NADPH oxidase and redox status in amygdala, hippocampus and cortex of male Wistar rats in an animal model of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a highly prevalent and impairing disorder. Oxidative stress is implicated in its pathogenesis. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is an important source of free radicals. The aim of the study was to assess oxidative stress parameters, activities of respiratory chain enzymes, and the expression of NADPH oxidase subunits (gp91phox, p22phox, and p67phox) in the single prolonged stress (SPS) animal model of PTSD. Twenty-four (12 controls; 12 subjected to SPS), 9-week-old, male Wistar rats were used. SPS included physical restraint, forced swimming, and ether exposure. The rats were euthanized seven days later. Cortex, hippocampus, amygdala, and thalamus were dissected. Malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), Complex I, and cytochrome C oxidase were measured using spectrophotometric methods, while the expression of NADPH oxidase subunits was determined by Western blot. Increased MDA and decreased GSH concentrations were found in the amygdala and hippocampus of the SPS rats. SOD activity was decreased in amygdala and GPx was decreased in hippocampus. Increased expression of the NADPH oxidase subunits was seen in amygdala, while mitochondrial respiratory chain enzyme expression was unchanged both in amygdala and hippocampus. In the cortex concentrations of MDA and GSH were unchanged despite increased Complex I and decreased GPx, while in the thalamus no change of any parameter was noticed. We conclude that oxidative stress is present in hippocampus and amygdala seven days after the SPS procedure. NADPH oxidase seems to be a main source of free radicals in the amygdala.

Influence of psycho-social factors on the emergence of depression and suicidal risk in patients with schizophrenia.

BACKGROUND: The aim of this study was to investigate the influence of certain psychosocial factors - insight, psycho-education, family and social support, loneliness and social isolation - on the appearance of depression and suicidal risk in schizophrenia. SUBJECTS AND METHODS: This was a cross-sectional study that comprised hospitalized patients with schizophrenia in the initial remission phase. The assessment of depression and suicidal risk was made by applying a semi-structured psychiatric interview that included scrutinized factors (insight, psycho-education, family and social support, loneliness and social isolation), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). On the basis of the assessment results, the sample was divided into two groups: Group of patients with depression and suicidal risk in schizophrenia (N = 53) and Control group (N = 159) of patients with schizophrenia without depression and suicidal risk. RESULTS: In the Group of patients with depression and suicidal risk, compared with the Control group, there was significantly higher frequency of insight in the mental status (χ² = 31.736, p < 0.001), number of patients without psycho-education (χ² = 10.039, p = 0.002), deficit of family support (χ² = 13.359, p = 0.001), deficit of social support (χ² = 6.103, p=0.047), loneliness (χ² = 6.239, p = 0.012), and social isolation (χ² = 47.218, p < 0.001). Using the model of multi-variant logistic regression, insight, deficit of psycho-education and social isolation (p < 0.05) were identified as predictors of depression and suicidal risk in schizophrenia. CONCLUSIONS: This study shows that considered psycho-social factors - insight in the mental status, lack of psycho-education, as well as social isolation - could be predictors for appearance of depression and suicidal risk in schizophrenia.

Inhibitory role of monovalent ions on rat brain cortex adenylyl cyclase activity.

Adenylyl cyclases, comprise of a large family of enzymes that catalyze synthesis of the cyclic AMP from ATP. The aim of our study was to determine the effect of monovalent ions on both basal, stimulated adenylate cyclase EC 4.6.1.1 (AC) activity and C unit of AC and on GTPase active G-protein in the synaptic membranes of rat brain cortex. The effect of ion concentration from 30 to 200 mM (1 mM MgCl2) showed dose-dependent and significant inhibition of the basal AC activity, stimulated and unstimulated C unit activity. Stimulation of AC with 5 µM GTPγS in the presence of 50-200 mM of tested salts showed inhibitory effect on the AC activity. From our results it could be postulated that the investigated monovalent ions exert inhibitory effect on the AC complex activity by affecting the intermolecular interaction of the activated α subunit of G/F protein and the C unit of AC complex an inhibitory influence of tested monovalent ions on these molecular interaction.

