND: Exposure to war-related trauma has long been recognised to have an adverse effect on mental health. We attempted to investigate whether people who have clinically significant personality-related problems 15 years after a war are more likely to have been exposed to severe war-related trauma than those who do not have significant personality difficulties. METHODS: A case -control study was conducted in southern Croatia, fifteen years after the 1991-1995 war. We recruited 268 participants: 182 cases who scored positively on the International Personality Disorder Examination scale (IPDE), and 86 controls who were IPDE negative. Severity of war-related trauma was assessed according to the 17 items on the Harvard Trauma Questionnaire (HTQ) trauma event scale, which were considered to be of severe (catastrophic) nature based on the ICD-10 description of catastrophic trauma and the opinion of trauma experts. All participants also completed measures of mental health (depression, anxiety and PTSD), social functioning and current substance misuse. RESULTS: Cases (IPDE positive) were eight times more likely to report exposure to severe war-related trauma than controls. This association increased after adjustments for demographic factors (OR = 10.1, 95% CI 5.0 to 20.4). The types of severe trauma most frequently reported were either the participants'own life being in direct danger or witnessing extreme violence inflicted on others or the result of violence towards others (murder, torture, seeing burned or disfigured bodies). Prevalences of depression, anxiety and PTSD were high among IPDE positive participants 15 years after exposure to war trauma. Their level of interpersonal dysfunction was considerably higher than that in controls (OR = 10.39, 95% CI 3.51 to 30.75). Alcohol consumption in cases was significantly higher with a mean of 14.24 units per week (sd = 11.03) when compared to controls whose mean number of alcohol units was 9.24 (sd = 7.25), t (73) = 2.16, p < 0.05, mean difference 4.99 (95% CI = 0.39 to 9.60). Similarly, a significantly higher number of cases reported current substance misuse (8.2% vs. 0.0%) X2 (1, n = 268) = 7.51, p < 0.05). CONCLUSION: Exposure to severe war-related trauma is a risk factor for interpersonal dysfunction15 years after people were exposed to an armed conflict. These findings have implications for assessing and meeting the long-term mental health needs of people in war-affected regions. Further research needs to be done to increase our understanding about the relationship between severe war trauma and personality related problems.

Diagnostic Interview for Genetic Studies: validity and reliability of the Croatian version.

OBJECTIVE: To test the validity and reliability of the Diagnostic Interview for Genetic Studies (DIGS) in patients with mental illness in Croatia. MATERIALS AND METHODS: Following translation, back-translation, and pilot testing, the Croatian version of DIGS (CRO-DIGS) was administered to a total of 150 inpatients and outpatients diagnosed at the Clinical Hospital in Split with bipolar and major depressive disorder (n=56), schizophrenia and schizoaffective disorder (n=62), and alcohol dependence or use disorders (n=32). Initial testing was performed independently by one interviewer and one observer blinded to the diagnosis, and a retest was performed after 8 weeks by a third examiner. RESULTS: The validity of CRO-DIGS was high (κ=0.916), with an excellent inter-rater (κ=0.824) reliability, especially for bipolar disorder (κ=0.956). Following an 8 week test-retest interval, the reliability for all diagnoses was found to be excellent (κ=0.843). CONCLUSION: Our study has shown excellent validity and reliability of the Croatian version of DIGS, making it a promising instrument to assess mental illness of patients. The development of a valid and reliable diagnostic tool such as the CRO-DIGS will considerably advance the scientific communities' ability to carry out genetic studies of psychiatric illness in the region.

Day Hospital Treatment as a Missing Link for Single Patients with Posttraumatic Stress Disorder (PTSD): a Preliminary Study.

BACKGROUND: The aim of this study was to examine the day hospital treatment outcome on severity of clinical manifestations, general neuroticism and coping mechanisms in patients suffering from chronic combat-related PTSD. SUBJECTS AND METHODS: The sample consisted of 38 consecutive patients admitted to the Day Hospital treatment of PTSD during one year observation period. The average age of the sample was 46.03 years. The patients completed 3 self-report measures upon admission to the hospital and upon discharge: The Mississippi scale for combat-related PTSD (M-PTSD), The Crown-Crisp experiential index (CCEI), and The COPE inventory. RESULTS: There was no significant change in the severity of clinical manifestations of PTSD, general neuroticism and coping mechanisms among the whole sample. However, compared to married participants and participants with children, single participants and those without children reported higher levels of anxiety when admitted to the hospital, but lower levels at discharge. In addition, patients without children reduced their avoidance behavior during the treatment. CONCLUSION: This preliminary study showed that single patients and those without children may benefit more from the day hospital treatment program. Our findings emphasize the importance of social support in the recovery process of severely traumatized persons, and may assist with the development of more effective therapeutic approaches.

