Quetiapine Add-On Therapy May Improve Persistent Sleep Disturbances in Patients with PTSD on Stabile Combined SSRI and Benzodiazepine Combination: A One-Group Pretest-Posttest Study.

BACKGROUND: To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine and non-benzodiazepine hypnotic adjuvant treatment as well as to first-generation antipsychotic add-on treatment. SUBJECTS AND METHODS: Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine, were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10 and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuropsychiatric Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the assessment period were used as efficacy measures. RESULTS: All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one hour (p<0.001), sleep latency decreased by 52.5 minutes (p<0.001), median number of arousals per night decreased from two to one (p<0.001), CAPS recurrent distressing dream item median decreased from five to four (p<0.001), and the number of patients dissatisfied with their sleep quality and quantity decreased from 45 to two (p<0.001). CONCLUSION: Quetiapine prescribed in the evening may be successful therapy for persistent sleep disturbances in patients with PTSD and generally good response to an SSRI and benzodiazepine combination, who previously failed to respond to some of the usual hypnotic medication or addition of first-generation antipsychotics: zolpidem, flurazepam, nitrazepam, promazine, and levopromazine.

Psycho-Oncology and Spirituality.

Psycho-oncology is a branch of medicine which, combining psychiatry and oncology, studies the biological and psychological factors related to the onset and treatment of carcinoma. The struggle with this life-threatening disease requires an adaptation to a new life situation characterized by changed routines of everyday life and dynamics of personal relationships. The psycho-oncological approach is a multidisciplinary one, as modern medicine recognizes more and more the role of spirituality in the treatment and recovery from various pathological conditions. Spirituality is the adaptive capability of intelligent beings to retain the will for life in spite of adversities and awareness of the imminence of death. Faced with a challenge of malignant disease people are nevertheless able to react with positive personality changes, which leads them to a more meaningful and substantial life. The so-called posttraumatic growth is a feature which enables an individual to assume control over his own reactions to disease, which in turn can have a positive influence on the treatment outcome. An essential role in this process is played by the spiritual growth of an individual. Malignant disease can represent an opportunity for spiritual growth, a dimension often neglected by contemporary lifestyles. Religion, as an important constituent part of spirituality, can offer the believer a meaning of suffering and thus turn the disease into an opportunity for self-knowledge and development of a more mature spirituality. Christian spirituality can represent a path which helps an individual to cope with malignant disease. Modern medicine should be based on a multidisciplinary approach to the patient and encompass all the human dimensions (rational, emotional and spiritual), whereas treatment itself must be both personalized and participatory.

Capsaicin - Potential Solution for Chronic Pain Treatment.

Chronic pain is a painful condition defined by its duration where pain persists three months or more. Pain is connected with the high price of health care, work inability and disability. Moreover, it has significant consequences for patients and their families, working organizations and the society as a whole. The prevalence of chronic pain can range between 11.0% and 51.3% in general population. Pain is usually coherent with distress and a range of psychological symptoms such as depression, anxiety, altered attention and cognition manifesting as fear. Comprehensive pain management should always include the treatment of associated psychological symptoms. Multidisciplinary approach in treating chronic pain and its comorbidities and proper education of primary care physicians and different specialists involved in the management of chronic pain are crucial for better clinical outcomes. Topical capsaicin acts as a highly selective agonist of transient receptor potential vanilloid 1 of C and Aδ nociceptors. Repeated applications or high concentrations give rise to a long-lasting effect termed defunctionalisation. In addition, the reduction of central sensitization through reduced C-nociceptor input contributes to capsaicin's indirect mechanism of action. Capsaicin provides effective durable pain relief and reduction of intensity and area of pain in adult patients with chronic pain with a faster onset of analgesia and considerably fewer systemic adverse effects than the conventional treatment. While offering high levels of pain relief, additional improvements in sleep, fatigue, depression and quality of life have been noticed. Topical administration avoids dangerous systemic adverse effects and enables the combination with other drugs and analgesics with limited drug-drug interactions. Adding capsaicin to the standard chronic pain treatment might improve, fasten and ease the challenging path of managing chronic pain consequently providing the patient and their society with better quality of life.

INFLUENCE OF THE SEROTONERGIC SYSTEM POLYMORPHISM ON THE EXPRESSION OF DENTAL ANXIETY.

