Does the Duration of the Illness Affect the Severity of Negative Symptoms of Schizophrenia?

Background: The negative symptoms of schizophrenia are less known aspects of the illness although they often mark its course and outcome. Negative symptoms refer to loss of function, and they are associated with poor outcomes. It is considered that they are more prominent with the longer duration of illness. Objective: To determine the negative symptoms in the patients with schizophrenia with regard to the duration of illness. Methods: A cross-sectional study was conducted in 60 consecutive outpatients with schizophrenia. Two groups were formed regarding the duration of illness (⩽2 years, and >3 years). The negative symptoms were established with the Brief Negative Symptom Assessment - BNSA. Results: Average score of negative symptoms in the group with the shorter duration of illness was 8.37±2.94, and in the group with longer duration was 10.73±2.86. Independent Samples Test was significant p=0.003, t-2.367, and therefore the difference between scores on BNSA within groups was significant. Moderate size effect was found (p = 0.69). Conclusion: Negative symptoms of schizophrenia are more prominent with the longer duration of illness.

Post-traumatic Stress Disorder, Metacognitions, Cognitive and Global Functioning in Bosnian War Veterans.

INTRODUCTION: Cognitive impairment is common finding in individuals with PTSD. Dysfunctional metacognitions in variety of anxiety disorders can represent generic vulnerability for anxiety disorders, as well as elements that contribute to maintaining the disorder. There is little empirical information about metacognition in war veterans with PTSD, and its relation to cognitive and/or social, occupational and psychological functioning. AIM: to determine the values and reciprocal correlations of different aspects of metacognition, with cognitive and global functioning in outpatient war veterans with PTSD. METHODS: The study was conducted on 25 war veterans (24 male), with confirmed diagnosis of PTSD by a trained psychiatrist, average age 48,5±6,2 (38-63) years, with average duration of symptoms of 9,9±4,7 (0,5-16) years. We used the Metacognitions questionnaire, Mini Mental Status Examination, and Global Assessment of Functioning Scale to assess metacognition, cognitive impairment, and global functioning. Median values of Metacognitions questionnaire subcomponents, Global Assessment of Functioning Scale and Mini Mental Status Examination were determined, and also reciprocal correlations of all parameters expressed with Spearman Rank Correlation. RESULTS: 12 patients (48%) had impaired cognitive function. Significant negative correlation of score on Mini Mental Status Examination, and negative beliefs about worry is observed (r=-0,4278, p=0,034), as well as non significant correlations between rest of metacognition subscales and score on Mini Mental Status Examination. Cognitive self-consciousness showed high positive correlation with Global Assessment of Functioning Scale (r =0,7436, p<0,0001). CONCLUSION: Follow up of metacognitions, cognitive and global functioning, and its relations, may have an important role in assessment of war veterans with posttraumatic stress disorder.

Sexual Dysfunctions in Bosnian War Veterans.

Sexual functioning of war veterans is significantly under-explored. During devastating aggression on Bosnia-Herzegovina (BiH) around 400 thousand soldiers were included in combats. It is estimated that more than 100 000 persons were killed, and more than 60 000 them were soldiers. Vast majority of them were deployed since war is ended. We found high prevalence of sexual dysfunctions in war veterans. Also significant difference in several areas of sexual functioning between war veterans with and without symptoms of posttraumatic stress disorder was found.

Family Atmosphere and Relationships as Predictors of Heroin Addiction.

INTRODUCTION: Studies show that dysfunctional family relationships are important predictors of addictions to all psychoactive substances. OBJECTIVE: To establish if there is a connection between family relations and heroin addiction and if found to exist, what is the quality of this connection. SUBJECTS AND METHODS: This research was conducted on the sample comprised of 160 subjects divided into two groups. The first group consisted of 61 heroin addicts treated at the Tuzla University Clinical Centre Psychiatric Hospital. The second group consisted of 99 subjects who were students at the Tuzla University Faculties of Philosophy and Electrical Engineering and who were not using any psychoactive substances. The subjects were tested with the Quality of Family Interactions Scale (KOBI) which measures the interactions between children and parents in two dimensions, described in literature as 'acceptance' and 'rejection'. RESULTS: The research team established statistically significant differences between the heroin addicts and the students, the non-users, in terms of their family relationships. The results show that the addicts families were characterized by lack of understanding, by conflicts, rejection, non-acceptance by parents, while the non-users families were characterized by understanding, acceptance by parents and good communication. CONCLUSIONS: There is a connection between inter-family relationships and addiction. Namely, rejection and non-acceptance of children/persons by their families and parents, bad communication and dysfunctional family relationships are significant predictors of heroin addiction.