Comparison of Sleep Disturbances in Post-Traumatic Stress Disorder and Depression Patients

The aim of this study was to explore differences in the intensity of depressiveness, sleep disturbances and sleepiness between post-traumatic stress disorder (PTSD) patients and patients with depression. A total of 170 patients were examined, including 120 PTSD patients and 50 patients with depression. All participants completed the Beck Depression Inventory, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. The results showed difference in the subjective assessment of sleep quality between the war veterans with PTSD and civilians with depression, without significant differences between them in the level of depressiveness and sleepiness. Considering the fact that insomnia can occur as an early, covert sign of both PTSD and depression and that differences in the intensity of sleep disturbances between the groups were established, the use of these and similar instruments for the assessment of sleep quality can be useful in distinguishing patients with PTSD and depression, treatment of their sleep disturbances, and prevention of more severe symptoms in both diagnostic categories.

Comorbidities with Posttraumatic Stress Disorder (PTSD) among combat veterans: 15 years postwar analysis.

The aim of this study was to investigate the differences in the prevalence of somatic diseases among combat veterans and their contemporaries who were not exposed to the traumatic experience at the battlefield, and to determine whether socio-demographic factors, exposure to war-time trauma and/or injury might predict individual somatic diseases. The study included 1,558 subjects living in south Croatia: 501 male combat veterans with Posttraumatic Stress Disorder (PTSD) and the corresponding control group of 825 men who were not exposed to combat experience. Veterans with PTSD, regardless of the length of time spent in war, suffered more often from cardiovascular, dermatological, musculoskeletal, pulmonary and metabolic diseases than corresponding control subjects who were not exposed to combat experience. The predictors of cardiovascular, musculoskeletal and malignant diseases in veterans were age, length of time spent in combat, having been wounded. A longer period in the combat zone was associated with arrhythmias in veterans with PTSD complicated with other psychiatric comorbidities. PTSD as a result of exposure to war trauma increases the possibility of developing somatic diseases.

El propósito de este estudio ha sido comparar la frecuencia de trastornos somáticos en veteranos de guerra y personas no expuestas a la experiencia traumática del campo de batalla, así como determinar si la exposición a factores socio-demográficos en tiempo de guerra pueden predisponer a traumas, alteraciones o trastornos somáticos. El estudio incluye 1,558 sujetos del sur de Croacia: 501 varones veteranos de guerra con síndrome de estrés postraumático (TEPT) y un grupo de control de 825 varones no expuestos a la experiencia de combate. Los veteranos con TEPT, independientemente del tiempo pasado en la guerra, desarrollan más a menudo alteraciones gastrointestinales, cardiovasculares, dermatológicas, locomotoras, pulmonares y metabólicas que los sujetos del grupo control. Los indicadores de alteraciones cardiológicas, locomotoras, entre otros, en veteranos han sido la edad, el tiempo pasado en combate y el daño allí sufrido. Un largo período en la zona de combate ha sido asociado con arritmias y otras complicaciones de tipo psiquiátrico. El TEPT, como resultado de la exposición a experiencias traumáticas del campo de batalla, incrementa la posibilidad de desarrollo de trastornos somáticos.

Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder.

BACKGROUND: Along with primary traumatization, wives of PTSD-diagnosed war veterans often become victims of the altered and dysfunctional state of their partners, which adds to the severity of symptoms of primary traumatization and furthers the development of other mental disorders. The aim of this study was to compare the effects of primary and secondary traumatization in wives of PTSD-diagnosed war veterans and wives of war veterans without PTSD. SUBJECTS AND METHODS: The experimental group consisted of 154 wives whose veteran husbands had been treated in Mostar Clinical Hospital for psychotrauma-induced PTSD. The control group was formed of 77 wives of war veterans who do not suffer from PTSD. The research used a general demographic questionnaire, the Harvard Trauma Questionnaire (HTQ) and the MINI International Neuropsychiatric Interview. RESULTS: Wives of veterans with chronic PTSD experienced a significantly greater number of traumatic events (t=2.66; p=0.008) and had higher scores of PTSD symptoms (t=8.93; p<0.001). A significantly larger number of these women reported chronic somatic diseases (χ²=4.553; p=0.033). Furthermore, wives of PTSD-affected veterans significantly more frequently met criteria for current depression episode (χ²=20.65; p<0.001), past depression episode (χ²=24.40; p<0.001), depression with melancholic features (χ²=19.20; p<0.001), dysthymia (χ²=7.15; p=0.007), panic disorder with agoraphobia (χ²=5.28; p=0.022), PTSD (χ²=18.39; ss=1; p<0.001) and generalized anxiety disorder (χ²=19.58; p<0.001). This group also showed a higher level of suicidality (χ²=8.95; p=0.003). CONCLUSION: The findings of this research show how mental difficulties experienced by wives of PTSD-diagnosed war veterans affect the interrelationship of their primary and secondary traumatization.