Correlation of pre-morbid alcoholism and changes in the level of biogenic amine metabolites in cerebrospinal fluid of accute brain infarction patients.

BACKGROUND: The disorder of biogenic amine metabolism (serotonin - 5-HT and dopamine - DA) is expected in the brain (neuron) damage caused by acute ischemia. It is known that long-term abuse of ethyl-alcohol damages the quality of neurons diffusely in the brain. Cerebrospinal fluid (CSF) and its biochemical content, 5-HT and DA, are reliable indicators of the vitality of neurons. The main objective of this research was to demonstrate that the elevated content of metabolites 5-HT and DA in the CSF in patients with acute brain infarction, who were pre-morbid alcohol-dependent patients, is additionally emphasized by diffusive damage of neuron vitality caused by alcoholism. SUBJECTS AND METHODS: Study sample consists of two groups - 50 alcohol-dependent patients with acute brain infarction under the age of 65 (group A) and 50 patients with acute brain infarction who were not alcohol-dependent (group B). All subjects underwent the same procedure - CSF was taken during admission to the hospital and history was obtained through anamnesis, heteroanamnesis and clinical examinations. RESULTS: Metabolism of DA and metabolic turnover of DA (3, 4 dihydroxyphenylacetic acid + homovanilic acid; DOPAC + HVA) was elevated in the liquor of both patient groups. The statistically significant difference between the groups was found in metabolic turnover of 5-HT (p<0.05), and metabolic turnover of DA (p<0.001). CONCLUSIONS: The metabolic neuron disbalance, i.e. their pathophysiological-biochemical dysfunction as a result of acute brain infarction, is present in a higher degree in patients with pre-morbid long-term alcohol abuse.

Anxiety in epileptic patients.

BACKGROUND: Anxiety may occur as ictal, postictal or interictal symptom in patients with epilepsy. The main aim of this research was to explore the intensity and frequency of anxiety in patients with generalized, temporal and extratemporal epilepsy. SUBJECTS AND METHODS: This is a cross-sectional study of three groups of patients with epilepsy (30 patients per group) - recently diagnosed with generalized epilepsy, temporal epilepsy and extratemporal epilepsy, and a healthy control group (N=30). The Beck Anxiety Inventory (BAI) was used for quantitative assessment of anxiety. RESULTS: Patients with temporal and extratemporal epilepsies had a significantly higher mean total scores on the BAI than the patients with generalized forms of epilepsies (ANOVA: F=6.323, p<0.01). There were no statistically significant differences between the temporal and extratemporal epilepsy groups according to the levels of anxiety on BAI (t-test: t=1.68, p>0.05). For the first three symptoms - numbness, wobbling in the legs and the fear of the worst happening - the group of patients with extratemporal epilepsies had significantly higher average levels of intensity and frequency of symptoms (ANOVA: F1=5.591, F2=6.555, F3=5.906; p<0.01) CONCLUSIONS: Patients with partial epilepsy have more frequent and prominent anxiety symptoms than patients with generalized epilepsy, and also more than the control group. All these findings clearly indicate the necessity to modify treatment strategies accordingly in order to include both the antiepileptic therapy and treatment for anxiety disorders.

Depression in breast cancer patients.

Breast cancer is the third most common illness in the world and the most frequent malignant disease with women. Cytotoxic therapy is connected to significant psychiatric adverse effects, and the appearance of depressive symptoms is the most common. The main goal is determining the degree of depression with breast cancer patients in the oncology ward of the University Clinical Hospital in Nis and its connection to their marital status, age, level of education, economic status and the number of therapy cycles. This research is a prospective study. The statistical data analysis included measures of descriptive and analytical statistics. The presence of depressive symptoms of different intensity was showed in 76.00% of the interviewees in group I, and the second included 77.4%. The frequency distributions show that 27.084% interviewees from the first group showed signs of depressive symptoms, while the second included 25%. The intensity of these symptoms categorizes them into the group of moderate to significantly expressed depressive states, so they require therapeutic treatment. Depression is significantly more often recorded with cancer patients receiving cytotoxic therapy; mild depression is the most common, followed by moderate and severe depression.