- The aim of the study was to test the correlation between 5-HTTLPR polymorphism and dental anxiety. Research hypothesis was that positive relation between the expression of dental anxiety and the S allele exists in the population of healthy Caucasians. We conducted a prospective study on 159 subjects, volunteers made up of medical and non-medical staff of the Sestre milosrdnice University Hospital Centre. Both genders were included, age range 19 to 59, mentally and physically healthy (according to DSM-5 classification of mental disorders). For the purpose of this research, we used a sociodemographic questionnaire containing the following information: age, gender, education level, work status, marital status and residence. Corah's Dental Anxiety Scale-Revised (DAS-R) was used to measure dental anxiety. Data distribution was tested by Kolmogorov-Smirnov test, difference between the groups by ?χ2-test and one-way analysis of variance, and correlation of variables by logistic regression. In the study population, we found positive correlation between S-allele and total result in DAS-R questionnaire. The presence of S allele suggests that the person will have a higher result in DAS-R questionnaire, i.e. higher expression of dental anxiety.

Glaucoma, depression and quality of life: multiple comorbidities, multiple assessments and multidisciplinary plan treatment.

BACKGROUND: The present mini review evaluates assessment and comorbidity of glaucoma and depression with the possibilities of treatment options. SUBJECTS AND METHODS: Web of science was searched for relevant articles using search terms "glaucoma", "depression", "glaucoma and depression", "quality of life and glaucoma". The additional relevant papers were added from the bibliography of selected papers. All types of articles were included, no time period was defined. RESULTS: We have reviewed 11 studies regarding the comorbidities of glaucoma and depression. The number of participants in all studies ranged from 86 to 6760. Formats of scale in one study was clinician rated, others were self-reported scales. Two studies of the above mentioned studies explored specific types of glaucoma. In the three studies out of 11 there was no significant evidence of elevated depressive symptoms associated with glaucoma. In the six studies the prevalence of depression was significant among glaucoma patients. One study provided suboptimal assessments of depression in glaucoma patients. The other one showed the presence of glaucoma significantly associated with depression after adjustment for the demographic factor. Most of the studies used one scale, while two of them used two scales. The reviewed studies did not analyze the therapy options of included patients. CONCLUSION: The results presented in this review indicate that glaucoma is accompanied by depression in the majority of analyzed studies. The comorbidity of glaucoma and depression should be the subject of further research on both, self-reflecting and clinician-rated scales, taking into account subjective experience of patients and physicians. The therapy options should be taken into account in future researches focusing on the multidisciplinary approach including novel possibilities of treating both diseases respectively.

Prevalence of metabolic syndrome among patients with major depressive disorder--differences between newly diagnosed first episode and recurrent disease.

The objective of the present study was to assess differences in prevalence of the metabolic syndrome among depressed patients in regard to the duration of the illness (first episode versus recurrent episodes). A total of 190 patients suffering from major depressive disorder were included in the study, diagnosed according to International classification of disorders, 10th revision. The same criteria were used to divide participants into two groups: first episode major depressive disorder and major depressive disorder with recurrent episodes. The metabolic syndrome was defined according to the criteria of the American National Cholesterol Education Program-Treatment Panel III. Results showed that metabolic syndrome is significantly more prevalent in patients with recurrent major depressive disorder (45.2%) compared to patients with first episode of major depressive disorder (27.3%), mainly due to differences in plasma glucose, triglycerides and HDL-cholesterol levels. These findings indicate the importance of the duration of depression and the number of recurring episodes as factors involved in etiopathogenesis of the associated metabolic syndrome.

Connection of depression and bone loss in perimenopausal and postmenopausal women.

Depression has been implicated as a possible risk factor for low bone mineral density (BMD). However, there is still no solid evidence that could connect these two different illnesses. This research examined the association between self-reported depression and low BMD in perimenopausal and postmenopausal women. This research screened 130 female patients who were 44 to 72 years old and registered at the densitometry clinic of KBC Rijeka during a three month period. Densitometry was performed in order to establish their BMD and according to the results two groups of participants were formed: normal BMD - 38 participants with normal BMD at hip and spine and reduced BMD - 75 participants with lower BMD at hip and spine. Depression was assessed using Beck depression inventory. Both groups of participants were compared regarding their depression scores. There were no significant differences between the groups with normal and reduced BMD regarding mean age, age of menopause, length of menopause and number of births (p = 0.001). Difference regarding depressiveness between the two groups was not significant (t = 0.73; p = 0.468). Also, there were no differences between the groups regarding the frequency of certain levels of depression. (chi2 = 2.27; p = 0.52). Results of this research suggest that self-reported depression is not associated with low BMD in perimenopausal and postmenopausal women.

Correlation of levels of depressiveness and choice of elective subjects in medical students.

