Perceived Stress, Salivary Cortisol, and Temperament Traits among Students of Dental Medicine: A Prospective and Interventional Study.

Academic stress affects students' psychological and physiological well-being. Dental undergraduate programs are known for their demanding curriculum, leading to significant stress symptoms. The objective was to determine if salivary cortisol levels were higher in students exposed to academic stress, assess the relationship between stress severity/temperament and cortisol values, and explore relaxation technique effects. Salivary cortisol was measured at two time points for all participants: Before exams and during a relaxation period after summer break. A third measurement was conducted for students with high pre-test cortisol levels who received instructions on progressive muscle relaxation (PMR) before subsequent exams. Additionally, participants completed two questionnaires: Perceived Stress Scale (PSS) and Fisher's Temperament Questionnaire. The group analysis based on the PSS indicated that 39 participants reported high stress. Women demonstrated significantly higher stress than men (p = 0.042054). A significant difference in stress levels was observed between director and builder temperament types (p = 0.029276). Cortisol levels showed a significant decrease from the first measurement to the second measurement, and the third measurement after implementing PMR. The grade in the "Dermatovenereology" course correlated with stress level according to the PSS (k = 0.578467). Pre-test cortisol levels correlated with the frequency of using PMR guidelines during winter test periods (k = 0.416138). Stress negatively affects the immune system and poses health risks. Implementing stress reduction techniques in dental/medical education could benefit students and the healthcare system.

Melatonin in Dermatologic Allergic Diseases and Other Skin Conditions: Current Trends and Reports.

Melatonin is the main hormone that regulates the sleep cycle, and it is mostly produced by the pineal gland from the amino acid tryptophan. It has cytoprotective, immunomodulatory, and anti-apoptotic effects. Melatonin is also one of the most powerful natural antioxidants, directly acting on free radicals and the intracellular antioxidant enzyme system. Furthermore, it participates in antitumor activity, hypopigmentation processes in hyperpigmentary disorders, anti-inflammatory, and immunomodulating activity in inflammatory dermatoses, maintaining the integrity of the epidermal barrier and thermoregulation of the body. Due predominantly to its positive influence on sleep, melatonin can be used in the treatment of sleep disturbances for those with chronic allergic diseases accompanied by intensive itching (such as atopic dermatitis and chronic spontaneous urticaria). According to the literature data, there are also many proven uses for melatonin in photoprotection and skin aging (due to melatonin's antioxidant effects and role in preventing damage due to DNA repair mechanisms), hyperpigmentary disorders (e.g., melasma) and scalp diseases (such as androgenic alopecia and telogen effluvium).

SALIVARY MELATONIN VALUES SIGNIFICANTLY CORRELATE WITH REDUCED QUALITY OF LIFE IN CHRONIC SPONTANEOUS URTICARIA PATIENTS: A PILOT STUDY.

Chronic spontaneous urticaria (CSU) is a dermatological disorder accompanied by itching that greatly affects the quality of life and quality of sleep. Therefore, it is assumed that CSU patients consequently experience reduced melatonin secretion and lower values of serum or salivary melatonin. This pilot study included 20 patients with CSU (chronic urticaria of unknown etiology that lasts for more than 6 weeks) and 10 healthy controls. All subjects were examined by a dermatovenereologist-allergist, as well as an oral pathologist, to exclude oral pathological conditions. Salivary melatonin levels were determined by ELISA and all subjects completed a standardized Dermatology Life Quality Index questionnaire and Pittsburgh Sleep Quality Index on the same day they gave a saliva sample for analysis. According to our results, 86% of CSU patients had decreased values of salivary melatonin, and lower salivary melatonin values significantly correlated with a reduced quality of life in CSU patients. This study was the first to analyze melatonin in CSU patients, also suggesting a possible new therapeutic option for the treatment of CSU.

Effects of aripiprazole long-acting injectable antipsychotic on hospitalization in recent-onset schizophrenia.

OBJECTIVE: Recent-onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long-acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first-line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS. METHODS: This mirror-image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale-severity of illness (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up. RESULTS: Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p = 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001). CONCLUSION: Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socio-economic healthcare burden.

Vitamin D and Neurotrophin Levels and Their Impact on the Symptoms of Schizophrenia.