Long-Term Treatment with Olanzapine in Hospital Conditions: Prevalence and Predictors of the Metabolic Syndrome.

INTRODUCTION: The risk of metabolic abnormalities is greatly increased in schizophrenic patients started on an atypical antipsychotic medication. Patients with psychiatric disorders exceed mortality ranges resulting from, among others, increased risk of cardiovascular events. Other factors contributing to the development of metabolic syndrome include prolonged duration of illness, increasing age, female sex and lifestyle factors. OBJECTIVE This cross-sectional study was taken up to assess the prevalence of the metabolic syndrome (MetS) in schizophrenic patients receiving olanzapine monotherapy for at least six months and to determine the most important risk factors associated with metabolic syndrome presence in these patients. METHODS A total of 93 long term hospitalized schizophrenic patients (71 men, 22 women), had a screening of the following: case-history data, psychiatric scales, anthropometric measures, blood (fasting glucose, lipid status, C-reactive protein--CRP) and urine samples (microalbuminuria). RESULTS: Prevalence of MetS according to International Diabetes Federation criteria in our study was 34.4%. The multivariate analysis distinguished the following significant predictors of MetS presence (in order of appearance): data about diabetes mellitus in family history (p = 0.002), body mass index > 25 kg/m2 (p = 0.002), hyperlipidemia in family history (p = 0.008), and elevated CRP value (p = 0.042). CONCLUSION: High rate of MetS in patients treated with olanzapine in this study exceeds MetS prevalence in general population. Among observed parameters, our study pointed to several "high risk" predictors associated with MetS presence. Regular monitoring of cardiometabolic risk factors is highly recommended. Positive heredity distress mentioned above may direct a psychiatrist to prescribe some other drug than olanzapine in the long term treatment of schizophrenia.

The effect of antipsychotic drugs on nonspecific inflammation markers in the first episode of schizophrenia.

BACKGROUND/AIM: Immune system disorder, including inflammation, takes a significant place when considering still unclear etiology of schizophrenia. The aim of this study was to determine the blood levels of nonspecific inflammation markers in the first episode of schizophrenia and their relation to the therapy response. METHODS: In this study we determined the blood levels of nonspecific inflammation markers: white blood cells count (WBC), C-reactive protein (CRP), erythrocytes sedimentation rate (ESR) and the elements of differential white blood cell counts (or the leukocyte formula): granulocytes (Gra), lymphocytes (Lym) and monocytes (Mon), in the first episode of schizofrenia, in 78 patients hospitalized at the Clinic for Psychiatric Disorders "Dr Laza Lazarevic" in Belgrade. The levels were measured at admission to the clinic, as well as after 4 weeks of antipsychotic treatment. The Positive and negative syndrome scale for schizophrenia (PANSS) was applied to measure the severity of psychopathology and response to the treatment. RESULTS: During the first episode of schizophrenia, before initiation of antipsychotic treatment, the frequency of abnormal values was high (≥ 25% of the patients) for the following non-specific inflammation markers: WBC, CRP, ESR and Gra, in the leukocyte formula, but dropped after 4 weeks of antipsychotic treatment at the level of high statistical significance for WBC and Gra (p < 0.001). The ESR remained unchanged in as many as 50% of the patients even after 4-week antipsychotic treatment, at the level of statistical significance in the non-responders compared to the responders (p = 0.045). CONCLUSION: The obtained results indicate that in the first episode of schizophrenia the blood levels of non-specific inflammation markers (WBS, CRP, ESR and Gra from the leukocyte formula) were high in the subpopulation of patients with the tendency towards normalization of inflammation parameters after a 4-week antipsychotic treatment.

Analysis of quality of life and anxiety in patients with different forms of epilepsy.