Long-term improvement in coping skills following multimodal treatment in war veterans with chronic PTSD.

Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years. The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.

The personality traits and social characteristics of Croatian heroin addicts and cannabis users.

The purpose of this study was to investigate differences in social characteristics (level of education, working and family status, and criminal record) between heroin addicts, cannabis users and a control group. Additional goal was to explore the possibility of discerning subjects of different addiction status (of both gender) based on their scores on Eysenck Personality Questionnaire (EPQ). In comparison to the control group, heroin addicts and cannabis users had lower level of education, were more frequently unemployed and with criminal record, and more often came from dysfunctional families. In cannabis users the frequency of these characteristics was generally lower than in heroin addicts. Proportion of correct classification of subjects in groups of different addiction status based on the EPQ scores was 23.3% for males (higher than by chance alone), and 30% for females.

Defense mechanisms in alcohol dependent patients with oral and oropharinegal cancer.

The effects of psychological factors in alcoholics with malignant tumor of the oral cavity and oropharynx are scarcely explored. The aim of the research was to examine early family relations and investigate differences in the use of defense mechanisms in alcohol dependent patients suffering from malignant tumor of the oral cavity and oropharynx compared to alcohol dependent persons without malignant tumors and healthy controls. The research included 51 alcohol dependent patients treated for malignant tumor of the oral cavity and oropharynx at the University Hospital Center Rijeka from 2005 to 2009. The control groups corresponded to the experimental group in age, sex and education level. The research used a general demographic questionnaire, the Mini International Neuropsychiatric Interview and the Revised Questionnaire of Life Style and Defense Mechanisms. The research groups showed significant differences in difficult childhood (p < 0.001) including abuse (p = 0.004). The alcohol dependent persons suffering from malignant tumors of the oral cavity and oropharynx significantly less frequently used primitive defense mechanisms of regression (p = 0.004) and displacement (p = 0.013) compared to alcoholics without malignant tumors who significantly more often used neurotic defense mechanisms - compensation (p = 0.005) and intellectualization (p < 0.001). The earliest emotional experiences and quality of family relations affect the development of defense mechanisms. These are the psychological factors in the development of oropharyngeal cancer in alcohol addicts.

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study.

AIM: To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). METHODS: The research included 247 veterans of the 1991-1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following self-assessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI). RESULTS: Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N=140) and the group with both PTSD and DESNOS (N=107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U=3733.5, P=0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U=1123.5, P=0.049) and twice more frequently reported comorbid depression with melancholic features (OR=2.109, P=0.043), social phobia (OR=2.137, P=0.036), or panic disorder (OR=2.208, P=0.015). CONCLUSION: Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes.

The Croatian version of diagnostic interview for genetic studies.

Diagnostic Interview for Genetic Studies (DIGS) is a modern structured interview schedule that has been in use since 1994. Main purpose of the DIGS is to record information regarding to a subject's functioning and psychopathology and it was specifically designed for psychiatric genetic studies. The DIGS is also suitable for making diagnosis, evaluation of comorbidity and other researches. It contents items and sections and has a semi-structured design that gives interviewers the freedom needed to extract the best in formation possible. The validity of a Croatian version of the DIGS was investigated. The original English version was initially translated into Croatian. The Croatian version was then back-translated and compared with the original. In this paper we will describe each item that DIGS contents as well as the use of this diagnostic instrument.

Schizophrenia spectrum psychosis in a Croatian genetic isolate: genealogical reconstructions.

BACKGROUND: Schizophrenia spectrum psychosis is a chronic mental disorder, based on a range of genes whose expression can be altered by different environmental factors. SUBJECTS AND METHODS: In this archival and demographic study of genetic isolate we show an incidence of schizophrenia spectrum psychosis in a minority population and transmission of schizophrenia spectrum psychosis through several generations of two families in an isolated rural area of Dalmatia from the second half of 19th and the first half of 20th century. RESULTS: The incidence of schizophrenia spectrum psychosis was between 0.58 and 2.58 per 1000 inhabitants. The genogram of Family 1 shows that out of 182 descendants in six generations, there were 27 people with schizophrenia spectrum psychosis. Schizophrenia spectrum psychosis occurred in two men who were born from a relationship of a mother with her relative. The genogram of Family 2 shows that 19 out of 86 descendants in five generations suffered from schizophreniform psychosis. CONCLUSION: The high occurrence of schizophrenia spectrum psychosis in an isolated village in central Dalmatia is in accordance with the results of earlier studies in that region. The fact that psychosis occurs in varying frequency, without obvious regularity, can be explained by the irregular expression of risk genes as well as by exogenous factors which may affect the activity of the key chromosome areas. Occurrence of psychosis in people born from incestuous relationships indicates the importance of genetic factors in the development of the disorder.