INTRODUCTION: Vitamin D is involved in brain development and functioning, as well as in regulation of neurotrophic factors. Changes in the expression of those factors are possibly responsible for morphologic abnormalities and symptoms in patients suffering from schizophrenia. OBJECTIVE: The main goal of this research was to investigate the interrelationship between vitamin D, nerve growth factors (NGF, brain-derived neurotrophic factor [BDNF], and neuregulin-1 [NRG1]), and schizophrenia symptom domains. METHODS: This research included 97 inpatients diagnosed with schizophrenia. Schizophrenia symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Blood samples were taken in order to analyze concentrations of vitamin D, BDNF, NRG1, and NGF growth factors. The obtained results were used in a multiple regression analysis. RESULTS: The vitamin D concentration positively affected the concentration of NRG1 (F = 8.583, p = 0.005) but not the concentration of other investigated growth factors (BDNF and NGF). The clinical characteristics and symptom domains of schizophrenia seemed to be unaffected by the concentrations of vitamin D, BDNF, and NGF, while the NRG1 concentration significantly affected positive symptom domains of schizophrenia (F = 4.927, p = 0.030). CONCLUSION: The vitamin D concentration positively affected NRG1 levels but not schizophrenia symptomatology as measured by PANSS. The as-sociation between the two could be intermediated via NRG1.

EIGHTY YEARS OF ELECTROCONVULSIVE THERAPY IN CROATIA AND IN SESTRE MILOSRDNICE UNIVERSITY HOSPITAL CENTRE.

In 1937, Ugo Cerletti and Lucio Bini performed electroconvulsive treatment (ECT) in Rome for the first time. That was the time when different types of 'shock therapy' were performed; beside ECT, insulin therapies, cardiazol shock therapy, etc. were also performed. In 1938, Cerletti and Bini reported the results of ECT. Since then, this method has spread rapidly to a large number of countries. As early as 1940, just two years after the results of the ECT had been published, it was also introduced in Croatia, at Sestre milosrdnice Hospital, for the first time in our hospital and in the then state of Yugoslavia. Since 1960, again the first in Croatia and the state, we performed ECT in general anesthesia and continued it down to the present, with a single time brake.

Correlation Between Salivary Biochemical Stress Indicators and Psychological Indicators.

Saliva is a complex body fluid that has various functions in the oral cavity. Central nervous system has the most important role in regulating salivation. Saliva as a sample is suitable for simplicity of sampling and because it contains analytes in the free active form. Stress is a condition in which the internal (psychophysical) balance of the body is disturbed. It activates the hypothalamic-pituitary axis, so salivary cortisol is a free cortisol indicator that correlates well with its serum value and reflects the free fraction that is biologically active. At the same time, stress conditions stimulate the sympathetic neuronal system causing change in the secretion of salivary α-amylase from salivary glands. The hypothesis of this study was that students with daily intensive physical activity are ex-posed to chronic stress compared to other students who have minimal physical activity. The study in-cluded 54 healthy volunteers, students of the University of Zagreb, divided into two groups. One volunteer group consisted of physically active volunteers (n=27) from the Faculty of Kinesiology (FK), and the other group consisted of physically inactive volunteers (n=27) from other faculties (OF). The subjects were first administered a psychological test that consisted of two questionnaires, Quality of Life Questionnaire and Questionnaire of Stressful Styles, and then underwent sampling of saliva. By comparing biochemical and psychological indicators in relation to stress, it was concluded that the two groups of students were equalized and that there was no objective support for either group to be considered exposed to chronic stress. Despite the substantial differences in physical activity, there was no difference between the two student populations.

Prescribing practices in Southeastern Europe - focus on benzodiazepine prescription at discharge from nine university psychiatric hospitals.

There is much concern about the widespread long-term use of benzodiazepines. Our manuscript addressed its use in the region of Southeastern Europe, which seems extensive, but insufficiently explored. At nine university psychiatric hospitals (Croatia, Macedonia and Serbia), we retrospectively analyzed discharge summary documents to find the prevalence of discharge benzodiazepine prescriptions and the prescribed benzodiazepine doses. This study included 1047 adult subjects and showed that 81.9% of them had benzodiazepines prescribed in the discharge summary document, with high mean daily dose of around 5mg lorazepam equivalents. Factors associated with the prescriptions were exclusively clinical factors (diagnosis of schizophrenia spectrum disorders, more lifetime hospitalizations, psychiatric comorbidity, co-prescription of antidepressant or mood stabilizer, shorter duration of the hospitalization), while socio-demographic factors were not found to influence benzodiazepine discharge prescriptions. Similarly, factors which influenced the prescription of higher daily benzodiazepine dose were more lifetime psychiatric hospitalizations and co-prescription of antidepressant or mood stabilizer, as well as the diagnosis of mental/behavioral disorders due to substance use and co-prescribed antipsychotic. Our data are emphasizing an urgent need for guidelines and improved education of both health care professionals and patients, in order to prevent long term benzodiazepine (mis)use and related side-effects.