Metabolic syndrome in schizophrenia - who is more to blame: FGA polypharmacy or clozapine monotherapy?

BACKGROUND: To establish the prevalence of metabolic syndrome and its parameters in group of patients with schizophrenia in polypharmacy - receiving first generation antipsychotics versus clozapine alone treated group. SUBJECTS AND METHODS: 48 outpatients with schizophrenia divided into two groups: the first group of 21 patients in polypharmacy with first generation antipsychotics, and the second group of 27 patients treated with clozapine alone were assessed for the presence of metabolic syndrome. We used logistic regression models to assess the relationship between metabolic syndrome and antipsychotic therapy, gender and age. RESULTS: Metabolic syndrome was found in 52.1% of all subjects. Compared to first generation antipsychotics polypharmacy, the monopharmacy with clozapine was associated with elevated rates of metabolic syndrome (28.6% vs. 70.4%, p=0.004). With regard to particular parameters of metabolic syndrome, the elevated plasma triglycerides were significantly more present in subjects within Clozapine group (p=0.03). Logistic regression analysis showed that female gender (p=0.004), and clozapine treatment (p=0.005) were significantly associated with metabolic syndrome. CONCLUSION: Compared to polypharmacy with first generation antipsychotics, the higher prevalence of metabolic syndrome is found in patients treated with Clozapine alone. The most prevalent metabolic disorder is dyslipidemia.

Aphasia disorders outcome after stroke.

INTRODUCTION: Aphasia is considered to be the most difficult disorders of speech-language communication, and is often companion by all forms of cerebrovascular disease. GOAL: To determine the outcome of aphasia disorder a year after a stroke and stroke type influence on the outcome of aphasia disorders. MATERIAL AND METHODS: We analyzed one-year outcome of aphasia disorders in patients who had a first stroke. Patients were tested by a speech pathologist with the International test for aphasia, immediately after admission and one year after the stroke. All patients that were hospitalized during treatment had a speech therapy and only a small number of patients were realsed from hospital. RESULTS: Out of 74 patients with aphasia who were discharged from hospital within one year 20 patients died and 2 patients did not respond to control clinical treatment review. Analysis of the remaining 52 respondents determined that out of the 10 patients with global aphasia 8 (80%) evolved into another aphasia syndrome, and two (20%) remained unchanged in form. In most cases, global aphasia was transformed in mixed non fluent aphasia (4 of 10 patients or 40%), and in two cases (20%) global aphasia was transformed in Broca aphasia. Broca aphasia (n = 20) in other forms evolved in 9 patients (45%), and 11 patients (55%) remained unchanged in form. Anomic aphasia had 11 patients (78.6%) which remained unchanged in form, while 3 (21.4%) evolved into an Alexia agraphia. Full recovery was noted in two patients (3.84%). Type of stroke did not affect the outcome of aphasia disorders. Out of the 52 analyzed patients after hospitalization, unfortunately, only 11 (21.2%) had some kind of speech pathology treatment after leaving the hospital. CONCLUSION: One year after the stroke severe aphasia evolved into a lighter form in a significant number of patients. Most often anomic aphasia remained (34.6%), followed by Broca (25%) and Conductive aphasia (7.7%). Type of stroke does not affect the outcome of aphasia disorders. Unfortunately only a small number of patients (21.2%) continued with aphasia speech therapy after leaving the hospital.

[Parkinson's syndrome--second life decade onset]. / Parkinsonov sindrom sa pocetkom u drugoj deceniji zivota.

INTRODUCTION: Incidence of parkinsonism prior age 40 is observed in only 5% of total number of patients, under age of 20 it's very rare. CASE REPORT: Male patient, age of 16 was hospitalized at Neurology Clinic regarding depression and anxiety, social withdrawal, studyng difficulties, lack of concentration, hands tremor and impaired balance. Difficulties started slow, three years before hospitalisation with affective symptoms. There was no history of similar disease in patient's family. During neurological examination signs which suggested extrapyramidal lesion were found (tremor, Cogwheel type of rigor, postural difficulties). Diagnosis of juvenile form of parkinsonism was set. Basic laboratory findings including serum caeruloplasmin and cooper level were normal. Neuroradiological investigations were without pathological signs, and visual evoked potentials were patological with left side lateralisation. Psychological tests suggested anxious personality characteristics with high emotional sensitivity, mental control and memory difficulties. Pharmacological approach with direct dopamine agonist (Bromocriptine) was started. On 7.5 mg daily significant reduction of symptoms was observed. CONCLUSION: In affective disturbances at younger population differential diagnosis rare form of juvenile parkinsonism should be considered.