BACKGROUND: Anxiety symptoms may have significant implications on the quality of life of patients with epilepsy. The aim of our research is a comparative analysis of the quality of life, i.e., of the level of disability in patients with different forms of epilepsy. METHOD: In this cross-sectional study, the sample consisted of three groups of 30 patients each--with recently diagnosed generalized epilepsy, temporal and extratemporal epilepsy. the anxiety level in these groups was compared with the control group of 30 healthy subjects. Beck anxiety inventory (Bai) was used for assessment of anxiety. level of functional disability due to anxiety was measured according to the Sheehan Disability Scale (SDS). RESULTS: Patients with extratemporal epilepsy had the greatest level of functional disability, while patients with generalized epilepsies had the lowest average of scores on the Sheehan scale. the correlation between the Bai and the SDS was highly statistically significant. CONCLUSIONS: Our results clearly indicate the need for a broader concept of therapy--neurological (antiepileptic therapy) and psychiatric (pharmaco-, psycho- and social therapy) when it comes to anxiety in patients with epilepsy.

Metabolic syndrome and C-reactive protein in patients with depressive disorder on antidepressive medication.

INTRODUCTION: Recurrent depression is a psychiatric disorder of which etiology and pathogenesis might be related to immune response. Metabolic Syndrome (MetS) and its components are also strongly associated with elevated inflammatory indicators, as so as the body mass index (BMI) and total cholesterol levels. OBJECTIVE: Objective of this study was to investigate if there was any difference in C-reactive protein (CRP) levels in patients with recurrent depressive disorder, treated with antidepressants, compared to a healthy control group of subjects and if there was an association between increased CRP levels and the presence of MetS in these two groups. METHODS: Sixty subjects entered the study; of these 35 patients with the diagnosis of recurrent depressive disorder, while the healthy control group included 25 subjects. MetS was defined according to the NCEP ATP III criteria. The cut-off point for CRP was set at > 5 mg/L. RESULTS: There was no statistically significant difference in the prevalence of MetS and CRP values between the studied groups. Waist circumference and total cholesterol levels were significantly higher in the experimental group. Patients that fulfilled the criteria for MetS showed significantly higher values of central obesity and arterial hypertension in the experimental group as well. The elevated CRP levels were associated with increased frequency of MetS in depressed patients. CONCLUSION: Both CRP levels and metabolic risk profile screening, according to the international criteria, may be beneficial in order to obtain better assessment for depressive long-term medicated patients.

Burnout, quality of life and emotional profile in general practitioners and psychiatrists.

OBJECTIVE: Many studies confirm that psychological factors and burnout in physicians are interconnected. It is however not known, whether quality of life is another factor that plays a role in this connection.The aim of this study was to explore the correlation between quality of life and emotional profile with the level of burnout in physicians. PARTICIPANTS: 120 physicians participated in this study, i.e., sixty general practitioners (GPs) and sixty psychiatrists. METHODS: The General Health Questionnaire (GHQ) and the Maslach Burnout Inventory (MBI) were used to measure the job stress. The Quality of Life (QOL) and the Emotions Profile Index (EPI) were used to determine quality of life and emotional profile. Data were analyzed using methods of single and multiple correlation and regression methods. RESULTS: The QOL was higher in psychiatrists as a direct consequence of questions about finances and friendship. Analysis by gender showed that the growth of the burnout risk level (MBI) correlated with the growth of number of women who had stress coping problems. CONCLUSIONS: This research suggests that quality of life and individual factors represent a very significant role in burnout among physicians. Further researches in a bigger sample are required in order to identify key factors of quality of life related to burnout reducing, as well as for improvement of supervision strategies, including more the relevance of psychological profile of physicians.

[Development of forensic psychiatry in Serbia].