Increased calcium-independent lipoprotein phospholipase A2 but not protein S100 in patients with schizophrenia.

BACKGROUND: The aim of this paper was to investigate serum concentrations of calcium-independent lipoprotein phospholipase A2 (PLA2) and protein S100 in schizophrenia patients in comparison to healthy controls and correlate them with the clinical severity, duration, and number of schizophrenia relapses. SUBJECTS AND METHODS: This study included 65 schizophrenia patients and 70 controls. Schizophrenia was diagnosed according to DSM-IV-TR criteria. Clinical severity was determined by PANSS. PLA2 and protein S100 concentration were assessed by the enzyme-linked immunosorbent assay (ELISA). RESULTS: PLA2 concentrations were higher in patients with schizophrenia, whereas protein S100 concentrations were not. Higher concentrations of PLA2 were positively correlated with the duration of illness and number of episodes, as determined by multivariate analysis. CONCLUSION: PLA2 might be considered a possible biochemical trait marker for schizophrenia. Further research with larger and more homogeneous clinical samples is required.

Connection between inflammatory markers, antidepressants and depression.

The aim of this study was to explore the role of inflammatory markers in the occurrence of depression. The concentrations of inflammatory markers were analyzed in the groups of healthy subjects and subjects with major depressive disorder (MDD) initially and after one-month antidepressant therapy in the latter. The intention was to demonstrate the role of inflammatory markers in the development of MDD by differences in their concentrations and to explain the mechanism of depression development. This would help us expand our understanding of the occurrence of depression and enable introduction of some new methods in the treatment and diagnosis of depression. Study results showed a statistically significant difference in the concentrations of inflammatory markers (C-reactive protein (CRP), interleukin-6 and tumor necrosis factor alpha) between the group of MDD subjects and control group of healthy subjects. These concentrations were higher in MDD subjects. A statistically significant difference was also found in CRP concentration before and after antidepressant therapy administered to MDD patients, i.e. it was lower after antidepressant therapy. Study results pointed to the efficacy of antidepressant therapy for depression by reducing the concentration of this inflammatory marker.

Elevated serum lipids in veterans with combat-related chronic posttraumatic stress disorder.

AIM: To assess possible differences in serum cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides, arteriosclerosis index, established risk factor (ERF) of arteriosclerosis, and 10-year risk for coronary disease according to the Adult Treatment Panel III (ATP-III) between veterans with combat-related posttraumatic stress disorder (PTSD) and a control group consisting of patients with major depressive disorder. METHOD: We determined serum cholesterol, LDL-C, HDL-C, and triglycerides in the patients with PTSD (n = 103) and patients with major depressive disorder (n = 92), using the enzyme-assay method. AI, ERF, and ATP-III were calculated from cholesterol, LDL-C, and HDL-C levels. The groups were matched in age and body mass index (BMI). Patients with major depressive disorder were chosen as a control group because they do not have changes in serum lipids. RESULTS: Patients with combat-related PTSD had higher mean concentration of cholesterol (6.2+/-1.1 mmol/L vs 5.3+/-0.9 mmol/L; p<0.001), LDL-C (3.9+/-0.7 mmol/L vs 3.5+/-1.0 mmol/L; p = 0.005), and triglycerides (2.9+/-2.3 mmol/L vs 1.5+/-0.5 mmol/L; p<0.001), and lower HDL-C (1.0+/-0.3 mmol/L vs 1.3+/-0.2 mmol/L; p<0.001) than the control group. Arteriosclerosis index (4.2+/-1.2 vs 3.7+/-1.7; p = 0.050), ERF (6.4+/-1.9 vs 5.5+/-2.4; p = 0.010), and ATP-III (12.1+/-3.3 vs 10.2+/-3.8; p<0.001) were higher in PTSD than in the control group. CONCLUSION: Elevated concentrations of serum lipids are associated with combat-related PTSD. This may imply that patients with combat-related PTSD are under a higher risk for arteriosclerosis.