The aim of this research was to establish if a correlation exists between the choice of an elective subject, namely subjects "Depression" and "Diabetes", and levels of depressiveness in medical students. Three groups of third year medical students attending School of medicine, Rijeka University, were tested for the level of depression using Beck's self-evaluation scale. The groups consisted of 30 non-randomly selected students that had enrolled elective subject "Depression" and 29 non-randomly selected students that had enrolled elective subject "Diabetes", and the third group of 30 randomly selected third year medical students that had enrolled none of the previously mentioned elective subjects. Median age of participants in this research was 25.24. The results showed no statistically significant difference in overall level of depressiveness among the groups. By testing for the difference between group pairs, there was a statistically significant difference between depressiveness in students attending "Depression" and "Diabetes", the latter being significantly more depressed (M = 8.30 in "Depression" group; M = 11.41 in "Diabetes" group; p = 0.04). In total there were 33 males and 56 females that participated in this research. Gender difference was also tested, and there was no statistically significant difference between sexes among groups. The difference was found only within the group of students attending "Depression" elective subject, where females scored significantly higher on Beck's questionnaire (z = 2.26; p = 0.03). The analysis of difference between items of the Beck's questionnaire showed statistically significant difference in the item "Feeling of rejection", where students attending elective subjects other then "Depression" scored significantly higher; differences in the items "Urge for punishment" and "Suicidal tendencies" were also found between "Diabetes" and "other elective subjects" group, in favor of "Diabetes" group; in the item "Weight loss" students attending "Diabetes" elective subject scored significantly higher then their peers in both other groups. The results indicate the possibility of a protective role of psycho-educative component provided to the students attending elective subject on depression within medical school environment, that has repeatedly been shown to be stressful and demanding and is beneficial for the onset of depressive disorders.

Posttraumatic stress disorder and depression as comorbid disorders.

INTRODUCTION: Depression is the most frequent disorder of today. It is unique for the fact that it can become a comorbid illness with almost any other psychiatric disorder. Premorbid depression is also a risk factor for the development of PTSD, while at the same time traumatic experience is a risk factor for the development of depression. These facts show us that a close connection between these two diagnostic entities exists. Aim of this research was to analyze the levels of depressiveness in patients that were hospitalized and patients that were treated in the Day hospital. Also, to establish the connection of age, time spent in combat (war), length of treatment and number of hospitalizations with the results from the Beck's depression inventory. SUBJECTS AND METHODS: Participants were divided into two groups, 36 patients that were treated for PTSD in a hospital setting and 64 patients that were treated in the Day hospital. Participants completed Beck's self-evaluation inventory for depression, as it assesses the degree of depression. RESULTS: Two groups did not differ regarding to age, time spent in combat (war), the length of treatment and level of depressiveness assessed by Beck's depression inventory. Score on Beck's depression inventory was significantly positively correlated with the age of participants and the number of hospitalizations. Older participants and participants that were hospitalized more often score higher on Beck's depression inventory. CONCLUSION: Results show that there is no difference between the two groups of participants of differing levels of depressiveness, but depression most often presents as severe depression in both groups of participants. Older participants and participants that were hospitalized more often are more depressed. This research points to the fact that it is necessary to treat PTSD and depression at the same time, because parallel treatment of these comorbid disorders leads to a decrease of the rate of suicide, due to the fact that depression is often the leading cause of suicide.

Dimensions of human spirituality, layman understandings of health and limits of medicine.

The essence of human uniqueness and what is special about humans is spirituality. What is unique to every human being is his: language, sociability, politic, science, art, technical and working attitudes, playing games, fun and laughter, as well as religiosity and ethical attitudes. All of these dimensions are based upon spirituality or even the human spirit. This paper aims to relate all these dimensions of human spirituality to the sick person and establish to what extent that person is imbued with them and whether he can rely on them. Furthermore, this paper attempts to shed some light on the limits of medicine, especially as seen by Ivan Illich. In the end we are left with a series of questions, and possibly with an indisputable fact that the person who is suffering physically or mentally is "saved" by his most amazing unique trait--his religiosity.

Lithium treatments: single and multiple daily dosing.

OBJECTIVE: To review the feasibility and effectiveness of single daily dosing of lithium in patients with affective disorder and to discuss advantages and disadvantages of this schedule of administration. METHOD: A comprehensive search of the literature was conducted using a combination of electronic databases and a search of reference lists and relevant journals. English-language articles were selected for the review if they discussed the issues comparing multiple and single daily dosing schedules of lithium. RESULTS: We found 9 comparative studies. Single daily dosing of lithium causes transient higher peak lithium concentrations; however, no comparative study revealed a significant difference in side effects between multiple and single daily dosing groups. Numerous reports concluded that taking lithium in a single dose prevents, or at least limits, the increase in urine output (and the reduction of osmolality) and subsequent thirst. There is no evidence that a single lithium dosing schedule preserves glomerular function. CONCLUSION: According to the presented data, it could be reasonable to use lithium as a single evening dose in patients who can tolerate this schedule because no studies have suggested any benefit from administration of multiple daily doses. Possible advantages of single daily dosing, especially in improved compliance, could not be veiled by disadvantages of transient and mild postabsorptive side effects.