The development of legislation in the field of mental health in our region is linked with the emergence and development of the oldest psychiatric hospitals in Serbia.The principle that the mentally ill who committed a criminal offense need to be placed in a psychiatric hospital instead of a prison was introduced at the same time as in the most developed European countries. The founders of the Serbian forensic psychiatry, Dr. Jovan Danic, Dr.Vojislav Subotic Jr. and Dr. Dusan Subotic, were all trained at the first Serbian Psychiatric Hospital ("Home for the Unsound of Mind") that was founded in 1861 in the part of Belgrade called Guberevac. Their successors were psychiatric enthusiasts Prof. Dr.Vladimir F.Vujic and Prof. Dr. Laza Stanojevic. A formal establishment of the School of Medicine of Belgrade, with acquirement of new experience and positive shifts within this field, based on the general act of the University in 1932, led to the formation of the Council of the School of Medicine, which, as a collective body passed expert opinions. Thus, the first Forensic Medicine Committee of the School of Medicine was formed and started its activities in 1931 when Forensic Medicine Committee Regulations were accepted. After the World War II prominent educators in the field of mental health, and who particularly contributed to further development of forensic psychiatry in Serbia were Prof. Dr. Uros Jekic, Prof Dr. Dusan Jevtic, Dr. Stevan Jovanovic, Prof. Dr. Borislav Kapamadzija, Prof. Dr. Maksim Sternic, Prof. Dr. Josif Vesel and Prof. Dr. Dimitrije Milovanovic.

[Dysfunctionality of the primary family as a supportive factor for the development of polytoxicomany in young people].

INTRODUCTION: Dependent behaviour represents a strong homeostasis of the family of an addict. OBJECTIVE: The aim of our research is to record and explore irregularities during the addicts' growth, as well as the specific type of family relations in the addicts' family. METHODS: For research purposes a general questionnaire was used on growth and development, and GRADIR questionnaire on the assessment of family relationships. RESULTS: Our results indicate that delinquent behaviour is often found with the addicts before the occurrence of abuse. A significant dysfunctional family of addicts was detected. Families with an addict were not substantially damaged or altered in terms of emotional exchange, but in their structure that enhanced dysfunction leading to addictive behaviour. CONCLUSION: Emotional investments without control, prohibitions and penalties, contribute to a lack of consciousness that disturbs the process of socialization. Due to the apparent control and the apparent support, the addicts do not have structured organization and socialization. Emotional stimuli without obligation for polytoxicomanes to maintain a reciprocal relationship with their parents influence the parental support of egoistic style of behaviour.

Development of hospital treatment of persons with mental disorders.

Discordances of harmonic mental functioning are as old as the human kind. Psychopathological behaviour of an individual in the past was not treated as an illness. That means that psychopathology was not considered an illness. In all past civilizations discordance of mental harmony of an individual is interpreted from the physiological aspect. Psychopathologic expression was not considered an illness, so social attitudes about psychiatric patients in the past were non-medical and generally speaking inhuman. Hospitals did not follow development of medicine for admission of psychiatric patients in past civilizations, not even in the antique era. According to historic sources, the first hospital that was meant for mental patients only was established in the 15th century, 1409 in Valencia (Spain). Therefore mental patients were isolated in a special institution-hospital, and social community rejected them. Only in the new era psychopathological behaviour begins to be treated as an illness. Therefore during the 19th century psychiatry is developed as a special branch of medicine, and mental disorder is more and more seen according to the principals of interpretation of physical illnesses. By the middle of the 19th century psychiatric hospitals are humanized, and patients are being less physically restricted. Deinstitutialisation in protection of mental health is the heritage of reforms from the beginning of the 19th century which regarded the prevention of mental health protection. It was necessary to develop institutions of the prevention of protection in the community which would primarily have social support and characteristics.

Development of polytoxicomania in function of defence from psychoticism.

