Clinical Characteristics and Comorbidity of Pediatric Trichotillomania: the Study of 38 Cases in Croatia.

BACKGROUND: The main goal of this study was to analyse and show clinical characteristics and psychiatric comorbidity in 38 participants aged between 10 and 17 with DSM-IV diagnoses of Trichotillomania (TTM) that we were treating at Children's Hospital Zagreb from 2008 to 2017. SUBJECTS AND METHODS: We analyzed the data obtained from semi-structured interviews by the criteria of DSM-IV, Youth Self Report (YSR) (Achenbach & Rescorla 2001) and survey that we created. RESULTS: From 38 participants 21 were girls. The activities during which the participants state that they mostly pull hairs are as follows: doing homework and learning, working on PC, in the toilet, watching TV etc. The most common sites on the body from which participants pulled hair were scalp and among nonscalp sites eyebrows and eyelashes. We found nail biting in more than a half of participants. In 22 participants one or more comorbid disorder has been found, of which ADHD (n=6) and tics (n=5) are most co-occurring disorders. The internalized and externalized problems were nearly evenly represented. Trichophagia was reported by two participants. The results indicate that more than two thirds of participants isolate themselves during hair pulling and half of them try to hide consequences. Median time from the first occurrence of the symptoms to the first visit to a child psychiatrist caused by TTM problem was 9 months (min 5; max 24) what we consider a very long period of time that increased the probability of complications. CONCLUSIONS: Knowledge about this disorder and cooperation among pediatric experts is extremely important for recognizing it at an early stage and starting the treatment especially considering habit-forming mechanism, the burden of an emotional distress and frequent comorbidity. Further research is needed.

Elevation of serum total triiodothironine and free triiodothironine in Croatian veterans with combat-related post-traumatic stress disorder.

OBJECTIVE: To asses possible differences in serum-free triiodothironine (FT3), total triiodothironine (TT3), free thyroxine, total thyroxine, and thyroid-stimulating hormone levels between male combat veterans with chronic post-traumatic stress disorder and healthy male control subjects. METHOD: Male combat veterans (N = 38; ages 23-53 years; mean +/- SD = 35.9 +/- 7.5 years) with chronic post-traumatic stress disorder (duration of illness was 2-6 years; mean +/- SD = 3.53 +/- 0.95 years) were compared with healthy male control subjects (N = 32; ages 25-50 years; mean +/- SD = 36.5 +/- 8.3 years). Serum samples were analyzed by luminoimmunochemical assays for basal levels of thyroid-stimulating hormone, total thyroxine, TT3, free thyroxine, and FT3. RESULTS: Combat veterans with chronic combat-related post-traumatic stress disorder had significantly increased values of FT3 (mean +/- SD, 5.92 +/- 1.11; t = 2.27; p < 0.02), as well as TT3 (mean +/- SD, 2.04 +/- 0.32; t = 6.26; p < 0.0001) than the control group. CONCLUSION: Elevated serum TT3 and FT3 are associated with chronic combat-related post-traumatic stress disorder.

Psychiatric help to psychotraumatized persons during and after war in Croatia.

AIM: To present organization of psychosocial support and treatment of traumatized persons during and after the 1991-1995 war in Croatia. METHOD: Description of application and results of community-based National Program of Psychosocial Help to War Victims, and retrospective analysis of hospitalizations for psychotrauma at the National Center for Psychotrauma, Dubrava University Hospital. RESULTS: During the 1991-1995 war in Croatia, the population faced severe traumatic events, and the need for organized psychosocial help to traumatized persons was great. Government has established the network of psychosocial help in 1994. This was the beginning of the National Program of Psychosocial Help to War Victims. As a strategy in building a social support, the pyramidal model consisting of five levels of psychosocial help was used. The levels were the following: 1) preventive programs in mental health, 2) nonspecific psychological help in community, 3) basic psychological help, 4) psychiatric institutionalized help and specific psychological help, and 5) national coordination and operative planning. During the war, the work primarily centered around community-based approach, satisfying the current needs of the traumatized people, such as food, medication, and clothes, and providing crisis psychological interventions and urgent psychiatric help. In 1999, this organizational scheme was replaced by the establishment of the National Center for Psychotrauma and four Regional Centers for Psychotrauma in Zagreb, Rijeka, Osijek, and Split. In the post-war period, the emphasis was on psychological and social help in the community and on institutionalized approach to treatment of psychotrauma. According to the data of the Croatian Institute of Public Health, in the 1998 and 1999 there were 1,744 and 2,415 hospitalizations due to PTSD and related disorders, respectively. CONCLUSION: The community-based approach remained central in dealing with psychotraumatized persons during and after the war. In the post-war period, the emphasis was put on non-specific and specific psychological and social help in the community, with institutionalized approach to the treatment of PTSD and related disorders, whereas satisfying the current needs (food, medication, clothing), intervention in the crisis situations and urgent psychiatric interventions were of prime importance during the war.