INTRODUCTION: Polytoxicomanic proportions in subpopulations of youth have been growing steadily in recent decades, and this trend is pan-continental. Psychoticism is a psychological construct that assumes special basic dimensions of personality disintegration and cognitive functions. Psychoticism may, in general, be the basis of pathological functioning of youth and influence the patterns of thought, feelings and actions that cause dysfunction. OBJECTIVE: The aim of this study was to determine the distribution of basic dimensions of psychoticism for commitment of youth to abuse psychoactive substances (PAS) in order to reduce disturbing intrapsychic experiences or manifestation of psychotic symptoms. METHODS: For the purpose of this study, two groups of respondents were formed, balanced by age, gender and family structure of origin (at least one parent alive). The study applied a DELTA-9 instrument for assessment of cognitive disintegration in function of establishing psychoticism and its operationalization. The obtained results were statistically analyzed. From the parameters of descriptive statistics, the arithmetic mean was calculated with measures of dispersion. A cross-tabular analysis of variables tested was performed, as well as statistical significance with Pearson's chi2-test, and analysis of variance. RESULTS: Age structure and gender are approximately represented in the group of polytoximaniacs and the control group. Testing did not confirm the statistically significant difference (p > 0.5). Statistical methodology established that they significantly differed in most variables of psychoticism, polytoxicomaniacs compared with a control group of respondents. Testing confirmed a high statistical significance of differences of variables of psychoticism in the group of respondents for p < 0.001 to p < 0.01. CONCLUSION: A statistically significant representation of the dimension of psychoticism in the polytoxicomaniac group was established. The presence of factors concerning common executive dysfunction was emphasized.

Reasons and conditions for involuntary hospitalization with special emphasis on detention without consent of mentally disordered person who voluntarily started hospital treatment.

The nature of some mental illness is such that persons affected by their conduct endangering life, health and safety, as well as life, health and safety of others from their surroundings. These persons, because of their mental condition, are often unable to properly assess their own interest. Because of the above it is permitted for these persons, under certain circumstances, to be forcibly hospitalized against their will. However, the problem of involuntary hospitalization of persons with mental disorders remains a controversial and complex ethical and legal problem, because it is characterized by a conflict of opposing interests and moral values. The main reason is the fact that involuntary hospitalization is an act of deprivation of liberty and intervention into the personal integrity, which at that the measure is taken against the individual who has not committed any crime. In order to provide restricted approach to the application of compulsory hospitalization, it is necessary to pass a legislation on the protection of persons with mental disorders that would more closely define the undertaken proceedings, reasons and conditions for involuntary detention and involuntary hospitalization in a psychiatric institution, forced detention of voluntarily hospitalized persons and penal policy violation of this law. It is necessary to initiate the procedure for amending the Law on Contested Procedure, which would reform the procedure for compulsory hospitalization, as an important segment of mentally disordered persons' rights, in order to be in accordance with international and European standards within this field.

Lamotrigine augmentation in delirium tremens.

INTRODUCTION: Delirium tremens (DT) is most severe neurological complication of alcohol withdrawal with high mortality rate. DT is related to an altered balance of excitatory and inhibitory amino-acid neurotransmitters, which is basically due to upregulation of glutaminergic neurotransmission induced by chronic ethanol exposure. Lamotrigine (LTG) is believed to act by reducing excitatory glutamate release due to inhibition of Na (+) channels. OBJECTIVE: The aim of this study was to investigate efficiency of the LTG therapy in the treatment of delirium tremens. METHODS: This prospective clinical study included 240 patients with ICD-10 criteria for DT, who were randomly divided into control and experimental group. The patients were observed within 28 days at the Intensive Care Unit of the Centre for Urgent Psychiatric disorders, according to a specific protocol, which included CIWA-Ar and MDAS clinical scales. Control and experimental group were treated according to the NIAAA protocol for 2004, and experimental group with adding of LTG according to a specific program. RESULTS: CIWA and MDAS scores in the experimental and control group has statistical significant differences after the third day (p > 0.1), and especially after the fifth day (ECIWA5/KCIWA5 = 8.36 +/- 6.782/32 +/- 5.562; EMDAS5/KMDAS5 = 4.89 +/- 3.408/26.33 +/- 1.497) (p > 0.5). CONCLUSION: LTG is significantly efficient in the treatment of delirium tremens, but it does not decrease mortality rate.

Aggression in adolescents: characteristics and treatment.

INTRODUCTION: Vulnerability of young people and frustration of their basic biological, emotional, cognitive and social needs can induce a series of psycho-pathological manifestations, including aggression. OBJECTIVE: Aim of this study is to examine the manifestations of aggressiveness in young people and to establish the difference between aggressive responses of two age groups; adolescents aged 16-19 years and older adolescents aged 20-26 years. METHODS: The sample consists of 100 young people aged 16-19 years (46 adolescents) and 20-26 years (54 adolescents). For the purposes of this study, we have constructed a questionnaire in which we entered the data obtained on the basis of a standard psychiatric examination, auto- and hetero-anamnesis data, and data obtained using the standard battery of psychological tests. RESULTS: Statistically significant association was found between verbal aggression and physical aggression (p = 0.002), verbal aggression and suicide attempts (p = 0.02), verbal aggression and substance abuse (p = 0.009), verbal aggression and low frustration tolerance (LFT) (p = 0.007), suicide attempt and LFT (p = 0.052). The younger group was significantly more verbally aggressive compared to the older group (p = 0.01). CONCLUSION: Verbal aggression, which was significantly associated with physical aggression, suicide attempts, substance abuse and LFT, indicates the need for timely interventions for the prevention of more serious and malignant forms of aggression.

Most common diagnoses requiring physical restriction of psychiatric patients: humanity at the test.

INTRODUCTION: Attitude about physical restriction has been changing through history. It has always been multidimensional approach, including ethic, medical and judicial aspect. OBJECTIVE: The main aim was establishing distribution of physical restrictions of patients for the following years: 2006/07, 2007/08, 2008/09, 2009/10 and 2010/11. METHODS: The research included patients that were hospitalized in the Special Hospital for Psychiatric Disorders "Dr. Laza Lazarevic" in Belgrade from June 1, 2006 to June 1, 2011. Retrospective review of illness history of hospitalized female patients was done (350 in total) and records were formed containing data on physically restrained patients. RESULTS: The largest number of referral diagnoses belonged to groups F20, F23 and F29; it was established that the number of physical restrictions was associated with referral diagnoses on the level of highly statistically significant difference (p < 0.001). The average number of restrainees per hospitalized patient which was growing in the studied period, which was also shown by the trend line (y = 0.5x + 1.06; R2 = 0.7242). CONCLUSION: Physical restrictions of psychiatric patients must backed up by benevolence, and it is not by any means the doctor's arbitrariness, which is strongly criticized and represents breach of ethical norms, human rights and the rights of the patient as guaranteed by law. This topic, which, indeed, refers to modern psychiatry, deserves more attention by public discussions, as well as by legislative regulations.

Hetero-aggressive outbursts in patients' behaviour in emergency psychiatry.

INTRODUCTION: Hetero-aggressive behaviour in patients with mental disorders is frequent and requires special skills of doctors and other medical staff in order to urgently protect the patient and indicate hospitalization. OBJECTIVE: The objective of this paper was to examine the frequency of the most common diagnostic categories in psychiatric patients with hetero-aggressive behaviour. The secondary objective was to examine aspects of realized hospitalization (voluntary, involuntary) and socio-demographic characteristics of these patients. METHODS: The sample was formed of 100 patients who expressed hetero-aggressive behaviour just before and during admission for hospital treatment. The data was collected from auto-anamnesis and hetero-anamnesis, and they were based on general somatic, neurological and psychiatric examination. The statistical analysis used descriptive analysis and Pearson's chi2-test. RESULTS: The frequency of the most common diagnostic categories was: F20-F29 73%; F10-F19 19%; F60-F69 11%; F00-F09 8%; F30-F39 and F70-F79 6%. Involuntary hospitalization was implemented in 56%. Socio-demographic characteristics of examinees revealed that the most common were: male gender (63%) and younger age, dominant secondary school qualification (74%), unmarried (76%), unemployed (76%), frequently repeated hospitalizations (66%). CONCLUSION: The most common diagnostic categories to which the patients with hetero-aggressive behavioural outbursts belonged were from the schizophrenic circuit, followed by substance abuse, personality disorders, etc. Involuntary hospitalization was the most common form of hospitalization in patients with violent behaviour. Socio-demographic characteristics of examinees revealed this profile as the most common: male gender, younger age, secondary education, unmarried and unemployed, repeatedly hospitalized.